Internal Medicine Update

16th annual The Art and Science of Managing Chronic Illness Nov. 30 and Dec. 1, 2012 280 W. Jefferson St.

16th annual Dear Colleague, On behalf of Norton Healthcare and the University of Louisville School of Medicine, it is our privilege to invite you to the 16th annual Internal Medicine Update. The tradition of the annual builds on our well-known progenitors over the past 30 years Methodist Evangelical Hospital s State-of-the-Art Update series, the Norton Hospital Medical Staff Symposia and the University of Louisville School of Medicine s prestigious reputation for medical education. This highly successful combined effort represents a collective history of providing opportunities for outstanding continuing education and renewal of the professional ties that bind our medical staffs locally and regionally. Our planning committee has once again selected a variety of topics to address the educational needs and practice challenges expressed by you and your peers across Kentucky and Southern Indiana. This program demonstrates our collective dedication to excellence in lifelong learning and the ongoing pursuit of providing the highest quality health care. We appreciate your continued support and shared commitment to strive for excellence and best practices of the physician s art, setting the standard for quality and caring. Steven T. Hester, M.D., MBA System Senior Vice President, Chief Medical Officer Norton Healthcare Kenneth C. Wilson, M.D. Course Co-director System Vice President, Quality and Clinical Effectiveness Norton Healthcare W. Paul McKinney, M.D., FACP Course Co-director Professor of Medicine and Public Health Associate Dean for Research School of Public Health and Information Sciences University of Louisville James M. Frazier, M.D. Course Co-director System Vice President, Medical Affairs Norton Healthcare Educational objectives Friday, Nov. 30, 2012 1. Discuss a working definition of patient activation. (Hibbard) 2. Practice measurement methods to increase patient activation to improve care and outcomes. (Hibbard) 3. Identify the causes and magnitude of the heart failure epidemic. (Lash) 4. Outline strategies and the importance of care delivery models in heart failure. (Lash) 5. Demonstrate how new technologies may be used to leverage heart failure care delivery. (Lash) 6. Correctly select patients who are candidates for advanced heart failure therapy. (McCants) 7. List acceptable outcomes for advanced heart failure therapy. (McCants) 8. Evaluate patients in a timely manner for referral for cardiac transplantation or left ventricular assist device therapy. (McCants) 9. Recognize the role of hyperglycemia in mortality and morbidity of the hospitalized patient. (Cyrus) 10. Calculate the monetary and human cost of inadequate management of hyperglycemia in critical care settings. (Cyrus) Saturday, Dec. 1, 2012 1. Effectively diagnose and treat dementia. (Furman) 2. Recognize the importance of advance care planning with dementia patients. (Furman) 3. Describe the impact of caregiver burden surrounding the dementia patient. (Furman) 4. Outline the need for antimicrobial stewardship. (Schulz) 5. List steps in how to develop an antimicrobial stewardship program. (Schulz) 11. Apply accepted guidelines for management of hyperglycemia in the inpatient population. (Cyrus) 12. Describe brief, effective methods for depression screening in primary care. (Wright) 13. List at least four evidence-based treatments for depression. (Wright) 14. Outline at least four evidencebased paths to treating chronic or treatment-resistant depression. (Wright) 15. Implement current strategies for treating chronic pain with particular attention to the rational use of controlled substances in today s legal environment. (Murphy) 16. Define new anticoagulants for atrial fibrillation. (Schwartz) 17. Discuss advantages and disadvantages of new anticoagulants versus warfarin. (Schwartz) 18. Recognize hematological malignancies as chronic illness. (Stevens) 19. Identify issues related to oral chemotherapy. (Stevens) 20. Outline current asthma management recommendations. (Hasselbacher) 6. Apply principles of antimicrobial stewardship to individual practice. (Schulz) 7. Assess patients using the most current diagnosis and treatment strategies for multiple sclerosis. (Tillett) 8. Recognize manifestations of and treatments for macular degeneration and diabetic retinopathy. (Purkiss) 9. Apply current treatment regimens for chronic kidney disease and renal failure. (Aronoff)

