Activity Evaluation Summary

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Chloe Hopkins
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300 W Station Square Dr Pittsburgh, PA Course Directors: Deborah Paschal, CRNP and Gregg Sherman, MD Date of Summary:

1 Clinical Updates for Nurse Practitioners and Physician Assistants: 2014 Activity Summary CME Activity: Clinical Updates for Nurse Practitioners and Physician Assistants: 2014 Saturday, December 6, 2014 Sheraton Pittsburgh at Station Square 300 W Station Square Dr Pittsburgh, PA Course Directors: Deborah Paschal, CRNP and Gregg Sherman, MD Date of Summary: January 6, NW 70 th Avenue, Suite 102 Plantation, FL (954) Phone (954) Fax info@naceonline.com

In December 2014, the National Association for Continuing Education (NACE) sponsored a live CME activity, Clinical Updates for Nurse Practitioners and Physician Assistants: 2014, in Pittsburgh, PA.

Diabetes, Alpha-1 Antitrypsin Deficiency, Psoriasis, and Inflammatory Bowel Disease. In planning this CME activity, the NACE performed a needs assessment.

competence or performance. Eighty five healthcare practitioners registered to attend Clinical Updates for Nurse Practitioners and Physician Assistants: 2014 in Pittsburgh, PA.

2 In December 2014, the National Association for Continuing Education (NACE) sponsored a live CME activity, Clinical Updates for Nurse Practitioners and Physician Assistants: 2014, in Pittsburgh, PA. This educational activity was designed to provide nurse practitioners and physician assistants the opportunity to learn about diagnosis and management of patients with varied conditions such as Diabetes, Alpha-1 Antitrypsin Deficiency, Psoriasis, and Inflammatory Bowel Disease. In planning this CME activity, the NACE performed a needs assessment. A literature search was conducted, national guidelines were reviewed, survey data was analyzed, and experts in each therapeutic area were consulted to determine gaps in practitioner knowledge, competence or performance. Eighty five healthcare practitioners registered to attend Clinical Updates for Nurse Practitioners and Physician Assistants: 2014 in Pittsburgh, PA. Fifty five healthcare practitioners actually participated in the conference. Each attendee was asked to complete and return an activity evaluation form prior to the end of the conference. Fifty four completed forms were received. The data collected is displayed in this report. CME ACCREDITATION The National Association for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The National Association for Continuing Education designates this live activity for a maximum of 6.0 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity. National Association for Continuing Education is approved as a provider of nurse practitioner continuing education by the American Association of Nurse Practitioners. AANP Provider Number This program has been approved for 6.0 contact hours of continuing education (which includes 3.5 pharmacology hours).

3 What is your professional degree? What is your specialty? Frequency Percent Mean: - Frequency Percent Mean: 4.32 MD Primary Care DO Endocrinology NP Rheumatology PA Pulmonology RN Cardiology Other Gastroenterolog y Other No No Indicate the number of patients you see each week in a clinical setting regarding each therapeutic area listed: Diabetes: Indicate the number of patients you see each week in a clinical setting regarding each therapeutic area listed: Alpha-1: Frequency Percent Mean: 3.90 Frequency Percent Mean: 1.54 None None > > No No Indicate the number of patients you see each week in a clinical setting regarding each therapeutic area listed: IBD: Integrated Item Analysis Report Indicate the number of patients you see each week in a clinical setting regarding each therapeutic area listed: Psoriasis: Frequency Percent Mean: 2.73 Frequency Percent Mean: 2.29 None None > > No No

