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| Title: Diagnosis and Management of Osteoporosis: A CME Initiative Based on the Updated National Osteoporosis Foundation Guidelines
| | | AAPA Release Date: May 20, 2009 | | | AAPA Expiration Date: May 31, 2010 | | | Presented by: The American Academy of Physician Assistants | | | Funding: Supported through an educational grant from Novartis Pharmaceutical Corporation with partial funding through an educational grant from Sanofi-aventis. | |
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Faculty
| Lawrence Herman, MPA, RPA-C, DFAAPA
Moderator
Physician Assistant
Senior Clinical Coordinator
Assistant Professor
Department of Physician Assistant Studies
New York Institute of Technology
Old Westbury, NY
Director, Medical Education
Island Medical Physicians, PC
Hauppauge, NY
Mr. Herman is senior clinical coordinator and a tenured professor at New York Institute of Technology, New York College of Osteopathic Medicine affiliation in Old Westbury. He is also vice president of medical education at Island Medical Physicians PC, in Hauppauge, New York, a large, multi-office family practice group.After completing his physician assistant studies at the State University of New York at Stony Brook, Mr. Herman received a master of public administration in health administration and health system finance from Long Island University in Brookville, New York. He was certified by the National Commission on Certification of Physician Assistants, with special distinction in both surgery and primary care and remains certified in primary care.As a Distinguished Fellow of the American Academy of Physician Assistants, Mr. Herman has served and chaired numerous committees including the Clinical and Scientific Affairs Council and the Professional Practice Council, as well as being a Past-President of the New York State Society of Physician Assistants. He has contributed numerous book chapters to the literature and has published many articles in journals such as the Journal of the American Academy of Physician Assistants, The Clinical Advisor, and The Journal of Emergency Medicine. He has participated in numerous randomized trials and continues to be an invited speaker at international and national meetings, including the World Organization of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians; the American Academy of Physician Assistants, the Association of Family Practice Physician Assistants, and the Association of Physician Assistants in Cardiovascular Surgery. | Mary P Ettari, MPH, PA-C
Physician Assistant
General Internal and Family Medicine
Stuart, FL
Ms. Ettari practices family medicine in Florida, with health care experience that crosses clinical, research, and academic areas.After earning an AS and Registered Nurse Certificate at Lasell Junior College in Auburndale, Massachusetts, Ms. Ettari received a BA from New England College in Henniker, New Hampshire and a BS in Health Sciences and Physician Assistant Certificate, graduating magna cum laude, from Duke University School of Medicine in Durham, North Carolina. She then earned a Masters in Public Health, Administrative Track, from George Washington University School of Medicine in Washington, DC.She has served as a Sub-Investigator and Investigator for studies involving diabetic foot ulcers, hypogonadism, and acute treatment of migraine in the primary care setting. A winner of the Duke University Alumni of the Year Award in 2002, the Outstanding Service Award, American Academy of Physician Assistants House of Delegates in 2001, and the Bob Scully Physician Assistant of the Year Award, Florida Academy of Physician Assistants in 2001, Ms. Ettari is active in a number of professional societies and committees. She is a Past President of the AAPA and Past-President of the Physician Assistant Foundation, as well as a member of the Order of St. Lazarus of Jerusalem and a former member of the AAPA Physician Assistant Foundation Board of Trustees. She also serves as a physician assistant expert witness for medical malpractice cases.Ms. Ettari has contributed to articles in such journals as Advance for Physician Assistants, New Therapeutics Bulletin, and Journal of the American Academy of Physician Assistants. She is a nationally known speaker, and has presented at over 70 professional symposia, conferences, and meetings. | Rick Pope, MPAS, PA-C, DFAAPA
Faculty Member
Physician Assistant
Adjunct Professor
Quinnipiac University
Department of Physician Assistant Studies
Hamden, CT
Senior Physician Assistant
Arthritis Center of CT
Waterbury, CT
President, Society of PAs in Rheumatology