Friday, Nov. 30, and Saturday, Dec. 1, 2012 Keynote speaker Judith H. Hibbard, Ph.D. Professor Emerita Department of Planning, Public Policy and Management Faculty Fellow Institute for Policy Research and Innovation University of Oregon Eugene, Ore. Local faculty George R. Aronoff, M.D., M.S., FACP Professor of Medicine and Pharmacology Division of Nephrology Vice Chair, Clinical Affairs Department of Medicine Jahangir Cyrus, M.D. Endocrinologist Norton Community Medical Associates Endocrinology Christian Furman, M.D., MSPH Associate Professor of Family and Geriatric Medicine Vice Chair, Geriatric Medicine Department of Family and Geriatric Medicine David A. Hasselbacher, M.D. Pulmonologist Chest Medicine Associates PSC Joseph A. Lash, M.D. Cardiologist Norton Cardiovascular Associates Kelly C. McCants, M.D. Assistant Professor of Medicine Medical Director, Cardiac Transplantation Program Assistant Director, Advance Heart Failure Program James P. Murphy, M.D. Pain Medicine Murphy Pain Center Assistant Clinical Professor of Anesthesiology President-Elect, Greater Louisville Medical Society Todd J. Purkiss, M.D. Ophthalmologist Kentucky Eye Care Paul S. Schulz, M.D. System Epidemiologist Medical Director of Infection Control Norton Healthcare Robert A. Schwartz, M.D. Cardiologist Norton Cardiovascular Associates Don A. Stevens, M.D. Medical Oncologist Norton Cancer Institute Robert S. Tillett Jr., M.D. Neurologist Norton Neuroscience Institute Medical Director, MS Center Jesse H. Wright, M.D., Ph.D. Director University of Louisville Depression Center Professor of Psychiatry Vice Chair of Academic Affairs Department of Psychiatry and Behavioral Sciences Continuing education Physicians AAFP credit Application for CME credit has been filed with the American Academy of Family Physicians. Determination of credit is pending. AMA PRA Category 1 Credits Accreditation: Norton Healthcare is accredited by the Kentucky Medical Association to provide continuing medical education for physicians. Designation: Norton Healthcare designates this educational activity for a maximum of 11.00 AMA PRA Category 1 Credits (7.25 on Friday, 3.75 on Saturday). Physicians should only claim credit commensurate with the extent of their participation in the activity. For questions related to CME, contact Carol Fout-Zignani, MSN, BSN, CCMEC, director of Norton Healthcare CME, at (502) 629-8574 or carol.fout-zignani@nortonhealthcare.org. Nurses Norton Healthcare is an approved provider of continuing nursing education by the North Carolina Nurses Association, an accredited approver by the American Nurses Credentialing Center s Commission on Accreditation. Nov. 30: ANCC #094-20-150; 7.25 contact hours Dec. 1: ANCC #094-80-151; 3.75 contact hours Participants must attend the entire course and complete the evaluation to receive contact hours. Sponsors reserve the right to substitute speakers with equivalent credentials for both days. Norton Healthcare adheres to the ANCC s policies, including the standards for commercial support, regarding industry support of continuing nursing education. For questions related to nursing credit, contact Debora Williams, MHA, BSN-C, R.N., Norton Healthcare Institute for Nursing, at (502) 629-7359 or debbie.williams@nortonhealthcare.org. Register online at NortonHealthcare.com/CME Live Activities

16th annual Disclosure policy Norton Healthcare adheres to the KMA Essential Areas and Policies, including the Standards for Commercial Support, regarding industry support of CME. During the planning process, all individuals in a position to control the content of this educational activity (course directors, planners, presenters) must disclose all relevant financial relationships they have with commercial interests as well as the nature of the relationship that may be a potential conflict of interest. These are assessed by the Norton Healthcare Office of CME to ensure adequate resolution of any identified conflicts prior to the activity. Disclosure of faculty and commercial relationships, as well as the discussion of unlabeled or unapproved use of any drug, device or procedure by the faculty, is disclosed here to the potential learners. Further, physician attendees will be asked to evaluate all speakers content for bias and balance at the symposium. Speaker Commercial interest Relevant financial relationship George R. Aronoff, M.D., M.S., FACP None None Jahangir Cyrus, M.D.