Sri Lanka Medical Association of North America
16th Annual General Meeting
Medicine Update — 2011― CME Program
New York Hilton and Towers
Avenue of the Americas
New York, NY
Saturday, November 12th, 2011
CME Chair: Sunil J. Wimalawansa, MD, PhD
Co-Chair: Selvarani Richards, MD
Cardio-Metabolic Wellness: Strategies for a New Decade
8:00 – 9.00 AM Registration and Breakfast
During the last decade, we have witnessed cardiac mortality curves dip down to curves similar to those for cancer mortality. This success means that quite soon cardiovascular causes will not be the number one cause of death in the West. This is a success story to be shared by physicians of all specialties together with specific advances in the field of endocrine, metabolic, and cardiovascular disciplines.
The 2011 SLMANA sessions will provide an exciting glimpse of what lies ahead. The focus of this symposium will be on the prevention of medical disorders.
Moderators: Dr. Gnana Sunderam & Dr. Wije Kottahachchi
|9.00 am||Moderators: Dr. Gnana Sunderam & Dr. Wije Kottahachchi|
|9.05 am||Dr. Darshi Sunderam – Targeting the Incretins System: Can It Improve Our Ability to Treat Type 2 Diabetes?|
|9.25 am||Dr. Nath Perinpanayagam – Primary Hyperhidrosis: Disease or Anxiety?|
|9.45 am||Dr. Sriyan Kurukulasuriya – Endocrine and Metabolic Challenges in Baby Boomers|
|10.05 am||Ylone Xavier, MBA, MPH – Value-Based Purchasing and What it Means for Physicians|
|10.25 am||Dr. Sunil Wimalawansa – Vitamin D: All You Need to Know|
|10.45 am||Networking Break and Visiting Display Booths and Posters
Moderators: Dr. Lal Samarasinghe and Dr. Daya Nadarajah
|11.15 am||Dr. Ramona Rajapakse – Prevention of Common Gastroenterological Problems|
|11.35 am||Dr. Upali Aturaliya – Ocular Manifestations of General Medical Conditions|
|11.55 am||Dr. Niloo Edwards – key Note Speaker
Surgical Therapy Following Failure of Medical Therapy for Heart Disease
|12.25 pm||Networking Break, and Visiting Display Booths & Posters Lunch Break
Surgical Advances – Moderators: Dr. Nihal de Silva and Dr. Vaithi Segeram
|1.15 pm||Dr. Aruna Seneviratne – Unicondylar Knee Arthroplasty for Unicompartmental Osteoarthritis of the Knee|
|1.35 pm||Dr. Sunishka Wimalawansa – Reconstructive Options in Breast Cancer|
|1.55 pm||Dr. Vel Sivapalan – Metabolic and Cardiac Consequences of HIV and HIV Treatment|
|2:15 – 2:45||SLMANA – Annual General Meeting|
Target Audience: Specialists and General Physicians, Dentists, and Allied Health Professionals
Upon completion of this activity, participants should be able to:
Better manage Type 2 diabetes, controlling HBA1c and minimizing complications
- Demonstrate and discuss the etiology and prevention of diabetes and obesity
- Identify (early) and manage hyperhidrosis
- Diagnose and manage common gastrointestinal problems
- Identify (early) and manage metabolic complications in the elderly
- Understand principles of management of common eye diseases
- Understand and manage common ophthalmologic conditions
- Understand and manage vitamin D deficiency
- Manage complications associated with HIV therapies
- Knew indications for the surgical management of failed medical therapy for heart failure
- Understand the principles of post-cancer breast reconstruction
- Provide appropriate referrals for joint surgery and replacement
East Orange General Hospital designates this educational activity for a maximum of 5.0 continuing medical education credits toward the AMA PRA Category 1 CreditTM. Each physician should claim only those credits that he/she actually spent in this educational activity. East Orange General Hospital is accredited by the Medical Society of New Jersey to provide continuing medical education for physicians. The CME committee is fully responsible for the program.