Mr. Pope received a certificate of PA education at the State University of New York at Stony Brook along with his BS in Health Science in 1980. He received his Master’s degree from the University of Nebraska Medical School in May of 2007. Since graduation from PA school in 1980, Mr. Pope has worked clinically in ER medicine, family practice and pediatrics, and then moved to the division of rheumatology at the Arthritis Center of CT in 1988. He was asked to develop and coordinate the rheumatology section at Quinnipiac University in 1996 which he still teaches to this day. He is an invited guest lecturer at Stony Brook University PA program where he also teaches first year PA students. Clinically he continues to specialize in rheumatic disorders and is the Senior PA at the Arthritis Center of CT in Waterbury. In addition Mr. Pope has joined the division of rheumatology at a large orthopedic group in Danbury, CT where he consults on rheumatic disorders and osteoporosis. He was an invited faculty member for the US Department of Health and Human Services on the "State of the Art in the Management of Osteoporosis"held in Washington in July 2003. Mr. Pope was the invited presenter for the "State of Art in Osteoporosis"in Las Vegas for the 31st annual AAPA meeting in May of 2004. This coming April Mr. Pope will be attending the National Osteoporosis Foundation’s annual meeting as an invited guest panelist speaking on "The role of the NP/PA in diagnosis and management of osteoporosis.” | |
© 2009 American Academy of Physician Assistants
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| | Title: Diagnosis and Management of Osteoporosis: A CME Initiative Based on the Updated National Osteoporosis Foundation Guidelines | | | AAPA Release Date: May 20, 2009 | | | | AAPA Expiration Date: May 31, 2010 | | | | Presented by: The American Academy of Physician Assistants | | | Funding: Supported through an educational grant from Novartis Pharmaceutical Corporation with partial funding through an educational grant from Sanofi-aventis. | | | Program Overview |
The American Academy of Physician Assistants (AAPA) estimates that physician assistants saw 6,697,969 patients for osteoporosis in 2007.(1)
Osteoporosis is a major public health concern, and the single most common bone disease. It is estimated that 34 million American’s are at risk for osteoporosis and approximately eight million women and two million men have this disease but have not yet been diagnosed and that one in two Caucasian women and one in five men will experience an osteoporosis-related fracture at some time in their life.(2,3)
Osteoporosis fractures are more common than heart attacks, strokes, and breast cancer combined.(4,5,6)
Physician assistants are commonly at the frontline in the screening for and diagnosis and management of osteoporosis.
The recently released Clinician’s Guide to Prevention and Treatment of Osteoporosis by the National Osteoporosis Foundation (NOF) represents a major breakthrough in the management of osteoporosis.(3)
In these guidelines, the NOF has expanded recommendations beyond Caucasian postmenopausal women to include African-American, Asian, Latino, and other postmenopausal women, as well as for the first time, a new recommendation specifically for at-risk men. These guidelines dramatically alter the approach to the diagnosis and management of osteoporosis, providing evidence-based recommendations to help healthcare providers assess fracture risk in their patients and make better treatment decisions. In July 2008, ACIP released their revised recommendations for the 2008-2009 influenza season. Central to the risk assessment recommendations is the recently released World Health Organization (WHO) algorithm for absolute fracture risk, called FRAX.(3,7)
For the first time, publication and dissemination of this algorithm accomplishes two goals: first and foremost, it raises awareness of this under-diagnosed and often forgotten condition. Secondly, it finally provides clinicians with an easy to use point of care tool to estimate the probability of a patient experiencing a fracture due to osteoporosis over a 10-year period. This provides for a clinically applicable methodology for identifying patients at risk, and for making treatment decisions for patients with low bone mass or osteoporosis. While osteopenia and osteoporosis have been readily diagnosed in the past, many clinicians made this diagnosis only after a fracture had occurred and by utilizing this assessment tool, clinicians can now more readily make treatment decisions affording appropriate preventative treatments before, rather than after the sequelae occur.The NOF guidelines were developed in collaboration with, and have been endorsed by the following organizations:-
American Association of Clinical Endocrinologists (AACE)
-
American College of Obstetricians and Gynecologists
- American College of Radiology
- American College of Rheumatology
- American Geriatrics Society
- American Orthopaedic Association
- The Endocrine Society
- International Society of Clinical Densitometry
- International Society of Physical Medicine and Rehabilitation
This program will provide an opportunity for the physician assistant to hear from experts in the management of osteoporosis as they discuss appropriate osteoporosis screening as this relates to the NOF guidelines and the implementation of these guidelines in the clinical setting. PAs will also participate in case-based programs, designed to address commonly seen patient scenarios to help solidify these recommendations for quick assimilation in the patient care setting. | | References | - American Academy of Physician Assistants Annual Survey. Available at http://aapa.org/research/InformationUpdates07/IUDisorders2007.pdf; Accessed October 9, 2008.
