Sarasota

SPECIFIC OBJECTIVES – DAY 1 - CLINICAL AND LABORATORY APPROACH TO RHEUMATIC DISEASES – Approach to the evaluation of the patient with rheumatic disease including: Relate the central role of the history and physical examination. Key x-ray findings in patients with rheumatic diseases. Importance of synovial fluid analysis. Use and limitations of laboratory testing. OSTEOARTHRITIS: DIAGNOSIS AND TREATMENT – Distinguish osteoarthritis from other forms of arthritis. Appropriate use of medical, physical and surgical treatments. MANAGEMENT OF TYPE 1 DIABETES – Diagnostic criteria for the diagnosis of diabetes. New insulin regimens for intensive glucose control. Screen for and manage cardiovascular complications of diabetes based on evidence-based studies. TREATMENT STRATEGIES IN TYPE 2 DIABETES – New pharmacologic agents available for glucose control. Apply concepts of pathophysiology to the selection of pharmacotherapy for Type 2 diabetes. Cost-effective approach to the management of diabetic complications. DAY 2 - POLYCYSTIC OVARY SYNDROME – Concepts in risk factors and pathophysiology. Simple laboratory screening process for diagnosis. Apply pathophysiology to design a treatment strategy. ADRENAL CASE STUDIES – Evaluation of the incidental adrenal mass. Diagnose and treat adrenal insufficiency. Manage patients with excessive adrenal steroid levels. CLINICAL ASPECTS OF RHEUMATOID ARTHRITIS – Clinical features of rheumatoid arthritis. The systemic nature of the disease. TREATMENT OF RHEUMATOID ARTHRITIS – Approach to the treatment of rheumatoid arthritis. Use and toxicity of disease modifying agents. DAY 3 - CRYSTAL ARTHROPATHIES – Describe the diagnosis and treatment of crystal arthropathies including gout and pseudogout. OSTEOPOROSIS: EVALUATION AND TREATMENT – Pathophysiology and epidemiology of osteoporosis. Role of bone mineral density measurement in the diagnosis of osteoporosis. Nonpharmacologic and pharmacologic treatments for osteoporosis. THE DYSLIPIDEMIAS: EVIDENCE-BASED DECISION MAKING – Landmark outcomes studies in reducing cardiovascular risk. Lipid lowering therapies. Apply evidence based protocols to at-risk patients. DISORDERS OF CALCIUM METABOLISM – Differential diagnosis of hypercalcemia. Cost effective workup to elevated calcium states. Evaluate hypocalcemic disorders using common laboratory studies. DAY 4 - THYROID CASE STUDIES, PARTS 1 & 2 – Etiologies and pathogenesis of hyper and hypothyroidism. Cost effective principles in the laboratory evaluation of thyroid conditions. Treatment protocols for various thyroid conditions. PSORIATIC ARTHRITIS AND THE SPONDYLOARTHROPATHIES – Clinical features of psoriatic arthritis and the spondyloarthropathies. Treatment modalities. SYSTEMIC LUPUS AND CONNECTIVE TISSUE DISEASES – Varied clinical presentations of SLE, Scleroderma and Myositis. Use of laboratory testing in diagnosis. Treatment options in systemic lupus erythematosus. DAY 5 - VASCULITIS – Clinical manifestations of the various vasculitides and diagnostic evaluation. Treatment modalities used in vasculitis. SOFT TISSUE RHEUMATOLOGY – Diagnosis and treatment of soft tissue rheumatic conditions. Clinical aspects of entrapment neuropathies and their association with systemic conditions. MALE HYPOGONADISM CLINICAL FEATURES – “Male menopause”. Cost-effective strategy to investigate causes of male hypogonadism. Treat various endocrine conditions arising in men. PITUITARY POTPOURRI – Differential diagnosis based on clinical features. Laboratory workup using a “best test” approach. Treatment options.