4 Upon completion of this activity, I can now: Identify the barriers between physicians and patients to discussing and initiating injectable treatments for diabetes; Recognize the importance of glucotoxicity in the development of beta cell failure and diabetic complications; Describe how best to initiate, utilize and intensify insulin therapy in patients with diabetes, and to recognize the role of combining GLP-1 analogues and SGLT-2 inhibitors with insulin to individualize care, achieve targets and minimize hypoglycemia Upon completion of this activity, I can now: Identify who and when to test for AAT deficiency; Describe the 50-year history of alpha1-antitrypsin (AAT) deficiency; Discuss how to incorporate testing for AAT deficiency into everyday practice; Describe the new insights into the efficacy of treatment for AAT deficiency Frequency Percent Mean: 1.13 Frequency Percent Mean: 1.12 Yes Yes Somewhat Somewhat Not at all Not at all No No Upon completion of this activity, I can now: Identify the conditions referred to as inflammatory bowel disease (IBD), and recognize their clinical presentations and degree of severity, implement appropriate pharmacologic and nonpharmacologic therapeutic strategies for managing IBD in accordance with evidence-based guidelines; Identify patients who are at high risk of complications from IBD and who may benefit from new mechanisms of action in IBD therapy; Employ approaches for effectively communicating the risks and benefits of IBD treatment options and facilitating adherence Upon completion of this activity, I can now: Discuss the most up-to-date treatment protocols based on the current understanding of psoriasis and its related disorders as T-cell mediated immune diseases; Define psoriatic disease and outline the clinical presentation and pathophysiology of psoriasis; Identify and discuss the ever-expanding numbers of co-morbid conditions associated with psoriatic disease; Interpret and apply evidence-based approaches for the treatment of patients with psoriatic conditions Frequency Percent Mean: 1.11 Frequency Percent Mean: 1.08 Yes Yes Somewhat Somewhat Not at all Not at all No No Overall, this was an excellent CME activity: Overall, this activity was effective in improving my knowledge in the content areas presented: Frequency Percent Mean: 1.30 Frequency Percent Mean: 1.31 Strongly Agree Strongly Agree Agree Agree Neutral Neutral Disagree Disagree Strongly Strongly Disagree Disagree No No

5 As a result of this activity, I have learned new and useful strategies for patient care: How likely are you to implement these new strategies in your practice? Frequency Percent Mean: 1.35 Frequency Percent Mean: 1.82 Strongly Agree Very likely Agree Somewhat likely Neutral Unlikely Disagree Not applicable Strongly Disagree No No As a result of this activity, I have learned new strategies for patient care. List these strategies: Screening for T-cell disease. Increased suspicion for psoriatic complications. More targeted exam for pt with psoriasis AAT testing/ treatment. Better evaluation of glucose logo. Oral V5 sub Q diabetic meds How to introduce injectable treatment for DM. Ways to idenify AAT deficiency. Identification of co-morbidies of psoiasis. Better idenify patients with IBD The best strategies best suited to the patient utilizing Basal insulin and GLP 1 without causing hypoglycemia in controlling glucose. Diagnosis AAT deficiency. Tx IBD and Psoriasis Use of GLP-1. Test for AAT. Further understanding Psoriasis and various type Reinforced that I need to be testing more of my patients for AAT. I also furthered my understanding of psoriasis and some initial (first time) treatments. And also the importance of when to refer Although I work primarily in surgery, learning more about the meds used for psoriasis and IBD is important. I now better understand why I need to continue these meds when my patients are staying in the hospital post op In gastro I have learned the difference between uceris and entocort as far as treating with Budesonide. Additionally, I will refer pts with increased LFTS to PCP to look for AAD if no other liver answers are found AAT testing Better management of diabetes. More effective management of COPD. Importance of early diagnosis and intervention I am better educated on when to suspect for AAT deficiency, newer options for DM management. I will be able to identify psoriasis easier in comparison to other skin conditions. I am more familiar with the treatment of IBD I could use information learned to facilitate patient education and management of diabetes. Since many of the meds prescribed lead to higher risk of diabetes Initiating short acting insulin at dinner for bedtime hyperglycemia. Initiating dual therapy for new onset of Diabetes Type II Feel more comfortable discussing DM management with pts and be familiar with the options available for therapy. Will assess pts with psoriasis for metabolic syndrome Test all COPD pts for alpha-1. Local diseases treated topical corticosteroids and/or Vit D analogs. Eval IBD with lab maker, adv, imaging or colon to determine anti-inflam Consider GLP-1 and SGLT-2 use with insulin. Consider AAT screening in patients with COPD. Diagnose psoriasis AAT testing in patients with COPD that is refractive to treatment. Adding GLP-1 and SGLP-2I's to management of patients with poor glycemic control. How to implement biologic therapies for psoriatic arthritis. Use of MR-Enterography for Imaging Alternative to CT for inflammatory bowel disease Test all COPD pts for AAT. Initiate combination therapy early in Crohn's pt that are high risk I will now incorporate SGL-1 with patient treatment. I will look at Blood Sugar reading Linear and not up and down. I want to do a study implementing alpha-1 antitrypsin screening in my office Working in Emergency room care, Alpha-1 is now on my differential for elevated LFT's or chronic respiratory patients I've learned how to present information to a patient that will break barriers to effective management Better increased communication with patients. Appropriate steps in diagnosis and disease. When to consider another therapy and why Start injectable GLP-1. Test for AATD- but I don't think insurance will cover Augmentation therapy. Diagnose PSA and various therapies to use. Use current therapies for IBD