- Ebeling PR. National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment. N Engl J Med. 2008;358:1474-1482
- National Osteoporosis Foundation Website: Accessed October 9, 2008; http://www.nof.org/professionals/Clinicians_Guide.htm
- American Cancer Society. Cancer Facts and Figures: 2003. Available at: www.cancer.org/downloads/STT/CAFF2003PWSecured.pdf. Accessed October 9, 2008.
- American Heart Association. Heart and Stroke Statistics: 2003 Update. Available at:www.americanheart.org/downloadable/heart/10590179711482003HDSStatsBookREV7-03.pdf. Accessed October 9, 2008.
- Riggs BL, Melton LJ III. Bone. 1995;17(5 Suppl):505S-511S.
- Kanis JA, et al. Bone. 2002;30:251-258; Kanis JA, et al. Osteoporosis Int. 2005;16:581-589
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Faculty
| | Lawrence Herman, MPA, RPA-C, DFAAPA Moderator Physician Assistant Senior Clinical Coordinator Assistant Professor
Department of Physician Assistant Studies
New York Institute of Technology Old Westbury, NY Director, Medical Education Island Medical Physicians, PC Hauppauge, NY | | | Mary P Ettari, MPH, PA-C
Physician Assistant
General Internal and Family Medicine Stuart, FL | | | Rick Pope, MPAS, PA-C, DFAAPA Faculty Member Physician Assistant Adjunct Professor Quinnipiac University Department of Physician Assistant Studies Hamden, CT Senior Physician Assistant Arthritis Center of CT Waterbury, CT President, Society of PAs in Rheumatology | | | Intended Audience | | Physician Assistants | | |
Clinical Dialogue Program Description
| | This 20 minute Webcast will provide PAs with a review of the current guidelines for the diagnosis and management of osteoporosis based on the National Osteoporosis Foundation (NOF). This Internet-based CME activity includes an optional pre-and post-survey, a CME post-test and program evaluation (feedback). CME credit will be awarded to those achieving a grade of 70% or higher on the post-test. | | |
eCase Challenge Program Description
| | This 20 minute text-based case challenge will provide PAs with a review of a case where they will be asked to make decisions pertaining to the current guidelines by the NOF. At the conclusion of the case, there is a Clinical Pearl video that the participant can view that will highlights the key take away messages from this program. This Internet-based CME activity includes an optional pre-and post-survey, a CME post-test and program evaluation (feedback). CME credit will be awarded to those achieving a grade of 70% or higher on the post-test. | | | Educational Objectives | |
At the conclusion of this activity, the physician assistant should be better able to:
| - Identify primary and secondary causes of osteoporosis
- Assess the risk factors associated with osteoporosis
- Differentiate and analyze the significance of bone density, bone quality, and bone strength
- Prescribe BMD testing for women 65 years and older and for men 70 years and older, regardless of clinical risk factors
- Prescribe BMD testing for younger postmenopausal women and for men 50-70 who have appropriate risk factors
- Routinely prescribe BMD testing to ascertain the degree of disease severity for patients who have experienced a fracture and who are over 50 years of age
- Manage osteoporosis in the context of co-morbidities; and,
- Evaluate non-pharmacologic preventive approaches as well as the efficacy and appropriate pharmacologic management for at-risk patients
| | | Accreditation Statements |  | | This program has been reviewed and is approved for a maximum of 0.5 hour of AAPA Category 1 CME credit by the Physician Assistant Review Panel. Physician assistants should claim only those hours actually spent participating in the CME activity. This program was planned in accordance with the AAPA’s CME Standards for Enduring Material Programs and for Commercial Support of Enduring Material Programs. Approval is valid for one year from the issue date of May 20, 2009. Participants may submit the self-assessment at any time during that period. | | |
Responsibility Statement
