Target Audience
This activity has been designed to meet the educational needs of hematologists, hemophilia specialists, hemophilia treatment center clinicians, and other healthcare providers interested in managing patients with hemophilia.


Statement of Need
People with severe hemophilia suffer from frequent intra-articular hemorrhages, leading to pain, swelling, reduced flexion, and arthropathy. Elective orthopedic surgery using FVIII replacement therapy to prevent uncontrolled bleeding has been endorsed as an effective treatment option for patients with severe or advanced hemophilic arthropathy. Unfortunately, some patients with hemophilia develop inhibitors, which neutralize FVIII activity and render the use of even massive amounts of FVIII replacement ineffective and very risky.


Patients with hemophilia complicated by inhibitors have a significant burden of joint disease, which is associated with a negative impact on their quality of life. Successful elective orthopedic surgery can result in decreased bleed frequency into a new joint, less time spent in hospital, increased mobility, and improved well-being.

Educational Objectives
After completing this activity, the participant should be better able to:

• Review the basics of hemophilic arthropathy in patients with hemophilia and inhibitors
• Integrate evidence-based data and clinical rationale for utilizing bypassing agents in patients with inhibitors who are candidates for elective orthopedic surgery
• Use a multidisciplinary approach to counseling and managing inhibitor patients for whom elective orthopedic surgery is indicated

Faculty
Prasad Mathew, MD, FAAP
Professor of Pediatrics
Director, Hemophilia and Hemostasis Program
University of New Mexico
Albuquerque, New Mexico


James V. Luck, Jr, MD
President, CEO & Medical Director
Orthopaedic Hospital
Professor and Vice Chairman
UCLA/Orthopaedic Hospital
Department of Orthopedic Surgery
Los Angeles, California



Physician Continuing Medical Education
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 the joint sponsorship of Postgraduate Institute for Medicine (PIM), the Cardiovascular & Metabolic Health Foundation, and Educational Concepts in Medicine. PIM is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation
Postgraduate Institute for Medicine designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™ for physicians and the equivalent contact hours for nurses. Clinicians should only claim credit commensurate with the extent of their participation in the activity.


Nursing Continuing Education
Credit Designation
This educational activity for 0.5 contact hours is provided by Postgraduate Institute for Medicine (PIM).

Accreditation Statement

Postgraduate Institute for Medicine is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.




Method of Participation
During the period December 23, 2009 through December 23, 2010, participants must:

• Read the learning objectives and faculty disclosures
• Study the educational activity
• Complete the posttest by recording the best answer to each question
• Complete the evaluation form

A statement of credit will be issued upon receipt of a completed activity evaluation form and a completed posttest with a score of 70% or better.


Fee
There is no fee to participate in or to receive credit for this educational activity.


Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) assesses conflict of interest with its instructors, planners, managers, and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by PIM for fair balance, scientific objectivity of studies utilized in this activity, and patient care recommendations. PIM is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Name of Faculty or Presenter	Reported Financial Relationship
Prasad Mathew, MD, FAAP	Consulting: Bayer Pharmaceuticals Corporation, CSL Behring, Novo Nordisk Inc., Wyeth Pharmaceuticals
James V. Luck, Jr, MD	Salary: Los Angeles Orthopaedic Hospital

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Name of Planner or Manager	Reported Financial Relationship
PIM Clinical Reviewers: Trace Hutchison, PharmD; Jan Hixon, RN, BSN, MSN; Linda Graham, RN, BSN; and Jan Schultz, RN, BSN, MSN	Have no real or apparent conflicts of interest to report.
ECM: Patrick J. Crowley, Senior Director, Operations; Jodi Andrews, Foundation Manager; Gay Boyle, Editorial Services	Have no real or apparent conflicts of interest to report.

Media
Internet

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Postgraduate Institute for Medicine (PIM), Cardiovascular & Metabolic Health Foundation (CMH), Educational Concepts in Medicine, and Novo Nordisk Inc. do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of PIM, CMH, Educational Concepts in Medicine, and Novo Nordisk Inc. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.


Commercial Support
This activity is supported by an educational grant from Novo Nordisk Inc.