6 As a result of this activity, I have learned new strategies for patient care. List these strategies: Better diabetes med insulin adjustments and titranins. Screening Alpha-1- all COPD/ emphysema patients. Identification of systemic effects of Psoriasis Treatment and management of diabetes. Screening for Alpha-1 antitrypsin deficiency. Identification of Psoriasis and other disorder that pts with psoriasis are at increased risk for Treating patients and options that we can use Topical Therapy. Ultraviolet light/ Lasers. Systemic Therapy. Biologics Alternative Psoriasis Therapy and for HIV pts. New diabetic medications. Initiation of insulin therapy Need to test for Alpha-1 more- in clinic. Will obtain "free" alpha-1 testing. Review recent patients seen that would have been tested Diagnosis Psoriasis. Treatment Psoriasis. Assessment and classification Screen for AAT. Aggressively screen and Rx psoriasis. Initiate injectables for DM earlier and more confidence Better utilization of GLP-1 analogues. Overall better control of DM. Encourage injectables for longer life span Treatment of diabetes, Alpha-1 Antitrypsin, Psoriasis When to consider injectables for diabetes. Further testing for COPD Basal insulin and PP insulin necessary. Keep AATD in differential with lung/liver symptoms. More common than thought Remember to use approved testing for patients (Alpha-1). Treatment options for Psoriasis/ Eczema Check for Alpha-1 deficiency in all COPD patient. Start combined therapy earlier for IBO. Start insulin earlier for DMII patients No longer use sliding scales- use analogs with insulin. Unfortunately augmentation therapy so experimental- I doubt insurance will cover. Will be able to identify for testing AAT- thank you. Initiating GLP is sooner and instead of DPPY's if necessary. Testing COPD pts for Alpha-1 Antitrypsin. Tx and screen for comorbites with Psoriasis When do you intend to implement these new strategies into your practice? In terms of delivery of the presentation, please rate the effectiveness of the speaker: Mark Stolar, MD (Diabetes): Frequency Percent Mean: 1.84 Frequency Percent Mean: 4.80 Within 1 month Excellent months Very Good months Good Not applicable Fair Unsatisfactory No No In terms of delivery of the presentation, please rate the effectiveness of the speaker: Susan Collazo, CRNP (Alpha-1): In terms of delivery of the presentation, please rate the effectiveness of the speaker: Kimberly Carter, MS, PA-C (IBD): Frequency Percent Mean: 4.69 Frequency Percent Mean: 4.74 Excellent Excellent Very Good Very Good Good Good Fair Fair Unsatisfactory Unsatisfactory No No

7 In terms of delivery of the presentation, please rate the effectiveness of the speaker: Paul S. Yamauchi, MD, PhD (Psoriasis): To what degree do you believe that the subject matter was presented fair, balanced, and free of commercial bias? Mark Stolar, MD (Diabetes): Frequency Percent Mean: 4.84 Frequency Percent Mean: 4.85 Excellent Excellent Very Good Very Good Good Good Fair Fair Unsatisfactory Unsatisfactory No No To what degree do you believe that the subject matter was presented fair, balanced, and free of commercial bias? Susan Collazo, CRNP (Alpha-1): To what degree do you believe that the subject matter was presented fair, balanced, and free of commercial bias? Kimberly Carter, MS, PA-C (IBD): Frequency Percent Mean: 4.83 Frequency Percent Mean: 4.85 Excellent Excellent Very Good Very Good Good Good Fair Fair Unsatisfactory Unsatisfactory No No To what degree do you believe that the subject matter was presented fair, balanced, and free of commercial bias? Paul S. Yamauchi, MD, PhD (Psoriasis): Which statement(s) best reflects your reasons for participating in this activity: Frequency Percent Mean: 4.85 Frequency Percent Mean: - Excellent Topics covered Very Good Location/ease of access Good Faculty Fair Earn CME credits Unsatisfactory No No Future CME activities concerning this subject matter are necessary: Frequency Percent Strongly agree Agree Neutral Disagree Strongly Disagree No Mean: 1.71 What topics would you like to see offered as CME activities in the future? Enteric nervous system. Nail disease differentials. Alternative medicine: evidence based Pain control. Thyroid Disease. EKG Interpretation Cancer- especially colon cancer. Genetics. Drug delivery system CPY emerging diseases. Infectious Diseases. Anemia

