Podcasts about clinical excellence

In this VETgirl veterinary continuing education podcast, we interview Drs. Erica Thiel, Director of Clinical Excellence at IndeVets, and Jennifer Merlo, CVBMC, Elite FFCP-V. VP, Veterinary Affairs, Fear Free LLC about the use of the game-changing pre-visit pharmaceuticals to enhance emotional safety for pets and veterinary professionals. We often feel guilty about sedating animals. Let's reframe it: compassionate care starts with reducing fear, not fighting through it.Sponsored By: IndeVets

Episode Highlights: Networking & Power Networking: Dr. Chris Salierno returns for an in-depth conversation on building meaningful professional relationships in dentistry. He offers his insights into "power networking," stressing the importance of showing up, saying yes to opportunities, and making deposits before making withdrawals. Learn how he identifies red flags in networking and why intentional relationship-building leads to lasting success. Clinical Excellence: Andrew and Dr. Salierno discuss the idea that the path to clinical excellence is not always linear. The conversation encourages grabbing knowledge from various sources—networking, colleagues, and even dental influencers—to continually improve patient care. Dr. Salierno talks about taking inspiration from both clinical work and soft skills, emphasizing the ongoing journey toward greatness in dentistry and hygiene. Hiring and Team Values: Dr. Salierno shares his perspective as Chief Dental Officer at Tend and his passion for hiring people who bring personality and technical skill. He discusses why hospitality and a clear mission matter, focusing on how creating a strong employee value proposition attracts the right kind of team members and boosts retention, especially in a competitive dental employment market. Social Media & Professional Comparison: The dangers of social media—especially comparing yourself to peers who only showcase their highlight reels—is a key theme in this episode. Dr. Salierno provides thoughtful advice on maintaining a healthy outlook and keeping professional standards high, both online and offline. Transitions & Career Flexibility: The episode touches on career pivots in dentistry and highlights Dr. Salierno's observations on professionals who successfully transition into various roles—be it technology, teaching, or administration. He shares that the dental field offers incredible flexibility for those willing to say yes, learn, and embrace new challenges. Where to Find More from Dr. Salierno: Dr. Salierno's Substack, "Leaving Healthcare," is packed with posts for anyone interested in non-clinical career options or broadening their horizons in dentistry. You can find him on Instagram as @thecuriousdentist for more content, updates on speaking engagements, and thoughtful discussions. Connect: Dr. Chris Salierno Substack: Leaving Healthcare Instagram: @thecuriousdentist Final Notes: Thanks to Dr. Salierno for sharing his time and wisdom! Make sure to subscribe, check the show notes for resources, and sign up for Andrew's newsletter for more content.

Episode Highlights: Networking & Power Networking: Dr. Chris Salierno returns for an in-depth conversation on building meaningful professional relationships in dentistry. He offers his insights into "power networking," stressing the importance of showing up, saying yes to opportunities, and making deposits before making withdrawals. Learn how he identifies red flags in networking and why intentional relationship-building leads to lasting success. Clinical Excellence: Andrew and Dr. Salierno discuss the idea that the path to clinical excellence is not always linear. The conversation encourages grabbing knowledge from various sources—networking, colleagues, and even dental influencers—to continually improve patient care. Dr. Salierno talks about taking inspiration from both clinical work and soft skills, emphasizing the ongoing journey toward greatness in dentistry and hygiene. Hiring and Team Values: Dr. Salierno shares his perspective as Chief Dental Officer at Tend and his passion for hiring people who bring personality and technical skill. He discusses why hospitality and a clear mission matter, focusing on how creating a strong employee value proposition attracts the right kind of team members and boosts retention, especially in a competitive dental employment market. Social Media & Professional Comparison: The dangers of social media—especially comparing yourself to peers who only showcase their highlight reels—is a key theme in this episode. Dr. Salierno provides thoughtful advice on maintaining a healthy outlook and keeping professional standards high, both online and offline. Transitions & Career Flexibility: The episode touches on career pivots in dentistry and highlights Dr. Salierno's observations on professionals who successfully transition into various roles—be it technology, teaching, or administration. He shares that the dental field offers incredible flexibility for those willing to say yes, learn, and embrace new challenges. Where to Find More from Dr. Salierno: Dr. Salierno's Substack, "Leaving Healthcare," is packed with posts for anyone interested in non-clinical career options or broadening their horizons in dentistry. You can find him on Instagram as @thecuriousdentist for more content, updates on speaking engagements, and thoughtful discussions. Connect: Dr. Chris Salierno Substack: Leaving Healthcare Instagram: @thecuriousdentist Final Notes: Thanks to Dr. Salierno for sharing his time and wisdom! Make sure to subscribe, check the show notes for resources, and sign up for Andrew's newsletter for more content.

In this VETgirl veterinary continuing education podcast, we interview Drs. Anita Patel, Senior Director of Clinical Excellence and Mentorship, and Dylan Krowicki, Director of Clinical Excellence at IndeVets, about the importance of acknowledging and healing from errors. It happens, good vets make mistakes. Tune in to hear how to acknowledge and address mistakes when they are made and how to turn mistakes into growth opportunities!Sponsored By: IndeVets

Bone health is a topic that affects so many women, especially as we move through midlife and beyond. In this episode, we're joined by Dr. Lisa Moore, Doctor of Physical Therapy and founder of Brick House Bones®. Lisa's mission is to help people with low bone density or osteoporosis rebuild confidence, strength, and resilience—so they can keep doing the things they love with the people they love. Dr. Moore is trained through BoneFit™ and the Institute of Clinical Excellence in bone health exercise. She blends the latest research with yoga, strength training, and mindful movement to help women strengthen their bones safely. She also offers a program called Journey to Fracture-Proof, which provides practical, research-based tools to improve bone health. For more information and links, visit our website at BecomingElli.com.  

In this episode, @sbship8_dpt discusses a pelvic health case study involving a female older adult experiencing pelvic pressure during childcare activities such as lifting and floor-to-stand transfers. We review clinical reasoning and treatment strategies—including pelvic floor retraining, load management, and functional strengthening—to support caregiving and reduce symptom burden. Want to better serve older adults in your community? Check out our Older Adult Specialist Certification from the Institute of Clinical Excellence - https://ptonice.com/certifications/mmoa/

Join Elevated GP: www.theelevatedgp.com Net32.com  Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram   Dr. Mandelaris attended the University of Michigan from undergraduate through dental school.  He completed a post-graduate residency program at the University of Louisville, School of Dentistry, where he obtained a certificate in the speciality of Periodontology as well as a Master of Science (M.S.) degree in Oral Biology.  Dr. Mandelaris is a Diplomate of the American Board of Periodontology and Dental Implant Surgery and has served as an examiner for Part II (oral examination) of the American Board of Periodontology's certification process. He is a Clinical Assistant Professor in the Department of Graduate Periodontics at the University of Illinois, College of Dentistry (Chicago, IL) and an Adjunct Clinical Assistant Professor at the University of Michigan, Department of Periodontics and Oral Medicine (Ann Arbor, MI).  Dr. Mandelaris is a Fellow in both the American and International College of Dentists. Dr. Mandelaris serves as an ad-hoc reviewer for the Journal of Periodontology and the International Journal of Oral and Maxillofacial Implants. In 2021, he was appointed as an Editorial Consultant to the International Journal of Periodontics and Restorative Dentistry. He has published over 40 scientific papers in peer-reviewed journals and has authored eight chapters in seven different textbooks used worldwide on subjects related to computer guided implantology, CT/CBCT diagnostics and surgically facilitated orthodontic therapy (SFOT). Dr Mandelaris is one of the recipients of the 2017 and the 2021 American Academy of Periodontology's (AAP) Clinical Research Award, an award given to the most outstanding scientific article with direct clinical relevance in Periodontics. A nationally recognized expert, he was appointed by AAP to co-chair the Best Evidence Consensus Workshop on the use of CBCT Imaging in Periodontics as well as co-author the academy's guidelines. In 2018, he was recognized with American Academy of Periodontology's Special Citation Award.  Dr. Mandelaris is the 2018 recipient of The Saul Schluger Memorial Award for Clinical Excellence in Diagnosis and Treatment Planning. Dr. Mandelaris currently serves on the American Academy of Periodontology Board of Trustees and has served as a Past President of the Illinois Society of Periodontists. He has served on several committees for the American Academy of Periodontology and is one of the AAPs recommended speakers on topics related to periodontics-orthodontics and imaging/implant surgery. He is a key-opinion leader for several industry leaders and holds memberships in many professional organizations, including the American Academy of Periodontology, Academy of Osseointegration, American Academy of Restorative Dentistry and the American Society of Bone and Mineral Research. Dr. Mandelaris is in private practice at Periodontal Medicine & Surgical Specialists, LLC. He limits his practice to Periodontology, Dental Implant Surgery, Bone Reconstruction and Tissue Engineering Surgery. He can be reached at 630.627.3930 or gmandelaris@periodontalmedicine.org.

Join Elevated GP: www.theelevatedgp.com Net32.com  Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram   Dr. Mandelaris attended the University of Michigan from undergraduate through dental school.  He completed a post-graduate residency program at the University of Louisville, School of Dentistry, where he obtained a certificate in the speciality of Periodontology as well as a Master of Science (M.S.) degree in Oral Biology.  Dr. Mandelaris is a Diplomate of the American Board of Periodontology and Dental Implant Surgery and has served as an examiner for Part II (oral examination) of the American Board of Periodontology's certification process. He is a Clinical Assistant Professor in the Department of Graduate Periodontics at the University of Illinois, College of Dentistry (Chicago, IL) and an Adjunct Clinical Assistant Professor at the University of Michigan, Department of Periodontics and Oral Medicine (Ann Arbor, MI).  Dr. Mandelaris is a Fellow in both the American and International College of Dentists. Dr. Mandelaris serves as an ad-hoc reviewer for the Journal of Periodontology and the International Journal of Oral and Maxillofacial Implants. In 2021, he was appointed as an Editorial Consultant to the International Journal of Periodontics and Restorative Dentistry. He has published over 40 scientific papers in peer-reviewed journals and has authored eight chapters in seven different textbooks used worldwide on subjects related to computer guided implantology, CT/CBCT diagnostics and surgically facilitated orthodontic therapy (SFOT). Dr Mandelaris is one of the recipients of the 2017 and the 2021 American Academy of Periodontology's (AAP) Clinical Research Award, an award given to the most outstanding scientific article with direct clinical relevance in Periodontics. A nationally recognized expert, he was appointed by AAP to co-chair the Best Evidence Consensus Workshop on the use of CBCT Imaging in Periodontics as well as co-author the academy's guidelines. In 2018, he was recognized with American Academy of Periodontology's Special Citation Award.  Dr. Mandelaris is the 2018 recipient of The Saul Schluger Memorial Award for Clinical Excellence in Diagnosis and Treatment Planning. Dr. Mandelaris currently serves on the American Academy of Periodontology Board of Trustees and has served as a Past President of the Illinois Society of Periodontists. He has served on several committees for the American Academy of Periodontology and is one of the AAPs recommended speakers on topics related to periodontics-orthodontics and imaging/implant surgery. He is a key-opinion leader for several industry leaders and holds memberships in many professional organizations, including the American Academy of Periodontology, Academy of Osseointegration, American Academy of Restorative Dentistry and the American Society of Bone and Mineral Research. Dr. Mandelaris is in private practice at Periodontal Medicine & Surgical Specialists, LLC. He limits his practice to Periodontology, Dental Implant Surgery, Bone Reconstruction and Tissue Engineering Surgery. He can be reached at 630.627.3930 or gmandelaris@periodontalmedicine.org.

From living with orofacial pain to becoming a leading voice in TMJ and complex pain therapy, Vita Zhylyak's journey is as inspiring as it is transformative. In this episode, we dive deep into:-Vita's personal story and the spark behind her “Unlocking Jaw Secrets” course-Her clinical philosophy for navigating intricate diagnoses like TMJD, Eagle Syndrome, Trigeminal Neuralgia, POTS, and MCAS, -Key insights into assessing chronic facial pain—and spotting what others often miss-The vital role of posture, breathwork, and nervous system regulation in effective TMJ care-How she customizes therapy far beyond the typical “exercise protocol”-Clinical pearls for working with post-surgical patients and collaborative care boundariesIf you're a myofunctional therapist, dental professional, or simply fascinated by the complexities of orofacial pain, this episode is packed with knowledge, compassion, and practical strategies. Tune in and discover how deeper understanding and whole-body integration can transform patient outcomes—and your clinical practice.Shownotes:CES Ultra: Helps with TMD, Vagus Nerve stimulant, Tinnitus etc.https://www.cesultra.comBook how to read faces and on Chinese Medicine: WTF? Why the face. Dr Todd Fisher:https://wtfwhytheface.com/product/wtf-why-the-face-a-practical-guide-to-understanding-health-and-personality-through-facial-diagnosis/Doterra oils:https://link.doterra.com/TrvWpR

In this episode of Being Human, Dr. Chua Sook Ning speaks with Dr. Scott Miller, founder of the International Centre for Clinical Excellence and a leading voice in behavioural health services. They discuss the concept of deliberate practise in psychotherapy and its powerful role in improving therapeutic effectiveness. Scott shares insights from his extensive research, challenging the belief that experience alone leads to better outcomes, and explains how deliberate practise offers a structured path for clinicians to refine their skills. To learn more about Relate Malaysia and our work visit www.relate.com.my

In this inspiring episode of Strength in Knowledge, Zach Baker, DPT, sits down with Dr. Corrie Jones—14-year PT veteran and Director of Clinical Excellence at Rehab 2 Perform—to explore the story behind her journey into physical therapy. From overcoming her own injuries to discovering a deep passion for helping others, Corrie shares how her experiences as a patient, student, and clinician shaped her core values and clinical philosophy.Whether you're a PT student, new grad, or just curious about the heart behind great care, Corrie's story offers powerful takeaways on purpose, resilience, and what it means to grow in this profession.

