© 2023 CRRT Inc. CRRT 2006 Conference Summary Program and Workshops Wednesday, March 1 6:00pm-8:00 pm Registration Thursday Morning, March 2 7:00am-7:30pm Registration 8:30am-4:15pm WORKSHOPS (open to all participants - applicable to physicians, nurses and allied personnel) (Codes: C= Core workshop, I = Intermediate, A = Advanced, N= Nurses, AP = of interest to nurses and allied personnel) Workshops designated by an asterisk (*) will be presented twice in different time slots. Workshops presented in a series are marked with a "1" for a primary workshop discussion in this area and "2" for a more complex or advanced discussion in this area. Please note that the series workshops 1 and 2 can be either taken subsequently (following each other) or they can each be taken independently (e.g. workshop 1 can be taken without taking workshop 2 and vice versa). Workshop Group 1 8:30-10:00 8:30-10:00 A01 CRRT Systems I - I. Fresenius Systems Christian Schlaeper, MS 8:30-10:00 A01 II. Baxter - Edwards Lifesciences Critical Care Nephrology Alliance Accura/Aquarius Bev Ryan, RN Device demonstrations of features, setup, operation, monitoring and discontinuation 8:30-10:00 B02 Vascular Access /Membrane and Circuit 1 Michael A. Kraus, MD Principles of catheter choice, placement, maintenance, recognition and management of complications, selection and use of membranes for different applications, circuit design, setup and monitoring 8:30-10:00 C03 Dialysis Dose Prescription and Delivery 1 William R. Clark, MD Mark R. Marshall, MBChB, FRACP Claudio Ronco, MD Operational characteristics influencing solute removal in IHD, PD and CRRT 8:30-10:00 D04 Drug Management 1 Bruce A. Mueller, PharmD, FCCP Miet Schetz, MD, PhD Dosing principles for critically ill patients and adjustments in extracorporeal support techniques 8:30-10:00 E05 Renal Support Around the World: Clinical Vignettes Rajasekara Chakravarthi, MD, DNB (Nephrology) Andrew Davenport, MD, MA Stefan Herget-Rosenthal, MD Eric AJ Hoste, MD Daxi Ji, MD Tomas Kotulak, MD Illustrative cases demonstrating applications of CRRT in various settings. Application of CRRT in developing countries 8:30-10:00 F06 Extracorporeal Techniques for Sepsis 1 Patrick M. HonorŽ, MD Oliver Joannes-Boyau, MD John A. Kellum, MD, FACP, FCCM, FCCP William L. Macias, MD, PhD Pathophysiology of sepsis and rationale for use of extracorporeal support in treatment of sepsis. Experimental models for high permeability membranes, HVHF, VHVHF and hybrid therapies 8:30-10:00 G07 Advances in Technology This workshop highlights the current and future advances in technology for extracorporeal support. Available equipment and products from different providers will be compared. This workshop provides a glimpse of all the key equipment and products available for CRRT in one session 10:00-10:15 Coffee Break Workshop Group 2 10:15-11:45 10:15-11:45 A08 CRRT Systems II - I. RenaMed Biologics Rick DaSilva, RN 10:15-11:45 A08 II. NxStage Therapy System Barbara Reeder Device demonstrations of features, setup, operation, monitoring and discontinuation 10:15-11:45 B09 Anticoagulation 1: Mechanisms and Techniques Andrew Davenport, MD, MA Oliver Joannes-Boyau, MD Miet Schetz, MD, PhD Anticoagulation regimens: Mechanisms, selection, prescription, monitoring and implementation 10:15-11:45 C10 Fluid Management 1 Ravindra L. Mehta, MBBS, MD, FACP Principles of volume assessment, fluid removal and fluid regulation with different CRRT equipment 10:15-11:45 D11 Organizational Aspects of CRRT Programs 1: Development