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. Discuss the rate of wound infection from suturing with sterile gloves, dressings, drapes, etc. versus non-sterile gloves, dressings in emergency department. Discuss the risk-benefit of using tranexamic acid (TXA) in the treatment of gastrointestional bleeds. Identify interventions designed to reduce fatigue among emergency department physicians. Determine whether a direct oral penicillin challenge is noninferior to the standard of care of penicillin skin testing followed by an oral challenge in patients with a low-risk pencillin allergy. 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 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 Article 3: 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 Article 4: 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 Article 5: 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 Article 6: 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   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.

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 advantage (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 don't 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 delivery work in VBC organizations (Nick's viewpoint)?         - Step 1: Journey from simple problems into complexity         - Step 2: What is the current reality 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 reality 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. clinic-based, homebased healthcare etc.) - 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 potential 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 Emergency 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 Wayzata 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 injuries that present to an urgent or emergency healthcare setting. Evaluate when a referral 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, bupropion 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.

This podcast, Dr. Lucas Dingman and Dr. Cady Welch, emergency medicine physicians with EMPAC and Ridgeview, discuss six articles on various topics related to emergency medicine, as part of this first ED journal review. 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 Describe how to rule out a pulmonary embolism (PE) in the emergency department using the YEARS criteria and age adjusted d-dimer. Differentiate when antibiotics for treating diverticulitis is warranted. Describe the benefits of using a small percutaneous catheter chest tube for treating a traumatic hemothorax. 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.  Study #1: Efficacy and Safety of Nonantibiotic Outpatient Treatment in Mild Acute Diverticulitis (DINAMO-study) A Multicentre, Randomised, Open-label, Noninferiority Trial - DINAMO study & diverticulitis - Multicenter, randomized, open label, non-inferiority trial (Nov.2016 - Jan.2020) - 480 randomized participants  and put into two groups - Results: admission to hospitals, ED revisits, no complications, no major significant findings - Nonantibiotic outpatient treatment of mild acute diverticulitis is safe and effective and is not inferior to current standard treatment. Study #2: Anterior–Lateral Versus Anterior–Posterior Electrode Position for Cardioverting Atrial Fibrillation - EPIC Atrial Fibrilation ( EPIC AF) - Two positions for pad placement for cardioverting patients - Multicenter, randomized, open label trial - 467 randomized patients, scheduled for elective cardioversion - Results: 50% successful conversion to normal sinus rhythm after one biphasic shock, many patients needed multiple shocks to cardioconvert (4-5 shocks). - AHA Guidelines: pad placement for AF and VF, treatment recommendations - Anterior-lateral electrode positioning was more effective than anterior-posterior electrode positioning for biphasic cardioversion of atrial fibrillation. There were no significant differences in any safety outcome. Study #3: The small (14 Fr) percutaneous catheter (P-CAT) versus large (28–32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial - Poiseuille's law and chest tubes - and involves components of rate of flow, radius of the tube, change in pressure and viscosity. - 120 participants - 8 years and older, traumatic hemothorax or pneumothorax, hemodynamically stable patient only - Treatment arm: 14 Fr cook catheter used (seldinger techique, anterior axillary or midaxillary line) - Control arm: 28-32 Fr. chest tube placed (standard way - 4th-5th intercostal, midaxillary line) - Results: Failure rate of the tube, repeat hemothorax requiring intervention, drainage outputs at different designated times, total chest tube days, insertion complications, ventilator days, ICU length of days, hospital length of stay - Patients had better experience with percutaneous catheter - Hemlich valve - Study discussed looks specifically at hemothoraces which require drainage of blood and chest tubes connected to traditional pleuro vac chamber - Small caliber 14 Fr PCs are equally as effective as 28- to 32-Fr chest tubes in their ability to drain traumatic HTX with no difference in complications. Patients reported better IPE scores with PCs over chest tubes, suggesting that PCs are better tolerated. Study #4: Aromatherapy Versus Oral Ondansetron for Antiemetic Therapy Among Adult Emergency Department Patients: A Randomized Controlled Trial - ScienceDirect - Single center, placebo controlled, blinded, randomized trial - Sample: 120 healthy adults, median age 40 years old presenting to ED with chief complaint of nausea/vomiting -  Change in nausea score at 30 min. (drop in mm on VAS) - Mean nausea baseline = 50 - Limitations: fairly young healthy participants, difficult to blind (can smell difference) - Among ED patients with acute nausea and not requiring immediate IV access, aromatherapy with or without ondansetron provides greater nausea relief than oral ondansetron alone. Study #5: Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism: A Randomized Clinical Trial - YEARS criteria with age adjusted vs only age adjusted - Cluster, randomized, crossover, non-inferiority trial to determine if YEARS plus age-adjusted could be used to rule out PE, age 18 or older, not pregnant - Sample size: 1414 patients within 18 EDs, PERC positive - Outcome: PE diagnosed in 100 patients, no missed PEs with patients with YEARS score of "0", - Among ED patients with suspected PE, the use of the YEARS rule combined with the age-adjusted D-dimer threshold in PERC-positive patients, compared with a concential diagnostic strategy, did not result in an inferior rate of thromboembolic events. Study #6: Oral versus intravenous rehydration of moderately dehydrated children: a randomized, controlled trial - Randomized, single masked study (providers were masked), controlled clinical trial, non-inferiority study design, single center study - Participants: children - aged 8 weeks to 3 years, moderately dehydrated (dehydration score greater than 3, but less than 7) - Outcomes: Successful rehydration at 4 hours, hospitalization rate, time to initiation of treatment, repeat ED visits within 72 hrs -Results: no difference between the groups with succesful rehydration at 4 hours - Limitations: small sample size - Oral rehydration therapy (ORT) is as good as intravenous fluid therapy (IVF) in rehydration of moderately dehydration children due to gastroenteritis. In addition, the study found that less time was required to intiate ORT when compared with IVF in the ED. Patients treated with ORT had fewerer hospitalizations. Results of the study suggested that ORT be the initial treatment of choice for moderately dehydrated children less than three years old with gastroeneritis. Thanks to Dr. Lucas Dingman and Dr. Cady Welch for their knowledge and contribution to this podcast. Please check out the additional show notes for more information/resources.

This podcast, Dr. Peter Eckman, a cardiologist and heart failure specialist, with Minneapolis Heart Institute, discusses heart failure and why it is an extensive medical issue. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Recognize heart failure as a problematic clinical disease and its morbidity and mortality that leads to comprehensive medical management. Identify and describe optimal contemporary medical therapy for heart failure. Describe novel options for heart failure. 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.  Heart Failure (HF)- Can occur without congestion or fluid retention - Characterized by fatigue, fluid retention, SOB, PND, orthopnea - We should consider the same urgency for heart failure as patients with CAD and CA. Heart Failure Preserved/Reduced Ejection Fraction (HFpEF/HFrEF)- HFpEF is a Preserved Ejcetion Fraction over about 50% - HFpEF - congestive phenotype more of a fluid retention       - an exercise intolerant phenotupe where the patient becomes intolerant of exercise induced dyspnea.       - Pulm HTN phenotype       - Increased pressure in the heart that gets transmitted to the lungs - HRrEF is Reduced EF is usually below 40% Medications- 4 classes of medications (MRAs, BB, SGLT2, ARNIs) - Treatment with mineralocorticoid receptor antagonists (MRAs) has been demonstrated to improve clinical outcomes in patients with HFrEF with mild to severe symptoms and also in patients with left ventricular dysfunciton after myocardial infarction. - SGLT2 inhibitors reduced the risk of cardiovascular death and hospitalizations for heart failure in a broad range of patients with heart failure, supporting their role as a foundational therapy for heart failure, irrespective of ejection fraction or care setting. - ARNI (angiotensin receptor/neprilysin inhibitor) medication is a newer treatment for heart failure. The combination of sacubitril and valsartan has helped people live longer and have a better quality of life. - Comprehensive EF therapy involves BB, ARNI, MRAs, angiotensin receptor/neprilysin inhibitors. Spironolactone, SGLT2 inhibitors. Treatment- Traditional therapy usually involves a BB and ACE inhibitor. - Currently we should be looking at comprehensive therapy when it comes to HF treatment.       - STOP USING LISINOPRIL.- SGLT2 inhibitors contraindicated ketoacidosis, amputation UTI, weight loss       - (SGLT2 inhibitors) DAPA-HF trial showed that dapagliflozin was superior to placebo at preventing cardiovascular deaths and heart failure events among patients with heart failure.  (Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1911303#article_citing_articles ) - Catheterization - a vast majority of HF patients will need a right heart catheterization. - Cardiac pulmonary pressure monitoring Cardio MEMS - same day outpatient surgery which helps with medication adjustments and hospitalization in half. Works regardless of EF. - CardioVere laser spectroscopy which uses different wavelengths to detect light characteristics to determine the level of edema/fluid present wihin someone's tissues. Currently in development. - Casana is a toilet seat with certain sensors that detect and monitor impedance that check levels between different tissues, monitors HR and weight. - Cardiac contractility modulation causing electrical stumulation during a particular contraction of the myocyets it will augment potential (like a pacemeaker). -CORCHINCH - HF trial catheter based device that cinches up the heart, thereby making it smaller. It works more efficiently.  (Source: Clinical Evaluation of the AccuCinch® Ventricular Restoration System in Patients Who Present With Symptomatic Heart Failure With Reduced Ejection Fraction (HFrEF): The CORCINCH-HF Study) Novel Treatments- Atrial shunting procedure is investigational trials. Potentially impactful in exercise capacity and pressures but stay tuned as the verdict is not out. HfPEF exercise induced intolerance may be the best candidate. - SVC trial feasibility trial more durable effects of cardiac output.  Stay tuned. - LVAD for advanced therapies. Sometimes a bridge for candidacy as well as recovery. - Biventricular pacing has shown promise. *Heart failure is a problematic clinical disease entity with significant morbidity and mortality often leading to comprehensive medical management. It is often beneficial to enlist the help of our heart failure colleagues for these complicated patients.  Thanks to Dr. Peter Eckman - MHI heart failure specialist for his knowledge and contribution to this podcast. Please check out the additonal show notes for additional information/resources.