It's been a minute, but we're back with another round of “Shit That Needs to Be Said.”No fluff. No sugar-coating. Just the real, raw truths about what's actually holding pelvic health business owners back.  Lightning round format.  The things that are pissing us off.Here's a taste of what we cover: ⚠️ You can't out-hustle low pricing ⚠️ Doing another social media post isn't 'marketing' ⚠️ No, you're not going to make money from your online course. ⚠️ No one cares about the letters after your name (or your fancy equipment) ⚠️ Please stop listening to advice from people who haven't done the thing.We're doing a quick-hitting 'sode on almost 20 different topics.  You won't want to miss this one!Business AcceleratorIf you want to take your business to the next level, make sure to check out the 6-month coaching intensive from Rising.  We help you market the practice, build out business systems and achieve Clinical Excellence in the practice.  Find out why we've worked with 700+ business owners with big-time results in their business (www.pelvicptrising.com/accelerator).We're now accepting applications for our January 2026 cohort!About UsNicole and Jesse Cozean founded Pelvic PT Rising to provide clinical and business resources to physical therapists to change the way we treat pelvic health.   PelvicSanity Physical Therapy (www.pelvicsanity.com) together in 2016.  It grew quickly into one of the largest cash-based physical therapy practices in the country.Through Pelvic PT Rising, Nicole has created clinical courses (www.pelvicptrising.com/clinical) to help pelvic health providers gain confidence in their skills and provide frameworks to get better patient outcomes.  Together, Jesse and Nicole have helped 700+ pelvic practices start and grow through the Pelvic PT Rising Business Programs (www.pelvicptrising.com/business) to build a practice that works for them! Get in Touch!Learn more at www.pelvicptrising.com, follow Nicole @nicolecozeandpt (www.instagram.com/nicolecozeandpt) or reach out via email (nicole@pelvicsanity.com).Check out our Clinical Courses, Business Resources and learn more about us at Pelvic PT Rising...Let's Continue to Rise!

In many cases, it helps to follow the roadmap to success laid down by those before us. In most cases, it helps to observe what people have done differently, and be inspired by the uniqueness of it all! The latest episode of The Dental Economist Show with host Mike Huffaker brings a dynamic conversation to the table as Mike sits down with Dr. Alex Sharp, CEO of Shared Practices Group, to explore how a dental podcast evolved into a thriving 38-location DSO. From pioneering a fully remote dental support organization to mastering denture and implant-focused practices, discover why "going deep" beats "going wide" in today's dental landscape. From how to build a scalable culture across remote teams to the surprising reasons why human capital remains the cornerstone of dental success, this episode brings unique insights to scaling your dental practice in today's day and age, without compromising on excellence.

In this episode of the MMOA podcast, Dustin Jones interviews Dr. Jake Sosnoff, a faculty dean of research at the University of Kansas, about innovative research on fall training techniques aimed at reducing injuries in older adults. The conversation covers the background of the research, the study population, the progression of training techniques, key safety measures, and the surprising findings regarding head injuries. Dr. Sosnoff emphasizes the importance of teaching individuals how to fall safely and the psychological benefits of reducing fear of falling. Relevant Links: Dr. Jake Sosnoff's Faculty Profile - https://www.kumc.edu/jsosnoff.html  Strategies to Minimize Fall-related Injuries in Older Adults at Risk of Falls: The Falling Safely Training Study - https://academic.oup.com/biomedgerontology/article-abstract/80/7/glaf076/8115447?redirectedFrom=fulltext ----- Want to better serve older adults in your community? Check out our Older Adult Specialist Certification from the Institute of Clinical Excellence - https://ptonice.com/certifications/mmoa/

In this episode of the MMOA Podcast, Dustin Jones and Dr. Becca Jordre discuss the Sustained Athlete Fitness Exam (SAFE) and its significance for senior athletes. They explore the origins of the SAFE, its components, and the trends observed in senior athlete performance. The conversation highlights the importance of choosing the right sports for longevity and health, as well as addressing injury trends and the positive aging narrative within sports. The episode concludes with a reflection on the inspiring role models found in the senior sports community. Relevant Links: Becca Jordre - https://www.usd.edu/research-and-faculty/faculty-and-staff/becca-jordre Sustainable Athlete Fitness Exam at the National Senior Games - https://nsga.com/healthygames/ The Sustained Athlete Fitness Exam – Outcomes of U.S. National Senior Games Athletes - https://drive.google.com/file/d/1r4ogDUdr9tFMlwT-mK66ArJvik4Ccuu1/view?usp=drive_link ----- Want to better serve older adults in your community? Check out the Older Adult Specialist Certification from the Institute of Clinical Excellence - https://ptonice.com/certifications/mmoa/

In this VETgirl veterinary continuing education podcast, we interview Anita Patel, DVM, Senior Director of Clinical Excellence and Mentorship, and Carolina Baquerizo, DVM, mentee and practicing veterinarian with IndeVets, about the importance of mentorship. Mentorship creates stronger bonds that transform sustainability in the veterinary profession. Tune in to find out how to maximize your mentorship potential!Sponsored By: IndeVets

In this essential episode of Parallax, Dr Ankur Kalra is joined by Dr Michelle O'Donoghue, cardiologist at Brigham and Women's Hospital and co-author of the recently updated AHA/ACC acute coronary syndrome guidelines. Together, they explore the revolutionary changes reshaping ACS management in 2025. Dr O'Donoghue shares insights from the landmark guideline development process that unified non-ST elevation ACS and ST elevation MI recommendations into a single comprehensive document. The conversation covers game-changing updates including new risk stratification approaches, the shift toward selective invasive strategies, and the introduction of bivalirudin as an alternative anticoagulation option. The discussion highlights the groundbreaking "lower is better" approach to LDL management with new targets below 55 mg/dL, evolving antiplatelet therapy strategies, and the emerging role of ticagrelor monotherapy. Dr O'Donoghue also addresses future directions in cardiovascular care, from GLP-1 agonists to mechanical circulatory support devices, emphasizing how these guidelines represent a fundamental shift toward more personalized, evidence-based ACS management. Questions and comments can be sent to "podcast@radcliffe-group.com" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

Robert Mandel MD, is the President of Clinical Excellence and Chief Medical Officer for Carelon Health, a subsidiary of the huge payer-provider platform Elevance Health.  He is also a physician leader steeped in the principles of Habitual Excellence who has been associated with some of the building block breakthroughs in delivering better healthcare quality and outcomes for patients, from individuals to huge populations, through his career across the payer-provider interface.  In this episode, hear why he is encouraged by what we've been able to learn and apply to improve care from the emerging large datasets so far, and how he and Carelon hope to support further improvement across healthcare by making clinical evidence even more front and central for members and providers and payers experiences with each other, and for members during the 95% of the time they aren't directly interacting with the healthcare system as well.  Robert also shares 5 ways he leads with the principles of Habitual Excellence to help everyone in the organization show up in the best way they can, every day, to advance the mission.

Robert Mandel MD, is the President of Clinical Excellence and Chief Medical Officer for Carelon Health, a subsidiary of the huge payer-provider platform Elevance Health.  He is also a physician leader steeped in the principles of Habitual Excellence who has been associated with some of the building block breakthroughs in delivering better healthcare quality and outcomes for patients, from individuals to huge populations, through his career across the payer-provider interface.  In this episode, hear why he is encouraged by what we've been able to learn and apply to improve care from the emerging large datasets so far, and how he and Carelon hope to support further improvement across healthcare by making clinical evidence even more front and central for members and providers and payers experiences with each other, and for members during the 95% of the time they aren't directly interacting with the healthcare system as well.  Robert also shares 5 ways he leads with the principles of Habitual Excellence to help everyone in the organization show up in the best way they can, every day, to advance the mission.

In this episode, Dr. Catherine Watkins, a seasoned dentist with over four decades of experience, joins the podcast to share her unique perspective on dental education, licensure compacts, continuity of care, and the critical importance of maintaining dentistry's identity as a surgical profession. She also discusses emerging technologies, DSOs, and the growing need for equitable access to care.

In this episode, Dr. Catherine Watkins, a seasoned dentist with over four decades of experience, joins the podcast to share her unique perspective on dental education, licensure compacts, continuity of care, and the critical importance of maintaining dentistry's identity as a surgical profession. She also discusses emerging technologies, DSOs, and the growing need for equitable access to care.

Join us for a compelling conversation on TALRadio English as we explore the cutting-edge world of eye care with Dr. B. Shanti Niketh, Chairman of Shanthi Nethralaya Eye Hospital. From clinical excellence to groundbreaking surgical innovations, discover how modern ophthalmology is restoring sight and transforming lives. Hosted by Suhasini, this episode dives into the future of eye health, patient care, and the mission to make vision accessible for all. Tune in on Spotify and Apple Podcast, because every eye deserves a clearer tomorrow.Host : SuhasiniGuest : Dr.B.Shanti NikethYou Can Reach Dr.B.Shanti Niketh @shanthinethralaya.com #TALRadioEnglish #VisionReimagined #EyeCareExcellence #OphthalmologyMatters #SightForAll #SurgicalInnovation #ShanthiNethralaya #ClearVision #RestoringSight #FutureOfEyeCare #ClinicalExcellence #HealthPodcast #TALHospitals #TouchALife #TALRadio

What actually makes a pelvic health business thrive?In this episode, we break down the Three Pillars of Business we teach inside the Business Accelerator: 1️⃣ Marketing + Sales 2️⃣ Business Systems 3️⃣ Clinical Excellence (getting buy-in and taking patients through their full plan of care)Most practices feel stuck because one (or more!) of these pillars is missing or weak. You can't out-market a broken patient experience. You can't build a team without systems. And you can't grow a sustainable business without getting the right people in the door.We talk about what goes into each pillar, common mistakes we see, and how to build a business you're proud of that actually works for your life.

In this episode of SoundPractice, we welcome Corey M. Cronrath, DO, MPH, MBA, FACOEM, CPE, FAAPL, a triple board-certified physician and fellow of the American Association for Physician Leadership. Cronrath's journey is a testament to resilience and dedication. From overcoming a challenging socioeconomic background and serving in the military, he has emerged as a prominent physician leader with aspirations for the future. Cronrath has committed his career to enhancing chronic disease care with a passion for supporting patients with mental illness. With his extensive list of credentials, he provides valuable insights and personal experiences on the optimal timing for physicians to pursue leadership education and certification. Key Topics: - Growing in Your Career: Cronrath discusses the importance of post-clinical education and career planning while prioritizing self-reflection. Driven by patient-centered values, he also shares his future goals of transitioning from Chief Medical Officer (CMO) to Chief Executive Officer (CEO). - Lessons From the Military: Learn from his experience in military healthcare and the valuable lessons he learned through training and service. The unique challenges and learning experiences in the military still shape his approach to civilian healthcare today. - Embracing Value-Based Care: In his current role at Mental Health Cooperative in Nashville, TN, Cronrath shares his work on implementing and expanding a successful value-based care model in a state that does not participate in Medicaid expansion. Listen to the Episode: Tune in to this episode on SoundPractice, or subscribe on your favorite podcast platform to stay updated with our latest episodes. Learn more about the American Association for Physician Leadership at https://www.physicianleaders.org/.

Ankoor Shah, VP of Clinical Excellence at Included Health, joins Kellogg MBA student Sonia Salunke to unpack how Included Health is redesigning the healthcare experience. They discuss what it takes to deliver truly personalized, all-in-one care - blending virtual, in-person, and AI-driven support. From building an integrated care model that centers patient experience to enabling value-based care, this episode explores what the future of connected, tech-enabled healthcare could look like. LinkedIn Timestamps: (1:58) Ankur's background and journey to working in healthcare  (8:11) Overview on the personalized healthcare experience at Included Health (14:20) Understanding Included Health's customers and business model  (20:36) Unpacking the member-first culture at Included Health (22:36) The technical capabilities that drive the experience (27:12) When to deliver care in-person vs virtual vs AI-based  (30:42) Metrics to demonstrate success to members and customers  (38:00) Rethinking the pharmacy experience (42:06) Rapid-fire Q&A  Visit our podcast page for more episodes on trends and innovation in healthcare and follow our socials so you never miss an update. 

