clinical updates for nurse practitioners and physician...

Clinical Updates for Nurse Practitioners

and Physician Assistants: 2014

Activity Evaluation Summary

CME Activity:

Clinical Updates for Nurse Practitioners and Physician Assistants: 2014 Saturday, October 11, 2014 Seattle Airport Marriott Seattle, WA

Course Directors:

Deborah Paschal, CRNP and Gregg Sherman, MD

Date of Evaluation Summary:

October 21, 2014

300 NW 70th Avenue, Suite 102• Plantation, FL 33317 (954) 723-0057 Phone • (954) 723-0353 Fax

email: [email protected]

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

Response Frequency Percent Response Frequency PercentWhat is your specialty?What is your professional degree?

Mean: - Mean: 2.77MD 0 0.00 Primary Care 26 63.41DO 0 0.00 Endocrinology 0 0.00NP 25 60.98 Rheumatology 0 0.00PA 17 41.46 Pulmonology 1 2.44RN 2 4.88 Cardiology 2 4.88Other 2 4.88 Gastroenterolog

y2 4.88

Other 8 19.51No Response 0 0.00 No Response 2 4.88

Response Frequency Percent Response Frequency Percent

Indicate the number of patients you see each week ina clinical setting regarding each therapeutic arealisted: Alpha-1:

Indicate the number of patients you see each week ina clinical setting regarding each therapeutic arealisted: Diabetes:

Mean: 4.13 Mean: 1.45None 2 4.88 None 24 58.541-5 5 12.20 1-5 11 26.836-10 9 21.95 6-10 3 7.3211-15 9 21.95 11-15 0 0.0016-20 6 14.63 16-20 0 0.0021-25 3 7.32 21-25 0 0.00> 25 6 14.63 > 25 0 0.00No Response 1 2.44 No Response 3 7.32


Indicate the number of patients you see each week ina clinical setting regarding each therapeutic arealisted: IBD:

Indicate the number of patients you see each week ina clinical setting regarding each therapeutic arealisted: Psoriasis:

Mean: 2.23 Mean: 2.69None 5 12.20 None 3 7.321-5 27 65.85 1-5 21 51.226-10 4 9.76 6-10 8 19.5111-15 1 2.44 11-15 3 7.3216-20 0 0.00 16-20 2 4.8821-25 2 4.88 21-25 0 0.00> 25 0 0.00 > 25 2 4.88No Response 2 4.88 No Response 2 4.88

Integrated Item Analysis Report

CME Activity Evaluation October 11, 2014 - Seattle, WAClinical Updates for Nurse Practitionersand Physician Assistants


Upon completion of this activity, I can now: Identifywho and when to test for AAT deficiency; Describe the50-year history of alpha1-antitrypsin (AAT) deficiency;Discuss how to incorporate testing for AAT deficiencyinto everyday practice; Describe the new insights intothe efficacy of treatment for AAT deficiency

Upon completion of this activity, I can now: Identifythe barriers between physicians and patients todiscussing and initiating injectable treatments fordiabetes; Recognize the importance of glucotoxicity inthe development of beta cell failure and diabeticcomplications; Describe how best to initiate, utilizeand intensify insulin therapy in patients with diabetes,and to recognize the role of combining GLP-1analogues and SGLT-2 inhibitors with insulin toindividualize care, achieve targets and minimizehypoglycemia

Mean: 1.20 Mean: 1.03Yes 33 80.49 Yes 39 95.12Somewhat 8 19.51 Somewhat 1 2.44Not at all 0 0.00 Not at all 0 0.00No Response 0 0.00 No Response 1 2.44


Upon completion of this activity, I can now: Identifythe conditions referred to as inflammatory boweldisease (IBD), and recognize their clinicalpresentations and degree of severity, implementappropriate pharmacologic and nonpharmacologictherapeutic strategies for managing IBD in accordancewith evidence-based guidelines; Identify patients whoare at high risk of complications from IBD and whomay benefit from new mechanisms of action in IBDtherapy; Employ approaches for effectivelycommunicating the risks and benefits of IBD treatmentoptions and facilitating adherence

Upon completion of this activity, I can now: Discussthe most up-to-date treatment protocols based on thecurrent understanding of psoriasis and its relateddisorders as T-cell mediated immune diseases; Definepsoriatic disease and outline the clinical presentationand pathophysiology of psoriasis; Identify anddiscuss the ever-expanding numbers of co-morbidconditions associated with psoriatic disease; Interpretand apply evidence-based approaches for thetreatment of patients with psoriatic conditions

Mean: 1.08 Mean: 1.18Yes 35 85.37 Yes 28 68.29Somewhat 3 7.32 Somewhat 6 14.63Not at all 0 0.00 Not at all 0 0.00No Response 3 7.32 No Response 7 17.07


Overall, this activity was effective in improving myknowledge in the content areas presented:

Overall, this was an excellent CME activity:Mean: 1.37 Mean: 1.32

Strongly Agree 26 63.41 Strongly Agree 28 68.29Agree 15 36.59 Agree 13 31.71Neutral 0 0.00 Neutral 0 0.00Disagree 0 0.00 Disagree 0 0.00StronglyDisagree

0 0.00 StronglyDisagree

0 0.00



How likely are you to implement these new strategiesin your practice?

