View From The Top: The Medical Home Model

& Pulmonary Embolism:

Diagnostic and Management Strategies

July 24, 2015,

Indianapolis, IN

Kayur V. Patel, MD, MRO, FACP, FACPE, FACHE, FACEP

Chairman,

Access2MD

CME topics will include those listed below. A small number of speakers are currently being confirmed. Registrants will receive a final agenda before the meeting. Thursday, July 23 – earn up to 5.25 CME credits 7:00 am - 6:30 pm Registration Open 10:00 am - 10:10 am Opening of the 2015 IAFP Scientific Assembly & Call for Resolutions 10:10 am - 11:45 am CME General Sessions

Anxiety Disorders in Primary Care – Joshua Lowinsky, MD Learning Objectives: Upon completion of this activity, the participant should be able to:

• Distinguish fear, anxiety, and anxiety disorder • Utilize case scenarios to diagnose and treat anxiety disorders • List 5 medical and 5 psychiatric causes of anxiety • Know how to integrate exposure (“avoiding avoidance”) education into a “medication for anxiety” visit

Bipolar Depression in Primary Care - Joshua Lowinsky, MD Learning Objectives: Upon completion of this activity, the participant should be able to:

• List 5 symptoms suggestive of bipolar depression rather than unipolar depression • Give 5 reasons that antidepressants are avoided in bipolar depression • Identify 5 pharmacologic and non-pharmacologic treatments - monotherapy, augmentation,

combination - for bipolar depression • List 5 common psychiatric and 5 common medical comorbidities of bipolar disorder

Joshua Lowinsky, MD, practices child, adolescent, adult, and family psychiatry and is a partner at Children’s Resource Group. He is co-founder of the Primary Care Psychiatry Foundation and chairs the integrated care work group of the Indiana Psychiatric Society. He is consultant, course director and speaker for Medical Education Resources, and is a board examiner for the American Board of Psychiatry and Neurology.

12:00 pm – 1:15 pm CME Luncheon Anemia of Chronic Kidney Disease

2015 IAFP Annual Convention Agenda

Learning Objectives: Upon completion of this activity, the participant should be able to:

• Recognize factors that contribute to the pathophysiology and symptoms of anemia of CKD • Recall and utilize appropriate diagnostic strategies for patients with anemia of CKD. • Discuss the benefits and limitations of available therapies and how to incorporate them into an effective

treatment plan. • Identify which patients should be referred to a nephrologist for treatment.

1:00 pm – 3:00 pm Foundation Board of Trustees Meeting 1:15 pm – 1:45 pm Break to View Exhibits (Exhibit Hall Open 1:15 pm - 4:00 pm) 1:45 pm - 3:15 pm CME General Sessions

Imported Infectious Diseases: It’s A Small World After All! – Joan Duwve, MD Learning Objectives: Upon completion of this activity, the participant should be able to:

• Consider imported diseases in their differential diagnoses of infectious diseases • Effectively screen for and identify patients at risk for imported infectious diseases • Recognize presenting symptoms for these diseases and appropriate testing and public health response

Dr. Joan Duwve is the Associate Dean for Public Health Practice at the IU Fairbanks School of Public Health and the Chief Medical Consultant at the Indiana State Department of Health. Joan received her bachelor’s degree in International Studies from The Ohio State University, a Masters of Public Health degree in Population Planning and International Health from the University of Michigan and her medical degree from The Johns Hopkins School of Medicine. She completed a residency in Family Medicine at St. Vincent’s Hospital and Health Services here in Indianapolis. Joan was a private practice family physician in Indiana for 11 years before joining the state health department. Joan serves on multiple committees. She cochairs the Indiana State Suicide Prevention Advisory Committee and the Indiana State Prescription Drug Overdose Prevention Task Force, serves as an advisor to the Midwest Injury Prevention Alliance Board of Directors, and is a member of the national Association of State and Territorial Health Officers Senior Deputies Committee and the Association of State and Territorial Health Officers Infectious Diseases Policy Committee. Attendee comments from Dr. Duwve’s presentation at a previous meeting: Fascinating! | Very engaging; answered questions I had about EVD and connected misperceptions Good overview | Very useful. Great speaker. Would love to hear from her again! Vitamin B12 Deficiency – William Tortoriello, MD Learning Objectives: Upon completion of this activity, the participant should be able to:

• Describe symptoms of vitamin B12 deficiency. • Explain the physiology of vitamin B12 deficiency. • Determine appropriate evaluation and treatment of vitamin B12 deficiency.

