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From Pre-Emptive to Salvage Antifungal Therapy:
Achieving Successful Outcomes
Case Discussion Series

Activity Overview
This Podcast is part of the Initiative Preventing & Managing IFIs: Progress & Promise in the 21st Century.

  • The first step in this Initiative consisted of 2 Live Webinars, now available as On-demand Webinars. In these Webinars, experts in medical mycology discuss scientific evidence (On-demand Webinars available at Vemco MedEd website/CME Portal).
  • Podcast represents the second step in this Initiative. Scientific evidence presented in the Webinars is reinforced and placed in clinical context through case discussions. Case discussion between physician and pharmacist experts brings in the viewpoint of both specialties. This approach highlights clinical considerations that both specialties should be aware of when formulating and evaluating their management approach.
This Podcast consists of 3 episodes released weekly beginning June 11, 2009. Reviewing all the 3 episodes is required before submitting the Post Test, Evaluation, and Credit Application form.

In Episode 1 (empiric vs. pre-emptive therapy), Dr. Perfect and Dr. Dodds Ashley discuss the case of a 25-year-old woman who undergoes bilateral lung transplantation and remains on long-term immunosuppressive therapy. She is doing generally well, but at a routine follow-up visit, nodules in the lungs are revealed on a CT scan.

In Episode 2 (superinfection), Dr. Perfect and Dr. Dodds Ashley discuss the case of a 56-year-old man with leukemia who undergoes HSCT from an unrelated donor. He develops GvHD in the GI tract and undergoes immunosuppressive therapy along with voriconazole prophylaxis. After several months of immunosuppressive therapy and voriconazole prophylaxis, he begins to improve. However, a biopsy of the stomach reveals an unusual lesion that is eventually identified as a Zygomycetes infection.
In Episode 3 (salvage therapy), Dr. Perfect and Dr. Dodds Ashley discuss the case of a 4-year-old boy who receives a bone marrow transplant to treat Hurler syndrome. He engrafts well but a lesion appears at the central venous catheter site. He was receiving low doses of voriconazole and lipid-based amphotericin B as prophylaxis. A biopsy of the lesion reveals septated hyphae and the current low-dose regimen of antifungals is continued. The infection eventually spreads to the bones and a large area of the chest wall.

Release Date: June 11, 2009
Credit Expiration Date: June 25, 2010


Credit Hours
Physician CME: 1.25
Pharmacist CPE: 1.25 (0.125 CEUs)

Activity Type
Application-based and performance-based

Educational Overview
When it comes to the management of invasive fungal infections (IFIs), a great deal of progress has been made with significant advancements in prevention, diagnosis, and treatment. Promising new clinical data allow for more targeted antifungal prophylaxis, identifying at-risk patients who would benefit most from this strategy. Evolving radiographic and serologic diagnostic techniques enable clinicians to initiate therapy at the time when therapeutic intervention is most effective. More options when determining treatment lead to better health outcomes for more patients at risk of or who have IFIs.

Today's healthcare teams are more vigilant in anticipating the possibility of a fungal infection. As a result, survival rates continue to increase while health outcomes improve. These positive efforts must continue. Clinicians, who acquire a level of knowledge and familiarity with new prevention approaches, diagnostic techniques, and management strategies for IFIs, will be empowered to make timely, accurate, evidence-based decisions that benefit their patients.

Target Audience
This activity has been developed for clinical pharmacists, infectious diseases physicians, hematologists/oncologists, and transplant physicians responsible for the management of IFIs.

Purpose Statement
The purpose of this activity is to educate physicians and pharmacists involved in the management of patients at risk of invasive fungal infections (IFIs) on prevention through the appropriate use of antifungal prophylaxis and early detection using new diagnostic techniques. With this knowledge, healthcare professionals will be able to minimize the incidence of IFIs and diagnose infection during the early stages.

Learning Objectives
At the conclusion of this activity, learners should be able to

  • Distinguish between the advantages of a pre-emptive strategy and empiric treatment when managing patients with IFIs
  • Identify the causes of treatment failure and recognize options for salvage therapy

Faculty
Elizabeth S. Dodds Ashley, PharmD, MHS, BCPS
Infectious Diseases Clinical Pharmacist
University of Rochester Medical Center
Rochester, NY

John R. Perfect, MD
Professor of Medicine
Associate Professor of Medicine (Infectious Diseases)
Duke University Medical Center
Durham, NC

Accreditation
Physicians
Accreditation Statement: This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through joint sponsorship of Center for Independent Healthcare Education (Center) and Vemco MedEd. Center is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation: Center designates for this activity a maximum of 1.25 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Pharmacists
Accreditation Council for Pharmacy EducationAccreditation Statement: Center for Independent Healthcare Education (Center) is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
Credit Designation: Center has assigned 1.25 contact hours (0.125 CEUs) of continuing pharmacy education credit for participation in this activity.