This podcast, Elizabeth Hopfenspirger, DNP, a psychiatric and family practice nurse practitioner with Lakeview Clinic, discusses various mental health topics, primarily in the adult patient, but also touches on some pediatric issues. Today's discussion will focus on the following areas of mental health - depression, anxiety, mixed disorders, ADHD and psychosis. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Describe different implemention stratgies in how to better establish a therapeutic relationship with the patient. Recognize how many psychotropics medications are on a "spectrum". Realize that treatment choice depends on several variables - including presenting symptoms and underlying organic issues. 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 state of mental health care in the US is not ideal- Lack of resources - Lack of practitioners - social, physical, economic and environmental challenges CASE REVIEW #1- 18 year old female with predominantly anxiety - Respectful curiosity: listening and asking questions without judgement - Medication for generalilzed anxiety disorder- High intensity aerobic exercise can improve anxiety symptoms. - Trauma? ADHD/Learning difficulties? Sleep? Appette and restriction of food/eating disorders? Substance use/abuse? - SSRI: bupropion>fluoxetine?Sertaline?escitalopram>fluvoxamine>paxil (most activating to least activating) - For pure anxiety - Elizabeth prefers escitalopram, citalopram and sertaline - Trauma and trauma therapy: Trauma can be anything (death of a loved one, MVC, etc.)      - Trauma therapy (EMDR: eye movement desensitization reprocessing)      - IFS (internal family systems - recognizing and connecting with your own history and younger self)     - ART (acceleraed resolution therapy) - Substance use: What is the substance doing for the patient? Why are they using? Helps to direct therapy and arrive at diagnosis. - ADHD (attention deficit hyperactivity disorder)     - sometimes missed or ignored     - PCPs have discomfort treating at times     - trial of stimulant may be beneficial - Suicide ideation and other adverse effects while first starting certain meds is real, but rare- Article resources:        Walkup, et.al   (https://pubmed.ncbi.nlm.nih.gov/18974308/)       Wetherell, et.al  (https://pubmed.ncbi.nlm.nih.gov/23680817/)       Critz-Christoph, et.al  (https://pubmed.ncbi.nlm.nih.gov/21840164/)      Trauma therapy : https://www.emdria.org/ CASE REVIEW #2- 32 year old male with depression - Labs? Physical activity? Testosterone concerns? - Lifestyle and sexual function - Post-retirement? (identity and purpose has changed/gone) - Consider bupropion if no seizures or other contraindications. Consult with neurologist if significant history - Sexual dysfunction an issue? Vortioxetine can be an option wich may help enhance libido - Physical activity (natural endorphins) and exposure to nature are improtant - Screen time? Smart phone and other screen time has dopaminergic effects; too much 'negative' screen time can be detrimental  (If AHDH is poorly treated, screen addiction may increase.) CASE REVIEW #3- 65 year old male with mixed depression and anxiety, off meds for many months - Find as many of patient's historical records as possible - Meeting a patient "where they are at". How motivates is the patient to get better? - Are they coasting (teenagers)? Are they taking an active role in getting better?       - may need to wait to push/empower patient until after giving medication and psychotherapy some time        - where is the patient in their willingness to change and get better?  - Meds in this ager group (and many others) to avoid:  TCAs and MAOIs - IF DM, HTN, CAD and other co-morbidities, fluoxetine is less likely to have interactions and adverse effects- Article resources:       Prochasa and DiClemente - Stages of Change https://www.ncbi.nlm.nih.gov/books/NBK556005/) Psychosis- Caplyta (stimulating) if more depressed with psychotic features - Zyprexa (sedating) if more manic/psychotic Genetic testing for optimization of medications is an option - Serves as a 'guide' for medication choice - SLC6A4 gene, for instance, is responsible for serotonin reuptake into the presynaptic neuron What to do while waiting for SSRI and SNRI to "work"?- Hydroxyzine, benzodiazepine - Sleep medication:      - Doxylamine, Trazadone or Remeron (older patients)      - Sleep medication: lunesta, sonata Polypharmacy- Is polypharmacy present and patients feeling poorly with persistent symptoms? May need thoughtful/ careful deprescribing. Nontraditional/novel treatment options- Nontraditional/novel options for treatment resistant depression, PTSD treatment, chronic pain, etc. - Ketamine - Psilocybe Psychiatry & Primary Care- Incorporating psychiatry into our own primary care practices is anxiety provoking but inevitable in this day and age of healthcare - We can learn new things and leverage our existing resources to better help our patients - Time with our patients is a barrier - Ask the patient: what is the most pressing issue for you today? What is the most distressing thing for the patient? Then consider Maslow's Hierarchy of Needs and build up from there.- Article resources:       Maslow Hierarcy of Needs (https://www.simplypsychology.org/maslow.html) Please check out the additonal show notes for additional information/resources.

This podcast, Dr. Abby Elliott returns and the debut of Dr. Natalie Stoltman, both primary care physicians with Lakeview Clinic. They are both here for the third episode of Ridgeview Podcast CME Series: Journal Review. This is the episode where our speakers talk through new, practice changing and/or just interesting journal articles. In this episode we have six articles addressing subjects related to primary care, including antibiotic presecribing, weight loss modalities, intermittent fasting, non-alcoholic fatty liver disease, LDL levels in relation to coronary plaque, and proton pump inhibitors. The articles referenced in this podcast are linked in the attached show notes. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Identify when antibotics are warranted for pediatric infections. Compare the differences in weight change between individuals who participated in a commercial weight management program to those who participated in a "do-it-yourself (DIY)" approach. Explain intermittent fasting and its correlation to health outcomes. Define nonalcoholic fatty liver disease and explain the different treatment modalities. Explain the correlation between LDL levels and calcium scores/CTA and cardiac outcomes. Describe the best practice approach to proton-pump inhibitors (PPI) de-prescribing in ambulatory patients. Name significant/relevant findings of the journal articles being reviewed and discussed. 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 article discussion summaries.  Journal Article 1: "Association of Inappropriate Outpatient Pediatric Antibiotic Prescriptions with Adverse DRug Events and Health Care Expenditures" CITATION:  Butler AM, Brown DS, Durkin MJ, et al. Association of Inappropriate Outpatient Pediatric Antibiotic Prescriptions With Adverse Drug Events and Health Care Expenditures [published correction appears in JAMA Netw Open. 2022 Jun 1;5(6):e2221479]. JAMA Netw Open. 2022;5(5):e2214153. Published 2022 May 2. doi:10.1001/jamanetworkopen.2022.14153.  Available: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2792723 Journal Article 2: "Efficacy of a Commercial Weight Management Program Compared With a Do-It-Yourself Approach: A Randomized Clinical Trial" CITATION:  Tate DF, Lutes LD, Bryant M, et al. Efficacy of a Commercial Weight Management Program Compared With a Do-It-Yourself Approach: A Randomized Clinical Trial [published correction appears in JAMA Netw Open. 2022 Sep 1;5(9):e2235316]. JAMA Netw Open. 2022;5(8):e2226561. Published 2022 Aug 1. doi:10.1001/jamanetworkopen.2022.26561  Available: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795182 Journal Article 3: "Intermittent Fasting and Obesity-Related Health Outcomes: An Umbrella Review of Meta-analyses of Randomized Clinical Trials" CITATION:  Patikorn C, Roubal K, Veettil SK, et al. Intermittent Fasting and Obesity-Related Health Outcomes: An Umbrella Review of Meta-analyses of Randomized Clinical Trials. JAMA Netw Open. 2021;4(12):e2139558. Published 2021 Dec 1. doi:10.1001/jamanetworkopen.2021.39558.  Available: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2787246 Journal Article 4: "Clinical Care Pathway for the Risk Stratification and Management of Patiemts with Nonalcholic Fatty Liver Disease" CITATION:  Kanwal F, Shubrook JH, Adams LA, et al. Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology. 2021;161(5):1657-1669. doi:10.1053/j.gastro.2021.07.049.  Available: https://www.gastrojournal.org/article/S0016-5085(21)03384-9/fulltext?referrer=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F Journal Article 5: "Association of Coronary Plaque With Low-Density Lipoprotein Cholesterol Levels and Rates of Cardiovascular Disease Events Among Symptomatic Adults" CITATION:  Mortensen MB, Caínzos-Achirica M, Steffensen FH, et al. Association of Coronary Plaque With Low-Density Lipoprotein Cholesterol Levels and Rates of Cardiovascular Disease Events Among Symptomatic Adults. JAMA Netw Open. 2022;5(2):e2148139. Published 2022 Feb 1. doi:10.1001/jamanetworkopen.2021.48139.  Available: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2788975 Journal Article 6: "AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review" CITATION:  Targownik LE, Fisher DA, Saini SD. AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review. Gastroenterology. 2022;162(4):1334-1342. doi:10.1053/j.gastro.2021.12.247.  Available: https://www.gastrojournal.org/article/S0016-5085(21)04083-X/fulltext?referrer=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F Please check out the additonal show notes for additional information/resources.

