Podcasts about Abbott Northwestern Hospital

Host Samantha Gambles Farr, MSN, AG-ACNP, FNP-C, RNFA, is joined by Roman Melamed, MD, to discuss the comparative effectiveness of reduced-dose versus full-dose alteplase for acute pulmonary embolism, focusing on patient outcomes and complications. They will highlight study findings on significant improvements in hemodynamic and respiratory parameters in both groups, with a lower rate of hemorrhagic complications in the reduced-dose group (Melamed R, et al. Crit Care Med. 2024;52:729-742). Dr. Melamed is a critical care intensivist and director of the Pulmonary Embolism Program at Abbott Northwestern Hospital in Minneapolis, Minnesota, USA, and an adjunct associate professor at the University of Minnesota.

Chaplains often show up on the worst days of people's lives. They arrive in a hospital room after a distressing diagnosis. They accompany police to help inform someone of a loved one's death.One in four Americans have been visited by a chaplain, usually at a hospital or hospice, though chaplains also work in prisons, on college campuses and with the military and police and fire departments.But the role of spiritual caregiver is evolving as society becomes both less religious and more religiously diverse.At the end of last year, Fairview Health Services laid off more than a dozen staff chaplains as part of a larger round of layoffs, raising questions about whether patients' spiritual care will continue to be seen as part of a health system's core services.MPR News host Angela Davis talked with three chaplains about the work they do and how it's changing. This is an encore conversation from January. Guests:The Rev. Jessica Chapman Lape is an assistant professor of Interreligious Chaplaincy and director of the Interreligious Chaplaincy Program at United Theological Seminary of the Twin Cities. She's an ordained minister in the United Church of Christ, a staff chaplain at Regions Hospital in St. Paul and a community trained birth doula.The Rev. Michael Le Buhn manages the spiritual care department at Abbott Northwestern Hospital. He previously worked as a chaplain in Allina Health's Mercy Hospital Unity Campus in Fridley and at Open Table Nashville, a nonprofit that serves people experiencing homelessness. Michael is a veteran of the United States Army.Rabbi Lynn Liberman is the community chaplain with Jewish Family Service of St. Paul. She has worked in a congregation, as a hospice and hospital chaplain, and she is a volunteer police and fire chaplain for Mendota Heights and West St. Paul. She also provides chaplain care for the Minnesota State Patrol sworn troopers and security officers who work at the Minnesota State Capitol.Subscribe to the MPR News with Angela Davis podcast on: Apple Podcasts, Google Podcasts, Spotify or RSS.  Use the audio player above to listen to the full conversation.

Chaplains often show up on the worst days of people's lives. They arrive in a hospital room after a distressing diagnosis. They accompany police to help inform someone of a loved one's death.One in four Americans have been visited by a chaplain, usually at a hospital or hospice, though chaplains also work in prisons, on college campuses and with the military and police and fire departments.But the role of spiritual caregiver is evolving as society becomes both less religious and more religiously diverse.At the end of last year, Fairview Health Services laid off more than a dozen staff chaplains as part of a larger round of layoffs, raising questions about whether patients' spiritual care will continue to be seen as part of a health system's core services.MPR News host Angela Davis talks with three chaplains about the work they do and how it's changing.  Guests:  The Rev. Jessica Chapman Lape is an assistant professor of Interreligious Chaplaincy and director of the Interreligious Chaplaincy Program at United Theological Seminary of the Twin Cities. She's an ordained minister in the United Church of Christ, a staff chaplain at Regions Hospital in St. Paul and a community trained birth doula. The Rev. Michael Le Buhn manages the spiritual care department at Abbott Northwestern Hospital. He previously worked as a chaplain in Allina Health's Mercy Hospital Unity Campus in Fridley and at Open Table Nashville, a nonprofit that serves people experiencing homelessness. Michael is a veteran of the United States Army.  Rabbi Lynn Liberman is the community chaplain with Jewish Family Service of St. Paul. She has worked in a congregation, as a hospice and hospital chaplain and is a volunteer police and fire chaplain for Mendota Heights and West St. Paul. She also provides chaplain care for the Minnesota State Patrol sworn troopers and security officers who work at the Minnesota State Capitol.   Subscribe to the MPR News with Angela Davis podcast on: Apple Podcasts, Google Podcasts, Spotify or RSS.  Use the audio player above to listen to the full conversation.    

Episode Resources:Click here to learn more about the WOCN Fellow ProgramClick here to apply for the 2024 WOCN Fellow Class until March 4, 2024, at 11:59 PM ETClick here to access the WOCN members-only online CommunitiesClick here to read Dr. Buscemi's WOCN member spotlight blogClick here to read Dr. Pieper's WOCN member spotlight blog About the Speaker:Dr. Pieper, PhD, RN, CWOCN, ACNS-BC, FAAN, WOCNF, completed her WOC education at Abbott-Northwestern Hospital in 1989. She held a joint academic-clinical position, Wayne State University, College of Nursing, Detroit, MI, and the Detroit Medical Center. In 1991, her clinical career and her research became focused on wound care especially in persons who injected street drugs. She received NIH funding, gave many presentations, and published many papers in refereed journals. She was a Fulbright Scholar in Trinidad and Tobago, 2020. She is a Professor Emerita.Dr. Buscemi, PhD, APRN, CWCN, WOCNF, is board certified as a Family Nurse Practitioner by the ANCC and board certified as a Wound Care Nurse with the WOCNCB. He has over 34 years of experience as a Nurse and more than 20 years as an APRN. He is a current member of the WOCN and has published in their journal. He is also an editorial reviewer for the JWOCN. He is a member of the AANP and sits on the editorial board for the JAANP. He also in on the editorial board for Wound Management. He has presented at regional, national, and international wound care conferences. He participates in interdisciplinary research with the Biomedical Engineering Dept. at FIU. He is a Fellow of the WOCN where he was inducted into their inaugural class.

"Being in nature and being more connected to the environment has made me more whole as a person." Hosts Tseganesh and David speak with Dr. Karoline Lange about foraging. About the guest: Karoline Lange is an internist and primary care physician at Allina. Dr. Lange grew up in Germany and completed medical school in Goettingen, Germany. Being a dual citizen, she decided to move to Minneapolis for internal medicine residency at Abbott Northwestern Hospital in 2014 and completed residency in 2017. She enjoys spending time in local parks hiking, mountain biking, and cross country skiing. She loves being in nature with her husband, and she has a particular enthusiasm for getting to know the local flora, fauna and, of course, fungi! More resources on foraging: North American Mycological Association https://namyco.org/ Alan Bergo - Foragerchef https://foragerchef.com/ Alan Bergo‘s Book - https://foragerchef.com/the-forager-chefs-book-of-flora/ Sam Thayer - https://www.foragersharvest.com/ Mushrooms of Upper Midwest handbook - https://namyco.org/mushrooms_of_the_upper_midwest.php Braiding Sweetgrass - book by Robin Wall Kimmerer https://milkweed.org/book/braiding-sweetgrass To see images of Dr. Lange's recent foraging finds, click here. Support for Doctor+ has been provided by the American College of Physicians. Doctor+ is hosted by Dr. David Hilden and Dr. Tseganesh Selameab and is produced by Julie Censullo. For more information, visit doctorpluspodcast.com.

➡️ Like The Podcast? Leave A Rating: https://ratethispodcast.com/successstory   ➡️ About The Guest⁣ Bill George is a senior fellow at Harvard Business School, where he has taught leadership since 2004. He is the author of four best-selling books: 7 Lessons for Leading in Crisis, True North, Finding Your True North, and Authentic Leadership, as well as True North Groups. His newest book, Discover Your True North, was published in August of 2015 along with its companion workbook, The Discover Your True North Fieldbook. Mr. George is the former chairman and chief executive officer of Medtronic. He joined Medtronic in 1989 as president and chief operating officer, was a chief executive officer from 1991-2001, and was board chair from 1996-2002. Earlier in his career, he was a senior executive with Honeywell and Litton Industries and served in the U.S. Department of Defense. Mr. George currently serves as a director of Goldman Sachs and The Mayo Clinic. He has recently served on the boards of ExxonMobil, Novartis, Target Corporation, and Minnesota's Destination Medical Center Corporation. He is currently a trustee of the World Economic Forum USA. He has served as board chair for Allina Health System, Abbott-Northwestern Hospital, United Way of the Greater Twin Cities, and Advamed. ➡️ Show Links https://twitter.com/Bill_George/  https://www.linkedin.com/in/williamwgeorge/  https://billgeorge.org/  ➡️ Podcast Sponsors HUBSPOT - http://hubspot.com/successpod/  ➡️ Talking Points⁣ 00:00 - Intro 01:45 - Bill George's origin story 04:33 - How many people pursue careers that they're not fulfilled or happy with? 06:24 - The concept of True North 10:49 - How to effectively action authentic leadership in an organization 12:28 - Leading an organization 30 years back vs now 15:24 - How and when should a leader take a stand? 17:32 - When should a CEO take a social stand? 20:10 - Advice for people who want to expand their business overseas 22:35 - Bill George on leading without True North 24:57 - What is Mark Zuckerberg trying to accomplish as a leader? 27:05 - Is there a place for a leader to be charismatic? 31:05 - Challenges leaders are going to experience in the next ten years 34:29 - What businesses are actually making a difference in the world? 35:56 - What can the new generation of leaders learn from the last generation of leaders? 37:57 - Advice for emerging leaders 39:41 - Where can people connect with Bill George? 40:47 - What does success mean to Bill George? Learn more about your ad choices. Visit podcastchoices.com/adchoices

