CBC - Self Study CME

Best Practices in Multiple Sclerosis Management Survey Report
Based on data solicited through the Multiple Sclerosis Update Series
MS Update: Volume 4, Issue 4

Needs Assessment
Multiple sclerosis (MS), a chronic heterogeneous disease with variable course, often imposes a substantial burden on the individual, with notable negative effects on patient function and quality of life (QOL), as well as on family and community. In addition to physical symptoms, less tangible, but also disruptive neuropsychological symptoms and comorbidities of MS can emerge. These neuropsychological symptoms—including cognitive impairment, depression, anxiety, anger, etc.—can often influence the QOL of patients with MS independent of physical disability or extent of lesions on magnetic resonance imaging (MRI). Indeed, neuropsychological symptoms impart significant challenges for patients with MS in maintaining an acceptable QOL while managing their disease and balancing family and career.

Clinical trials have shown the benefits of early disease-modifying therapy (DMT) in delaying the onset of clinically definite disease as well as disability progression. Beneficial effects on neuropsychological symptoms have also been detected with most of the experience being with the interferon betas (IFNb). The association of brain lesions, atrophy, and central nervous system inflammation with neuropsychological symptoms highlights the importance of pharmacologic intervention in ameliorating neuropsychological disturbances in patients with MS. Indeed, the search for effective diagnostic and therapeutic strategies for neuropsychological symptoms and their effects on patient QOL remain active areas of research, as do advancements in neuroprotection and neurorepair. As such, neurologists require the tools and knowledge to implement the most appropriate and effective targeted pharmacologic therapies in order to impact the trajectory of neuropsychological comorbidities and QOL over time.

Target Audience
This activity has been developed for physicians, MS nurses, and other healthcare providers who care for patients with MS.

Learning Objectives
Upon completion of this activity, clinicians will be better able to:

Select a treatment strategy to manage MS while positively impacting QOL in patients with MS
Summarize screening and diagnostic strategies for cognitive dysfunction in MS and pharmacologic options for slowing cognitive decline in patients with MS
Discuss the complex interrelationship among neuropsychological symptoms in MS
Describe imaging correlates of neuropsychological symptoms including MRI features of depression and cognitive dysfunction
Develop a treatment plan using pharmacologic, psychological, and physical treatment strategies to manage depression and slow cognitive decline in patients with MS

Accreditation
The Carolinas Center for Medical Excellence (CCME) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This CME activity was planned and produced in accordance with ACCME essentials.

CME Credit
CCME designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Disclaimer
The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This enduring material is produced for educational purposes only. Use of the Carolinas Center for Medical Excellence or Center for Bio-Medical Communication, Inc. name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

Release date: March 5, 2010
Expiration date: March 31, 2011

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Neuropsychological Comorbidity in Multiple Sclerosis
Therapeutic Strategies and Imaging Correlates From ECTRIMS
MS Update: Volume 4, Issue 3

Needs Assessment
Multiple sclerosis (MS) is a heterogeneous disease, with substantial variability in clinical course and symptoms among individuals. While motor symptoms account for clinically apparent signs of disability in MS, often overlooked are multiple neuropsychological symptoms, including cognitive impairment, depression, anxiety, anger, or other affective disorders. These symptoms can have a disruptive effect on quality of life, social functioning, and activities of daily living. Although neuropsychological symptoms can occur independently, there is evidence of complex interrelations, with each symptom potentially impacting on another. Deficits in cognitive functioning have been shown to correlate with brain lesions and atrophy on magnetic resonance imaging (MRI). Although the etiology of depression in MS remains less certain, it too appears to be linked to brain lesions and atrophy. Furthermore, depression is apparently associated with lesions in specific brain regions. Inflammation of the central nervous system—a pathologic hallmark of MS—has also been linked to depressive symptoms.

The 25th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), which took place September 9-12, 2009, in Düsseldorf, Germany, investigated many key issues related to neuropsychological symptoms in MS. Among the topics explored at ECTRIMS were the complex interrelation among neuropsychological symptoms, imaging correlates of these symptoms, and pharmacologic interventions to ameliorate neuropsychological disturbances.

Physicians need to be aware of these comorbidities, imaging correlates, and available therapeutic strategies for managing depression and cognitive dysfunction in MS. In addition, familiarity with updated guidelines for diagnosis of MS—including the pivotal role of gadolinium-enhanced MRI— is critical for early intervention and improving outcomes. The purpose of this activity is to provide participants who may not have been able to attend this important educational congress, with an update on key information on these comorbidities as presented at ECTRIMS.

Target Audience
This activity has been developed for physicians, MS nurses, and other healthcare providers who care for patients with MS.

Learning Objectives
Upon completion of this activity, clinicians will be better able to:

Recognize the importance of neuropsychological symptoms in the symptomatology of MS
Discuss the complex interrelation between depression and cognitive dysfunction in MS
Describe imaging correlates of neuropsychological symptoms including MRI features of depression and cognitive dysfunction
Utilize an understanding of disease-modifying therapy to optimally manage neuropsychological symptoms
Develop a treatment plan using pharmacologic, psychological, and physical treatment strategies to treat depression and slow cognitive decline in patients with MS

Release date: OCTOBER 28, 2009
Expiration date: OCTOBER 31, 2010

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Cognition and Neuroprotection in Multiple Sclerosis
Evolving Diagnostic and Therapeutic Strategies
MS Update: Volume 4, Issue 2

Needs Assessment
Cognitive dysfunction affects about half of all patients with multiple sclerosis (MS) and is commonly manifested in deficits in learning, complex attention, speed and efficiency of information processing, and memory (long-term and working). While motor signs account for clinically apparent signs of disability in MS, cognitive dysfunction and the loss of executive functioning have a particularly disruptive effect on quality of life, social functioning, and activities of daily living. Despite its pivotal importance in the core symptomatology and long-term prognosis of MS, cognitive dysfunction often ranks behind motor disability as the focus of clinical management. Moreover, it does not always mirror motor deficits. Cognitive dysfunction thus represents a distinct neurotherapeutic target in the long-term management of MS, and, as suggested by abstracts from recent meetings, one that is amenable to management by disease-modifying therapies.

The search for effective therapeutic strategies for cognitive dysfunction in MS remains an active area of research. Neuroprotection and neurorepair are other areas of intense investigation. Neurologists are in a critical position to impact the trajectory of cognitive changes over time in their patients with MS and target both the inflammatory and neurodegenerative components of the disease. The purpose of this activity is to provide a broad audience of US neurologists and neurology nurses with an update on cognition- and neuroprotection-related findings and other key information available in the literature and presented at recent scientific meetings including the World Congress on Treatment and Research in Multiple Sclerosis (WCTRIMS) (September 17 to 20, 2008) and American Academy of Neurology (AAN) 61st Annual Meeting (April 25 to May 2, 2009).

Target Audience
This activity has been developed for physicians, MS nurses, and other healthcare providers who care for patients with MS.

Learning Objectives
Upon completion of this activity, clinicians will be better able to:

Discuss the pivotal importance of cognitive dysfunction in the symptomatology of MS
Summarize diagnostic and assessment strategies for cognitive dysfunction in MS
Utilize pharmacologic options to slow cognitive decline in patients with MS
Discuss approaches for detecting neurodegeneration in MS and for evaluating neuroprotection or repair
Describe emerging neuroprotective strategies in patients with MS

Accreditation
The Center for Bio-Medical Communication, Inc. (CBC) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This CME activity was planned and produced in accordance with ACCME essentials.

CME Credit
CBC designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Disclaimer
The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This enduring material is produced for educational purposes only. Use of the Center for Bio-Medical Communication, Inc. name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

Release date: AUGUST 14, 2009
Expiration date: AUGUST 31, 2010

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Available

Quality-of-Life Issues in Multiple Sclerosis
Highlights From the 2009 American Academy of Neurology Annual Meeting
MS Update: Volume 4, Issue 1

Needs Assessment
Multiple sclerosis (MS), a chronic disease with variable course, often imposes a substantial burden on the community, family, and individual, with notable negative effects on patient quality of life (QOL). There is a substantial burden of illness on QOL scales associated with MS when compared to normative QOL data. MS frequently affects young adults who are in the midst of child rearing, developing careers, and caring for parents, and are involved in the process of life planning. As such, patients with MS face significant challenges in maintaining an acceptable QOL while managing their disease and balancing family and career.

Recent trials—such as BENEFIT, CHAMPS, ETOMS, and PreCISe—have shown that initiating disease-modifying therapy at the time of the first clinical event suggestive of MS can delay the onset of clinically definite MS (CDMS), and in the case of interferon beta-1b (IFNb-1b), disability progression and cognitive impairment as measured by the Paced Auditory Serial Addition Test (PASAT). These findings have led to earlier treatment initiation in clinical practice. With the evolution of diseasemodifying therapy over the past 2 decades, treatment options also exist for enhancing patient QOL. However, improving QOL depends upon long-term adherence with disease-modifying therapy, which can be problematic for various reasons such as lack of efficacy and treatment-related burdens (eg, side effects). Conversely, treatment adherence with disease-modifying therapy significantly improves a number of clinical outcomes, including MS symptoms, activities of daily living, relationships with family members, and emotional and sexual relationships— all key aspects of QOL.

Neurologists are in a critical position to impact the QOL of their patients with MS by identifying and evaluating QOL issues, recommending support programs, helping patients develop coping strategies, managing MS symptoms, providing QOL-focused long-term therapeutic options, supporting treatment adherence, and resolving and preventing potential treatment side effects. The purpose of this activity is to provide a broad audience of US neurologists and neurology nurses with an update on QOL-focused clinical trial results and other key information presented at the American Academy of Neurology (AAN) 61st Annual Meeting that took place April 25 through May 2 in Seattle, Washington. The information presented in this issue of the Update explores treatment strategies to manage MS while positively impacting QOL and treatment adherence.

