PERIOPERATIVE MANAGEMENT

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1 ContinuIng Medical Education PERIOPERATIVE MANAGEMENT A COURSE DESIGNED FOR PRACTITIONERS TO LIMIT RISK AND IMPROVE PATIENT OUTCOMES BY PROPER Preoperative EVALUATION, INTRAOPERATIVE MANAGEMENT AND POSTOPERATIVE CARE NOW From the Leader in Perioperative Medicine I N ITS 30th YEAR Up-to-date Topics and Clinical Vignettes Individual Consultations with Faculty Experts Knowledge to empower your practice and organization to improve patient care Sunday Wednesday March 9 12, 2014 Marco Island Marriott Marco Island, Florida

2 DESCRIPTION Thirty million patients undergo surgical procedures in the U.S. each year, and the age and medical complexity of this patient population is increasing. All these patients require preoperative assessment, intraoperative management, and postoperative care. Every year the body of peerreviewed literature on this topic increases and new guidelines on clinical management are formulated. Because the breadth of knowledge in perioperative medicine, which includes the diverse disciplines of cardiology, pulmonology, hematology, endocrinology, infectious diseases and geriatrics, is vast, many practitioners may not have up-to-date information that is critical to clinical practice. The curriculum for this course was specifically created to address the needs of clinicians who provide care for patients before, during, and after surgery based on current literature, feedback from course participants, and the opinion of experts from multiple institutions. As the established leader in perioperative medicine, this course aims to provide practitioners with the most up-to-date knowledge necessary to deliver effective, evidencebased care by affecting health care practices at the level of the individual and the larger health system. WHO SHOULD ATTEND This activity is intended for anesthesiologists, internal medicine specialists, hospitalists, surgeons, family practitioners, nurse anesthetists, nurse practitioners and physician assistants. OBJECTIVES After attending this activity, the participant will demonstrate the ability to: Describe current guidelines for preoperative cardiac and pulmonary risk assessment and list several ways to predict and prevent cardiac and pulmonary complications using preoperative testing, and intraoperative and postoperative interventions. Describe the perioperative risks associated with diabetes, obesity, renal insufficiency, and cognitive dysfunction/delirium and list medical and/or surgical management strategies to minimize complications in patients with these medical conditions. Describe bleeding and thrombotic risks in surgical patients and list several strategies to reduce complications through evidence-based use of blood conservation methods, transfusion, anti-fibrinolytic agents and management of antithrombotic drug therapies. Recognize how to prevent, diagnose, and treat common healthcare associated infections that complicate surgical procedures. Recognize the impact of health care provider stress and institutional health care culture on the safety and quality of health care delivery in the perioperative period. ACCREDITATION STATEMENT is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. CREDIT DESIGNATION STATEMENT designates this live activity for a maximum of AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity. OTHER CREDIT American Nurses Credentialing Center American Nurses Credentialing Center accepts AMA PRA Category 1 Credit TM from organizations accredited by the ACCME. American Academy of Family Physicians This Live activity, Perioperative Management-In Its 30th Year, with a beginning date of 03/09/14, has been reviewed and is acceptable for up to Prescribed credits by the American Academy of Family Physicians. Physicians should claim only the credit commensurate with the extent of their participation in the activity. American Association of Nurse Anesthetists This program has been prior approved by the American Association of Nurse Anesthetists for 23 CE credits; Code Number ; Expiration Date 03/12/14. American Association of Nurse Practitioners American Association of Nurse Practitioners accepts AMA PRA Category 1 Credit TM from organizations accredited by the ACCME. American Academy of Physician Assistants American Academy of Physician Assistants accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a maximum of AAPA Category 1 CME credits for completing this program. Contact Hours for Non-Physicians The Johns Hopkins University has approved this activity for contact hours for non-physicians. POLICY ON SPEAKER AND PROVIDER DISCLOSURE It is the policy of the Johns Hopkins University School of Medicine that the speaker and provider disclose real or apparent conflicts of interest relating to the topics of this educational activity, and also disclose discussions of unlabeled/unapproved uses of drugs or devices during their presentation(s). OCME has established policies in place that will identify and resolve all conflicts of interest prior to this educational activity. Detailed disclosure will be made in the activity handout materials.