Craig Bowron, M.D., F.A.C.P., is a practicing physician and a board-certified internist. He works with first-year medical students at the University of Minnesota Medical School and trains resident physicians at the Internal Medicine Residency Program of Abbott Northwestern Hospital in Minneapolis. He is also the author of Man Overboard! A Medical Lifeline for the Aging Male. A member of the Association of Health Care Journalists and a fellow of the American College of Physicians, Dr. Bowron lives in St. Paul, Minnesota. Visit him at CraigBowronMD.com. LISTEN TO THIS EPISODE IF: You are over 40 or if you expect to be someday! You are confused by all the medical jargon and misinformation regarding nutrition, medicine, and exercise You are passionate about wellness and staying healthy You want to start better habits to help you live longer You want to understand your health and live your best life

This week, please join authors John McMurray and David Cherney, editorialist Kausik Umanath, as well as Associate Editors Ian Neeland and Brendan Everett as they discuss the original research articles "Initial Decline (Dip) in Estimated Glomerular Filtration Rate After Initiation of Dapagliflozin in Patients With Heart Failure and Reduced Ejection Fraction: Insights from DAPA-HF" and "Renal and Vascular Effects of Combined SGLT2 and Angiotensin-Converting Enzyme Inhibition" and editorial ""Dip" in eGFR: Stay the Course With SGLT-2 Inhibition." Dr. Carolyn Lam: Welcome to Circulation On the Run, your weekly podcast summary and backstage pass to the Journal and its editors. We're your co-hosts, I'm Dr. Carolyn Lam, Associate Editor from the National Heart Centre and Duke National University of Singapore. Dr. Greg Hundley: I'm Dr. Greg Hundley, Associate Editor and director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr. Carolyn Lam: Greg, it's the season of double features. Except this time, we're having a forum discussion of two related articles and an editorial that discusses both. What is it on? SGLT2 inhibitors. In the first paper, an analysis from the DAPA-HF trial, looking specifically at that initial dip in GFR that follows initiation of dapagliflozin in patients with HFrEF. Then we will discuss further, in a mechanistic way, the renal and vascular effects of combining SGLT2 inhibition on top of ACE inhibition. Lots and lots of good learning and insights, but let's go on first to the other papers in today's issue. Shall we? Dr. Greg Hundley: You bet, Carolyn, and I'm going to grab a cup of coffee. Carolyn, in this issue, wow, so many exciting original articles. In fact, there are two more articles that were going to pair together, both clinical and pertaining to TAVR procedures. In the first one, it was a group of authors led by Dr. Duk-Woo Park from the Asan Medical Center at the University of Ulsan College of Medicine. They conducted a multicenter, open-label randomized trial comparing edoxaban with dual antiplatelet therapy or DAPT, aspirin plus clopidogrel, in patients who had undergone successful TAVR and did not have an indication for anticoagulation. Now in this study, Carolyn, the primary endpoint was an incidence of leaflet thrombosis on four-dimensional computed tomography, CT, performed at six months after the TAVR procedure. Key secondary endpoints were the number and volume of new cerebral lesions on brain magnetic resonance imaging or MRI and the serial changes of neurological and neurocognitive function between six months and that time immediately post the TAVR procedure. Dr. Carolyn Lam: Oh, interesting. What did they find? Dr. Greg Hundley: Right, Carolyn. In patients without an indication for long-term anticoagulation after successful TAVR, the incidence of leaflet thrombosis was numerically lower with edoxaban than with dual antiplatelet therapy, but this was not statistically significant. The effect on new cerebral thromboembolism and neurological or neurocognitive function were also not different between the two groups. Now because the study was underpowered, the results should be considered really as hypothesis generating, but do highlight the need for further research. Dr. Greg Hundley: Carolyn, there's a second paper pertaining to transcatheter aortic valve prosthesis. It's led by a group directed by Dr. Paul Sorajja from the Minneapolis Heart Institute Foundation and Abbott Northwestern Hospital. Carolyn, these authors prospectively examined 565 patients with cardiac CT screening for HALT, or what we would define as hypoattenuating leaflet thickening, at 30 days following balloon-expandable and self-expanding TAVR. Now, deformation of the TAVR prosthesis, asymmetric prosthesis leaflet expansion, prosthesis sinus volumes, and commissural alignment were analyzed on the post-procedural CT. For descriptive purposes, an index of prosthesis deformation was calculated, with values greater than 1 representing relative midsegment underexpansion. A time-to-event model was also performed to evaluate the association of HALT with the clinical outcomes. Dr. Carolyn Lam: Oh, interesting. What did they find? Dr. Greg Hundley: Right, Carolyn. Nonuniform expansion of TAVR prosthesis resulting in frame deformation, asymmetric leaflet, and smaller neosinus volume was related to the occurrence of HALT in patients who underwent TAVR. What's the take home here, Carolyn? These data may have implications for both prosthesis valve design and deployment techniques to improve clinical outcomes in these patients. Now, Carolyn, both of these articles are accompanied by an editorial from Dr. Raj Makkar from the Smidt Heart Institute at Cedars-Sinai's Medical Center. It's a very lovely piece entitled Missing Pieces of the TAVR Subclinical Leaflet Thrombosis Puzzle. Well, how about we check what else is in this issue? My goodness, this was a packed issue. First, Carolyn, there are three letters to the editor from Professors Ennezat, Dweck, and then a response from Dr. Banovic pertaining to a follow-up from a previously published study, the AVATAR study, in evaluating valve replacement in asymptomatic aortic stenosis. There's also a Perspective piece from Dr. Wells entitled “Treatment of Chronic Hypertension in Pregnancy: Is It Time For A Change?” There's a Global Rounds piece from Professor Berwanger entitled “Cardiovascular Care in Brazil: Current Status, Challenges, and Opportunities.” Then there's also a Research Letter from Professor Eikelboom entitled “Rivaroxaban 2.5 mg Twice Daily Plus Aspirin Reduces Venous Thromboembolism in Patients With Chronic Atherosclerosis.” Dr. Carolyn Lam: There's another Research letter by Dr. Borlaug on longitudinal evolution of cardiac dysfunction in heart failure with normal natriuretic peptide levels. There's also a beautiful Cardiology News piece by Bridget Kuehn on the post-COVID return to play guidelines and how they're evolving. Well, that was a great summary of today's issue. Let's hop on to our feature forum. Shall we? Dr. Greg Hundley: You bet, Carolyn. Can't wait. Dr. Carolyn Lam: Today's feature discussion is actually a forum because we have two feature papers in today's issue. They all surround the cardiorenal interaction, should I say, of the SGLT2 inhibitors. For the first paper, discussing that initial decline or that dip in the GFR following initiation of dapagliflozin would be Dr. John McMurray, who's the corresponding author of this paper from DAPA-HF. Dr. John McMurray's from the University of Glasgow. Now next, we have also the corresponding author of another paper, really going into the mechanistic insights of the renal and vascular effects of combined SGLT2 and ACE inhibition. Dr. David Cherney is from Toronto General Hospital, University of Toronto. Dr. Carolyn Lam: We have the editorial list of these two wonderful papers, Dr. Kausik Umanath from Henry Ford Health in Michigan. Finally, our beloved associate editors, Dr. Ian Neeland from Case Western Reserve and Dr. Brendan Everett from Brigham and Women's Hospital, Harvard Medical School. Thank you, gentlemen. Now with all of that, what an exciting forum we have in front of us. Could I start by asking, of course, the respective authors to talk a little bit about your papers? I think a good place to start would be with Dr. McMurray. John, please. Dr. John McMurray: Thanks, Carolyn. I think our paper had three key messages. The early dip in eGFR that we saw was, on average, very small in patients with heart failure, about 3 mLs/min or about 5%. Very few patients had a large reduction in the eGFR. It was around 3%. Dapagliflozin-treated patients had a 30% or greater decline compared to about 1% of placebo patients. Finally, very few of those patients had a decline in the eGFR below a critical threshold, which for cardiologists might be around 20 mLs/min. We saw that in only five patients; that's 0.2% of the dapagliflozin-treated patients. Second message was that that early decline partially reverses. The nadir in our study was about 14 days. But by 60 days, on average, eGFR had increased again. Hold your nerve if you see an early decline in eGFR.   Dr. John McMurray: Maybe the most important message was that that decline in the eGFR is not associated with worse cardiovascular or renal outcomes. In fact, if anything, the opposite. If you look at the patients in the dapagliflozin group with a 10% or greater decline in eGFR, then compare it to patients who didn't have that decline, these individuals were about 27% less likely to experience the primary composite outcome of worsening heart failure and cardiovascular death. If you look at the placebo group, we saw exactly the opposite. Amongst those who had a greater than 10% decline in eGFR compared to those who didn't, those people with the early decline in eGFR were 45% more likely to experience the primary composite endpoint. The same is true for other cardiovascular outcomes for worsening kidney function. In the dapagliflozin group, decline in eGFR was not associated with more adverse events, not associated with more treatment discontinuation. That small decline in the eGFR is not a bad prognostic sign. If anything, it might be the opposite. Dr. Carolyn Lam: Thank you so much. That was really clear. David, are you going to tell us why this decline occurs? Dr. David Cherney: Yeah. Perhaps the paper that we published gives some insights into the mechanisms that are responsible for some of those changes in GFR that are thought to be acute hemodynamic effects. In the between trial, which is the trial that we published examining the effect of ACE inhibition followed by SGLT2 inhibition in patients with type 1 diabetes, we also saw that there was an expected effect of adding SGLT2 inhibition on top of an ACE inhibitor in people with uncomplicated type 1 diabetes. This acute dip in GFR was seen in this cohort of patients. We included only 30 patients in this small mechanistic study. At the same time, along with that dip in GFR, we also saw an increase in measures of proximal natriuresis. That proximal sodium loss is linked with changes in sodium handling in the kidney, which then causes changes in both probably afferent and efferent tone, which causes this dip in GFR primarily through natriuresis in this phenomenon called tubuloglomerular feedback. That was one major observation that gives insight into what we see in larger trials around the dip in GFR. Dr. David Cherney: In our mechanistic study, we also saw an additive effect on blood pressure. Blood pressure went down further with the addition of empagliflozin on top of an ACE inhibitor. In terms of the mechanisms that are responsible for the reduction in blood pressure, natriuresis certainly may be in part responsible, but we also saw a novel observation whereby there was a reduction in peripheral vascular resistance using noninvasive measures. There are likely several mechanisms that are responsible for the reduction in blood pressure. Then finally, we also saw reductions in markers of oxidative stress, which may also account for some of the effects that we see in blood pressure, as well as potentially some of the anti-inflammatory and anti-fibrotic effects that we see at least in experimental models that may have some clinical translatability to humans as well around the clinical benefits. I think the blood pressure, the renal hemodynamic effects, and some of the neurohormonal mechanisms are the major observations that we saw that may in part explain some of the really nice changes that were seen in Dr. McMurray's study. Dr. Carolyn Lam: Right. Thanks, David. But these were patients with type 1 diabetes and no heart failure. John, do you have any reflections or questions about how that may apply? By the way, what a beautiful study. Thank you, David. Dr. David Cherney: Pleasure. Thank you. Dr. John McMurray: Yes, David. I really enjoyed your study. In fact, I think, Carolyn, it does shed some insights perhaps to what's going on. As David pointed out, the reduction in peripheral arterial resistance, reduction in blood pressure, that may play some role in that early dip in eGFR as well as autoregulation in the kidney. Then the other interesting thing is that the distal nephron seems to adapt to that effect in the proximal tubule. Again, that may account for some of that recovery in eGFR, that reversal in the early dip that I spoke about, and which I think is very clinically important because, of course, physicians should make sure that they recheck eGFR if they see that early dip. Because they may find that few weeks later that that dip is much smaller and of much less concern. Dr. Carolyn Lam: Thank you, John. In fact, you're saying, stay the course, right- Dr. John McMurray: I have. Dr. Carolyn Lam: ... with the SGLT2 inhibitors. I'm actually stealing the words of the title of the editorial, a beautiful editorial by Kausik. I love that. Stay the course. Kausik, please, could you frame both papers and then with an important clinical take home message for our audience? Dr. Kausik Umanath: Sure. I think the analysis by John and his