Target Audience
This activity has been developed for physicians, MS nurses, and other healthcare providers who care for patients with MS.

Learning Objectives
Upon completion of this activity, clinicians will be better able to:

Identify factors influencing QOL in patients with MS
Describe the impact of psychosocial and physical domains on QOL in patients with MS
Select a treatment strategy to manage MS while positively impacting QOL in patients with MS
Provide patients with recommendations for coping strategies to enhance QOL
Select a strategy to reduce treatment burden associated with disease-modifying therapies
Support long-term treatment adherence with disease-modifying therapies to improve outcomes and QOL

Disclaimer
The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This enduring material is produced for educational purposes only. Use of the Center for Bio-Medical Communication, Inc. name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

Release date: MAY 14, 2009
Expiration date: MAY 31, 2010

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Available

Best Practices in MS Management Survey Report
MS Update: Volume 3, Issue 4

Needs Assessment
As a chronic disease with variable course severity, multiple sclerosis (MS) may impose a substantial burden on the individual, family, and community. In the previous 2 decades several immunomodulatory and immunosuppressive therapies have been shown to favorably impact the inflammatory activity and course of MS. Numerous large-scale clinical trials in early, active patient populations have established the clinical efficacy of beta interferons (IFNb) and glatiramer acetate (GA) in reducing relapses and delaying disability progression in relapsing-remitting MS (RRMS). There is now almost universal consensus that patients benefit from early therapy. Nevertheless, more effective and tolerable therapeutic approaches are being sought. While a number of novel therapeutic strategies are in testing, such as new monoclonal antibodies (mAbs) and oral therapies,8 currently approved injectable disease-modifying therapies remain the backbone of treatment for MS.

Clinical decision making in MS is complex because of the number of available drugs and special factors that may influence efficacy, such as the development of neutralizing antibodies (NAbs). As treatment options increase, choosing individual therapies and treatment strategies (eg, escalation versus induction therapy) will become even more complicated. Although consensus opinion and guidelines provide some guidance, the clinical complexity of MS management underscores the importance of analyzing absolute and relative results of class 1 clinical trials.

The purpose of this educational activity is to address key practical issues of interest to healthcare providers who care for patients with MS. Current practices in MS management are outlined by summarizing survey data collected through Volume 3 of the MS Update Series, and best practices are highlighted through expert commentary analyzing these data. Survey responses and expert commentary included in this issue will allow clinicians to benchmark their own current practices against those of their peers, and will provide clinicians with expert opinion on the best available options that may ensure optimal treatment and outcomes for their patients with MS.

Target Audience
This activity has been developed for physicians, MS nurses, and other healthcare providers who care for patients with MS.

Learning Objectives
Upon completion of this activity, clinicians will be better able to:

Discuss the prognostic factors associated with long-term cognitive impairment, disability, and response to drug therapy
List management options to slow disease progression in early MS
Describe the management strategies for patients that develop NAbs
Describe best practice for slowing the decline in cognitive function
State best practice regarding management of suboptimal response to initial disease-modifying therapy
Manage patients who relapse while on disease-modifying therapy

Disclaimer
The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This enduring material is produced for educational purposes only. Use of the Center for Bio-Medical Communication, Inc. name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

Note: The data discussed in this issue were collected from 3 monographs (Multiple Sclerosis Update Series Volume 3, Issues 1, 2 and 3) distributed several months apart. As responses to Issues 2 and 3 are ongoing and were tabulated to date, the number of responses to each question and group of questions will vary.

Release date: FEBRUARY 20, 2009
Expiration date: FEBRUARY 28, 2010

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Long-Term Considerations and Emerging Treatment Options in Multiple Sclerosis
Highlights From Montreal
MS Update: Volume 3, Issue 3

Needs Assessment
Treatment strategies for multiple sclerosis (MS) have evolved rapidly since the initial introduction of disease-modifying therapy (DMT) with interferon beta-1b. MS is a chronic disease that often requires continued therapy for years or even decades, yet few studies have examined the long-term efficacy and safety of interferon beta or glatiramer acetate. Adherence to treatment is often challenging for patients with MS. Current DMTs require subcutaneous or intramuscular self-injections as often as every other day, but are primarily indicated to avoid future relapses and disease progression rather than to produce immediate symptomatic improvement. Several novel therapeutic strategies in testing include oral therapies, monoclonal antibodies, and various vaccines. Mechanisms to expand use of existing therapies, such as early initiation of treatment, are also under investigation. Evidence is emerging that early therapy may produce the best patient outcome in the long term. As the number of therapeutic options grows, it is important for clinicians who treat patients with active MS to be aware of the results of the new clinical trials, and to participate in the debates surrounding these studies.

Target Audience
This activity has been developed for physicians, MS nurses, and other healthcare providers who care for patients with MS.

Learning Objectives
Upon completion of this activity, clinicians will be better able to:

Discuss the impact of early intervention with DMT on long-term MS outcomes
Incorporate efficacy, safety, and tolerability considerations in selecting long-term DMT
Describe the status of novel and investigational treatments in the MS armamentarium
List the implications for outcomes of patient adherence to treatment
Discuss the pharmacoeconomic implications of MS treatment

Disclaimer
The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This enduring material is produced for educational purposes only. Use of the Center for Bio-Medical Communication, Inc. name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

Release date: NOVEMBER 4, 2008
Expiration date: NOVEMBER 30, 2009

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Best Practices in Rheumatoid Arthritis Management Survey Report
Rheumatoid Arthritis Update: Volume 1, Issue 3

Needs Assessment
As a chronic disease, with variable course severity, RA imposes a substantial burden on the individual, family, and community. Without effective treatment, major outcomes include joint deformity, functional disability, work disability, and often premature death. Recent years have seen considerable advances in our understanding of both the clinical and basic-research aspects of RA. Clinical progress has come from a better understanding of the mechanisms of disease as well as advances in therapeutic, diagnostic, and monitoring modalities. In parallel, advances in biotechnology have facilitated development of targeted therapeutics.

Since the American College of Rheumatology (ACR) guidelines were published in 2002, considerable efficacy and safety experience has accumulated in several classes of agents as reflected in treatment strategies recommended in the 2008 guidelines for the use of nonbiologic and biologic DMARDs. While these recommendations reflect refinements in the use of nonbiologic and biologic DMARDs based on disease severity and prognosis, the longitudinal management of RA still remains guided by clinical experience and best practices.

The purpose of this educational activity is to address key practical issues of interest to healthcare providers who care for patients with RA by organizing and summarizing survey data on the treatment of RA obtained through the Rheumatoid Arthritis Update Series questionnaires and to provide expert commentary analyzing these data. This educational report will focus on topics of importance to physicians and other healthcare providers who treat patients with RA: therapy for patients with early RA and DMARD-refractory disease. Survey responses included in this issue will allow physicians to become more aware of their own data interpretations and to learn how experts and their peers regard the same issues. The format of this activity is intended to allow rapid assimilation of the information and to allow feedback defining additional educational needs.

Target Audience
This activity has been developed for rheumatologists, rheumatology nurses, and other allied healthcare professionals who diagnose and treat patients with RA.

Learning Objectives
Upon completion of this activity, the participant will be able to:

Discuss optimal approaches for treating recent-onset RA
Apply best practices to achieve optimal outcomes in clinical practice
Describe optimal approaches for the management of patients with TNF-inhibitor-refractory disease
Monitor patients in clinical remission, including use of appropriate imaging modalities
Identify strategies for managing “primary” and “secondary” failure of TNF-inhibitor treatment

Accreditation
The Center for Bio-Medical Communication, Inc. (CBC) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education (CME) for physicians. This CME activity was planned and produced in accordance with ACCME Essentials.

CME Credit
CBC designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Disclaimer
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of the Center for Bio-Medical Communication, Inc. name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

Release date: October 3, 2008
Expiration date: October 3, 2009

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Treatment Adherence and Its Impact on MS Course and Quality of Life
Highlights From the 22nd Annual Meeting of the Consortium of Multiple Sclerosis Centers
MS Update: Volume 3, Issue 2

Needs Assessment
Healthcare professionals who care for patients with MS have a wealth of knowledge, ability, and clinical experience in diagnosing and monitoring MS, implementing therapy, and maintaining adherence in their patients. However, with continued progress in the field, caregivers and their patients will benefit from educational activities designed to increase clinician awareness, communicate the most current evidence, and promote optimal care for their MS patients. The purpose of this activity is to provide an up-to-date review and expert commentary on the importance of neurologic assessments and therapeutic adherence as discussed at the 22nd Annual Meeting of the Consortium of Multiple Sclerosis Centers to a wide range of neurologists and neurology nurses who might not have had the opportunity to attend this important meeting.

Target Audience
This activity has been developed for physicians, MS nurses, and other healthcare providers who care for patients with MS.