As a result of this activity, I have learned new anduseful strategies for patient care:

Mean: 1.39 Mean: 1.44Strongly Agree 26 63.41 Very likely 24 58.54Agree 14 34.15 Somewhat likely 14 34.15Neutral 1 2.44 Unlikely 0 0.00Disagree 0 0.00 Not applicable 1 2.44StronglyDisagree

0 0.00No Response 0 0.00 No Response 2 4.88As a result of this activity, I have learned new strategies for patient care. List these strategies:ResponseBe aware of cardiac meds in psoriatic patientsTest for Alpha-1 in chronic (CAL) Airway Limitation diseases. Refer all CAL clients for testing at any age for AATdeficiency. Be more aggressive with treating psoriasis - not just a skin disorder. Treat IBD early and aggressivelyWill be changing practice in Alpha-1 antitrypsin screening. Feel more confident in insulin titration and incretinsHow 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 viaEMR. Screen all COPDersMany of the suggestions for treatments were new interventions. This was a very informative conferenceScreening for AATD. Insulin dosing methodsWe do a lot of PFTs in Occupational Medicine. AAT deficiency lecture helpfulGlucose lowering therapy. AAT screeningWill consider incorporating in practiceWhen to initiate GLP1 versus higher titration of basal insulin. Start talk of injectables early - don't make using insulinseem to be treatment failure, screen COPD patients for Alpha-1 antitrypsin deficiency. Worry about cardiovascular riskwith patients with psoriasis. When to refer to Rheumatology. Identify Crohn's versus ulcerative colitis; identifyinflammatory bowel disease in general; IBD treatment adherenceChanges in prescribing injectable DM medications. Screening patients for AATMore AAT testingID disease and change treatment. ID referral needDM injectables. Psoriasis treatment. AAT testingCheck for AAT deficiency. More system checks in psoriasisTesting in COPD useful. Study more about IBD - I have to memorize the meds and names, etc. Psoriasis - need to workon names of medsStarting injectables for DM sooner. Updated my knowledge of psoriasis. Why important to treat aggressively. Refer forendoscopy when considering IBDTest for AAT. Improved patient education for psoriasis. Clarity on psoriasis treatmentStart insulin early if not well controlled hyperglycemia. Take time to educate patient on injection of insulinDiabetes - add GLP-1 early/increase therapy faster. COPD - see about test kits for AAT deficiency. Psoriasis - evaluatepatients for co-morbidities, treat systemic IBD, promote early aggressive treatment of CDUse 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 OARMore aggressive dermatology/treatment of psoriasis. Change carb ratioTest AAT; update appropriate Rx; IBD patient care; no change in DM carePositive approach to injectables. Increase screening for Alpha-1 ATMorbidity issues regarding different treatmentsNew ways to use and titrate insulin. Will test for Alpha-1 deficiency. Assessing cardiac risk factors in psoriasis patientsHow 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:ResponseUse newer Rx's more aggressively for T2DM control. Screen more for ATTDBetter insulin management. Improved testing for Alpha-1Screening for AATD. Implementing insulin therapyI will have a lower threshold to treat diabetics with insulin. I will begin to screen patients for Alpha-1 antitrypsindeficiency. I will be more aggressive with psoriasis patients treatmentTesting all COPDers for AAT. Monitoring CV risk factors in patient with psoriasis. Considering GLP-1 usageHow to approach patients regarding injection therapy for DM. How to distinguish different dermatology conditionssimilar to psoriasis. Screening for AATDLearned to screen for Alpha-1 deficiency to decrease COPD mortality. Learned treatment options for psoriasisBroader screening for psoriasis patients. Consider Alpha-1 antitrypsin testingInsulin sooner. More GLP-1. Diabetes education. Recall patients >70 A1C and change regimen


In terms of delivery of the presentation, please rate theeffectiveness of the speaker: Gary Scheiner, MS, CDE(Diabetes):

When do you intend to implement these newstrategies into your practice?