* Sanofi-Aventis, Lilly, Novo Nordisk Honorarium for speaker role Christian Furman, M.D., MSPH None None David A. Hasselbacher, M.D. None None Judith H. Hibbard, Ph.D.* Insignia Health Honorarium for speaker role Joseph A. Lash, M.D. None None Kelly C. McCants, M.D. None None James P. Murphy, M.D. None None Todd J. Purkiss, M.D.* QLT Inc. Consulting fees and paid speaker Paul S. Schulz, M.D.* Pfizer Honorarium for speaker role Robert A. Schwartz, M.D. None None Don A. Stevens, M.D. None None Robert S. Tillett Jr., M.D.* Teva Pharmaceuticals Biogen Idec Roche Pharmaceuticals Sun Pharmaceuticals Novartis Pharmaceuticals Sanofi Honorarium as speaker Honorarium as speaker, research grant, principle investigator Research grant, principle investigator Research grant, principle investigator Research grant, principle investigator Research grant, principle investigator National Institute of Mental Health Research grant as principle investigator Jesse H. Wright, M.D., Ph.D.* Empower Interactive, Mindstreet Stock as ownership interest American Psychiatric Publishing Guilford Press, Simon & Schuster Royalties as book author Planning Committee None None *Speakers with identified conflicts of interest have satisfactorily resolved conflicts prior to the symposium. A special thanks to the Planning Committee Helen Anderkin CME Coordinator, Norton Healthcare Office of CME Carol Fout-Zignani, MSN, BSN, CCMEC Director, Norton Healthcare Office of CME James M. Frazier, M.D. System Vice President, Medical Affairs, Norton Healthcare Mary Ann Henry, M.D. Norton Healthcare Physician Donna Irmscher, CCMEC CME Coordinator, Norton Healthcare Office of CME W. Paul McKinney, M.D. Professor and Associate Dean for Research, University of Louisville Robert Powell, M.D. Medical Director Emeritus, Norton Hospital Debora Williams, MHA, BSN-C, R.N. Clinical Educator, Norton Healthcare Institute for Nursing Kenneth C. Wilson, M.D. Norton Healthcare System Vice President, Quality and Clinical Effectiveness Acknowledgment Norton Healthcare gratefully acknowledges support from entities known at the time of this printing: The William H. Anderson M.D. Memorial Pulmonary Lectureship Fund

Friday, Nov. 30, and Saturday, Dec. 1, 2012 Goal and target audience The goal of this jointly sponsored activity is to bring together physicians, nurse practitioners, nurses, residents, students and other interested internal medicine and family medicine health care professionals to enhance knowledge, competence, performance and patients outcomes. Statement of need Topics and speakers have been determined based on real or perceived gaps in education: those expressed by you on previous years evaluations, current practice issues highlighting new medicine or new technologies available, or gaps determined by our planning experts to be highly salient to today s practice challenges. Further, needs have been correlated with maintenance of certification (MOC) requirements and competency areas outlined by the American Board of Medical Specialties and Accreditation Council for Graduate Medical Education. William H. Anderson, M.D. Memorial Pulmonary Lectureship This year s conference features the fourth Norton Healthcare presentation of an annual lectureship created in memory of long-time pulmonary physician William H. Anderson, M.D. After serving in the Navy and graduating from medical school, Dr. Anderson returned to practice medicine in his native Appalachian region, where an early interest in treating coal miners eventually led him to a position as associate professor of medicine at the University of Louisville. In 1969, he became the first chief of the pulmonary section, a post he held for 21 years. From 1972 to 1982, Dr. Anderson served as associate dean of the U of L School of Medicine. He retired from U of L to private practice in 1990 after training 72 physicians to be pulmonary specialists and gaining national recognition for his lung disease research. He passed away in July 2004. An endowed fund was