Learning Objectives
Upon completion of this activity, clinicians will be better able to:

Use disease-modifying therapy to reduce acute relapses and long-term disability
Recognize patients who are at risk of treatment nonadherence
Institute measures to improve treatment adherence
Help patients with MS to improve their quality of life
Employ exercise and neurorehabilitation to reduce the impact of MS

Disclaimer
The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This enduring material is produced for educational purposes only. Use of the Center for Bio-Medical Communication, Inc. name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

Release date: AUGUST 14, 2008
Expiration date: AUGUST 31, 2009

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New Challenges and Opportunities
Multiple Sclerosis at the 2008 American Academy of Neurology Annual Meeting
MS Update: Volume 3, Issue 1

Needs Assessment
A growing body of evidence demonstrates that disease-modifying therapies improve the clinical course of patients with multiple sclerosis (MS), even when administered soon after a single demyelinating event.1, 2 Although experts in the management of MS have increasingly advocated early treatment, a number of important clinical questions remain.3 MS is a lifelong disorder, yet there is relatively little information about the long-term efficacy, safety, and tolerability of disease-modifying therapy over a period of many years. Patients often develop binding antibodies (BABs) or neutralizing antibodies (NABs) during interferon beta therapy, and the importance of these antibodies in MS care is controversial.4 It is not clear how these antibodies affect the long-term course of MS, and management strategies for patients who develop NABs are not well defined. In addition, new treatment strategies continue to evolve as novel pharmacologic agents are developed and as new information becomes available from clinical trials of established disease-modifying therapies.

Target Audience
This activity has been developed for physicians, MS nurses, and other healthcare providers who care for patients with MS.

Learning Objectives
Upon completion of this activity, clinicians will be better able to:

Use clinical and radiographic features to assess prognosis for patients with MS
Select a treatment strategy to reduce the impact of cognitive impairment associated with MS
Identify patients who require a change of treatment strategy due to NAB formation
Assess long-term efficacy and safety outcomes of disease-modifying therapy

Disclaimer
The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This enduring material is produced for educational purposes only. Use of the Center for Bio-Medical Communication, Inc. name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

Release date: JUNE 4, 2008
Expiration date: JUNE 30, 2009

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Observations and Insights on New and Emerging Topics in Rheumatology
Rheumatoid Arthritis Update: Volume 1, Issue 2

Needs Assessment
Rheumatoid arthritis (RA) is a common condition, with an estimated worldwide prevalence of 0.5 to 1.0% in the adult population. If left untreated, RA can be extremely disabling. Most patients require continuous treatment to retard or stop progression and to control disease flares.

In recent years, advances in diagnostic modalities and targeted therapeutics have accelerated. Experience with established therapeutics, such as the TNF inhibitors, has grown significantly, providing reassurance about the long-term safety of these agents. New drugs in this class, which potentially offer clinical advantages, such as rapid onset of action and an enduring effect, are in later stages of development.

Extended experience with additional therapeutic classes that target other key steps in the pathogenesis of RA, such as the B-cell depleting agents and costimulatory modulators, are encouraging. Novel classes of anti-RA agents are also on the horizon.

These advances have been mirrored by an evolution in imaging modalities and theories, although the clinical significance of this progress remains to be determined. In addition, advances in automation and bioinformatics have yielded insights into the pharmacogenomics and pharmacogenetics of RA, which, in turn, are translating into more targeted therapeutics and greater understanding of therapeutic failures.

As research into new product classes and combination therapies continues, there is a clear need to educate rheumatologists and nurses on the latest therapeutic and management options available in order to provide the best outcomes for their patients with RA.

Target Audience
This activity has been developed for rheumatologists, rheumatology nurses, and other allied healthcare professionals who diagnose and treat patients with RA.

Learning Objectives
Upon completion of this activity, physicians will be better able to:

Recognize the long-term efficacy and safety of established TNF inhibitors
Discuss the efficacy and safety implications of extended experiences with B-cell depleting agents and costimulatory modulators
Identify emerging therapeutic approaches and agents
Cite the potential and limitations of novel and emerging imaging concepts in RA
Describe the potential role of pharmacogenetics and pharmacogenomics in suboptimal responses to anti-RA agents and in identifying genes that confer modest risk for RA

Release date: April 30, 2008
Expiration date: April 30, 2009

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Best Practices in MS Management Survey Report
MS Update: Volume 2, Issue 4

Needs Assessment
According to the Consortium of Multiple Sclerosis Centers (CMSC), multiple sclerosis (MS) is an unpredictable and challenging disease to treat. The course of the disease is highly variable, but it affects patients and their families emotionally, socially, and physically. Fortunately, according to the National Multiple Sclerosis Society, hundreds of clinical trials are currently under way on therapeutic options to improve the management and outcomes of patients with MS.

The purpose of this educational activity is to address key practical issues of interest to healthcare providers who care for patients with MS. Best practices in MS management are presented by summarizing survey data collected through Volume 2 of the MS Update Series questionnaires and providing expert commentary analyzing these data. This educational report will focus on topics of importance to physicians and other healthcare providers who treat patients with MS: advances in therapy for patients with early MS, most accurate diagnostic measures, and hope for the future. Survey responses included in this issue will allow physicians to become more aware of potential gaps in their own current best practices and to learn how experts and their peers regard the same issues. The format of this activity is intended to allow rapid assimilation of the information, and to allow feedback defining additional educational needs.

Target Audience
This activity has been developed for physicians, MS nurses, and other healthcare providers who care for patients with MS.

Learning Objectives
Upon completion of this activity, clinicians will be better able to:

Discuss the management and followup of patients with a clinically isolated syndrome (CIS) suggestive of MS
Develop a treatment and monitoring plan for patients with relapsing-remitting MS, considering patient characteristics as well as therapeutic limitations and side effect profiles
Discuss the role of patient age in determining aggressive versus conservative treatment of patients with probable MS
Recommend a potential treatment algorithm for patients with probable MS and those anticipated to evolve to clinically definite MS (CDMS)

Disclaimer
The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This enduring material is produced for educational purposes only. Use of the Center for Bio-Medical Communication, Inc. name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

Note: The data presented in this issue are derived from 3 CME monographs distributed several months apart. Participation in these CME activities is ongoing; thus, the results discussed in this “Best Practices” issue represent the most current response data available.

Release date: March 21, 2008
Expiration date: March 31, 2009

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Rheumatoid Arthritis
The Next Generation of Biologic Agents
Rheumatoid Arthritis Update: Volume 1, Issue 1

Needs Assessment
Rheumatoid arthritis (RA) is estimated to affect between 0.5% and 1.0% of the adult population worldwide. Most patients require continuous treatment to retard or stop progression and to control disease flares. In addition to direct costs, disability leads to reduced productivity and, as a result, substantial indirect costs.

It is well known that RA is characterized by a complex interplay of cellular activation through cell and cytokine networks leading to chronic synovitis and cartilage and bone destruction. Recent years have witnessed a greater understanding of these processes.

Greater insight into the pathogenesis of RA is increasingly translating into therapeutic strategies targeting various steps in the pathogenic process. Besides anti-tumor necrosis factor (TNF) and anti-interleukin (IL)-1 agents (infliximab, adalimumab, etanercept, and anakinra) whose clinical efficacy is now established, new drugs are entering the clinical treatment of RA, including blockade of B-cell activity with anti-CD20 monoclonal antibody (mAb; rituximab) and prevention of costimulatory T-cell signals (abatacept). In this respect, other targeted agents, such as the humanized TNF antagonist, certolizumab pegol, and IL-6 receptor blocker, tocilizumab, also look promising.

As research into new product classes and combination therapies continues, which in turn affects the constantly shifting treatment paradigm, there is a clear need to educate rheumatologists and nurses on the latest therapeutic and management options available in order to provide the best outcomes for their patients with RA.

Target Audience
This activity has been developed for rheumatologists, rheumatology nurses, and other allied healthcare professionals who diagnose and treat patients with RA.

Learning Objectives
Upon completion of this activity, physicians will be better able to:

Discuss the pathophysiology of RA and the rationale for biologic therapy
Differentiate the mechanisms of action of the biologic agents that have shown efficacy in RA
Compare the efficacy, safety, and tolerability of conventional versus newer agents for RA
Identify appropriate treatment options following inadequate response to methotrexate and TNF inhibitors

Release date: January 30, 2008
Expiration date: January 31, 2009

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Navigating Through the Layers of Melanoma Care
Melanoma Update: Volume 1, Issue 2

Biopsy is required to diagnose and microstage the tumor, including a measure of penetration depth (Breslow thickness) and anatomic level of skin invaded by tumor (Clark’s level). These criteria form the basis of the American Joint Committee on Cancer (AJCC) classification.² AJCC classification includes melanoma in situ (stage 0), and 5 levels of invasive disease (stages IA, IB, III, III in transit, or IV). It is estimated that between 82% and 85% of patients present with localized disease (stage I/II), 10%-13% present with regional disease (stage III), and 2%-5% present with metastatic disease (stage IV).²

Treatment for melanoma consists of excision wherever possible, with adjuvant therapy for disseminated stage IV disease and for those at high risk of recurrence.^{3, 4} Within the current AJCC staging system, there is a need to better define high-risk melanoma subgroups. Adjuvant therapy options include nodal radiation therapy, systemic therapy with interferon α2b, or a clinical trial. Several agents are being tested for patients with regionally advanced or metastatic disease (http://www.clinicaltrials.gov) including gene therapies, vaccine therapies, vascular endothelial growth factor signaling inhibitors, mammalian target of rapamycin inhibitors, multikinase inhibitors, and alkylating agents.

As researchers continue delving into new product classes and combination therapies, which in turn affect the constantly shifting treatment paradigm, there is a clear need to educate oncologists, nurses, and dermatologists on the latest therapeutic and management options available in order to provide the best outcomes for their patients with melanoma.

Target Audience
Oncologists, dermatologic oncologists, dermatologists, oncology nurses and other healthcare professionals involved in the diagnosis and treatment of patients with cutaneous melanoma.

