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 Marriott Seattle, WA Deborah Paschal, CRNP and Gregg Sherman, MD Date of Evaluation Summary: October 21, 2014 300 NW 70 th Avenue, Suite 102 Plantation, FL 33317 (954) 723-0057 Phone (954) 723-0353 Fax email: info@naceonline.com
In October 2014, the National Association for Continuing Education (NACE) sponsored a live CME activity, : 2014, in Seattle, WA. 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. Sixty seven healthcare practitioners registered to attend Clinical Updates for Nurse Practitioners : 2014 in Seattle, WA. Forty two 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. Forty two 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 121222. This program has been approved for 6.0 contact hours of continuing education (which includes 3.5 pharmacology hours).
What is your professional degree? What is your specialty? Frequency Percent Mean: - Frequency Percent Mean: 2.77 MD 0 0.00 Primary Care 26 63.41 DO 0 0.00 Endocrinology 0 0.00 NP 25 60.98 Rheumatology 0 0.00 PA 17 41.46 Pulmonology 1 2.44 RN 2 4.88 Cardiology 2 4.88 Other 2 4.88 Gastroenterolog 2 4.88 y Other 8 19.51 No 0 0.00 No 2 4.88 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: 4.13 Frequency Percent Mean: 1.45 None 2 4.88 None 24 58.54 1-5 5 12.20 1-5 11 26.83 6-10 9 21.95 6-10 3 7.32 11-15 9 21.95 11-15 0 0.00 16-20 6 14.63 16-20 0 0.00 21-25 3 7.32 21-25 0 0.00 > 25 6 14.63 > 25 0 0.00 No 1 2.44 No 3 7.32 Indicate the number of patients you see each week in a clinical setting regarding each therapeutic area listed: Psoriasis: Integrated Item Analysis Report Indicate the number of patients you see each week in a clinical setting regarding each therapeutic area listed: IBD: Frequency Percent Mean: 2.23 Frequency Percent Mean: 2.69 None 5 12.20 None 3 7.32 1-5 27 65.85 1-5 21 51.22 6-10 4 9.76 6-10 8 19.51 11-15 1 2.44 11-15 3 7.32 16-20 0 0.00 16-20 2 4.88 21-25 2 4.88 21-25 0 0.00 > 25 0 0.00 > 25 2 4.88 No 2 4.88 No 2 4.88
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: 1.20 Frequency Percent Mean: 1.03 Yes 33 80.49 Yes 39 95.12 Somewhat 8 19.51 Somewhat 1 2.44 Not at all 0 0.00 Not at all 0 0.00 No 0 0.00 No 1 2.44 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 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 Frequency Percent Mean: 1.08 Frequency Percent Mean: 1.18 Yes 35 85.37 Yes 28 68.29 Somewhat 3 7.32 Somewhat 6 14.63 Not at all 0 0.00 Not at all 0 0.00 No 3 7.32 No 7 17.07 Overall, this was an excellent CME activity: Overall, this activity was effective in improving my knowledge in the content areas presented: Frequency Percent Mean: 1.37 Frequency Percent Mean: 1.32 Strongly Agree 26 63.41 Strongly Agree 28 68.29 Agree 15 36.59 Agree 13 31.71 Neutral 0 0.00 Neutral 0 0.00 Disagree 0 0.00 Disagree 0 0.00 Strongly Disagree 0 0.00 Strongly Disagree 0 0.00
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: 1.39 Frequency Percent Mean: 1.44 Strongly Agree 26 63.41 Very likely 24 58.54 Agree 14 34.15 Somewhat likely 14 34.15 Neutral 1 2.44 Unlikely 0 0.00 Disagree 0 0.00 Not applicable 1 2.44 Strongly 0 0.00 Disagree No 0 0.00 No 2 4.88 As a result of this activity, I have learned new strategies for patient care. List these strategies: Be aware of cardiac meds in psoriatic patients Test for Alpha-1 in chronic (CAL) Airway Limitation diseases. Refer all CAL clients for testing at any age for AAT deficiency. Be more aggressive with treating psoriasis - not just a skin disorder. Treat IBD early and aggressively Will be changing practice in Alpha-1 antitrypsin screening. Feel more confident in insulin titration and incretins How to identify barriers between providers and patients to introduce injectable treatments/medications in diabetes. Intensify treatment early. Add insulin early. How to ID and test for AAT deficiency. Integrate testing into work flow via EMR. Screen all COPDers Many of the suggestions for treatments were new interventions. This was a very informative conference Screening for AATD. Insulin dosing methods We do a lot of PFTs in Occupational Medicine. AAT deficiency lecture helpful Glucose lowering therapy. AAT screening Will consider incorporating in practice When to initiate GLP1 versus higher titration of basal insulin. Start talk of injectables early - don't make using insulin seem to be treatment failure, screen COPD