group was really relevant with the large sample size. What's impressive? Similar to a lot of these other SGLT2 studies that have come out, both in heart failure and in kidney disease progression and so on, it's remarkable how the other analysis, like the analysis of EMPA-REG and CREDENCE and so on, of similar dips. All show more or less the same magnitude, the same relative proportions of this GFR trajectory. I think the mechanistic study only highlights that though it's working with a slightly different population of type 1 patients and much earlier in their course in terms of where their GFRs are. Dr. Kausik Umanath: The other piece is that ultimately we need to understand this dip and know to monitor for it and so on. But I think the general clinician should really understand that a dip of greater than 10% really occurs in less than half the population that takes these agents. That dip, if it occurs, certainly doesn't do any harm. That said, if they see a bigger dip in the 30% range, monitor more closely and consider making sure that there aren't any other renal issues out there for that patient because they are a much smaller proportion of patients in these large trials that generate that level of dip. They should be monitored. Dr. Kausik Umanath: The other thought that we had, and thinking through this in a practical sense, is because you expect this dip, many of our cardiologists or even the nephrologists when we titrate these drugs, they're on a suite of other drugs. It's probably best to not adjust their Lasix or their loop diuretic, or their RAAS inhibitor at the same time as you're adjusting the SGLT2 inhibitor or starting it because then you may just introduce more noise into the GFR changes that you see over the next several weeks. It may be a sequential piece or at least holding those other agents constant while this gets titrated and introduced is a prudent course of action, so you don't misattribute changes. Dr. Carolyn Lam: Thanks so much. What clinically relevant points. In fact, that point about the diuretic especially applies in our heart failure world. You see the dip. Well, first, make sure the patient's not overdiuresed. Remember, there's more that the patient's taking. Thank you. That was a really great point. Brendan and Ian, I have to get you guys to share your views and questions right now. But before that, can I take a pause with you and just say, aren't you just so proud to be AEs of Circulation when we see papers like these and we just realize how incredible the data are and the clinical implications are? I just really had to say that. All right. But with that, please, what are your thoughts, Brendan? Dr. Brendan Everett: Yeah, sure. Thank you, Carolyn. Hats off to all three of our authors today for doing some amazing science. Thank you for sending it to Circulation. I think, in particular, I handled David's paper. I'm not a nephrologist and I'm probably the furthest thing from a nephrologist. Had to do my best to try and understand these concepts that I'm not sure I ever even was exposed to in medical school many years ago. I think it shows the breadth of the interest in our readership. The fact that these changes in eGFR have become a primary focus for our cardiovascular patients and that the clinical implications are really important. I guess my question, David, is... In your paper, you talked a little bit about this hypothesis of hyperfiltration and the role that hyperfiltration plays in setting patients with diabetes up for kidney disease. Is that playing a role in John's observation or not? Again, as a non-nephrologist, I have trouble connecting the dots in terms of that hypothesis and John's observation of the clinical benefit for patients that have a reduction in eGFR as opposed to no change. Dr. David Cherney: Yeah. It's a great question. It's very difficult to know with certainty in a human cohort because we can't measure the critical parameter, which is intraglomerular pressure, which we think these changes in GFR are a surrogate for. But if we go along with that train of thought, along reductions in glomerular hypertension, it very much makes sense that the patients who dip are those who have the... They're taking their medication, number one. Number two, they respond physiologically in the way that you expect them to, which is that their GFR dips at least transiently and then goes back up again through some of the compensatory mechanisms that John mentioned earlier. As was mentioned not only in this paper, but also in previous analyses from CREDENCE and previous analyses from VERTIS CV and others have shown that indeed that dip in GFR is linked with longer term renal benefits, at least. That is reflected in a reduction in the loss of kidney function over time. Dr. David Cherney: The patients who are on an SGLT2 inhibitor and those who dip by around 10% or less, those patients tend to do the best over time in terms of preserving GFR, not losing kidney function compared to patients who are on an SGLT2 inhibitor but do not dip, or those patients who actually have an increase in GFR. That is consistent with this idea that there may be a reduction in glomerular pressure, which is protective over the long term. That ties back into your question around hyperfiltration that this may indeed be due to a reduction in glomerular pressure, which is linked with risk over the long term. Dr. Carolyn Lam: Ian? Dr. Ian Neeland: I wanted to echo Brendan's comments about the excellent science. When I read these papers, it really speaks to the existential struggle that cardiologists have between kidney function and these medications that we know have cardiovascular benefits. How do we manage that practically? It's so clinically relevant, both the observation that John's paper made about the dip in the DAPA-HF trial as well as, David, your mechanistic insights. Dr. Ian Neeland: I wanted to ask John potentially about the most fascinating aspect to me of this paper was that patients with a dip of 10% or more actually ended up doing better in terms of cardiovascular outcomes, specifically hospital heart failure and hospitalizations than people on placebo with a greater than 10% dip. It speaks to the fact that... Is the physiology going on here different between those individuals whose GFR went down on placebo versus those who are on SGLT2 inhibitors? All the mechanistic insight that David's paper had in terms of blood pressure and intraglomerular pressure, how does that feedback and speak to why heart failure is strongly linked to this mechanism? We see this not just with SGLT2 inhibitors, but there are other medications now coming out showing that there's a relationship between this dip in GFR and heart failure. Can you speak to why this heart failure-kidney connection is so important and becoming greater and greater in terms of our understanding? Dr. John McMurray: Well, thank you for asking me the hardest question and one that I truly don't think I have a good answer to. I think it's obvious to all of us that the kidney is central in heart failure and perhaps cardiologists have neglected that fact, focusing more on the other organ. But by definition, almost the fluid retention that characterizes heart failure in terms of signs, and probably is the primary cause of symptoms, that clearly is a renally-mediated phenomenon. The kidney must be central to all of this. I think David right. I think the decline in eGFR that you see with this drug is simply a marker that the drug is having its physiological effect or effects. Whatever those are, they're beneficial. Clearly, patients who have an eGFR decline on placebo are different and they reflect, again, the patients that we see all the time. As our patients with heart failure deteriorate, one of the things that we commonly see, in fact becomes one of the biggest problems that we have to deal with, is that their kidney function declines. As their symptoms get worse, as their cardiac function gets worse, their kidney function also declines. Dr. John McMurray: I think you're seeing two contrasting effects here. One is the background change in eGFR, which is the placebo patients, and we've always known that that's a bad thing. Then we're seeing that early within 14 days marker of the pharmacological or physiological action of the drug. I hope you don't ask me how SGLT2 inhibitors work in heart failure. That's the other most difficult question I can think of, but I think this is just a marker of the fact that they are working. Dr. David Cherney: Yeah. Just to add to that briefly, there is this difficulty in sorting out the mechanisms that are relevant around the acute effects in the kidney that the dip in GFR reflects natriuresis that could keep patients out of heart failure; that the reduction in glomerular pressure reduces albuminuria. Albuminuria reduction is linked with kidney protection. It's linked with heart failure and ASCVD protection. Then there's also this concept of if you dip and then you stay stable afterwards, your GFR stays stable afterwards, those patients with stable kidney function that's not declining, the dippers in other words, those patients are probably able to maintain salt and water homeostasis better than someone who's declining more rapidly. All these things probably tie together in order to reflect, of course, there's a renal protective effect, but that some of those mechanisms may also tie into the heart failure mechanisms that John was mentioning. Dr. John McMurray: But, David, it's hard to imagine if we don't protect the kidney, we won't protect patients with heart failure given how fundamental, as I said, the kidney is, and how fundamentally important worsening kidney function is. Not only because it is a marker of things going badly, but also because it often results in discontinuation or reduction in dose of other life-saving treatments. To Kausik's point, it was very important about the risk of changing background life-saving disease modifying therapy. Actually, we didn't see that in DAPA-HF, which was very intriguing. There was no reduction in use of renin-angiotensin system blockers or mineralocorticoid receptor antagonists. Dr. Carolyn Lam: Thank you so much, gentlemen. Unfortunately, we are running out of time, but I would really like to ask one last question to the guests, if possible. Where do you think the field is heading? What next? What's the next most important thing we need to know? David, do you want to start? Then John, then Kausik. Dr. David Cherney: I think one of the aspects that we need to know in the future is where else can we extend these therapies into novel indications and extend the boundaries of where we currently work with these therapies. People with type 1 diabetes, for example, with either heart failure or with significant kidney disease, patients with kidney transplantation, is there a renal or cardiovascular protective effect? Then another high risk cohorts who have not been included in trials, those on immunosuppressants, for example, who were excluded from the trials. I think those are some of the areas that we need to extend into now that we understand how these therapies work in even very sick patients and that we also know that they likely have at least some benefit through suppressing inflammation, and possibly reducing infectious risks. That would provide a rationale for extending into some of these new areas. I think that's certainly, hopefully on the horizon for us. Dr. Carolyn Lam: John? Dr. John McMurray: Carolyn, obviously I think looking at post myocardial infarction population, that's an obvious place to go. There are a couple of trials there. I suppose the trial that I would love to see, and which I think would address the core question that we've been discussing today, which is: Is this all about the effect in the kidney and how important is the diuretic and natriuretic action of these drugs in heart failure? I think the key study that would address this would be doing a study in patients on dialysis. Because in those patients we could, I think, separate the issue of natriuresis, diuresis, and maybe even the dip in EGR that we've been talking about. If these drugs prove to be effective in end-stage kidney disease, patients on dialysis, that would be really fascinating. Dr. Carolyn Lam: Kausik? Dr. Kausik Umanath: That is a very interesting point. I don't know that we know necessarily outcomes, but I think from working with the DAPA-CKD, we do have a little bit of the safety data because we did continue it. I was the US MLI for that study and we did continue the SGLT2 passed into renal failure. There is a little bit of safety data there. But I don't think once you've declared an outcome, you're not collecting outcomes data after that point. That's a very interesting area to look into. Dr. Kausik Umanath: I also think the other place where this field's heading is trying to better tier and layer the multitude of agents. I think we've been waiting for about 20 to 30 years, at least in the kidney field, for something new to affect the progression of kidney disease after the ACE/ARB trials and so on. This one we've got SGLT2 inhibitors. We've got the new MRA, finerenone, and so on, which also have very beneficial cardiovascular effects. The question becomes: How do we layer these therapies? Which sequence to go in? Some of the others that are in pipeline as well that are out there that have very beneficial cardiovascular effects that may indeed also help kidney function and diabetes control, which do you go with first and so on? Dr. Carolyn Lam: Wow! Thank you so much. We really could go on forever on this topic, but it has been tremendous. Thank you once again. On behalf of Brendan, Ian, Greg, thank you so much for joining us today in the audience. You've been listening to Circulation On the Run. Don't forget to tune in again next week. Dr. Greg Hundley: This program is copyright of the American Heart Association 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, please visit ahajournals.org.