Mean: 1.54 Mean: 4.37Within 1 month 25 60.98 Excellent 21 51.221-3 months 10 24.39 Very Good 14 34.154-6 months 1 2.44 Good 6 14.63Not applicable 3 7.32 Fair 0 0.00

Unsatisfactory 0 0.00No Response 2 4.88 No Response 0 0.00


In terms of delivery of the presentation, please rate theeffectiveness of the speaker: Paul Yamauchi, MD, PhD(Psoriasis):

In terms of delivery of the presentation, please rate theeffectiveness of the speaker: Franck Rahaghi, MD(Alpha-1):

Mean: 4.88 Mean: 4.78Excellent 36 87.80 Excellent 29 70.73Very Good 5 12.20 Very Good 8 19.51Good 0 0.00 Good 0 0.00Fair 0 0.00 Fair 0 0.00Unsatisfactory 0 0.00 Unsatisfactory 0 0.00No Response 0 0.00 No Response 4 9.76


To what degree do you believe that the subject matterwas presented fair, balanced, and free of commercialbias? Gary Scheiner, MS, CDE (Diabetes):

In terms of delivery of the presentation, please rate theeffectiveness of the speaker: Gerald W. Dryden, MD(IBD):




To what degree do you believe that the subject matterwas presented fair, balanced, and free of commercialbias? Paul Yamauchi, MD, PhD (Psoriasis):

To what degree do you believe that the subject matterwas presented fair, balanced, and free of commercialbias? Franck Rahaghi, MD (Alpha-1):



Which statement(s) best reflects your reasons forparticipating in this activity:

To what degree do you believe that the subject matterwas presented fair, balanced, and free of commercialbias? Gerald W. Dryden, MD (IBD):

Mean: 4.73 Mean: -Excellent 24 58.54 Topics covered 23 56.10Very Good 9 21.95 Location/ease

of access27 65.85

Good 0 0.00 Faculty 4 9.76Fair 0 0.00 Earn CME

credits34 82.93

Unsatisfactory 0 0.00No Response 8 19.51 No Response 1 2.44

Response Frequency Percent

Future CME activities concerning this subject matterare necessary:

Mean: 1.85Strongly agree 14 34.15Agree 19 46.34Neutral 6 14.63Disagree 1 2.44StronglyDisagree

0 0.00No Response 1 2.44What topics would you like to see offered as CME activities in the future?ResponseINC8. Pulmonary hypertension. Lipid guidelinesHospice and palliative care i.e. when to refer, truth and myths about pain control, new CMS guidelinesResistant HTN. Motivational interviewing. Preventative care updates. HERMusculoskeletal topics/surgical. ICD 10 and the providerHow to identify dermatology lesions and treatmentsHematology - anticoagulation, dyslipidemia, SGTP-2 - all aboutCeliac disease. Sleep apneaComplicated patient management - tips for multiple diseasesSport injuries - orthopedic testsPain management; assessing sports injuries; general management of rash, back pain, headacheFibromyalgiaLovemox bridgingSleep disorders. Neuropathy


What topics would you like to see offered as CME activities in the future?ResponseOSAEvaluation and treatment of low back pain. Sepsis. Chronic ulcers to lower extremitiesFibromayalgia. Disease of the person with 'body pain' (muscles, joints, etc.)Cardiology. RheumatologyThyroid. HTNMedical aesthetics - pitfalls, providers, and negative outcomes, candidates for treatment, non-candidatesShort topic presentation of disease with new RxInfectious disease. EbolaFunctional medicine approach to disease management. Leaky gut and immune system. Anti-inflammatory dietCommon musculoskeletal disorders. X-raysanyHomeopathic remedies for arthritis and inflammatory diseases. Polypharmacy - how do we stop itAnything cardiovascular. Asthma. Wellness exams and vaccinesNew guidelines on treatment of dyslipidemiaRheumatoid ArthritisDementia and behavioral disturbance. ESLD/liver failure. Renal failure. Edema. RADermatology. Radiology - readingOsteoporosis. Hyperlipidemia update. Breast cancer treatmentCHF. Dermatology

Additional comments:ResponseOverall great, thanksToo many case studies in Derm lecture. More hot water for teaLecture 2 - Excellent presentation and information. Appreciate use of 'practitioner. New information very helpful. Keptaudience engaged. Lecture 3 - Excellent presentation and examples. Very knowledgeableGreat course. A great deal of helpful informationI enjoyed these topics and learned a great deal. Thank you. Deborah Paschal is very professional and good at her workWas 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 ARNPsin Washington (different than FL, IL, KY if they are not PA-C's). Very good presenters. Should direct audience to includeMDsThank you for providing opportunity for free CMEExcellent slides'Mid-level' provider is not an appreciated term. Downtown Seattle, or Lynnwood Convention Center locationThanks for excellent educational conferenceThank youPlease don't call ARNP and PA's 'mid-levels'Enjoy interactive and dynamic speakersGreat speakers. Dr. Dryden's presentation may be better for GI specialists than Primary CareMy second NACE conference - good info/speakersDM treatments - should review all meds in more detail - less on the psychosocial and more on the medications andsteps of treatment, i.e. algorithms for treatment would have helpedLocation was good. I'd love to see you come to Portland, OregonGreat conferences. Thanks for inviting me. I look forward to seeing you again next year


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