and Implementation Jorge Cerda, MD, FACP, FASN Rhonda K. Martin, RN, MS, MLT(ASCP) Karen E. Schardin, BSN, RN, CNN Practical issues for organization and implementation of a CRRT program. Developing and implementing policies and protocols for CRRT 10:15-11:45 E12 Plasma Exchange Therapy and Hybrid Techniques Andre A. Kaplan, MD David M. Ward, MD, FRCP Principles of plasma exchange, sorbent based and hybrid therapies for extracorporeal support. Results from experimental models and human studies 10:15-11:45 F13 Heart Failure and Cardio-Renal Syndrome 1 Richard Amerling, MD J. Thomas Heywood, MD Pathophysiology, recognition and management strategies for cardiac and renal failure in the critically ill patient 10:15-11:45 G14 Pediatric CRRT: The Basics Steven R. Alexander, MD Timothy E. Bunchman, MD Joseph V. DiCarlo, MD Technique requirement and application for use in children including neonates 11:45-1:00 Lunch on your own Thursday, Afternoon March 2 Workshop Group 3 1:00 - 2:30 1:00 - 2:30 A15 CRRT Systems III - I. Gambro Prisma William R. Clark, MD 1:00 - 2:30 A15 II. B. Braun Diapact Tony Annone, CRRT Product Special Device demonstrations of features, setup, operation, monitoring and discontinuation 1:00 - 2:30 B16 Solutions for CRRT 1 Jeffrey F Barletta, Pharm.D., FCCM Timothy E. Bunchman, MD Michelle A. Hladuewich, MD Sheldon W. Tobe, MD Basic concepts for formulation and application of various solutions for pre-dilution, replacement and dialysate in critically ill patients 1:00 - 2:30 C17 Therapy Comparisons I: SLED vs. CRRT vs. PD Kevin W. Finkel, MD, FACP, FASN Mark R. Marshall, MBChB, FRACP Raymond C. Vanholder, MD PhD Comparisons of operational characteristics including anticoagulation, membranes, solutions and flows and approaches for ongoing and future research 1:00 - 2:30 D18 Nutritional Assessment and Support 1 Tomas Kotulak, MD Bruce A. Mueller, PharmD, FCCP Pathophysiology of malnutrition in critically ill patients. Principles of nutritional assessment and support 1:00 - 2:30 E19 A Systems-based Approach to CRRT Linda Awdishu, BSc Pharm Ravindra L. Mehta, MBBS, MD, FACP Principles of systems based management strategies and their application to CRRT. Approaches to reduce errors in therapy prescription and delivery 1:00 - 2:30 F20 Liver and the Kidney 1 Tarek Hassanein, MD Rajiv Jalan, MD, PhD Pathophysiology of hepatic failure and rationale for use of different techniques for extracorporeal support techniques (Cell based systems, MARS, CRRT) for hepatic support 1:00 - 2:30 G21 Nursing Issues in Pediatric CRRT Helen Currier, BSN, RN, CNN John J Gardner, RN Practical issues for setting up and maintaining a pediatric CRRT program. Policies and procedures and protocol based management 2:30 -2:45 Coffee Break Workshop Group 4 2:45-4:15 2:45-4:15 A22 CRRT Systems I - I. Fresenius Systems Christian Schlaeper, MS 2:45-4:15 A22 II. Baxter - Edwards Lifesciences Critical Care Nephrology Alliance Accura/Aquarius Bev Ryan, RN Device demonstrations of features, setup, operation, monitoring and discontinuation 2:45-4:15 B23 Vascular Access/Membrane and Circuit 2 Eric AJ Hoste, MD Oliver Joannes-Boyau, MD Michael A. Kraus, MD Case based discussion of various factors influencing circuit longevity, membrane function and troubleshooting for problems encountered 2:45-4:15 C24 Dialysis Dose Prescription and Delivery 2 William R. Clark, MD Mark R. Marshall, MBChB, FRACP Claudio Ronco, MD Case based discussions of prescription of dose, modality choice and optimal dose delivery to match the