For this podcast, we don't just have one but two guests. Returning to the show is Dr. Tara McMichael, an Internal Medicine Physician with Lakeview Clinic and Internist for Ridgeview, and Stacy Jepsen, a clinical nurse specialist with Ridgeview. During this podcast, Dr. McMichael and Stacy will be discussing Post Intensive Care Syndrome, also known as PICS. They will both bring unique perspectives from the initial critical illness and care in the ICU to the patient's outpatient visits and long term prognosis. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Define post intensive care syndrome (PICS) and post intensive care syndrome-family (PICS-F). Identify risk factors for devcelopment of PICS and PICS-F. Summarize prevention and treatment strategies for PICS and PICS-F Interpret the prevalence of PICS within the community. Utilize available resources to support patients/families with PICS symptoms. Describe how patients and their families can be supported who are struggling with PICS. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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. To receive continuing education credit for this activity - 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.  CLINICAL NURSE EDUCATOR- Advance practice RN who operates as an expert clinician, educator, researcher or consultant. - Masters or doctorate degree - Role had been around the US for over 60 years. POST INTENSIVE CARE SYNDROME (PICS)- New or worsening cognitive, psychological, physical limitation, post survival of critical illness and stay in ICU. - Post intensive care syndrome - family (PICS): family memvers who have mental limiations from the experience of having a loved on eiwth a critical illness. - First defined by Society of Critical Crea Medicine in 2010. - Remains difficult to diagnose for coding and reimbursement. ICD-10 code does not exsist. RISK FACTORS - critical illness with stay in ICU- Delirium- Sedataion during hostpital stay- Diagnosis of sepsis, ARDS, etc. DIAGNOSIS - Cognitive: short term memory loss, slow cognition, mental disorganization - Physical: changes in balance and gait - Psychological: anxiety, depression, insomnia, PTSD TESTING - no specific tests available for PICS          - MoCa           - Mini mental status           - PHQ9 (in setting of depression)           - GAD7 (in setting of anxiety) - two or more symptoms in any category - cognitive, physical and psychological 4-6 weeks post hspitalization. PREVALENCE - Of 5.8 ICU admissions, 4.8 million survive - Of the 4.8 million survivors, 50-80% will beet diagnostic criteria - COVID has brought PICS to forefront. PREVENTION- Prevention tips (multidisciplinary rounds, ABCDEF bundle, checklists for goals, support groups)- ABCDEF Bundle    A - Assess, precent and manage pain     B - Sedation reduction and vent weaning     C - Choice of analgesic and sedation      D - delirium prevention, recognition and treatment     E - Early mobility     F - Family BARRIERS - Communication, not true barrier, but requires effort PICS RESOURCES & TREATMENT - PICS clinics (pros & cons) - For primary care physician (it exists, dont; have to solve it one go; there are online resources available) - Addition PICS resources (listed in show notes). Thanks for listening.Please check out the additonal show notes for additional resources.

In this podcast, Dr. Jeff Twidwell, a urologist (retired) and Dr. Jim Lehmann, an internist (retired) join the podcast to discuss various aspects of prostate cancer from a unique personal and professional viewpoint.  Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Describe prostate specific antigen and what levels are considered normal. Identify when to include PSA testing and to what specific patient populations. Determine when a referral to a urologist is needed for further patient evaluation. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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. To receive continuing education credit for this activity - 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.  Diagnosis - Call to action - "I will not miss a case of cancer of the prostate." (Dr. Jim Lehmann) - Main risk factors:  age, black/hispanic ethicity, genetics - Evidence based moment  (see show note attachment for link to referenced article)Screening- PSA (prostate specific antigen) - level greater than 4.0 ng/ml is "abnormal" - Age adjustment - PSA levels reduced with 5-alpha reductase inhibitor - PSA increases 0.75 ng/ml per year - Stop screening when life expectancy is less than 10 years - Shared decision making Next Steps in Diagnosis- Biopsy (template and MRI) - MRI - 4K score blood test - Ultrasound - Gleason score and grade - Decipher testing - PSMA-PET scan Prostate Cancer Care Team - Urologists - Primary Care - Radiation oncology - Oncology Treatment- Observation - Surgery (open, DaVinci, Laparoscopy) - Radiation - Hormonal (androgen deprivation) - Cryosurgery - Brachytherapy (prostate radioactive seeds) - Chemotherapy - Immunotherapy (advanced prostate cancer) - Proton therapy (up and coming) Thanks for listening.Please check out the additonal show notes for additional resources.

In the second podcast of season 5, Dr. Nima Adimi, a pain and spine specialist at Ridgeview discusses many areas around pain management, including how we evaluate, manage and treat pain and spine patients, the multidisciplinary teamwork involved, current guidelines, new and contemporary management strategies, and what is in the pipeline for the future of pain medicine. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Describe the types of tools available for people suffering with chronic pain. Identify ways to get patients access for pain management. Differentiate the diverse and broad nature of treatments available to those suffering from chronic pain. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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. To receive continuing education credit for this activity - 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.  In-take process:About 80% of patients referred to Ridgeview's pain center are LBP patients. The first conversation is the usual Goals of Care which are highly important in setting the expectations for the patient, including what type of testing or imaging the patient has received, what treatment modalities have they tried. Neuropathic pain is caused by damage or injury to the nerves that transfer information between the brain and spinal cord from the skin, muscules and other parts of the body. The pain is usually described as a burning sensation and affected areas often sensitive to the touch.   Nociplastic pain (a type of pain caused by damage to body tissue. A pain that feels sharp, aching or throbbing) or a type of pain which is mechanically different from the normal nociceptive pain caused by inflammation and tissue damage or the neuropathic pain which results from nerve injury. It may occur in combination with the other types of pain or in isolation. Its location may be generalized or multifocal and it can be more intense than would be expected from associated physical causes. Its causes are not fully understood, but is thought to be a dysfunction of the central nervous system whose processing of pain signals may have become distorted or sensitised. This type of pain typically arises in some chronic pain conditions, with the archetypal condition being fibromyalgia. Opiod Induced HyperalgesiaWhich is a common diagnosis for Dr. Adimi. During this podcast, listeners learn the limitations for further interventions due to hyperalgesia. These interventions will often require opioid titration prior to implementing therapy. Multimodal Treatment Options:Include non-addictive strategies, such as physical therapy, chropractic, fucntional/personal trainer, behavioral health. Discussions continue regarding medications such as gabapentinoids and their side effects, NSAIDs, muscle relaxers, medical cannabis, low dose naltrexone, etc. Interventional StrategiesLeast invasive strategies are discussed, including: trigger point injectsions, epidural, radiofrequency ablation medial branch blocks, facet joint injections, occipital and trigeminal nerve blocks, spinal cord stimulators, peripheral nerve stimulators. During this section of the podcast, Dr. Adimi discusses how spinal cord stimulators are impacting pain with new and exciting modalities, intrathecal pain pumps and their limitations an dhow the use of narcotics, anesthetics and snal poison (ziconotide) are implemented. Dr. Adimi notes that SCS are not effective for mechanical back pain/arthritis patients. Vertiuflex for spinal stenosis patients is discussed, along with the "mild" procedure and minimally invasive lumbar decompression.      In wrapping up the podcast, Dr. Adimi discusses the future of pain and the new arena or space the pain specialist will be occupying. New research on SCS for Prakinson, movement disorders, dystonia as well as how it impacts select patient populations like Peripheral Diabetic Neuropathy Study.        Thanks for listening.Please check out the additonal show notes for additional resources.