In this episode of Agile&Me, host Richard Leaver chats with Marla Ranieri, VP of Clinical Excellence at Prompt Therapy Solutions, about AI's transformative role in physical therapy. Marla shares her journey from physical therapist to innovator, exploring how AI technologies improve clinical practices. They discuss how AI tackles challenges like clinician burnout and reimbursement complexities while addressing concerns about data accuracy and compliance. Tune in to discover how AI is shaping the future of healthcare, enhancing patient care, and offering practical tools for integrating AI into physical therapy practices.To learn more about us, visit our website at https://www.allianceptp.com/

Virtual Nursing: From Planning to Evaluation of Innovative Care SolutionsDescription: In this episode, we explore an innovative approach to addressing nursing workforce shortages through virtual nursing programs. Explore how an inpatient virtual nursing program has made a significant impact, improving nurse retention, enhancing patient safety, and reducing length of stay in rural and critical access hospitals. Discuss model expansion that includes a virtual obstetrics nursing program aimed at improving maternal and neonatal outcomes in underserved areas and the impact these programs had on rural health. Join us as we discuss the technology, operational impact, and real-world results of these initiatives, including key metrics and anecdotal success stories.Objectives1.Discuss how virtual nursing programs are helping to alleviate nursing workforce shortages and improve patient care in rural hospitals.2. Explain the integration of virtual obstetrics nursing and its potential to enhance maternal and neonatal outcomes in underserved areas.3.Identify operational changes, technology, and impact of a virtual nursing program.4. Describe how AI-driven monitoring and virtual nursing can improve patient safety by reducing falls and enhances nurse retention.Guest/BiosKarna Pfeffer, MSN, RN, RHNCKarna Pfeffer serves as the Director of Clinical Excellence, Education and Quality at Avera St. Mary's hospital in Pierre, SD. She has over 15 years of hospital nursing experience, specializing in process improvement and quality with a focus in rural healthcare. She received a Bachelor of Science in Nursing from South Dakota State University, and an MSN in Nursing Leadership from Western Governors University.Kristine Becker, MAKristine Becker serves as the director of Virtual Health at Avera Health in Sioux Falls, South Dakota. With nearly 20 years of experience in healthcare, Kristine is an experienced professional specializing in process improvement, healthcare technology and telehealth solutions. With a solid background in rural healthcare, she brings expertise in virtual and digital health initiatives and managing complex technology implementations and systems. Kristine holds a bachelor's and a graduate degree in anthropology from the University of Minnesota.ReferencesThe Center for Health Workforce Studies (CHWS). Health Care Employment Projections: 2010-2020, March 2012. Retrieved from www.healthit.gov/sites/default/fi…_report_2012.pdf 2022 March of Dimes Maternity Care Report. Retrieved from www.marchofdimes.org/sites/default/files/2022- 10/2022_Maternity_Care_Report.pdf2023 South Dakota Department of Health Maternal Mortality in South Dakota. Retrieved from doh.sd.gov/media/2q4nzral/mate…ty-1-pager_2023.pdf

Dr. Corrie Jones, one of our sports residency instructors and our Director of Clinical Excellence answers the question:  What's the biggest realization you've come to as a physical therapy after school?  Having been practicing for nearly 14 years, Dr. Jones shares her insights as to what really makes the biigest difference in patient outcomes and executing a plan of care as a sports PT!Listen to find out what she says!

In this episode of 'Modern Chiropractic Mastery', Dr. Kevin Christie interviews Jeff Moore, a physical therapist from the Institute of Clinical Excellence and founder of Onward Physical Therapy Clinics. They discuss the nuances of leadership in private practice, the importance of mentorship, and how to cultivate conviction in clinical skills. Jeff shares insights into a fitness-forward approach to physical therapy, the structure of his cash-based clinic model, and the role of interpersonal skills in successful practice management. The conversation also delves into strategies to prevent burnout and the importance of skill stacking for career advancement. This episode offers valuable advice for chiropractors and physical therapists looking to enhance their leadership capabilities and practice efficiency. https://ptonice.com/https://onwardphysicaltherapy.com/

In today's episode, I'm joined by Brett Hawes — clinical nutritionist, functional medicine practitioner, and founder of The Academy of Clinical Excellence. Brett delves into the current political climate in Canada, focusing on the awakening of public consciousness regarding healthcare and government policies. We discuss the impact of the pandemic on people's perceptions, the flaws within the Canadian healthcare system, and the threats facing natural health products. The conversation emphasizes the importance of personal responsibility and the need for individuals to navigate the complexities of health and wellness in a rapidly changing world. Brett also discusses the control of health access by governments and corporations, the importance of reclaiming health sovereignty, and the necessity of building local communities for better health outcomes. They explore the political landscape, expressing concerns about disenfranchisement and the future of governance, emphasizing the need for self-sufficiency and personal responsibility in health and wellness.Buckle up friends, this is a GOOD one!!! Connect with Brett Hawes: The Academy of Clinical ExcellenceInstagramThe Onward PodcastSend us a textDon't forget to subscribe and leave a 5-star review.Send your questions & comments to: info.thewowpodcast@gmail.com You can also share it on your social media and tag me @the.wowpod & @iam.drkaylalucasJoin us inside The Faithful Well Broadcast Thank you so much for being a part of the WOW pod community; until next time! Lead with love and joy!

In this episode we dive into the huge value of mentorship!  Anyone with a growth mindset can appreciate the fact that we do NOT know it all.  It takes a community to share knowledge in order to grow and become better at a craft or profession.  Here, our Chief Clinical Officer, Dr. Zach Baker and our Director of Clinical Excellence, Dr. Corrie Jones, share thoughts about mentorship. In this episode they cover:How to progress past what DPT school teaches The need to structure knowledge and how mentors can help with thisMentorship to improve applying our knowledge in the clinical settingWhat needs to be in place for a mentorship to workWho should participate in mentorship?Shoulder mentorship be mandatory?The ability of mentorship to evolveThis is a huge way to improve employee retention and satisfaction as well as improve patient outcomes and remain up-to-date on evidence-based practices.  Hear what they have to say!

Nurse educators are critical to clinical excellence, staff confidence, and patient safety. But are they being leveraged effectively? Join the co-hosts for a candid conversation about their personal experiences, perspectives, ideas, and tips for optimizing your collaboration with nurse educators.    We'd love to hear from you!  Send your thoughts, reactions, and ideas to amsnpod@amsn.org    Also, be sure to SUBSCRIBE/FOLLOW, RATE, & REVIEW Med-Surg Moments wherever you listen to podcasts.    MEET OUR CO-HOSTS Samantha Bayne, MSN, RN, CMSRN, NPD-BC is a nursing professional development practitioner in the inland northwest specializing in medical-surgical nursing. The first four years of her practice were spent bedside on a busy ortho/neuro unit where she found her passion for newly graduated RNs, interdisciplinary collaboration, and professional governance. Sam is an unwavering advocate for medical-surgical nursing as a specialty and enjoys helping nurses prepare for specialty certification.    Kellye' McRae, MSN-Ed, RN is a dedicated Med-Surg Staff Nurse and Unit Based Educator based in South Georgia, with 12 years of invaluable nursing experience. She is passionate about mentoring new nurses, sharing her clinical wisdom to empower the next generation of nurses. Kellye' excels in bedside teaching, blending hands-on training with compassionate patient care to ensure both nurses and patients thrive. Her commitment to education and excellence makes her a cornerstone of her healthcare team.   Marcela Salcedo, RN, BSN is a Floatpool nightshift nurse in the Chicagoland area, specializing in step-down and medical-surgical care. A member of AMSN and the Hektoen Nurses, she combines her passion for nursing with the healing power of the arts and humanities. As a mother of four, Marcela is reigniting her passion for nursing by embracing the chaos of caregiving, fostering personal growth, and building meaningful connections that inspire her work.   Eric Torres, ADN, RN, CMSRN is a California native that has always dreamed of seeing the World, and when that didn't work out, he set his sights on nursing.  Eric is beyond excited to be joining the AMSN podcast and having a chance to share his stories and experiences of being a bedside medical-surgical nurse.   Maritess M. Quinto, DNP, RN, NPD-BC, CMSRN is a clinical educator currently leading a team of educators who is passionately helping healthcare colleagues, especially newly graduate nurses. She was born and raised in the Philippines and immigrated to the United States with her family in Florida. Her family of seven (three girls and two boys with her husband who is also a Registered Nurse) loves to travel, especially to Disney World. She loves to share her experiences about parenting, travelling, and, of course, nursing!   Sydney Wall, RN, BSN, CMSRN has been a med surg nurse for 5 years. After graduating from the University of Rhode Island in 2019, Sydney commissioned into the Navy and began her nursing career working on a cardiac/telemetry unit in Bethesda, Maryland.  Currently she is stationed overseas, providing care for service members and their families.  During her free time, she enjoys martial arts and traveling. 

Dr. Corrie Jones, Director of Clinical Excellence at Rehab 2 Perform discusses how to put your students in the best situations for success. It is always fun having students in the clinic and helping them navigate their personal journey on their path to becoming a physical therapist. With this priviledge, comes responsibility. Dr. Jones talks about how you can foster and facilitate a productive and positive learning environment.

Generally, the definition of success may vary, but in the world of dentistry, patient care, profitability and operational excellence are measures of success that every business is trying to achieve. In the latest episode of The Dental Economist Show, host Mike Huffaker welcomes Eric Pastan, Director, Skytale Group, and a former DSO owner, who scaled his business to 45 locations. Together, they take from Pastan's wealth of experience to explore the critical elements of successful dental organization growth. From insights on maintaining clinical excellence while scaling operations to the importance of data analysis done right, and how to prepare your organization for eventual transactions, this episode highlights the keys to dental success, in today's day and age. Tune in to discover how, sometimes, the best path to growth starts with sitting at the front desk!

This special episode is recording of our recent event, Connecting Physical Therapy with Community Fitness for Older Adults. This event featured an incredible panel of experts dedicated to helping older adults stay strong, active, and resilient long after being discharged from physical therapy.The panel included four specialized physical therapists—Lori DeShelter, Teresa Gingles, and Betsy Spieler, all recruited from the Institute of Clinical Excellence (ICE) Older Adult division—and returning guest Susan Frikken. Joining them was Linda Cantrill, a seasoned fall prevention specialist who collaborates closely with physical therapists to support clients in maintaining their mobility and preventing falls.You'll hear from the panelists about how they've successfully bridged the gap between clinical and community settings through collaboration, sharing real-life examples of what works and how we can all contribute to keeping older adults socially engaged and physically active.This event was inspired by a paper co-written by Jeff Musgrave, a past podcast guest and a faculty member of the ICE Older Adult courses titled “Transforming Lives with Group Fitness: Considerations for Rehabilitation Professionals.the panelists emphasize the importance of warm handoffs, proactive communication, and building trusting relationships between healthcare providers and fitness specialists. They share key initiatives and actionable strategies to connect the physical therapy and fitness worlds—all with the shared mission of helping older adults thrive.Links: Institute of Clinical Excellence: https://ptonice.com/ Transforming Lives with Group Fitness: Considerations for Rehabilitation Professionals paperYouTube recording: https://youtu.be/kOcoO7nC4cI?si=xf5Vf0WwMe4Ahvp-Contact information on panelists:Susan Frikken, DPT, LMTwww.yaharatherapy.comwww.ballroombasicsforbalance.orgsusan@yaharatherapy.comTeresa Gingles, PT, DPTBoard Certified Geriatrics SpecialistBetter at Last,Founder/Executive Directort.gingles@betteratlast.orgwww.betteratlast.org Lori DeShetler, PT, MSPT, OCS, NBC-HWCBoard Certified Orthopedic SpeicalistOhio State Wexner Medical CenterLori.Deshetler@osumc.edusportsmedicine.osu.edu Betsy Spieler PTBoard Certified Geriatric Clinical SpecialistFounder/Coach UBStronger 55+www.ubxomaha.com Linda CantrillFounder Spirited Balance LLC Aging Specialist, Fall Prevention, Pilates, Senior FitnessWebsite: www.spiritedbalance.comemail: balancinglindac@gmail.comConnect with Second Act Fit Pros:erin@secondactfitpros.comwww.secondactfitpros.com

While she loves working with patients of all ages, Dr. Link realized early in her career that busy working adults were a severely underserved population. Dr. Link feels incredibly humbled to be growing a community where hearing loss and hearing aids are no longer stigmatized. You will be celebrated no matter where you are on your hearing journey. She loves looking at you as a whole person and empowering you to tackle the unique challenges you present to her. You can be sure that you will receive personalized evidence based care from Dr. Link while learning from one another.Dr. Link grew up on her family's farm in Ohio and received her Bachelor of Science degree from Miami University. Having grown up on a farm, she is passionate about preventable noise-induced hearing loss. Dr. Link earned her Doctor of Audiology degree from Rush University in Chicago, one of the top 10 audiology schools in the country. She was awarded a Distinction in Clinical Excellence at graduation. Dr. Link cultivated her clinical excellence through mentorship from some of the top audiologists in Chicago in a variety of clinical settings including university hospitals, the VA hospital, Chicago community hospitals, ENT clinics, a hearing aid research and development center, and the Ann and Robert H. Lurie Children's Hospital.When not practicing audiology, Dr. Link finds joy in biking, skiing, and live music in the great outdoors. When she cannot get away to the mountains you can find her catching up on her favorite podcasts, sipping American pale ales, and challenging her family and friends to a competitive game of Ticket to Ride, Mancala or Kings on the Corner.Website: https://www.theaudiologymethod.com/Facebook: https://www.facebook.com/TheAudiologyMETHOD*************************************************************Judy is the CEO & Founder of the Judy Carlson Financial Group. She helps her clients design, build, and implement fully integrated and coordinated financial plans from today through life expectancy and legacy.She is an Independent Fiduciary and Comprehensive Financial Planner who specializes in Wealth Decumulation Strategies. Judy is a CPA, Investment Advisor Representative, Life and Health Insurance Licensed, and Long-Term Care Certified.Judy's mission is to educate and empower her clients with an all-inclusive financial plan that encourages and motivates them to pursue their lifetime financial goals and dreams.Learn More: https://judycarlson.com/Investment Adviser Representative of and advisory services offered through Royal Fund Management, LLC, an SEC Registered Adviser.The Inspired Impact Podcasthttps://businessinnovatorsradio.com/the-inspired-impact-podcast/Source: https://businessinnovatorsradio.com/the-inspired-impact-podcast-with-judy-carlson-interview-with-dr-julie-link-founder-owner-the-audiology-method

Daniel Laheru , MD, is the Professor of Oncology and Co-Director of Skip Viragh Center for Pancreatic Cancer Research at the Sidney Kimmel Comprehensive Cancer Center at The Johns Hopkins Hospital. He holds the Ian MacMillian Professorship in Clinical Pancreatic Cancer Research. Dr. Laheru has developed a vaccine along with Dr. Elizabeth Jaffee, that supercharges the immune system and causes immune cells, which tend to be tolerant of cancer, to seek out and kill pancreatic cancer cells throughout the body. He is a Member of the Miller-Coulson Academy of Clinical Excellence, Member of Bloomberg-Kimmel Institute for Cancer Immunotherapy, and Associated Director of the Institute for Convergence Science.  “There's no job that's insignificant here. Whatever you're doing, you need to do it to the best of your abilities.” A monumental lesson from Dr. Daniel Laheru's parents taught him to notice the janitor who moves by silently in the corner, the nurse who works overtime without appreciation, and the security guard who passes a silent glance at every passerby. In this episode of The Medicine Mentors, Dr. Daniel Laheru explains recognizing the interconnected nature of every person's role in the infrastructure of medicine, instilling gratitude in our practice, and paying it back by paying it forward. Pearls of Wisdom:   1. Enjoy the time that you're a student because you'll wonder what you did with all your time after. The future is entirely open to you, the ceiling is what you make it. 2. I'm happy doing what I'm doing right now, and if I can do this five years from now, I'll be ecstatic.  3. The fellows, residents, and medical students are the lifeblood of the institution and the next generation so don't be shy about asking somebody if they have time to meet with you.  4. A good mentor is like a parent in the sense that they put your goals ahead of their own. My mentor really saw my future before I was able to understand it for myself. 5. The little things in the course of a day actually make a big difference. Thanking and appreciating someone goes a long way. 