3 GENERAL INFORMATION REGISTRATION Saturday, March 8 5:00 7:00 Capri Foyer Once registered, please join us for a reception at the Sunset Terrace South on Saturday from 5:00-7:00 pm. FEES REGISTRATION CUT-OFF DATE: March 3, 2014 Methods of Payment: Payment by check or credit card must accompany the registration form prior to the activity. On-site payments by credit card only. Foreign payments must be by credit card or with a U.S. Dollar World Money Order. The registration fee includes instructional materials, continental breakfast, and refreshment breaks. Physicians...$729 Nurse Anesthetists/Physician Assistants/Nurse Practitioners/Other Health Professionals...$635 Residents/Fellows/Nurse Trainees*...$350 *with verification of status You will receive a confirmation by if you have provided your address. Otherwise confirmation will be sent by mail. If you have not received it by March 3, 2014 call (410) to confirm that you are registered. A certificate of attendance will be sent by April 30, 2014 to the address you provide on the registration form. The Johns Hopkins University reserves the right to cancel or postpone any activity due to unforeseen circumstances. In this event, the University will refund the registration fee but is not responsible for travel expenses. Additionally, we reserve the right to change the venue to a comparable venue. Under such circumstances registrants will be notified as soon as possible. LATE FEE AND REFUND POLICY A $50 late fee applies to registrations received after 5:00 p.m. EST on March 3, A handling fee of $50 will be deducted for cancellation. An additional fee may apply for cancellation of other events, including workshops and social activities. Refund requests must be received by fax or mail by March 3, No refunds will be made thereafter. Transfer of registration to another Johns Hopkins conference in lieu of cancellation is not possible. SOCIAL EVENT A complimentary reception for registrants and faculty will be held on Saturday, March 8th, from 5:00 7:00 p.m. on the Sunset Terrace South. Light snacks will be served. Pre-registration will also be available during that time. Please indicate your attendance on the registration form. NOTE: The commercial support received is solely for the educational component of this activity and will not be used to support this social event. EVALUATION A form will be available to attendees to evaluate each session and each speaker s presentation, as well as to identify future educational needs. SYLLABUS There are three options available for obtaining the syllabus: Flashdrive: All registrants will receive a flashdrive with the slides and paper for note taking. This is included in the cost of your registration. Hard Copy with Binder: A hard copy of the syllabus should be ordered ahead of time and is available for an additional charge. (See Registration Page) Online Version available for download: A link to the syllabus will be provided via shortly before the activity, if you prefer to print the syllabus ahead of time. (There is a business center at the hotel, however, computers/printers are limited and the Marriott levies a charge for this service.) HOTEL AND TRAVEL INFORMATION Marco Island Marriott Resort Golf Club and Spa (800) South Collier Boulevard (239) Marco Island, Florida Fax: (239) The award winning Marco Island Marriott is scenically located directly on the Gulf of Mexico along 3 1/2 miles of white sand beach at the southwestern tip of Florida. The resort is easily accessible by car and enjoys breathtaking sunset views over the Gulf of Mexico. Nearby Naples offers incredible shopping and dining opportunities. With March temperatures averaging 80 degrees, the Marco Island Marriott is truly the perfect winter getaway meeting location! Our special group room rate is $399, single or double, plus state and local taxes. The cut-off date for hotel reservations is Thursday, February 13, If you intend to stay at the Marriott, please book early. The hotel is usually SOLD OUT by January 15- before the cut-off date. Check in time is 4:00 p.m. and check out time is 11:00 a.m. All reservation requests require a credit card guarantee of one night s deposit. Deposits will be refunded for rooms cancelled more than seven days prior to arrival. HOTEL RESERVATION CUT-OFF DATE: FEBRUARY 13, 2014 Avis Rent-A-Car: For car rental discounts, call Avis at (800) and mention AWD number A EMERGENCY CALLS On March 9-12, 2014 direct emergency calls to (239) and ask that a message be sent to the Johns Hopkins registration desk. Messages will be posted for participants. OUTCOMES SURVEY A survey will be sent to all physician attendees within three months post activity to assist us in determining what impact this activity had on the attendee s practice.

