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by Valerianna Amorosa, M.D. - University of Pennsylvania School of Medicine; Assistant Professor of Clinical Medicine; Chief of Infectious Diseases and Clinic Director, HIV and Infectious Diseases Clinic, Philadelphia VA Medical Center, Philadelphia, PA; by William T. Ayoub, M.D., F.A.C.P., F.A.C.R. - Geisinger Medical Group, Geisinger Health System; Associate, Department of Rheumatology, State College, PA; by Christopher V. Chambers, M.D. - Jefferson Medical College, Thomas Jefferson University; Professor and Director, Clinical Trials, Department of Family and Community Medicine; Philadelphia, PA; by Glenn Eiger, M.D., F.C.C.P. - Jefferson Medical College, Thomas Jefferson University; Associate Professor of Medicine; Director, Internal Medicine Residency Program and Associate Chairman, Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA; by Timothy J. Fries, M.D. - University of Vermont College of Medicine; Associate Professor of Neurology, Vice Chair of Neurology, Director of Education and Neurology Clerkship Director; Director of the Electromyography Laboratory and the Botulinum Toxin Clinic, Section of Neurology, Fletcher Allen Health Care, Burlington, VT; by Donald Kaye, M.D., M.A.C.P. - Drexel University, College of Medicine; Professor of Medicine, Philadelphia, PA; by Herbert L. Muncie, Jr., M.D. - Louisiana State University Health Sciences Center School of Medicine; Professor of Family Medicine and Director, Predoctoral Education, Department of Family Medicine, New Orleans, LA; by Gary H. Oberlender, M.D., F.A.C.P. - Consultant in Geriatric Medicine; by Merri Lou Pendergrass, M.D., Ph.D. - Harvard Medical School; Associate Professor of Medicine; Associate Clinical Chief and Director of Clinical Diabetes, Division of Endocrinology, Metabolism and Hypertension, and Interim Chief, Diabetes Section, Brigham and Women's Hospital, Boston, MA; by Neil S. Skolnik, M.D. - Temple University School of Medicine; Professor of Family and Community Medicine; Associate Director, Family Practice Residency Program, Abington Memorial Hospital, Abington, PA; and by Gregory Tino, M.D., F.C.C.P. - University of Pennsylvania School of Medicine; Associate Professor of Medicine; Chief, Pulmonary Clinical Service, Hospital of the University of Pennsylvania, Philadelphia, PA.

OVERALL OBJECTIVES: The overall objective is to provide the participant with practical and clinically relevant information. Upon completion of this CME activity, the physician or healthcare provider should be able to describe the current approach to formulating differential diagnoses, diagnostic, therapeutic, and preventive management of the various disciplines presented.

EDUCATIONAL GAP AND NEEDS ANALYSIS STATEMENT: There is a need to maintain a breadth of knowledge to effectively care for the variety of patient presentations in the PCP’s office. Therefore, there is a need for an annual review and update of many practical issues in Primary Care Medicine which are provided by this CME activity. There are new Asthma Guidelines and in addition, our Needs analysis identifies the commonly seen disorders of CHF, VTE, COPD, Seizures, Hypercholesterolemia, TB, Depression and various Endocrine and Rheumatologic conditions as being fundamental to the daily knowledge and skills necessary for Primary Care Practitioners today. There is also a “gap” in the care of the elderly patient regarding Sensible Prescribing and End of Life Issues that also needs to be communicated and filled. Educational gap analysis has identified two areas that must be addressed: increased knowledge and increased confidence on the part of Primary Care Physicians. To address these needs and close these gaps, this annual update, presenting current thinking and new information, will help Primary Care physicians obtain adequate knowledge and provide them with the confidence to educate, diagnose and treat their patients with these disorders.