Dr. Paul Killoren // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Dry Needling division lead Paul Killoren discusses the important considerations when choosing dry needling education. As the founder of iDryNeedle and the division lead at the Institute of Clinical Excellence, Paul shares his extensive experience in the field, having taught dry needling for over a decade. He addresses common questions and concerns about training options, emphasizing the need for unbiased evaluation of different educational programs. Whether you're a student physical therapist or a professional in a newly accepting state, this episode provides valuable insights into navigating the diverse landscape of dry needling education. Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn more about our live dry needling courses, check out our dry needling certification which consists of Upper Body Dry Needling, Lower Body Dry Needling, and Advanced Dry Needling.

In this solo episode, Tracy explores the critical mindset shifts healthcare providers need to make to transform their practices from survival mode to thriving businesses. She introduces the concept of the "practitioner's paradox" - where the very mindset that makes someone an excellent healthcare provider can actually hinder their success as a business owner. Through real-world examples and practical frameworks, Tracy explains how practitioners can transition from working in their business to working on their business, without sacrificing the quality of patient care. Key Concepts: The Practitioner's Paradox: How clinical excellence mindset can limit business growth The hidden costs of burnout on business decision-making The Owner's Mindset Shift: Moving from "how can I do this better?" to "how can this be done better without me?" Practical Tools Introduced: The Energy Audit: A simple weekly tracking system marking activities as energizing (+) or draining (-) The Owner's Hour: Dedicated time for high-level strategic thinking Imperfect Delegation: Learning to accept 80% perfect execution from team members Case Study Highlight: The episode features "Sarah," a neuropsychologist struggling with perfectionism and overwhelming workload, illustrating how mindset shifts can transform both practice management and quality of life. Key Takeaways: Success in healthcare practice has less to do with clinical expertise than business mindset Burnout is not the inevitable price of success The most profitable practices are often led by owners who maintain work-life balance Delegation and systems thinking are crucial for sustainable practice growth Moving from "working harder" to "working smarter" requires intentional mindset shifts Download Your Energy Audit here. Tracy's Bio:  Tracy Cherpeski, MBA, MA, CPSC, is an executive coach and leadership development expert. Her mission is to unlock the potential for success in every individual and organization she works with. With a background in operations and a passion for driving growth, she approaches each engagement with professionalism and a keen eye for optimizing structures, processes, and productivity to boost profitability. Tracy's coaching, consulting, and training programs are designed to provide a holistic experience, integrating leadership development, executive coaching, and mindset mastery. Her expertise has been sought after by small business owners, industry groups, networking organizations, government agencies, and corporations alike. Originally hailing from the Pacific Northwest, Tracy now calls Chapel Hill, North Carolina, her home. Wherever she goes, her commitment to helping people and organizations reach their full potential remains unwavering. Connect With Us: Be a Guest on the Show Thriving Practice Community Schedule Strategy Session with Tracy Tracy's LinkedIn Business LinkedIn Page Thriving Practice Community Instagram

Dr. Amit Gosalia is a well-renown Los Angeles-based audiologist with over 20 years of experience. Having served as President of the Arizona Speech-Language-Hearing Association and Chair of the American Academy of Audiology's Public Awareness Committee. In 2024, he received the Clinical Excellence in Audiology Award from the American Academy of Audiology. He co-founded AudBoss, a platform supporting private practice audiologists in business management and professional development, and has since developed one of the most influential groups for Audiologists in the world. In this interview, recorded in November 2024 - he joined me to share his story, how he found himself in Audiology, how he grew and exited his first practice (with the biggest lessons behind it) and where the future of Audiology is heading.

Why is it so important to get all three of these pillars - Marketing & Sales, Business Systems, and Clinical Excellence - right for a well-running business?In this 'sode we discuss the three main pillars of business.  If only one or two of these are working well, the business is going to take a lot of effort and always feel precarious.Marketing & Sales - If you don't have a consistent source of leads and are always worried about getting the phone to ring, marketing your practice is vital.  We need a systematic plan for marketing to avoid dips and the 'rollercoaster' of business.Business Systems - If you're feeling overwhelmed or burned out, it's usually because you're lacking systems.  We often make up for poor systems with more work and late nights, but that's not sustainable.Clinical Excellence - If you're having patients drop off, space out their visits, or stop coming in because 'it's expensive', we aren't getting the clinical buy-in necessary.When all three of these are working well, the business gets much easier to run, grows faster and is actually fun to work in!Accelerator Program - Registration Opens Dec 12th!If you know one - or more - of these areas needs work, consider joining us for the January cohort of the Business Accelerator Program!  We've helped 300+ business owners grow their practice and build a business that truly works for them.  You can see all the details and real-world results at www.pelvicptrising.com/accelerator.About UsNicole and Jesse Cozean founded Pelvic PT Rising to provide clinical and business resources to physical therapists to change the way we treat pelvic health.   PelvicSanity Physical Therapy (www.pelvicsanity.com) together in 2016.  It grew quickly into one of the largest cash-based physical therapy practices in the country.Through Pelvic PT Rising, Nicole has created clinical courses (www.pelvicptrising.com/clinical) to help pelvic health providers gain confidence in their skills and provide frameworks to get better patient outcomes.  Together, Jesse and Nicole have helped 600+ pelvic practices start and grow through the Pelvic PT Rising Business Programs (www.pelvicptrising.com/business) to build a practice that works for them! Get in Touch!Learn more at www.pelvicptrising.com, follow Nicole @nicolecozeandpt (www.instagram.com/nicolecozeandpt) or reach out via email (nicole@pelvicsanity.com).Check out our Clinical Courses, Business Resources and learn more about us at Pelvic PT Rising...Let's Continue to Rise!

With 23 years and counting in CDI, Rhoda Chism has seen a lot. The rise of new regulations and reimbursement mechanisms, and the advent of new technologies that have radically transformed chart reviews.  Rhoda has not only weathered these changes and navigated the turbulent waters, but remains as warm and personable, and pro-person, as you will ever meet.   But not anti-technology.  Today she is the Director of Clinical Excellence and Adoption for the software company Iodine, a new position she's held for just two months. But I think she could be called Chief People Officer.  We get into the blending of human and machine, discussing the following:  Rhoda's journey into healthcare and nursing at the tender age of 19.  The transition from bedside nursing to CDI in 2001  Melissa Varnavas and the lasting impact of a simple message of encouragement and belief  Using authentic, personal stories to communicate difficult CDI concepts and education, including heart failure and AKI  How technology has radically transformed CDI over the last two decades  AI driven technology as human amplifier, not replacement, and the importance of emotional intelligence in CDI work  Career advice for young professionals in a world of rapid change 

In this episode, Christina Moore, Senior Director of Clinical Excellence at IndyVets, shares her journey from practicing veterinarian to transformative leader in the veterinary field. Christina dives into her concept of “vibes” in the workplace—how the energy we bring shapes team dynamics and morale. Through personal stories, including a defining moment with an empathetic leader, Christina reveals the power of compassionate leadership, burnout prevention, and personalized mentorship. Join us to explore actionable insights on creating a supportive, high-energy workplace that empowers every team member to thrive. Additional Resources: Learn more about Skutvik Consulting Learn more about workvibes Check Your Vibe  Follow PeopleForward Network on LinkedIn  Learn more about PeopleForward Network Key Takeaways: Adapting Work Environments to Combat Burnout: The veterinary profession, much like other healthcare fields, is prone to burnout, but innovative solutions like flexible scheduling and personalized support have transformed Christina's impact on this field. Redefining Accountability through Empathy: Christina has created teams where people willingly take accountability by feeling seen and valued, showing how empathy can fuel productivity and self-accountability. Personalizing Leadership Approaches: By understanding the unique needs and goals of each team member, Christina demonstrates how to foster an inclusive, engaging, and fulfilling work environment.

Tuesday, October 22, 2024 First Principles Genetic disease means that gene broken since conception. Novel medicines are possible ways to fix the gene - Genetic Therapies (ASO &/or AAV), this is recent, before now, kids with these diseases were a “go home and love them” situation. These are delivered via spinal tap or directly to the brain in leading medical centers. First though, regulators must approve.   Our job Develop medicines or get industry to - This is happening see Pipeline Get regulators to approve trials Get medical centers up to speed on SYNGAP1-Related Disorders (SRD) What we are building on CHOP ENDD funded externally (see #S10e92) and replicating what was built for STXBP1, check last week's webinar https://curesyngap1.org/resources/webinars/93-endd-chop-2024-syngap1/ Rare-X platform for PRO collection Regulatory pathway being made clearer every day by Stoke (Dravet), Praxis (SCN2A), Ionis (many) all of whom are working on SYNGAP1 as well.   What we are asking for We need to raise at least $500k (3rd site), preferably $1.13M (ProMMiS) Make your largest gift ever to SRF Fundraise with friends and family ACES is now ProMMiS, who knew ACE meant Adverse Childhood Event, not us. Key slides: S1 Path to Treatment | 2024 (09.27.24) 1. Why Now?  Why is it time to go from bench to bedside (research to clinical)? At least 10 companies on our pipeline not to mention multiple small molecule efforts We have limited resources – so the focus has to transition, clinical funding first. CHOP Gift is 1 year down… 2. Why NHS?Understand SYNGAP1 better, go beyond Vlaskamp 2019 and Wiltrout 2024, see #S10e105  FYI at CHOP, as I shared in #S10e151, at year 1, we are at  – 86 (Visits) + 10 (new scheduled) + 19 (2nd) + 4 (3rd)  + 22 (follow up)  Learn what to measure in clinical trials for SRD, remember our seizures are challenging Ideally we develop a Synthetic Control Arm if we use GCP Why top shelf?  We need institutions the FDA will take seriously and our children are very complex requiring experienced clinicians.  3. Why Multidisciplinary. Neuro, Psych, Genetics, PT, ST, OT, GI, Sleep, ENT, Ortho. Beyond the sheer burden of getting our kids out and about for multiple appointments the coordination by a parent is almost impossible.   4. Why Multisite/3 sites?Replicable/scalable required by regulators Accessibility (not primary reason) Establish more locations where trials will be managed Laying a foundation for a national self-sustaining network 3 is the minimum, look at STARR or Angelman, both had/ve 4. 5. How and why so fast? Because we can.  Time is Brain. Following a well trodden path SMA, Rett, Angelman, Dravet, but we are moving FASTER. 6. Does the industry really care? We are next there are so so many behind us, eager to take the resources we have access to today. Market size (Per our Census 425 US/1500 global is tip of iceberg) Multiple players reassuring each other Relatively strong amount of scientific and clinical research Haploinsufficiency (like Dravet – STOKE) – so relatively easy 7. Expensive? No. Clinical Research is more expensive than basic scientific research. Leveraging CHOP and Rare-X, setting up required networks to prepare for clinical trials.  It's time. 8. Why Bother/Help? Now is the time for SYNGAP1, we miss it at our peril. Sure, once in these places we will still see our patients, but the study, the support and the focus may pass. Our kids don't die, regardless of patient age, what we are doing can change their future and that of their loved ones and caregivers. If not us, then who? It is a rare exception when a non-family member gives a gift, and it is always because a family member asked.  We must ask. 9. What can I do? Donate to, share, join our Coast2Coast Clinics Challenge – two SYNGAP1 Squads in West and East – it's critical $500k goal by end of 2024; more than $1M needed just for the SYNGAP1ProMMiS. So far, donations from $25 to $25,000 – each and every contribution matters. This requires our entire S1 network to solicit family, friends, work colleagues, companies, etc. to contribute. Many causes out there – why not ours? Syngap.Fund/C2C   https://Syngap.Fund/C2C > https://secure.givelively.org/donate/syngap-research-fund-incorporated/coast2coast-clinics-challenge   Two teams:  https://Syngap.Fund/West & https://Syngap.Fund/East

In this VETgirl veterinary continuing education podcast, we interview Dr. Marisa Brunetti, VMD, Chief Veterinary Officer and Dr. Christina Moore, DVM, MBA, Senior Director of Clinical Excellence at IndeVets. We're talking about importance of and need for a good system of support for veterinarians. Remember vet school when you were constantly surrounded by support, medical expertise, compassion, and a community of people who shared your passion? We'd probably get more than a few raised hands if we asked a room full of vets if, by contrast, their days now had a lot more isolation and frustration, and a lot less support and collaboration. That's why, seven years ago, Dr. Brunetti helped create IndeVets on three firm conditions that created a radical change from what's become the accepted standard in the vet industry. Join us as we hear from Drs. Brunetti and Moore about the radical support they provide for their vets so they can do what they love with the support they deserve.Sponsored By: IndeVets

