Hospitals, on average, expend between 40 and 70 percent of their budgets on salaries and benefits, greatly surpassing supply chain as a hospital’s largest expense. Even with this major investment in human capital, it is still the rate-limiting factor on the delivery side of health care. Implementation of the Affordable Care Act will exacerbate this issue through the imposed coverage requirements in 2014. This virtual web seminar will address one significant strategy to increase workforce cap...

Forces of Change brings together leaders representing key stakeholders to address critical issues facing the health care marketplace, mindful of emerging issues in health reform with a focus on how you can lead through change. Forces offers not only an overview of the challenge in the health care industry, but also powerful tips, tools, and techniques for overcoming these challenges. Upon completion of this program, participants will be able to: - Advance projects and new initiatives fr...

Fulfill your Vascular Lab CME Requirements with this globally revered course! For over twenty years, this annual symposium has provided a comprehensive update on vascular imaging and diagnosis. The newest edition is available here on DVD-ROM, focusing on real time B-mode imaging, color and spectral Doppler and other non-invasive techniques. The course will also address important issues in MSK ultrasound, Vascular Laboratory management, vascular ultrasound education, reimbursement and labora...

•Perform pre-operative screening for cognitive impairment and dementia in elderly patients •Identify risk reduction strategies for post-operative morbidity in elderly surgical patients •Evaluate elderly surgical patients for frailty •List recommended pre-operative tests for elderly surgical patients •Identify the pros and cons of crystalloid versus colloid resuscitation •Discuss current trends and recommendations for blood product use in trauma resuscitations •I...

Operative vaginal delivery has a definite time and place in obstetric practice and is associated with reduced maternal complications compared to cesarean section. While vacuum extraction now exceeds the use of forceps, the indications and efficacy for them are essentially the same. A case study will be presented that illustrates how to manage risks and pitfalls of operative vaginal delivery and the clinical guidelines that can assist the obstetrician’s decision-making in difficult labors. ...

You all have them, you can’t avoid them, and you may not even like them. Studies have shown that up to 15% of patient encounters are perceived as difficult by the clinician that is treating them. As a primary care clinician, you are most often the entryway to patients for their healthcare, even the most “difficult” patients. Many factors contribute to a challenging patient including those that refuse your recommendations, have coexisting conditions and a multitude of symptoms, have unrea...

You all have them, you can’t avoid them, and you may not even like them. Studies have shown that up to 15% of patient encounters are perceived as difficult by the clinician that is treating them. As a primary care clinician, you are most often the entryway to patients for their healthcare, even the most “difficult” patients. Many factors contribute to a challenging patient including those that refuse your recommendations, have coexisting conditions and a multitude of symptoms, have unrea...

You all have them, you can’t avoid them, and you may not even like them. Studies have shown that up to 15% of patient encounters are perceived as difficult by the clinician that is treating them. As a primary care clinician, you are most often the entryway to patients for their healthcare, even the most “difficult” patients. Many factors contribute to a challenging patient including those that refuse your recommendations, have coexisting conditions and a multitude of symptoms, have unrea...

You all have them, you can’t avoid them, and you may not even like them. Studies have shown that up to 15% of patient encounters are perceived as difficult by the clinician that is treating them. As a primary care clinician, you are most often the entryway to patients for their healthcare, even the most “difficult” patients. Many factors contribute to a challenging patient including those that refuse your recommendations, have coexisting conditions and a multitude of symptoms, have unrea...

Statement of Need The purpose of this activity is to provide knowledge and skills to health care providers to enhance the nutritional health of pediatric patients. Learning Objectives At the conclusion of this initiative, participants will do the following: 1. Identify appropriate macro- and micro-nutrient requirements for healthy children and adolescents 2. Support age-appropriate weight gain in childhood 3. Incorporate evidence-based nutritional guidelines into the management plans ...