therapy to the patients need 2:45-4:15 D25 Drug Management 2 Linda Awdishu, BSc Pharm Thomas A. Golper, MD Bruce A. Mueller, PharmD, FCCP Case based discussion of practical aspects for drug prescription, delivery and management of drug interactions in CRRT 2:45-4:15 E26 CRRT Around the World Emmanuel Burdmann, MD, PhD Rajasekara Chakravarthi, MD, DNB (Nephrology) Stefan Herget-Rosenthal, MD Daxi Ji, MD Vijay Kher, MD Illustrative cases demonstrating applications of CRRT in various settings. Application of CRRT in developing countries 2:45-4:15 F27 Extracorporeal Techniques for Sepsis 2 Patrick M. HonorŽ, MD John A. Kellum, MD, FACP, FCCM, FCCP Mehran Monchi, MD Technical considerations and practical application of extracorporeal support techniques for sepsis. Results of human studies for use of high permeability membranes, HVHF, VHVHF and hybrid techniques for sepsis 2:45-4:15 G28 Advances in Technology This workshop highlights the current and future advances in technology for extra corporeal support. Available equipment and components from different providers will be compared. This workshop provides a glimpse of all the key equipment and products available for CRRT in one session 4:30-7:00 OPENING SESSION 4:30 -4:35 Opening Remarks Ravindra L. Mehta, MBBS, MD, FACP Plenary 1 MINI-SYMPOSIA Organ Dysfunction in the Critically Ill Patient: Emerging Concepts for Organ Preservation 4:30-7:00PM Co-chair: Noel Gibney, MD 4:35- 4:55 pm The Host Response to Infection William L. Macias, MD, PhD 4:55-5:15 Abdominal Compartment Syndrome: Recognition and Management Patrick M. HonorŽ, MD 5:15-5:35 Acute Lung injury and ARDS: Pathophysiology and predictors of outcome Boyd Taylor Thompson, MD 5:35- 5:55 Vascular Brain Injury: Pathophysiology and Treatment Strategies Brett C Meyer, MD 5:55- 6:15 Liver Dysfunction in the Critically Ill Rajiv Jalan, MD, PhD 6:15-6:45 Key Note Address: Pathophysiology of AKI Bruce A. Molitoris, MD 6:45-7:00 Panel Discussion 7:00-8:30 pm Welcome Reception and Poster Viewing and Exhibits Open Friday Morning, March 3 6:30am-4:00pm Registration 7:25-7:30 Announcements Ravindra L. Mehta, MBBS, MD, FACP Plenary 2 MINI-SYMPOSIA Acute Kidney Injury (AKI) What's New? 7:30-9:45 Co-chair: William L. Macias, MD, PhD Co-chair: Claudio Ronco, MD 7:30-7:50 Sepsis and the Kidney Bruce A. Molitoris, MD 7:50-8:05 Terminology, definitions, classification and grading: The AKIN Project Ravindra L. Mehta, MBBS, MD, FACP 8:05-8:20 Predicting Outcomes in AKI: The RIFLE Classification System Eric AJ Hoste, MD 8:20-8:35 Techniques for early detection of AKI Stefan Herget-Rosenthal, MD 8:35-8:50 Cardiorenal Syndrome J. Thomas Heywood, MD 8:50-9:05 Kidney Dysfunction in Liver Disease Tarek Hassanein, MD 9:05-9:20 Pediatric Acute Kidney Injury: From Insult to Treatment. Stuart L. Goldstein, MD 9:20-9:45 Crush Injury and AKI in Natural Disasters: Lessons learned and applied Raymond C. Vanholder, MD PhD 9:45-10:00 Panel Discussion 10:00-10:15 Coffee Break Plenary 3 MINI-SYMPOSIA Controversies in Management of the Critically Ill Patient: Can We Modulate the Response to injury? 