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REGISTRATION FORM 7th Annual Regional Neonatology Symposium: ________________________________________________________________________ ENHANCING THE MANAGEMENT OF THE First Name MI Last Name HIGH RISK INFANT ________________________________________________________________________ Last 4 digits of Soc Sec # (for transcript purposes) Credentials ________________________________________________________________________ Friday, October 28, 2011 Employer Employer County 11:30 am – 6:30 pm ________________________________________________________________________ Job Title Department Renaissance Charlotte Suites Hotel 2800 Coliseum Centre Drive ________________________________________________________________________ Charlotte, North Carolina 28217 Address (❏ Home ❏ Work) ________________________________________________________________________ City State Zip Code ________________________________________________________________________ Work Phone Number Home Phone Number ________________________________________________________________________ Fax Number Email Address Registration Fee: $35.00 Event #: 33678 Payment Options: ❏ Check enclosed (make checks payable to Charlotte AHEC) ❏ Visa ❏ MasterCard ❏ Discover ❏ American Express) ________________________________________________________________________ Credit Card # or CHS Bus. Unit/Dept. # Exp. Date ________________________________________________________________________ Cardholder’s Signature or Dept. Head Signature Mail Form and Payment to: Charlotte AHEC - ATTN: Registrar PO Box 32861 • Charlotte, NC 28232-2861 or Fax form to 704.512.6561 You may register online at www.charlotteahec.org Sponsored by Carolinas HealthCare System, Charlotte AHEC Continuing Medical Education (CME) Levine Children’s Hospital, Department of Neonatology PROGRAM DESCRIPTION AGENDA This program focuses on evaluating the evidence and discussing potential practice 11:30 a.m. Registration changes related to the high risk infant. 12:00 p.m. Buﬀet Lunch 1:00 p.m. Transfusion Related Gut Injury After PRBC Transfusion OBJECTIVES Edmund LaGamma, MD At the end of this symposium, participants should be able to: 2:00 p.m. Nutritional Issues Associated with Short Bowel Syndrome • Evaluate the bene ts and risks associated with nutritional management of the infant Samuel A. Kocoshis, MD with Short Gut Syndrome 3:00 p.m. Break • Discuss the evidence surrounding transfusion related acute gut injury 3:30 p.m. Infection and the Preterm Brain • Review the long-term e ects of intraventricular hemorrhage (IVH) in the premature Michael O'Shea, MD infant 4:30 p.m. Long Terms E ects of IVH • Discuss potential outcomes related to infection and the preterm brain Michael O'Shea, MD 5:30 p.m. Reception TARGET AUDIENCE Neonatologists, Neonatal Nurse Practitioners, Neonatal Nurses, Neonatal Respiratory Therapists SYMPOSIUM LOCATION FACULTY The Renaissance Charlotte Suites is conveniently located in the heart of Charlotte and easily accessible from the Charlotte/Douglas International Airport. Samuel Kocoshis, MD Medical Director, Pediatric Nutrition and Intestinal Care Center A complimentary shuttle from the airport is available simply by calling the hotel’s Medical Director, Small Bowel Transplantation Program front desk. Professor of Pediatrics, Cincinnati Children's Hospital Cincinnati, Ohio Edmund LaGamma, MD Chief, Division of Newborn Medicine Carolinas HealthCare System, Charlotte Area Health Education Center is the continuing Director, Neonatal-Perinatal Fellowship Program education provider for this activity. Professor of Pediatrics, Biochemistry & Molecular Biology ACCREDITATION STATEMENT The Regional Neonatal Center-Maria Fareri Children's Hospital- This activity has been planned and implemented in accordance with the Essential Westchester Medical Center, New York Medical College Areas and policies of the Accreditation Council for Continuing Medical Education Valhalla, New York (ACCME) through the direct sponsorship of Carolinas HealthCare System/Charlotte Michael O'Shea, MD AHEC. The Carolinas HealthCare System/Charlotte AHEC is accredited by the ACCME to Vice Chair, Pediatrics provide continuing medical education for physicians. Professor, Pediatrics, Hypertension and Vascular Research Center Epidemiology & Prevention, Social Sciences & Health Policy CREDIT DESIGNATION STATEMENT Wake Forest Baptist Medical Center The Carolinas HealthCare System/Charlotte AHEC designates this Live Activity for a Winston-Salem, North Carolina maximum of 4.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in this activity. Other PROGRAM COORDINATORS healthcare professionals 0.4 CEUs. POLICY ON FACULTY AND SPONSOR DISCLOSURE Thomas Kueser, MD Jay M. Kothadia, MD The Carolinas HealthCare System/Charlotte AHEC adheres to the ACCME Standards Division of Neonatology Neonatal-Perinatal Medicine regarding industry support of continuing medical education. Disclosure of faculty and CMC-Levine Children's Hospital Pediatrix Medical Group Charlotte, North Carolina commercial support relationships, if any, will be made known at the activity. Pam Spivey, MSN, RN, CCNS ADA STATEMENT Neonatal Clinical Nurse Specialist If you need any auxiliary aids or services identi ed in the American with CMC-Levine Children's Hospital Disabilities Act in order to attend this conference, please call Gabriela Staley at Charlotte, North Carolina 704.512.6596 or by email at email@example.com.
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