This CME activity was planned and produced in accordance with the ACCME Essentials.

The content on which this exam is based is available at: www.medicalletter.org/tml/cme. Please review this content and use it to answer the exam questions.

MISSION STATEMENT:
The mission of The Medical Letter's Continuing Medical Education Program is to support the professional development of health care professionals including physicians, nurse practitioners, pharmacists and physician assistants by providing independent, unbiased drug information and prescribing recommendations that are free of industry influence. The program content includes current information and unbiased reviews of FDA-approved and off-label uses of drugs, their mechanisms of action, clinical trials, dosage and administration, adverse effects and drug interactions. The Medical Letter delivers educational content in the form of self-study material.

The expected outcome of the CME Program is that knowledge and consideration of the information contained in The Medical Letter can affect health care practice and ultimately may result in improved patient care and outcomes.

The Medical Letter will strive to continually improve the CME program through periodic assessment of the program and activities. The Medical Letter aims to be a leader in supporting the professional development of health care professionals by providing continuing medical education that is unbiased and free of industry influence.

The Medical Letter is supported solely by subscription fees and accepts no advertising, grants or donations.

LEARNING OBJECTIVES
Activity participants will read and assimilate unbiased reviews of FDA-approved and off-label uses of drugs and other treatment modalities.

Activity participants will be able to select and prescribe, or confirm the appropriateness of the prescribed usage of, the drugs and other therapeutic modalities discussed in The Medical Letter with specific attention to clinical trials, pathophysiology, dosage and administration, drug metabolism and interactions, and patient management.

Activity participants will make independent and informed therapeutic choices in their practice.

NEEDS ASSESSMENT
Participants in the program have indicated their interest in this subject matter and need for information by subscribing to The Medical Letter, the content of which provides the basis for this activity. The activity is periodically evaluated, and comments and suggestions from subscribers reviewed and implemented as deemed appropriate.

CONFLICT OF INTEREST
The Medical Letter is an independent nonprofit organization that provides health care professionals with unbiased drug information. The Medical Letter is supported solely by subscription fees and accepts no advertising, grants or donations. The editorial process used for its publications relies on a review of published and unpublished literature, with an emphasis on controlled clinical trials and peer review. The questions in The Medical Letter CME Activities are designed and created by the Editorial Staff and CME Exam Committee at The Medical Letter. All individuals involved in the content on which this activity is based are required to disclose any relevant financial relationship(s) they, including spouse or partner, have with a commercial interest that benefits the individual in any financial amount that has occurred within the past 12 months. Any presenter whose disclosed relationships prove to create an irresolvable conflict of interest, with regard to their contribution to the activity, will not be permitted to present.

DISCLOSURE
The Medical Letter requires that individuals responsible for the content on which a CME activity is based disclose to the audience when a conflict exists and when discussing any unlabeled or investigational use of any commercial product, or device, not yet approved for use in the United States.

The content of The Medical Letter and related CME Program is controlled by the Editor, who declares no conflict of interest.

ACCREDITATION
The Medical Letter is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Medical Letter designates this educational activity for a maximum of 13 AMA PRA Category 1 Credits(s)™. Physicians should only claim credit commensurate with the extent of their participation in this activity.

This CME activity was planned and produced in accordance with the ACCME Essentials.

The Medical Letter is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

The Medical Letter (2008) has been reviewed and is acceptable for up to 26 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins 01/01/08. Term of approval is for one year from this date. This exam is approved for 13 Prescribed credits. Credits may be claimed for one year from the date of this exam.

The American Academy of Nurse Practitioners and the American Academy of Physician Assistants (AAPA) accept AMA Category 1 credit for the Physician’s Recognition Award from organizations accredited by the ACCME.

This activity, being ACCME (AMA) approved, is acceptable for Category 2-B credit by the American Osteopathic Association.

Physicians, nurse practitioners, pharmacists and physician assistants may earn 13 credits with this exam.

CERTIFICATES
Certificates/statements of credit will be emailed to those who submit and pass the exam. A score of 70% or greater is required to pass the exam.

SPECIAL CONTINUING MEDICAL EDUCATION REPORTING FORMS
American Academy of Family Physicians -- When filled out and sent to us, the personalized continuing medical education reporting forms for AAFP members will be forwarded to AAFP headquarters once individual test results are available.

Other Organizations -- We shall make every effort to expedite reports. Please fill out any requisite forms as fully as possible before sending them to us for completion.

PRINCIPAL FACULTY FOR THIS ACTIVITY
Mark Abramowicz, M.D., Editor - The Medical Letter
Mark Abramowicz, M.D. has no disclosure or potential conflict of interest to report.

Dr. Abramowicz has been writing and editing medical education material for over 35 years and has been Editor of The Medical Letter since 1973. He received his medical degree from Washington University in St. Louis in 1960, completed his internship and residency in Pediatrics at Boston City Hospital and Massachusetts General Hospital, and trained in Infectious Diseases and Epidemiology at Boston City Hospital. In addition, Dr. Abramowicz served as a Captain in the U.S. Army Medical Corps from 1962 to 1964. After completing his training, he was a full-time member of the Pediatrics Department at the Albert Einstein College of Medicine. Dr. Abramowicz has been instrumental in developing The Medical Letter’s unique approach to addressing the CME needs of physicians.

Gianna Zuccotti, M.D., MPH, Executive Editor - The Medical Letter
Vice Chair of Medicine, Clinical Affairs - Memorial Sloan Kettering Cancer Center
Gianna Zuccotti, M.D., MPH has disclosed that her spouse is on the Speaker’s Bureau for Astellas, Pfizer, and Schering-Plough and has served as an Advisory Consultant for Astellas, Pfizer, Merck, Schering-Plough, and Cubist.

Eric J. Epstein, M.D., Contributing Editor - The Medical Letter
Assistant Professor of Medicine - Albert Einstein College of Medicine
Eric J. Epstein, M.D. has no disclosure or potential conflict of interest to report.

Jean-Marie Pflomm, Pharm.D., Deputy Editor - The Medical Letter
Jean-Marie Pflomm, Pharm.D. has no disclosure or potential conflict of interest to report.

Susan Morey, Pharm.D., Assistant Editor, Drug Information - The Medical Letter
Susan Morey, Pharm.D. has no disclosure or potential conflict of interest to report.

For questions about this examination you may call Customer Service at The Medical Letter at (800) 211-2769.