10:15-12:30 Co-chair: Patrick M. HonorŽ, MD Co-chair: Bruce A. Molitoris, MD 10:15-10:30 Endothelial Dysfunction in MODS William L. Macias, MD, PhD 10:30-10:45 From the Jaws of Death: HVHF For Out of Hospital Cardiac Arrest Mehran Monchi, MD 10:45-11:00 Immunomodulation with hemofiltration: Lessons from Sepsis Claudio Ronco, MD 11:00-11:15 Protecting the lung: What works? Boyd Taylor Thompson, MD 11:15-11:30 Unwitting Immunomodulation John A. Kellum, MD, FACP, FCCM, FCCP 11:30-11:45 Albumin dialysis: does it support the liver? Rajiv Jalan, MD, PhD 11:45-12:15 Adjunctive Therapy for sepsis: can we change outcomes? John A. Kellum, MD, FACP, FCCM, FCCP 12:15-12:30 Panel Discussion 12:30-1:30 Lunch Hosted by Conference SPECIAl LUNCHTIME SYMPOSIUM Dialysis Treatment of Acute Renal Failure Dialysis Opinion Symposium This symposium will present and discuss the results of a worldwide opinion survey conducted at nephrology and intensive care meetings during 2005 and including responses from 5,000 nephrology and intensive care professionals. Claudio Ronco, John Kellum, Ingrid Ledebo William Clark, Ravindra Mehta (lunch will be served) Friday Afternoon, March 3 Session II: Emerging Concepts in ARF and CRRT 1:30-3:00 Concurrent Workshops and Nursing and Allied Personnel Sessions Simultaneous Session for Nursing and Allied Personnel MINI-SYMPOSIA Contemporary Topics in Nursing Care 1:30-3:00 Co-chair: Richard Amerling, MD Co-chair: Linda Awdishu, BSc Pharm 1:30-1:50 Infection Control Maria T Pascual, RN BSN MPH 1:50-2:10 Challenges in End of Life Care Boyd Taylor Thompson, MD 2:10-2:30 Critical Care Pharmacology: What's new ? Bruce A. Mueller, PharmD, FCCP 2:30-2:50 Special Interest Groups: Will they improve care? Rhonda K. Martin, RN, MS, MLT(ASCP) 2:50-3:00 Panel Discussion Workshop Group 5 1:30-3:00 1:30-3:00 A29 CRRT Systems II - I. Rena Med Biologics Rick DaSilva, RN 1:30-3:00 A29 II. NxStage Therapy System Barbara Reeder Device demonstrations of features, setup, operation, monitoring and discontinuation 1:30-3:00 B30 Anticoagulation 2: Special Techniques Citrate Kevin W. Finkel, MD, FACP, FASN Noel Gibney, MD Mehran Monchi, MD David M. Ward, MD, FRCP Comparison of various techniques for regional citrate anticoagulation including requirements, setup, monitoring and results 1:30-3:00 C31 Fluid Management 2 Ravindra L. Mehta, MBBS, MD, FACP Case based discussion of application of techniques for fluid regulation in CRRT 1:30-3:00 D32 Organizational Aspects of CRRT Programs 2: Development and Implementation Thomas A. Golper, MD Michael A. Kraus, MD Karen E. Schardin, BSN, RN, CNN Case studies of proven techniques for growing and enhancing a CRRT program. Multidisciplinary teams, collaborative precatice, Finanical modelsand other strategies for succsess 1:30-3:00 E33 Plasma Exchange Therapy and Hybrid Techniques 2 Andre A. Kaplan, MD Claudio Ronco, MD Case based discussion of practical application of plasma exchange, sorbent based and hybrid therapies for extracorporeal support. 1:30-3:00 F34 Heart Failure and Cardio-renal Syndrome 2 Jorge Cerda, MD, FACP, FASN Emil P. Paganini, MD, FACP, FRCP Technical considerations, practical application and results of different methods to treat heart failure and cardio-renal syndrome 1:30-3:00 G35 Hot Topics in Pediatric CRRT Timothy E. Bunchman, MD Joseph V. DiCarlo, MD Stuart L. Goldstein, MD News from the ppCRRT, CRRT in the Newborn: the State of the Art, Is Microdialysis the Key to Understanding MODS at the Level of the Cellular Interstitium?, Zero-balance Ultrafiltration in Blood-Primed CRRT Circuits ORAL ABSTRACTS 1:30-3:00 Co-chair: Emmanuel Burdmann, MD, PhD Co-chair: Vijay Kher, MD 1:30-1:45 Vandana S. Mathur, MD FASN Intra-Renal Nesiritide Rapidly and Significantly Improves the Glomerular Filtration Rate and Renal Plasma Flow in Patients with Chronic Kidney Disease Receiving Contrast Media: Data from a Multi-center, Randomized, Placebo-Controlled Trial 1:45-2:00 Stuart