Ted Rogalski considers himself to be in the relationship business. Maximizing outcomes and organizational effectiveness in rural communities with limited resources require a culture of connection, a culture that fosters strong relationships. Hear Ted's thoughts on this and much more during our conversation with Ted Rogalski, Administrator of Genesis Medical Center in Aledo, IL. “We must create a culture and work environment that is a draw for caregivers by developing relationships outside the organization.” ~Ted Rogalski Edward J. (Ted) Rogalski is the Administrator for Genesis Medical Center, Aledo, a 22-bed critical access hospital located in Aledo, Illinois. Rogalski completed his Bachelor of Arts in Business Administration at St. Ambrose University and received his Master's degree in Health Care Administration from the University of Iowa. He is a Fellow in the American College of Healthcare Executives. During his 24 years with Genesis Health System, Rogalski has held a number of leadership positions. Over the past ten years, he has directed operations in Aledo, IL where he joined the organization under a management agreement with Mercer County Hospital (now Genesis Medical Center, Aledo). During his tenure, Rogalski led a $1.6 million dollar turn-around effort and successfully guided the organization through affiliation and ultimately acquisition. On February 1, 2013, Mercer County Hospital, Medical Associates Clinic (a six provider RHC) and Mercer County Nursing Home (92 bed LTC) joined Genesis Health System. The Hospital immediately embarked on an extensive $12 million renovation plan. Prior to joining Genesis, Rogalski worked for Mercy Hospital, Iowa City, IA; Abbott Northwestern Hospital, Minneapolis, MN; and started his healthcare career at St. Luke's Hospital, Davenport, IA. Rogalski currently serves as Chair-Elect for the Illinois Hospital Association Board of Trustees and Treasurer for the Illinois Critical Access Hospital Network. He has also served as the Chair for the Small and Rural Hospital Committee of the Illinois Hospital Association and has been an active community volunteer and serves or has served on the boards of the American Hospital Association - Regional Policy Board, Vera French Mental Health Center, St. Ambrose University PA Program, Mercer County Better Together, Mercer County YMCA, St. Paul the Apostle School, Assumption High School Century Club, and Friendship Manor. Rogalski and his wife, Lisa, have five adult married children and one grandson.

Record-breaking heat has a grip on Minnesota. For the last week, temperatures have been in the 90s with high humidity. Next week is looking almost as hot. It's the longest the temperature has been this high so early in the season. At 11 a.m. on Thursday, host Angela Davis spoke with a climatologist from the Minnesota Department of Natural Resources and an emergency room doctor about the trends they're seeing and how to stay safe in the heat. She also talked with the organizer of a new event called Black Tech Talent Summit about what it takes to get a job in the field of technology. Guests: Mike Jackson is the organizer of Black Tech Talent Summit Kenny Blumenfeld is the senior climatologist for the Minnesota Department of Natural Resources Climatology Office. Katherine Katzung is the chair at the Emergency Department at Abbott Northwestern Hospital.

In this episode, you’ll hear from three physicians who work with medical scribes. If you haven’t had experience with either in-person or virtual (remote) scribes, this episode will give you a pretty good picture. First, Dr. Christopher Obetz, CEO of Emergency Care Consultants (ECC) and featured guest in Episode 15, talks about launching their scribe program 15 years ago. Scribes work right alongside the physician, taking notes and doing data entry in the electronic medical record. Dr. Obetz describes how the scribe program and the resulting “very robust, descriptive and helpful notes” were a big part of turning the Emergency Department into the “nerve center” of Abbott Northwestern Hospital, a quaternary referral center. They have about 200 scribes and lease scribe services to other medical and surgical specialties. Many scribes continue their education and then return to ECC as physicians, physical therapists, and physician assistants. https://licensedtoleadpodcast.com

ALMOST TO HEAVEN by Jean Nielsen This book, Almost to Heaven, by Jean is written to thank the community, church, hospital, and Jean’s family for all that was accomplished while working together with Jean’s emergency care one important morning. These values brought Jean back into realizing the importance of why she is here on earth. The book is an account of Jean’s Near-Death Experience with God. Jean died on August, 26, 2013 and was given another chance of life on August 28, 2013, because of the expertise of Dr. Jeff Rayl with the New Ulm’ Medical Center and Dr. Tim Henry at Abbott Northwestern Hospital in the cities. Jean’s life was given back because of more than the medical care she received. It was through her husband, Rod; daughters, Louise and Rose; sisters; parents; aunts; uncles; cousins; nieces; and nephews; and church, co-workers, friends, neighbors that showed Jean what can happen when a community works together and how the power of prayer truly works. This book is written as well to remind the media how positive stories can always develop from stories/experiences if we choose to work together even in a smaller community for the good of the whole, the sake of one person. For those reading this story, please know, your prayers will always be remembered in my heart. It is three years since the time this experience happened. Even though the book is technically finished, the story continues as Jean pledges to serve the New Ulm community and God, while distributing and setting up the most precious gift we have on earth, the Real Presence of Jesus in the Eucharist while being in Full Communion of the Catholic Church! PLEASE KNOW THAT NO MATTER WHAT AREA OF LIFE I’M LIVING, IT’LL BE LIVED IN FULL COMMUNION OF THE CHURCH TO GLORIFY GOD’S NAME! MAY ONLY GOOD COME OUT OF THIS BOOK! https://www.stratton-press.com/books/almost-to-heaven/ http://www.bluefunkbroadcasting.com/root/twia/jenielsen.mp3

This podcast is Part 2 of the Clinical COVID-19 Review podcasts. In this podcast, Dr. John Litell, an intensivist with Abbott Northwestern Hospital, and Dr. Haylee Veazey, an emergency medicine physician with Hennepin Healthcare, discuss clinical management for COVID-19 patients through a case review format. Enjoy the podcast! Objectives:     Upon completion of this podcast, participants should be able to: Discuss and implement fundamental critical care support for COVID-19 patients. Recite best practices for screening and managing COVID patients in the hospital setting. 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: "Clinical COVID-19 Review (PART 2): Clinical Management" (**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. Thanks for listening.