In the first podcast of season 5, Dr. Glenn Paetow, the medical director of the Interdisciplinary Simulation and Education Center at Hennepin Healthcare answers many questions around simulation, education and training needs in healthcare. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Describe the utility and effectiveness of healthcare simulation in medical education, quality improvement, and clinical operations. Summarize the tools and techniques within healthcare simulation. Review and use best practices in simulation debriefing. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - 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 show information.  History: Simulation  - Began as early as 1800s   - 1930s: aviation industry started using simulation   - 1960s: mannequins used for medical CPR and rescue breaths.   - 1980s: anesthesia started using simulation and pioneers for simulation with focus on       crises resource management and team training. Benfits of Simulation:   - Most helpful in advanced stages of learning    - Good for training teams to help reduce errors    - Increases positive outcomes    - Can be used for multiple madalities    - Finding latent risk threats   - Evidence based moment: "Benefits of Simulation"  (article review) Starting a Simulation Program:   - Objective dependent    - Location    - Equipment (task trainers, mannequins, etc.)    - Simulation Specialist    - Educator    - Courses for educators and technology specialists   The Sim: Creating a Physicoligcally Safe Space:   - Psychology safe space    - Pre-briefing    - Neurobiology of learning    - Deliberate practice    - Cognitive load / Yerkes Dodson Curve Sim Structure:  - 1 hour simulation session         - 5 minute pre-brief         - 10 to 20 minute simulation         - 30 to 40 minutes debrief   (1 to 2 ration sim to debrief)   - Pitfalls The Debrief:   - many debriefing frameworks available    - Debriefing with Good Judgement              - Reactions Phase               - Understanding Phase               - Conclusion/wrap-up Thanks for listening.

Promotional trailer to Ridgeview Podcast Series - Season 5.

In this podcast, Dr. Joseph Karam, a vascular surgeon with Minneapolis Heart Institute leads the discussion on everything related to vascular disease from head to toe. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Define vascular disease. Identify vascular disease and differentiate the treatment modalities available. Describe clinical entities related to vascular disease such as peripheral artery disease (PAD), aortic aneurysms, carotid artery disease (CAD), and venous disease. Recognize when a referral to a vascular specialist is warranted. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - 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 show information.  Vascular Medicine  - Evolving profession & essential to any healthcare     system Risk Factors   - Prevention    - Reducing risk factors    - Social determinants Carotid Disease    - Asymptomatic CAD    - Work up (ultrasound, CTA)    - Treatment options Thoracic/Abdominal Aortic Disease       - Thoracic aortic aneurysm (Type A, Type B)    - Abdominal aneurysm    - Infra renal aneurysms     - Aortic dissections    - Post-op complications (TVAR, abdominal aortic       aneurysm) Peripheral Vascular Disease       - Studies of natural history    - Critical limb ischemia    - Acute limb ischemia    - Treatment   Thanks for listening.

In this podcast, Susan Gaines, is a Certified Life Coach who specializes in helping physicians deal with burnout, life purpose and reigniting passion. In this podcast, Susan talks about burnout, why it happens, what it looks like, and tools to fight it. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Recognize professional burnout in themselves and their colleagues. Explain the human and financial costs: personal, team, and system-wide. Identify at least 3 exercises that would calm onself in the midst of stress. Give examples for ways to build resilience longer term. State how to de-stigmatize asking for help, and demanding balance. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - 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 show information.  This podcast focuses predominately on physicians, but understand that many listeners of this podcast work in various healthcare roles. It is recognized that burnout, especially for the last several years affects each of the various specialties across the organization. Many of the concepts discussed in this podcast, though specifically for physicians, are applicable across various healthcare disciplines. *For the articles referenced in the podcast, please see the attached Show Notes for links. Article 1: "Death by 1000 Cuts": Medscape National Physician Burnout & Suicide Report 2021- 12,00 physicians surveyed across 29 specialties- Results:     - 42% reported burnout     - 79% stated burnout started prior to the pandemic     - Causes:  too many bureaucratic tasks, too many hours at work, lack of respect from all groups     - burn out had moderate to severe impact on their life     - approx. 300 physicians commit sucide each year. Article 2: Estimating the Attributable Cost of Physician Burnout in the United States- $4.6 billion on national scale in physician turnober and reduced clinical hours - At an organizational level - burnout costs $7600 per employed physician each year, due to turnover and reduced clinical hours Thanks for listening.

In this podcast, Dr. Riddell Scott, a dermatologist with Ridgeview Medical Center and Clinics, leads the discussion about skin cancer. Dr. Scott discusses changes to our DNA, what dermatology office visits look like, types of skin cancer and treatments available, as well as prevention efforts.  Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Explain the 3 main types of skin cancer and how they differ from each type. State how most skin cancers are treated. Identify how sun exposure contributes to the onset of skin cancer. Describe 3 activities that help to reduce skin cancer incidence. Counsel patients about skin cancer prevention efforts. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - 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 show information.  What happens to our DNA- Ultraviolet light hits skin and energy is transferred- Melanocytes & Melanin - Skin cancer risk factors Office visits- Family history - Dermatology: pattern recognition - Dermatoscope - Patient education - Repeat exams & recommendations - ABCDE (asymmatry, border irregularity, color variation, diameter, evolution)  Types of skin cancer: Squamous , Basal Cell Carcinoma, Melanoma- Cell physiology - Metastatic rate - Presentation - Primary vs secondary sources - Diagnosis - Stages (0,1,2) - Treatment (biopsy, MOHS, surgery, radiation, medication) Skin Cancer Prevention:- 3 Big Things:       - Wear a wide brimmed hat       - Wear sun protective clothing       - Wear sun screen daily - Sunscreen recommendations * For more information - see attached "Show Notes". Thanks for listening.

In this podcast, Edith Nagel Eisinger continues entertaining us with the seventh chapter of her memoirs in Waconia, MN.  Edith Nagel Eisinger, was the wife of Dr. Harold Nagel and nurse in the hospital she talks about in her memoirs. In 1936, the Nagel's founded the first hospital in Waconia - Nagel Hospital - which later became Waconia Hospital, and eventually Ridgeview Medical Center. Enjoy the next chapter of Edith Nagel Eisinger's story.

In this podcast, Dr. Andraya Huldeen, an obstetrician and gynecologist with  Western OB/GYN, a division on Ridgeview Clinics will discuss several obstetrical myths; including medication safety profiles for pregnant women, epidurals, COVID vaccinations and induction of labor. Also joining in this podcast is Dr. Nate Beerling, an anesthesologist with Ridgeview, who will add to the discussion of epidurals. Enjoy the podcast! Objectives:   Upon completion of this podcast, participants should be able to: Assess timing for induction of labor. Recognize there is lack of evidence of COVID vaccines causing infertility. Describe the different medication classes in pregnancy and how to balce risk/benefit in prescribing some medications. Summarize the role epidurals play in labor. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - 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 show information.  Medications in Pregnancy:- Current, but not standard system     - Risks vs outweighing benefits - Old system: ABCD & X     - A: studied extensively, no risk     - B: used extensively & very few problems     - C: "waste baskeet garbage world"     - D: can cause increase risk of birth defects but benefit outweighs the risk     - X: Never use, serious side effects or defects MYTH: All medications cause birth defects if taken during pregnancy- Cold medicines - NSAIDs - Acetaminophen - Narcotics - Ondansetron MYTH: Cervical exam has to be less than 4 to get epidural MYTH: Epidurals slow down labor and cause c-sections- History of epidurals - Epidural at what stage of labor - Epidural placement - Combined Spinal Epidural - Intrathecal: Spinal block - Contraindications for epidurals/spinal blocks - Complications:      - Epidural hematomoa      - Postural puncture headache MYTH: COVID vaccinations are not safe for pregnant women MYTH: COVID vaccine cause infertility- Concerns & live attenuated vaccines - Pertussis vaccination - COVID vaccination & infection & pregnancy outcomes - IVF & Fertility Outcomes MYTH: Induction of labor causes more c-sections- Previously: induction at 41 weeks unless medical reason to be induced earlier - With higher primary C-section & repeat C-sections - morbidity & mortaility - Prevent 1st C-section - 39th week is  lowest risk week to deliver - "Arrival Trial" - Induction of labor      - Bishop scale      - No specific order for starting induction - provider dependent * For links and resources - see attached "Show Notes". Thanks for listening.