4 SPEAKERS Course Directors Professor of Anesthesiology/Critical Care Medicine and Surgery Director, Perioperative Hemostasis and Thrombosis Research Laboratory Director, Perioperative Genomic Research Sean Berenholtz, MD, MHS, FCCM Associate Professor of Anesthesiology/Critical Care Medicine and Surgery Director, ICU Performance Improvement Committee Co-Director, Johns Hopkins Quality and Safety Research Group Johns Hopkins Faculty Lauren Berkow, MD Associate Professor of Anesthesiology/Critical Care Medicine and Otolaryngology and Head and Neck Surgery Director, Airway Services Professor of Anesthesiology/Critical Care Medicine, Surgery, and Nursing Associate Dean and Director of Continuing Medical Education Vice Chair, Dept. of Anesthesiology/Critical Care Medicine Assistant Professor of Medicine Division of General Internal Medicine Director of Education, Johns Hopkins Hospitalist Service Derek Fine, MD Associate Professor of Medicine Division of Nephrology Anne Lidor, MD Associate Professor of Surgery Division of Gastrointestinal Surgery Professor of Surgery and Anesthesiology/Critical Care Medicine Director, General Surgery and Surgical Critical Care Training Programs Co-Director, Surgical Intensive Care Mark Romig, MD Assistant Professor of Anesthesiology AMERICANS WITH DISABILITIES ACT fully complies with the legal requirements of the ADA and the rules and regulations thereof. Please notify us if you have any special needs. ACKNOWLEDGEMENT Applications for commercial support from health care related industries are pending. A complete list of contributors will be provided in the syllabus. Please note: The Physician Payments Sunshine Act was enacted by Congress to increase public awareness of financial relationships between drug and medical device manufacturers and physicians. In compliance with the requirements of this Act, the commercial supporter/s of this activity may require the Johns Hopkins University School of Medicine to report certain professional information (such as name, address, National Provider Identifier, and State License #) of physician attendees who receive complimentary food and beverage in conjunction with a CME activity. The commercial supporter is required to submit the collected data to the Centers for Medicare and Medicaid Services which will then publish the data on its website. Frederick Sieber, MD Professor of Anesthesiology/Critical Care Medicine Clinical Director, Johns Hopkins Bayview Campus Jerry Stonemetz, MD Staff Anesthesiologist, Dept of Anesthesiology National Medical Director for Anesthesia Services, Hospital Corporation of America Assistant Professor of Medicine Division of Cardiology Guest Faculty Elizabeth Martinez, MD, MHS Staff Anesthesiologist, Massachusetts General Hospital Associate Professor of Anesthesiology, Harvard Medical School Boston, Massachusetts Peter Rock, MD, MBA, FCCM, FCCP Professor of Medicine, Surgery, and Anesthesiology Chair, Dept. of Anesthesiology, University of Maryland School of Medicine Baltimore, Maryland J. Bryan Sexton, PhD Associate Professor of Psychiatry, Duke University School of Medicine Director of Patient Safety, Training and Research Durham, North Carolina Marc Shnider, MD Staff Anesthesiologist, Beth Israel Deaconess Hospital Clinical Instructor in Anesthesia, Harvard Medical School Boston, Massachusetts Brett Simon, MD, PhD Anesthesiologist-in-Chief, Beth Israel Deaconess Hospital Professor of Anesthesiology, Harvard Medical School Boston, Massachusetts TO REGISTER or FOR FURTHER INFORMATION Register Online (credit card and echeck) Register by Phone (410) (credit card only) Register by Fax (866) Confirmation/Certificates (410) General Information (410) the Office of CME cmenet@jhmi.edu Follow us on Twitter: Facebook: For general information, the direct link for this CME activity web page is: edu/coursedetail.aspx/