Learning Objectives
Upon completion of this activity, physicians will be better able to:

Identify appropriate adjuvant/systemic therapy choices based on patient characteristics, disease stage, therapeutic efficacy, and therapeutic tolerability
Decide upon the appropriateness of immunotherapy for a given patient
Provide details on novel agents undergoing clinical testing in melanoma
Define the role of surgical procedures in stage III and stage IV melanoma

CME Credit
CBC designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This continuing nursing education activity was approved by the Oncology Nursing Society, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

Release date: January 2, 2008
Expiration date: January 31, 2009

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The Evolution of Clinical Trials on Treatment for Multiple Sclerosis
MS Update: Volume 2, Issue 3

Needs Assessment
The number of treatment options for patients with multiple sclerosis (MS) has expanded considerably over the last decade. Established therapies have been refined by continued clinical testing, and new medications have entered clinical practice. Despite these advances, clinicians who treat patients with relapsing-remitting MS (RRMS) still confront important challenges because some patients respond only partially to disease-modifying therapy and experience increasing physical and cognitive disability over time.

Recent clinical trials have raised issues about the importance of the timing of MS therapy in obtaining the optimal result. Evidence is emerging that early therapy may produce the best patient outcome in the long term. It is important for health care professionals who treat patients with active MS to be aware of the results of the new clinical trials, and to participate in the debates surrounding these studies.

The purpose of this activity is to provide a broad audience of US neurologists and neurology nurses with an update of clinical trial data from the 2007 ECTRIMS annual meeting on the optimal therapeutic management options for patients with MS and to explain how changes in clinical study parameters may change how and when patients initiate treatment in order to provide optimal outcomes for patients with MS.

Target Audience
This activity has been developed for physicians, MS nurses, and other healthcare providers who care for patients with MS.

Learning Objectives
Upon completion of this activity, clinicians will be better able to:

Select patients with early evidence of MS who would benefit from therapy
Discuss the impact of early treatment of MS on disability and quality of life
Describe changes in the populations recruited for clinical trials on MS therapies over the last 20 years
List key findings from recent clinical trials

Disclaimer
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of the Center for Bio-Medical Communication, Inc. name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contra indications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

Release date: DECEMBER 31, 2007
Expiration date: DECEMBER 31, 2008

Click here to download the newsletter.

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Navigating Through the Layers of Melanoma Care
Risk, Prevention, Diagnosis, Prognosis, and Staging
Melanoma Update: Volume 1, Issue 1

A SUMMARY OF KEY DATA PRESENTED AT:
14th European Cancer Conference
September 23-27, 2007

First World Meeting of Interdisciplinary Melanoma/Skin Cancer Centers
September 5-8 2007

Needs Assessment
In the United States (US) alone, it is expected that there will be 59,940 new diagnoses of melanoma and 8110 deaths from this disease in the year 2007.1 Furthermore, the number of new diagnoses may be an underestimate since many superficial and in situ melanomas treated in the outpatient setting are not reported. Rates of melanoma are increasing more rapidly than any other tumor type in men. In women, melanoma rates are the second highest only to lung cancer. Risk factors for melanoma include family history, dysplastic nevi, and tendency to sunburn easily. Biopsy is required to diagnose and microstage the tumor, including a measure of penetration depth (Breslow thickness) and anatomic level of skin invaded by tumor (Clark’s level). These criteria form the basis of the American Joint Committee on Cancer (AJCC) classification.2 AJCC classification includes melanoma in situ (stage 0), and 5 levels of invasive disease (stages IA, IB, III, III in transit, or IV). It is estimated that between 82%-85% of patients present with localized disease (stage I/II), 10%-13% present with regional disease (stage III), and 2%-5% present with metastatic disease (stage IV).2 Treatment for melanoma consists of excision wherever possible, with adjuvant therapy for disseminated stage IV disease and for those at high risk of recurrence.3, 4 Within the current AJCC staging system, there is a need to better define high risk melanoma subgroups. Adjuvant therapy options include nodal radiation therapy, systemic therapy with interferon alfa-2b, or a clinical trial. Several agents are being tested for patients with regionally advanced or metastatic disease (http://www.clinicaltrials.gov) including gene therapies, vaccine therapies, vascular endothelial growth factor signaling inhibitors, mammalian target of rapamycin inhibitors, multikinase inhibitors, and alkylating agents. As researchers continue delving into new product classes and combination therapies, which in turn affect the constantly shifting treatment paradigm, there is a clear need to educate oncologists, nurses, and dermatologists on the latest therapeutic and management options available in order to provide the best outcomes for their patients with melanoma.

Target Audience
This activity has been developed for oncologists, dermatologic oncologists, dermatologists, oncology nurses, and other health care professionals who diagnose and treat patients with cutaneous melanoma.

Learning Objectives
Upon completion of this activity, clinicians will be better able to:

List recent trends in melanoma diagnosis and staging
Provide details on prognostic biomarkers and genetic susceptibility loci
Define the prognostic value of SLNB
Identify changes being made to the current staging system for melanoma

Accreditation
The Center for Bio-Medical Communication, Inc. (CBC), is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This CME activity was planned and produced in accordance with ACCME essentials.

This continuing nursing education activity was approved by the Oncology Nursing Society, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

Release date: October 31, 2007
Expiration date: October 31, 2008

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Erythropoiesis-Stimulating Agents and Anemia Management: Safety Considerations

This CME activity is a web-based audio slide set based on an April 20, 2007 Satellite Symposium to the 21st Annual Critical Care Medicine 2007 Comprehensive Update and Board Review Course in McLean, Virginia. An addendum to the live event is also included on issues raised at the 5/10/2007 ODAC meeting.

Release date: July 30, 2007
Expiration date: July 31, 2008

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Treating Patients With Relapsing MS Over Time
HIGHLIGHTS OF AAN 2007
MS Update: Volume 2, Issue 2

The purpose of this issue of the MS Update is to provide an overview of presentations at AAN 2007 on recent progress in the treatment of relapsing forms of MS. Key investigations include the outcomes of early diseasemodifying treatment and emerging options for patients with aggressive forms of RRMS.*

*All abstracts referred to in this report are available online at http://am.aan.com/scientific/abstracts.cfm

Needs Assessment
Healthcare professionals who treat patients with active MS have clinical experience with identifying symptoms and treating patients with approved immunomodulatory therapies, including interferon betas and glatiramer acetate. However, the best course of therapy to provide optimal long-term outcomes in patients with relapsing MS is yet to be confirmed. How should these relapsing patients best be managed? Is it more beneficial to treat later disease stages with aggressive therapies, or does safer, early treatment provide better outcomes? New data from the BENEFIT study support the need for identification of patients who would benefit from early treatment, and demonstrate the benefits of early treatment in these patients. Healthcare providers who treat patients with relapsing MS need to be aware of the newest data on long-term treatment of these patients in order to provide them with the best possible care. The purpose of this activity is to update a broad audience of US neurologists and neurology nurses on the newest data on treatment paradigms over time for patients with relapsing MS.

Target Audience
This activity has been developed for physicians, MS nurses, and other healthcare providers who care for patients with MS.

Learning Objectives
Upon completion of this activity, clinicians will be better able to:

Cite new data on the benefits of early interferon beta treatment for patients at high risk of developing MS
Describe the “therapeutic window” hypothesis on the optimal timing of therapy to minimize disability due to MS
Identify emerging therapeutic options for patients with active RRMS despite treatment with interferon beta or glatiramer acetate
Compare and contrast risk management strategies for emerging MS therapies associated with serious adverse events

This CME activity was planned and produced in accordance with ACCME essentials.

CME Credit
CBC designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date: June 15, 2007
Expiration date: June 30, 2008

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Potential Changes to Current Immunomodulatory Therapies for MS
MS Update: Volume 2, Issue 1

This report will describe strategies to improve the efficacy of established immunomodulatory therapies for the treatment of MS, discuss the rationales for these new strategies, and review the preliminary or interim data supporting these new approaches that have been presented at recent scientific congresses.

Needs Assessment
Healthcare professionals who treat patients with MS have clinical experience with existing immunomodulatory therapies for MS, including interferon betas and glatiramer acetate. However, 3 of the therapies approved for treatment of RRMS patients are in Phase III trials that, if successful, will result in a formulation change or in the availability of a higher therapeutic dose. Healthcare providers who treat patients with MS need to become familiar with the rationales for changing existing MS therapies, and to be aware of the potential advantages and disadvantages of prescribing reformulated or differently dosed therapies for their patients with MS. The purpose of this report is to describe the proposed changes to immunomodulatory therapies currently being used to treat MS, discuss the rationales for these changes, and review the preliminary or interim data presented at scientific congresses. Expert commentary assessing the potential impact of the proposed product changes will be provided.

Target Audience
This activity has been developed for physicians, MS nurses, and other healthcare providers who care for patients with MS.

Learning Objectives
Upon completion of this activity, clinicians will be better able to:

Describe proposed changes in formulation and dosing of glatiramer acetate, interferon beta-1a subcutaneous (sc), and interferon beta-1b (sc)
Cite the rationale for changes in formulation and dosing of existing treatments
Summarize early data on clinical efficacy and safety of new dosing and formulations
List the implications of changes on patient care

This CME activity was planned and produced in accordance with ACCME essentials.

Release date: April 15, 2007
Expiration date: April 30, 2008

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Best Practices in MS Management Survey Report
MS Update Issue 4

Providing optimum care for multiple sclerosis (MS) patients is a multifaceted process that depends on the physician’s ability to recognize and respond to changes in a patient’s condition. While academic training assists with these tasks, interaction with colleagues also provides important information. Issues of this update series, which reviewed key neurology meetings and guidelines in 2006, were read by 719 healthcare providers for patients with MS. These readers were asked about their treatment practices to create “virtual discussions” between colleagues on topics emphasized at neurology meetings in 2006 such as:

Optimum management of first clinical events suggestive of MS
The value of the McDonald diagnostic guidelines for clinicians
The importance of cognitive dysfunction to MS patients
Tactics for coping with treatment failure.