SPECIFIC OBJECTIVES – DAY 1 - HYPERTENSIVE UPDATE: CREEPING UP ON A SILENT KILLER – JNC guidelines in the treatment of hypertension. Selection of different antihypertensive agents in select subgroups of patients. The newest antihypertensive agents and the rationale for choosing these over older agents. ANEMIA – Guidelines for diagnosing anemia in children and adults. Common diagnostic studies available for diagnosing the etiology of the anemia. Role of consultants in the evaluation and management of anemia. COMMUNITY ACQUIRED PNEUMONIA: DIAGNOSING AND TREATING THE #1 CAUSE OF DEATH IN THE U.S. FROM INFECTIOUS DISEASES – How to stratify your patients with CAP into those needing outpatient (most) vs. inpatient (few) treatment, using the PORT scoring system. Antibiotic options in treating CAP including the role of respiratory tract fluoroquinolones, and newest macrolide agents as well as more conventional therapies. Role and timing of ordering chest x-rays, blood cultures and initiation of antibiotic therapy. DEPRESSION IN PRIMARY CARE – The incidence and prevalence of anxiety and depression. Signs and symptoms associated with anxiety and depression. Treatment strategies available. DAY 2 - ASTHMA – Epidemiology of asthma. Modalities to diagnose asthma. Different treatments for asthma, both pharmacological and environmental. CURRENT TRENDS IN THE DIAGNOSIS AND TREATMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE – Increase awareness of the large number of your patients who suffer from COPD, and who are currently going undiagnosed. Diagnose those with COPD within a single office visit. Current GOLD guidelines, in the diagnosis and treatment of those with COPD. CORONARY ARTERY DISEASE – Common presenting symptom complexes of patients. The diagnostic evaluation of a patient with chest pain. Current medication and surgical treatment options. CARE OF THE DIABETIC PATIENT – Benefits of a multidisciplinary approach to the management of DM and the critical role of the Primary Care Physician. Latest diagnostic criteria for diagnosing diabetes. Newest medications in the treatment of diabetes. DAY 3 - URINARY TRACT INFECTIONS – Uncomplicated and complicated UTIs, and why it is important to differentiate between the two. Importance of antimicrobial resistance when treating those with UTIs. Current guidelines in the treatment of uncomplicated cystitis, pyelonephritis and asymptomatic bacteriuria. IDENTIFICATION AND TREATMENT OF TRAUMATIZED PATIENTS – Characteristics associated with traumatic events. The “red flags” or symptomatic manifestations of trauma in patients. How to obtain a trauma history from a patient. Interventions designed to treat the symptoms of trauma. COLON CANCER PREVENTION – Patients who are at average and above average risk for developing colon cancer. Benefits and shortcomings of currently available means of colon cancer screening: from simple FOBT and genetic stool analysis to virtual colonoscopy and conventional colonoscopy. Latest advances in colon cancer screening. IMPROVING COMPLIANCE – Patient/physician communication issues that enhance compliance. Techniques to increase compliance. Follow-up plan for each STI. DAY 4 - EATING DISORDERS – Behavioral and psychosocial triggers that promote eating disordered behaviors. Anorexia, bulimia and binge eating behaviors. Clinical “red flags” that indicate eating disordered behavior. Interventions designed to treat eating disordered behaviors. DEVELOPMENTAL SCREENING OF INFANTS AND YOUNG CHILDREN – Prevalence of developmental and behavioral disorders in children. Standardized developmental screening tools available for use. Strategies to provide periodic screening in the office based setting. ADULT HEALTH SCREENING UPDATE – Current primary care guidelines for recommended screening tests for adults. Recommended immunizations for adults. FEVER IN THE YOUNG INFANT – Common etiologies of serious bacterial infection in neonates and infants and select appropriate therapies. Evaluation of the febrile neonate and infant, and differences in published criteria. The intolerance of serious bacterial infection in the neonate and infant. DAY 5 - SMOKING CESSATION – Role of smoking in disease etiology. Smoking cessation techniques. CARING FOR THE ADOLESCENT PATIENT – Strategy for conducting adolescent interviews that will address appropriate confidentiality issues. Prevalence of various at risk behaviors in the adolescent patient. Sexual maturity ratings for puberty and when delayed sexual maturity should be suspected. OBESITY – Epidemiology of obesity in America and the health risks associated with obesity. Patients that are obese and that are in need of treatment. Treatment options available, including diet, exercise, medications, and bariatric surgery. PEDIATRIC IMMUNIZATIONS AND SCREENING – Appropriate pediatric screening to be done during the first five years of life. Appropriate immunizations and time of immunizations for this age group.

SPECIFIC OBJECTIVES – DAY 1 - NEW AND CHANGING DISEASES – Etiology and pathogenesis of these infections. Clinical approach and methods of diagnosing these infections. Management of these infections. HERPESVIRUS INFECTIONS – Clinically pertinent aspects of herpesvirus infections. Syndromes, clinical complications and attributes of recurrent disease. Management and use of anti-virals. VIRUSES TO BE COVERED INCLUDE – Herpes simplex virus; Epstein-Barr virus; Cytomegalovirus; Varicella-zoster virus; HHV6. URINARY TRACT INFECTION – Epidemiology of UTIs. Attributes of lower tract and upper tract infections and reinfections and relapses. Chronic bacterial prostatitis. Approach to antimicrobial therapy, to include the use of short course therapy. Approach to prevention. PROPHYLAXIS OF ENDOCARDITIS AND PROSTHETIC JOINTS: ISSUES FOR PRIMARY CARE – Current recommendations for antibiotic prophylaxis of endocarditis and prosthetic joints. Data supporting prophylaxis. Appropriate patients for prophylaxis. Administration of prophylactic antibiotics. Prophylaxis in the allergic patient. SEXUALLY TRANSMITTED DISEASES – Current understanding of the epidemiology of common STDs. Attributes of clinical presentations. Diagnostic approaches. Current treatment recommendations. DAY 2 - HEPATITIS – Pathogenesis and clinical manifestations of hepatitis A, B, C, D or E. Differences in rates of complications. Treatment options for hepatitis B, C and their rates of success. TRAVEL HEALTH – General preventive measures including what not to eat and drink. Immunizations. Prevention of malaria, diarrhea and