Ridgeview Podcast: CME Series

In this final podcast of the Ridgeview CME Podcast Series [sigh], Dr. Dennis Mohling, an obstetrician/gynecologist with Western OB/GYN, a Division of Ridgeview Clinics, along with one of his patients, Abie Rosckes discuss a special case around a improbable postpartum event and the decisions that were made. *Disclosure note: None of the speakers or planners for this education activity have relevant financial relationships to disclose with any inelgible company - who's primary business is producing marketing, selling, re-selling, or distributin healthcare products used by or on patients. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Explain the presentation of late postpartum hemorrhage (PPH). Distinguish the need for rapid evaluation and treatment of late postpartum hemorrhage (PPH). Summarize the team members and resources needed (and available) to ensure rapid delivery of treatment in a patient experiencing postpartum hemorrhage. This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.  CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. None of Ridgeview's CME planning committee members have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.  All of the relevant financial relationships for the individuals listed above have been mitigated. Thank-you for listening to the podcast. Thanks to Dr. Dennis Mohling and Abbie Roskes for their expert knowlege and contribution to this podcast. Also a special thanks to Jason Hicks and Fred DeMeuse for their contribution to all the Ridgeview CME Podcasts the past 6 seasons, as they made the educational podcasts fun and entertaining.

In this podcast, Dr. Chris Solie, an emergency physician, along with Jason Hicks, Fred DeMeuse, Greta Sowels (physician assistants), working for Emergency Medicine Physicians and Consultants (EMPAC) who review journals and papers around emergency medicine. *Disclosure note: None of the speakers or planners for this education activity have relevant financial relationships to disclose with any inelgible company - who's primary business is producing marketing, selling, re-selling, or distributin healthcare products used by or on patients. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Identify emergency medicine journal articles that may be potentially practice changing. Differentiate between using a HEAR score versus a HEART score when assessing patients coming into the ED with chest pain. Restate whether vaccination during pregnancy could reduce the burden of respiratory syncytial virus (RSV) - associated lower respiratory tract illness in newborns and infants. xxxx xxxxx       This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.  CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. None of Ridgeview's CME planning committee members have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.  All of the relevant financial relationships for the individuals listed above have been mitigated. RESOURCES The following links are to the journal articles mentioned/reviewed in this podcast. Article 1: O’Rielly, C.M., Andruchow, J.E., McRae, A.D. et al. External validation of a low HEAR score to identify emergency department chest pain patients at very low risk of major adverse cardiac events without troponin testing. Can J Emerg Med 24, 68–74 (2022). https://doi.org/10.1007/s43678-021-00159-y Article 2: Kampmann B, Madhi SA, Munjal I, et al. Bivalent Prefusion F Vaccine in Pregnancy to Prevent RSV Illness in Infants. N Engl J Med. 2023;388(16):1451-1464. doi:10.1056/NEJMoa2216480           Fowler LA, Hirsh EL, Klinefelter Z, Sulzbach M, Britt TW. Objective assessment of sleep and fatigue risk in emergency medicine physicians. Acad Emerg Med. 2023;30(3):166-171. doi:10.1111/acem.14606   HALT-IT Trial Collaborators. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Lancet. 2020;395(10241):1927-1936. doi:10.1016/S0140-6736(20)30848-5   Copaescu AM, Vogrin S, James F, et al. Efficacy of a Clinical Decision Rule to Enable Direct Oral Challenge in Patients With Low-Risk Penicillin Allergy: The PALACE Randomized Clinical Trial. JAMA Intern Med. 2023;183(9):944-952. doi:10.1001/jamainternmed.2023.2986       Zwaans JJM, Raven W, Rosendaal AV, et al. Non-sterile gloves and dressing versus sterile gloves, dressings and drapes for suturing of traumatic wounds in the emergency department: a non-inferiority multicentre randomised controlled trial. Emerg Med J. 2022;39(9):650-654. doi:10.1136/emermed-2021-211540     Thank-you for listening to the podcast. Thanks to Dr. Chris Solie, Jason Hicks, Fred DeMeuse and Greta Sowels for their expert knowledge and contribution to this podcast (and all podcasts produced).

In this podcast, Dr. Purvi Gada, a hematologist and oncologist, along with Alicia Wojchik, a nurse practitioner, both with Minnesota Oncology, come together to discuss immunotherapy in regards to cancer treatment. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Describe how the immune system functions (works), and how it impacts immunotherapy. Define the difference between immunotherapy and chemotherapy. Describe how immunotherapy drugs work. Identify and manage side effects of immunotherapy. This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.  CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. None of Ridgeview's CME planning committee members have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.  All of the relevant financial relationships for the individuals listed above have been mitigated. Thank-you for listening to the podcast. Thanks to Dr. Purvi Gada and Alicia Wojchik for their expert knowledge and contribution to this podcast.