Needs Assessment
According to the Consortium of Multiple Sclerosis Centers (CMSC), MS is an unpredictable and challenging disease to treat. The course of the disease is highly variable, but it affects patients and their families emotionally, socially, and physically. Fortunately, according to the National Multiple Sclerosis Society, hundreds of experimental trials are ongoing to improve treatment for patients. The purpose of this educational activity is to address key practical issues of interest to healthcare providers who care for patients with MS by organizing and summarizing survey data on treatment of MS obtained through the MS Update Series questionnaires and to provide expert commentary analyzing these data. This educational report will focus on topics of importance to physicians and other healthcare providers who treat patients with MS: advances in therapy for patients with early MS, most accurate diagnostic measures, and hope for the future. Survey responses included in this issue will allow physicians to become more aware of their own data interpretations and to learn how experts and their peers regard the same issues. The format of this activity is intended to allow rapid assimilation of the information, and to allow feedback defining additional educational needs.

Target Audience
This activity has been developed for physicians, MS nurses, and other healthcare providers who care for patients with MS.

Learning Objectives
Upon completion of this activity, clinicians will be better able to:

Discuss the management of patients with a clinically isolated syndrome (CIS) suggestive of MS
Review their colleagues’ views on the McDonald guidelines
Assess the incidence of cognitive issues in MS
Describe the issues related to identifying and responding to treatment failure

This CME activity was planned and produced in accordance with ACCME essentials.

Release date: January 31, 2007
Expiration date: January 31, 2008

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Advances in Diagnosis of Relapsing-Remitting MS
MS Update Issue 3

The diagnosis of multiple sclerosis (MS), one of the major causes of neurologic-based disability in young adults, is challenging because of the heterogeneity of signs and symptoms, many of which are not specific to MS (Table 1), and because there is no single test to verify MS.1, 2 During the last 40 years, the diagnosis of MS has been aided by increasing knowledge of the natural history and pathophysiology of the disease and by technologic advances in clinical, laboratory, and radiologic testing.1, 2 This report will describe the evolution of MS diagnostic guidelines for physicians in clinical practice with a focus on guidelines for relapsing-remitting MS (RRMS), which is both the most common and the most treatable form of MS.

Needs Assessment
The diagnosis of relapsing-remitting multiple sclerosis (RRMS), the most common form of multiple sclerosis, and one of the major causes of neurologic-based disability in young adults, is challenging. The signs and symptoms are heterogeneous and similar to those for many other central nervous system (CNS) disorders, and there is no single test for detecting RRMS. During the last 40 years, the diagnosis of MS has been aided by increasing knowledge of the natural history and pathophysiology of the disease and by technologic advances in clinical, laboratory, and radiologic testing. Despite these improvements, and perhaps because of them, diagnosis of RRMS remains a complex process for many patients as it necessitates obtaining evidence of multiple attacks and multifocal white matter pathology of the CNS and ruling out conditions that mimic RRMS. The development of disease-modifying therapies has increased the importance of early diagnosis so that the risk of disease progression and development of irreversible pathology and disability may be decreased. This monograph will provide a comprehensive and up-to-date description of diagnostic guidelines for RRMS.

Target Audience
This activity has been developed for physicians, MS nurses, and other healthcare providers who care for patients with MS.

Learning Objectives
Upon completion of this activity, clinicians will be better able to:

Review the evolution of diagnostic guidelines for MS
Assess the new and recent information on the revised 2005 diagnostic guidelines for MS
Cite the evidence leading to revision of the guidelines
Utilize the new guidelines to better evaluate and diagnose patients with relapsing-remitting MS

This CME activity was planned and produced in accordance with ACCME essentials.

CME Credit
CBC designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Disclaimer
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of the Center for Bio-Medical Communication, Inc. name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.

Release date: September 29, 2006
Expiration date: September 30, 2007

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Long-Term Benefits of Immunomodulatory Therapy for MS: Highlights of AAN 2006
MS Update Issue 2

Multiple sclerosis (MS) is a lifelong disease that usually manifests in a patient’s early 30s.1 Current approved therapies may control but do not cure MS, and treatment may be required for decades (possibly 50 years) following diagnosis. Unfortunately, well-controlled clinical trials are not designed to study the long-term effects of therapy, so little clinical evidence is available on the long-term treatment effect of these drugs. Both physicians and patients may wonder whether an MS therapy is effective over time, and whether serious adverse events are likely to develop over time.

At the 58th American Academy of Neurology (AAN) meeting held in San Diego April 1-8, 2006, long-term data on the efficacy and safety of immunomodulatory therapies to treat MS were either newly presented or discussed in educational sessions. The purpose of this report is to review and assess the available data on long-term Immunomodulatory therapy for MS. Key presentations will be summarized, and additional viewpoints on these topics will be provided by 3 MS specialists.

Needs Assessment
Multiple sclerosis is a lifelong disease frequently affecting young adults, who may require long-term treatment to optimize or maintain their functional capabilities. Because some patients have now received immunomodulatory therapy for 16 years or more, long-term data on the efficacy and safety of MS therapies are becoming available. As these analyses are recent, much of the data is unpublished and may not be familiar to treating physicians.

Healthcare providers who treat MS patients over long periods of time can use data on the long-term consequences of Immunomodulatory therapy to help in their treatment decisions. Because not all healthcare providers who treat patients with MS were able to attend key sessions on long-term MS therapy at AAN, this educational activity is designed to further disseminate this information.

Target Audience
This activity has been developed for physicians, MS nurses, and other healthcare providers who care for patients with MS.

Learning Objectives
Upon completion of this activity, clinicians will be better able to:

Discuss potential approaches for performing long-term studies on the efficacy of MS therapies.
Summarize the advantages and disadvantages of registry studies and clinical trial follow-up studies.
Review long-term data on the efficacy and safety of Immunomodulatory therapies for patients with relapsing-remitting MS (RRMS).
Assess the strengths and weaknesses of the available long-term data on MS therapies.

This CME activity was planned and produced in accordance with ACCME essentials.

Faculty
Editor-in-Chief: Barrie J. Hurwitz, MB, MRCP(UK)
Expert Commentators: Patricia Coyle, MD; Douglas R. Jeffery, MD

Disclaimer
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of the Center for Bio-Medical Communication, Inc. name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.

Release date: July 28, 2006
Expiration date: August 1, 2007

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Avoiding Adverse Effects of Drug Therapy for MS: Presentations on Safety and Tolerability from AAN 2006
MS Update Issue 1

Evidence-based medicine for the treatment of multiple sclerosis (MS) evaluates the balance between the efficacy and safety of individual therapies to assist physicians in optimizing patient outcome. Although efficacy is usually the central focus when analyzing clinical data, safety considerations have come to the forefront since serious adverse events and deaths have been associated with natalizumab. A recent article outlined the adverse events of disease-modifying therapies to treat MS. Furthermore, numerous presentations at the 58th meeting of the American Academy of Neurology (AAN) held in San Diego from April 1–8, 2006, focused on the safety of therapies used to treat relapsing-remitting MS (RRMS), including natalizumab.

The purpose of this report is to summarize presentations on the safety and tolerability of MS therapies from this year’s AAN meeting. Additional viewpoints on these topics will be provided by 3 MS specialists.

Needs Assessment
Multiple sclerosis is a lifelong disease most frequently affecting young adults, who may require long-term treatment to optimize their functional capabilities. Because treatment is ongoing, tolerability and safety issues are important to MS patients and their practitioners. New studies on the tolerability and safety of MS therapies were presented at the AAN in April 2006, a forum for research on neurologic diseases, including MS. This activity has been designed to disseminate the data presented at the AAN, because not all healthcare providers for MS patients were able to attend these presentations at the Congress.

Target Audience
This activity has been developed for physicians, MS nurses, and other healthcare providers who care for patients with MS.

Learning Objectives
Upon completion of this activity, clinicians will be better able to:

Review data on the safety and tolerability of therapies for RRMS
List strategies for managing the adverse events associated with interferon-beta therapy
Summarize the controversy regarding the safety of natalizumab
Discuss the need for additional clinical data on the safety and tolerability of MS therapies

This CME activity was planned and produced in accordance with ACCME essentials.

Faculty
Editor-in-Chief: Barrie J. Hurwitz, MB, MRCP(UK)
Expert Commentators: Patricia Coyle, MD Douglas R. Jeffery, MD

Disclaimer
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of the Center for Bio-Medical Communication, Inc. name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.

Release date: May 26, 2006
Expiration date: June 1, 2007

Click here to download the newsletter.

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CME Extended through October 31, 2007

Advances in Treatment of Early Multiple Sclerosis
SELECTED HIGHLIGHTS FROM ECTRIMS 2005

Important new data on the efficacy and tolerability of disease-modifying treatment for patients with evidence of early multiple sclerosis (MS) were recently presented at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) meeting. The ECTRIMS meeting is the largest congress in the world that focuses entirely on MS: more than 200 talks and 600 posters on MS are presented annually. This Rapid Reporter presents selected highlights from the recent ECTRIMS meeting.

Needs Assessment
Few effective therapies are available for patients with advanced MS, but recent studies suggest that the onset of MS can be delayed by early immunomodulatory therapy. Thus, some manifestations of MS may be preventable. The data in this area are evolving rapidly, and not all of the studies have been published. For example, the BENEFIT data have only been presented at ECTRIMS 2005. Clinicians managing patients with syndromes suggestive of early MS need to be aware of the characteristics associated with development of clinically definite MS, and of recent studies examining the efficacy and tolerability of immunomodulatory therapy for patients with early MS.