8 What topics would you like to see offered as CME activities in the future? HTN management update. Scalp dermatitis conditions. Lyme disease/ tick-born diseases. Fibromyalgia update. Anemias review Psychiatric topics and related medication management SIRS. CKD. Lymphoma. Hyperparathyroidism Food allergy vs. Food intolerance. Pediatric topics Blood thinners in regards to surgical management. Diabetics and steroids with post op Brain-gut/ IBS. Gastroparesis. Dysphagia. Fatty Liver/ Cirrhosis Pulmonary Hypertension. PAD. PCOS OBGYN topics- GYN cancer, hypertension in pregnancy Mental health topics CHF treatment and control to include DM pt HCV therapy. IBS therapy. Cardiac/ Vascular Diseases/ disorders CVD. PAVD. Perioperative cardiac clearance in non cardiac patients Other Arthritis/ DJD related topics. Other Dermatology topics PVD. DVT prophalaxis and surgery. Management of antiplatelet medications perioperatively Basic primary care musculoskeletal complaints and management ie. Knee, back, ankle pain Autism update More diabetes, pathophys and treatment. Chronic pain disorders/ Arthralgras and management Substance abuse. Womens Health. Mens Health Auto-immune disease- screening and when to refer. Chronic balle pain management. Psych in family practice ie. Anxiety, depression, dysthymia Metabolic syndrome COPD. Endocrine disorders. Orthopedic disorders Osteoarthritis Sleep. Physical Medicine. ADD. Depression/ Anxiety Interpretation of CVR. EKG Interpretation Pulmonary Function testing- interpretation. CVR interp. Chest CT interp Pancreatic Cancer Lipids. Geriatric. BP. Osteoperosis Cardiovascular topics. Skin topics. of chest x-rays Asthma. Diabetes EKG review Migraine. SL Antigin Therapy Hypertension control. Heart failure. Depression Addiction and treatments including detox and rehab tx SLE, anything Ortho. Headaches Additional comments: 1st presentation "I loved" however too long to sit with back pain. A break would have been nice Nice set-up, beverages, snacks. I like the blank "key notes" page; very useful Use Provider vs Physician or Doctor. Fabulous conference- excellent, thank you Great conference Good program Great conference! Keep doing them in Pittsburgh Well presented

9 Additional comments: Great CME value- currently not practicing Excellent Thank you for a great day. Shorten the lunch break I want to clarify my response to the above question. There was some very useful information- practical info- however I work in Orthopedic surgery. The likleyhood of me implementing any of this is extremely low because it is not my main concern. However it has given me a better understanding and made me more aware of DM and COPD for my in hospital patients. Psoriasis talk was a little long. I do think the pre/post test questions help to solidify take home points Can a CME event be scheduled outside of the city? Would like to see a CME conference near Cranberry or Robinson Excellent course Thanks

Activity Evaluation Summary. Physician Assistants: 2014 Saturday, October 11, 2014 Seattle Airport Marriott Seattle, WA

Activity Evaluation Summary. Physician Assistants: 2014 Saturday, October 11, 2014 Seattle Airport Marriott Seattle, WA Clinical Updates for Nurse Practitioners and Physician Assistants: 2014 Activity Evaluation Summary CME Activity: Course Directors: and Physician Assistants: 2014 Saturday, October 11, 2014 Seattle Airport