Dr. Tortoriello is a graduate of Rush Medical College in Chicago. He completed his Family Medicine residency at St. Francis Hospital in Peoria, IL. He is currently the Associate Director of the Deaconess Family Medicine Residency in Evansville, IN. He is also the CME director for Deaconess Health System in Evansville, IN.

1:45 pm – 5:00 pm Breakout SAM Study Group on Preventive Care – Jared Kocher, MD

CONCURRENT BREAKOUT SESSION – LITMITED SPACE Experienced faculty Jared Kocher, MD, will guide you through the 60 questions of the Knowledge Assessment portion of the Preventive Care SAM module. Upon completion of this activity, the participant should be able to:

• Fulfill the knowledge assessment portion of the SAM process easily with this short session that simplifies the ABFM’s MC-FP Part II requirement, and offers the latest information on preventive care

• Engage in meaningful discussion and debate with your colleagues and decide on the correct answer together

• Benefit from automatic reporting of your answers to the American Board of Family Medicine

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• Earn 12 AAFP CME credits when you complete the Clinical Simulation portion of the SAM

Dr. Kocher graduated from Southern Illinois University School of Medicine in 2003. He completed his residency with the Deaconess Family Medicine Residency Program in 2006 and subsequently obtained board certification in Family Medicine. Following his residency training, Dr. Kocher practiced in Pana, Illinois for 6 years as an employee of Pana Community Hospital. Dr. Kocher has served as an assistant director of the Deaconess Family Residency Program since 2012.

3:15 pm – 3:45 pm Break to View Exhibits 3:30 pm – 5:30 pm IAFP Board of Directors 3:45 pm - 5:00 pm CME General Sessions

Anxiety and Insomnia Medications: The Link to Alzheimer’s – Noll Campbell, PharmD Talking to Your Patients About Vaccinations – Joan Duwve, MD

6:00 pm – 7:00 pm Welcome Reception for all attendees, their guests, and exhibitors

Meet INDYCAR driver Charlie Kimball and hear his presentation! Friday, July 24 – earn up to 9.0 CME credits 6:30 am - 6:00 pm Registration Open 7:30 am – 9:00 am CME Breakfast Psoriatic Arthritis

Learning Objectives: Upon completion of this activity, the participant should be able to:

• Describe describe presenting symptoms and deploy detailed diagnostic strategies • Apply knowledge of psoriatic arthritis therapies to provide patients with effective treatments

9:00 am – 9:30 am Break to View Exhibits 9:30 am – 12:00 pm CME General Sessions

Management and Surveillance of Women at High Risk for Breast Cancer – Erica Giblin, MD Learning Objectives: Upon completion of this activity, the participant should be able to:

• List clinical exam findings suggestive of breast cancer presenting a as a mass as compared to a benign entity

• Identify when breast MRI is indicated • Recognize the utility of and rationale for tomosynthesis • Discuss timing for followup clinical exam and imaging of benign breast masses

Dr. Erica Giblin is board certified and fellowship trained in breast surgery oncology. Her medical interests include breast surgery for cancer and benign breast diseases and nipple sparing mastectomy. Dr. Giblin is a member of The American Society of Breast Surgeons; Society of Surgical Oncology; and the Society of Breast Diseases. She received her medical degree from State University of New York, Upstate Medical University, Syracuse, NY. She completed her general surgery residency at Tufts University School of Medicine, Baystate Medical Center, Springfield, MA. She completed her cardiothoracic surgical residency at the Medical University of South Carolina, Charleston, SC. She completed a breast surgical oncology fellowship with Anne Arundel Medical Center, Annapolis, MD and Johns Hopkins Medical Center, Baltimore, MD.

Attendee comments from Dr. Giblin’s presentation at a previous meeting: Best presentation of the day | Good program | Excellent information Would love to see longer presentation by her! | Excellent!

Pre-Diabetes: Preventive Medicine To Battle A Growing Epidemic

- Robert Arthur, MD Learning Objectives: Upon completion of this activity, the participant should be able to:

• Describe the vast prevalence of pre-diabetes in the United States • Describe screening methods for pre-diabetes. • Discuss current treatment paradigms for pre-diabetes. • Explain the nature and component parts of a national initiative, the Diabetes Prevention Program.

