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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; Glenn Eiger, M.D., F.C.C.P., F.A.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; Stephen J. Gluckman, M.D., F.A.C.P. - University of Pennsylvania School of Medicine; Professor of Medicine; Chief, Infectious Diseases Clinical Services, Hospital of the University of Pennsylvania; Clinical Director, Global Health, University of Pennsylvania School of Medicine, Philadelphia, PA; Laurence J. Kinsella, M.D., F.A.A.N.. - Saint Louis University Medical School; Professor of Neurology; St. Louis, MO; Herbert L. Muncie, Jr., M.D. - Louisiana State University Health Sciences Center School of Medicine; Professor of Family Medicine and Director, Medical Student Education, Department of Family Medicine; New Orleans, LA; Gary H. Oberlender, M.D., F.A.C.P. - Consultant in Geriatric Medicine; Merri Lou Pendergrass, M.D., Ph.D. - University of Texas Southwestern Medical School at Dallas; Clinical Assistant Professor of Medicine; Vice President, Diabetes National Practice Leader, Medco Health Solutions, Inc., Fort Worth, TX; Albert J. Peters, D.O., F.A.C.O.G. - Sher Institute for Reproductive Medicine (SIRM); Medical Director; New Jersey and Gregory Tino, M.D., F.C.C.P., F.A.C.P. - University of Pennsylvania School of Medicine; Associate Professor of Medicine; Chief, Pulmonary Clinical Service, Hospital of the University of Pennsylvania, Philadelphia, PA.

PURPOSE: The purpose of the American Medical Seminars, Inc. CME Program is to develop and deliver clinically relevant, evidence-based CME activities in an effort to align physician behavior with current clinical guidelines and the evidence to improve their competence and the care they provide their patients.

OVERALL OBJECTIVES: Upon completion of this CME activity, through the use of clinical vignettes emphasizing Guidelines and Evidence-Based Medicine, the physician or healthcare provider should be able to formulate a differential, make a diagnosis and develop a plan for the prevention and/or therapeutic management of the various disorders presented.

SPECIFIC OBJECTIVES FOR EACH TOPIC
TOPIC 1	Common Endocrine Disorders - Upon completion of this session, the participant should be able to: 1. Recognize, evaluate and treat common endocrine abnormalities including: a. Hypoglycemia, b. Hypercalcemia, c. Low testosterone, d. Adrenal masses.
TOPIC 2	Asthma Update - We will review the current status of asthma diagnosis and treatment, emphasizing evidence-based NHLBI 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 3	Approach to the Patient with Chronic Cough - Cough is a very common outpatient problem, which can be difficult to manage. An evidence-based approach to diagnosis and treatment from the ACCP will be reviewed. Upon completion of this session, the participant should be able to: 1. Characterize the pathophysiology and clinical aspects of the most common etiologies of cough. 2. Outline pertinent features of a focused history and physical. 3. Develop an evidence-based and cost effective approach to diagnosis and treatment.
TOPIC 4	Stroke - An Evidence-Based Review of Risk Factors and Prevention - Upon completion of this session, the participant should be able to: 1. Recall risk factors and modification. 2. Apply principles of localization to classify stroke subtypes. 3. Recognize when to refer patients for carotid endarterectomy. 4. Determine use of aspirin, clopidogrel, dipyridamole, warfarin, heparin and carotid endarterectomy.
TOPIC 5	Clinical Aspects of Rheumatoid Arthritis - Upon completion of this session, the participant should be able to: 1. Outline the clinical features of rheumatoid arthritis. 2. Appreciate the systemic nature of the disease.
TOPIC 6	Treatment of Rheumatoid Arthritis - Upon completion of this session, the participant should be able to: 1. Outline a rational approach to the treatment of rheumatoid arthritis. 2. Summarize the use and toxicity of disease modifying agents.
TOPIC 7	Advanced Nutritional Assessment and Therapy - Upon completion of this session, the participant should be able to: 1. Utilize readily available clinical data to make accurate and comprehensive nutritional assessments. 2. Identify common vitamin and mineral deficiencies in seniors. 3. Identify a range of therapeutic nutritional approaches for acutely ill, chronically ill, and frail patients. 4. Apply nutritional therapies towards improved wellness.
TOPIC 8	Prevention of Type 2 Diabetes - Upon completion of this session, the participant should be able to: 1. Identify patients with pre-diabetes. 2. Describe recommendations of professional organizations regarding diabetes prevention. 3. Treat CVD risk factors in patients with pre-diabetes.
TOPIC 9	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. Describe the proper monitoring and adjustment of warfarin therapy for DVT/PE.
TOPIC 10	Vitamin B-12 Deficiency in the Elderly - Upon completion of this session, the participant should be able to: 1. Describe normal B-12 physiology and the pathophysiology of B-12 deficiency and its causes. 2. Describe the use of metabolic markers in B-12 deficiency. 3. Define work-up of B-12 deficiency in clinical practice.
TOPIC 11
& 12	COPD: Overview of Patient Management, Parts I and II - COPD is a common and important clinical entity. We will review the current status of its diagnosis and treatment. Evidence-based practice parameters will be reviewed. Upon completion of this session, the participant should be able to: 1. Derive an understanding of the definition and pathophysiology of COPD. 2. Characterize the natural history and clinical features of COPD. 3. Outline the adverse health effects of cigarette smoking and present recommendations for helping patients “kick the habit”. 4. Identify the many aspects of outpatient management including long term oxygen therapy, pulmonary rehabilitation and pharmacologic treatment. We will present a treatment algorithm and discuss indications for specialist referral. 5. Review surgical treatment options for emphysema.
TOPIC 13	Amenorrhea - Upon completion of this session, the participant should be able to: 1. Assess the various causes of primary and secondary amenorrhea and their associated health risks, as well as apply the appropriate evaluation for both. 2. Provide therapy to the patient with regard to hormone replacement therapy or infertility. 3. Categorize the various anatomic and functional levels of distinction with respect to amenorrhea.
TOPIC 14	Use and Interpretation of Thyroid Tests - Upon completion of this session, using the American Thyroid Association guidelines as well as the Cochrane Abstract Database, the participant should be able to: 1. Compare the utility of the various serum tests for thyroid function. 2. Distinguish the combination of results that occur in clinical settings. 3. Describe the appropriate follow-up of abnormal thyroid tests. 4. Describe the impact of other medications on thyroid function testing.
TOPIC 15	Health Advice for International Travel - Upon completion of this session, the participant should be able to: 1. Analyze a travel itinerary for potential health risks. 2. Prescribe appropriate vaccines and medications. Specific areas to be covered include: a. Pre-travel i. Immunizations, ii. Malaria prophylaxis, iii. Medications; b. Travel safety on planes and boats; c. During travel i. Safe food and water, ii. Traveler’s diarrhea, iii. HIV and travel, iv. Pregnancy and breast feeding.
TOPIC 16	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 effective approaches to common physical symptoms in the terminally ill. 3. Describe effective clinical care of patients and their families in the last days of life. 4. Describe dementia as a terminal illness.

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