Target Audience
This activity has been developed for physicians, MS nurses, and other healthcare providers who care for patients with multiple sclerosis.

Learning Objectives
Upon completion of this activity, clinicians will be better able to:

Discuss the rationale for treating early MS patients with immunomodulatory therapy
List diagnostic criteria for patients at high risk of MS, and for those with clinically definite MS
Discuss the key studies on treatment of early MS
Summarize the results of the BENEFIT trial

Disclosure
Disclosure is requested when faculty members are confirmed. This educational activity may include discussion of an unlabeled use or an investigative use not yet approved for a commercial product. Therefore, it is incumbent on individuals participating in this activity to be aware of these factors in interpreting its contents and evaluating its recommendations. Every effort has been made to encourage faculty to disclose any commercial relationships or personal benefits that may be associated with their participation in this activity. The following indicates the faculty and the nature of their commercial relationships and off-label or investigative use discussion. As part of CBC’s mechanism for resolving potential conflicts of interest, the contents of this activity have undergone peer review by an independent CME reviewer.

Barrie J. Hurwitz has received grant/research support from Berlex Laboratories. He is also a consultant for Berlex Laboratories and is on the speakers bureau for Berlex Laboratories and Serono Labs.

Patricia Coyle has received grant/research support from Berlex Laboratories and Teva. She is a consultant for Berlex, Pfizer, Serono Labs, and Teva.

Douglas Jeffery has received grant/research support from Berlex, Pelzor, Serono, and Teva. He is a consultant and scientific advisor for Berlex, Pelzor, Serono, and Teva. He is on the speakers bureau for Berlex, Pelzor, Serono, and Teva.

Fred D. Lublin has received grant/research support from Acorda, Amgen, Biogen, and Teva. He is a consultant and a scientific advisor for Bayer, Berlex, Biogen, Novartis, Pfizer, Plough, Schering, and Serono. He is on the speakers bureau for Berlex, Pfizer, Serono, and Teva.

Avertano Noronha has no commercial relationships to disclose in relation to this activity.

Off-Label Product Discussion
The following faculty members have disclosed that they will discuss unlabeled or investigative use of a commercial product: Dr. Hurwitz reports that this report discusses investigational use of interferon beta-1a (sc) and interferon beta-1b (sc) for treatment of patients with clinically isolated syndrome (CIS) suggestive of early MS.

Disclaimer
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of the Center for Bio-Medical Communication, Inc. name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.

Release Date: October 19, 2005
Expiration Date: October 31, 2007

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CANDIDIASIS: New Approaches to Diagnosis and Treatment

Needs Assessment
The economic and clinical burden of candidiasis is rising due to a variety of disease- and host-related factors, including changing epidemiology of infection and emerging resistance among isolates, as well as changes in patient demographics and delays in diagnosis. Early diagnosis is an essential part of the disease management process to lessen the morbidity and mortality associated with Candida infection. Novel therapies and approaches, including echinocandins, extended-spectrum azoles, and combination regimens, are being evaluated for efficacy and safety.

Release date: February 1, 2006
Expiration date: February 28, 2007

Click here to go to this program self-study page.

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Treating Chronic Hepatitis B in Practice: Increasing Options, Improving Outcomes

This course includes five PowerPoint slide presentations from the CME-certified symposium held on the 13th November 2005 at the San Francisco Marriott.

Needs Assessment
Chronic hepatitis B (CHB) remains a global health problem, with 400 million chronically infected worldwide. Determining what constitutes best practice for patient management in chronic hepatitis B (CHB) is challenging and requires a clear understanding of current treatment strategies and the most appropriate therapeutic endpoints with which to measure clinical success. Furthermore, physicians treating patients with CHB must have a complete appreciation of the risk:benefit relationship for each therapeutic option. In recent years, the number of available treatment options for chronic hepatitis B has increased considerably. The advent of newer immune-based and/or antiviral therapies is paving the way towards improved clinical outcomes in patients with HBeAg-positive and HBeAg-negative chronic hepatitis B. However, identifying patients who will respond to therapy, rationalizing therapy choices and monitoring therapeutic endpoints for particular treatment strategies are therefore crucial for effective CHB disease management.

With new data being reported especially relating to the long-term outcomes of therapy It is important that physicians are armed with the information they need to make the best treatment choices to improve disease management and outcomes for patients with CHB.

Release date: 01 December 2005
Expiration date: 31 December 2006

Click here to go to this program self-study page.

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IN-Viro - Advancing The Study Of Liver Disease
HEPATITIS C IN SPECIAL POPULATIONS

NEEDS ASSESSMENT
In the past two decades we have seen significant strides in the management of hepatitis C. According to Centers for Disease Control and Prevention (CDC) data, during the 1980s an estimated 242,000 Americans were infected with hepatitis C (non-A, non-B hepatitis) annually. Between 1989 and 1998 the annual infection rate had dropped to 41,000 new cases. This is an 80 percent decrease in the annual infection rate. Increased public awareness of the risks and consequences of hepatitis C infection, identification of risk groups, and advances in therapy have resulted in this major impact on the prevalence of hepatitis C in the United States. The impact of improved therapy on the general HCV patient population is now bringing to light challenges in managing special patient populations. Treatment response is more difficult to obtain in some patient subpopulations than others. These include: HIV/HCV coinfected patients, African Americans, alcohol abusers, and those with genotype 1 infections. Lack of controlled HCV studies in children, women (pre- and postmenopause), and pregnancy complicate decisions on how, when, or if to treat. Added to this, most prevalence data does not include incarcerated persons, for which the HCV infection rate is extremely high (range 15 to 40 percent). The alarming prevalence in the penal system is a stark contrast to the strides made for the general population! Frequently in the Conclusions section of clinical abstracts the final line reads, “The subject needs further study.” This issue of IN-Viro™ will provide some insight into the progress made in those cases still under study.

Advisory Board:

William Carey, MD
Section Head of Hepatology
Medical Director of Liver Transplantation
Director, Cleveland Clinic Center for Continuing Education
Cleveland Clinic Center
Cleveland, Ohio

Ramsey Cheung, MD
Chief of Hepatology
VA Palo Alto Health Care System
Palo Alto, California
Associate Professor of Medicine
Stanford University
Stanford, California

Russell H.Wiesner, MD
Professor of Medicine Division of Gastroenterology and Hepatology
Mayo Clinic
Rochester, Minnesota

Target Audience: This CME study program is intended for primary care physicians, gastroenterologists, hepatologists.

CME Credit: CBC designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit(s)^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release Date: August 1, 2005
Expiration Date: August 31, 2006

Click here to download the Home Study Booklet.

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Management of Antiretroviral-Related Metabolic Disorders
Highlights from a CME Satellite Symposium to Clinical Infectious Disease 2005

NEEDS ASSESSMENT
Antiretroviral therapy has improved the clinical course and survival of patients with HIV infection. A variety of metabolic complications are associated with certain antiretrovirals. Insulin resistance, dyslipidemia, and fat redistribution can be major problems that predispose patients to cardiovascular disease and other complications. Clinicians who are managing patients receiving antiretroviral therapy need to recognize the potential for these metabolic derangements. Lipid-lowering therapies, insulinsensitizing agents, growth hormone, and antiretroviral regimen changes have been used to manage these disorders. This educational program will discuss how to monitor these derangements, distinguish those that cause clinically important sequelae, and prevent and manage such complications.

OBJECTIVES
Upon completion of this program, clinicians will be able to:

Identify important metabolic abnormalities associated with antiretroviral use
Develop a strategy to monitor antiretroviral therapy-related lipid and insulin disorders
Understand the current therapeutic strategies available for patients with antiretroviral therapy-related metabolic disorders

TARGET AUDIENCE
Physicians who care for patients with HIV/AIDS

ACCREDITATION
The Center for Bio-Medical Communication, Inc. (CBC) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

This CME activity was planned and produced in accordance with the ACCME essentials.

CME CREDIT
CBC designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

ACKNOWLEDGEMENT
The sponsor of this program gratefully acknowledges the unrestricted educational grant received from Bristol-Myers Squibb Company in support of this activity.

Editor-in-Chief
Colleen Hadigan, MD, MPH
Harvard Medical School
Program in Nutritional Metabolism
Massachusetts General Hospital
Boston, Massachusetts

Editors
W. Michael Scheld, MD
University of Virginia
Health Sciences Center
Charlottesville, Virginia

Henry Masur, MD
George Washington University
School of Medicine
Washington, DC
Bethesda, Maryland

Richard J. Whitley, MD
University of Alabama
School of Medicine
Children’s Hospital of Alabama
Birmingham, Alabama

Release Date: 07/01/2005
Expiration date: 07/31/2006

Click here to download the Home Study Booklet.

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Advances in Mild Cognitive Impairment and Alzheimer Disease

Alzheimer disease (AD) is the most common type of dementia and one of the most devastating infirmities of old age. At present, the most successful treatment strategy for AD involves early and persistent use of cholinesterase inhibitors. Recent research, however, has led to the development of new techniques for early detection (before the onset of dementia symptoms) and the potential for earlier intervention. Of particular importance is identifying the amnestic subtype of the syndrome known as mild cognitive impairment (MCI) as a frequent precursor to AD. Increasing the recognition and monitoring of patients with MCI is likely to shorten the time from symptom onset to diagnosis and treatment of patients who progress to AD.