Robert B. Arthur, MD, has been practicing Family Medicine with Indiana University Health Physicians since 1986. He is currently Assistant Professor of Clinical Medicine for the Department of Family Medicine at the Indiana University School of Medicine in Indianapolis, Indiana. He is board certified by the American Board of Family Medicine. At the University of Illinois College of Engineering in Urbana, Illinois, he earned a Bachelor of Science degree in Electrical Engineering as well as a Masters of Science in Nuclear Engineering. Following that he earned his medical degree from the University of Illinois College of Medicine.

Abnormal Liver Enzymes – David Pound, MD Learning Objectives: Upon completion of this activity, the participant should be able to:

• Describe what usually constitutes abnormal liver tests and how a patient’s ethnicity can play a role in their development

• Discuss when to further evaluate abnormal tests and when to refer. • Identify the steps in a staged evaluation.

Linton, Indiana native, Dr. David C. Pound is the President of the Indianapolis Gastroenterology Research Foundation and a member of the Franciscan St. Francis Health Regional Board. He is a member of the Franciscan St. Francis Health Indianapolis Credentials Committee. An active volunteer, Dr. Pound is a Director, the Medical Advisor and Past Chairman for Lifeline Christian Mission and a past Director and Chairman of FAME (Fellowship of Associates for Medical Evangelism). Dr. Pound is a nationally recognized gastroenterologist and hepatologist. He has participated in numerous clinical research studies and has contributed to many medical publications. For his work in hepatology the Indiana Chapter of the American Liver Foundation presented him their Salute to Excellence Award in 2005. He was honored as an inaugural Fellow of the American Association for the Study of Liver Disease (AASLD) in 2014. Graduating from Indiana State University, Dr. Pound earned his Medical Degree from the Indiana University School of Medicine in 1980. He completed his Internal Medicine Residency and Gastroenterology Fellowship at Indiana University Medical Center (IUMC) in Indianapolis. In his free time, Dr. Pound devotes himself to medical mission work. He has led numerous short-term medical mission teams in Haiti sometimes joined by his wife and children.

12:00 pm – 1:30 pm Past Presidents’ Lunch 12:00 pm - 1:30 pm Lunch with Exhibitors

View From The Top: The Medical Home Model – Kayur Patel, MD Learning Objectives: Upon completion of this activity, the participant should be able to:

• Describe the medical home model • List strategies used to develop a successful medical home model • Recognize the decrease in the risk of litigation by delivering excellent customer care

Dr. Patel is a nationally-renowned thought leader and an experienced physician with more than 20 years of practice and leadership roles in Internal Medicine, Emergency Medicine and Occupational Health. Chairman of Access2MD, Dr. Patel also serves on the Board of the Indiana Rural Health Association and was awarded the 2013 Indiana Rural Health Leadership Award which recognizes individuals that make have made an outstanding difference in rural health. Dr. Patel previously served as Medical Director to HealthCare Excel, a Quality Improvement Organization focused on executing CMS' vision in the State of Indiana. He was formerly the Chief Medical Officer of a 274-bed hospital in Terre Haute and Senior Vice President of TeamHealth. Attendee comments from Dr. Patel’s presentation at a previous meeting: Dynamic speaker | Related to the audience well. Hope he comes back | Excellent talk – one of the best talks this year (thanks for having him) | Good speaker, very engaging | Excellent interaction with audience

1:30 pm – 5:30 pm CME General Sessions

Breakout Low Back Pain Workshop – Paul Evans, DO; Michael Rowane, DO

CONCURRENT BREAKOUT SESSION – LIMITED SPACE Workshop Objectives: Upon completion of this activity, the participant should be able to:

• Present a brief history of manipulation • Present basic concepts of manipulation • Describe outcome studies for success by novices • Present AHCPR (AHRQ) and AOA Guidelines for low back pain • Learn assessment and treatment techniques for:

- Long restrictors (piriformis and psoas) - Lumbar - Sacral areas

• Perform a low back pain patient visit using manipulation in a 15 minute office visit

Dr. Paul Evans is the Vice President and Dean of Marian University College College of Osteopathic Medicine. He grew up in Melrose, Massachusetts, and graduated from the University of Miami in Coral Gables, Florida. He earned a D.O. degree from Philadelphia College of Osteopathic Medicine, completed an internship at Letterman Army Medical Center in San Francisco, CA, and did a residency in Family Practice at Womack Army Community Hospital in Ft. Bragg, NC. Dr. Evans has also completed a Faculty Development Fellowship in Family Medicine at the University of North Carolina, Chapel Hill, and the Teaching Scholars post-doctoral fellowship at the University of Washington in Seattle. He is board certified by the American Osteopathic Board of Family Physicians and the American Board of Family Medicine, and is a fellow of both the American Academy of Family Physicians and the American College of Osteopathic Family Physicians. His prior career experience includes positions as a chief resident, residency program director, department chair, and director of a large multi-specialty managed care group. He retired from the US Army after serving for 26 years in military medicine. He is the founding dean of the Georgia Campus, Philadelphia College of Osteopathic Medicine. His areas of research are in low back pain, faculty development, and medical education issues. Dr. Evans has lectured nationally and internationally, and has published extensively in his specialty. His honors include numerous teaching and military service awards to include the Order of St. Barbara, the Order of Military Medical Merit, and the Legion of Merit. He is married and enjoys finch breeding, birding, mountain biking, nature art collecting, and playing bad golf in good places.