Continuing Medical Education Committee:
Sunil Wimalawansa, MD (Chairperson)
Selvarani Richards, MD (Co-Chair)
Aruna Seneviratne, MD
Rohan Perera, MD
Darshi Sunderam, MD
This educational activity is funded in part by a non-restricted grant from the Manhattan Laboratories, 16 East 52nd Street, New York, NY 10022, and
the Sri Lanka Medical Association of North America (SLMANA)
Nath Perinpanayagam, MD
Assistant Professor Neurosurgery
NYU Langone Medical Center Department of Neurosurgery
Suite 8-S, 530, 1st Avenue
New York, NY 10016
Aruna Seneviratne, MD
Associate Attending Orthopedic Surgeon
Lenox Hill Hospital
New York, NY 10075
Ramona Rajapakse, MD, FRCP
Associate Professor of Clinical Medicine
Division of Gastroenterology
Stony Brook Medical Center
Stony Brook, NY 11794
Upali Aturaliya, MD
Associate Clinical Professor
University of Minnesota Duluth Medical School
915 Ridgewood Road
Duluth, MN 55804
Niloo Edwards, MD
Professor and Chair
University of Wisconsin School of Medicine
H4/358 Clinical sciences Center
600 Highland Avenue
Madison, WI 53792
Sriyan Kurukulasuriya, MD
Endocrinology, Diabetes & Metabolism
Department of Internal Medicine
Cosmopolitan Diabetes and Endocrinology Center
D 109, One Hospital Drive
Columbia, MO 65212
Sunishka Wimalawansa, MD, MBA
Plastic & Reconstructive Surgery
Resident Assistant Professor of Surgery
Division of Plastic Surgery
Boonshoft School of Medicine
Wright State University 30 E. Apple St,
Suite 2200 Dayton, OH 45409
Vel Sivapalan, MD
Assistant Clinical Professor of Medicine
Harlem Hospital Center
Room 3108 Division of Infectious Disease
506 Lenox Avenue
New York, NY 10037
Darshi Sunderam, MD
East Orange General Hospital
310 Central Avenue, Suite 205
East Orange, NJ 07018
Sunil Wimalawansa, MD, PhD, MBA
Professor of Medicine & Endocrinology Endocrinology, Metabolism & Nutrition Director, Regional Osteoporosis Center UMDNJ-RWJMS
New Brunswick, NJ 08902
Ylone Xavier, MBA, MPH
Healthcare Performance Management Consultant
Mountain Lake, NJ 07046
All faculty participating in this Continuing Medical Education activities sponsored by East Orange General Hospital are expected to disclose to the audience any real or apparent commercial financial affiliations related to the content of their presentation/materials. The faculty planners and reviewers of this presentation have not at present and/or have had within the past 12 months a relevant financial relationship with a commercial interest. This program is co-sponsored by East Orange General Hospital.
Welcome to the Continuing Medical Education Sessions
SLMANA President’s Message:
It is my pleasure to welcome you all to an exciting conference on Cardio-Metabolic Wellness: Strategies for a New Decade, organized by the Sri Lanka Medical Association of North America – East.
There will be two morning sessions and one afternoon Continuing Medical Education session. Between sessions, you will have time explore the exhibit booths and poster presentations. The Annual General Meeting will be held at the conclusion of the CME.
I would like to thank the Continuing Medical Education committee, especially the chairpersons, Drs. Sunil Wimalawansa and Selvarani Richards. They worked very hard to put together an excellent list of faculty with impeccable credentials. We are thankful and happy that you have consented to share your knowledge and experience with us.
I hope you will enjoy the Continuing Medical Education sessions and take with you some “pearls of wisdom” that could be applied to your practice.
Lakshman Denepitiya, DDS, PhD
President, SLMANA East
Welcome to the CME Program and the Scientific Poster Presentation
SLMANA is committed to furthering professional excellence and enhancing patient care by providing ongoing education and support to the medical community. This is the second year SLMANA has hosted a poster/abstract session in the Sri Lanka Medical Association of North America annual Continuing Medical Education meetings.