Dr. Justin Grunewald works at Abbott Northwestern Hospital in the heart of Minneapolis treating patients during their hospital stays. He works nights for seven to 10 days in a row, then he'll get about two weeks off. When Cindra caught up with Justin, he was in Colorado ready to go on a RV trip, running, camping and adventuring in the woods. On Episode #14 on the High Performance Mindset back in 2015, Cindra interviewed Justin’s wife, Gabe Grunewald. The fearless middle distance runner who was going after her dreams to make an Olympic team despite cancer. Gabe’s life was cut short at just 32 last year, but she still managed to make a huge impact on the running community and beyond. While battling a rare form of cancer and competing as one of the best middle-distance runners in the country, she inspired countless people to live bravely. For over 10 years, she fought adenoid cystic carcinoma, a rare cancer of the salivary glands, which she was diagnosed with as a fifth-year senior running for the University of Minnesota. Despite the diagnosis, she went on to become an All-American in the 1500 meters, and after that, a professional runner who almost made the 2012 Olympic team. In this podcast, Justin and Cindra talk: · Gabe’s life physiology and how we can each learn to live bravely · How their foundation “Brave Like Gabe” started · How Gabe was able to turn a difficulty into an opportunity · Their “chance” encounter in Central Park with Chip Gaines that changed their world · An inside look at the mindset of an elite athlete HIGH PERFORMANCE MINDSET SHOWNOTES FOR THIS EPISODE: www.cindrakamphoff.com/justingrunewald HOW TO ENTER THE PODCAST GIVEAWAY TO WIN $500 CASH: www.drcindra.com/giveaway FB COMMUNITY FOR THE HPM PODCAST: https://www.facebook.com/groups/2599776723457390/ FOLLOW CINDRA ON INSTAGRAM: https://www.instagram.com/cindrakamphoff/ FOLLOW CINDRA ON TWITTER: https://twitter.com/mentally_strong Love the show? Rate and review the show for Cindra to mention you on the next episode: https://podcasts.apple.com/us/podcast/high-performance-mindset-learn-from-world-class-leaders/id1034819901  

Dr. Chris Leisz joins ScopeMD to discuss work related injuries in medicine. Dr. Leisz highlights the prevalence of work related injuries in medicine and offers tips and strategies you can use each day to avoid back, wrist, shoulder, neck and other work related injuries. Dr. Chris Leisz is Physical Medicine and Rehabilitation physician at Abbott Northwestern Hospital in Minneapolis, MN.

Back after an unprecedented weekend in the The Twin Cities and emotionally exhausted but here to tell your story. Maria was on the 35W bridge when the tanker drove through the crowd, Steve works at Abbott Northwestern Hospital, ground zero for those hurt physically and Scott from Pimento Kitchen is doing everything they can to help our community with food/goods. We'd love to hear your story every morning on Go 96.3. https://www.welovelakestreet.com/ $1000 MINUTE: Elisa from Chaska played today for our NEW Grand Prize of a pair of tickets to the next 10 shows after the Coronavirus Quarantine and valued at more than $1000. Listen tomorrow morning at 7:35 to play! Thanks for listening to Ben and Dana Make Mornings Suck Less on Go 96.3/Twin Cities!

Dr Zieve talks with Dr Penny George of the Bravewell Collaborative about applying philanthropy to support and encourage the use of integrative principles and techniques in mainstream medicine. Penny George PsyD is a leader in the national movement to transform medicine and healthcare through the principles and practices of integrative medicine. Dr. George is co-founder of the Bravewell Collaborative, a national collaboration of philanthropists dedicated to advancing the principles and practice of integrative medicine. She also co-founded what is now known as the Penny George Institute for Health and Healing at Abbott Northwestern Hospital in Minneapolis, the George Institute is the largest hospital-based integrative medicine program in the country. Read more at bravewell.org. If you cannot see the audio controls, your browser does not support the audio element

In this podcast, Dr. Mark Young, a stroke Neurologist with Abbott Northwestern Hospital, discusses current guidelines for ischemic stroke management and care. Enjoy the podcast! Objectives:     Upon completion of this podcast, participants should be able to: Summarize the latest guidelines and management for acute ischemic stroke. Describe current interventional management for large vessel occlusion with thrombectomy. Identify modified Rankin scores and the impacts on stroke patients. Demonstrate an understanding of new timelines to guide therapy such as Diffuse-3 and DAWN trials. CME credit is only offered to Ridgeview Providers 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 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: "Stroke Updates: Guidelines and Management for 2018-2019" (**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.)  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.”    FACULTY DISCLOSURE ANNOUNCEMENT  It is our 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. 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: CHAPTER 1: One large impact on stroke care 2018 is the thrombectomy window expansion time for large vessel occlusion out to 24-hours. https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.023310 Current perfusion imaging available is able to identify core infarct- establish the quantity and mismatch ration of available brain that is salvageable. Futile reperfusion is something that should not be undertaken due to high risk of reperfusion hemorrhage which can ultimately worsen outcomes. Last known well time means exactly that. When was the patient last seen well. So if they go to bed and then come in with a wake up stroke then LKW is when they went to bed. Some studies on wake up strokes showed that the majority developed symptoms 2-3 hours prior to waking up. LKW and wake up stroke are different but can often help us guide therapy. For instances pt goes to bed is LKW time and then wakes up with stroke like symptoms. Perfusion imaging is instrumental in the decision process for these patients often guiding us with further management. The NINDS trials came out in '95-'96. However the bottom line showed - in patients, with ischemic stroke within 3 hours, tPA administration significantly improved HIHSS scores but did not confer survival benefit. https://www.nejm.org/doi/full/10.1056/NEJM199512143332401 Stroke neurologist typically want a call early in clinical course. Don't wait for CT prior to calling. Then when was the last known well time. Blood glucose, blood pressure, PMH and deficits (ie NIHSS), 'what are you observing'. Don't wait on labs - consideration is warfarin. There are trials following the NINDS trial that show evidence that patient with low HIHSS with potentially disabling deficits and rapidly improving stroke improve with TPA treatment and that the hemorrhage rates are lower. Definitely consider treating rapidly improving stroke sxs. With stutter stroke sxs, the clock resets when the patient returns back to baseline. CHAPTER 2: Most stroke centers uses -0-4.5 hours time frame for IV thrombolytics. Absolute and relative contraindications for thrombolytics include: greater than 2/3 MCA territory don't treat as there is little benefit. Patient on warfarin with INR greater than 1.7. Recent stroke or ICH. Endocarditis. Coagulopathy. People on DOACs. Significant thrombocytopenia. There are many more but these are the highlights. American Stroke Association says patient must be off DOAC's for 48-hours before lytic treatment as relative contraindication. Dr. Young's standard conversation with pt who are experiencing a stroke when discussing TPA. First, it is the standard of care, next the chance of hemorrhage is around 6-7%, but Abbott has a much lower rate of around 2.5%. We know that even with that risk patients do much better overall. At 90 days, the chance that the patient will be living independently are much better. 90-day Modified Rankin Scores are standards that we use to measure stroke outcomes. Modified Rankin Scale score of 0 is no deficit, no residual. MR of 1 can do everything you use to do although may still have mild symptoms that patient may notice. MR of 2 - you have some limitations but can live independently and do all ADLs MR of 3 - is dependent with ADLs although can walk with or without a device. MR or 4. Can't walk. MR of 5 - bed bound. MR of 6. DEAD. Some criteria for TPA with lower HIHSS with compelling deficits are #1, what's disabling #2. Others include limb ataxia, aphasia, paresis, dominant hand problem, dysphagia, dysarthria. Controversy Hemianopsia. Greater than or equal to NIHSS of 6 is generally recommended to get a CTA to evaluate for LVO stroke. Imaging generally requires CT/CTA of the head and neck. Always include imaging of the neck. Rapid perfusion imaging for LVO used in Diffuse 3 - (6-16 hours) for the window vs DAWN out to 24-hours. CHAPTER 3: So the order of imaging includes noncom CT head, CTA, CT perfusion. When evaluating the imaging studies we want the core infarct to be less than 70ccs and the ratio of the core infarct to at risk brain penumbra to be greater than 1.8. The use of rapid sequencing MRI has utility for post circulate symptoms, ie vertigo with/out nystagmus, abrupt onset. Generally diffusion weighted gradient echo/T2 flair images looking for blood. Other indications maybe for subacute findings/duration. LVO's that can be intervened on include: anterior communicating, distal carotid or carotid terminus, MCA M1, M2, basilar, distal verts, maybe PCA/P1. Important point if a patient has a LVO lesion and is within the 4.5 hour window at a small rural setting with lytic capabilities and the patient is going to a large tertiary stroke center does the patient still need to receive IV lytic therapy - knowing that the patient will require thrombectomy and answer is YES. No increased risk when using lytic with thrombectomy. A little controversial but we maybe seeing the bypass of non-stroke hospitals specifically with LVO to tertiary stroke centers with a new scoring system that EMS can do called RACE (Rapid Arterial oCclusion Evaluation)  https://neuronewsinternational.com/racecat-trial-update/ CHAPTER 4: After care by the PMD what can we expect from these patients follow a LVO? 90-day Rankin  50% with modified Rankin 2 less to live independently following LVO. 50% of LVO have a 90 mortality. 70-80% will not live independently. Discharge meds for these patients will include DOACs or Warfarin, antiplatelet agents - such as Plavix. Occasionally patient will end up on dual antiplatelet therapy depending on disease state. Stoke mimics that have been given thrombolytics have less than 1/2% chance of hemorrhage.

This type of Cancer is not talked about as much as other types.  But it has gained more notice due to the recent diagnoses of "Jeopardy!" host Alex Trebek and Congressman John Lewis.  Abbott Northwestern Hospital oncologist Dr. Joseph Leach describes the symptoms, signs, and effects of this disease.