other illnesses of travelers. Management of diarrhea of travelers. HELICOBACTER PYLORI INFECTION – Clinical manifestations . Methods of diagnosing. Treatment. INFECTIVE DIARRHEA – Presentation of toxigenic and invasive diarrhea. Food-borne pathogens. When to use fecal WBC, stool cultures, and stool O&P examinations. Indications for antibiotic therapy. Appropriate antibiotic choices. ILLUSTRATIVE CASES – Expected clinical manifestations of the disorders presented. Appropriate therapeutic regimen for each case. Contraindications or possible resistance problems, if any, with each case. Expected outcomes of therapy for each case study. DAY 3 - NEWER ANTIBIOTICS – The antibacterial spectrum of activity. Pharmacology of the agents. Indications and dosing recommendations. Side effects, adverse reactions and drug interactions. ADULT IMMUNIZATIONS – Current recommendations for the following vaccine preventable diseases: influenza, pneumococcal infection, hepatitis B, hepatitis A, varicella-zoster, and meningococcal infection. UPDATE ON ANTIMICROBIAL RESISTANCE – Pattern of emergence of resistance to certain infecting bacteria. Epidemiology that may indicate potential resistance among the organisms discussed such as: Staphylococci; Pneumococci; Enterococci; Gram negative bacilli. Approach to current therapeutic regimens while considering resistance. HIV PRIMER FOR THE PRIMARY CARE PHYSICIAN – Latest epidemiology of HIV infection. Utility of diagnostic tests (e.g. viral load, CD4 count) and their application for disease management. Principles of antiretroviral treatment and currently available medications. Prophylaxis to prevent opportunistic infections. ILLUSTRATIVE CASE STUDIES – Expected clinical manifestations of the disorders presented. The appropriate therapeutic regimen for each case. Contraindications or possible resistance problems, if any, with each case. Expected outcomes of therapy for each case study. DAY 4 - COMMUNITY ACQUIRED PNEUMONIA – Microbial causes of community acquired pneumonia. Accepted methods, and potential pitfalls of making the diagnosis. Prognostic factors related to outcome. Treatment options according to severity of illness. SOFT TISSUE INFECTIONS: CELLULITIS, FASCIITIS AND THE DIABETIC FOOT – Typical and atypical manifestations. Pathogenesis. Principles of medical and surgical treatment. Prognosis. TUBERCULOSIS – Groups at risk for developing active tuberculosis. Principals of antituberculous therapy. Mantoux technique for tuberculin skin testing. Indications for treatment of latent TB infection. WHAT THE PRIMARY CARE PHYSICIAN SHOULD KNOW ABOUT ACUTE MENINGITIS – Epidemiology of meningitis and the different types of meningitis. Clinical signs and symptoms of different types of meningitis. Indications for lumbar puncture (LP) and interpretations of LP results. Treatment options and the need for hospitalization and public health notification. ILLUSTRATIVE CASES – Expected clinical manifestations of the disorders presented. Appropriate therapeutic regimen for each case. Contraindications or possible resistance problems, if any, with each case. Expected outcomes of therapy for each case study.

SPECIFIC OBJECTIVES – DAY 1 - Elements of a lawsuit including: Duty; Breach; Injury; Causation. Discuss torts as they developed from the common law of England and the United States. Evolution of the standards of medical care from local to national standards. Legal theories used to establish liability of medical providers. DAY 2 - The process through which a complaint is filed and evidence obtained. How the defense responds to the complaint. Constructive behaviors as they relate to legal procedures. Strategy and objectives for both plaintiff and defendant during the litigation process. DAY 3 - Components of the actual trial process. Interests of the liability insurer and interests of the physician defendant. Various forms of alternative dispute resolution for settlement of claims. DAY 4 - The plaintiff’s claims concerning damages. The defenses utilized to rebut plaintiff’s claims for damages. Partial but representative list of the types of legal claims physicians frequently encounter. Methods that can minimize the potential of a liability claim being brought against the physician. DAY 5 - The legal importance of the medical record for the plaintiff and defendant. Methods to improve charting and the ability to defend one’s care. How the National Health Practitioners Data Bank affects Medicolegal encounters. Various areas in medicine or practice behaviors that predispose to high risk for medical malpractice claims. Situations or patient encounters that commonly result in behavior consistent with high risk for causing an action. Strategies and resources available when a perceived high risk behavior or encounter has occurred.

SPECIFIC OBJECTIVES: TOPIC 1: FEVER AND RASH - Identify common and uncommon rashes associated with fever in children and infants. Enumerate those historical clues that are helpful in evaluating difficult to identify rashes. TOPIC 2: PEDIATRIC EKG WORKSHOP - Contrast normal adult and pediatric EKGs. Describe the transition from pediatric to adult EKG pattern. Identify important pediatric EKG abnormalities. TOPIC 3: PEDIATRIC PRESENTATIONS OF CARDIAC DISEASE - Recognize common clinical scenarios indicating the presence of cardiac disease in children. Review the pathophysiology of some common pediatric heart diseases. TOPIC 4: VISUAL DIAGNOSIS - Recognize common, uncommon and atypical presentations of childhood illnesses. Formulate an initial approach to the management of certain childhood illnesses or injuries based on visual clues. Ask appropriate questions to discriminate among similar appearing pediatric diagnoses. TOPIC 5: PEDIATRIC PAIN MANAGEMENT AND SEDATION - Name the common pharmacologic agents used for pediatric pain relief and sedation. Describe the side effects and contraindications for the specific medications used for pain relief and sedation. Select an appropriate sedative plan for specific situations requiring sedation. TOPIC 6: ORTHOPEDICS IN THE PEDIATRIC PATIENT - Describe the anatomic differences between child and adult bones/joints. Classify pediatric fractures involving the growth plate. Identify fractures associated with abuse. Treat common orthopedic injuries and know when to refer. TOPIC 7: JUDICIOUS USE OF ANTIBIOTICS IN THE OUTPATIENT SETTING - Identify antibiotic prescribing patterns, outcomes, and expenditures for common pediatric conditions. Compare parent and physician beliefs for prescribing antibiotics.