ACPE Universal Activity Number: 473-999-09-011-H01-P

Estimated time to complete activity: 1.25 hours

For questions regarding the accreditation of this activity, please contact Center at info@jointsponsor.com

Method of Participation and Instruction for Credit

  1. Review the entire CME/CE information including target audience, learning objectives, and disclosures.
  2. Review the 3 Podcast Episodes in their entirety.
  3. Print and complete the Post Test, Evaluation, and Credit Application form.
  4. Mail the completed Post Test, Evaluation, and Credit Application form to Vemco MedEd, 245 US Highway 22, Suite 304, Bridgewater, NJ 08807 Or Fax to (908) 450-3300.
Documentation of credit will be mailed within 4 weeks of receipt of the completed Post Test, Evaluation, and Credit Application form.

Disclosure of Conflicts of Interest
Center for Independent Healthcare Education requires faculty, planners, and others who are in a position to control the content of continuing education activities to disclose to the audience any real or apparent conflict of interest related to the activity. All identified conflicts of interest are reviewed to ensure fair balance, objectivity, and scientific rigor in all activities. The faculty is further required to disclose discussion of off-label uses in their presentations.

Disclosure
Faculty
Elizabeth S. Dodds Ashley, PharmD, MHS, BCPS
Grant/Research Support: Astellas and Schering-Plough
Advisory Boards: Astellas
Promotional Speakers Bureau: Schering-Plough and Merck

John R. Perfect, MD
Grant/Research Support: Enzon, Pfizer, Schering-Plough, Merck, and Astellas
Advisor/Consultant: Enzon, Pfizer, Schering-Plough, Astellas, and Merck

Planning Committee Members
Employees of Center for Independent Healthcare Education and Vemco MedEd have no relevant financial relationships to disclose.

Off-label Disclosure Statement
During this activity, off-label use of the following antifungal agents is discussed:
Episode 1: voriconazole (empiric therapy for presumed fungal infection)
Episode 2: voriconazole (antifungal prophylaxis); posaconazole (treatment of zygomycosis); combination antifungal therapy (treatment of invasive fungal infection)
Episode 3: voriconazole (antifungal prophylaxis); lipid-based formulations of amphotericin B (antifungal prophylaxis)

Joint Sponsorship
This activity is jointly sponsored by Center for Independent Healthcare Education and Vemco MedEd.

Commercial Support
This activity is supported by an educational grant from Schering-Plough Corporation.

Fee
There is no fee to participate in this educational activity.

Hardware/Software Requirements
Web Browser
Internet Explorer or Mozilla
Note: Please disable any “pop-up blocker” features.

Software
Flash Player to view the presentations
Adobe Acrobat Reader version 4 or above to view PDF files (If you do not have Acrobat Reader, you can download it for free from http://get.adobe.com/reader)

Connection Speed
Cable, DSL, or better of at least 300 kbps

Hardware
PC or Apple to view the presentations
Audio Speakers

System Check
Please e-mail any questions or concerns to info@vemcomeded.com.

Copyright Statement
Copyright © 2009 Vemco MedEd, LLC. All Rights Reserved. Permission for accreditation use granted to Center for Independent Healthcare Education.

Disclaimer
The opinions expressed in this educational activity are those of the faculty and do not reflect the views of Center for Independent Healthcare Education (Center) and Vemco MedEd. This educational activity may discuss off-label and/or investigational uses and dosages for therapeutic products/procedures that have not been approved by the United States Food and Drug Administration (FDA). Center and Vemco MedEd do not recommend the use of any product/procedure outside of the labeled indications. A qualified healthcare professional should be consulted before using any therapeutic product/procedure discussed. Learners should verify all information and data before treating patients or employing any therapies described in this continuing education activity. Please refer to the official prescribing information for each product/procedure for approved indication, contraindications, and warnings.

Privacy Policy
http://www.vemcomeded.com/privacy.asp

Contact Information
For questions regarding the accreditation of this activity, please contact Center for Independent Healthcare Education at info@jointsponsor.com

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Episode 1

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Episode 2

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Episode 3

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