We encourage active participation from all SLMANA members for future meetings. We believe these sessions will enhance the knowledge of physicians, dentists, and allied health workers and provide interactions and learning opportunities to all of us to build our knowledge. We would like to take this opportunity to thank the SLMANA Council and the presenters for their interest, ideas, and time in making this a success.
Thank you for your participation,
Sunil Wimalawansa and Selvarani Richards
Behalf of the CME committee
Abstracts of the Invited Presentations of the CME Program
Surgical Therapy Following Failure of Medical Therapy for Heart Disease
Niloo Edwards, MD, Professor, Division of Cardiothoracic Surgery, University of Wisconsin, H4/358 Clinical Science Centre, 600 Highland Avenue, Madison, WI 53792
Heart failure affects 5.8 million people in the United States, and about 500,000 new cases are diagnosed each year. Despite optimal medical management, long-term survival for patients with advanced heart disease is poor. The gold standard for the treatment of heart failure is heart transplantation, but limited organ availability and patient age have forced the investigation of alternatives to heart transplantation.
One such treatment option is the use of left ventricular assist devices (LVAD). These devices originally were used to support patients until a heart became available, and although they are still used as a “bridge to transplant,” they have also opened other doors. LVADs can be used as an alternative to transplantation in patients who are ineligible for transplant (”destination devices”), allowing for both an excellent quality of life and survival.
Increasingly we are beginning to understand that these devices may be used to rest the heart until it recovers from acute or chronic heart failure, thereby expanding the devises’ role as “bridges to recovery.” But epidemiologically, the greatest contribution of these devices is as a back-up for high-risk surgical procedures to fix the cardiac defects. This talk explores the risks and benefits of heart transplantation and ventricular assist devices for the treatment of patients with advanced heart failure.
Endocrine and Metabolic Challenges in Baby Boomers:
How Lessons Learned Will Affect the Rest of the World
Damascene Sriyan Kurukulasuriya, MD, FACP, CMD,
University of Missouri at Columbia, Division of Endocrinology, Diabetes & Metabolism
Seventy-six million people born in the United States during the period 1946 through 1964 constitute a very medically and sociologically diverse and economically and politically heterogeneous group called baby boomers (“boomers” for short). The first wave of boomers entered the geriatric age of 65 years on January 1, 2011. They consist of two subtly different principal cohorts: the first cohort, born from 1946 to 1955 (post-World War 2 through the Korean War); and the second cohort, born from 1956 to 1964 (post-Korean War through Vietnam War).
The life expectancy at age 65 in the United States, particularly for women, is currently lower than that for rest of the top Organization for Economic Co-operation and Development (OECD) countries of the western hemisphere. One of the significant attributes to this anomaly, despite the USA spending nearly 17% of its gross national product on health care, results from the heavy cardio-renal-metabolic disease burden of boomers. This is further complicated by their tendency to have heavy loads of chronic degenerative diseases. As the US lifestyle becomes more sedentary, boomers have become poster children of metabolic diversity. According to the American Diabetes Association, 79 million Americans have pre-diabetes. Pre-diabetes
is a pernicious condition that has marked potential for progressing to frank Type 2 diabetes. This is obvious in diabetes, with the growing population of people of Hispanic origin, in addition to the black and native American populations, two groups who traditionally have a disproportionately heavy metabolic disease burden (diabetes and obesity prevalence) compared with Americans of Caucasian or Asian origin.
Across the world aging demographic has very distinct similarities to the endocrine and metabolic profiles of the US population. The best example is the rapidly increasing prevalence of diabetes and obesity, especially in countries such as India. Some of the major reasons for this include the proliferation of screen media and the explosion of advertising by the processed food industry, which floods the market with a blitz of promotions of foods with high sodium content, are laden with fat, and/or have massive amounts of cheap calories; these advertised foods include unhealthful sodas and sweets. This dangerous situation requires globally tailored metabolic interventions, including aggressive dietary and exercise literacy with emphasis on rapidly enhancing the availability of preventive health manpower with adequate funding.