established with the help of Dr. Anderson s graduate fellows to ensure a tribute to The Chief in the form of the William H. Anderson, M.D. Memorial Pulmonary Lectureship, in honor of Dr. Anderson s professional achievements in pulmonary medicine and lifelong dedication to the education and training of young physicians. Agenda Friday, Nov. 30, 2012 7 a.m. Registration, buffet breakfast, exhibits open 7:45 a.m. Welcome 8 a.m. Opening keynote: Engaging Patients to Reach the Triple Aim Judith H. Hibbard, Ph.D. 9 a.m. Developing Care Delivery Models for Heart Failure: Back to the Future? Joseph A. Lash, M.D. 10 a.m. Break/exhibits open 10:30 a.m. End-stage Treatment for Advanced Heart Failure Kelly C. McCants, M.D. 11:15 a.m. Inpatient Diabetes and Metabolic Management and Control Jahangir Cyrus, M.D. Noon Lunch (included)/exhibits open 1 p.m. Afternoon keynote: Maximizing the Effectiveness of Treatment of Depression Jesse H. Wright, M.D., Ph.D. 1:45 p.m. Pain Management Update James P. Murphy, M.D. 2:30 p.m. Advances in Anticoagulation for Atrial Fibrillation Robert A. Schwartz, M.D. 3:15 p.m. Break/exhibits open 3:45 p.m. Blood Cancers and Primary Care Don A. Stevens, M.D. 4:30 p.m. Closing keynote: William H. Anderson, M.D. Memorial Pulmonary Lectureship Asthma Update David A. Hasselbacher, M.D. 5:15 p.m. Evaluation/adjournment Saturday, Dec. 1, 2012 7:55 a.m. Registration, buffet breakfast, exhibits open 8 a.m. Morning keynote: Dementia Update Christian Furman, M.D., MSPH 8:45 a.m. Developing an Institutional Program to Enhance Antimicrobial Stewardship Paul S. Schultz, M.D. 9:30 a.m. Multiple Sclerosis in 2012: One Step Closer to a Cure Robert S. Tillett Jr., M.D. 10:15 a.m. Break 10:30 a.m. Macular Degeneration and Diabetic Retinopathy for the Primary Care Physician Todd J. Purkiss, M.D. 11:15 a.m. Chronic Kidney Disease and Chronic Renal Failure Update George R. Aronoff, M.D., M.S., FACP Noon Evaluation/adjournment Register online at NortonHealthcare.com/CME Live Activities

16th annual Special needs Norton Healthcare is committed to making its conferences accessible to all individuals. At the time of registration, describe any auxiliary aids or services (identified in the Americans with Disabilities Act) that might be needed. Advance notification of any special needs help us better accommodate them. Most requests can be obliged. Registration Early bird deadline: Oct. 30, 2012 Final deadline: Nov 23, 2012 Three ways to register NortonHealthcare.com/CME (click on Live Activities) Fax completed registration form/credit card information to Norton Healthcare CME at (502) 629 6556. Mail completed registration form with check to: (Make check payable to Norton Healthcare) Norton Healthcare CME 315 E. Broadway, Suite 505 Louisville, KY 40202 Walk-in registration We encourage you to take advantage of the price break for early registration. In order to be good stewards of our resources, we adhere to the numbers known at that time. Therefore, we highly discourage walkin registration. Should you choose to do so, we cannot guarantee you a seat or meal. Confirmation/cancellation All registrants will be sent a confirmation if registration is received prior to Nov 23, 2012. The registration fee is refundable minus a $30 cancellation fee if canceled by participant prior to Nov 23, 2012. Should the sponsors cancel this conference, registration fees will be reimbursed in full. However, Norton Healthcare is not responsible for any other costs incurred by the participant. E-syllabus We will not provide a handout of the slides at the activity. We will upload a PDF of all slides we are able to secure by Friday, Nov. 23, at NortonHealthcare.com/CME. Click on the Live Activities button. Locate the activity and open the E-Syllabus link. Each agenda title that appears in blue contains a link to the speaker s syllabus contribution. Registration fees Fee includes breakfast (both days), breaks (both days), lunch (Friday only), self-parking (both days) and continuing education credits. Providers at Norton Medical Group practices If you are a physician or nurse working in a Norton Medical Group practice (i.e., Norton Community Medical Associates or Norton Immediate Care Centers), your management has provided a grant that covers your registration fees. However, you must register so