In the first of two podcasts, Dr. Tara McMichael, a board certified Internist with Lakeview Clinic, and hospitalist with Ridgeview Medical Center, discusses liver function tests, and presents a few cases she has seen in her practice. Enjoy the podcast! Objectives:     Upon completion of this podcast, participants should be able to: Identify the appropriate next steps when discovering abnormal liver function tests. Identify how to diagnose cirrhosis, autoimmune hepatitis, and cholecystitis. Address appropriate 2nd and 3rd line testing for abnormal LFTs. CME credit is only offered to Ridgeview Providers 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 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: "Abnormal Liver Function Tests (LFTs) - Part 1" (**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.)  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.”    FACULTY DISCLOSURE ANNOUNCEMENT  It is our 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. 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: INTRODUCTION: Dr. Tara McMichael is joining us today, who is a board certified internist with Lakeview Clinics, as well as a hospitalist at Ridgeview Medical Center. She did her internal medicine residency at Abbott Northwestern Hospital in Minneapolis.  Today, we will discuss abnormal liver tests. What to do with them and what's causing them. In the first of two podcasts, Dr. McMichael will walk through a few cases she has seen in her practice. First, she's going to give us an overview, though, about liver "function" tests. So ditch the parka, come in from the cold and hop on that rowing machine you've been resolving to use again. It's time for Ridgeview podcast, CME series with Dr. Tara McMichael. PART-1: A quick recap on the overall approach to abnormal liver tests. The name liver "function tests" is a bit of a misnomer. Many of these transaminase tests are actually liver biochemistries or more simply, liver tests, as opposed to an actual "function test" of the liver. PT/INR and albumin are more accurately termed "function tests", because they are a true proxy for the functional status of the liver. These tests are ordered frequently, and often come back somewhat abnormal in otherwise healthy or asymptomatic people. In our medical system, the online subscription health reference, UpToDate, is used, and it turns out this is one of the most commonly searched topics. While the tests are commonly ordered, they are not supposed to be part of routine screening in the otherwise healthy patient. In general, these are tested for in symptomatic patients, or if patients are on certain medications that can cause liver damage. The AGA and the ACG have specific guidelines for testing liver serologies. If tests come back mildly elevated, in other words, two times upper normal or less, the tests should be rechecked in 2-to-4 weeks. If not escalating in that amount of time, they can be rechecked in 6-months. If there is escalation, referral to GI is appropriate. Checking LFTs is appropriate if taking statins, INH, methotrexate and the like. Social history is also important, besides alcohol. Travel, occupational and recreational exposure (i.e. drug abuse). Stay tuned as Dr. McMichael launches into her first liver case. CASE 1:64-yo male with 10 days of diarrhea, nausea, fevers and chills. He claims to not drink "too much". Diarrhea increases over the course of the illness and the temp has gone to 100.8. Oh, by the way, some old cephalexin laying around at home seemed like a good idea to the patient, so he began taking it. No better or worse with this. It turns out, after further teasing, he drinks 7 to 10 drinks in a setting. PMH includes HTN, DM type-2, hyperlipidemia and chronic LE edema with recurrent cellulitis. Also has psoriasis with psoriatic arthritis. He's obese and a non-smoker. Meds include baby ASA, vit D, methotrexate for the past 5-years, cephalexin preventatively and lisinopril. His social and family hx is unremarkable. Vital signs are unremarkable, and his overall appearance and exam is unremarkable. Except that he has a protuberant abdomen, a BMI of 37 (morbidly obese), and an unchanged swollen left lower limb. Labs were done: CMP, CBC, CRP, sed rate, blood cultures and a chest x-ray. Chest x-ray was unremarkable. However, lab work revealed the following positives; AST slightly up at 59. ALT normal. ALP 148, also slightly elevated. Total bili elevated and low total protein was also noted. Remember that direct bilirubin is conjugated bilirubin. It is conjugated in the liver. And when it is high enough, it spills into the urine. Indirect is actually found more often than direct. Such as Gilbert and hemolysis. Thus far we are thinking acute gastroenteritis. These are mildly elevated LFTs after all. However, in follow-up, Treatment so far includes hydration, and possibly testing the stool for enteric pathogens. Hepatitis seems unlikely due to minimally elevated LFTs. One must also consider his likely underreported alcohol intake. But what about his methotrexate? No imaging was done in the preliminary work up. His symptoms progressively improved. Repeat LFTs are done in a follow-up about 10-days later. His AST, ALT, ALP and bili are all just a little bit more now. Albumin is also a little lower now. He does drink while continuing to take methotrexate. NASH or NAFLD are synonymous. Non-alcoholic steatohepatitis and nonalcoholic fatty liver disease. Liver biopsy at this point is the gold standard, however, there are non-invasive options that some hepatologists employ, such as fibroscan and elastography. Coupled with abnormal labs and history, the liver biopsy may in some cases be averted. In our patient, and abdominal ultrasound was performed, that reveals hepatomegaly, mild ascites and a coarsened liver parenchyma that is suspicious for cirrhosis. In addition, this patient also has a liver biopsy that reveals cirrhosis, and not NAFLD. What exactly is cirrhosis? It is the late stage of progressive liver fibrosis. It can be reversible in its earlier presentation, but is not reversible in its more advance stages. Alcohol, but also as we will find out, other factors can cause this. Cirrhosis from all causes comprises 80% of the liver transplant list. In our patient, Is he drinking too much? Probably. But there may be other factors. Regarding alcohol, 210 grams or 15 standard sized drinks for a male per week is considered significant alcohol intake and for women 140 g or 10 standard drinks per week. Be sure to specify with patients what their standard pour is per drink. Is it a 12 oz beer or 40 oz beer, etc. Other labs are helpful as well in cirrhosis in terms of monitoring and diagnosis. These patients are often hyponatremic, due to impaired ADH and thrombocytopenic due to sequestration of platelets as opposed to decreased production. AST is typically twice the value of the ALT, although you may also see this in NAFLD. In this patient, there is probable interplay between alcohol and methotrexate. We must also think about Hepatitis B and C. So hepatitis serologies are important. Autoimmune hepatitis, Wilson's disease, hemochromatosis (think family history here), right heart failure, hepatorenal syndrome, primary biliary sclerosis and primary sclerosing cholangitis should be considered. Other important physical findings can include palmar erythema, limb atrophy, telangiectasias, caput medusa (prominent veins on a protuberant abdomen) and gynecomastia. Dr. McMichael prefers to refer these patients to GI and hepatology earlier than later. Often a tertiary center where they can be comanaged. The MELD score of MELD sodium score is a compilation of criteria that predicts the 3-month mortality rate in end stage liver disease. This helps the hepatologist or intensivist to determine when to consider putting the patient on the transplant list. Going back to drugs causing liver damage, there are literally hundreds of possible culprits. Supplements as well. Some of these drugs and supplements include statins, INH, methotrexate, aminodarone, various antibiotics, black kohash, wild mushrooms, weight reduction medications, antifungals and many others. Cirrhosis is associated with a lot of stigma, so take this into consideration when approaching the diagnosis in your patients. Remember, while it is often is the alcohol, there may be other issues causing this disease process. Hopefully this podcast was helpful and informative. Cirrhosis is an all too common problem. Again liver test abnormalities can be subtle, and the cause is not always just alcohol. The life expectancy in compensated cirrhosis is 12-years or more, but uncompensated cirrhosis is less than 6-months. This would involve complications like variceal bleeding, ascites, hepatorenal syndrome, hepatocellular carcinoma, SBP and hepatopulmonary syndrome. That's all for now, folks! Be sure to tune into Abnormal Liver Tests - Part 2 with Dr. McMichael.

Topher (Christopher) Obetz is an emergency physician in practice at Abbott Northwestern Hospital in Minneapolis, MN. He graduated a year or two after I did from the EM residency at Regions Hospital. Somehow, he found his way into the role of President of the multi-hospital democratic emergency medicine group – Emergency Care Consultants (ECC) and… Read More »

Topher (Christopher) Obetz is an emergency physician in practice at Abbott Northwestern Hospital in Minneapolis, MN. He graduated a year or two after I did from the EM residency at Regions Hospital. Somehow, he found his way into the role of President of the multi-hospital democratic emergency medicine group – Emergency Care Consultants (ECC) and… Read More »

On this episode of Blunt Force Truth, Chuck and Mark are joined by Danielle Stella. Danielle is running for U.S. congress in Minnesota's 5th congressional district, which is currently being held by Ilhan Omar. Danielle shares what inspired her to run in this heavily Democraticdistrict, and why she believes she is qualified to do so. Chuck and Mark ask Danielle about her plans to raise funds and what she is planning to do to gain tractions in a district that has been blue for over 50 years. They conclude by asking Danielle about allegations of some ongoing legal trouble, and why she is not running under her legal name. Theydiscuss how this will probably come up much more during the campaign and will be used by Democrats to discredit her. More about Daniella Stella: Danielle Stella is a special education needs professional launching a campaign to represent Minnesota's 5th congressional district. She dedicates her life to teaching, supporting, and caring for children withAutism. She is devoted to volunteering her time to supporting numerous healthcare organizations, to include the Courage Kenny Rehabilitation Institute, Courage Center, Abbott Northwestern Hospital, Allina Clinics, Aftercare, and Extended Care. Danielle did not hold prior aspirations to run for political office. However, as a result of the lack of honorable representation for Minnesota's 5th congressional district, she believes it is her duty and privilege to stand up and speak for the forgotten American citizens in the district and throughout the state. She firmly believes that members of congress are charged with representing every American they were elected to serve. Danielle is a compassionate Minnesotan who remains steadfast with her values and beliefs in the U.S. Constitution, which directly motivates and guides her political positions. She is a staunch supporter of the rights afforded to Americans by the Constitution. She understands the significance of protecting the First and Second Amendment rights and identifies that the U.S. has a mental health concern disguised as a gun control issue. Danielle stands by her conservative values and firmly supports the President of the United States. Danielle supports legal immigration and believes in the laws of the land, authored and enacted by Congress. She believes immigrants that are in the country lawfully, working hard to become legal citizens, deserve their spot in line. She feels these immigrants should be our focus. Danielle respects and supports the hard-working men and women that dedicate their lives to keeping our borders secure. She acknowledges the risks that members of ICE and DHS take on a daily basis. Danielle greatly supports the U.S. military, law enforcement, and first responders. She has a heartfelt appreciation for our country’s veterans and believes they deserve the nation’s utmost support beyond the uniform. She works with veterans dealing with PTSD and with citizens in Minnesota’s District 5 with trauma therapy. Danielle also believes that homelessness within the district requires attention and local support. Danielle is dedicated to working for and respectfully representingevery single American in Minnesota's 5th congressional district - regardless of race, gender, ethnicity, or religious or political differences. She trusts the Bill of Rights and fights to ensure that every American’s Constitutional rights remain unimpeded. She hopes to inspire unity within a nation divided. Danielle Stella looks forward to the enthusiastic support from the great citizens of Minnesota during her journey to become their honored representative for the 5thdistrict. Connect with Daniella Stella: Website:

Listen to our first episode with two guests! Ankur spoke with Emmanouil S Brilakis, MD and Michael Megaly, MD from the Minneapolis Heart Institute, Abbott Northwestern Hospital about their article on the role of drug-coated balloons in small-vessel coronary artery disease (SVD) published in US Cardiology Review 13.1. Percutaneous coronary intervention of SVD remains challenging due to difficulties with device delivery and high restenosis rate, making drug-coated balloons an attractive emerging option in patients with SVD. In this brilliant conversation, Ankur, Emmanouil and Michael unravel the potential advantages, challenges and practical realities of using drug-coated balloons in SVD, and the findings of the latest randomised controlled trials studying this area. Hosted by @AnkurKalraMD. Produced by @RadcliffeCardiology. [Disclaimer: The use of drug-coated balloons in coronary intervention is still off-label; it has not been approved by the FDA.]