Primary Hyperhidrosis: Disease or Anxiety?
Noel I. Perin MD, FRCS (Ed), FACS
Department of Neurosurgery, NYU Langone Medical Center
530, 1st Avenue, Suite 8-S, New York, NY 10016
Primary focal hyperhidrosis (PFH) is a condition in which excessive sweating occurs In areas of the body that are not related to thermoregulation. PFH is bilateral and typically appears during the second or third decade of life; it can cause significant occupational, emotional, and physical impairment, as well as social embarrassment. About 7.8 million individuals in the United States (2.8% of the population) have PFH. Common conservative treatments have included antiperspirants, anticholinergics, iontophoresis, and therapies based on biofeedback. All of these treatments produce temporary relief and may be adequate in milder cases.
More recently, botulinum toxin has been approved for the treatment of PFH. The beneficial effects usually are expected to last 4 to 6 months. Repeated injections of botulinum toxin in palmar PFH is less appealing because of pain, muscle weakness, and possible atrophy, and they are not recommended for long-term use in patients with hand sweating. Botox injections may be more appropriate for axillary hyperhidrosis. Endoscopic thoracic sympathectomy (ETS), a minimally invasive surgical approach for the treatment of palmar, axillary, and facial PFH, is a more definitive treatment with low morbidity rates and excellent outcomes. This procedure is appropriate for patients in whom initial conservative measures have failed. Compensatory hyperhidrosis (CH), the development of increased sweating after ETS in parts of the body not previously affected, has been reported to occur at an average rate of about 60% (range, 35–98%). The relationship between the development of CH and patient satisfaction with the ETS procedure has not been clearly elucidated. We evaluated the outcomes after ETS with regard to the incidence and severity of CH and its impact on patient satisfaction.
Vitamin D: All You Need to Know
Sunil J. Wimalawansa, MD, PhD, MBA, FACE, FACP, FRCP, FRCPath, DSC
Professor of Medicine, Endocrinology & Physiology
Department of Medicine, UMDNJ-RWJMS, New Brunswick, NJ 08903
Vitamin D deficiency is one of the most common and under-diagnosed medical conditions in the world. Adequate vitamin D is necessary for optimal human health. Vitamin D obtained via sun exposure and from food and dietary supplements is critical for skeletal healthy: bone development, remodeling, and maintenance. Emerging data also suggest that adequate vitamin D levels may promote not only healthy bones, but also immune function and cell protection in both the young and the old. Recent literature on vitamin D is full of controversies regarding its measurement and benefits and the diagnosis and management of its deficiency.
Consequences of vitamin D deficiency:
Rickets in children and osteomalacia in adults are classic manifestations of severe vitamin D deficiency. In addition to enhancing calcium absorption and mineralization of osteoid tissues, vitamin D has other physiological effects, including immuno- and neuro-modulation, and enhancing muscular coordination.
Vitamin D facilitates the absorption of calcium from the intestine and bone mineralization and maintains bones. In children, vitamin D deficiency causes rickets, whereas in adults, it causes osteomalacia, muscle weakness, falls, osteoporosis, and fractures. Corroborative and cohort studies suggest that low vitamin D levels may induce or worsen several non-skeletal disorders, including cancer, metabolic syndrome, obesity and diabetes, infectious diseases, and autoimmune disorders. Whether increased incidences of these diseases are the consequence of widespread vitamin D deficiency remains to be determined.
Measurement of serum 25-hydroxyvitamin D is the way to evaluate vitamin D status. Serum vitamin D levels below 20 ng/mL are considered deficient, whereas optimum levels are considered to be between 30 and 40 ng/mL. An additional 1,000 IU of vitamin D/day generally is sufficient for lighter-skinned individuals, whereas an extra 2,000 IU/day is necessary for the elderly and dark-skinned individuals to maintain normal serum 25(OH)D levels. Additional research is needed to determine the relationship between vitamin D and the non-skeletal systems and the non-classic functions and targets of vitamin D.