In this podcast,Dr. Greg Giese, an internal medicine physician with Ridgeview talks about diabetic ketoacidosis (DKA). More specifically Dr. Giese will discuss the pathophysiology, initial assessment findings and diagnosis of DKA, along with addressing the differences between diabetic ketoacidosis (DKA) and hypersmolar hyperglycemic state (HHS), and treatment options for DKA patients. Enjoy the podcast! Objectives:   Upon completion of this podcast, participants should be able to: Define diabetic ketoacidosis. State the differences between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Summarize how to diagnose and treat diabetic ketoacidosis. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - 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 show information.  DKA: Deficit of insulin- Typical scenario     - Insulin deficienty + counterregulatory hormones     - Catabolic state     - Gluconeogensis     - Glycogenolysis     - Elevated blood sugar causes concomitant osmotic       diuresis DKA: 3 Parts- Ketones (ketonemia) - Hyperglycemia (lack of insulin) - Acidosis (Anion gap Metabolic Acidosis) Presentation- Critically ill individual on set in 24-48 hours - Kussmaul respirations - Other causes (infections, UTI, pneumonia, skin    infections, MI, drugs,) - Altered mental status - HHS: Hyperosmolar hyperglycemic state Work-up- Basics CBC with differential; metabolic panel, serum ketones, blood gas, urine analysis, plasma osmolality - Evaluation: Elevated WBC;  elevated anion gap;  electrolyte abnormalities;  Chest x-ray Results- Potassium (hold insulin if K was 3.4 or below) - Hyponatremia - Bicarb - Anion gap - Normal to elevated calcium - BUN greater than creatinine ration - Elevated creatinine - Elevated WBC due to catecholamines and stress response - Hgb/platelets - Urine Treatment- Fluids - Potassium - Insulin Transition to baseline- Discontinue insulin when anion gap metabolic acidosis closed and able to take oral nutrition- Bridge, start subcutaneous long acting insulin, stop insulin drip 1-2 hours later. Thanks for listening.

In this podcast, Dr. Kim Thielen, a nephrologist/kidney specialist with Minnesota Kidney Specialists joins us today to continue part 2 of our discussion on acute kidney injury, as we wade further "into the weeds"  discuss intrinsic renal disease. This episode will break down hallmark urinary findings and further subdivide intrinsic concerns into bland, nephrotic and nephritic, various causes, and treatment. Enjoy the podcast! Objectives:   Upon completion of this podcast, participants should be able to: State the 3 types of urinary analysis findings related to instrinic acute kidney injury. Describe etiology of presentation of each type of intrinsic acute kidney injury. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - 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 show information.  Intrinsic Kidney Injuries: Urinary analysis findings- Bland Urine: no protein - Nephrotic: protein - Nephritic: protein and blood Hallmark Urinary Findings: Casts - Tamm Horsfall Protein : Mucoprotein made by tubular epithelial cells that precipitate out and congeal    to form casts on whatever is in the cells at the time.  (i.e. RBCs, WBCs, tubular debris) Bland Urine States- Crystalline Induced Renal Injury: obstruction and infllamatory response       - Uric Acid Neuropathy (Most common)              - Cancers, lymphomas, etc.              - Drugs: acyclovir, methotrexate, protease inhibitors, etc.              - Toxins: Ethylene glycol - Bland Urine Disease states: results from injury to tubules, instertim or pre glomerular blodd vessels, not    the filters of the kidney       - Interstital Nephritis              - Hallmark: pyuria and WBC casts                      - Biopsy: inflammatory infiltrate              - Causes:  viral, PPIs, Adenover, mizalamin, etc., Checkpoint inhibitors       - Acute Tubular Necrosis              - Hallmark: tubular epithelial cell cast                      - Granular: (course or fine) diagnostic of ATN              - Biopsy: denuded dilated tubular cells              - Causes: #1: Ischemia;  toxins, drugs, contrast dye;  pigment injury. myoglobin              - What about contrast dye?                      - Categorized under ATN                      - Per Dr. Thielen, plays a role, but injury is not solely dependent on dye alone.       - Hepatorenal Syndrome: ischemic injury to the kidney due to unopposed vasocontstriction               - Ace inhibitors cause unopposed efferent vasoconstriction + nonsteroidals cause                 unposed afferent vasoconstriction = no glomerular perfusion pressure       - Multiple Myeloma              - Hallmark: Light chain cast nephropathy or myeloma kidney                      - Light chains precipitate  out causing obstruction, inflammatory response and causes                        tubular damage              - Presentation: older possibly with anemia, bone pain and elevated creatinine with a bland urine.              - Protein to creatinine ratio: + for protein (non albumin)              - Dipstick: (which measures for albumin and not light chains) will be negative for protein aka                 bland urine       - Hypertensive Nephrosclerosis              - Small vessel vascular disease                     - Blood vessels prematurely atherosclerosis causing glomerular drop out and scarring of the                        interstim       - Scleroderma                - Limited cutaneous systemic sclerosis                - Diffuse cutaneous systemic sclerosis: 60-80% have renal injury from disease state itself                           - FANA positive                           - Concern for Scleroderma Renal Crisis = medical emergency                                   - AKI, moderate to severe HTN and bland urine                                   - Uncontrolled accumulation of collage, thickens vascular walls, narrowing and renal                                       ischemia                          - Occurs in 10-15% of those with Diffuse Cutaneous Systemic sclerosis and happens early                              in disease                                     - Left untreated: renal failure in 1-2 months and death in 1 year                          - Treatment: ACE Inhibitor Nephrotic Urine States - Urine protein: albumin excretion greater than 3.5g in 24 hours - Nephrotic Syndrome:      - Present with 3 things (nephrotic range protein, hypoalbuminemia, peripheral edema)       - Hyperlipidemia: due to increased hepatic lipogenesis                - Increased risk of renal disease and arthroscleratic       - Venous thrombotic disease:                 - Loose proteins other than albumin and develop a hypercoagulale state                 - Renal and peripheral venous thrombosis      - Lipiduria (forms fatty casts,  looks like a latese cross under microscope)  -Pathophysiology or nephrotic syndrome    - Glomerular capillary wall           - 3 layers that work as a glomerular filtration and responsible in the filtration between blood and             urine                  - Fenestrated Capillary Enothelial cells (fenestrations allow plasma through to the basement                     membrane)                 - Glomerular Basement Membrane (maintains glomerular filtration barrier; negatively charged,                     repels albumin)                 - Epithelium: Podocytes (Have highly specialized foot processes that connect and form slit                     diaphragms; Slit diaphragm important for the efficient flow of small solute and water)          - Anything that messes with any of these layers: nephrotic proteinuria - Nephrotic Disease States:     - Biopsy: anyone with nephrotic proteinuria (besides diabetics)          1) Light microscopy: high overview          2) Immunofluorescens: looks for nephritic component and identif immunce complexes          3) Electron microscopy: (EM) helps look at the ultrastructure and better identify immune deposits    - Diabetic nephropathy           - Leading cause of kidney disease in U.S. and western society           - Responsible for 30-40% of all ESRD causes           - Hyperglycemia: produces inflammatory responses, oxidative stress, and injures the podocytes and             deposits that charge and affect the ability of the kidney to filter.     - Amyoidosis            - Organize into betapleted sheets and produce spikes of the capillary uniion and poke through the               GF membrane            - Easily identified by apple green birefringence on congo red            - Terminal illness            - Present with HTN, cardiac effects and elevated creatine  - Nephrotic Disease states based of histologic appearance      - Diagnosed by histologic appearance but does not determine the etiology      - Minimal Change Disease              - Fairly common              - Minimal change under light microscope              - EM: podocytes are abnormal, fused, no unique cell-cell junction              - Primary: Immune generated circulating facture;  alters the cytoskeleton of the podocytes       - Secondary               - Nonsteriodal - most common cause of secondary minimal change disease               - Gama interferon               - Hodgkin's lymphoma               - Allergy: 30% of minimal change have associate allergy (mechanism unknown)       - Presentation               - Sudden onset (days to weeks)               - Marked edema and hypoablbuminemia               - 60% have normal blood pressure,    82% have normal creatinine - Focal Segmental Glomerulosclerosis (FSGS) - primary and secondary         - Most common cause idopathic nephrotic syndrome in adults        - Primary glomerulonephritis in the US that causes ESRD        - Widespread podocyte injury     - Primary: circulating factor that messes with regulation of foot process and adhesion to the         glomerular basement membrane (afffect all podocytes)          - Present with nephrotic syndrome and rapid progression          - HTN and elevated creatinine    - Secondary: the visceral epithelial cells don't replicate          - Nephron loss or obesity or direct foot process injury          - Cannot replicate (podocytes), leads to decreased to podo denisty at specific areas (focal injury)          - 2/3 of all cases FSGS          - Present: with slowly increasing proteinuria and kidney impairment over time          - Causes: interferon, bisphosphonates, talc, anabolic steroids    - Genetics: gene mutations that encode for the slit diaphragms of the podocytes (affect all podocytes)            - Present in Childhood: full blown nephrotic and progress rapidly to ESRD Membranous Nephropathy - Most common cause of nephrotic syndrome in caucasion adults - 80% present with nephrotic but develops more slowly to ESRD - Primary: Major antigen identified      - antibody to trans-membrane receptor that is highly expressed on the glomerular podocyte - Secondary: Cancers (lung, breast, GI), Lupus, Thyroiditis, Hep B, Syphilis, Nonsteroidals, Monoclonal    Antibodies Nephritic Syndrome - Hematuria and proteinuria    - Hematuria: blood from kidney or outside the kidney             - Outside the kidney: look the same             - Inside the kidney: dysmorphic red cells    - Present:             - Renal impairment for days to weeks             - Edmatous, HTN and look critically ill              - Vasculitis, sinusitis, oral ulcers             - Pulmonary renal syndrome: short of breath or hemoptysis             - Skin changes: bruising , bleeding, purpura             - Myalgias and arthritis     - Urine:             - Hallmark: red blood cell casts (polymorphic red cells)             - dipstick + for blood             - elevated proteinuria    - Biopsy: nephritic and + urine Nephritic Disease States (based on immunofluorescence staining) - Pauci Immune Disease         - Ankle vasculitis, common         - A paucity (little amount) of immune complexes         - See black on imaging         - Lab work: check on ANCA and peripheral eosinophils - Anti-GBM Disease         - Renal limited, or classic pulmonary renal: Good Pasture's          - linear staining of the glomerular basement with anti IGG (looks like a ribbon on a package)          - Treat with cytotoxic agents - Immune Complex          - Starry sky pattern          - Glomerulus looks dotted with stars                - Stars = immune complex definition          - Diseases:  Lupus (FANA), Post Infectious GN, Membranous Proliferative GN  - IGA Nephropathy           - Most common cause of glomerulonephritis in the world          - Presentation:                 - Peak incidence is the 2nd and 3rd decades of life                - 40-50% gross hematuria with upper respiratory and GI illness          - Risk Factors for Progression:                - younger age or hypertension at time of presentation                - > 1g proteinuria                - Elevated creatinine at time of presentation Thanks for listening.