Dr. Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Pelvic faculty member Rachel Moore breaks down how purity culture and pelvic floor dysfunction are linked, and ways we can empower and educate women to reduce dyspareunia Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION RACHEL MOOREGood morning, guys. What is up? Happy Monday morning. My name is Dr. Rachel Moore, and I'm hopping on this morning representing our pelvic crew to dive in and talk about a topic that's pretty near and dear to my heart in the area that I live in in Texas. We're going to be diving into purity culture and the pelvic floor. So if you're not familiar with what purity culture is, it is a set of beliefs that really focuses on promoting abstinence for sexual health and well-being and kind of involves a lot of feelings of shame or guilt or even fear focused around sexual functions and sex as a whole. So we know that sexuality in and of itself is biologic and it's instinctual. But there are a lot of overtones and a lot of components of sexuality and the development of sexuality that come from culture. Culturally embedded meanings are just kind of rampant in this space. And we see that one really large cultural component that can lead to issues with the pelvic floor, like dyspernia or vaginismus, is this topic of purity culture. We have studies that have looked at this in a lot of different countries. And what we see is that countries that really emphasize sexual purity hone in on and focus in on male sexual satisfaction over female cultures that emphasize like virgin brides and have a lot of societal contracts or context in place to eliminate or reduce premarital sexual relations have higher rates of vaginismus and dyspareunia. We know that societies that suppress female sexuality have higher rates of pelvic floor dysfunction that are associated with pain with intercourse. In order to understand all of this, we really need to understand purity culture in and of itself and understand kind of the component pieces and things that go into dyspareunia and vaginismus. So we already honed in on what purity culture is just a little bit. A lot of times purity culture is in theory linked with religiosity. And I see that in my area of Texas. I'm in a very conservative part of Texas and I've seen a lot of patients with vaginismus and with dyspareunia that were raised in a very religious household and have a lot of certain feelings and ideals and beliefs around sex and sexuality that are went kind of hand in hand with that is the common thought. However, we actually have a case study that looked at the link between religiosity and dyspareunia and vaginismus. And it was a 2020 case study that sent out a survey to 901 women. 19% of them had pain with intercourse. So dyspareunia or pain with intercourse And what they found is that religiosity was actually not linked with the presence of dyspareunia or vaginismus, whether it was current religiosity or previous religiosity, the way they were raised. But what they found is that the attitudes and connotations around sex and sexuality in and of itself is actually what was linked with that presence of pain with intercourse. So really kind of debunking this idea that religiosity and pain with penetration and intercourse go hand in hand. I think purity culture in and of itself gets linked a lot with the religiosity or that highly conservative group, but it's not necessarily because of the religion aspect. It really boils down to the education that we provide women about their bodies and the attitudes and beliefs about intercourse and sexuality in and of itself. There's actually another study that was done. It was another study that surveyed women that had vaginismus and they asked them, like, what are the reasons or what are the things that kind of led up to this happening? And what they found is that the number two reason for vaginismus was a negative attitude or a negative connotation around sex and sexuality as they were raised. And the number one reason was fear of pain with penetration. So that's pretty powerful that the way that we are taught about our bodies and the way that we are taught about sex and sexuality can have long lasting effects on the rest of our lives as females. It's really interesting because we used to think back in the day before women's health was really studied that vaginismus was just a purely motor response, right? Like with the penetration, these muscles tense up and they spasm and therefore penetration is painful and uncomfortable. and women are not able to have intercourse or are not able to enjoy intercourse. But just like every other realm of physical therapy, we're really diving into all of these different subsets of this diagnosis as a whole. And what we're finding is that the biopsychosocial piece of this is massive. The way that we are taught about our bodies, the way that we are taught about intercourse, the way that we are taught to feel about our natural desires and sexual urges can lead to a physiologic response that is outside of our control. So our pelvic floor has a protective reflexive mechanism when we are stressed or scared, and that protective reflexive mechanism can be maladaptive. But if we're taught from a young age that sex is shameful and that our bodies are something to be ashamed of, or maybe they only serve one purpose and that is only for reproduction and you're not trying to have sex to reproduce, then that can cause this reflexive reaction to kick in, where those muscles tighten and tense up. Even if you do all of the relaxation work in the world, and even if you do all of the things to stop it, that ideal is really deeply ingrained. And so that really leans into a lot more psychological work that needs to be done, not necessarily the physical work. so with that being said kind of segue into how can we help because we can't obviously go back in time and change the way that somebody was raised or change the way that somebody feels about sex and sexuality necessarily from their childhood or from the way that their parents raised them so as pts when we see this diagnosis walk in we see somebody come in who Has pain with intercourse and has or has dyspnea has vaginismus any other sexual condition? That is linked with pain or the inability to have or enjoy intercourse We want to start thinking about this in the back of our mind like this needs to be a way a topic that we come across maybe not necessarily directly asking like how were you raised to view sex and but it's something that we want to kind of keep in our back burner because if this is on board, then it's going to require a lot more collaborative care and it's a great opportunity for us to partner up with a mental health therapist in our area and really refer out and make sure that we're hitting this from all angles. One of the biggest things that we can do as pelvic PTs is educate. It is insane how many people are not educated about their bodies and especially in this purity culture realm, There's a lot of misinformation and miseducation and wrong education that is done that is really kind of focused or driven out of fear. And there's a lot of just lack of education. Women aren't taught about their bodies at all. And if we think about that, if you knew nothing about this area at all and something was going wrong, you would probably start panicking a little bit. It seems silly to reference it to our shoulder because we all obviously see our shoulders and know about our shoulders and For the most part, even if you have no anatomical knowledge, kind of get a sense of like, it does this, it does this, it needs to do all these things. But that's not true about our pelvic floor. Especially in cultures where purity is really honed in on, nobody is talking to women about the proper way to clean their vulvas. people aren't talking to women about the number of holes. Most of these cultures are not, absolutely not teaching about clitoral stimulation and female orgasm. And so keeping that in mind, like not knowing something can lead to a lot of confusion and fear when we do start having sensations of discomfort or pain. So educating in and of itself can be huge. Educating about the anatomy, we have three holes down there in a female pelvis. There are a lot of adult women that do not know that they have three holes. That in and of itself is a large piece of education. Educating them about how our pelvic floor works, what its functions are, how it aids in sex and sexuality, and the ways that we can really kind of lean into that and make sex or make the pelvis in and of itself not even sex, but the pelvis demystified. so that they're not looking at this area as a big black box with a question mark over it. And they have an understanding of the functions and the basic ways and inner workings of their own bodies. The other thing that we can really hone in on is working on parasympathetic drive work. So working on relaxation work, helping them get out of this fight or flight response. This is something that we can start in pelvic floor PT for sure and is a great way to partner with a local therapist or counselor or somebody that is trained in working with people with Sexual dysfunctions because a lot of this comes down to like taking a lot of steps back So we're not even talking about like let's relax while you're about to have intercourse we're talking about like let's lay in bed next to your partner and Hold hands and practice relaxing and then let's talk about maintaining that as your partner touches your leg and just kind of working in on these component pieces and Sometimes it's even like, let's go all the way backwards, just you. Like your partner is not even a piece of this puzzle. Let's talk about ways that you can get comfortable with your own body so that you can go into this partnership and this relationship with a degree of comfort and understanding, and it's not about this other person at all. finding a counselor or a therapist in your area, or maybe not in your area, but virtually, that is somebody that you trust, that can help guide this path. We can absolutely help. We can be a facilitator of that. But the great thing about having that mental health component is they can really kind of go back a little bit farther and more in depth than we can, because they're trained in that, to really break down those beliefs and talk about ways to rebuild that from a psychological level. And then we can go in, with that happening and align that with the physical piece. So kind of bridging those two pieces together so that we're getting this complete rehab component. A lot of the times in this population, the assumption is like, oh, we just need to work on strengthening other areas or whatever. But I think that in the sense of vaginismus, absolutely, we always are promoting strength training our hips and strength training our core and making sure that the muscles around our pelvis are strong and supporting the pelvic floor. So the pelvic floor isn't becoming the hero and becoming super tense and tight in a response to that. But especially when we're thinking about vaginismus, we're really looking at like the attitudes and core beliefs and the situation around the intercourse or the act that is causing that vaginismus to occur in and of itself. So we always can layer those things in. We love that, but really focusing in on that relaxation and finding ways to promote that relaxation paired with education and partnering with a provider that we trust that can help address the psychological component. We know, we have surveys that show that women that are raised in households where the mother had negative views about sex or negative beliefs about sex or talked negatively about it, have higher rates of vaginismus and dyspnea, which is wild to me. It makes sense when we think about it. You know, we always talk about how our kiddos are really mirroring the things that we say and we do in the way that we act. So as adults in and of ourselves, not necessarily even in the PT realm, But making sure that the way we talk about these functions is in a way that is not promoting shame or fear. I think that again purity culture is often linked with religion and so you have kind of these two sides and this can be a really polarized topic. And I think no matter what you believe, the big goal is that at the end of the day, our young women need to understand how their bodies work, they need to understand the functions of their bodies, and then they need to understand what sexuality means. In whatever way it is that we believe that, making sure that sexuality isn't seen as something that is really driven in shame or driven in fear, but it's something that is celebrated because at the end of the day, it is one of our basic biologic functions that we all need in our lives. And so making sure that we are setting our future generations up for not having these pelvic floor dysfunctions down the line. providing education at a community level in any way that you're able to can also be really wonderful. We've set up before like a mom and daughter workshop where we literally just talked about like, this is the pelvic floor, and this is the way the menstrual cycle works, and this is the way the pelvic floor functions, not diving into this is how you have sex, but base knowledge. That base knowledge can be so powerful in a community that doesn't have that knowledge. i hope you guys enjoyed this i hope that this hit a chord with you maybe especially if you're in an area where you're seeing a lot of patients that come in that are raised in cultures where sex is seen as shameful and seen as something that is not to be celebrated and is um maybe fear-based so um SUMMARY If you guys are interested in hopping into one of our courses in the pelvic division we talk a lot about pelvic pain in our l2 cohort which we have seats available for that october cohort coming up we just started our second cohort of the year so that one is kicked off We've got one more cohort of L2 coming up at the end of the year, so if you want to hop into that, look at that online. We've got L1 coming up in two weeks, and then we've got a lot of courses coming up in the end of the year. We are rounding out quarter four with tons of courses. We're on the road a lot. We're all over the United States, so if you are interested in hopping into one of our Pelvic Live courses, go to the website, PTOnIce.com, get into one of those courses. We can't wait to see you on the road. Have a great rest of your Monday, and I'll see you guys around. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Alan Fredendall // #TechniqueThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Chief Operating Officer Alan Fredendall discusses the difference between myofascial decompression & cupping, if myofascial decompression works or not, and how to elevate the use of myofascial decompression in practice Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about courses designed to start your own practice, check out our Brick by Brick practice management course or our online physical therapy courses, check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION ALAN FREDENDALLMyofascial decompression. What is it? How does it work? Does it work? And how can you elevate what you're currently doing practice if you're already implementing this style of soft tissue treatment? WHAT IS MYOFASCIAL DECOMPRESSION? So let's take it from the top and let's talk about what is myofascial decompression, sometimes abbreviated MFD. and how is it different from cupping? So you may consider these in your mind to be synonymous and that is very very wrong. Why? Calling myofascial decompression cupping is really a misnomer because if we dig deep people have been cupping each other for many many many thousands of years. It comes from eastern medicine and you may have seen it in practice, maybe you do it in practice, maybe you've seen it on social media or the internet, and you see people laying in a static position, sometimes with their whole body covered in plastic or glass cups, right? And so that is cupping, that is sitting in a static position, that is using things like meridian or chi points, the idea that maybe we're removing toxins from the body, and you may even heard of something called wet cupping, where we pull blood to the surface with a cup, and then maybe we puncture it with a needle or a knife and we draw blood out of people. So all of that is kind of in the sphere of the term cupping. And what's very, very, very different about myofascial decompression is that we are using some sort of pump, manual or automatic, to get a decompressive effect through the tissue. And in the context of myofascial decompression, we are always, always, always, always, including movement. We are never having people lay statically with just cups on their body. We are not educating them that we're removing toxins from their body or altering their chi or anything like that. And certainly, hopefully, you are not cutting people open and using the decompressive pressure of the cups to suck blood out of their body, right? And so that is the difference between cupping and myofascial decompression. Both use plastic or glass cups, but they come from very, very different paradigms in why we're using it, what we're doing, and the effect that we're hoping to have. So with myofascial decompression, we know now with MRI studies that when we put these cups on, if we have enough pressure, we know that we can put hundreds of millimeters of mercury of pressure through this cup, and that we can sometimes reach the level of the bone. And so we are decompressing not only just the skin and the fascia beneath the skin, but down to the level of the muscle, fascia between levels of muscle, and even deeper levels of muscle all the way down to the bone. And so thinking about the various levels, when you look at your forearm, for example, what is between you and the outside layer of your skin and the bone? Several layers of tissue. We have our epidermis, we have our dermis, we have super fascial tissue and fascia, we have deep fascia, and then we get into the fascia in and around the muscle. We have the epimysium, we have the paramycium, and we have the endomysium. And that we know with a large enough cup and enough pressure from one of our pressure guns that again we can reach the level of the bone. So we're using higher pressures combined with movement to create this decompressive and sometimes sheer force effect on the tissue, combining the decompression with the movement, that is myofascial decompression. And that is how much different it is from traditional maybe Eastern medicine, quote unquote, just cupping. So the second question that we often get and the second point I want to make is often, does it work? There is a lot of myths on social media and the internet that this is not doing anything, that this could never cause a change in tissue. and that is team Patently Untrue. Certainly, if you do this wrong, you can be very ineffective with this style of treatment, but if you do it right, it can be very, very effective. So I wanna give a shout out to Dr. Chris DiPrato. He's a physical therapist out in the Bay Area of California. You may have heard of him. He owns the company Cup Therapy. He teaches myofascial decompression courses. We had the pleasure of taking one of his courses a couple weeks ago when he was here in Michigan, and we had a great time. In particular, I love to learn all the research he had to share. And some of that research around does this actually work is pretty mind opening. And my point with today's podcast is that when we elevate our techniques, we elevate the efficacy and the efficiency of our techniques as well. And again, certainly, if you do this wrong or sloppy, you will have a minimum effect on the tissue. But if you do it right, you can have a profound effect on the soft tissue of the body. DOES IT ACTUALLY WORK? And Chris shares that in his course when he seeks to answer the question, does it actually work? Chris has used cups with myofascial decompression on embalmed cadavers. He has used them on fresh or what may be called wet cadavers. And he has used them on live living people in an MRI tube and looked at what is happening to the tissue when we have a large cup with a lot of pressure in it. What do we see? And what he has seen over the years doing these studies himself of having people in MRI tubes is that with a large enough cup and enough pressure, again, we can begin to decompress multiple layers of tissue, fascia, muscle all the way down to the level of the bone, which is pretty significant. And that in general, the more hydrated the tissue, the more decompressive effect we have seen. So when he has tested this on embalmed cadavers where all of the body water, liquid blood, everything is removed and the tissue is essentially dried out, we see a minimal effect when we use this technique. But when we use it on a fresh or wet cadaver or a living person that still has blood, all the sorts of fluid that we have inside of our body, that we get a much more profound effect. And more importantly, looking at these MRI studies, we see that not only do we see that effect in the moment, but that we see that effect for at least three to five days after we have done the myofascial decompression. So what is it? It is a technique using high pressure with movement to create a decompressive effect and some sheer force on the body. And does it work? Yes, if you do it right. So that's what I want to spend the rest of this podcast episode discussing. INTERLUDE Before I do that, I just want to introduce myself. My name is Alan. I have the pleasure of surfing as our chief operating officer here at ICE and a faculty member in our fitness athlete and practice management divisions. This is Technique Thursday. On Thursdays, we either cover leadership topics or we cover technique topics. Today is a technique topic today. And it is Technique Thursday, which also means it is Gut Check Thursday. This week's Gut Check Thursday comes from our own fitness athlete faculty member, Joe Hinesco, who sent me a nice little number for you all to do this week. It is every two minutes, hop on a fan bike, an echo or a salt bike, hammer out 20 calories for the guys or 15 for the ladies. And then any remaining time in that two minute window, you're going to do max repetitions of a barbell thruster. with the prescribed weight of 95 for guys and 65 for ladies. The goal there getting hopefully at least 10 thrusters every round and your workout is finished when you hit 75 thrusters. So the moment you hit that 75th thruster you are done with the workout. So it rewards an aggressive start, it rewards somebody who can be aggressive on the bike but still hop off and pick up that barbell and do big sets of thrusters. So If you try that and you hated it, send all that shade towards Joe. He's the one that came up with this workout, so send that his way. And then I just want to plug again, Chris DePrato cuptherapy.com. He has live and online courses, a level one course, a level two course, both live and online. And if you finish today's episode and you want to learn more about this, maybe you're like me and you kind of just started doing this without any formal training. I promise you, if you take his courses, you will come away with a lot of very actionable stuff that's going to do nothing but elevate these techniques in your own clinical practice. So let's talk about this. PRACTICAL APPLICATION Let's talk about practical application. First things first, if you have done cuffing before, You have probably seen clear cups. What's the difference? We also have cups. These are rock pods. We have these in the clinic as well. What is the main difference? The main difference is that I cannot control the pressure with something like a rock pod. All I can do is essentially stick it on my skin and get whatever pressure comes out of it, right? That might be not enough pressure to do anything and I may have to reset it. And then I basically am just getting lucky maybe with enough pressure for the patient to maybe feel something. But this is not ideal. It does not have a way for us to control the pressure. It does not have a way for us to objectively measure how much pressure we're using. And most importantly, we can't see through this, right? We can't see the tissue. We can't see what's happening underneath the tissue. There is some important stuff that can happen inside of a clear cup that you'll want to see. and I won't steal Chris's thunder, I'll have you take his course to learn that, but it's really important that we have a clear cup, and that we have some sort of control over the pressure, that we have some sort of pump gun, automatic or manual, to pump up the pressure, and really be sure we're just not getting a random application every time we put on a cup like a rock pot. So what does that look like? We have a manual gun, right? It has a trigger here, you connect it to the cup, and you pull pressure out, right? You decompress. And then with this style of cup, you just squeeze to let the air out. Now, what's great about Chris and Cup Therapy that has really made me feel good about this technique is they have solved the problem of how much pressure exactly am I using so that I can be sure if I repeat this treatment in the future, or maybe somebody else has to repeat this treatment for me, they're using the same pressure as me. Lo and behold, the automatic pressure gun, right? So you can see right here, if you're listening on the podcast, you can't see anything. So go over to our YouTube channel, or our Instagram page and watch me on the video. But what you'll see here is we have a pressure gauge, right? And it's measured in millimeters of mercury. It goes from zero up to 760 millimeters of mercury. And as you apply the cup, you will see the pressure gauge change. And that can dial you in more on how much pressure you're putting through the cup. And again, let you hopefully repeat that treatment in the future. And also be sure you're reaching the levels of tissue depth that you want to be working at. So this is a very, very great tool. This is brand new as of this year, I believe. So if you've taken his course before, you'll want to jump on cuptherapy.com and buy one of these. But this is very, very, very, very nice. And so I'm going to put this on myself. I'm going to put some, just some free up, and then I'm going to show you all how great it is with this auto pressure gun. So just putting some lotion over the area where I'm going to apply the cup. I'm going to apply the hose to the cup like so, and then I'm going to squeeze the pressure gun. Doing this one handed is super tough, but I think we can get it. There we go. And so you can hear the gun working a bit. And now as I take the hose off, you can see some pretty darn good pressure, right? A lot of tissue deformation right there, a couple of inches of skin fascia and muscle pulled into the cup. And I can tell you, this is a very different feeling than just having something like a rock pod or otherwise just a squeeze application silicone cup. This is right on the border between discomfort and pain. However, it is enough pressure that I could move those muscles. I could do a bicep curl. I could do pull-ups. I could move my forearm through whatever range of motion I wanted to, and you can see that cup is not going anywhere, and that comes down to making sure that we have enough pressure through the cup that we're reaching not only enough pressure that we can move with the cup on, but again, that we're reaching the levels of tissue depth that we want to achieve. And that is very, very easy to do with the automatic pressure gun. Let's talk about those pressures. What are they? If we really want to reach deep muscle or reach even the levels of intermuscular tissue and fascia, we need to have a lot of pressure through these cups. We need to have 300 to 600 millimeters of mercury. What is the problem with a cup like this? Or what is the problem with the manual gun? I have no idea what pressure I'm at, right? Hence the importance of the pressure gauge on the new automatic gun. Going down in pressures, if I just want to reach the level of the deep fascia, the pressure comes down a bit, 200 to 400 millimeters of mercury. And then if I want to stay superficial, even maybe if I just want to promote some lymph flow, maybe a patient has some swelling or some lymphedema, I can keep the pressure really light, 40 to maybe 150 millimeters of mercury. Again, how can I be sure I'm keeping pressure light enough to only promote lymph flow? Well, with something like a silicone cup or even the manual gun, I have no idea how heavy or how light my pressure is. And so again, it reinforces the need for that automatic pressure gun. And now I would say the key here, and again, the difference between myofascial decompression and cupping is that when we have these cups on, we're doing some sort of movement, right? Chris will take you through a whole protocol in his course of how to get the cups on and how to slowly introduce movement to an area, especially maybe if it's very restricted or very painful, but also different applications using lighter or deeper pressures to inhibit or facilitate different muscles. For example, he's a big fan of putting cups with heavy pressure on the traps for somebody who does a really contrived trap shrug when they lift overhead. And if you want to maybe isolate the deltoids or the upper back, and sort of think about turning the traps off a bit, we can stick some cups on the trap and really put a lot of pressure through those cups. It's going to be really hard to engage and move those traps, and it's going to promote movement through the muscles that we want to target. Again, maybe the deltoids or the upper back. And he has a number of different examples and circuits scenarios for you in his class but the key is the pressure matters and we can't know what pressure we're at if we don't have an objective way to measure it and then track it over time and for me that was a big game-changer what I learned is I was simply not using enough pressure using something like a silicone cup or or using something like a clear cup, but with just the manual gun. Simply not putting enough pressure into the cup to get the treatment effects that I was looking for. And certainly, probably not being light enough on the other end, if I wanted to do something like promote lymph flow, or I just wanted to have some cups on some muscles to facilitate muscle activation, I was probably going too light for deeper structures and too hard for more superficial structures. or movement facilitation. And again, the automatic gun with the pressure gauge changed all of that. SUMMARY So what is myofascial decompression? It is not cupping. It is using pressure, specifically various ranges of pressure depending on the level of tissue that we want to target. always combined with movement to promote movement through that muscle, movement through that tissue. That is very different from cupping where people typically lay in a static position, have a number of different cups applied to them, usually with no idea how much pressure is being put through that cup. Does it work? Yes, if you do it right, it works. As with most things in life, if you do it wrong, it won't work very well. And so understanding that if we have enough pressure through a large enough cup, we can move through several layers of tissue, including all the way down to the level of the bone, which is probably much more of a pronounced effect than maybe we ever thought possible. How can we get better at this? I would recommend if you haven't yet that you take Chris's course. You learn where to put these cups to target different muscles, to target different movement patterns, and that more importantly than anything else, you get yourself that automatic gun either from Chris's website or that you get with the level two course where you have that objective pressure grade knowing that different levels of pressure will target different structures and have different treatment effects. So it's really important we know what those are and what we're trying to achieve with that patient in front of us. us. So I hope this was helpful. Big shout out again to Chris. I reached out to him before doing this episode and just ran this by him and we really appreciate all of his collaboration. You'll notice that ICE does not have a myofascial decompression course. We think Chris is doing it better than anybody else and if it's not broke, don't fix it. So just go see Chris if you want to learn more about this. He runs a fantastic course, very evidence-based, Very movement focused, which you know, anything from us here at ICE, that's what we're all about. So just go see Chris if you want to learn more about this. I hope you all have a wonderful Thursday. Have fun with Gut Check. I don't think you will. Again, if you hate it, just send Joe those nasty messages. Just pass me right on by and go right to Joe. And I hope you have a wonderful weekend and a fantastic Thursday. Bye everybody. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.  