| | The American Academy of Physician Assistants takes responsibility for the content, quality, and scientific integrity of this CME activity. | | | Faculty Disclosures | | It is the policy of the American Academy of Physician Assistants to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member has with the commercial interest of any commercial product discussed in an educational presentation. The participating faculty reported the following: | | | Lawrence Herman, MPA, RPA-C, DFAAPA, reports that he has no relationship with any commercial interests whose products or services may be mentioned during this presentation. | | | Mary P Ettari, MPH, PA-C, reports that she has no relationship with any commercial interests whose products or services may be mentioned during this presentation. | | | Rick Pope, MPAS, PA-C, DFAAPA, reports that he is a member of the Novartis Speaker’s bureau. | | | Off-Label Discussion | | There are no references to unlabelled/unapproved uses of products in this program. | | Disclaimer | | The opinions and comments expressed by faculty and other experts, whose input is included in this program, are their own. This enduring material is produced for educational purposes only. Please review complete prescribing information of specific drugs mentioned in this program including indications, contraindications, warnings, and adverse effects and dosage before administering to patients. | | |
Archived Presentation
| | The Clinical Dialogue and eCase Challenge will be archived for clinicians. CME credits will be provided by the AAPA from May 20, 2009 through May 31, 2010 for physician assistants at www.AAPA.org. | | | Obtaining CME Credits | | Upon completion of your participation in the program, physician assistants will be directed to www.AAPA.org to complete a post-test and receive your certificates. | | | Successful completion of the self-assessment by physician assistants is required to earn Category 1 CME credit. Successful completion is defined as a cumulative score of at least 70% correct. Upon successful completion of the post-test, the AAPA will issue a certificate of completion for your records. | |
Technical Requirements
| | Processor Speed: 1.4 GHz P3 | | Memory: 256 MB RAM (20MB available) | | Operating Systems Supported: Windows 2000/XP, MAC | | Browsers Supported: Internet Explorer 5.5 or greater, Mozilla Firefox and Safari 3.525 or greater | |
Additional Requirements: Flash player 8.0 or greater, 800x600 Resolution or higher with 32-bit color
| | Connection Speed: 128 Kbps or better | | Adobe Acrobat 6.0 or greater | | | Sponsored by the American Academy of Physician Assistants | 
| Supported through an educational grant from Novartis Pharmaceutical Corporation with partial funding through an educational grant from Sanofi-aventis.
| | Produced by: |  | | |
© 2009 American Academy of Physician Assistants. All rights reserved.
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| Diagnosis and Management of Osteoporosis: A CME Initiative Based on the Updated National Osteoporosis Foundation Guidelines | | |
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| Processor Speed: 1.4 GHz P3 Memory: 256 MB RAM (20MB available) Operating Systems Supported: Windows 2000/XP, MAC Browsers Supported: Internet Explorer 5.5 or greater, Mozilla Firefox and Safari 3.525 or greater
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Connection Speed: 128 Kbps or better Adobe Acrobat 6.0 or greater
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IN ACCORDANCE WITH AAPA POLICY, PRIOR TO PARTICIPATING IN THIS ACTIVITY PLEASE REVIEW THE INFORMATION BELOW. YOU MAY LAUNCH THIS PROGRAM AT THE BOTTOM OF THIS PAGE.
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| | Title: Diagnosis and Management of Osteoporosis: A CME Initiative Based on the Updated National Osteoporosis Foundation Guidelines | | AAPA Release Date: May 20, 2009 | | | | AAPA Expiration Date: May 31, 2010 | | | | Presented by: The American Academy of Physician Assistants | | | Funding: Supported through an educational grant from Novartis Pharmaceutical Corporation with partial funding through an educational grant from Sanofi-aventis. | | | Program Overview |
The American Academy of Physician Assistants (AAPA) estimates that physician assistants saw 6,697,969 patients for osteoporosis in 2007.(1)
Osteoporosis is a major public health concern, and the single most common bone disease. It is estimated that 34 million American’s are at risk for osteoporosis and approximately eight million women and two million men have this disease but have not yet been diagnosed and that one in two Caucasian women and one in five men will experience an osteoporosis-related fracture at some time in their life.(2,3)
Osteoporosis fractures are more common than heart attacks, strokes, and breast cancer combined.(4,5,6)
Physician assistants are commonly at the frontline in the screening for and diagnosis and management of osteoporosis.