1:30 pm – 5:30 pm CME General Sessions

Pulmonary Embolism: Diagnostic & Management Strategies - Kayur Patel, MD Learning Objectives: Upon completion of this activity, the participant should be able to:

• Utilize Critical decision-making using a five step approach for all patients with inconclusive/exclusive criteria

• Describe ways to decrease the risk of PE/DVT to improve patient outcomes • Distinguish criteria regarding admission treatment versus outpatient treatment of patients diagnosed

with DVT

ICD-10 Update Hear the latest updates and get tips, advice, and resources to help you as the October 1 implementation deadline approaches.

3:00 pm – 3:30 pm Break to View Exhibits 3:30 pm – 5:30 pm CME General Sessions Legislative Update – Allison Taylor, JD

The IAFP’s legislative and health policy director will update you on the latest legislative developments directly affecting family physicians in Indiana. In addition to her role at the IAFP, Allison is an attorney at the healthcare law firm Hall Render in downtown Indianapolis. Allison's practice focuses on general health law, regulatory compliance and contracting and reimbursement issues, as well as government relations. Allison has over nine years of experience representing

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health care clients before Indiana's legislative and administrative bodies. Before joining Hall Render, Allison was a government affairs consultant for a law firm and then served as the Legislative and Regional Affairs Director for the Indiana Academy of Family Physicians. Allison graduated from DePauw University in 2003 and from Indiana University Robert H. McKinney School of Law in 2008. Allison routinely speaks to health care organizations on health law and legislative matters. She is a member of the American Bar Association, Indiana State Bar Association, Indianapolis Bar Association, American Health Lawyers Association, Governmental Affairs Society of Indiana, and more.

Panel Discussion on Emerging Practice Models – Andrew Hector, MD; David Schultz, MD; Allison Taylor, JD Learning Objectives: Upon completion of this activity, the participant should be able to:

• Describe several innovative practice models. • Discuss coding, billing, and staffing changes that can affect implementation of a successful and

profitable modern practice. 6:00 pm - 7:00 pm Town Hall Dinner

Featuring an update from John Wernert, MD, MHA, Secretary (Agency Head) at Indiana Family and Social Services Administration (FSSA) Dr. John J. Wernert began the full-time medical practice of psychiatry in 1989. He obtained his M.D. degree from the University of Louisville School of Medicine in 1985. His postdoctoral training included an internship and residency at the Indiana University School of Medicine through the Department of Psychiatry. Dr. Wernert completed a Master’s Degree in Health Administration from Indiana University in 1996. He is board certified in Adult Psychiatry. Dr. Wernert currently is the Secretary of the Indiana Family and Social Services Administration (FSSA), appointed to this cabinet position by Governor Michael Pence in June 2014. He is the first physician to lead this large multi-division state agency which is responsible for the provision of social benefits and healthcare for 1.4 million Hoosiers in need. In addition to Medicaid, Dr. Wernert oversees the Division of Mental Health and Addictions, the Division of Aging, the Division of Disability and Rehab Services and the Division of Family Resources. From Pre-K education to end-of-life care, FSSA addresses the life-long needs of disadvantaged Hoosiers.

Dr. Wernert previously served as the Medical Director of Medical Management at Eskenazi Health in Indianapolis, and has served in various leadership roles in medical professional organizations, including the AMA.

7:00 pm – 9:00 pm 1st Session Congress of Delegates 9:00 pm – 11:00 pm Reference Committees

9:00 pm Reception Saturday, July 25 – earn up to 7.25 CME credits 6:30 am - 5:00 pm Registration Open 7:00 am – 9:30 am 2nd Session Congress of Delegates 9:30 am – 11:45 am CME General Sessions

Abdominal Pain – Thomas Kintanar, MD

Keynote Address: Family Medicine For America’s Health – Jason Marker, MD Family Medicine for America’s Health is a new collaboration between the eight leading family medicine organizations in the United States (including the AAFP and AAFP Foundation) to drive continued improvement of the U.S. health care system and demonstrate the value of true primary care.