1. Wimalawansa SJ. Vitamin D: Everything You Need to Know. Printers; Karunaratne & Sons, Homagama, Sri Lanka, 2011.
2. Holick MF, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911–30.
3. Ross AC, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 2011; 96(1):53–8.
Metabolic and Cardiac Consequences of HIV and HIV Treatment
Vel Sivapalan, MD
Division of Infectious Diseases, Harlem Hospital Center, New York, NY
Since the more potent HIV therapies became available in the mid-1990s, there has been a marked decrease in AIDS-related deaths. As patients with HIV live longer with highly active anti-retroviral therapy (HAART), an increasing incidence of lipodystrophy, dyslipidemia, systolic hypertension, diabetes mellitus, and insulin resistance has been observed, increasing their risk for cardiovascular disease (CVD); this increased incidence has been attributed to HAART. However, there have been conflicting results from large retrospective studies looking at whether patients with HIV are at increased risk for CVD. One large prospective study, The Data Collection on Adverse Events of Anti-HIV Drugs, looked at the incidence of myocardial infarction and found that the incidence increases with prolonged exposure to HAART (1).
Long-term exposure to certain antiretroviral agents may contribute to endothelial dysfunction (2), hypertension, and insulin resistance, resulting in increased risk for CVD. There is mounting evidence to suggest that the increased risk of CVD observed in HIV infection is likely to be an interaction of many factors, such as the host, virus, and antiretroviral therapy. Dyslipidemia is fairly common in persons with HIV and can be found as an isolated problem or as part of the HIV-associated metabolic syndrome. A decrease in plasma high-density lipoprotein and low-density lipoprotein cholesterol levels and an increase in triglyceride levels have been observed independent of any exposure to antiretroviral therapy. Tobacco use has been found to be more common in persons with HIV. Researchers have also demonstrated a direct link between HIV and atherosclerosis by the direct effects of the virus on smooth muscle cells and macrophages and by its promoting an inflammatory response.
Currently, all available data suggest that persons with HIV have an increased cardiovascular risk, and this may be attributable to HIV infection, complications of anti-retroviral therapy, or both.
Physicians treating patients with HIV, in addition to seeking complete viral suppression with HAART, should aggressively treat the traditional risk factors for cardiovascular disease, such as hypertension, hyperglycemia, hyperlipidemia, obesity, and tobacco use in order to reduce the risk of cardiovascular events in these patients.
1. Friss-Moller N, et al. Combination anti retroviral therapy and the risk of myocardial infarction. N Engl J Med 2003.
2. Chai H, et al. Effects of 5 HIV protease inhibitors on vasomotor function and superoxide anion production in porcine coronary arteries. J Acquir Immune Defic Syndr 2005.
Reconstructive Options in Breast Cancer
Sunishka M. Wimalawansa, MD, MBA
Division of Plastic Surgery, Boonshoft School of Medicine,
Wright State University: Resident, Plastic and Reconstructive Surgery
Breast cancer will affect 1 in 8 women during their lifetimes; excluding non-melanoma skin cancers, it is the leading cancer in women. As many as 30% undergo mastectomy. Surgical loss of a breast can have far-reaching effects on women’s mental and physical well-being, but appropriate restoration of the breast can help reverse this.
The goals of reconstruction include minimizing deformities and morbidity, improving local tissue quality and wound healing (i.e., after XRT), achieving aesthetically acceptable symmetry, and helping women move on with their lives. Several options exist to treat the spectrum of post-ablative breast deformities. Specific options to be discussed include implant-based reconstruction, tissue expansion, autologous tissue transfers, nipple-areola reconstruction, contralateral symmetry procedures, and oncoplastic techniques.