SPECIFIC OBJECTIVES
TOPIC 1	Primary Care-Based Management of CHF - Upon completion of this session, the participant should be able to: 1. Describe the correctable causes of CHF. 2. Discuss the “new paradigm” in CHF management addressing disease mechanisms. 3. Describe the role of new and old classes of drugs in CHF management. 4. Develop a treatment plan for a patient with CHF.
TOPIC 2	Common Endocrine Disorders - Upon completion of this session, the participant should be able to: 1. Recognize, evaluate and treat common adrenal, pituitary and gonadal abnormalities. 2. Evaluate disorders of calcium metabolism. 3. Counsel patients who are concerned they may have a "hormone problem.”
TOPIC 3	Venous Thromboembolism (VTE): Diagnosis and Treatment - Upon completion of this session, the participant should be able to: 1. Describe the sensitivity and specificity of the diagnostic tests available for the identification of DVT. 2. Explain the algorithm for diagnosing a PE in various clinical settings. 3. Compare the role of inpatient and outpatient treatment of DVT. 4. Describe the proper monitoring and adjustment of warfarin therapy for DVT/PE.
TOPIC 4	Asthma Update - We will review the current status of outpatient asthma diagnosis and treatment, emphasizing recent NIH guidelines. Upon completion of this session, the participant should be able to: 1. Characterize the pathophysiology of this inflammatory disease. 2. Identify the typical and atypical clinical presentations with cases serving as examples. 3. Characterize the available diagnostic modalities. 4. Develop a stepwise approach to treatment including bronchodilators, corticosteroids and methylxanthines. There will be a mention of new agents and alternative therapies. 5. Select techniques to ensure patient compliance. We will review proper inhaler technique and peak flow monitoring. 6. Identify the patient who is not responding and define indications for subspecialty referral.
TOPIC 5	Chronic Obstructive Pulmonary Disease (COPD): Evaluation and Treatment - Upon completion of this session, the participant should be able to: 1. List the diagnostic criteria for COPD. 2. Describe the natural history of COPD and the influence of smoking cessation. 3. Compare and contrast the pharmacologic treatment options to reduce morbidity associated with COPD. 4. Describe the usual follow-up assessments of patients diagnosed with COPD.
TOPIC 6	Infections in the Immunocompromised Patient - Upon completion of this session, the participant should be able to: 1. Identify the immunocompromised patient who is at most risk for serious infections due to diabetes, malignancy, and chemotherapy or medications such as the immunomodulators. 2. Recognize the spectrum of infectious diseases and factors putting patients at risk in these populations. 3. Describe the often times atypical presentations of infection in these groups. 4. Apply an approach to the treatment and follow up of these infections for each type of at risk patient.
TOPIC 7	Sensible Prescribing Practices for the Elderly - Upon completion of this session, the participant should be able to: 1. Recognize the limits of studies on drug safety and efficacy as they apply to the elderly. 2. Appreciate the subtle but significant drug side effects in the elderly. 3. Describe undesirable prescribing practices and better approaches.
TOPIC 8	Diagnosis and Treatment of Epilepsy - Upon completion of this session, the participant should be able to: 1. Differentiate seizures from syncope, pseudoseizures and other masqueraders. 2. Discuss a rational approach to initiating treatment with anticonvulsants. 3. Discuss the use of anticonvulsants in pregnancy and in the elderly. 4. Discover when to stop anticonvulsants.
TOPIC 9	Pain Management - Upon completion of this session, the participant should be able to: 1. Describe the prevalence and importance of pain in the population. 2. Describe the different classes of pain medications and when to use each class of pain medication. 3. Recognize and protect against the abuse of narcotic pain medications. 4. Effectively utilize adjuvant pain medications.
TOPIC 10	Advice for the Traveler - Upon completion of this session, the participant should be able to: 1. Summarize the general preventive measures including what not to eat and drink. 2. List the needed immunizations. 3. Describe the prevention of malaria, diarrhea and other illnesses of travelers. 4. Relate the management of diarrhea of travelers.
TOPIC 11	Contemporary Issues in End of Life Care - Upon completion of this session, the participant should be able to: 1. Describe a practical approach to assessment of the whole patient in a hospice setting. 2. Describe practical and effective approaches to common physical symptoms in the terminally ill. 3. Describe effective clinical care of patients in the last days of life. 4. Describe dementia as a terminal illness.
TOPIC 12	Tuberculosis - Upon completion of this session, the participant should be able to: 1. Characterize the epidemiology of tuberculosis. 2. Discriminate the clinical presentations including pulmonary, pleural and extrapulmonary tuberculosis. 3. Identify ATS/CDC criteria for positive tuberculin skin test. 4. Review treatment of LTBI. 5. Distinguish the role of skin testing, sputum examination and bronchoscopy in diagnosis. 6. Outline the most recent ATS/CDC/IDSA Guidelines for TB therapy. We will discuss specific agents and their toxicities as well as formal treatment regimens. 7. Characterize the problem of multi-drug resistant tuberculosis and implications for therapy.
TOPIC 13	Systemic Lupus Erythematosus and Other Connective Tissue Diseases - Upon completion of this session, the participant should be able to: 1. Appreciate the varied clinical presentations of SLE, Scleroderma and Myositis. 2. Describe the use of laboratory testing in diagnosis. 3. Identify treatment options in systemic lupus erythematosus.
TOPIC 14	Top Studies of the Year - Upon completion of this session, the participant should be able to: 1. Identify new studies and articles that have come out with large importance to primary care medicine. 2. Discuss the practice implications of these important new studies. 3. Discuss the strengths and weaknesses of the research on which we will be basing our practices.
TOPIC 15	Geriatric Depression: Advances in Diagnosis and Treatment - Upon completion of this session, the participant should be able to: 1. Describe the variety of clinical presentations of depressive syndromes in the elderly. 2. Discuss the utility and application of the Geriatric Depression Scale. 3. Identify the relative advantages and disadvantages of the various medications available for treatment of depression. 4. Recognize the role of nutritional supplementation and non-pharmacologic treatments in conjunction with medical treatments.
TOPIC 16	Hypercholesterolemia - Upon completion of this session, the participant should be able to: 1. Discuss the current guidelines for stratification of risk in patients with hypercholesterolemia. 2. Recognize the limitations of non-pharmacologic therapy in most patients with hypercholesterolemia. 3. Develop a treatment strategy using currently available medications for hypercholesterolemia. 4. Develop a strategy for monitoring and follow-up of patients treated for hypercholesterolemia.

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