patients for Alpha-1 antitrypsin deficiency. Worry about cardiovascular risk with patients with psoriasis. When to refer to Rheumatology. Identify Crohn's versus ulcerative colitis; identify inflammatory bowel disease in general; IBD treatment adherence Changes in prescribing injectable DM medications. Screening patients for AAT More AAT testing ID disease and change treatment. ID referral need DM injectables. Psoriasis treatment. AAT testing Check for AAT deficiency. More system checks in psoriasis Testing in COPD useful. Study more about IBD - I have to memorize the meds and names, etc. Psoriasis - need to work on names of meds Starting injectables for DM sooner. Updated my knowledge of psoriasis. Why important to treat aggressively. Refer for endoscopy when considering IBD Test for AAT. Improved patient education for psoriasis. Clarity on psoriasis treatment Start insulin early if not well controlled hyperglycemia. Take time to educate patient on injection of insulin Diabetes - add GLP-1 early/increase therapy faster. COPD - see about test kits for AAT deficiency. Psoriasis - evaluate patients for co-morbidities, treat systemic IBD, promote early aggressive treatment of CD Use of appropriate testing, lab, colonoscopy. Use of combination as first line for remission (with increased risk factor of) mucosal nealing. Use steroid sparing agent. Communication with patients, affirm patient OAR More aggressive dermatology/treatment of psoriasis. Change carb ratio Test AAT; update appropriate Rx; IBD patient care; no change in DM care Positive approach to injectables. Increase screening for Alpha-1 AT Morbidity issues regarding different treatments New ways to use and titrate insulin. Will test for Alpha-1 deficiency. Assessing cardiac risk factors in psoriasis patients How to differentiate different diseases to facilitate making a diagnosis
As a result of this activity, I have learned new strategies for patient care. List these strategies: Use newer Rx's more aggressively for T2DM control. Screen more for ATTD Better insulin management. Improved testing for Alpha-1 Screening for AATD. Implementing insulin therapy I will have a lower threshold to treat diabetics with insulin. I will begin to screen patients for Alpha-1 antitrypsin deficiency. I will be more aggressive with psoriasis patients treatment Testing all COPDers for AAT. Monitoring CV risk factors in patient with psoriasis. Considering GLP-1 usage How to approach patients regarding injection therapy for DM. How to distinguish different dermatology conditions similar to psoriasis. Screening for AATD Learned to screen for Alpha-1 deficiency to decrease COPD mortality. Learned treatment options for psoriasis Broader screening for psoriasis patients. Consider Alpha-1 antitrypsin testing Insulin sooner. More GLP-1. Diabetes education. Recall patients >70 A1C and change regimen 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: Gary Scheiner, MS, CDE (Diabetes): Frequency Percent Mean: 1.54 Frequency Percent Mean: 4.37 Within 1 month 25 60.98 Excellent 21 51.22 1-3 months 10 24.39 Very Good 14 34.15 4-6 months 1 2.44 Good 6 14.63 Not applicable 3 7.32 Fair 0 0.00 Unsatisfactory 0 0.00 No 2 4.88 No 0 0.00 In terms of delivery of the presentation, please rate the effectiveness of the speaker: Franck Rahaghi, MD (Alpha-1): In terms of delivery of the presentation, please rate the effectiveness of the speaker: Paul Yamauchi, MD, PhD (Psoriasis): Frequency Percent Mean: 4.88 Frequency Percent Mean: 4.78 Excellent 36 87.80 Excellent 29 70.73 Very Good 5 12.20 Very Good 8 19.51 Good 0 0.00 Good 0 0.00 Fair 0 0.00 Fair 0 0.00 Unsatisfactory 0 0.00 Unsatisfactory 0 0.00 No 0 0.00 No 4 9.76 In terms of delivery of the presentation, please rate the effectiveness of the speaker: Gerald W. Dryden, MD (IBD): To what degree do you believe that the subject matter was presented fair, balanced, and free of commercial bias? Gary Scheiner, MS, CDE (Diabetes): Frequency Percent Mean: 4.58 Frequency Percent Mean: 4.56 Excellent 21 51.22 Excellent 25 60.98 Very Good 10 24.39 Very Good 14 34.15 Good 2 4.88 Good 2 4.88 Fair 0 0.00 Fair 0 0.00 Unsatisfactory 0 0.00 Unsatisfactory 0 0.00 No 8 19.51 No 0 0.00