In this podcast, we are joined by Dr. Kim Thielen, a nephrologist/kidney specialist with Minnesota Kidney Specialists. This episode is part one of a two part series dealing with acute kidney injuries. During this episode Dr. Thielen will discuss pre and post acute kidney injury etiologies. Included with the podcast is additional shownotes that Dr. Thielen references throughout the podcast.  Also check out the next podcast/episode on intrinsic kidney injuries. Enjoy the podcast! Objectives:   Upon completion of this podcast, participants should be able to: Describe how to work up a patient who presents with kidney injury. State the 3 types of kidney injury etiologies. Identify various causes of kidney injury. Choose treatment options for the specific types of kidney injury. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - 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 show information.   Acute Kidney Injury- Abrupt decrease in kidney function - Suspected with oliguria, elevated creatinine, proteinuria, and hematuria Oliguria - Less than 500mls of urine in 24 hour period. PreRenal- Anything that decreases circulating volume or disruption of blood flow to the kidney, causing ischemic kidney - Causes:     - Total body salt and water depletion     - Dehydration     - Hemorrhage     - Decompensated right or left ventricular failure     - Renal arterial stenosis or renal vasospasm Signs and Symptoms - Orthostatic, hypotensive, tachycardiac - Most sensitive indicator of ischemic kidney: Urinary sodium concentration Urinary Sodium Concentration- Distinguishes between prerenal and instrinsic causes - Urine sodium less than 20 in oliguria is indicator of ischemic kidney Fractional Excretion of Sodium- Fractional excretion of less than 1% is indicative of ischemic kidney or a prerenal state - Fractional excretion of 2% is indicative of tubulules not working or ATN Fractional Excretion of Urea - For patients on diuretics - Urea not affected by water concentrating effect of kidney - Prerenal state: fractional excretion of urea less than 35 - Intrinsic: fractional excretion of urea greater than 35 Classic Presentation of Prerenal - BUN to Creatinine Ratio greater than 20.1 signifies dehydration       - Variables: GI bleed can increase BUN - Elevated bicarb Post Renal Etiologies - Anything that interfers with the drainage of the urine from the renal pelvis out to the urethra. - Causes:       - Intraluminal obstruction: stones or tumors       - Dysfunctional bladder: spinal injury, diabetes              - Dysfunction with bladder drainage       - Extrinsic compression on ureter                - Ruptured AAA: edema                - Retroperitoneal fibrosis                - Prostate                - Urethral strictures Post Renal Presentation - Can present with pain or not - Decreased urine output or outflow - Hypertensive - Volume overload Treatment - Foley distal obstructions of urethra - Imaging: ultrasound        - Horizontal view:               - Normal: (bright white) collecting system is collapsed due to normal drainage of pelvis               - Post renal obstruction                       - Dilated (dark pools) collecting system - Chronic obstruction        - Functional dilatation        - Further testing: functional lasix radiograph        - Kidney transplant: functional dilated picture               - Changed physiology of the ureter, and can get flow both ways and thus chronic dilation Thanks for listening.

In this podcast, Dr. Lioudmila Sitnikova, a urologist with Minnesota Urology, discusses micturition, pathology of incontinence including stress, urge and neurological, as well as various treatments available. Enjoy the podcast! Objectives:   Upon completion of this podcast, participants should be able to: Describe the normal function of the bladder. List the different types of incontienence. Describe how female urinary incontinence is diagnosed. Identify treatment options for each type of urinary incontinence. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - 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 atachment for the full chapter summaries.   Phases of Micturition- Storage - Evacuation Risk Factors - BMI, smoking, caffiene, spicy food, heavy lifting, child-bearing, diabetes, pelvic surgeries. Hormone Replacement Therapy (HRT)- Oral estrogen/progesterone vs placebo Prevalence - 1 out of 4 women over age 80 suffer incontinence. Types & identification- Stress incontinence - Urge incontinence - Overflow incontinece - Bladder outlet obstruction Evaluation for incontinence- Questionnaires - Voiding diaries - Assess quality of life - Physical assessment and pelvic exam Treatment - Stress incontinence: physical therapy, surgical, bulking agents, Burch procedure - Urge incontinence: biofeedback, antimuscarinics and Beta 3 agonists, Botox, nerve stimulator - Hypotonic bladder (non-obstructive urinary retention): nerve stimulator *For links to reference materials please see the full show notes.

In this podcast,three great physicians come to gether to discuss colon cancer. Dr. Sabina Khan, a gastroenterologist with Rigeview, Dr. Dawn Stapleton , a general surgeon with Lakeview Clinic, and Dr. Purvi Gada, an oncologist and hemotologist with Minnesota Oncology; together they cover history, screening, staging and treatment for colon and colorectal cancer. Enjoy the podcast! Objectives:   Upon completion of this podcast, participants should be able to: Summarize colonoscopy screening guidelines. Recognize symptoms of colon cancer in order to make a cancer diagnosis. Describe surgical and adjuvant therapies available for colon cancer diagnoses. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - 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 the full chapter summaries.  Statistics - Colon cancer is the 3rd leading cause of cancer death in the U.S.- USPSTF recommendation states approximately 10.5% of new colorectal cancer occurs in individuals younger than 50 years old.- Incidence of colorectal cancer has increased by almost 15% from the early 2000s to 2016. - Recommended age to start colon screening is now at 45 years, down from 50 years old. Screening Recommendations: - screening tests and intervals are fecal immunochemical testing or high-sensitivity guaiac-based fecal occult blood testing every 2 years - Colonoscopy every 10 years - Flexible sigmoidoscopy every 10 years - plus fecal ummunochemical testing every 2 years. Systematic Review: Post-Colonoscopy Complications & Review of Enhanced Recovery Programs in Colon Surgeries - Complications post-colonoscopy- ERAS: Enhanced Recovery After Surgery- Fast track surgery protocols - shortened hosptial length of stay - Adjuvant therapies - Targeted therapies - Treatment side effects *For links to reference materials please see the full show notes.