Dr. Julie Brauer // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult lead faculty Julie Brauer discusses important tools for acute care PTs: a good attitude, a backpack, a white board, resistance bands, sticky notes, and gait belts. Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION JULIE BRAUER Good morning crew. Welcome to the PT on Ice daily show. My name is Julie. I am a member of the older adult division. and I am coming to you live from my garage. So this morning what we are going to dive into are fitness forward tools that you can use in acute care and I'm going to do my best to demonstrate some of these tools that you can use to start loading these really sick folks up early. All right so We are going to dive in first by talking about the most important tools that you need to have with you as you go through the hospital and you go visit your patients in their rooms. TOOL #1 - THE RIGHT ATTITUDE So number one, the most important tool that you need is the right attitude. You have to have the right attitude about this. So let me unpack that. Bringing fitness forward care to sick older adults in the hospital. It is not about getting them to do a sexy deadlift with a dumbbell. It's not the sexy thing. It is not, holy crap, I just got this patient, they're in a hospital gown, they're super sick, and they're doing a deadlift with a dumbbell in the hospital. It's not about that. It's not about being able to get the video of that or the picture of that and being able to share that. That is sexy and that is cool and it is badass. However, the meaning is deeper. What the attitude you need to have is, is that you have this beautiful, amazing opportunity to plant a fitness forward seed in this patient who is sick, who has a ton of medical complexity, and you only get to see them potentially one time. You've got one shot to plant that seed and potentially be the catalyst that sets this person up on a better trajectory of health. That's an amazing opportunity. And I would encourage you all to be obsessed with that opportunity. Okay. Every single time I would go into a room, I thought, wow, I have this opportunity. I've got one shot. I could be the catalyst that changes their lives. And the thing about you all who work in acute care, man, you are doing some dirty work, right? You are seeing folks, whether they're young or old, they have multiple types of diagnoses and medical complexities. You are seeing them at their worst and you are seeing them in a very, very vulnerable situation. The fact that you are able to plant that seed yet you don't get to see the sexy outcome and yet you give them your whole heart and whole soul is so important. And it's hard to be in acute care and know that you're not going to get to see a sexy discharge where a patient is lifting a super heavy barbell or they are going all out on an assault bike. You're not going to see that. And that's tough, but you have to reframe it to be, I'm going to be obsessed with having the attitude that I could go into every single one of these rooms, plant the seed, and the patient is able to walk into an outpatient clinic. They want to do fitness-forward care because I planted that seed. And I think that's an incredibly, incredibly important story to tell yourselves so that you can continue to have the motivation to go in and see these folks who are sick day after day. And many times you may not actually get to get them to do the cool fitness board stuff. Okay. So that's the most important thing is having that right attitude. Okay. TOOL #2 - A BACKPACK So the second tool that you're gonna need to bring along with you to every single room is a backpack, all right? You absolutely need a backpack. So this is not the backpack I used in acute care. I used the backpack that they gave us as like a Christmas gift one year. This is a Nomadic. This is my travel backpack. This is a very sturdy, but very expensive and nice backpack. I do not recommend getting something like this to go into hospital rooms, okay? But I do recommend that you get something that's sturdy because you're going to be carrying around a lot of stuff in it. So get yourself the backpack. So what are we putting in the backpack? You're going to put weights in the backpack. No, most acute care therapy offices do not have weights. But you can bring your own. So I would bring a 15 pound dumbbell. and an eight-pound dumbbell, and I would put that in my backpack. Now, some of you are not able to bring a backpack potentially into the patient's room. Cool, then you bring it around and you leave it at the nurse's desk, okay? But the idea here is that you're bringing everything with you so that there is no excuse that you don't have the equipment because you're in the hospital. So you have your weights. Now, I've had people say, well, Julie, isn't that tough to carry around? And I say, yes, it is tough, it's heavy, but who else would want to be able to go rucking through the hospital with weights more than fitness-forward clinicians who are here listening this morning? I thought it was awesome. I felt like I was getting a lot of fitness in by carrying this stuff around throughout the hospital all day. TOOL #3 - THE WHITEBOARD Okay, so after weights, you're gonna have a whiteboard, okay? I'm using a whiteboard right now for my talking notes for this podcast. you all are going to want to use a whiteboard to create workouts with your patient. So have your dry erase markers and as you are digging into their meaningful goals and you're coming up with functional movements that match those meaningful goals, you are writing this stuff down, you are coming up with reps and sets, you are doing this with your patient. Now, I will say, you're not going to buy these and leave these in patient's rooms, right? This stays with you, okay? You can take a picture of this and give it to your patient, or the really cool thing about acute care is that they typically have whiteboards in the patient's rooms, and they're usually filled with some random information many times they are covered up with Call don't fall signs Those become great whiteboards. Okay, so I usually they're not helpful We all can can agree that call don't fall signs are not something that prevents somebody from falling. So I they're great whiteboards so I would take those down turn them around and with my dry erase markers cut right down the whiteboard on those signs then I would leave that in the patient's room maybe I would go find a couple extras and I would put some motivational phrases on there like uh i remember one very specifically i'm trying to kick covid's ass so i can get home in shopwood something like that or something that lets the providers know a little bit more about this patient their name is something that i always put on these signs their name and something about them a goal an interesting fact i want to try and have every provider who walks into the room treat this person a little bit more like a human than a number or a diagnosis and that's a way to do that so whiteboard, slash use the hospital whiteboards, use those signs that are all around the room, turn them over, use those as your whiteboard. TOOL #4 - RESISTANCE BANDS Okay, next, resistance band and TheraBands. Okay, so both. So resistance band is something like this, okay? These offer a lot more resistance than a TheraBand. However, I usually would bring a bag of theravans because i want to be able to leave some with patience right you can do endless things with the TheraBands. I would tie them to the bed rails many times. So even folks who are typically they're just lying supine majority of the day because they're so deconditioned, you can tie those around on the bed rails. They can pull from above, they can pull from the side, there's a lot of stuff you can do with them just tying them to the bed rails. with the resistance bands, this is where I would many times get people up into standing and I would do something like a paloff press. So if they're standing here and this is attached to the bed rail, I can have them do a paloff press to work some core. I can have them do some rotations, you can do rows, you can do a whole bunch of stuff with those resistance bands, but those come with me. I'm not leaving those in the room. TOOL #5 - STICKY NOTES Okay, next are sticky notes. Okay, sticky notes are amazing because they're versatile. So I have sticky notes and then even better than sticky notes, I have a really bright, uh, note card. And then I've also used paint swatches that you can get for free at Lowe's or Home Depot. Okay. So what I do with sticky notes or these things, they become targets, right? So if I'm gonna have folks be reaching for things or stepping to things and maybe I'm calling out colors or I will write on a sticky note a number and then they're not only doing a motor task, they're also doing a cognitive dual task perhaps, These are great tools. They're light, they're easy, they're cheap. The other thing I like with the sticky notes is I'd like to put little notes on them for people. So if I'm using targets with a sticky note, perhaps to show them exactly where I want them to do their deadlift, pick the weight up from and put it down on, I will put a note here that just says like, you're a badass or never give up or something like that. And then that's something that the patient can keep. So they're wonderful for targets. They are wonderful to do some dual tasking. So you can have people reach for yellow or reach for a number that is written on one of the colors. So you can yell out the color or the number. Very versatile tools, very easy to carry around with you. TOOL #6 - GAIT BELTS All right, and then also obviously a gait belt. You need to have a gait belt. obvious reasons for safety but also i have used a gait belt before and i have put it around the bed rail and okay i have never ripped a bed rail off of anything by putting the gait belt around it and tugging on it okay so i'll just say that are they the most sturdy things in the world no i've never ripped one off so that's my preface there. But I have looped this around the bed rail and then perhaps someone is sitting in a wheelchair and they have a really hard time just sitting up tall in their wheelchair, their core is very weak, I will do almost a modified rope climb where the gait belt is around the bed rail and they are pulling themselves up to sit tall, and then going back to the back of their seat, the back of their wheelchair, and then pulling themselves up to sit tall. I've done this in home health, where I looped this to the end of the bed, the bed frame, what am I calling it, footboard. But typically, in acute care, there really isn't a big enough space in those footboards, maybe some of them, but definitely a really cool tool to use to do unmodified rope climb really get that core activated for someone who is so weak that they barely can even sit tall in their wheelchair. TOOL #7 - SNACKS Okay and then lastly You need snacks, okay? Don't forget your snacks. I became so much more efficient and so much more productive when I started bringing food up on the floor with me and putting that in my backpack. So, get you some nuts, get you a bar, a little bit of healthy sugars, maybe some, I always had like clementines or mandarins, those were one of my favorite snacks. Make sure that you have some fuel so you are not having to really put a big stop in the middle of your day. You're not going down to the cafeteria, getting crappy cafeteria food, and it just kind of keeps you focused. When you take that break and go down to get a snack or a coffee, I think it just puts you in that mindset of like, I'm going to just chill and not work as hard. When you just keep hammering throughout your day and you're able to do that because you have fuel, it's really important. Okay, so that is what I put in my backpack. All right, so let's talk about some specific acute care hacks to load up your patients when you don't use the weights. Okay, so let's throw the weights out. My favorite hack, one of them, is to use towels. All right, now this is a towel that I have soaked in water. All right, because a soaked up towel is really heavy compared to a towel that's not soaked in water. So I will roll a towel up and I will put it in the toiletry buckets that are in every single patient's room. So usually these buckets come with soaps and little doodads, things like that. I just get rid of that and I soak up towels and I put them in the basin. Now, you can do a whole bunch of stuff with this. So for someone even in sitting, even having to hold on to this basin, can be very challenging. We can increase the difficulty by going overhead. We can increase the difficulty by doing some marching in sitting. We can do a deadlift from sitting. We can then get up into standing and we can do a deadlift as well. So the great thing about this is it's a great way to introduce the hinge to a patient who is post-op lumbar fusion. Yes, I am loading up someone who is post-op lumbar fusion day one. Why? Because they're going to be discharged. They were probably never taught how to do a hinge in the first place, which contributed to them ending up having surgery. and I want to be the person to break that cycle, right? They're gonna go home, they gotta empty the dishwasher, lift up Fluffy's kitty litter box, whatever it is, why not teach them here and now? So I will put the towel in the basin, and then I will teach them how to properly hinge with an elevated surface in the basin. So I'm teaching them a hinge pattern, loading it up a little bit so that they know how to properly hinge when they go home, okay? And less amounts of things you can do with that basin. The next piece of equipment that I love are your bedside commode buckets. Yes, the things that poop usually goes in. But this is not what we're using them for. We are using clean bedside commode buckets, okay? So the cool thing, buckets, they usually have a handle, okay? So it makes it a lot easier to hold on to than potentially the basin. So what I will do is I will put a bunch of crap in the bucket. So I will put my weights in there or I will go and get a bunch of ankle weights because typically therapy departments and acute care have ankle weights, put them in the bucket and now we got some load. So you can do the same thing. You can deadlift with the bucket, okay? you could do my favorite, which are carries. Okay, so loaded carries. So as you're walking with your patient, they could carry on to the bucket. And the cool thing is that it adds a little bit of a perturbation. Okay, so they're getting an internal perturbation just by holding on to an object. There's a truck coming by, I'm sorry. I am out in my garage. and there is destruction going on in my neighborhood. And it's disruptive. So I'm gonna wait until they go by. Okay, they're hanging out. I'm just gonna talk louder. Okay, so with the bucket, Come on, my friends, keep it moving, keep it moving. Don't say no on a live podcast. Okay, with the bucket, what you can do is if someone is non-ambulatory, they can hold on to the bed rail and they can go like this, back and forth with that bedside commode bucket full of equipment and full of weights, okay? They could hold on to it, hold on to the bed rail and march, just like this. They can swing that bucket forward and backwards. There's a lot of things you can do with the bedside commode buckets to add in a little bit of a perturbation. Okay, lastly, we'll talk a little bit about how to put all this stuff together. So when you are with your whiteboard, right? And you're talking and you're sitting with your patient and you're figuring what movements that you're going to do. This is where you can start introducing what an EMOM is every minute on the minute. You could start introducing what a rounds for time is. So very, very early on, typically patients don't hear about this stuff or feel what intensity is like or load until they're way into their journey and they go into outpatient potentially, right? So the amazing thing is that you get to start introducing them to what a workout is like this early on. Imagine that seed that you've planted, then your patient will understand what it's like to lift heavy and to work hard. They go to home health or they go to inpatient rehab and then they go to outpatient and they're able to advocate for themselves and understand, okay, This is too easy. I don't need that yellow TheraBand or I'm not working hard enough. This isn't challenging enough for me. You are able to give them that opportunity, which is absolutely amazing. And remember, you can be the one that has an impact on them. Farther down the road, you are not going to see that sexy discharge, but you were able to be the catalyst to spark some change. Okay. All right, my friends, that is all. The next time I come on here, I will actually show you an example of like an EMOM or a rounds for time, some examples of what I would actually do with patients in acute care. I will also, on the ice stories, I will post some of my reels I made back when I was in acute care, going back into the archives. I will post on our story my reels that show some of this stuff in action. Lastly, talking about our courses that are coming up. MMOA Live will be in Alabama, we will be in Minnesota, Wyoming, and Oregon for the rest, not the rest of September, we're not in September yet, but in September, so many opportunities to catch us live on the road. Alright everyone, have a wonderful rest of your Wednesday. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Justin Dunaway // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Spine Division lead faculty Justin Dunaway takes a deep dive into a series of three studies tracking the same cohort of patients over 10 years and what they say about the importance of short term changes! Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our Persistent Pain Management course or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION JUSTIN DUNAWAYAll right, team, good morning. I am Justin Dunaway, lead faculty with the Institute of Clinical Excellence, coming at you live from Portland, Oregon. Welcome to another Clinical Tuesday. I am lead faculty for Total Spine Thrust and also our Persistent Pain Comprehensive Management course. 