L Goldstein, Baylor College of Medicine, Houston, TX, USA Urinary KIM-1 predicts severe AKI earlier than serum creatinine in pediatric patients 2:00-2:15 Elizabeth Maccariello, NepHro; Rede D«Or de Hospitais; Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil RIFLE CLASSIFICATION DOES NOT PREDICT OUTCOME IN DIALYTIC ACUTE KIDNEY DISFUNTION 2:15-2:30 Azra Bihorac, Division of Critical Care, Department of Anesthesiology, University of Florida, Gainesville Incidence Clinical predictors and outcome of acute renal failure among trauma patients: A Prospective Multicenter Study 2:30-2:45 Patricio D Downey, MD High volume hemofiltration in the management of severe hyperdynamic septic shock 2:45-3:00 Olivier Joannes-Boyau, University Hospital of Bordeaux, Pessac, France "Pulse" high volume hemofiltration in septic shock 3:00pm Adjourn 4:00-9:00pm Social Event - San Diego Zoo Saturday Morning, March 4 7:00am-5:00pm Registration Session III: Technique Characteristics 7:25-7:30 Announcements Ravindra L. Mehta, MBBS, MD, FACP Plenary 4 MINI-SYMPOSIA Challenges and Controversies in Renal Support and CRRT 7: 30-10:00 Co-chair: Andrew Davenport, MD, MA Co-chair: Sheldon W. Tobe, MD 7:30-7:45 Spectrum of Renal Support in the ICU: Results from the BEST study John A. Kellum, MD, FACP, FCCM, FCCP 7:45-8:00 Renal Support in the Developing World: Latin America Emmanuel Burdmann, MD, PhD 8:00-8:15 Renal Support in the Developing World: India Vijay Kher, MD 8:15-8:30 On-Line Preparation of Fluids for Dialysis: Practical Aspects vs Safety and Regulations Ingrid Ledebo, PhD 8:30-8:45 On-Site production of dialysate for CRRT: A decade of experience Emil P. Paganini, MD, FACP, FRCP 8:45-9:00 Changing fluid composition: Pre-mixed vs on-Site: What are the Issues? Linda Awdishu, BSc Pharm 9:00-9:15 Glucose, Insulin and the Kidney Miet Schetz, MD, PhD 9:15-9:30 Panel Discussion 9:30-9:45 Coffee Break Plenary 5 MINI SYMPOSIA Emerging strategies in extracorporeal support 9:45-12:30 Co-chair: Thomas A. Golper, MD Co-chair: Ashita Tolwani, MD 9:45-10:05 SPECIAL LECTURE Emerging Techniques and Indications for Extracorporeal Support Claudio Ronco, MD 10:05-10:20 HVHF and Nutrition: Special Considerations Patrick M. HonorŽ, MD 10:20-10:35 Short Term HVHF for pancreatitis and thrombotic disorders 10:35-10:50 C-SLED Kevin W. Finkel, MD, FACP, FASN 10:50-11:05 Cascade Hemofiltration Mehran Monchi, MD 11:05-11:25 Cell based therapy to reverse organ dysfunction H. David Humes, MD 11:25-11:40 Ultrafiltration for Heart Failure Emil P. Paganini, MD, FACP, FRCP 11:40-11:55 Concurrent CRRT and Therapeutic Plasma Exchange Peter D Yorgin, MD 11:55-12:10 Pharmacoeconomics of Extracorporeal Support: The Financial Case Richard A. Andrews 12:10-12:30 Panel Discussion 12:30-1:30 Lunch Hosted by Conference Saturday Afternoon, March 4 Session IV: Future Trends in CRRT 1:30-3:00 Concurrent Workshops and Nursing and Allied Personnel Sessions Simultaneous Session for Nursing and Allied Personnel MINI-SYMPOSIA Nursing Care in the Electronic Era 1:30-3:00 Co-chair: Noel Gibney, MD Co-chair: Maria T Pascual, RN BSN MPH 1:30-1:45 EMR Kristen J Alandydy, Manager, ACIS 1:45-2:00 CPOE Amy V Graham 2:00-2:15 e-MAR Debra A Winter, MS, BSN,RN 2:15-2:30 SIM-MAN Patti Graham, RN, MS, CCRN, CS 2:30-2:45 Electronic Tools for Documentation: Will They Improve Outcomes? Joshua Lee, MD 2:45-3:00 Panel Discussion Workshop Group 6 1:30-3:00 1:30-3:00 A36 CRRT Systems III - I. Gambro Prisma William R. Clark, MD 1:30-3:00 A36 II. B. Braun Diapact Tony Annone, CRRT