In this podcast, Dr. Ron Tarrel, a Stroke Neurologist with Allina Health, discusses everything stroke. Dr. Tarrel walks through recognition, evaluation, and management of stroke. He also discusses current guidelines, as well as the future of stroke medicine. Enjoy the podcast! Objectives:   Upon completion of this podcast, participants should be able to: Identify and describe warning signs of stroke and its initial presentation. Assess when initial urgent/emergent evaluation, imaging, coordination of care and decision making needs to occur in regards to stroke. Discuss treatment options and indications in regards to stroke care. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - 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. ADDENDUM TO SHOW NOTES:Please note the Dr. Tarrel refers to TPA as a blood thinner at one point throughout the podcast. He would like the listerner to know that this medication (TPA) is a clot dissolving medication and not a blood thinner. Dr. Tarrel does not wish to confuse the listner on the nomenclature of TPA vs blood thinners (i.e. anticoagulants). SHOW NOTES: FAST The American Heart Association (AHA) put forth an initative for the lay person to recognize signs and symptoms of stroke and that was the FAST assessment which is (Facial asymmetry or weakness, Arm weakness, Speech difficulties, and Time), but now it has moved to the BE-FAST screening test. the BE portion of the FAST exam is assessment of Balance and Eyes to determine if there are posterior circulation findings. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.116.015169 HINTS ExamThe HINTS exam is a bit more specific and sensitve, looking for posterior circulation strokes in the correct patient population. Briefly, HINTS is a Head Impulse test direction-changing Nystagmus in eccentric gaze, or skew deviation. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.109.551234 Common DeficitsThe majority of strokes are going to occur in the anterior circulation which would be the carotid distribution, then into MCA (M1, M2, M3, M4, M5). Most of the deficits are going to be unilateral weakness, sensory or cognitive symptoms - example: aphasia/ neglect (cortical symptoms). Whereas, posterior circulation (vertebrobasilar) may have more devastating qualities. Symptoms for posterior stroke can include dizziness, nausea and vomiting, nystagmus, coordination, ataxia. However, see the article linked below where posterior cirulation vs anterior crculation infarcts can sometimes be difficult to determine on a clinical exam alone. Therefore, neuroimaging is recommended to accurately determine stroke distribution. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.112.652420 This study indicates that the symptoms/signs considered typical of posterior circulation infarcts occur far less often than was expected. Inaccurate localization would occur commonly if clinicians relied on the clinical neurological deficits alone to differentiate posterior circulation infarcts from anterior circulation infarcts. Neuroimaging is vital to ensure acurate localization of cerebral infarction. Hemorrhagic vs Ischemic StrokeWhich one is it? According to Dr. Tarrel, intracranial hemorrhage appears to exhibit more headache symptoms, such as this is the "worst headache of my life" , whereas ischemic stroke appears to be more painless, usually. Blood pressure and loss of consciousness can closely mimic hemorrhagic vs ischemic. Telestroke GuidelinesTelestroke guidelines are generally insitution specific. Refer to the linked article below, on the current guidelines in telestroke medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802246/pdf/tmj.2017.0006.pdf BP / 1st Line AgentFor hemorrhagic strokes, the neurosurgeons and neurologist like the systolic blood pressure to be in the 140-160 range. BP is usually controlled with Nicardipine as a 1st line agent. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.117.020058 Last Known Well (LKW)Last Known Well (LKW) is extremely important especially since we know that we are working against the closk for the use of lytic therapy (currently 4.5 hour window).https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4630074/pdf/nihms699406.pdf https://www.ahajournals.org/doi/epub/10.1161/CIRCULATIONAHA.116.023336 Imaging Imaging modalities for stroke workup can often include an initial non-contrast CT of the head to rule out ICH, but hen what happens? Generally, it is recommended to work in concert with the stroke neurologist to then determine the next line of imaging studies. If it is determined the patient looks to have a high NIHSS and concerns for LVOT (Large Vessel Occulusion) a CTA of the head and neck can be considered. Perfusion studies and advanced MR imaging should be discussed with consulting neurologists. Clinicians should also remember to follow their specific institutional guidelines for imaging studies if the stroke neurologist is unavailable or there is a delay in consultation. LKW along with CTA and CT perfusion of the head in ischemic stroke patients can sometimes give us a picture of the infarct core with surrounding penumbra (ratio). If circumstances are faborable, it may allow the pursuit of a thrombectomy. The current guidelines are for thrombectomy within 6 hours, but consideration upwards of 24 and beyond in the right patient population. Please see the DAWN and DIFFUSE 3 trials. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.119.027974 ThrombectomyGenerally the neurointerventionalist does not pursue thrombectomy beyond the MCA (M2 region), sometimes depending on anatomy. ASPECT ScoreThe ASPECT Score (Alberta Stroke Program Early CT Score) determines the volume of subcortical and cortical infarct involvement via perfusion study. Generally the score provided is 1-10. Anything less than a 6 portends a poor outcome. More early changes seen on CT suggest poorer outcomes from stroke. Patients with scores >8 have a better chance for an independent outcome. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.117.016745 IV TPAIV TPA with thrombectomy is safe. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.109.568451 TNK appears to have the same efficacy as TPA. Single dose IV push over 5 minute infusion. Easier and faster delivery of TNK. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.119.025080 Institutions may have different absolute and relative contraindications to TPA. Practice should be guided by institutional protocol and consultation with neurology. https://www.ahajournals.org/doi/epub/10.1161/STR.0000000000000086 Secondary PreventionSecondary prevention of stroke with the aid of DAPT (Dual Antiplatelet Therapy) - usually Plavix and Aspirin. Patients with cerebra ischemia are at high risk for early recurrent stroke, and use of DAPT for secondary prevention is reflected in current guidelines. Good BP and lipid management is paramount for 2nd stroke prevention. https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.119.028400 Scoring SystemsHAS-BLED score for major bleeding risk. CHA2DS2-VASc Score for artrial fibrillation stroke risk. Anti-thrombotic Therapy & Elderly PatientsChoosing antithrombotic therapy for elderly patients with atrial fibrillation who are at risk for falls.https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/484991 Fall risk and anticoagulatoin for atrial fibrillation in the elderly: A delicate balance. https://www.ccjm.org/content/ccjom/84/1/35.full.pdf  

In this podcast, Dr. Laura Mohling, a pediatrician with Lakeview Clinic, talks about pathogens that infect children, childhood immunizations, current guidelines regarding vaccine scheduling, and vaccine hesitancy. Enjoy the podcast! Objectives:   Upon completion of this podcast, participants should be able to: Name at least 3 pathogens mentioned in the podcast children/adolescents were/are susceptible to. Distinguish between the two different meningococcal vaccines available. Summarize Human Papilloma Virus (HPV) recommendations for adolescents. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - 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 the full chapter summaries.  Vaccines - Biggest impact on public health- Vaccine safety continues to improve.- No causation of autism from MMR or other vaccines. (Andrew Wakefield debunking, Thimerosal-free). - ACIP Schedule for Childhood Immunization Meningococcus - Causation - Neisseria meningitidis - Incidence declining - Case fatality approximately 15%, with 10-20% survivor have serious sequelae. - Serogroups       - Serogroup B and C - most frequent cause of disease in U.S.      - Meningitis type B accounts for about 1/3 of cases in adolescents.      - Serogroup A is rare in U.S. - Meningococcal Vaccine      - Meningococcal B vaccines (Trumenba and Bexsero) developed in 2014.      - Vaccine short duration of protection (1-2 years) based on antibody response      - Trumenba (2 doses 6 mos apart) Bexero (2 doses at least 1 mo apart)     - MenACWY vaccine in 2005 primary dose at age 11, booster at age 16. HPV - HPV vaccine is the cancer prevention vaccine!- Statistics - Vaccine - Gardasil 9      - ACIP recommendation of vaccine at age 11 or 12      - dosing schedule of HPV vaccine COVID-19 (SARS-CoV2)- Approved vaccine for age 12 and above. (Pfizer-BioNTech) - RNA vaccines - Antigentic target  - how the vaccine works - Co-administering with other vaccines - ACIP, UpToDate, FDA statements regarding vaccine in adolescents *For links to reference materials please see the full show notes.

In this podcast, Emily Clegg, senior director of risk mitigation response with Constellation, presents information around medical malpractice. Join us as Emily discusses definitions, the steps that occur in medical malpractice lawsuits, and tips in managing what could be only a stressful ordeal. Enjoy the podcast! Objectives:     Upon completion of this podcast, participants should be able to: Define basic malpractice terms. Summarize the steps taken in a medical malpractice lawsuit, and what to expect if a lawsuit occurs. Identify ways in which a health care provider can protect their emotional health through the malpractice process. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - 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 the full chapter summaries.  Basics of medical malpractice- Lives in civil court- 4 elements of medical malpractice- Statute of limitations Claims- Where claims arise - Contributing factors - Initial steps in a claim - Discovery - uncovering facts - What depositions are like - Small amount end up going to trial Trial- What trials are like - Advice about speaking - honesty Insurance/Damages - Damages vs policy limitations Communication - Staying engaged - Early communication beneficial  

In this podcast, the Edith Nagel Eisinger's memoirs continues, with the sixth chapter.  Edith Nagel Eisinger, was the wife of Dr. Harold Nagel and nurse in the hospital she talks about in her memoirs. In 1936, the Nagel's founded the first hospital in Waconia - Nagel Hospital - which later became Waconia Hospital, and eventually Ridgeview Medical Center. Enjoy the next chapter of Edith Nagel Eisinger's story.