that we can provide you with a seat and meals. Norton Healthcare employees not with Norton Medical Group practices If you are a Norton Healthcare employee who does not work in a physician practice, deduct $20 from the registration fees listed below. internal medicine students/residents/interns No charge Physicians Friday, Nov. 30, 2012 $120 per registrant (On or before Oct. 30, 2012) $130 per registrant (After Oct. 30, 2012) Saturday, Dec. 1, 2012 $65 per registrant (On or before Oct. 30, 2012) $75 per registrant (After Oct. 30, 2012) Both days $185 per registrant (On or before Oct. 30, 2012) $205 per registrant (After Oct. 30, 2012) Nurses, physician assistants, allied health professionals Friday, Nov. 30, 2012 $75 per registrant (On or before Oct. 30, 2012) $85 per registrant (After Oct. 30, 2012) Saturday, Dec. 1, 2012 $45 per registrant (On or before Oct. 30, 2012) $55 per registrant (After Oct. 30, 2012) Both days $120 per registrant (On or before Oct. 30, 2012) $140 per registrant (After Oct. 30, 2012) Location and accommodations Conveniently located off I-65, the is connected by pedway to the Kentucky International Convention Center as well as Fourth Street Live!, Louisville s exciting entertainment district. Nearby attractions include the Muhammad Ali Center, Kentucky Center for the Arts, Louisville Slugger Museum, Waterfront Park, Louisville Science Center, Frazier History Museum, Glassworks and Louisville Slugger Field. A block of rooms at a special opening rate ($159 single or double) is available for symposium participants until Thursday, Nov. 1, 2012. Room reservations are the responsibility of the individual and may be obtained by calling the at (800) 533-0127 (mention you are attending the Norton Symposium to obtain the special room rate). A link to hotel registration can be accessed at NortonHealthcare.com/CME Live Activities. Self-parking is available in the hotel s underground garage, accessible off of Liberty Street. Be sure to bring in your parking ticket for validation at the registration desk.

Friday, Nov. 30, and Saturday, Dec. 1, 2012 Registration form Deadlines For registration: Nov. 23, 2012 (Early bird rates end Oct. 30) For hotel: Nov. 1, 2012 q M.D. q Resident M.D. q Intern M.D. q Student q Nurse practitioner q R.N. or LPN q Other: Specialty: Name: Mailing address: City: State: ZIP: Professional license #: State of licensure: AHSN# (Norton Healthcare employees): Phone: ( ) Fax: ( ) Email address: Do you prefer to receive a letter of confirmation via: q Email q U.S. mail q Fax q Disability accommodations are available. Please indicate if they are needed and attach a description of auxiliary aids or services required. Physicians Friday, Nov. 30, 2012 q $120 (On or prior to Oct. 30) q $130 (After Oct. 30) $ Saturday, Dec. 1, 2012 q $65 (On or prior to Oct. 30) q $75 (After Oct. 30) $ Both days q $185 (On or prior to Oct. 30) q $205 (After Oct. 30) $ q I am a Norton Healthcare employed physician not part of Norton Medical Group Deduct $20 $ q I am employed by Norton Medical Group and included in their grant to cover my registration. $ NC Employment location name: Practice manager: Total amount $ Nurses, physician assistants, allied health professionals Friday, Nov. 30, 2012 q $75 (On or prior to Oct. 30) q $85 (After to Oct. 30) $ Saturday, Dec. 1, 2012 q $45 (On or prior to Oct. 30) q $55 (After to Oct. 30) $ Both days q $120 (On or prior to Oct. 30) q $140 (After to Oct. 30) $ q I am a Norton Healthcare employee not part of Norton Medical Group Deduct $20 $ q I am employed by Norton Medical Group and included in their grant to cover my registration. $ NC Employment location name: Practice manager: Total amount $ U of L students/residents/interns Friday, Nov. 30, 2012 q $ NC Saturday, Dec. 1, 2012 q $ NC Mail form with check made payable to Norton Healthcare to: Norton Healthcare CME, 315 E. Broadway, Suite 505, Louisville, KY 40202 Pay by credit card Name on card: Billing address: City: State: ZIP: Card type: Expires: Card number: Register online at NortonHealthcare.com/CME Live Activities

P.O. Box 35070 Louisville, KY 40232-5070 NONPROFIT ORG. U.S. POSTAGE PAID LOUISVILLE, KY PERMIT #149 Norton Healthcare 9/12 PHY-5196_mlr 16th annual The Art and Science of Managing Chronic Illness Nov. 30 and Dec. 1, 2012 280 W. Jefferson St.