5 PROGRAM Sunday, March 9, :00-7:45 Registration/Continental Breakfast 7:45-8:00 Introduction 8:00-8:30 The Perioperative Stress Response 8:30-9:00 Preoperative Evaluation: Optimized, Not Cleared 9:00-9:30 Preoperative Cardiac Risk Assessment and Testing 9:30-10:00 Perioperative Myocardial Ischemia: Mechanisms and Management Strategies 10:00-10:15 Questions and Answers 10:15-10:30 Case Discussion with Faculty/ 10:30-11:00 Perioperative Management of Patients on Chronic Anti-Platelet Therapy 11:00-11:30 Surgical Site Infections 11:30-12:30 Controversial Clinical Vignettes Evidence-Based Preoperative Testing Sean Berenholtz, MD, MHS The Preoperative Patient with a Pacemaker or ICD Perioperative Management of the Hypertensive Patient Perioperative Management of Patients on Chronic Anti- Coagulant Therapy 12:30-1:00 Health Care Provider Stress I: Recognition and Impact on Provider and Patient Outcomes J. Bryan Sexton, PhD 1:00-1:15 Questions and Answers Monday, March 10, :00-7:30 Continental Breakfast and Case Discussion with Faculty 7:30-7:45 Questions and Answers 7:45-8:15 Preoperative Pulmonary Risk Assessment and Testing Peter Rock, MD, MBA, FCCM, FCCP 8:15-8:45 Perioperative Management of Diabetes and Hyperglycemia 8:45-9:15 Perioperative Management of Patients with Cardiomyopathy 9:15-9:45 Health Care Provider Stress II: Fatigue Management J Bryan Sexton, PhD 9:45-10:00 Questions and Answers 10:00-10:15 Case Discussion with Faculty/ 10:15-10:45 Perioperative Respiratory Insufficiency: Mechanisms and Management Peter Rock, MD, MBA, FCCM, FCCP 10:45-12:00 Controversial Clinical Vignettes: Perioperative Glucose Management in the Brittle Diabetic Preoperative Evaluation and Management of the Patient with Heart Failure Intra- and Post-operative Challenges in Patients with Heart Failure Elizabeth Martinez, MD, MHS Allergy and Anaphylaxis Managing the Difficult Airway Outside the OR Lauren Berkow, MD 12:00-12:30 Perioperative Risks and Management of Pulmonary Hypertension Brett Simon, MD, PhD 12:30-1:00 Health Care Provider Stress III: Dealing with Difficult Colleagues J Bryan Sexton, PhD 1:00-1:15 Questions and Answers Tuesday, March 11, :00-7:30 Continental Breakfast and Case Discussion with Faculty 7:30-7:45 Questions and Answers 7:45-8:15 Preventing, Identifying, and Managing Common Healthcare Associated Infections 8:15-8:45 Perioperative Renal Dysfunction Derek Fine, MD 8:45-9:15 Perioperative Management of the Patient with Hepatic Disease Brett Simon, MD, PhD

6 9:15-9:45 Management of Perioperative Bleeding and Transfusion 9:45-10:00 Questions and Answers 10:00-10:15 Case Discussion with Faculty/ 10:15-10:45 Perioperative Management of the Patient with Obstructive Sleep Apnea Peter Rock, MD, MBA, FCCM, FCCP 10:45-11:15 Acute Pain Management: Opioids, Non-Narcotics, and Nerve Blocks Marc Shnider, MD 11:15-12:45 Controversial Clinical Vignettes: Perioperative Fluid Management Managing Bleeding in Patients Anticoagulated with Novel IIa/Xa Inhibitors Perioperative Management of Steroids and Adrenal Insufficiency Derek Fine, MD Perioperative Management of the Patient on Chronic Immunosuppressive Therapy Mark Romig, MD Pain Management in the Opioid- Tolerant Patient: A Case-Based Discussion Marc Shnider, MD Perioperative Nutrition Support Anne Lidor, MD 12:45-1:15 Surgical Management of Obesity Anne Lidor, MD 1:15-1:30 Questions and Answers Wednesday, March 12, :00-7:30 Continental Breakfast and Case Discussion with Faculty 7:30-7:45 Questions and Answers 7:45-8:15 Perioperative DVT and Pulmonary Embolism 8:15-8:45 Post-Operative Delirium and Cognitive