A Strategy for Family Medicine’s Future Family Medicine for America’s Health wants to transform the family medicine specialty to ensure that we can meet the nation’s health care needs and ultimately, improve the health of every American. Specifically, this means:

● Furthering the evolution of the patient-centered medical home ● Advancing the use of technology ● Ensuring a strong primary care workforce ● Shifting to comprehensive primary care payment

Family Medicine’s strategic plan centers on seven core strategies to achieve these objectives. Together these strategies chart the course that family medicine will take over the next five years. Implementing this plan will mean that people across the United States can expect family medicine, in collaboration with other primary care professionals, patients and families, to:

1. Show the value and benefits of primary care 2. Ensure every person will have a personal relationship with a trusted family physician or other primary

care professional, in the context of a medical home 3. Increase the value of primary care 4. Reduce health care disparities 5. Lead the continued evolution of the Patient-Centered Medical Home 6. Ensure a well-trained primary care workforce 7. Improve payment for primary care by moving away from fee for service and towards comprehensive

primary care payment

Jason E. Marker, MD, MPA, FAAFP, serves as President on the Board of Trustees of the American Academy of Family Physicians Foundation. Dr. Marker was born and raised in northern Indiana near the town of Wyatt, where his private medical practice includes one other physician and a nurse practitioner as well as employees cross-trained in social work. He graduated from Indiana University with a Bachelor of Science in Biology and then attended Indiana University School of Medicine. Upon graduation from medical school, Dr. Marker entered the family medicine training program at Memorial Hospital in South Bend, Indiana, where he was the first graduate of the four-year curriculum in Health Services Management. This program allowed him to incorporate time for a Masters Degree in Public Affairs from Indiana University, as well as advanced training in practice management, health finance, economics, and health services delivery. In 2002, Dr. Marker opened his practice in Wyatt and continues to practice the full scope of family medicine including OB, office procedures, house calls, and nursing home care. In recent years, he has incorporated some medico-legal consulting and two nursing home medical directorships into his schedule as the addition of other providers in his practice has allowed the time for these community-supporting activities. In addition to his private practice, Dr. Marker is active in church and community events and has contributed to the advancement of many charitable causes not just financially, but also through the gifts of time and service. He is an active community leader in both medical and non-medical activities. In 2007, Dr. Marker was elected to a term on the AAFP Board of Directors as a New Physician, allowing him to learn about and contribute to his specialty at a national level. Awards include the 2006 Memorial Hospital Family Medicine Teacher of the Year and the 2008 Indiana Rural Health Association Doc Hollywood Physician of the Year. Dr. Marker has served the AAFP Foundation as an active Trustee, serving on multiple committees and leading the Education Signature Program Task force for several years, as well as serving as Treasurer of the organization in 2012 and 2013.

12:00 pm – 1:15 pm CME Lunch 1:15 pm – 5:30 pm CME General Sessions

HIV Update – Diane Janowicz, MD Learning Objectives: Upon completion of this activity, the participant should be able to:

• Describe the current HIV/AIDS epidemic in Indiana, the reasons behind it, and how it may affect FPs’ practice.

• Compare and contrast the clinical application of various antiretroviral therapies used in the treatment of HIV

• Implement a practice-based regimen for patients affected by HIV, and continue to provide care as the disease progresses

• Explain possible side effects of therapies and discuss the importance of adherence to a prescribed treatment regimen.

Head and Neck Cancer – Michael G. Moore, MD Learning Objectives: Upon completion of this activity, the participant should be able to:

• Describe the epidemiology for HPV-related head and neck cancers • Discuss current management approaches to patients with head and neck cancers • Describe a vaccination strategy to prevent HPV-related head and neck cancers and explain how best to

discuss this with patients

Michael G. Moore, M.D., FACS is Associate Professor of Otolaryngology–Head and Neck Surgery; Division Chief, Head and Neck Surgery; and Head and Neck Fellowship Director at Indiana University School of Medicine in Indianapolis. He received his MD degree at the Medical School at UCLA and completed his residency in Otolaryngology-Head and Neck Surgery at Harvard University. He completed a fellowship in Head and Neck Oncology at the University of Washington. He joined the IU Faculty in 2008 and in 2011 was appointed as the Chief of Head and Neck Surgery.