7-Night Eastern Caribbean Cruise Conference from Ft. Lauderdale, Florida December 28, 2013 - January 4, 2014 BIAS FREE CME - No Commercial Support was provided for this CME activity. 14 AMA PRA Category 1 Credit(s)™ 14 Contact Hours Course Fee Physicians - $695 All Others - $450 Course Fee Cancellation Policy 30 days or more - None; 7-29 days - 50%; less than 7 days - 100% IMPORTANT NOTE: All conferees, their families, and guests must book their cruise within the CME me...

Propofol/Ketamine for Moderate Sedation Online CE Course propofol-200mg Goldilocks Anesthesia Technique "Not too much, not too little, just right" This 4 hour CE program is presented by Dr. Barry Friedberg who explains his propofol and ketamine technique for moderate sedation in the out patient setting. As an increasing number of procedures requiring sedation are done in the outpatient setting, Sedation Consulting is presenting this seminar to help physicians and nurses involved in...

Nursing Sedation CEU Course Online Sedation Nurse This web based online sedation course has been developed and is presented by an anesthesiologist with over 25 years of clinical experience. It is appropriate for providers who are involved in the administration, management, monitoring or recovery of sedated patients. Course consists of 8 video modules that are approximately 1 hour each (total run time of 8:50:21) after viewing each module a 10 question examination will be available and...

This web based online sedation course has been developed and is presented by an anesthesiologist with over 25 years of clinical experience. It is appropriate for providers who are involved in the administration, management, monitoring or recovery of sedated patients. Course consists of 8 video modules that are approximately 1 hour each (total run time of 8:50:21) after viewing each module a 10 question examination will be available and a passing score of 80% will be required to proceed, m...

Lissette Arnott©, a CME-certified case-based branched learning game, is provided by Texas Health Research & Education Institute to improve outcomes for women with depression in the primary care setting. The interactive and immersive 3D virtual learning environment provides concise information on depression management and helps you sharpen decision-making and critical-thinking skills to apply to your patients immediately. Branch out today into this dynamic, online simulated world. Making th...

The Electronic Fetal Heart Rate Monitoring program introduces a comprehensive, systematic, evidence-based approach to standardized intrapartum fetal heart rate interpretation and management that reflects consensus in the medical literature, is practical, and teachable. Unlike other fetal heart rate monitoring education programs, this course moves past the definitions into how to interpret and manage the information being received—and how to use that information to help make critical cl...

Learning Objectives After participating in this educational activity, participants should be better able to Recognize the common and less common signs and symptoms of thyroid disorders and have a low index of suspicion for patient work-up Prescribe thyroid replacement therapy according to relevant guidelines, and follow up with patients regularly, adapting treatment and doses as needed Identify pregnant women at high risk of thyroid dysfunction who would benefit from screening, and ...

The Spanish speaking population has grown tremendously over the past few decades and healthcare providers in many areas of the country are challenged to communicate with this expanding patient population.The goal of this conference is to teach basic, intermediate and advanced Medical Spanish language skills in the classroom and to implement the usage of these skills with native Spanish speakers in an immersion setting. At the conclusion of this conference, participants should be able to improv...

Learning objectives 1. Evaluate the level of evidence to inform decision making for the treatment radiation induced sarcoma of the breast. 2. Explain diagnostic criteria for radiation-induced sarcoma. 3. Describe the effectiveness of surgery, chemotherapy and radiation therapy for radiation induced sarcoma of the breast. Introduction. Radiation-induced sarcoma (RIS) is a rare, aggressive malignancy. Breast cancer survivors treated with radiotherapy constitute a large fraction of RIS pati...

Learning objectives 1. Determine the frequency, indications, and outcomes of opioid rotation in cancer outpatients. 2. Describe the predictors of successful opioid rotation. Background. Opioid rotation is used to treat uncontrolled pain and/or opioid-related adverse effects. Our aim was to determine the frequency, indications, outcomes, and predictors of successful opioid rotation in outpatients with cancer. Methods. Medical records of consecutive outpatients with cancer who received s...

Learning objectives 1. Describe the effect of worsening fatigue after breast cancer surgery on physical functioning and psychological distress. 2. Better identify women at risk for developing cancer-related fatigue. 3. Direct target interventions to patients most in need. Purpose. Fatigue is one of the most frequent symptoms in patients with cancer. However, the precise determinants of fatigue are still unknown. This study was conducted to investigate factors correlated with cancer-relat...