Dysfunction Frederick Sieber, MD 8:45-9:15 Managing End of Life Issues in Surgical Patients 9:15-9:45 Improving Perioperative Quality and Safety through System and Culture Change Sean Berenholtz, MD, MHS, FCCM 9:45-10:00 Questions and Answers 10:00-10:15 Case Discussion with Faculty/ 10:15-10:45 Healthcare Reform: Implications of New Payment Models and Compliance for Your Practice Jerry Stonemetz, MD 10:45-12:15 Controversial Clinical Vignettes: Perioperative Management of the Patient with Dementia Frederick Seiber, MD A Practical Approach to Measuring and Improving Safety and Teamwork Culture Sean Berenholtz, MD, MHS, FCCM Improving the Quality of Sepsis Care Sean Berenholtz, MD, MHS, FCCM Using Technology to Improve Perioperative Outcomes Mark Romig, MD Anesthesia in the MRI and Endoscopy Suites Lauren Berkow, MD Medico-Legal Liability in Perioperative Medicine: Common Pitfalls and How to Avoid Them Jerry Stonemetz, MD 12:15-12:30 Questions and Answers 12:30 Summary Adjourn Please complete and return the Evaluation and Credit Report Forms. The Registration Desk will remain open during conference hours. HISTORICALLY, THE HOTEL SELLS OUT QUICKLY. PLEASE MAKE YOUR RESERVATIONS EARLY. Marco Island Marriott (800) Reservation Cut-Off Date: Thursday, February 13, 2014 MARK YOUR CALENDAR Future date for Perioperative Management at the Marco Island Marriott March 15-18, 2015 takes responsibility for the content, quality and scientific integrity of this CME activity. This schedule is subject to change.

7 REGISTRATION FORM Course Number Perioperative Management - In Its 30th Year March 9-12, 2014 To Register: Online (credit card and echeck): By fax: (866) By phone (credit card only): (410) Or mail this form to the Johns Hopkins University, Office of Continuing Medical Education, P.O. Box 64128, Baltimore, Maryland Include check payable to HOPKINS/ or include credit card information below. PAYMENT MUST ACCOMPANY FORM TO CONFIRM YOUR REGISTRATION. M I am a Johns Hopkins speaker for this activity. Please type or print clearly: last name first name m.i. highest degree primary specialty Hopkins faculty/staff only JHED ID For Physicians Only: NPI 10 digits State License # State of License mailing address city state ZIP country daytime telephone fax number You will receive a confirmation notice and your attendance certificate by if you provide your address. M Check here if you wish to receive notices about upcoming CME activities. M I will attend the complimentary pre-conference reception on Saturday evening. What do you hope to learn by attending this activity? Please notify us if you have any special needs. Registration Fees: The registration fee includes instructional materials, continental breakfasts and refreshment breaks. M Physicians...$729 M Nurse Anesthetists/Physician Assistants/Nurse Practitioners/Other Health Professionals...$635 M Residents*/Fellows*/Nurse Trainees...$350 *with verification of status M Hard Copy of Syllabus...$ 50 Hard copies ordered in advance can be picked up at the time of registration. Limited quantities of syllabi will be made available for purchase on-site for $60. Total amount enclosed $ Payment Type: JHU Faculty/Staff Only: If you are using your Tuition Remission Benefit or an ION budget, please complete this registration form and return with appropriate payment processing form to OCME, Turner 20. Forms can be found on-line at For registrations received after 5:00 p.m. EST on March 3, 2014 include a $50 late fee. On-site registrations are payable only by credit card. M Check (See instructions on top of form.) M Credit Card: M VISA M MASTERCARD M DISCOVER M AMEX Card # Exp. Date Name on Card Signature & Date

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