With regard to oncoplastic techniques, patient safety data from the Institute Curie Study will be specifically addressed; similarly, mastectomy reconstruction safety data from the SEER database review will be discussed. Both data sets indicate that these techniques are safe and feasible from an oncologic standpoint. It important to note that insurance coverage for breast-reconstructive surgery is mandated by the Women’s Health and Cancer Rights Act of 1998. Unfortunately, a significant number of women as well as their primary care physicians are not fully aware of the options and rights regarding breast reconstruction. This is reflected in the 2010 SEER study, which indicates that a mere 17% of mastectomy patients elect reconstruction.
Plastic surgeons are positioned to counsel patients regarding their reconstructive options and can assist oncologic surgery colleagues with optimal completion of care for these patients.
1. Agarwal S, Liu JH, Crisera CA, Buys S, Agarwal JP. Survival in breast cancer patients undergoing immediate breast reconstruction. Breast J 2010; 16(5):503–9.
2. Clough K, Cuminet J, Fitoussi A, Nos C, Mosseri V. Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical treatment. Ann Plast Surg 1998; 41:471–81.
3. Wimalawansa SM, McKnight A, Bullocks JM. Socioeconomic impact of ethnic cosmetic surgery: trends and potential financial impact the African-American, Asian, Hispanic, and Middle Eastern communities have on cosmetic surgery. Seminars of Plastic Surgery 2009; 23:159–62.
4. Fitoussi A, Berry M, Fama F, et al. Oncoplastic breast surgery for cancer: analysis of 540 consecutive cases. Plas Recon Surg 2010; 125:454–462.
Prevention of Common Gastroenterological Problems
Ramona Rajapakse, MD, FRCP, Associate Professor of Medicine
Stony Brook University Medical Center, Stony Brook, NY 11794
Colorectal cancer and esophageal carcinoma are two potentially preventable gastroenterological problems. Gastroesophageal reflux disease (GERD) affects approximately 20% of adult Americans at least once per week. Barrett’s esophagus refers to replacement of esophageal squamous epithelium with intestinal metaplasia secondary to GERD. GERD and Barrett’s esophagus are the major risk factors for esophageal carcinoma, the frequency of which has increased more than sixfold during the past few decades in the United Stated. Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Colonoscopy is deemed the most effective CRC prevention tool. This talk focuses on predisposing factors, as well as primary and secondary prevention of GERD, Barrett’s esophagus, esophageal carcinoma, and colon cancer.
With regard to GERD, the pathophysiology of reflux disease, lifestyle factors that affect reflux, and treatment modalities will be discussed. Indications for upper esophageal endoscopy and surveillance strategies for Barrett’s also will be mentioned, together with current management of esophageal dysplasia as a means of preventing esophageal carcinoma. As a prelude to colon cancer prevention, there will be a brief description of carcinogenesis and colon cancer genetics. Guidelines for colorectal cancer screening will be discussed in relation to the general population and those at higher risk. There will also be a brief mention of colon cancer chemoprevention in select high-risk groups.
Conclusion: Colorectal cancer and esophageal cancer are two gastroenterological conditions that are preventable with judicious endoscopic surveillance and some lifestyle interventions.
1. American College of Gastroenterology Guidelines for Colorectal Cancer Screening 2008. ACG Practice guidelines
2. Levin B, Lieberman DA, et al. Screening and Surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology 2008; 1570–95.
3. Wang K, Sampliner R. Updated guidelines for the diagnosis, surveillance and therapy of Barrett’s esophagus. Am J Gastroenterol 2008; 103:788–97.
4. Shaheen N, Sharma P, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med 2009; 360:2277–88.
Targeting the Incretins System:
Can It Improve Our Ability to Treat Type 2 Diabetes?
Darshi Sunderam, MD
East Orange General Hospital, Department of Endocrinology
300 Central Avenue, East Orange, NJ 07018
The prevalence of Type 2 diabetes is accelerating in the developed and developing world. More than 90% of people with diabetes have Type 2.