SPECIFIC OBJECTIVES - DAY 1 - CUTTING EDGE ED AIRWAY MANAGEMENT – Essentials of airway pharmacology. Approach to airway assessment. Rapid sequence intubation. ADVANCED AIRWAY TECHNIQUES: STATE-OF-THE-ART – General approach to the patient with a difficult airway. Contemporary airway rescue techniques. Management of the failed airway. ST-SEGMENT ELEVATION: MI OR NOT MI – Clinical conditions that can result in ST elevation on the ECG. ECG findings that can aid the clinician in determining the significance of ST-elevation on an ECG. Possible adjuncts a clinician can use to further define the significance of ST-elevation on an ECG. ACUTE CORONARY SYNDROME IN THE ED: SO MANY DRUGS AND SO LITTLE TIME – The scope of the problem of ACS in the ED. Evidence-based treatment of ACS based on the latest applicable literature. Areas of controversy in the treatment of this disease entity. Emerging therapies that may prove useful for the treatment of ACS in the ED. DAY 2 - WIDE-COMPLEX TACHYCARDIAS: WHEN IS V-TACH NOT V-TACH – Possible etiologies and ECG appearance of wide complex tachycardias. Identify ECG features of these rhythms that will help differentiate between ventricular tachycardia and other more benign etiologies. Evidence-based treatment of these dysrhythmias. Clinical significance of the underlying medical conditions that result in these dysrhythmias. PERICARDITIS AND MYOCARDITIS: HOW CAN TWO DISEASES SEEM SO SIMILAR? – Pathophysiology and clinical presentation of these two entities. Potential pitfalls in the diagnosis and management of these diseases. Commonalities and differences of these closely related diseases. Evidence-based work-up and treatment options for pericarditis and myocarditis. PITFALLS IN ORTHOPEDICS – High-risk scenarios in emergency orthopedics. Severe true orthopedic emergencies. Commonly missed/mis-managed orthopedic conditions, using a case-based approach. Causes, clinical presentation, diagnosis and management of compartment syndrome. Approach to the patient with penetrating extremity trauma. Indications for vascular assessment in knee dislocations. MASTERING LOCAL AND REGIONAL ANESTHESIA – Pharmacology of local anesthetics. Controversies in local anesthetic techniques. Regional anesthetic techniques appropriate for the ED. DAY 3 - SUBARACHNOID HEMORRHAGE: WHAT IS NEW IN DIAGNOSIS AND MANAGEMENT? – Principles and pathophysiology of SAH. New advances in the diagnosis and management of this disease. Evidence-based treatment of SAH based on the latest applicable literature. Pitfalls in the diagnosis and management of SAH in the ED. LOW BACK PAIN IN THE ED: WHAT WE KNOW, WHAT WE THINK WE KNOW, AND WHAT WE DON’T KNOW – Evidence-based approach to the evaluation of non-traumatic back pain. “Red flags” that should heighten the suspicion for serious pathology in the evaluation of back pain. Effective as well as disproved therapies in the treatment of back pain. Potential pitfalls in the treatment and disposition of low back pain. AORTIC DISASTERS – Pathophysiology and clinical presentation of aortic dissection and AAA. Diagnostic options for emergency detection of these life-threatening vascular emergencies. Essentials of emergency management of aortic dissection and AAA. CASE STUDIES IN ABDOMINAL PAIN – Evidence-based approach to evaluation of the ED patient with abdominal pain. Common pitfalls in the assessment of patients with abdominal pain. High-risk scenarios related to patients with abdominal pain. DAY 4 - MEDICAL ERRORS – TURNING ERRORS INTO OPPORTUNITY – Elements of the emergency care environment that predisposes the clinician to decision-making errors. Cognitive strategies that reduce the likelihood of error. Methods for reviewing, discussing and addressing medical errors. IMAGING IN THE TRAUMATIZED PATIENT – Which patients need imaging following trauma. Which imaging studies are most effective in diagnosing injury. How the clinician should approach image interpretation. EARLY GOAL DIRECTED THERAPY IN SEPSIS: WHY ALL THE FUSS? – Pathophysiology of sepsis and the sepsis syndrome. Scope of the problem regarding effective management of sepsis in the ED. Principles of early goal-directed therapy in the treatment of sepsis. Potential gains that can be realized, as well as the pitfalls to avoid, in the management of sepsis utilizing early goal directed therapy. FROM HEMATEMESIS TO MELENA: AN EVIDENCE-BASED APPROACH TO GI – Common ED pitfalls in the diagnosis and management of GI bleeding. Evidence-based recommendations for treating this disease. High-risk features of certain GI bleeds that predict a worse outcome. DAY 5 - PE AND DVT IN THE EMERGENCY DEPARTMENT – Scope of the problem of thromboembolic disease in the ED. Latest diagnostic algorithms and adjuncts available to aid the clinician in the diagnosis of thromboembolic disease. Evidence-based treatment of thromboembolic disease based on the latest applicable literature. Limitations of current diagnostic modalities for these diseases. THROMBOLYSIS FOR STROKE – Principles and pathophysiology of stroke and stroke treatment. Applicable medical literature that is available to the clinician. Performance of thrombolysis for stroke to this point in time. Controversy regarding this therapy. Emerging technologies and therapies useful for the treatment of stroke in the ED. CASE STUDIES IN TRAUMA, PARTS I & II – Critical issues in the evaluation and management of the injured patient using a case-based format. Management imperatives of: Severe and minor brain injury; Spinal trauma; Blunt chest trauma; Blunt abdominal trauma; Pelvic trauma; Genitourinary trauma. Common pitfalls in the evaluation of the injured patient.