To what degree do you believe that the subject matter was presented fair, balanced, and free of commercial bias? Franck Rahaghi, MD (Alpha-1): To what degree do you believe that the subject matter was presented fair, balanced, and free of commercial bias? Paul Yamauchi, MD, PhD (Psoriasis): Frequency Percent Mean: 4.78 Frequency Percent Mean: 4.83 Excellent 32 78.05 Excellent 30 73.17 Very Good 9 21.95 Very Good 6 14.63 Good 0 0.00 Good 0 0.00 Fair 0 0.00 Fair 0 0.00 Unsatisfactory 0 0.00 Unsatisfactory 0 0.00 No 0 0.00 No 5 12.20 To what degree do you believe that the subject matter was presented fair, balanced, and free of commercial bias? Gerald W. Dryden, MD (IBD): Which statement(s) best reflects your reasons for participating in this activity: Frequency Percent Mean: 4.73 Frequency Percent Mean: - Excellent 24 58.54 Topics covered 23 56.10 Very Good 9 21.95 Location/ease 27 65.85 of access Good 0 0.00 Faculty 4 9.76 Fair 0 0.00 Earn CME 34 82.93 credits Unsatisfactory 0 0.00 No 8 19.51 No 1 2.44 Future CME activities concerning this subject matter are necessary: Frequency Percent Strongly agree 14 34.15 Agree 19 46.34 Neutral 6 14.63 Disagree 1 2.44 Strongly 0 0.00 Disagree No 1 2.44 Mean: 1.85 What topics would you like to see offered as CME activities in the future? INC8. Pulmonary hypertension. Lipid guidelines Hospice and palliative care i.e. when to refer, truth and myths about pain control, new CMS guidelines Resistant HTN. Motivational interviewing. Preventative care updates. HER Musculoskeletal topics/surgical. ICD 10 and the provider How to identify dermatology lesions and treatments Hematology - anticoagulation, dyslipidemia, SGTP-2 - all about Celiac disease. Sleep apnea Complicated patient management - tips for multiple diseases Sport injuries - orthopedic tests Pain management; assessing sports injuries; general management of rash, back pain, headache Fibromyalgia Lovemox bridging Sleep disorders. Neuropathy
What topics would you like to see offered as CME activities in the future? OSA Evaluation and treatment of low back pain. Sepsis. Chronic ulcers to lower extremities Fibromayalgia. Disease of the person with 'body pain' (muscles, joints, etc.) Cardiology. Rheumatology Thyroid. HTN Medical aesthetics - pitfalls, providers, and negative outcomes, candidates for treatment, non-candidates Short topic presentation of disease with new Rx Infectious disease. Ebola Functional medicine approach to disease management. Leaky gut and immune system. Anti-inflammatory diet Common musculoskeletal disorders. X-rays any Homeopathic remedies for arthritis and inflammatory diseases. Polypharmacy - how do we stop it Anything cardiovascular. Asthma. Wellness exams and vaccines New guidelines on treatment of dyslipidemia Rheumatoid Arthritis Dementia and behavioral disturbance. ESLD/liver failure. Renal failure. Edema. RA Dermatology. Radiology - reading Osteoporosis. Hyperlipidemia update. Breast cancer treatment CHF. Dermatology Additional comments: Overall great, thanks Too many case studies in Derm lecture. More hot water for tea Lecture 2 - Excellent presentation and information. Appreciate use of 'practitioner. New information very helpful. Kept audience engaged. Lecture 3 - Excellent presentation and examples. Very knowledgeable Great course. A great deal of helpful information I enjoyed these topics and learned a great deal. Thank you. Deborah Paschal is very professional and good at her work Was SGTP-2 just a tease? Sorry to leave early, but family sick "The best drugs for patients are the ones they can afford" - have speakers be aware of the scope of practice for ARNPs in Washington (different than FL, IL, KY if they are not PA-C's). Very good presenters. Should direct audience to include MDs Thank you for providing opportunity for free CME Excellent slides 'Mid-level' provider is not an appreciated term. Downtown Seattle, or Lynnwood Convention Center location Thanks for excellent educational conference Thank you Please don't call ARNP and PA's 'mid-levels' Enjoy interactive and dynamic speakers Great speakers. Dr. Dryden's presentation may be better for GI specialists than Primary Care My second NACE conference - good info/speakers DM treatments - should review all meds in more detail - less on the psychosocial and more on the medications and steps of treatment, i.e. algorithms for treatment would have helped Location was good. I'd love to see you come to Portland, Oregon Great conferences. Thanks for inviting me. I look forward to seeing you again next year