Fracture Care – Kevin Gebke, MD

Learning Objectives: Upon completion of this activity, the participant should be able to:

• Discuss diagnostic strategies for various types of fractures commonly seen in the FP’s office • Outline the treatment recommendations for those fractures • Describe situations in which a referral is necessary for a patient who has suffered a fracture

Kevin B. Gebke, MD, was named OneAmerica Professor of Preventive Health Medicine and chair of the Indiana University Department of Family Medicine in 2011. Dr. Gebke is an associate professor of clinical family medicine and director of the Primary Care Sports Medicine Fellowship and IU Center for Sports Medicine. He joined the Department of Family Medicine in July 2001 as an assistant professor. He served as the interim co-chair of the Department of Family Medicine prior to being named chair.

Dr. Gebke graduated with a bachelor's degree in biological sciences from Southern Illinois University. He received his medical degree from the University of Illinois College of Medicine and completed his internship and residency at MacNeal Family Practice Residency Program in Berwyn, Ill. Dr. Gebke also completed a primary care sports medicine fellowship at the IU Department of Family Medicine. He is board-certified in both family medicine and sports medicine and received the “Bowen Research Fellow of the Year” award. Dr. Gebke is an active distance runner and enjoys traveling with his family.

6:00 pm – 7:00 pm Reception 6:00 pm – 10:00 pm IAFP Foundation Silent Auction 6:00 pm – 9:00 pm Children’s Dinner 7:00 pm – 10:30 pm Banquet/All Member Event Sunday, July 26 – earn up to 4.0 CME credits 6:30 am - 10:00 am Registration Open 7:00 am - 9:00 am CME Breakfast Diagnosing and Treating Low Testosterone

Learning Objectives: Upon completion of this activity, the participant should be able to: ● Explain causes of low testosterone, including disorders of the testicles, pituitary gland or brain; genetic

causes; or chemotherapy. ● Describe the impact of low testosterone on male patients which can result in low sex drive, erectile

dysfunction, fatigue, mood problems, and increase risk of other serious illnesses. ● Explain which therapies are currently approved for use to fight low testosterone and how they differ.

● Develop an appropriate treatment plan for men affected by low testosterone and formulate a follow up treatment plan.

9:00 am – 12:00 pm CME General Sessions

ADHD Stimulant Abuse in Adolescents – David Schultz, MD Learning Objectives: Upon completion of this activity, the participant should be able to:

• Describe the pharmacology of ADHD medications (stimulant & non-stimulant), and the behavioral and physical effects the have on patients, as well as possible side effects and other drug interactions

• Explain the current abuse epidemic of ADHD stimulants (like Adderrall, Concerta, & Ritali ) and how it is affecting Indiana’s young people

• Formulate a sensitive and effective treatment plan that utilizes evidence-based recommendations. Hyperandrogenism

Coding and Billing Update - Joy Newby, LPN, CPC Learning Objectives: At the conclusion of this continuing medical education activity, the participant will be able to:

• Recognize the appropriate use of electronic health (EHR) record templates • Identify the J-8 Part A/B Medicare Administrative Contractor’ local coverage decisions • Recall the importance of sufficient documentation to support the medical necessity for ordering durable

medical equipment, prosthetics, orthotics, and supplies 10:15 am Board Meeting 12:00 pm Convention Adjourns CME Credit: Application has been made to the AAFP for 26.0 Live Prescribed Credits. Updated credit certificates will be available on site. DISCLAIMER: The material presented is being made available by the Indiana Academy of Family Physicians for educational purposes only. This material is not intended to represent the only nor necessarily the best methods or procedures appropriate for the medical situations discussed, but rather is intended to present an approach, view, statement, or opinion of the faculty, which may be helpful to others who face similar situations. The IAFP disclaims any and all liability for injury or other damages resulting to any individual participating and for all claims, which may arise out of the use of the techniques, demonstrated therein by such individualism, whether these claims shall be asserted by a physician or any other person. Every effort has been made to assure the accuracy of the data presented. Physicians may care to check specific details such as drug doses and contraindications, etc., in standard sources prior to clinical application. This material may contain recommendation/guidelines developed by other organizations. Please note that although these guidelines may be included, this does not necessarily imply the endorsement of IAFP. CONSENT TO USE OF PHOTOGRAPHIC IMAGES: Registration and attendance at, or participation in, IAFP meetings and other activities constitutes an agreement by the registrant for IAFP use and distribution (both now and in the future) of the registrant or attendee's image or voice in photographs, videotapes, electronic reproductions, and audiotapes of such events and activities.