SPECIFIC OBJECTIVES: TOPIC 1: APPROACH TO ACID-BASE DISTURBANCES - Identify primary metabolic and respiratory acid- base disturbances and their compensatory mechanisms. Discover a formal, stepwise approach to the interpretation of any acid-base problem. Outline the differential diagnosis of the major simple and mixed acid-base disturbances. Several illustrative case studies will be discussed. TOPIC 2: SHOCK AND HEMODYNAMIC MONITORING - Shock is a common problem in the intensive care unit. Define shock and describe the causes. We will focus on the pathophysiology of common entities. Characterize basic resuscitation techniques including volume replacement and the use of vasopressors. The discussion will include a review of early goal directed therapy. Recognize the current controversies surrounding the use of invasive hemodynamic monitoring. Outline the possible indications and contraindications to pulmonary artery catheter placement as well as the complications that can arise. Define new treatments for septic shock. This will include the use of activated protein C and the role of corticosteroids. TOPIC 3: ACUTE RESPIRATORY FAILURE AND MECHANICAL VENTILATION - We will provide a practical review of this exciting topic. We will cover the basics of mechanical ventilation. Characterize the pathophysiology and differential diagnosis of acute hypoxemic and hypersonic respiratory failure. Describe the pathophysiology and differential diagnosis of acute respiratory failure. Identify the basic concepts of management for patients on mechanical ventilation. Differentiate commonly used ventilator modes. We will also discuss the use of positive end expiratory pressure (PEEP). Identify the indications for and complications of mechanical ventilation. Characterize weaning, including general principles and strategies for weaning from mechanical ventilation. TOPIC 4: CRITICAL CARE CASES FOR REVIEW, PART 1 - A variety of Critical Care cases will be presented with audience participation. X-rays and other diagnostic studies will be shown in an attempt to emphasize some of the common problems seen in the ICU. Cases will include a variety of pulmonary as well as non-pulmonary topics. TOPIC 5: PULMONARY THROMBOEMBOLIC DISEASE - A very common, difficult to diagnose problem with devastating consequences if not treated promptly. Characterize the epidemiology, risk factors, & clinical presentation of PE & DVT. Identify the role of DVT prophylaxis and the current status of low molecular weight heparin. Diagram the diagnostic work-up including V/Q scanning, lower extremity studies, CT scanning, pulmonary angiography and others. Outline treatment modalities including anticoagulation, thrombolysis & vena cava filters. TOPIC 6: CRITICAL CARE CASES FOR REVIEW, PART 2 - A variety of Critical Care cases will be presented with audience participation. X-rays and other diagnostic studies will be shown in an attempt to emphasize some of the common problems seen in the ICU. Cases will include a variety of pulmonary as well as non-pulmonary topics. TOPIC 7: PREOPERATIVE PULMONARY ASSESSMENT - The primary care provider is commonly asked to “clear” a patient with lung disease for surgery. Characterize the respiratory effects of anesthesia and surgery with emphasis on patients with at-risk complications. Describe the perioperative risk factors associated with post-op pulmonary complications. Identify the elements of appropriate preoperative evaluation including the role of arterial blood gas measurement and spirometry. Describe preoperative measures that can minimize operative and postoperative respiratory complications.