Learning objectives 1. Describe the range of palliative procedures utilized in gynecologic cancers. 2. Evaluate the indications for palliative bowel surgery in ovarian cancer. 3. Assess the clinical scenario for which palliative pelvic exenteration would be considered. 4. Compare the morbidities associated with palliative gynecologic surgeries to the potential benefits gained The decision to undergo major palliative surgery in end-stage gynecologic cancer is made when severe disease sym...

Learning objectives 1. Identify lower limb drainage nodes preoperatively and during pelvic lymphadenectomy for endometrial cancer. 2. Map lower limb drainage nodes during pelvic lymphadenectomy for endometrial cancer, using the "reverse mapping concept". 3. Preserve lower limb drainage nodes during pelvic lymphadenectomy for endometrial cancer in order to reduce the risk of lower limb lymphedema. Objectives. Pelvic lymphadenectomy is associated with a significant risk of lower-limb lymph...

Learning objectives 1. Describe the potential contributors to bone demineralization in patients receiving systematic treatment for gynecological malignancies. 2. Define what is meant by "osteopenia" and "osteoporosis" and describe their relevance to fracture risk. 3. Explain the importance of preventing and managing bone mineral loss and its complications in gynecological cancer survivors. Background. An association between treatment for gynecological cancers and risk of osteoporosis has...

Learning objectives 1. Cite reasons given by patients over age 65 for their decisions to participate or not to participate in clinical trials. 2. Cite reasons given by physicians for their decisions not to enroll patients over age 65 in clinical trials or discuss enrollment with these patients. Purpose. Patients older than 65 years are underrepresented in clinical trials. We conducted a prospective study (SWOG S0316) to determine physician- and patient-perceived barriers to breast cancer ...

Learning objectives 1. Describe the spectrum of diseases, represented by CD30+LPDs, that can give rise to a reactive process. 2. Discuss the favorable prognoses of reactive CD30+ LPDs and how they may not therefore require aggressive therapy. 3. Explain how iALCL follows Hanahan and Weinberg's principles and acquires the ability to metastasize with new mutations. CD30+ lymphoproliferative disorders represent a spectrum of diseases with distinct clinical phenotypes ranging from reactive c...

Learning objectives 1. Evaluate the therapeutic impact of hysterectomy after chemoradiation therapy in locally advanced cervical cancer. 2. Evaluate the rate of histologic residual disease in patients with complete clinical and radiologic response after chemoradiation therapy. Background. Concomitant chemoradiation (CRT) (including brachytherapy) is considered the standard management for stage IB2 or II cervical cancer in many countries. Nevertheless, some of them discuss completion surge...

Learning objectives 1. Explain biological patterns of behavior behind BRCA related ovarian cancer. 2. Identify targetable defects in ovarian cancer. Ovarian cancer is the leading cause of death among gynecological cancers. It exhibits great heterogeneity in tumor biology and treatment response. Germline mutations of DNA repair genes BRCA1/2 are the fundamental defects in hereditary ovarian cancer that expresses a distinct phenotype of high response rates to platinum agents, improved disea...

Learning objectives 1. Identify risk factors for lymphoceles after cytoreductive surgery in ovarian cancer. 2. Describe the impact of lymphocleles on outcomes in women with ovarian cancer. Introduction. We describe the incidence, impact on survival, and the risk factors for symptomatic lymphoceles in patients with ovarian cancer. Methods. This retrospective study includes patients with ovarian cancer who had complete cytoreductive surgery and para-aortic and pelvic lymphadenectomy perf...

Learning objectives 1. Describe the ability of the revised 2008 FIGO staging system to determine risk strata in patients with uterine leiomyosarcoma. 2. Compare concordance indices of the older and the revised FIGO staging systems. 3. Identify gaps in the current FIGO staging system. Background. In 2008, the Federation of Gynecology and Obstetrics (FIGO) revised their 1988 staging system for uterine leiomyosarcomas. In this article, we compare performance of the 2008 and 1988 FIGO system...