In this podcast, Dr. Brian Driver, an emergency medicine physician with Hennepin Healthcare, brings his research expertise to this podcast and will help to decipher the complexities of research articles, what makes a good study, and how we can better interpret the literature. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Define what is meant by "evidence-based medicine". Explain what makes a good research study. Correctly interpret findings in research articles. This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.  CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. None of Ridgeview's CME planning committee members have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.  All of the relevant financial relationships for the individuals listed above have been mitigated. Thank-you for listening to the podcast. Thanks to Dr. Brian Driver for his expert knowledge and contribution to this podcast.

In this podcast, Dr. Nick Schneeman, a geriatrican and the Chief Medical Officer for LifeSpark, brings his passion and expertise to discuss the state of care in geriatrics, along with how current delivery in care and payment models effect the geriatric population. Disclosure note: Dr. Nick Schneeman , speaker for this educational event, has no relevant financial relationship(s) with ineligible companies to disclose. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Describe what is meant by "value-based care". Describe current barriers to delivering high value care to a senior population. This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.  CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. None of Ridgeview's CME planning committee members have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.  All of the relevant financial relationships for the individuals listed above have been mitigated. Thank-you for listening to the podcast. SHOW NOTES:   *See the attachment for additional information.  PODCAST OVERVIEW- Geriatric care delivery and quality has not evolved significiantly. - Pockets of excellence exist in academic centers. - Social support systems is integral, but lacking in many parts of the country. - Fee for service (FFS) system is not a sustainable model per Dr. Schneeman for complex senior patients. - Training and exposure to the 'business platforms' in medicine is lacking with providers - FFS = paying for a specific service, procedure, treatment, etc. Value Based Care (VBC)- Value based care = outcomes/cost         - Clinical outcomes         - Experience outcomes of patient/family and caregiving team - How is VBC measured?         - Medical loss ratio (cost containment) - How does VBC work?         - Organization contracts with payor         - VBC organization takes on risk         - Money savings opportunity - Half of seniors in USA are already in a VBC model         - Medicare (CMS)         - ACO (group of doctors, health care organization, etc.)         - Medicare advatage (CMS product that insurance companies contract with federal government) - Cost Product (medicare advantage product)         - Introduced in MN with assumption that this state will do such a good job with cost containment, but this wasn't how it worked out.         - For profits not participate in Medicare advantage products which keep the non-profits more accountable, although there are also disadvantages with for profit programs. - How does the care deliery work in VBC organizations (Nick's viewpoint)?         - Step 1: Journey from simple problems into complexity         - Step 2: What is the current rality and quality of life?  (When people hear you restating their story, trust goes up immensily.)         - Step 3: What are you hoping for? (patient, family, etc.)         - Step 4: Acute care planning         - Step 5: Chronic care planning         - Outcomes:  POLST (physician orders for life-sustaining treatment) form that is comprehensive;            Chronic care plans that are clear and purposeful and match goals of care - Well done POLST forms require intential discussion with patient and advocates who have decision making capacity and understanding of the patient's realit and values Palliative Care- How it's integrated and its controversy - All practitioners should be able to make palliative decisions with and for their patients who they know intimately - Palliative care as a specialty exists largely due to a FFS model - Often this is a clinican the patient has never met before and is a one time consult - Private equity had created palliative care 'cold call' business models in recent years Value Based Care (VBC) - continued- How does a practitioner go about doing this? - Make sure the organization you join actually values the primacy of primary care - Clinicians need TIME with their complex patients and to be paid for this time - FFS can work well for simple problems - Who does this well? Small pockets, mostly senior care (i.e. ChenMed, Oak Street, LifeSpark, etc.) - Clinic based (ChenMed, Oak Street) - LifeSpark is homebased - nurse, APP, physician - are assigned to each patient and continue to follow their care, avoid overprescribing, inappropriate abx - Private equity and Big insurance is getting into the game, but their approaches tend to be siloed and perhaps less humanistic - Recruiting quality providers to this care delivery model is imperative - Improved patient outcomes and costs exisst (i.e. geriatric assessment before cancer care) - Value Based Care really has to be an "all in" experience for a clinic or organization for it to work Training- Training typically happens in house, as opposed to a training program or course - Subspecialists will still be very much part of the care team, although decision making about proceeding with advanced therapies will be oriented around the VBC  medical home team - Pharmacy is a valuable team member as well, especially if part of the "goals of care" as opposed to merely looking up medications - challenge: SNFs and long term care facilities often have significant staff turnover, care quality issues, and these can lead to unnecessary care, ED visits and hospitalizations Evidence Based Moment (EBM)  ResourcesMagill MK. Time to Do the Right Thing: End Fee-for-Service for Primary Care. Ann Fam Med. 2016 Sep;14(5):400-1. doi: 10.1370/afm.1977. PMID: 27621155; PMCID: PMC5394371. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394371/pdf/0140400.pdf Basu S, Phillips RS, Song Z, Landon BE, Bitton A. Effects of New Funding Models for Patient-Centered Medical Homes on Primary Care Practice Finances and Services: Results of a Microsimulation Model. Ann Fam Med. 2016 Sep;14(5):404-14. doi: 10.1370/afm.1960. PMID: 27621156; PMCID: PMC5394379. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.annfammed.org/content/annalsfm/14/5/404.full.pdf Thanks to Dr. Nick Schneeman for his expert knowledge and contribution to this podcast.