Recent advances offer promise for improved diagnosis and treatment of AD. Imaging technologies are now being used to visualize areas of beta-amyloid accumulation in the brain, one of the hallmarks of AD pathology, and to monitor treatment effects. Ongoing research with cholinesterase inhibitors lends support to speculation that these agents may not be purely symptomatic treatments, but may have disease-modifying properties. Finally, the burgeoning field of outcomes research is being used to identify opportunities to improve health not only for AD patients, but also for their caregivers.

This program combines clinical data and case-based learning to familiarize clinicians with the symptoms and progression of AD, techniques for screening and diagnosis, and treatment options. Areas of ongoing research and innovation are highlighted as these developments continue to advance the recognition and treatment of this common neurologic disease.

Faculty:
Howard Fillit, MD
Norman R. Relkin, MD, PhD

Release Date: 05/22/2005
Expiration date: 06/01/2006

Click here to download the Home Study Booklet.

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Clinical Approaches in BIPOLAR DISORDERS

This is an international, peer-reviewed journal that aims to enhance communication and discussion of the key issues affecting those active in the diagnosis, treatment, and overall care of patients with bipolar disorders. The journal seeks to inform, educate, and unify all those interested in bipolar disorder by publishing invited review-type articles that will lead to a greater appreciation and understanding of bipolar disorders, and improve patient treatment and care.

Click here to visit website (www.bipolardisorders.net).

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How Should we Manage the Breast Cancer Patient who has Been on Tamoxifen for 2 to 3 years?

Breast cancer is the most commonly diagnosed cancer among women and the second leading cause of cancer death. Given the prevalence and substantial pharmacoeconomic burden of this disease, there is an urgent need to improve therapeutic strategies to improve survival. A better understanding of the disease and treatment would emerge from a convergence of clinical research into potential new pharmacological agents. After listening to the audiotape and reviewing the poster panels, participants should be able to discuss the efficacy and safety of the newer endocrine agents in the treatment of early-stage breast cancer.

Faculty:
Professor Fritz Jänicke
Chairman and Head
Department of Obstetrics and Gynaecology
Universitats-Frauenklinik Eppendorf
Hamburg, Germany,

Target Audience:
Healthcare professionals who are responsible for the diagnosis and treatment of patients with breast cancer.

CME Credit:
CBC designates this activity for a maximum of 1 hour in Category 1 credit towards the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. The American Medical Association has determined that physicians not licensed in the United States who participate in this CME activity are eligible for AMA PRA Category 1 credit.

Release Date: October 30, 2004
Expiration Date: October 31, 2005

Supported by an unrestricted educational grant from Pfizer Inc

Click here to download the Home Study Booklet.

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Can Low-Molecular-Weight Heparin Prolong Cancer Patient Survival?

As a result of the findings from early clinical studies, speculation has arisen regarding the potential benefits of anticoagulant therapies including low-molecular-weight heparin (LMWH) in cancer patients with respect to their ability to prolong survival. Although patients with cancer are known to be at increased risk of developing VTE, current evidence suggests that the survival benefits seen with agents such as LMWH occur as a result of mechanisms that are independent of their antithrombotic effects. A better understanding of the suggested survival benefit with antithrombotic agents and the potential mechanisms associated with this effect are required.

After listening to the audiotape and reviewing the poster panels, participants should be able to discuss the recent evidence suggesting a survival benefit with antithrombotic agents, in particular LMWH, in cancer patients, and the potential mechanisms associated with this effect.

Faculty:
Professor Ajay Kakkar
Professor and Chairman
Centre for Surgical Sciences
Consultant Surgeon St Bartholomew’s and the London Hospitals School of Medicine
University of London
London, UK

Target Audience:
Healthcare professionals who are responsible for the diagnosis and management of cancer patients with venous thromboembolism (VTE).

Release Date: October 30, 2004
Expiration Date: October 31, 2005

Supported by an unrestricted educational grant from Pfizer Inc

Click here to download the Home Study Booklet.

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In-Viro™ Advancing the study of liver disease Volume 2 Number 3: Update on Hepatitis B

With so much focus on HIV and hepatitis C infections over the past decade, hepatitis B infection (HBV) has become overshadowed as one of the world’s most dangerous and infectious diseases. It is estimated that 30 percent of the world’s population, approximately 2 billion individuals, have serologic evidence of past or present HBV infection (World Health Organization data). It is also estimated that 350 million people have chronic HBV infection and that 65 million will die of HBV-related disease. The cause of primary hepatocellular carcinoma, one of the top 10 most common cancers in the world, can be traced to HBV infection in 80 percent of cases. Only tobacco is a more potent human carcinogen!

IN-Viro™ is pleased to provide our readership with abstracts highlighting the progress to date in managing HBV infection, including conference abstracts from this year’s 55th annual AASLD meeting in Boston, Massachusetts, as well as MEDLINE abstracts.

Advisory Board:
William Carey, MD
Section Head of Hepatology
Medical Director of Liver Transplantation
Director, Cleveland Clinic Center for Continuing Education
Cleveland Clinic Center
Cleveland, Ohio

Ramsey Cheung, MD
Chief of Hepatology
VA Palo Alto Health Care System
Palo Alto, California
Associate Professor of Medicine
Stanford University
Stanford, California

Russell H.Wiesner, MD
Professor of Medicine
Division of Gastroenterology and Hepatology
Mayo Clinic
Rochester, Minnesota

Target Audience: This CME study program is intended for primary care physicians, gastroenterologists, hepatologists.

CME Credit: CBC designates this educational activity for a maximum of 1 hour in Category 1 credit towards the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.

Release Date: December 15, 2004
Expiration Date: December 15, 2005

CME credit cannot be awarded after the expiration date.

Click here to download the Home Study Booklet.

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Clinical Management of Patients With Stress Urinary Incontinence

Neurotransmitters serve many roles and have many functions in disease etiology. This audio home study program focuses on their roles in stress urinary incontinence.

After reviewing this audio home study program, participants should be able to:

Explain the prevalence and impact of stress urinary incontinence
Define the typical patient with stress urinary incontinence
Understand the neurourologic component of SUI and new pharmacotherapy

Faculty:
Robert M. Guthrie, MD
Professor of Emergency Medicine, Internal Medicine, and Pharmacology
Associate Director of Clinical Pharmacology
The Ohio State University
Columbus, Ohio

Target Audience: This program is intended for primary care physicians, general practitioners, family physicians, urologists, gynecologists, and other health care providers who may treat patients with stress urinary incontinence.

CME Credit: The Center for Bio-Medical Communication, Inc. designates this educational activity for a maximum of 1.0 hour in Category 1 credit towards the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.

Release Date: July 28, 2004
Expiration Date: July 28, 2005

CME credit cannot be awarded after the expiration date.

Click here to download the Home Study Booklet.

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Targeting Remission: Treating Both Emotional and Physical Symptoms Associated With Depression

Neurotransmitters serve many roles and have many functions in disease etiology. This audio home study program will focus on their roles in major depression.

After reviewing this audio home study program, participants should be able to:

Explain the necessity for recognizing emotional and physical symptoms as equally important components of depression
Understand the importance of treating both the emotional and physical symptoms associated with depression
Define the difference between response and remission in depression

Faculty:
Robert M. Guthrie, MD
Professor of Emergency Medicine, Internal Medicine, and Pharmacology
Associate Director of Clinical Pharmacology
The Ohio State University
Columbus, Ohio

Target Audience: This program is intended for primary care physicians, general practitioners, family physicians, and other healthcare providers who may treat patients with depression.

Release Date: July 28, 2004
Expiration Date: July 28, 2005

CME credit cannot be awarded after the expiration date.

Click here to download the Home Study Booklet.

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Pertussis Disease: On the Rise in Adolescents and Adults

Pertussis disease, commonly thought to be exclusively an infant and toddler disease, is in fact a significant problem among adolescents and adults in the United States. Waning protection from childhood vaccines plays a large role in the rising rates of adolescent and adult pertussis disease. Booster immunization was hindered in the past by the age-dependent increase in adverse reactions to the available whole-cell vaccines. However, new acellular vaccines, which contain purified pertussis toxoid and key bacterial outer-membrane proteins, are effective and better tolerated than the whole-cell forms.

Healthcare providers should be aware of adolescent and adult pertussis disease for a number of reasons. First, although typically the disease is less severe in these older populations than in infants, it is not without risk, and complications of the disease can include pneumonia, seizures, and encephalopathy. Second, adolescents and adults are thought to serve as the primary reservoir of Bordetella pertussis for transmission to infants and young children, the groups most susceptible to severe disease. Finally, the economic impact of the disease can be high.Thus, a number of academic studies argue that pertussis booster immunization may be warranted in adolescents.

Faculty:
David Greenberg, MD
Associate Professor of Pediatrics
University of Pittsburgh Medical School Division of Allergy, Immunology and Infectious Diseases
Children's Hospital of Pittsburgh, Pittsburgh, Pa

Target Audience: This program is intended for healthcare providers who may treat pertussis disease.

CE Credit: This program has been approved for 1.0 contact hour of continuing education (which includes 0.4 hours of pharmacology) by the American Academy of Nurse Practitioners.

Release Date: June 12, 2004
Expiration Date: June 30, 2005

CE credit cannot be awarded after the expiration date.

Click here to download the Home Study Booklet.

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Meningococcal Disease: Examining Risk

Meningococcal disease is an extremely serious bacterial infection. Most commonly presenting as either meningococcal meningitis or meningococcemia, its fatality rate is high (10%), and many survivors (11%-19%) are permanently disabled with neuropathies or limb or hearing loss.