Learning objectives 1. Compare the epidemiologic and reproductive risk factors in BOTs with those in ovarian cancers and describe the molecular background of development of BOTs. 2. Use the pathological terminology with either original grouping of borderline category or new subclassification of BOTs and assess the major predictor of recurrence and survival. 3. Determine an appropriate diagnostic algorithm for patients with symptoms suggesting malignant ovarian tumors that will identify bord...

Learning objectives 1. Describe the need for additional vigilance regarding renal dysfunction when platinums, pegylated liposomal doxorubicin, bevacizumab, and gemcitabine are used for prolonged treatment of recurrent ovarian cancer in combination or sequentially following pre-existing renal damage. 2. Describe and quantify the risk of chronic kidney disease in patients treated for ovarian cancer. Background and Objective. Ovarian cancer is usually diagnosed at an advanced stage, with mos...

Learning objectives 1. Compare the risk of secondary cancer versus benefits of maintenance therapy for women with ovarian cancer who have a complete response to pegylated liposomal doxorubicin. 2. Explain the need to perform regular and frequent oral examinations in women with ovarian cancer who received treatment with pegylated liposomal doxorubicin. Purpose. To describe occurrences of oral squamous cell carcinoma (SCC) in patients who had received long-term pegylated liposomal doxorubic...

Learning objectives 1. Describe the rate of discordance of predictive marker phenotype (i.e. ER/PR, HER2) between the primary and the relapsed/metastatic breast cancer lesion. 2. Explain the impact of a change in predictive marker phenotype between the primary and relapsed/metastatic lesion on treatment options for these patients. Background. Metastatic breast cancers have historically been presumed to have the same predictive biomarkers as the initial primary tumor. We compared the expre...

Learning objectives 1. Describe rates of adherence to anthracycline-based chemotherapy in elderly patients with early breast cancer, using a population-based database. 2. Identify a subset of early breast cancer patients with a higher likelihood of non-adherence to the course of chemotherapy treatment. Background. Rates of anthracycline adherence in breast cancer (BC) patients are unknown, but noncompletion of chemotherapy is associated with worse outcomes. Methods. Using the Surveilla...

Learning objectives 1. Describe the significant heterogeneity among the published studies on the link between CYP2D6 genotype and tamoxifen treatment efficacy. 2. Explain the role of CYP2D6 metabolism in the conversion of tamoxifen to its active metabolite, endoxifen, and the potential importance of CYP2D6 polymorphisms to this process. 3. Discuss the role that insufficient genotyping, CYP2D6 inhibition, and tamoxifen combination treatment may have had in the inconsistent findings of past p...

Learning objectives 1. Discuss the optimal strategies to treat HER-2-positive metastatic breast cancer patients in the first-line setting and after recurrence with adjuvant trastuzumab. 2. Identify the current first-line therapeutic options for HER-2-positive metastatic breast cancer, including HER-2/hormone receptor co-positive tumors. 3. Discuss the most important advances for HER-2-positive metastatic breast cancer and the potential of novel anti- HER-2 therapies. Background. The prog...

Learning objectives 1. Explain the differences in risk and aggression of breast cancer for Hodgkin's lymphoma survivors. 2. Describe the difference in breast tumor sites for Hodgkin's lymphoma survivors. 3. Use adapted guidelines for surveillance and treatment of these high-risk patients. Purpose. To assess breast cancer (BC) risk after Hodgkin's lymphoma (HL) and compare characteristics, risk of second BC, and prognosis of patients with these BCs with patients with first primary BC. ...

Learning objectives 1. Compare the clinical value of copy-number-based FISH versus HER-2/CEP17 ratio-based FISH in identifying patients who may benefit from taxane-containing neoadjuvant chemotherapy. 2. Consider the implications of HER-2 copy-number and aneusomy-17 when making treatment decisions in patients with locally advanced breast cancer. Purpose. Aneusomy 17 causes inconsistency in fluorescence in situ hybridization (FISH)-based human epidermal growth factor receptor (HER)-2 statu...