In this podcast, Dr. Nedaa Skeik, a vascular surgeon with Minneapolis Heart Institute, brings his knowledge and experience in regards to vascular insufficiency, and the importance of a timely diagnosis and management options. *Disclosure note: Dr. Nedaa Skeik, speaker for this educational event, has disclosed that he received honorarium from Medtronic.  All relevant financial relationships for Dr. Skeik have been mitigated. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Summarize the pathophysiology of different venous disorders. Recognize and confidently diagnose venous insufficiency. Identify the risks and benefits of different interventions for venous conditions. Differentiate medical management (conservative and interventional) for venous insufficiency. This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.  CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. None of Ridgeview's CME planning committee members have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.  All of the relevant financial relationships for the individuals listed above have been mitigated. Thank-you for listening to the podcast. SHOW NOTES:   *See the attachment for additional information.  PODCAST OVERVIEW Wide Range of Venous Disorders and Presentations - Morphologic (spider, reticular, varicose), skin discoloration, ulceration - Functional (venous reflux +/- loss of pumping mechanism - Anatomic (thrombosis, congenital anomalies) - Presentation (asymptomatic vs symptomatic)Anatomy PathophysiologyEpidemiology - Chronic vein abnormalities- Prevalence (venous insufficiency) - Varicose veins & prevalence- Presence of symptoms Risk factors - Family component- Other  Clinical features - Correlation - severity of venous reflux, age- Asymptomatic - General symptoms - Vein appearance - Severity Disease Severity - Classification Scales - CEAP calssification scale- Venous Clinial Severity Score  Disease Progression - Correlation- pregression of disease not well understoodDiagnosis - History - Symptoms - Exam findings - including venous ultrasound - Differential diagnoses (edema, skin manifestations, vein engorgement) - Pre-management considerations (severity, superficial and/or deep, proximal/distal, multiple or single, comorbidities) ManagementAsymptomatic - visual sclerotherapy- surface laser therapy - complications Symptomatic- compression therapy - exercise - leg elevation - skin care Conserative Therapy- leg elevation - exercise - compression stockings Pharmacologic Therapy and Skin Care- vasoactive drugs - rheologic agents - skin care Interventional Options - Preintervention measures (venous anatomy, preop medications, anesthesia) - Sclerotherapy (visual, US guided)- Vein closure procedures (thermal - RFA/EVLA, chemical, MOCA, PEM, EHIT) - Surgical (phlebectomy, ligation, stripping) Post Intervention Care - pain management - ambulation - leg elevation - compression - return to normal activity/work - post procedural US - follow up appointment Thanks to Dr. Nedaa Skeik for his expert knowledge and contribution to this podcast. Please check out the additional show notes for more information/resources.