Although once most common in infants and young children, meningococcal disease now shows a significant incidence peak in adolescents and young adults as well. The Advisory Committee on Immunization Practices (ACIP) recommends that undergraduate college students, particularly freshmen who live or plan to live in dormitories or residence halls, consider getting a meningococcal vaccine. Currently available meningococcal vaccines are 85% to 100% effective against serogroups A, C,Y, and W-135, but physicians should be aware that they do not protect against serogroup B, which causes up to 40% of reported cases, mainly in infants. Moreover, vaccines available today are formulated from bacterial polysaccharides, which are ineffective in young children and fail to elicit long-term immunological memory in adolescents and adults. When available in the United States, quadrivalent meningococcal conjugate vaccines will protect against serogroups A, C,Y, and W-135, and are expected to have long-lasting immune memory.

Faculty:
Lee H. Harrison,MD
Associate Professor of Epidemiology and Medicine
University of Pittsburgh, Pittsburgh, Pa
Adjunct Associate Professor of International Health
Johns Hopkins University, Baltimore, Md

CE Credit: This program has been approved for 1.0 contact hour of continuing education (which includes 0.4 hours of pharmacology) by the American Academy of Nurse Practitioners.

Release Date: June 12, 2004
Expiration Date: June 30, 2005

Click here to download the Home Study Booklet.

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Vascular Dementia: Advances in Diagnosis and Treatment

Vascular dementia is the second most common form of dementia worldwide, and the care of VaD patients is an increasing problem to society and to healthcare professionals. However, there are currently no approved treatments for the symptoms of VaD. Patients with cardiovascular and cerebrovascular conditions are at risk of developing VaD.Therapy for vascular conditions helps to prevent or delay VaD onset, and monitoring for signs of impairment enables early detection of this condition. The clinical presentation of VaD may be quite distinct, and specific tools for screening and identifying VaD are available. However, many VaD cases go unrecognized, as memory loss is not always apparent. Provision of optimal care to the VaD patient, and communication of appropriate treatment expectations to the patient’s caregiver and family, may only be possible following accurate diagnosis of this condition. Using a case study example, this program presents an overview of VaD causes, subtypes, diagnosis, and current management strategies, as well as showing data on ChE inhibitor therapies in VaD.

Faculty: Stephen Salloway,MD, MS; David Wilkinson, MB, ChB, MRCGP, FRCPsych

Release Date: February 21, 2004
Expiration date: February 28, 2005

Click here to download the Home Study Booklet.

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Effective Management of Gaucher Disease: Bone Manifestations

CME Extended through January 31, 2005!

This monograph will review the pathophysiology of Gaucher disease in the skeleton, imaging modalities for specific aspects of Gaucher disease skeletal pathology, internationally recognized monitoring and treatment guidelines for Gaucher disease skeletal pathology, and the clinical data on the efficacy of ERT for treating skeletal complications in patients with Gaucher disease.

Scientific Advisors: Henry J. Mankin, MD; Edith M. Ashley

CME Credit: CBC designates this educational activity for a maximum of 1 hour in Category 1 credit towards the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.

Release Date: January 31, 2004
Expiration Date: January 31, 2005

Acknowledgment: The sponsor of this program gratefully acknowledges the unrestricted educational grant from Genzyme Corporation in support of this educational activity.

Contact & More Information: Please call (201) 342-6070.

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REACH CME Slide Lecture Program:

Bipolar disorder is a devastating illness that is usually chronic, recurring, and associated with considerable morbidity, mortality, and caregiver burden. Bipolar disorder can be difficult to recognize and treat appropriately. The misdiagnosis and inappropriate management of bipolar illness is associated with poor symptom control, or even a worsening of symptoms, that can lead to deteriorating health, repeated hospitalizations, cumulative functional impairment, and an increased risk of suicide.

Information on the early and accurate diagnosis of bipolar disorder and its appropriate treatment is needed. An awareness of the current standards of care, and emerging treatment options, is necessary when formulating a treatment program. Choosing the appropriate treatment can increase rates of response, enhance adherence to medication, and improve quality of life.

Upon completion of this activity, the participant should be able to:

Identify the key clinical approaches in the treatment of mania, bipolar depression, and long-term maintenance therapy.
Assess the effectiveness of these approaches in patients with bipolar disorder
Use the information on pharmacologic and psychosocial approaches as guidance for the appropriate management of patients with bipolar disorder

CME Credit: The Center for Bio-Medical Communication, Inc., designates this educational activity for a maximum of 1.5 hours in Category I credit toward the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.

Release Date: November 13, 2003
Expiration date: November 30, 2004

Click here to go to the REACH homepage.

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AHF On-line CME Series

This series is geared for physicians and covers a range of topics within the herpesvirus arena. Instructions for receiving CME credit are included in the document itself. At this time, you will have to print out the information sheet, posttest, and evaluation form and mail it in with a $15 processing fee, per the instructions.

Click here to go to the website.

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Intravenous Antiepileptics: Beyond the Treatment of Seizure Disorders

This program is intended for neurologists and other physicians who may treat neurological disorders. Upon completion of this CME activity, participants should be able to review the pharmacology and safety of IVAEDs, including rapid dosing data, explain the clinical impact of IVAEDs for the treatment of seizure disorders, and present alternative usages of IVAEDs.

Scientific Advisors: Ninan Mathew, MD, FRCP; Dean Naritoku, MD

CME Credit: CBC designates this educational activity for a maximum of 1 credit hour in Category 1 credit towards the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.

Release Date: March 30, 2003
Expiration Date: March 30, 2004

Acknowledgment: Supported through an unrestricted educational grant from Abbott Laboratories, Inc.

Contact & More Information: Please call (201) 342-6070.

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Ask The Experts: A CME Activity

The text of this CME activity was taken from audience-generated questions at the Comprehensive Gynecology 2001: A Clinical Update for the Practicing Physician course held October 12-14, 2001 at the Crowne Plaza Manhattan in New York City. At the conclusion of each session, a 30-minute question-and-answer panel discussion was conducted. Panel members included the course directors and faculty members. This CME activity presents the questions and replies from the panel members to help understand the complex issues faced by health professionals who provide primary healthcare services to the female patient.

Click here to go to the website.

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Internet Critical Care Medicine 2003 - Webcast Encore

This internet course has been organized to provide a comprehensive update in the diagnosis, monitoring, and management of the critically ill patient and to provide preparation for the critical care subspecialty examination of the American Board of Internal Medicine. It was specifically designed for those individuals who were unable to attend the live meeting.

Course Directors: Joseph E. Parrillo, MD; Henry Masur, MD;
Dates: 4/20/2003 - 1/1/2004
Location: Internet - Webcast Encore
CME hours: 41.5 hours

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Emerging Trends in the Use of Oral Contraceptives

Oral contraceptives are safe and 99.9% effective; however side effects and misconceptions have kept some women from using them. This slide kit strives to dispel some of the misconceptions about oral contraception by presenting information on trends in oral contraceptive use, evolution of the oral contraceptives, noncontraceptive benefits of oral contraceptives, and pharmacologic and clinical data on a new oral contraceptive containing drospirenone.

Scientific Advisors: Judi Lee Chervenak, MD; Lee P. Shulman, MD; Albert Yuzpe, MSc, MD

CME Credit: CBC designates this educational activity for a maximum of 2 hours in Category 1 credit towards the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.

Release Date: March 18, 2002
Expiration Date: March 31, 2003

Acknowledgment: The sponsor of this program gratefully acknowledges the unrestricted educational grant from Berlex Laboratories.

Contact & More Information: Please call (201) 342-6070.

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The Role of Estrogen in the Prevention of Postmenopausal Osteoporosis

The purpose of this slide kit is to discuss the risk factors, diagnosis, and drug therapy options for prevention of osteoporosis, concentrating on estrogen. With a better understanding of the available treatments, physicians will be able to provide their patients with optimal care.

Scientific Advisors: Bruce Ettinger, MD;

Release Date: March 18, 2002
Expiration Date: March 31, 2003

Acknowledgment: The sponsor of this program gratefully acknowledges the unrestricted educational grant from Berlex Laboratories.

Contact & More Information: Please call (201) 342-6070.

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Metabolic Issues and the Effects of Transdermal ERT on the Midlife Woman

This slide kit reviews the use of HRT in the prevention of osteoporosis, cardiovascular disease, and dementia, and reviews the controversy surrounding the association between HRT and breast cancer.

Scientific Advisors: Sarah L. Berga, MD; Joseph W. Goldzieher, MD; Susan Wysoski, RNC, NP

Release Date: March 18, 2002
Expiration Date: March 31, 2003

Acknowledgment: The sponsor of this program gratefully acknowledges the unrestricted educational grant from Berlex Laboratories.

Contact & More Information: Please call (201) 342-6070.

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The PMS Puzzle: A Sensitive Balance Between Diagnosis, Prevalence, and Treatment

This CME slide kit provides definitions and descriptions of premenstrual symptoms, premenstrual syndrome (PMS), and premenstrual dysphoric disorder (PMDD). It discusses the prevalence of and risk factors for PMS and PMDD, as well as their diagnosis and treatment. Practical considerations for the pharmacologic management of these conditions is provided through review of three case studies.

Scientific Advisors: Jeff E. Borenstein, MD, MPH; Vivain M. Dickerson, MD; Jean Endicott, PhD; Andrea J. Rapkin, MD; Kimberly A. Yonkers, MD

Release Date: March 18, 2002
Expiration Date: March 31, 2003

Acknowledgment: The sponsor of this program gratefully acknowledges the unrestricted educational grant from Berlex Laboratories.

Contact & More Information: Please call (201) 342-6070.

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