Managing the high output stoma is a challenge for the patient, the family and the nurse. If the stoma is poorly managed, it can lead to local and systemic complications. In this episode of WOCTalk, Dr. Mary Arnold Long reviews the causes and consequences of a high output stomas, as demonstrated in her past educational session, “Slowing the Flow: Dietary, Fluid & Medication Management of the Patient with a High Output Stoma”. To view the full conference session, click here. Want to review more sessions from past WOCN® Society annual conferences? The full conference libraries are available for purchase. Choose from the entire package, or individual sessions here. Speaker Bio Dr. Mary Arnold Long DNP, CRRN, CWOCN-AP, ACNS-BC Clinical Nurse Specialist, Roper Hospital Mary Arnold Long obtained an Enterostomal Therapy certificate from Abbott-Northwestern Hospital in Minneapolis, MN. She achieved CETN (now CWOCN) certification in 1994 & advanced practice CWOCN certification in 2009. She is also board certified as a certified rehabilitation registered nurse (CRRN) & as an adult health clinical nurse specialist (ACNS-BC). In 2016 she was awarded her doctorate in nursing from Otterbein University. Mary has served the Regional and National Wound, Ostomy and Continence Nurses SocietyTM (WOCN®) in many roles. In 2005, she was awarded the College of Mount St. Joseph Alumni Leadership Award. In 2008, she received the MidEast Region WOCN “CWOCN Nurse of the Year” award. In 2015, she was honored with a “Palmetto Gold” award, recognizing her as one of the 100 best nurses in South Carolina. In 2017, she was recognized as an Oak Hills High School Distinguished Alumnus. She practices full scope WOC Nursing inpatient and has an ostomy outpatient practice, at Roper Hospital in Charleston, SC.

Dr. Carolyn Lam:               Welcome to Circulation On The Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Our journal this week features an in-depth review on transcatheter therapy for mitral regurgitation, a very, very hot and interesting topic. You have to listen on, coming up right after these summaries.                                                 Our first original paper this week sheds light on the influence of aging on aldosterone secretion and physiology. First author Dr. Nanba, corresponding author Dr. Rainey and colleagues from the University of Michigan in United States, examine the relationship between age and adrenal aldosterone synthase in 127 normal adrenals from deceased kidney donors. The donors' ages ranged from nine months to 68 years. The authors found that adrenals from older individuals displayed less normal aldosterone synthase expression and zona glomerulosa, and greater content of abnormal foci of aldosterone synthase expressing cells.                                                 Furthermore, older age was independently associated with dysregulated and autonomous aldosterone physiology, in an ancillary clinical study of subjects without primary aldosteronism. This study therefore suggests that aging may be associated with a sub-clinical form of aldosterone excess and provides at least one potential explanation for age related cardiovascular risk.                                                 The next study shows, for the first time, that the chemokine receptor, CXCR4, in vascular cells, limits atherosclerosis. The CXCL12 and CXCR4 chemokine ligand receptor axis is known to control cell homeostasis and trafficking. However, its specific in atheroprotection has thus far been unclear. This is addressed in today's study by first author Dr. During, corresponding author Dr. Weber, and colleagues of The Institute for Cardiovascular Prevention in Munich, Germany. In hyperlipidemic mice, the authors showed that cell-specific deletion of CXCR4 in arterial endothelial cells, or smooth muscle cells, marked the increase atherosclerotic lesion formation. Mechanistically, CXCR4 axis promoted endothelial barrier function through VE-cadherin expression and a stabilization of junctional VE-cadherin complexes. In arterial smooth muscle cells, CXCR4 sustained vascular reactivity responses, and a contractile smooth muscle cell phenotype. Whereas, CXCR4 deficiency favored the occurrence of macrophage-like smooth muscle cells in atherosclerotic plaques and impaired cholesterol efflux.                                                 Finally, in humans, the authors identified a common allele variant within the CXCR4 locus that was associated with reduced CXCR4 expression in carotid RG plaques, and increased risk for coronary heart disease. Thus, the study suggests that enhancing the atheroprotective effect of arterial CXCR4 by selective modulators may open normal therapeutic options in atherosclerosis.                                                 The next paper is the first to study the effects of rosuvastatin on carotid intima-media thickness in children, with heterozygous familial hypercholesterolemia. First author Dr. Braamskamp, corresponding author Dr. Hutten, and colleagues from Academic Medical Center Amsterdam in the Netherlands, study children with heterozygous familial hypercholesterolemia aged 6 to less than 18 years, with LDL cholesterol more than 4.9, or more than 4.1 millimoles per liter in combination with other risk factors, who received rosuvastatin for 2 years, starting at 5 milligrams once daily, with uptitration to 10 milligrams for children aged 6 to 10 years old, or 20 milligrams daily for those aged 10 to 18 years old.                                                 Carotid intima-media thickness was assessed by ultrasonography at baseline, 12 months and 24 months in all patients and in age-matched, unaffected siblings. Carotid intima-media thickness was measured at 3 locations, the common carotid artery, the carotid ball, and the internal carotid artery in both the left and right carotid arteries. At baseline, the mean carotid intima-media thickness was significantly greater for the 197 children with heterozygous familial hypercholesterolemia compared with the 65 unaffected siblings. Rosuvastatin treatment for 2 years resulted in significantly less progression of increased carotid intima-media thickness in children with heterozygous familial hypercholesterolemia than in the untreated, or unaffected siblings. As a result, there was no difference in carotid intima-media thickness between the two groups after two years of rosuvastatin. These findings, therefore, support the value of early initiation of statin treatment for LDL cholesterol reduction in children with heterozygous familial hypercholesterolemia.                                                 The final study highlights the therapeutic potential of a novel alpha calcitonin gene-related peptide for the treatment of heart failure. First author Dr. Aubdool, corresponding author Dr. Brain, and colleagues from King's College London in United Kingdom, tested the stable alpha analog of calcitonin gene-related peptide in 2 models ... First, an angiotensin 2 infused mouse, and secondly, pressure overload cardiac hypertrophy mouse model using suprarenal aortic ligation. They showed that systemic colon injection of the alpha analog blunted the angiotensin 2 induced rise in blood pressure, as well as the vascular and cardiac remodeling, changes in water consumption, and renal injury, that are normally associated with angiotensin 2 infusion. Furthermore, protective effects were also seen when starting the alpha analog treatment, only during the last week of the 2-week angiotensin 2 infusion, in other words, when hypertension was already established. Finally, the alpha analog preserved heart function, and diminished the degree of hypertrophy and fibrosis in the aortic ligation model.                                                 Thus, these results demonstrate the therapeutic potential of the alpha calcitonin gene-related peptide pathway, and the possibility that this injectable alpha analog may be effective in cardiac disease.                                                 Well, that wraps it up for this week's summaries! Now, for our featured discussion.                                                 For our feature discussion this week, we're talking about trans-catheter therapy for mitral regurgitation, a very hot field and a field in which there have been a lot of advances. To help us break it down, and get right into the insights, the challenges, and potential solutions, I am so pleased to have the first author of this in-depth review paper, Dr. Paul Sorajja from Minneapolis Heart Institute Foundation and Abbott Northwestern Hospital, as well as Dr. Manos Brilakis, associate editor from UT Southwestern, here with us today!                                                 Paul, could I start with you, and just ask you first to give us an idea of what we're talking about here when we talk about mitral regurgitation ... There are different kinds, which are we referring to, and what are the challenges involved in a trans-catheter therapy for mitral regurgitation? Dr. Paul Sorajja:                I think there are a number of challenges, I think the first thing is that MR is often thought of as one disease, but it's really an incredibly heterogeneous disease ... Broadly, we talk about primary versus secondary MR, but the mitral valve is so complex, with multiple different components, any one of which can disrupt and cause MR. When we're talking about trans-catheter therapy, it's often very easy, again, to think we could have one therapy that could treat a simply insufficient valve, but it's way more complex than that, and as a result, there have been many different approaches that have been developed, adding to the complexity of how we manage these patients. Dr. Carolyn Lam:               Right, and in your paper, I loved the way you grouped them, very logically, under those from mitral valve repair, and that for mitral valve replacement ... And then, under repair, you grouped it into leaflet versus targeting the LV ... Could you maybe give us some top-line insights on these techniques? Dr. Paul Sorajja:                Yeah, there are a number of different approaches that have mechanistically gone after the different components through the pathophysiology of MR, where there is leaflets, where there's analysts, cords, or ventricular approach ... I think it's somewhat simplistic to think of it that way, but as catheter-based technology, we are technically limited by what we can do from a catheter standpoint. I think it's inevitable to think about these catheter technologies as eventually being combined, rather than singular, in order to approach what surgeons do in the OR. Dr. Carolyn Lam:               Right, but then even going further, you spent quite a bit of the paper talking about trans-catheter mitral valve implantation ... So, replacing the mitral valve, that's really cool, could you tell us a bit about that, and about that important issue brought up about patient selection. Dr. Paul Sorajja:                Yes, it's a very good point, I think in terms of trans-catheter mitral replacement, I think that that's really where the future is going to go ... The simple analogy is that people think that it will follow the route of TAVR, but I think it will follow the route of TAVR more quickly so, because when you look at how the mitral valve is currently treated in the OR, sometimes, a lot of the times, patients can end up worse. Whereas, a trans-catheter solution actually, I think in terms of the safety margin, actually will equate a degree of safety relative to surgery, if it's done and developed correctly, as opposed to how TAVR's done. I think for TAVR, it's been a number of years for our field to be equivalent or superior to surgery, whereas I think with mitral, I think there's a lot of potential for mitral to have equated a degree of safety. As an example, in the Tendine Feasibility Study, it was published this past January ... A high-risk population, there was not a single procedure death, out of 30 patients ... And for these patients who would go to the OR with an eject fraction of 30 to 40 percent, I think that's quite remarkable. Dr. Carolyn Lam:               Wow, that's really exciting indeed! Manos, you handled this paper, and it's just so beautifully laid out ... That flow chart, I just want to refer all our listeners to the flow chart in Figure 7, that talks about maybe an approach that can be considered. Manos, could you share some thoughts on how this developed? Dr. Manos Brilakis:           Yeah, absolutely, and obviously Paul is the expert on this, but I think it's very important about this paper, and through discussions with Paul and through the development of the paper, is that there's more of a collaboration between the surgeons and the interventionists. So instead, if it's additional style of ... Or the interventionists are doing one thing and the surgeon is doing another, I think the key to success in the mitral field is working very closely together ... Many of those valves right now, the percutaneous valves, are done through a cut down and a typical approach, so working very closely to addressing the anatomic components of the mitral valve problem is a big plus.                                                 The other thing I think that is very important is the new emergence of imaging, trying to understand whether the new mitral valve is going to create issues with LVOT obstruction or not. I think that's leading to a whole new understanding of when and how patients are even candidates for this approach, and I think Paul can elaborate more on this, but as things evolve, fewer and fewer patients are going to be excluded from these new technologies. Dr. Carolyn Lam:               Paul, would you like to take that? What do you think is happening and will happen with patient selection? Dr. Paul Sorajja:                There has been a challenge in current feasibility studies, in terms of getting patients in, the anatomical restraints are exactly what Dr. Brilakis has outlined. There's a certain bulkiness and size to the valve, which essentially poses risk for LVOT obstruction if the valve is too big ... As a feasibility study that's still early, or a field that's still early in its development, there's been a really conservative approach in terms of patient selection to ensure that LVOT obstruction doesn't happen. I think we're pushing the boundaries for that, and I think we've learned a lot from CT imaging, in terms of predicting LVOT obstruction, and I think the valves are also getting to be shorter in profile, which makes it less likely ... But that is definitely one of the limitations, and it's a limitation that exists, not just for trans-cat therapy but also for surgical therapy. Dr. Carolyn Lam:               Right, and then maybe a question for both of you ... What do you think the future is going to hold? What do we need to make this more mainstream, and where do you think this will leave surgical approaches? I know you said a combined approach, but maybe you could elaborate a little bit more? Dr. Paul Sorajja:                I do think, and I agree, I think Manos' point is spot on about that ... This will have to be multidisciplinary, the surgeons and cardiologists absolutely need to continue to work together, that's what's led to the successful development of TAVR, and I think that will be even more so for mitral, because the mitral valve is just infinitely more complex, and we have a lot to learn from the surgeons. But I think going forward, the collaboration is going to be a requirement, and then the training is also going to be a significant portion ... Putting in a mitral valve is much more complex than putting in an aortic valve ... I think if there's a safety margin that's demonstrated, I still think that it will be more appealing and more rapidly adopted than aortic disease. Dr. Carolyn Lam:               Well, Manos? Dr. Manos Brilakis:           No, I completely agree with Paul on that respect. I think, in my mind, at least, an again, this is from an early standpoint, the next big step would be to make it completely percutaneous, right now, you still have to do the cut down, and it's a little more invasive, although still safer than the completely open surgery, but maybe having a complete percutaneous system would be the next big step ... There's no question in my mind, as well ... And watching very closely how Paul and the surgical team are handling this, I think this is definitely the way for the future. Sometimes, in TAVR, it's not as technically demanding, and you don't really need to have too many people in the room, but for this procedure, it's definitely more important to have everyone in the room, and benefit from everyone's expertise. Dr. Carolyn Lam:               Manos, could I switch tracks for a moment now, and ask you to comment on the question that I get a lot ... You're an Interventionist, you handle a lot of the interventional papers for Circulation, and a lot of people are wondering, what makes papers like Paul's ... What makes interventional papers something that we would want to publish in Circulation? Could you share some thoughts? Dr. Manos Brilakis:           Absolutely, thanks Carolyn ... That's a big part, I think, of the appeal of Circulation right now. We're really trying to communicate to people that cutting-edge, clinical science is actually at the heart and the core of Circulation, and clinical content is what drives a lot of editorial ... Especially in intervention, where particularly interesting and new, cutting-edge technologies, new trials, observational studies ... But essentially, things that are cutting-edge, and are going to have a specific implication and impact in the way the field is going ... And this is part of Dr. Sorajja's paper, showing where the future lies in terms of trans-catheter mitral technologies, but along the same lines, we love to have cutting-edge papers on various aspects ... Coronary, peripheral, all aspects of interventional cardiologies, as well as interventional imaging ... The goal, again is to make the submission easy, there are not many honors requirements for submitting the papers, it's very simple to submit, and there's an answer going out very quick, so we're looking forward to receiving more and more interventional papers on cutting-edge science. Dr. Carolyn Lam:               Thank you so much for joining us today, and don't forget to tune in again next week.  