In this podcast, Dr. Gabi Hester, a pediatric hospitalist and Quality Improvement (QI) medical director for Children's Hospitals of Minnesota in Duluth, brings her knowledge and experience in  everything related to croup and bronchiolitis (specifically pertaining to in-patients and to frontline healthcare providers). *Dr. Gabi Hester, speaker for this educational event, has disclosed that she is a consultant who provides content recommendations to AvoMed. All relevant financial relationships for Dr. Hester have been mitigated.  Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: State at least 2 challenges in the recognition of and treatment of acute respiratory illnesses in children. Describe potiential interventions for bronchiolitis that have not been shown to provide signigicant benefit to most patients. Recognize common "mimickers" of croup. This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.  CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. None of Ridgeview's CME planning committee members have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.  All of the relevant financial relationships for the individuals listed above have been mitigated. Thank-you for listening to the podcast. SHOW NOTES:   *See the attachment for additional information.  PODCAST OVERVIEW CROUP (layngotracheitis)Overview - 400,000 approx. ER visits/year in U.S. - Costly, approx. $53 million/year - Scary disease due to airway obstruction - Para-influenza most common - Classically, kids are admitted after 2 racemic epinephrine nebulizers         - Dr. Hester studied croup and hospitalization (see resources below)         - Kids admitted, and no further treatment or intervention (observed) Presentation and treatment - Rhinorrhea, low grade fever, barky cough (seal bark)- Inspiratory stridor, usually worse when agitated - Rarely insp and exp stridor (if progressed disease state) - Dexamethason 0.6 mg/kg (max dose of 12-16 mg) - Nebulized racemic epinephrine (RA)       - bridge for steroid to kick in      - reserved for stridulous patient - Think about croup mimics       - not responding to racemic epinephrine       - older kids (i.e. 7 yr old), think about other diagnoses       - Epiglottitis            - cough is less barky            - respiratory distress and tripoding            - thumb print sign       - Bacterial tracheitis            - can be complication of viral croup            - can quickly decompensate - Foreign body, airway anomalies, etc. TREATMENT: - cool outdoor air can be soothing, no good studies to support - humidified air - imaging can be done (steeple sign on AP neck) but not routinely required         - Worried about foreign body? Epiglottitis?         - not responding to racemic epi         - CXR if hypoxia. Not typical of croup to be hypoxia.Research (links below) - Most kids don't need further treatment after ED course. -

In this podcast, Dr. Robert Steffen, a cardiac surgeon with Minneapolis Heart Institute. Dr. Steffen brings his knowledge and experience regarding the prevalence of aortic valve disease, advancements in technology, as well as treatment modalities for patients who suffer with this problematic disorder. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: State the prevalence of aortic valve disease. Identify when patients with aortic valve disease need intervention. Describe the different therapeutic options for patients with aortic valve disease and when to use them. This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.  CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast.

In this podcast, Dr. Michael Maddaus, a retired thoracic surgeon, but currently a physician coach with a special interest in helping surgeons.  Dr. Maddaus brings his knowledge and experience around burnout, wellness, resiliency and other healthcare provider challenges. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Define reslience and identify how it applies to adversities encountered in medicine. Identify behaviors that promote resilience, including managing expectations, setting realistic goals and finding gratitude. This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.  CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:   *See the attachment for additional information.  PODCAST NOTES & REFERENCES Resilience Bank Account scientific paper: https://www.annalsthoracicsurgery.org/article/S0003-4975(19)31352-9/fulltext Podcast by Dr. Maddaus: https://www.sts.org/topics/resilient-surgeon Authors and Sites Referenced Love + Work by Marcus Buckingham www.principlesyou.com  (Ray Dalio) www.jocko.com  (Jocko Willink) Dark Horse by Todd Rose The End of Average by Todd Rose Waking Up and www.wakingup.com by Sam Harris www.michaelmaddaus.com Thanks goes out to Dr. Michael Maddaus for his expert knowledge and contribution to this podcast. Please check out the additional show notes for more information/resources.

In this podcast, Dr. Matt Weber, a podiatrist with Ridgeview Specialty Clinics, brings his knowledge and experience around the causes of ankle instability, how common it is, and the different approaches for therapy and management. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Recognize ankle ligament instability from a patient's clinical history and exam. Diagnose ankle problems (pathology) assiciated with ankle instability, including acute injury vs. chronic conditions. Choose appropriate treatment protocols for an ankle instability condition. This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.  CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:   *See the attachment for additional information.  PODCAST OVERVIEW Ankle Sprains - 25% go on to further sprains. - Graded 1-3 - Anatomy - Ottawa ankle rules - Physical therapy - Acute vs chronic Ankle Surgery - Brostrom Gold (pants over vest) - Attenuated Gracilis Repair - Following surgery - 3-4 weeks immobilized, then boot for 2-3 weeks, then physical therapy. - 4 months post injury - back to activity Thanks to Dr. Matt Weber for his expert knowledge and contribution to this podcast. Please check out the additional show notes for more information/resources.