SPECIFIC OBJECTIVES - DAY 1 - DELIRIUM IN THE ELDERLY – CURRENT CONCEPTS – Diagnostic features and common causes of delirium. Distinguish between delirium and dementia. Causes of persistent delirium. Non-pharmacologic and pharmacologic treatment approaches to the delirious patient. EXERCISE PROGRAM IN THE ELDERLY – Relationship between maximal oxygen consumption, aging, and functional status. Potential benefits of exercise. Risks of exercise and how to minimize them. Components of an exercise program. DEMENTIA IN THE ELDERLY – Prevalence and significance of dementia. Common causes of dementia and the value of objectifying cognitive performance. Atypical patterns and differential diagnosis of dementia syndromes. Risks and benefits of commonly used drugs to treat dementia. Medical evaluation of a newly identified patient. OFFICE ORTHOPEDICS IN THE OLDER PATIENT – Common causes of acute low back pain. Symptoms and treatment of spinal stenosis. Causes of shoulder pain. Common causes of neck pain. DAY 2 - ADVANCED NUTRITIONAL ASSESSMENT AND THERAPY – Metabolic changes and inflammatory effects of aging and poor diet. Utilize readily available clinical data to make accurate and comprehensive nutritional assessments. Therapeutic nutritional approaches for acutely ill, chronically ill, and frail patients. Apply nutritional therapies towards improved wellness. TREATMENT OF CHRONIC PAIN IN THE ELDERLY – Alterations in body composition and physiology that alter the pharmacology of various analgesics. Adverse effects of NSAIDs. Use of the opioids and adjunctive medications in the treatment of chronic pain. Non-pharmacological treatments available for the treatment of chronic pain. VITAMIN B-12 DEFICIENCY IN THE ELDERLY – Normal physiology and the pathophysiology of B-12 deficiency and its causes. Use of metabolic markers in B-12 deficiency. Work-up of B-12 deficiency in clinical practice. OSTEOARTHRITIS: DIAGNOSIS AND TREATMENT IN THE OLDER PATIENT – Describe newer understandings of the pathophysiology of OA. Recognize the typical and atypical clinical features of OA. Describe the various treatments of OA and how to integrate them. Distinguish OA symptoms from those of other localized or generalized disorders. DAY 3 - OSTEOPOROSIS: CONTEMPORARY DIAGNOSIS AND TREATMENT – Define osteoporosis pathologically and by the WHO standards. Distinguish between the effects on bone metabolism of aging and those during the post-menopausal period. Usefulness of the T-score on DEXA scan reports and how to incorporate bone markers into treatment decision. Anti-resorptive agents available for the treatment of osteoporosis. SENSIBLE APPROACHES TO GERIATRIC INFECTIONS – Atypical presentation of infectious illness. Causes of pneumonia and UTI and describe the approach to antibiotic selection. Considerations in emerging antibiotic resistance. Issues in reasonable antibiotic use. RHEUMATOLOGIC LAB TESTS AND RHEUMATOID ARTHRITIS IN THE ELDERLY – Impact of aging on the sensitivity and specificity of rheumatologic lab tests. Alterations in the presentation of rheumatoid arthritis. Use of corticosteroids in elderly onset rheumatoid arthritis. Complications of methotrexate therapy and proper lab monitoring during its use. Role of newer treatments for rheumatoid arthritis. SENSIBLE PRESCRIBING PRACTICES FOR THE ELDERLY – The limits of studies on drug safety and efficacy. Subtle but significant drug side effects. Undesirable prescribing practices and better approaches. DAY 4 - GERIATRIC DEPRESSION: ADVANCES IN DIAGNOSIS AND TREATMENT – Clinical presentations of depressive syndromes. Utility and application of the Geriatric Depression Scale. Relative advantages and disadvantages of the various medications available for treatment of depression. Benefits of non-pharmacologic treatments alone or in conjunction with medical treatments. MUSCULOSKELETAL EXAM AND ARTICULAR AND SOFT TISSUE INJECTIONS FOR THE PRIMARY CARE PHYSICIAN – Equipment necessary for specific injections. Contraindications to and complications of injections. Proper technique for handling of and the necessary tests on synovial fluid. The technique for the injection of several commonly affected structures. CONTEMPORARY ISSUES IN END OF LIFE CARE – Aapproach to assessment of the whole patient in a hospice setting. Practical and effective approaches to common physical symptoms in the terminally ill. Effective clinical care of patients in the last days of life. Dementia as a terminal illness. DAY 5 - POLYMYALGIA RHEUMATICA AND GIANT CELL ARTERITIS – Typical symptoms, physical findings, and laboratory abnormalities in polymyalgia rheumatica. Treatment options for PMR. Typical and atypical presentations of GCA. Appropriate indication and technique for temporal artery biopsy. Most effective treatment and the most serious complications of GCA. RISK MANAGEMENT AND CARE OF THE ELDERLY – Principles of effective risk management practices. Newer concepts and approaches in dealing with medical errors. Benefits of honest disclosure of medical errors. GOUT AND PSEUDOGOUT IN THE ELDERLY – The unique characteristics of gout. Factors that impact the presentation and treatment of gout. The Allopurinol hypersensitivity syndrome and predisposing factors. Clinical manifestations of calcium pyrophosphate deposition. Polarized microscopic findings for uric acid and CPPD crystals. IMPROVING COMMUNICATION SKILLS IN MEDICAL PRACTICE – Ways that people perceive communication and process information. Your personal communication strengths and limitations. Communication issues unique to older patients. Practices to maximize effective communication and listening.