The recently released Clinician’s Guide to Prevention and Treatment of Osteoporosis by the National Osteoporosis Foundation (NOF) represents a major breakthrough in the management of osteoporosis.(3)
In these guidelines, the NOF has expanded recommendations beyond Caucasian postmenopausal women to include African-American, Asian, Latino, and other postmenopausal women, as well as for the first time, a new recommendation specifically for at-risk men. These guidelines dramatically alter the approach to the diagnosis and management of osteoporosis, providing evidence-based recommendations to help healthcare providers assess fracture risk in their patients and make better treatment decisions. In July 2008, ACIP released their revised recommendations for the 2008-2009 influenza season. Central to the risk assessment recommendations is the recently released World Health Organization (WHO) algorithm for absolute fracture risk, called FRAX.(3,7)
For the first time, publication and dissemination of this algorithm accomplishes two goals: first and foremost, it raises awareness of this under-diagnosed and often forgotten condition. Secondly, it finally provides clinicians with an easy to use point of care tool to estimate the probability of a patient experiencing a fracture due to osteoporosis over a 10-year period. This provides for a clinically applicable methodology for identifying patients at risk, and for making treatment decisions for patients with low bone mass or osteoporosis. While osteopenia and osteoporosis have been readily diagnosed in the past, many clinicians made this diagnosis only after a fracture had occurred and by utilizing this assessment tool, clinicians can now more readily make treatment decisions affording appropriate preventative treatments before, rather than after the sequelae occur.The NOF guidelines were developed in collaboration with, and have been endorsed by the following organizations:-
American Association of Clinical Endocrinologists (AACE)
-
American College of Obstetricians and Gynecologists
- American College of Radiology
- American College of Rheumatology
- American Geriatrics Society
- American Orthopaedic Association
- The Endocrine Society
- International Society of Clinical Densitometry
- International Society of Physical Medicine and Rehabilitation
This program will provide an opportunity for the physician assistant to hear from experts in the management of osteoporosis as they discuss appropriate osteoporosis screening as this relates to the NOF guidelines and the implementation of these guidelines in the clinical setting. PAs will also participate in case-based programs, designed to address commonly seen patient scenarios to help solidify these recommendations for quick assimilation in the patient care setting. | | References | - American Academy of Physician Assistants Annual Survey. Available at http://aapa.org/research/InformationUpdates07/IUDisorders2007.pdf; Accessed October 9, 2008.
- Ebeling PR. National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment. N Engl J Med. 2008;358:1474-1482
- National Osteoporosis Foundation Website: Accessed October 9, 2008; http://www.nof.org/professionals/Clinicians_Guide.htm
- American Cancer Society. Cancer Facts and Figures: 2003. Available at: www.cancer.org/downloads/STT/CAFF2003PWSecured.pdf. Accessed October 9, 2008.
- American Heart Association. Heart and Stroke Statistics: 2003 Update. Available at:www.americanheart.org/downloadable/heart/10590179711482003HDSStatsBookREV7-03.pdf. Accessed October 9, 2008.
- Riggs BL, Melton LJ III. Bone. 1995;17(5 Suppl):505S-511S.