In this podcast, Dr. Nicole Roeder, a pulmonologist with Ridgeview Specialty Clinics, brings her knowledge and experience to discuss how to properly diagnose and manage asthma and chronic obstructive pulmonary disease (COPD) in patients exhibiting signs and symptoms of these chronic conditions. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Identify signs and symptoms of asthma and chronic obstructive pulmonary disease (COPD). Review methods for diagnosing asthma and COPD. Select treatment options for asthma and COPD. This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.  CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:   *See the attachment for additional information.  PODCAST OVERVIEW COPD - Major contributor - tobacco use - Environmental exposures - Types (chronic bronchitis, emphysema, mixed) - Symptoms and exam - Exacerbation red flag -  more frequent use of rescue inhaler use, more cough and wheeze - Tests (imaging - CXR, CT, pulmonary function testing, spirometry, BODE screening test, alpha antitrypsin) - Inpatient COPD management - Outpatient COPD management - Prevention (immunizations, vaccines, smoking cessation, daily maintenance medication/compliance) - Severe COPD considerations (lung transplant, endobronchial valves) - Pulmonary Rehab (9-week program, multidisciplinary team, baseline assessment, exercise/education sessions) - Pulmonary Function Testing (PFT) including spirometry, lung volume testing, lung diffusion capacity, and    methachoine challenge testing ASTHMA- Prevalence - Work-up (CXR, PFTs, CT chest, Allergy testing, referral to pulmonary) - Theophylline (bronchodialiator, antiinflammatory) - Differential Dx - consider other conditions if not improvment (CHF, PE, pneumothorax, etc.) - Peak flow testing - Action plans (Green, Yellow, Red) - Treatment - for mild, moderate and severe cases Thanks to Dr. Nicole Roeder for her expert knowledge and contribution to this podcast. Please check out the additional show notes for more information/resources.

In this podcast, Dr. Bill Roberts - a family medicine physician and Professor Emeritus with the University of Minnesota. Dr. Roberts brings his vast expertise of sports medicine to discuss a potpourri of sports medicine topics. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Summarize the evolution of changes to sports medicine. Identify common sports related injuries and treatment modalities. Describe how supplements, substances and proformance enhancing drugs (PEDs) impact athletes and the environment of sports medicine. This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.  CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:   *See the attachment for additional information.  Pre-participation Evaluation (sports qualifying exam) - Better screening questions and techniques - Mental health screening incorporation - Sudden Cardiac Death dilemma "Weekend Warrior" - Activity level and training for things (marathons, etc.) - when to check in with your provider. - More CAD in older marathoners who started training later in life - CAD, not long distance running, associated with Sudden Cardiac Arrest (SCA/SCD). Youth Athletes - Young children (pre-teen) should experience a wide variety of motor activities. - Life sports - throwing sports, running, biking, skiing "The Runner" - Start slow, build slow. - Overuse injuries Environmental - Heat and cold injuries "We've got an athlete down!" - SCA - sudden cardiac arrest - heat stroke - hypthermia - concussion/head injury - stroke or ICH (intracranial hemorrhage) - electrolytes (hyponatremia due to overhydration) Supplements, Substances and Performance Enhancement for Athletes - legal vs "illegal" - supplement use - "Eat well, sleep well, study well...." - peer and social pressure Pearls of Wisdom - pearls from Dr. Roberts Thanks to Dr. Bill Roberts for his expert knowledge and contribution to this podcast. Please check out the additional show notes for more information/resources.

In this podcast, Dr. Steve Smith - an emergency medicine physician with Hennepin Healthcare and full faculty Professor of Family Medicine at the University of Minnesota, discusses OMI (occlusion myocardial infarction) and NOMI (non-occlusion myocardial infarction) matrix, along with the importance of proper ECG interpretation and how this impacts the management of acute coronary syndrome. Dr. Smith also talks about STEMI and NSTEMI and the use (or the replacement) of these terms. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Express that acute coronary occlusion must be diagnosed and treated emergently. Recognize that ST elevation on the EKG is a very poor way of diagnosing occlusion myocardial infarction (OMI). Recognize that the entire QRST wave on the EKG is important for the diagnosis of occlusion mycardial infarction (OMI). Identify when other modalities (other than the EKG) may be needed to make a diagnosis of acute coroanary occlusion (OMI). Recognize that deep convolutional neural networks are the future of EKG diagnosis of acute coronary occlusion. This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.  CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:  *See the attachment for additional information.  Links:Steve Smith ECG Blog OMI Manifesto Please check out the additional show notes for more information/resources.