SPECIFIC OBJECTIVES - DAY 1 - THE NUTS AND BOLTS OF PERFORMING A NEUROLOGICAL EXAMINATION – Obtain a more precise history of weakness or numbness. Perform a more complete screening neurological examination. When to use supplementary portions of the exam in selected clinical situations. Common pitfalls and errors in performing the neurological examination. INTERPRETING THE NEUROLOGICAL EXAMINATION: A CASE-BASED APPROACH – Common abnormalities on the neurological examination. Determine whether a lesion is in the central or peripheral nervous system. Categorize weakness and numbness by their patterns of distribution and recognize these patterns as aids to localization. Selected cases which will serve as examples of how to recognize and localize classic problems noted on the neurological examination. CRANIAL NEUROPATHIES: VERTIGO, BELL'S PALSY AND TRIGEMINAL NEURALGIA – Clinical features of cranial neuropathies. Techniques available to confirm a diagnosis of cranial neuropathy. Therapeutic modalities available to treat vertigo, Bell’s palsy, and trigeminal neuralgia. VISUAL LOSS AND DOUBLE VISION: NEURO-OPHTHALMOLOGY FOR THE PRIMARY CARE PHYSICIAN – Differential diagnosis for patients presenting with acute and chronic monocular loss of vision. Differential diagnosis for patients presenting with horizontal and vertical diplopia. Components of the bedside neurologic exam which will distinguish between the various etiologies of visual loss and diplopia. Therapeutic and prognostic aspects of the specific causes of visual loss and diplopia. DAY 2 - NEURODIAGNOSTICS TESTS: HOW CAN THEY HELP YOU MAKE THE DIAGNOSIS? – Indications for neurodiagnostic studies and answer the questions: Should every seizure patient have an EEG? Should every numb hand have an EMG? False positives and incidental findings obtained from neurodiagnostic testing. Limitations of EMG, EEG and lumbar puncture. Obtaining useful information from neurodiagnostic tests. Advising patients as to what is involved in the performance of these selective neurodiagnostic tests. NEURORADIOLOGY: INTERPRETING THE INTERPRETATIONS OF CAT SCAN AND MRI – Clinical relevance of the findings reviewed in CAT scan and MRI reports. The rationale for ordering neuroradiologic testing. Common neuroradiologic abnormalities. AN EFFECTIVE APPROACH TO GAIT ABNORMALITIES – Common gait abnormalities, both persistent and episodic. Evaluate patients with gait dysfunction using a directed neurological exam and appropriate lab and imaging studies. Categorize persistent gait abnormalities into dysfunction of sensation, power, balance, coordination/posture, and tone. Hysterical gait abnormalities. THE CLINICIAN’S APPROACH TO PERIPHERAL NEUROPATHY – The multiple presentations of the neuropathy of diabetes. Differential diagnosis of patients who present with peripheral neuropathy. Diagnostic work-up of patients with peripheral neuropathy. Therapeutic options available for peripheral neuropathy. DAY 3 - ALZHEIMER’S DISEASE AND OTHER DEMENTIAS – Evaluate patients with dementia and answer the question: What testing should be done in a patient with suspected Alzheimer’s disease? Answer the question: What are the red flags suggesting that special testing for other causes of dementia is appropriate? When to initiate a Cholinesterase inhibitor or NMDA antagonist in patients with Alzheimer’s disease. What interventions for depression and agitation can be most helpful in their patients with Alzheimer’s disease. ESSENTIAL TREMOR AND PARKINSON’S DISEASE – Mild Parkinson’s disease and other disorders that produce parkinsonism. What medications to begin in their patients with Parkinson’s disease and essential tremor. The intractable patient with Parkinson’s disease or essential tremor and advanced strategies for treatment of these movement disorders including deep brain stimulation. Other types of tremor in addition to those seen in Parkinson’s disease and essential tremor. MULTIPLE SCLEROSIS IN THE 21ST CENTURY – Clinical features of patients with multiple sclerosis. Diagnostic testing strategy to confirm a diagnosis of multiple sclerosis. Etiologic questions in multiple sclerosis. Newest therapeutic advances in the treatment of multiple sclerosis. MIGRAINE AND OTHER HEADACHES: A DIAGNOSTIC APPROACH LEADING TO RATIONAL THERAPY – Clinical spectrum of symptoms in patients with migraine headache. Types of headache which can mimic migraine. Newest therapeutic advances in the treatment of migraine headache. DAY 4 - BRAIN ATTACK! ACUTE TREATMENT OF STROKE AND TIA – Imaging studies of the brain and cerebral vessels in the setting of acute cerebrovascular disease. How management of blood pressure, fever, blood sugar and airway can improve the prognosis of stroke patients. Time is brain and what immediate interventions, including thrombolytics, are necessary in stroke patients. Manage and triage patients with intracerebral hemorrhage. HOW TO MINIMIZE YOUR PATIENT’S RISK OF STROKE – Most recent developments in the use of statins and antihypertensive medications in patients with a risk for stroke. Risk factors for stroke. Selecting an antiplatelet or anticoagulant medication after a stroke or TIA. Indications and potential benefits of vascular procedures such as carotid endarterectomy and stenting. THE DIAGNOSIS AND TREATMENT OF NEUROPATHIC PAIN, PARTS 1 AND 2 – Current thinking about the pathophysiology of neuropathic pain. Clinical features of a patient with neuropathic pain. Pharmacologic options available to treat patients with neuropathic pain. Clinical features which distinguish lumbosacral radiculopathy from other causes of low back pain. Clinical spectrum of lumbosacral radiculopathy. DAY 5 - DIAGNOSIS AND TREATMENT OF EPILEPSY – Differentiate seizures from syncope, pseudoseizures and other masqueraders. Approach to initiating treatment with anticonvulsants. Use of anticonvulsants in pregnancy and in the elderly. When to stop anticonvulsants. In status epilepticus, time is brain - an approach to treatment to stop status epilepticus in 1 ½ hours or less. SYNCOPE: A REVIEW OF FITS, FAINTS, AND FUNNY SPELLS – Neurologic and non-neurologic causes of syncope. Clinical features of dysautonomia, POTS and neurocardiogenic syncope. Role of diagnostic testing in patients presenting with syncope. Therapeutic options available for patients with dysautonomia and neurocardiogenic syncope. TO SLEEP, PERCHANCE TO DREAM: COMMON SLEEP DISORDERS – Obtaining a sleep history. The utility of these studies and answer the question: Should your sleepy patient get a polysomnogram or multiple sleep latency study? Common sleep disorders such as insomnia, obstructive sleep apnea, narcolepsy and restless legs syndrome. MYASTHENIA GRAVIS AND MYOPATHY – Clinical features of myasthenia gravis and other disorders of the neuromuscular junction. Clinical features and differential diagnosis for patients with myopathy. Diagnostic testing available for patients presenting with symptoms of either myasthenia gravis or myopathy. Therapeutic options available for patients with myasthenia gravis and myopathy.