Learning objectives 1. Describe the risk of treatment-related infertility in breast cancer patients. 2. Explain the conflicting data regarding the efficacy of GnRH agonists in this setting. Objective. Fertility preservation is an important survivorship issue for women treated for breast cancer. The aim of this work was to examine the referral practices of health care professionals who treat women with breast cancer in the United Kingdom, and to investigate their understanding and knowledg...

Learning objectives 1. Describe diagnostic and imaging options to identify inflammatory breast cancer. 2. Outline current treatment options for women with inflammatory breast cancer. Purpose. We review the current status of multidisciplinary care for patients with inflammatory breast cancer (IBC) and discuss what further research is needed to advance the care of patients with this disease. Design. We performed a comprehensive review of the English-language literature on IBC through com...

Learning objectives 1. Describe the role and potential benefits of patient navigation in breast cancer care. 2. Explain disparities in breast cancer care and their impact on patient populations. The elimination of cancer disparities is critically important for lessening the burden of breast cancer (BC). Patient navigator programs (PNPs) have been shown to improve rates of BC screening in underserved communities, but there is a dearth of evidence regarding their benefits after the actual d...

Learning objectives 1. Describe the prognostic role of TOP2A gene dosage determined by quantitative PCR in HER2-negative breast cancer. 2. Describe the relationship between HER2 status and TOP2A status in breast cancer tumors Background. Previous studies showed the prognostic and predictive impact of human epidermal growth factor receptor 2 (HER-2) gene alterations analyzed separately and jointly with topoisomerase II α (TOP2A) gene alterations; however, the role of TOP2A gene abnormalit...

Learning objectives 1. Describe the ways in which regional ultrasound has contributed to more accurate staging in a population of locally advanced breast cancer patients. 2. Explain how regional nodal information leads to changes in radiation therapy portals and total doses. Assessment of the regional lymphatics is important for accurate staging and treatment of breast cancer patients. We sought to determine the role of regional ultrasound in providing clinically relevant information. We ...

Learning objectives 1. Discuss the difficulties in fertility preservation for women with BRCA postitive/negative breast cancer. 2. Cite some of the effective methods for preserving fertility. 3. Describe the utilizaton of aromatase inhibitors as ovarian stimulants to reduce estrogen exposure in women with breast cancer attempting fertility preservation via embryo or oocyte cryopreservation. Women with breast cancer face many challenges when considering fertility preservation. Delayed ref...

Learning objectives 1. Explain the process by which tissue factor (TF) initiates blood coagulation and is implicated in tumor progression. 2. Describe the proposed mechanisms of targeting TF in malignancy. 3. Discuss the applications of TF targets in developing new treatments for aggressive cancers including triple negative breast cancer. Tissue factor (TF), a 47-kDa transmembrane glycoprotein that initiates blood coagulation when complexed with factor VIIa (FVIIa), is expressed in sever...

Learning objectives 1. Discuss methods for improving the efficiency of global clinical trials. 2, Explain the need for national regulatory authorities and collaborative cancer groups to initiate efforts to quicken the activation process in their countries. 3. Describe the activation process of phase III studies and its complex and heterogeneous regulation across different geographic and economic regions. Purpose. This study measured the time taken for setting up the different facets of A...

Learning objectives 1. Evaluate the effect of postmastectomy radiotherapy (PMRT) in terms of locoregional-recurrence free survival and disease free survival in triple negative breast cancer (TNBC) patients. 2. Identify the subgroup of TNBC patients most likely to benefit from PMRT. 3. Assess the role of PMRT in TNBC patients with intermediate-risk (T1/2N1) disease. Purpose. Several studies have demonstrated poor locoregional control in patients with triple-negative breast cancer (TNBC), ...

Learning objectives 1. Contrast the definitions of TN and Basal-like. 2. Describe the undistinguishable global gene expression patterns of non-Basal-like TN tumors versus non-TN tumors that are non-Basal-like. 3. Describe the relationship between TN heterogeneity and tumor heterogeneity plus microenvironmental heterogeneity. Triple-negative (TN) and basal-like (BL) breast cancer definitions have been used interchangeably to identify breast cancers that lack expression of the hormone rece...