Promotional trailer to Ridgeview Podcast Series - Season 6

In this podcast, Dr. Kelly Lemieux - a pediatrician with Wazata Children's Clinic brings some insight into pediatric ADHD, specifically around the history, symptoms and treatment options. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Define the differential diagnosis for children presenting with academic difficulties. Utilize the DSM-5 criteria when diagnosing ADHD in children. Identify common co-morbidities for children with ADHD. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:  *See the attachment for additional information.  ADHD History - 1902 - British pediatrician definition of ADHD- Evolution - 1990s - increase in diagnosis - 2013 - Change in age range for diagnosis Diagnosis - Symptoms - Comorbidities - Concerns for learning disabilities - Diagnostic tools Prevalence - CDC estimates 6 million children (ages 3 to 17) with ADHD (approx. 9.8%) Assessment - Three key symptoms (inattention, hyperactivity, impulsivity) - How ADHD is explained to parents- Standarized tools (including listening to parents) - Neuropsychological testing & Vanderbilts Nonpharmocologic strategics At school - ADHD coach - Therapy - Bounce ball chairs - special study halls - other resources At home - Daily schedules  - reducing disctractions (minimize) - noise cancelling - exercise  Pharmacologic interventions - Risk benefits - Prescribing age - 2 broad categories of medications (stimulants v. non-stimulants)- other medications - limitations Thanks to Dr. Kelly Lemieux for her knowledge and contribution to this podcast. Please check out the additional show notes for more information/resources.

In this podcast, Dr. Daniel Marek - an orthopedic hand surgeon with Twin Cities Orthopedics, brings pearls and wisdom of how to better manage various injuries of upper extremity fractures in adults. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Summarize various types of upper extremity injuries that can occur in adults. Describe how to diagnose and treat common hand injures that present to an urgent or emergency healthcare setting. Evaluate when a referal is needed to an orthopedist and/or orthopedic surgeon. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:  *See the attachment for additional information.  The Hand- Alignment - Fractures - Splinting The WristScaphoid - The most commonly missed fracture - How to diagnose injury - Treatment = 6 to 10 weeks of treatment Lunate - Rare fracture - Slow healing injury (6 to 10 weeks) - Requires splint and cast  - Scapholunate ligament ter - 10 weeks of cast and surgery bookended - Lunate/Perilunate dislocation - needs immediate reduction and surgery - Triquetral Fracture - treatment with removable splint Distal Radius and Ulna- Fall onto outstretched hand - most common - Colles' Fracture -       ncbi.nlm.nih.gov/books/NBK553071/ - Smith's Fracture -      ncbi.nlm.nih.gov/books/NBK547714/ - Barton's Fracture -     ncbi.nlm.nih.gov/books/NBK499906/ - Ulnar styloid fracture - Median nerve symptoms - Volar displaced fractures very hard to maintain reduction - will likely need surgery. - What needs to be reduced?  3 radiographic angles (length, radial inclination, tilt) - Closed fracture complications - Splinting issues The Forearm- Monteggia - Galeazzi - Radial head fracture (very common) - Radial neck fracture - Proximal ulna (olecranon) The Humerus- Mid humerus - Proximal humerus - Distal humerus Describing Fracture to Orthopedist- Looking at correct film/correct patient - Open or closed fracture - Location of fracture - Involvment of articular surface? - Simple or comminuted fracture and what direction? (transverse, oblique, spiral, avulsed) - Displaced? if so which direction - Angulation - Rotation - Impaction Future horizon for Upper Extremity and Hand Surgery - Awake surgery - Hand transplant Thanks to Dr. Daniel Marek for his knowledge and contribution to this podcast. Please check out the additional show notes for more information/resources.

In this podcast, Dr. Natalie Stoltman - a primary care physician with Lakeview Clinic, brings pearls and highlights around the topics of: behavior weight loss interventions in older adults, falls risk and increasing medications, chronic pain management in older adults, and current concepts of diabetes management in the post-acute and long-term care setting. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Summarize the latest standards in regards to care in geriatric medicine. Identify and review interventions targeting geriatric obesity. Identify falls risk enhancing drugs and ways for deprescribing. Summarize the updates provided related to chronic pain management in geriatrics. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:  *See the attachment for additional information.  Major Themes:  deprescribing medications, poly pharmacy, individualization of care and a tailored approach, and the need for a multidisciplinary team. Beyond Behavior Weight Loss Intervention in Older Adults- Impact and Impairments - How to begin: "diet takes on new connotation in the elderly" - Weight loss interventions/behavior modifiations - Weight loss interventions - medications - Weight loss surgeries (Roux-n-y/Sleeve gastrectomy) - Multidisciplinary team Getting Rid of "FRIDS" or Fall Risk Increasing Drugs-  More than 30% of older adults fall - Deprescribing Managing Chronic Pain in Older Adults- Classification of pain (nociceptive /neuropathic /nociplastic) - Pain evaluation - Nonpharmocologic interventions - Pharmacological Current Concepts of Diabetes Management in the Post-Acute and Long-term Care Setting- Patient goals and change in goals - Goals of care - Life expectancy Thanks to Dr. Natalie Stoltman for her knowledge and contribution to this podcast. Please check out the additional show notes for more information/resources.