- Kanis JA, et al. Bone. 2002;30:251-258; Kanis JA, et al. Osteoporosis Int. 2005;16:581-589
| | |
Faculty
| | Lawrence Herman, MPA, RPA-C, DFAAPA Moderator Physician Assistant Senior Clinical Coordinator Assistant Professor
Department of Physician Assistant Studies
New York Institute of Technology Old Westbury, NY Director, Medical Education Island Medical Physicians, PC Hauppauge, NY | | | Mary P Ettari, MPH, PA-C
Physician Assistant
General Internal and Family Medicine Stuart, FL | | | Rick Pope, MPAS, PA-C, DFAAPA Faculty Member Physician Assistant Adjunct Professor Quinnipiac University Department of Physician Assistant Studies Hamden, CT Senior Physician Assistant Arthritis Center of CT Waterbury, CT President, Society of PAs in Rheumatology | | | Intended Audience | | Physician Assistants | | |
Clinical Dialogue Program Description
| | This 20 minute Webcast will provide PAs with a review of the current guidelines for the diagnosis and management of osteoporosis based on the National Osteoporosis Foundation (NOF). This Internet-based CME activity includes an optional pre-and post-survey, a CME post-test and program evaluation (feedback). CME credit will be awarded to those achieving a grade of 70% or higher on the post-test. | | |
eCase Challenge Program Description
| | This 20 minute text-based case challenge will provide PAs with a review of a case where they will be asked to make decisions pertaining to the current guidelines by the NOF. At the conclusion of the case, there is a Clinical Pearl video that the participant can view that will highlights the key take away messages from this program. This Internet-based CME activity includes an optional pre-and post-survey, a CME post-test and program evaluation (feedback). CME credit will be awarded to those achieving a grade of 70% or higher on the post-test. | | | Educational Objectives | |
At the conclusion of this activity, the physician assistant should be better able to:
| - Identify primary and secondary causes of osteoporosis
- Assess the risk factors associated with osteoporosis
- Differentiate and analyze the significance of bone density, bone quality, and bone strength
- Prescribe BMD testing for women 65 years and older and for men 70 years and older, regardless of clinical risk factors
- Prescribe BMD testing for younger postmenopausal women and for men 50-70 who have appropriate risk factors
- Routinely prescribe BMD testing to ascertain the degree of disease severity for patients who have experienced a fracture and who are over 50 years of age
- Manage osteoporosis in the context of co-morbidities; and,
- Evaluate non-pharmacologic preventive approaches as well as the efficacy and appropriate pharmacologic management for at-risk patients
| | | Accreditation Statements |  | | This program has been reviewed and is approved for a maximum of 0.5 hour of AAPA Category 1 CME credit by the Physician Assistant Review Panel. Physician assistants should claim only those hours actually spent participating in the CME activity. This program was planned in accordance with the AAPA’s CME Standards for Enduring Material Programs and for Commercial Support of Enduring Material Programs. Approval is valid for one year from the issue date of May 20, 2009. Participants may submit the self-assessment at any time during that period. | | |
Responsibility Statement
| | The American Academy of Physician Assistants takes responsibility for the content, quality, and scientific integrity of this CME activity. | | | Faculty Disclosures | | It is the policy of the American Academy of Physician Assistants to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member has with the commercial interest of any commercial product discussed in an educational presentation. The participating faculty reported the following: | | | Lawrence Herman, MPA, RPA-C, DFAAPA, reports that he has no relationship with any commercial interests whose products or services may be mentioned during this presentation. | | | Mary P Ettari, MPH, PA-C, reports that she has no relationship with any commercial interests whose products or services may be mentioned during this presentation. | | | Rick Pope, MPAS, PA-C, DFAAPA, reports that he is a member of the Novartis Speaker’s bureau. | | | Off-Label Discussion | | There are no references to unlabelled/unapproved uses of products in this program. | | Disclaimer | | The opinions and comments expressed by faculty and other experts, whose input is included in this program, are their own. This enduring material is produced for educational purposes only. Please review complete prescribing information of specific drugs mentioned in this program including indications, contraindications, warnings, and adverse effects and dosage before administering to patients. | | |
Archived Presentation
| | The Clinical Dialogue and eCase Challenge will be archived for clinicians. CME credits will be provided by the AAPA from May 20, 2009 through May 31, 2010 for physician assistants at www.AAPA.org. | | | Obtaining CME Credits | | Upon completion of your participation in the program, physician assistants will be directed to www.AAPA.org to complete a post-test and receive your certificates. | | | Successful completion of the self-assessment by physician assistants is required to earn Category 1 CME credit. Successful completion is defined as a cumulative score of at least 70% correct. Upon successful completion of the post-test, the AAPA will issue a certificate of completion for your records. | | |
Technical Requirements
| | Processor Speed: 1.4 GHz P3 | | Memory: 256 MB RAM (20MB available) | | Operating Systems Supported: Windows 2000/XP, MAC | | Browsers Supported: Internet Explorer 5.5 or greater, Mozilla Firefox and Safari 3.525 or greater | |
Additional Requirements: Flash player 8.0 or greater, 800x600 Resolution or higher with 32-bit color
| | Connection Speed: 128 Kbps or better | | Adobe Acrobat 6.0 or greater | | | Sponsored by the American Academy of Physician Assistants | 
| Supported through an educational grant from Novartis Pharmaceutical Corporation with partial funding through an educational grant from Sanofi-aventis.
| | Produced by: |  | | |
© 2009 American Academy of Physician Assistants. All rights reserved.
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