The pathophysiology of Type 2 diabetes is complex and involves multiple abnormalities, including insulin resistance, increased hepatic glucose production, and abnormalities in the secretion of multiple hormones, such as insulin, glucagon, amylin, and incretins. The incretin hormones are released during meals from the gut endocrine cells. They potentiate glucose-induced insulin secretion and may be responsible for as much as 70% of postprandial insulin secretion. The incretin hormones include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulino-trophic polypeptide (GIP), both promote proliferation/neogenesis of beta cells and prevent apoptosis. The current interest in the incretin hormones is attributable to the incretin effect being severely reduced or absent in patients with Type 2 diabetes. In addition, there is hyperglucagonemia, which is not suppressed by glucose.
The pathogenesis of Type 2 diabetes seems to involve a dysfunction of the incretin system. Thus, enhancement of incretin action is an important therapeutic solution. Such includes the development of metabolically stable activators of GLP-1 receptors and inhibition of DPP-4 enzymes that destroy the native GLP-1. Two types of incretin-based therapies are now in use: incretin mimetics (glucagon-like peptide-1 [GLP-1] receptor agonist that bind to specific receptors and mimic the action of natural GLP-1) and incretin enhancers (inhibit the enzyme that degrades the incretin hormones and thus prolongs their activity). These drugs can be given as monotherapy or added to other antidiabetic agents to lower blood glucose with very low risk of hypoglycemia and without weight gain.
Two GLP-1 mimetics (also known as GLP-1 receptor agonist) are available: Exenatide and Liraglutide. They are DPP-4–resistant analogues of human GLP-1. They are both injectables: Exentide is given twice a day and Liragultide once a day. Currently licensed DPP-4 agents include sitagliptin, saxagliptin, and linagliphtin, and they have the advantage of oral administration.
1. DeFronzo RA. Current issues in the treatment of type 2 diabetes. Overview of newer agents: where treatment is going. Am J Med 2010; 123(Suppl):S38–48.
2. Parker HE, Reimann F, Gribble FM. Molecular mechanisms underlying nutrient-stimulated incretin secretion. Expert Rev Mol Med 2010; 12:e1.
3. Mortensen K, Christensen LL, Holst JJ, Orskov C. GLP-1 and GIP are colocalized in a subset of endocrine cells in the small intestine. Regul Pept 2003; 114:189–96.
Unicondylar Knee Arthroplasty for Unicompartmental Osteoarthritis of the Knee
Aruna Milinda Seneviratne, MD
Orthopedic Surgeon, Lenox Hill Hospital, New York
Until recently, surgical options for patients with isolated medial or lateral compartment arthritis of the knee were total knee arthroplasty. In Europe, unicondylar knee arthroplasty has been used successfully since the 1980s with development of the implants occurring as early as the 1970s.
Unicondylar knee arthroplasty has been slow to be adopted in the United States. It has been performed here since the 1990s; however, short-term results have not been favorable. In 2004, the Oxford Unicondylar Knee System was approved for use in the United States. This implant has had an excellent long-term track record, with implant survivorship of as much as 90% at 20 years, making it similar to that of total knee arthroplasty.
The presentation will cover a summary of the history of the unicondylar Oxford implant, indications for use, postoperative care, and technique of implantation with a focus on educating the primary care physician.
Value-Based Purchasing and What it Means for Physicians
Ylone Xavier, MBA, MPH
President, Healthcare Performance Management Consultant
Value-based purchasing (VBP), a program authorized by the Patient Protection and Accountable Care Act of 2010, gives the Centers for Medicare & Medicaid Services (CMS) the power to base a portion of hospital reimbursement payments on how well hospitals perform in 25 core measures. The move is intended to help CMS flex its muscles and move from being a passive bystander to an active buyer of what its officials have deemed higher-quality health care.
Currently this program is affecting only the Medicare reimbursement that the hospital receives. However, other payers will soon be following suit, which means that hospitals will be using this information for physician credentialing, as well as payments to physicians. In 2015, CMS will be extending this program to change physician payments as well.
This presentation will provide physicians with an understanding of both, how their treatment of patients within the hospital setting and their practice patterns will affect their income as well as the hospital’s financial status.
There will be 10 Poster Presentations during the CME Program