In this podcast, Dr. Jon Cole - an emergency medicine physician with Hennepin Healthcare and medical director with Minnesota Poison Control Center and Samantha Lee, PharmD - managing director with Minnesota Poison Control Center discuss the poison control system - past and present; along with a disscusion around toxicology - the big, the bad, and the ugly. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Describe the purpose of the Minnesota Poison Control Center, and how it works. Name the most common call types coming into MN Poison Control Center. Summarize the management of toxicological exposures for APAP, buprioprion and calcium channel blockers. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:  *See the attachment for additional information.  HISTORY of MN POISON CONTROL CENTER TOXICOLOGYCalcium Channel Blockers - Diltiazem, Verapamil, Amlodipine - Causes bad distributive shock - Pulmonary edema is an issue - Norepinephrine infusion is recommended in setting of shock with high dose insulin simultaneously - "Red, white and blue" therapy for refractory Ca++ blocker overdose - Activated charcoal - not for all patients, give if patient not at risk of aspiration for potentially lethal ingestions Bupropion - Chemical structure similar to amphetamine and bath salts - Sympathomimetic effects (tachycardia, agitation, seizures, ultimately cardiogenic shock) - Treatment with benzodiazepines - usually high dose - may need intubation - Norepinephrine for cardiogenic shock - ECMO may be needed Sodium Nitrite - Salt used to cure meats - Internet suicide phenomenon - Effect: Life threatening methemoglobinemia (chocolate colored blood, pallor, low O2 sats) - Very rapid onset of symptoms - Methylene Blue use N-acetylcysteine (NAC) for acetaminophen poisoning - Transitioning from 3 bag Prescott regimen to a 2 bag regimen - Rumack-Matthew nomogram is the same Article Resources:Cole JB, Lee SC, Prekker ME, Kunzler NM, Considine KA, Driver BE, Puskarich MA, Olives TD. Vasodilation in patients with calcium channel blocker poisoning treated with high-dose insulin: a comparison of amlodipine versus non-dihydropyridines. Clin Toxicol (Phila). 2022 Nov;60(11):1205-1213. doi: 10.1080/15563650.2022.2131565. Epub 2022 Oct 25. PMID: 36282196.   Cole JB, Olives TD, Ulici A, Litell JM, Bangh SA, Arens AM, Puskarich MA, Prekker ME. Extracorporeal Membrane Oxygenation for Poisonings Reported to U.S. Poison Centers from 2000 to 2018: An Analysis of the National Poison Data System. Crit Care Med. 2020 Aug;48(8):1111-1119. doi: 10.1097/CCM.0000000000004401. PMID: 32697480. Coralic Z, Kapur J, Olson KR, Chamberlain JM, Overbeek D, Silbergleit R. Treatment of Toxin-Related Status Epilepticus With Levetiracetam, Fosphenytoin, or Valproate in Patients Enrolled in the Established Status Epilepticus Treatment Trial. Ann Emerg Med. 2022 Sep;80(3):194-202. doi: 10.1016/j.annemergmed.2022.04.020. Epub 2022 Jun 17. PMID: 35718575. Kline JA, Tomaszewski CA, Schroeder JD, Raymond RM. Insulin is a superior antidote for cardiovascular toxicity induced by verapamil in the anesthetized canine. J Pharmacol Exp Ther. 1993 Nov;267(2):744-50. PMID: 8246150.   Thanks to Dr. Jon Cole and Samantha Lee, PharmD for their knowledge and contribution to this podcast. Please check out the additional show notes for more information/resources.

In this podcast, Dr. Michelle Haroldson, a hospitalist and a sleep medicine physician with Ridgeview's Sleep Clinic, talkes about sleep and why it is important, specific sleep conditions and various treatments. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Summarize the importance of sleep for physical health and wellness Identify barriers to (impacts upon) sleep Identify treatment options for sleep disorders. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:  *See the attachment for additional information.  How do we break the cycle of burnout? Approximately 50% of burnout is present with clinicians prior to COVID. Why sleep is important- 1/3 of an individual's life is spent sleeping. - Sleep is when the body resets, restores, and heals - Higher mortality rates may occur with those who sleep less than 6 hrs a night. - Optimal sleep window is 6.5 to 8.5 hours a night. Stages of Sleep- 4 stages (Light sleep, slow wave, dream sleep) - Sleep architecture -Shift work REM sleep- what happens during this sleep stage Sleep conditions/disorders - Narcolepsy - Sleep walking - Dream enactment - Sleep apnea - Sleep talking - Snoring - Kleine-Levin Why see a sleep specialist- People are paying attention to their sleep- Sleep study Impacts upon sleep - Society's values on sleep - Blue wave light - Lack of sleep associated with major accidents How to improve sleep - Decide sleep is a priority - Appropriate bedtime - Decreasing exposure to blue wavelength light - Remove light from sleeping environment - Sleep temperature - White noise - Sleep zone Medications that affect sleep (for better or worse) - Mental health or psychiatric meds - Vistaril, Benadryl - Beta blockers- Melatonin - antidepressants Thanks to Dr. Michelle Haroldson for her knowledge and contribution to this podcast. Please check out the additional show notes for more information/resources.