The way we think about and look at food is changing. The FDA is giving nutrition labels on all food packaging a makeover. Serving size, sugar and fat labels will be different.Listen in as Registered Dietitian Janel Hemmesch with Abbott Northwestern Hospital, talks about when we will start to see the new labels, how to read them and what we really should be looking for when it comes to our food choices.

The science of medicine is always improving and evolving – and Abbott Northwestern Hospital is often leading the way. Dr. Ben Bache-Wiig, president of Abbott Northwestern in Minneapolis is here to talk with you about the top five medical advancements in 2015.

You may have heard that to make the healthiest choices at the grocery store, you should shop the perimeters of the store, but is everything in these areas really healthy?Liz Vander Laan, a dietitian with the Bariatric Center at Abbott Northwestern Hospital is here to let you know what you should be looking for if you are trying to make healthier food choices at the grocery store.

Alzheimer's - Meeting You As Best I Can, Wherever You May Go Our Guest today is Kaia Svien, MS.  Kaia's mother had dementia for the last 5 years of her life, and that experience brought the family very close.  Kaia will share her journey with us, along with some tips and techniques she found beneficial in building her relationship with her mother.  Kaia is a Meditation Instructor at Abbott Northwestern Hospital's Penny George Institute & in the community.  Kaia is a former adjunct professor in the Holistic Health Studies Master's Program at St Catherine's University. Contact Kaia Svien www.mindfulnessforchangingtimes.com ksvien@ties2.net Our 2nd guest is Joseph Bensmihen, MSW, CRG He is the current founder and CEO of Boca Home Care Services – A Non-Medical Home Care  Nurse Registry (1998), Boca Home Care ( A Medicare Certified Agency -2005) and National President of the Private Care Association. We will discuss not only taking care of the person with dementia but the caregivers. Boca Home Care Services Serving Palm Beach & Broward Counties in South Florida– 561-989-0611 or Toll Free- 877-706-0785 www.bocahomecareservices.comSupport this Show: https://alzheimersspeaks.com/donate-now/See omnystudio.com/listener for privacy information.

Dr. Raed H. Abdelhadi, Cardiac Electrophysiologist at the Minneapolis Heart Institute at Abbott Northwestern Hospital, reviews the background for the Riata ICD recall and the available data on the Riata ICD lead, explains the preliminary results for the Riata Multicenter Study, discusses the challenges regarding screening and management and summarizes the Riata Summit.

Dr. Timothy Henry, Director of Research at the Minneapolis Heart Institute Foundation, and Dr. Jay Traverse, Senior Consulting Cardiologist at the Minneapolis Heart Institute at Abbott Northwestern Hospital, review the results of the LateTIME, SCIPIO and CADUCEUS trials.

Dr. Thomas Knickelbine, Director of Preventive Cardiology at the Minneapolis Heart Institute at Abbott Northwestern Hospital discusses US population risk factors, explains how to approach patients with statin intolerance, describes the current approaches to treatment of non-HDL cholesterol and Metabolic Syndrome and outlines MHI prevention goals and future vision.

Dr. Benjamin Sun, Chair of Cardiac, Thoracic and Transplant Surgery at the Minneapolis Heart Institute at Abbott Northwestern Hospital, identifies which valves can be repaired, explains why we don't repair valves more frequently and describes when valve replacement is still preferred.

Dr. Nedaa Skeik, Vascular Medicine Consultant at the Minneapolis Heart Institute® atAbbott Northwestern Hospital, explains different treatment modalities for deep vein thrombosis (DVT), describes the history of inferior vena cava (IVC) filters, lists indications and complications (common and rare) of IVC filters, and explains identification and management of arterial pseudoaneurysm as a rare complication of IVC filters.

Dr. Barry J. Maron, Director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute at Abbott-Northwestern Hospital looks explains how to risk stratify hypertrophic cardiomyopathy (HCM) patients and describes the role of the implantable cardioverter defibrillator in HCM patients.

Senior Consulting Cardiologist at the Minneapolis Heart Institute at Abbott-Northwestern Hospital, Dr. Robert Hauser, summarizes pacing hemodynamics, describes the value of cardiac synchronization, and explains ICD reliability and patient longevity.