In this podcast, Dr. Jim Kolbeck, interventional and structural cardiologist with Minneapolis Heart Institute at United Hospital, discusses ECMO (extracorporeal membrane oxygenation) and the various aspects of this procedure. Enjoy the podcast! Objectives:     Upon completion of this podcast, participants should be able to: Explain the history and purpose for extra corporeal membrane oxygenation (ECMO). Assess when ECMO CPR (ECPR) is warranted. Identify and define inclusion criteria for ECMO and contraindications to ECMO. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - 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 the full chapter summaries.  Chapter 1: Definitions- History of ECMO- Extracorporeal membrane oxygenation (ECMO):       - V-A Veno-Arterial       - V-V Veno-Venous- Who gets ECMO        - V-A: Shock states        - V-V        - ECPR: V-A            - Out-of-hospital cardiac arrests            - ARREST Trial            - Refractory Cardiac Arrest            - Criteria Chapter 2: Cannulation- V-A ECMO       - Bifemoral- V-V ECMO       - Bifemoral or Femoral/Jugular       - Dual Lumen: Jugular vein        - Anticoagulation       - V-V to V-A       - Discussions of care Chapter 3:- Cannulate and Ship Model- Who's Involved- The Machine: Cardiohelp (portable ECMO machine)- Physiology of ECMO- Monitoring the Results Chapter 4: - Who Gets ECMO- Contraindications- The Future / Next steps

In this podcast, Dr. Haylee Veazey, an emergency medicine physician, internist, and medical director of the Adult Gender and Sexual Health Clinic with Hennepin Health Care (HCMC), provides insight into the world of gender medicine. Enjoy the podcast! Objectives:     Upon completion of this podcast, participants should be able to: Review and choose appropriate and non-offensive terminology in regards to gender affirming healthcare. Explain issues surrounding gender affirming care. Assess pertinent medical concerns for patients on gender affirming treatments. Identify ways to improve the experiences of transgender patients in the healthcare setting in order to reduce those delaying health care. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - 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 the full chapter summaries.  Chapter 1: Definitions- Getting on board with definitions - Terminology and definitions:        - Assigned sex                                      - Gender expression        - Gender                                               - Gender dysphoria        - Cis-gender/Transgender- Risk factors Chapter 2: Medical Gender Affirming Care- Informed consent- HRT masculinization: Testosterone        - Hormone changes        - Risks - HRT Feminization: Estrogen, etc.        - Hormone changes        - Risks        - Contraindications        - Testosterone blocking agents - Monitoring - Resources and Guidelines Chapter 3: Surgical Gender Affirming Healthcare - Top surgery  or  Chest surgery         - Masculinizing         - Feminizing - Bottom surgery         - Feminizing (vaginoplasty, orchiectomy)        - Masculinizing  (metoidioplasty, phalloplasty vaginectomy, hysterectomy,            oophorectomy, or salpingectomy) Chapter 4: The Trans Broken Arm Syndrome - Care of the LGBTQ Population - Don't necessarily have to ask about all surgeries a patient has (or has not) had, especially if that assessment not indicated for the presentation.- Important items for primary care (screenings, safe spaces)- Being comfortable with non-gendered language  * For links and resources - see attached "Show Notes".

Heart disease in women is under recognized under treated, and under researched compared to men; although it is the number one killer of women in the world. In this podcast, Dr. Retu Sexena, a cardiologist with Minneapolis Heart Institute, discusses the epidemiology, symptoms and pathology of heart disease as it relates to women and cardio-obstetrics. Enjoy the podcast! Objectives:     Upon completion of this podcast, participants should be able to: Summarize the historical nature of heart disease in women. Recognize the cardiovascular risks in women. Identify signs/symptoms of heart disease in women. Review prevention efforts for heart disease in women. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - 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 the full chapter summaries.  Chapter 1:- History of cardiovascular disease in women - Symptoms - Risk factors Chapter 2:- Cardio-Obstetrics (CV-Ob) - Cardiomyopathies in pregnancy Chapter 3: - Treatment/Therapies and concerns - Hypertension - ICD guidelines, ASCVD risk scores, AHA guidelines, recommendations * For journal articles cited, and web links - see attached "Show Notes".

As part of an annual review of medical literature, this podcast will dissect several medical journal articles, discuss some of their finer points, and how it can relate to medical practice today. In this podcast Dr. Valerie Johnson, an emergency medicine physician with EMPAC, and Dr. Abby Elliott, a family medicine physician with Lakeview Clinic, cover a variety of topic areas from five journal articles. If you like to skip to the conclusion part of the article, this podcast is for you. Enjoy the podcast! Objectives:     Upon completion of this podcast, participants should be able to: Define non-consensus TIA. Identify long-term risks of non-consensus TIA. Recognize the mechanism of action of GLP-1 agonists. Summarize key principles of sepsis recognition, early screening/detection, early management, and titration of care. Name significant/relevant findings of the journal articles being reviewed and discussed. Select a credible/relevant journal article. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - 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. SHOW NOTES:  *See the attachment for article discussion summaries.  Journal Article 1: "Healthy Weight Loss Maintenance with Exercise, Liraglutide, or Both Combined" CITATION:  Lundgren, J., Janus, C., Jensen, S., Juhl, C., Olsen, L., Christensen, R., Svane, M., Bandholm, T.,Bojsen-Møller, K., Blond, M., Jensen, J., Stallknecht, B., Holst, J., Madsbad, S. and Torekov, S.,  2021. Healthy Weight Loss Maintenance with Exercise, Liraglutide, or Both Combined. New England Journal of Medicine, 384(18), pp.1719-1730. Available: https://www.nejm.org/doi/full/10.1056/nejmoa2028198 Journal Article 2: "Diagnosis of Non-Consensus Transient Ischaemic Attack with Focal, Negative, and Non-Progressive Symptoms: Population-Based Validation By Investigation and Prognosis" CITATION:  Tuna, M. and Rothwell, P.,  2021. Diagnosis of non-consensus transient ischaemic attacks with focal, negative, and non-progressive symptoms: population-based validation by investigation and prognosis. The Lancet, 397(10277), pp.902-912. Available: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31961-9/fulltext Journal Article 3: "Cardiovascular Outcomes and Mortality Associated with Discontinuing Statins in Older Patients Receiving Polypharmacy" CITATION:  Rea, F., Biffi, A., Ronco, R., Franchi, M., Cammarota, S., Citarella, A., Conti, V., Filippelli, A., Sellitto, C.and Corrao, G., 2021. Cardiovascular Outcomes and Mortality Associated With Discontinuing Statins in Older Patients Receiving Polypharmacy. JAMA Network Open, 4(6), p.e2113186. Available: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780952 Journal Article 4: "Early Care of Adults with Suspected Sepsis in the Emergency Department and Out-of-Hospital Environment: A Consensus-Based Task Force Report" CITATION:  Yealy, D., Mohr, N., Shapiro, N., Venkatesh, A., Jones, A. and Self, W.,  2021.  Early Care of Adults With Suspected Sepsis in the Emergency Department and Out-of-Hospital Environment: A Consensus-Based Task Force Report. Annals of Emergency Medicine, 78(1),pp.1-19. Available: https://www.annemergmed.com/article/S0196-0644(21)00117-7/fulltext Journal Article 5: "Associations of Suicidality Trends with Cannabis Use as Function of Sex/Depression Status" CITATION:  Han, B., Compton, W., Einstein, E. and Volkow, N., 2021. Associations of Suicidality Trends With Cannabis Use as a Function of Sex and Depression Status. JAMA Network Open, 4(6), p.e2113025. Available: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781215

The memoirs of Edith Nagel Eisinger continues. This podcast contains the fifth chapter of the personal memoirs of Edith Nagel Eisinger, wife of Dr. Harold Nagel. In 1936, the Nagel's founded the first hospital in Waconia - Nagel Hospital - which later became Waconia Hospital, and eventually Ridgeview Medical Center. Enjoy the next chapter of Edith Nagel Eisinger's story.

The memoirs of Edith Nagel Eisinger continues. This podcast contains the fourth chapter of the personal memoirs of Edith Nagel Eisinger, wife of Dr. Harold Nagel. In 1936, the Nagel's founded the first hospital in Waconia - Nagel Hospital - which later became Waconia Hospital, and eventually Ridgeview Medical Center. Enjoy the next chapter of Edith Nagel Eisinger's story.

This podcast is a reading of the third chapter from the personal memoirs of Edith Nagel Eisinger, wife of Dr. Harold Nagel. In 1936, they founded the first hospital in Waconia - Nagel Hospital - which later became Waconia Hospital, and eventually Ridgeview Medical Center. Enjoy the next chapter of Edith Nagel Eisinger's story.

Western and Eastern medicine both offer unique perspectives fundamental to healthcare today. In this podcast, Nikki Vanecek a traditional Chinese medicine practitioner with EastWest Acupuncture, discusses different modalities of Eastern medicine, and how both Eastern and Western medicine can benefit patients. Enjoy the podcast! Objectives:     Upon completion of this podcast, participants should be able to: Describe acupuncture and the different Chinese medicine treatments. Identify when to refer patients for acupuncture and Chinese medicine treatment. Determine what is best treated with acupuncture or other Chinese medicine treatment modalities. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  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  rmccredentialing@ridgeviewmedical.org. Click on the following link for your CME credit: CME Evaluation: "Collaboration of Acupuncture and Chinese Medicine with Western Medicine - A unique perspective" (**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.