In this special podcast, discussions occur around the impact of physician burnout. Dr. Michelle LeClaire, a critical care physician with Minnesota VA Medical Center, discusses her first hand account of provider burnout, how burnout is measured, how we can affect change with physician champions and wellness programs, moral distress, residue, injury and gender discrepancies in medicine, and discussions occur around the culture, healthcare organizations, patient complexity, and how a pandemic can affect and lead to burnout.  Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Identify hallmarks of burnout and implications of burnout in clinicians. Define moral distress and moral injury. Describe gender discrepancies in medicine and burnout rates among gender. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:  *See the attachment for additional information.  How do we break the cycle of burnout? Approximately 50% of burnout is present with clinicians prior to COVID. Mini Z Asks 10 questions: 1.  Overall  "I am satisfied with my current job." 2. "I feel a great deal of stress because of my job." 3. "Using your own definition of 'burnout', please circle one of the following answers below:       a) I enjoy my work. I have no symptoms of burnout.       b) I am under stress and don't always have as much energy as I did, but I don't feel burned out.       c) I am definately burning out and have one or more symptoms of burnout (e.g. emotional exhaustion).       d) the symtpms of burnout that I am experiencing won't go away. I think about work frustrations a lot.       e) I feel completly burned out. I am at the point where I may need to seek help. 4. My control of my workload is? 5. Sufficiency of time for documentation is: 6. Which number best describes the atmosphere in your primary work area? 7. My professional values are well aligned with those of my department leaders. 8. The degree to which my care team works efficiently together is: 9. The amount of time I spend on the electronic health record at home is: 10. My proficiency with the electronic health record is: - Predisposed providers get burned out if you can predict it - you can prevent it. Predictor factors include the three C's : Control, Chaos, Culture 1.) work control 2) chaos 3) culture which include time pressure and work control 4) controlling our schedule 5) chaos in the workplace 6) teamwork Maslach burnout inventory/emotional exhaustion. These include reduced personal accomplishment, depersonalization and lack of compassion. The control model of a job is the teeter-totter that demands control/support. You need to prevent burnout by offsetting the demands with control and support. - Burnout leas to more intent of leaving the job that is three times the odds of leaving. In addition, there are poor patient outcomes.  Patient disenrollment, destabilzation of groups on the indiviual side - there is a high rat of alcoholism, suicide, broken relationships and substance abuse. Items that help with burnout include physician champions, wellness programs and measuring burnout. Culture is massive. Organizations job is to provide a benue for healthcare providers to treat and help patients. External and internal factors of the "mini z" include teamwork, work control, sufficient time for documentation, stress, job satisfaction Gender discrepancies  Women have a 60% burnout over their male counterparts. Gender expectations for listening, a phenomenon of attracting more complicated patients, faster work pace, less values alignment with leadership. Moral distress Situation troubling providers where they know the right thing to do and they cannot. Compromises and patient care due to staffing. Resources and administrative support not in place. This also secondary to social determinants, healthcare disparities, abusive families and patients, not being able to alleviate suffering. Unresolved moral distress becomes moral injury. Moral injury is a more pervasive issue which leads to cognitive dissidents, depersonalization, bad ethical decision making. Moral residue leads to unresolved moral distress. EDM or ethical decision making is dealing with moral injury. Generally secondary to self-reflective providers, empowerment, having a practice - culture - open to multi-disciplinary and reflection, teamwork, mutual respect within the multi-disciplinary team, active involvement of the bedside nurses with end-of-life care, providers active in decision-making, practicing culture of ethical awareness. Article:Trends in Clinician Burnout With Associated Mitigating and Aggravating Factors During the COVID-19 Pandemic  Thanks to Dr. Michelle LeClaire for her knowledge and contribution to this podcast. Please check out the additional show notes for more information/resources.