Product Special Device demonstrations of features, setup, operation, monitoring and discontinuation 1:30-3:00 B37 Solutions for CRRT 2 Marlies Ostermann Amy M. Sprague, MD Sheldon W. Tobe, MD Ashita Tolwani, MD Case based discussions of applications of solutions for acid-base and metabolic control, electrolyte and divalent ion homeostasis 1:30-3:00 C38 Therapy Comparisons 2: SLED vs. CRRT vs. PD Richard Amerling, MD Kevin W. Finkel, MD, FACP, FASN Eric AJ Hoste, MD Mark R. Marshall, MBChB, FRACP Case Based Examples of SLED (daily and Continuous), PD (intermittent, tidal) and practical aspects for recognizing and managing complications and approaches for ongoing and future research. 1:30-3:00 D39 Nutritional Assessment and Support 2 Patrick M. HonorŽ, MD Tomas Kotulak, MD Bruce A. Mueller, PharmD, FCCP Case based discussion of technical and practical considerations for nutritional support with CRRT 1:30-3:00 E40 A Systems-based Approach to CRRT2 Linda Awdishu, BSc Pharm Ravindra L. Mehta, MBBS, MD, FACP Case studies of applications of systems based approaches for problem solving and continuous quality improvement in CRRT. Strategies to implement best practices to improve patient safety and outcomes. 1:30-3:00 F41 Liver and Kidney II: Hepatic Support Andrew Davenport, MD, MA Rajiv Jalan, MD, PhD Rhonda K. Martin, RN, MS, MLT(ASCP) Jan Stange, MD Technical considerations, practical application and results of different methods of hepatic support for patients with hepatic failure and hepatorenal syndrome 1:30-3:00 G42 Controversies in Pediatric CRRT Patrick D. Brophy, MD, FAAP, FRCPC Stuart L. Goldstein, MD Kevin McBryde, MD Jordan M. Symons, MD Pro-con discussions of a key area of controversy in pediatric CRRT: Citrate is superior to heparin anticoagulation for pediatric CRRT ORAL ABSTRACTS 1:30-3:00 Co-chair: Steven R. Alexander, MD Co-chair: David M. Ward, MD, FRCP 1:30-1:45 J.K. Leypoldt, VASLCHCS & University of Utah, Salt Lake City, UT, USA IMPROVED DIFFUSIVE SOLUTE CLEARANCES WITH NOVEL CRRT EQUIPMENT AND DIALYZER DESIGN 1:45-2:00 Rafael Ponikvar, Department of Nephrology, University Medical Center, University of Ljubljana, Slovenia VASCULAR ACCESS IN CRITICALLY ILL PATIENTS WITH ACUTE RENAL FAILURE TREATED WITH HEMODIALYSIS / HEMOFILTRATION 2:00-2:15 Mariann Churchwell, Pharm.D. Trace Element Clearance in Critically Ill Patients Treated with Continuous Venovenous Hemodiafiltration (CVVHDF) 2:15-2:30 C Vitale, Nephrology Unit, Mauriziano Hospital, Turin, Italy DERMATAN SULPHATE: AN ALTERNATIVE TO HEPARIN FOR ANTICOAGULATION IN CRRT 2:30-2:45 Ashita J. Tolwani, University of Alabama at Birmingham, Birmingham, AL, USA SAFETY OF 0.5% ISOTONIC CITRATE REPLACEMENT SOLUTION FOR CONTINUOUS VENOVENOUS HEMODIAFILTRATION (CVVHDF) 2:45-3:00 Francisco X. Flores, M.D CRRT IN PEDIATRIC SEPSIS A REPORT FROM THE PROSPECTIVE PEDIATRIC CONTINUOUS RENAL REPLACEMENT THERAPY (ppCRRT) REGISTRY GROUP 3:00-3:15 Coffee Break Plenary 6 MINI- SYMPOSIA Looking to the Future: What Can We Expect? 3:15-5:00 Co-chair: Jorge Cerda, MD, FACP, FASN Co-chair: Miet Schetz, MD, PhD 3:15-3:35 Novel Imaging Techniques for Discovery, Diagnosis and Monitoring Bruce A. Molitoris, MD 3:35-3:55 Biomarkers, Diagnostics and Theranostics: Emerging Tools for the ICU Gunars E Valkirs, PhD 3:55- 4:15 Enhancements in Technology: Modified Membranes William R. Clark, MD 4:15- 4:35 Remote Monitoring and Therapy: The eICU Noel Gibney, MD 4:35-4:55 Panel Discussion 4:55 Closing Remarks Ravindra L. Mehta, MBBS, MD, FACP 5:00 Adjourn