SPECIFIC OBJECTIVES - DAY 1 - OFFICE MANAGEMENT OF MILD TO MODERATE ASTHMA – Benefits and drawbacks of using nebulizers or metered-dose inhalers with spacers to deliver beta2-agonists. Evidence supporting the use of ipratropium bromide for moderately ill asthmatic children. Use of corticosteroids in this setting, including Dr. Scarfone’s research on the use of oral prednisone and nebulized dexamethasone. ED MANAGEMENT OF SEVERE ASTHMA – Appraise the literature with regard to the treatment of children with severe asthma. Role of continuously nebulized albuterol for children with severe asthma. Use of magnesium sulfate and intravenously administered beta2- agonists in this setting. BRONCHIOLITIS – Benefits and limitations of the most recent recommendations for the treatment of bronchiolitis. Features placing infants at risk for more serious disease. VISUAL DIAGNOSIS, PART I – Common, uncommon and atypical presentations of childhood illnesses. Approach to the management of certain childhood illnesses or injuries based on visual clues. Questions to discriminate among similar appearing pediatric diagnoses. DAY 2 - PEDIATRIC DERMATOLOGY: COMMON RASHES YOU SHOULD KNOW – Characteristics of rashes encountered in the acute care setting. Treatment for common dermatologic conditions. FEVER AND RASH – Approach to a febrile child with petechiae. Characteristics of rashes in the child with fever. Historical clues that are helpful in evaluating difficult to identify rashes. THE RED HOT EYE – Eight-point eye examination and clinical conditions may be identified by each step in the examination. Eye pathology resulting from infection or trauma and when to refer a child to an ophthalmologist. Difference between inflammatory edema, peri-orbital cellulitis and orbital cellulitis. WHAT’S NEW IN PEDIATRIC EMERGENCY MEDICINE? – Nnew treatment practices in the pediatric emergency department. Use data from recently published clinical trials to offer an evidence-based approach to the management of ill or injured children. Cost-effective treatment strategies for children with common pediatric emergency diagnoses. DAY 3 - NO TIME TO WASTE – SURGICAL EMERGENCIES IN CHILDREN – Signs and symptoms of various acute surgical emergencies in children. Appropriate diagnostic studies to obtain in the evaluation of children with surgical emergencies. Consequences of delayed diagnosis in children with surgical emergencies. INFANTS BEHAVING BADLY – Differential diagnosis for critically ill infants. Key management strategies in actual cases of infants presenting to a pediatric emergency department. Evaluation and management options available for infants with interesting and uncommon diagnoses. PEDIATRIC STATUS EPILEPTICUS AND FEBRILE SEIZURES – Management of Status Epilepticus. Appropriate laboratory and imaging studies in the acute care setting. Typical features of a simple and complex febrile seizure. ANIMAL BITES – Bites that are at particular risk of infection. Arguments for and against the use of prophylactic antibiotics in specific bite wounds. Match specific infecting organisms with the biting animal. DAY 4 - INTERESTING CASES IN PEDIATRIC EMERGENCY MEDICINE – Approach to the acutely ill child with a confusing presentation. Differential diagnosis for the acutely ill or injured child. THE FEBRILE YOUNG TODDLER – Stratify the young child with high fevers into specific risk categories of occult bacteremia. Current literature regarding occult bacteremia. Use and utility of prophylactic antibiotics in children with occult bacteremia. THE FEBRILE YOUNG INFANT – Appropriate evaluation and treatment of the febrile infant who is less than eight weeks of age. Serious bacterial infections for which the febrile infant is at risk. Appraise recent data suggesting that a subset of febrile infants may be treated as outpatients. VISUAL DIAGNOSIS, PART II – Diagnoses in children by simple visual inspection. Common pediatric diagnoses by asking appropriate historical questions. DAY 5 - PEDIATRIC HEAD TRAUMA – Victims of Shaken-Baby Syndrome. Children who have sustained concussions. Children who require imaging studies as part of their medical evaluation. PAIN MANAGEMENT IN THE OFFICE AND ED – Reasons why pain in children has often been inappropriately managed in the past. Use of pain management for specific case scenarios commonly seen in an office setting. Use of pain management for specific case scenarios commonly seen in an ED. PEDIATRIC ORTHOPEDIC PITFALLS – Historical and physical clues suggestive of serious causes of limp. Utility and limitations of studies used in the evaluation of limp. Interaction of anatomy, mechanism and age in common pediatric causes of limp. PHYSICAL CHILD ABUSE – Findings that are characteristic of physical abuse. Physical findings often confused with physical abuse. Further evaluation and an appropriate course of action when the suspicion of abuse exists.