32nd cohort just began yesterday. So if you're thinking about jumping in that will the registration will remain open for another day or so So if you're thinking about it, go ahead and take a look But enough about that. Let's get into today's topic today we're gonna talk about full thickness a traumatic rotator cuff tears and looking at physical therapy or Surgery and what what kind of predicts that stuff? and it's really cool because it's a series of three studies over a decade that looked at the same same kind of cohort of humans and And while I'm going to talk a bunch about these three studies, realize that this really is more than a story about rehab for rotator cuff tears. This is really a story about the importance of our ability to demonstrate within session and between session change, early, often, and frequently. And at Ice, we often hear that we are obsessed with incessant change. We are obsessed with our ability to show short-term changes. And I couldn't agree with that sentence more. Like, totally. I am absolutely obsessed with that. The second half of that, though, which I don't agree with, is that short-term change, within-session change, those things don't matter. What we're really talking about is regression of mean or natural history. And short-term change doesn't predict long-term change. And I couldn't disagree with those sentences more on lots of different levels. But I think that the story I'm about to tell, the three studies that we're about to walk through, give some of the best evidence and support for the need for short-term and within-session change, for at least one of the many reasons why this stuff is so important. So let's dive in. First study, study number one, the effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears, multi-center prospective cohort study by Kuhn and Dunn, 2013. Mouthful. But basically what they did is they took a whole bunch of humans, 452 of them, that had full-thickness chronic degenerative rotator cuff tears, and all of them got six weeks of physical therapy. And then at the end of the six weeks, they were asked, you know, how are you doing? And they got one of three options. They could stay cured, in which case they were done, and we'll just check in at 12 weeks, and then at a couple time points over the next two years, or they're improved, in which case they would get another six weeks of physical therapy, or no better, and then they could opt for surgery. And then at the 12-week mark, the people that were left, that weren't cured in the first six, asked them the same question. If they were cured, awesome. If they were anything but cured, they were offered surgery, and then tracked over the next two years. The physical therapy protocol, I couldn't get my hands on the full version of Appendix A that went into detail about what they actually did, but in the study, in the methodology they just talked about doing the physical therapy was range of motion, was postural control, was scapular training, was mobilizations, was general strength training stuff. And I've got some thoughts on that and we'll dive into here in just a second. But the outcome here is what they found is that less than 25%, okay, full thickness chronic degenerative rotator cuff tears, less than 25% of the 452 people in the trial at the end of the 12 weeks needed surgery. At the six week mark, only 6% of people opted for surgery. At the 12 week mark, that number was up to 15. And then over the next two years, a few more trickled in and that went up to like 24%. So at gut shot, 75% of people with full thickness rotator cuff tears went on to have excellent results in pain, disability, range of motion, strength, functional stuff, and went totally back to life. That's awesome. That's huge, right? The second piece The thing I want to think about here, though, is I think that number could be a bit better, right? I'm going to make an assumption that once we dive into the exercise protocols there, were they really doing strength stuff? Were they really looking at multi-joint movements, overhead presses, rows, pushes, horizontal presses, things like that, and dosing them appropriately for strength? you know, thinking about low or high sets, low reps, two to three minute rest at roughly 80% of their calculated one rep max, or are they doing like three sets of 15 with a band? And call it strength. I have no idea. My assumption is that we probably could be a bit more aggressive with exercise, and I bet that number could get a bit better. But 75% is awesome. So let's run with that. And the conclusion of this first study, which is super important, That if I'm just gonna read the quote if a patient avoids surgery in the first 12 weeks He or she is unlikely to undergo surgery at a later time point up to 12 up to two years So this is the first point here if the patient doesn't opt for surgery in the first 12 weeks They're probably not going to get surgery so our ability to to show them functional improvements in the first six, in the first 12 weeks, is absolutely huge. Because if they don't feel like they need surgery at the end of the 12 weeks, they're not going to get it probably ever. And when we think about conservative management versus surgery, both these things can be effective. But there is massive risk to surgery, right? There's massive financial risk. It's super expensive. And then thinking about the risks of anesthesia, of something going wrong during the surgery, of infection, of interactions, adverse events with the medications, opioid addiction. All of these things are risks of surgery that don't exist in conservative management. Okay, so that's the first study. If you don't opt for surgery in the first 12 weeks, it's unlikely that you're going to. 75% of humans got totally back to life without needing surgery. Study number two, predictors of failure of non-operative treatment of chronic symptomatic full thickness rotator cuff tears. Same research team. This was published in 2016. Again, looking at the same cohort of 452 individuals, This time what they wanted to see is, okay, 25% of you failed conservative management, failed physical therapy. Why? Is there anything in there? Is there anything about you that predicts whether you will or won't do well with physical therapy? And this was really cool. So they looked at all the patient demographics. They looked at age, they looked at sex, they looked at pain, severity of the tear, disability, chronicity, activity levels. They looked at work status and education and handedness and really everything under the sun. And what they found, the first thing they found is that structural factors were not predictive at all. Tear didn't matter, pain didn't matter, disability didn't matter, what your MRI didn't look like. None of that stuff predicted whether you needed surgery or not. The number one most powerful and really only significant predictor of whether you went on to need surgery or not for your full thickness rotator cuff tear was belief that physical therapy wouldn't help you. That was it. If you believe physical therapy would help you, you succeeded, you didn't need surgery. If you didn't believe that, then you opted out and went for surgery. And then smoking status moved the needle just a little bit, which makes sense. If you're smoking, your body is widely inflamed. Things heal slower. Your pain systems are far more sensitive. And then the other thing that was a very small predictor was activity levels. If you had higher activity levels, you were slightly more likely to opt for surgery early. And that makes sense too, right? My shoulder hurts. I can't do all the things I want to do. I'm still trying to do them. Things aren't getting better quick enough. Give me the magic bullet. The important thing here, again, one, structure was not predictive. Two, the only real strong predictor was your belief in physical therapy. Now, this is where it gets interesting, right? If that is the thing that determines whether you get surgery in the first six to 12 weeks, or that's the thing that determines whether you get surgery, and most humans are gonna make that decision within the first six to 12 weeks, you cannot make the argument that within session change and short term changes don't matter and probably aren't the most important thing there is, right? Because I cannot, if the thing that determines whether you need surgery or not, whether you get into that MRI tube, whether you get in the OR suite, whether you're getting those injections, pills, things like that, is your belief that physical therapy can help you, I cannot think of a more powerful way to foster that relief than having some tools in my toolbox that when you walk in the door, very quickly, I can modulate your pain, I can change your pain, your pain pressure threshold, turn on painfully inhibited muscles, gain some access to proprioception, and then get out into the gym and do some things that actually build capacity in humans, and demonstrate that thing within session, and then session after session after session. Short-term change and within-session change are the things that get patients to believe in physical therapy. And belief in physical therapy is the thing that keeps the patient out of the OR. Simple as that. That is the most important tool we have to foster those beliefs. Okay, study number three. This one just came out like last month. The predictors of surgery for symptomatic, atraumatic, full thickness rotator cuff tears change over time. Same research team, again, looking at these same humans that were in this study. Now this is tracking them down 10 years later. The first thing that pops out is that at the 10 year mark, only 27% of these people went on to get surgery. So you think about that, at the two-year mark, it was around 24%. So just a few more people kicked into the surgery over the next two, between two years, year two and year 10. Most of them, over half, opted for surgery before the six-month mark, and then the rest of them slowly trickled in over the next 10 years, with it kind of being less and less each year down the road. At the six-month mark, And everything prior to that, the most predictive thing, again, whether you need surgery or not, was belief in physical therapy and nothing else, right? So those beliefs are gonna be powerful all the way up to the six month mark. Everything we can do in that window to convince patients. that this is the path they need is gonna be the thing that keeps them off the other path. Beyond six months, it doesn't switch to structure, it doesn't switch to pain and disability and any of that stuff. The only two predictors beyond six months were if you were on worker's comp, and again, if you reported high levels of activity. Now this is super important too, right? Because okay, we're six months, we're a year, we're two years, we're five years out. We've done physical therapy, it didn't work, we've kind of forgot about it, that's off the table. And now, the stuff that's really bugging us is the fact that, okay, we're still having trouble at work, we're on workers' comp, we're kind of in that system, we still have all these activities that we want to do that we can't do the way we want to do them, now it's time to do something else. It's important to realize that overall, at the 10-year mark, 70-ish percent of humans, again, didn't need the surgery. And this is an interesting bullet point, too, because one of the things that you'll frequently hear is that, great, people do well with conservative management for rotator cuff tears. But if you don't repair it anyway, you set the patient up for degenerative changes, arthritis, problems down the road. What this study showed us is that the 10-year mark, the 70% of humans that did well with conservative management 10 years ago in that six to 12-week PT window, All of them were successful. And the success that they gained 10 years ago didn't decline over time. They didn't have more disability. They didn't have increased pain or arthritis or things like that. Their gains stuck. And this is one of a few studies that look at conservative management for rotator cuff tears, track them out over long periods of time, and show that there is no negative mechanical effects from not repairing that thing. So, the important stuff here, the key clinical factors here, is that team, at the end of the day, beliefs and expectations are the foundation. They're everything. They're the thing that drive the decisions that patients make, right? And if we don't have the ability to demonstrate change to our patient, if we don't have the ability to show them, not just tell them, But show them time and time again, ruthlessly, within session and between sessions, slowly building up functional outcomes, session after session after session, they're not going to buy this. And if they don't believe in what they're doing, if they don't believe in physical therapy, if they don't think that this is the thing, that's the stuff that determines, OK, am I going to get shots? Am I going to be taking pain medications? Am I going to end up in the OR suite? We need, what this research tells me is that we really need to drill down on our ability to have tools in the toolbox that create quick, transient changes in pain, range of motion, muscle activation. And I get that that's transient, but what we're doing is we're open a window. And then once that window is open, we absolutely have to jump through it, get right into the gym and start doing the large functional movements that build capacity in humans. And then be ruthless about your comparable measures, your functional stuff between sessions and your objective stuff within sessions. and make sure that multiple times every session, you're showing patients change. In every session, when they walk in the door, you can show them change over time. This is where you started. This is where we were after the first week. This is where we were after the second week. The better we get at that, the better we get at demonstrating change in the moment and showing them incremental change over time in the short term, the better our odds of keeping these patients out of the surgical suite. If the only thing that separates these two groups, physical therapy or going under the knife, is their belief in the power of what we're doing in the clinic, then we have to invest everything we have in our ability to demonstrate those changes. All right, team, hope you're half as excited about these three studies as I am. I think it's a really cool thing to look at and then track these patients over the last 10 years. If you got any questions, throw them in the chat. Have an awesome day in the clinic, and I look forward to seeing you out there. OUTROHey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Alan Fredendall // #LeadershipThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Chief Operating Officer Alan Fredendall discusses using the reMarkable writing tablet to reduce daily documentation burden to 5 minutes per day Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about courses designed to start your own practice, check out our Brick by Brick practice management course or our online physical therapy courses, check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION ALAN FREDENDALLHow can we make our documentation more remarkable? Often a very boring topic, but a necessary topic as we are required by law to do a treatment note for every single patient that we see. So today we're going to talk about what is that law that requires us to do those notes. And then we're going to talk about new technology and a new way to think about documentation that's probably going to streamline everyone's documentation in a very significant manner. How can we potentially reduce our documentation burden to maybe five minutes per day? DO WE HAVE TO DO DOCUMENTATION? So first things first, what is that law that says we have to do a note for every patient that we treat? That law is actually the HIPAA law. Way back in 1996, the Health Information and Portability Accountability Act, or what we know as HIPAA. And so that has a lot of things in it about not sharing protected health information, about in 1996 the emergence of the internet and what we can and can't do with submitting patient data electronically. But the main thing it establishes is that we do need to do documentation on every single patient that we see, and that that documentation be available to be transmitted electronically via fax or email upon patient request. Prior to this law, we just basically handed over copies of paper documentation, and it could be a lengthy amount of time before patients could get access to their records. In this day and age, patients need our notes sometimes for things like reimbursement. If we're a cash-based practitioner and they're trying to get out-of-network reimbursement, they may need it to submit because they got the day off work or something like that. And so there's a lot of reasons why folks may need their documentation and why they may need access to it very, very quickly. So the HIPAA law of 1996 established that documentation must be available to be transmitted electronically immediately to patients or other providers with patient approval upon request. Some of you may have interacted with a patient who needed documentation because they were involved in an automobile accident or something like that and they need that documentation to then send on forward. HIPAA also mandates that we keep documentation for up to six years and that essentially means the best way to do that is to store it electronically instead of maybe in an old filing cabinet. Now the thing about HIPAA is it says that documentation must be available to be transmitted electronically via email or via fax, but what it does not say is that our documentation must be inherently electronic. Documentation can still be written as long as it is transferred or changed into an electronic format, stored for those six years, and then available upon demand to be sent when requested. And so we're going to talk about how that opens up freedom for us today to do documentation maybe in a very different way that we have not considered before. Before we get into that, what are the penalties for not following this? What if I don't do notes? What if I just never do notes? What if I'm a cash-based practitioner? I don't interact with other healthcare providers on a regular basis. My patients pay me cash. Most of them aren't asking for auto network reimbursement, so they're not trying to see those notes or see super bills or see claim forms or anything like that. You should know the penalties here are quite severe because we are dealing with a federal law and we are dealing with the federal government. So with HIPAA, they have a four-tier system for violations, Tier 1 through Tier 4. Tier 1 is the lightest punishment. Tier 4 is the highest punishment. Tier 1 is considered that you were not aware of what you were supposed to do, and that you could have not avoided what happened. Now, this is kind of in regards to maybe accidentally revealing protected health information, but also if you don't have documentation stored electronically, and you literally can't submit it to someone, and also that you didn't know that you had to do that. That little caveat that you're not aware that you committed a violation is going to be, the burden is going to be on to you to prove that. If you can prove that though, that you literally had no idea what you were supposed to do and you have no way to fix it, the penalty for that is only $100. Very, very light. But realistically, no one lives here, right? Everyone is aware of what they're supposed to do and probably has a way to reasonably fix it. And so we kind of immediately move up to Tier 2. Tier 2 is you're aware of what you were supposed to do, but there's no way that you could have avoided that violation. This is a very common area for us to live in, right? Let's say you finish with patients for the week on Friday afternoon, and then hey, you're catching a plane, you're going on vacation with your family for a couple weeks, but oops, in that couple weeks while you're gone, a patient requests a note from you. You are aware that you needed to comply with that, but you're just not able to do that, right? Your maybe physical note is sitting on your desk next to your computer at the clinic still. There is no way for you to convert that to an electronic format and then transmit it to the patient. that comes with a little bit steeper fine, that's a $1,000 fine each time that happens. And then we kind of move things very, very quickly when we get to tier three. Tier three is the tier where we start to use the term willful neglect, that you are aware you need to do this, you did not do it, but you are willing to catch up on all of the neglect that you have committed in the past. Now when this happens, the fine jumps up to $10,000, right, a tenfold increase. And then tier four is willful neglect, but you're not willing to correct it, right? You know you're supposed to do notes, you know you're supposed to store them electronically, but essentially you show a habit, you show a pattern of just not doing that, even maybe if you've gotten in trouble in the past. And so tier four is the most punishing tier. Tier four comes with a fine of $50,000 every time that happens, so a very severe penalty. And so when we talk about that in the context of our brick by brick class, when we're teaching people to open their practice, the easy rule is just do it, right? Don't try to butt heads and win an argument with the federal government. The fines are very severe. The penalties are very severe. Just do it as annoying as it is. And my second and third part of today's podcast is showing you that we can make it we can't get rid of it completely, but that we can make it quite simple. So let's talk about that right now. USING THE REMARKABLE  Let's talk about making your documentation remarkable with the remarkable. So if you're listening on the podcast right now and you're only hearing my voice, go over to our YouTube channel, the Institute of Clinical Excellence YouTube channel, and find the video of this so you can see what I'm doing. So this is a Remarkable. I'll close it up for you. It's got just a little folio and then it opens up and it's essentially just a tablet, right? This does allow finger input, but more importantly, it comes with a very nice stylus that lets you write the same as if you were writing on paper. So what we have been trialing here at our clinic in Michigan is using the Remarkable to replace our electronic documentation. So you can see what I have on here is I have a bunch of body chart templates. And so we have a folder for every day of the week stored on this tablet. And then we have body charts for every patient that has come into the clinic for treatment that day. So let me open up a brand new template for you all to look at. And now you can see here is our body chart template, just like we used to do on physical paper. Now it is on this tablet. We can write all over this thing. We can write eggs and eases. We can shade body charts so we can do our subjective and objective when patients come back into the clinic. And then the nice thing is with remarkable, we can add blank pages so we can itemize our manual therapy. And we can write all over this thing. And whatever we want to itemize, should we choose so can also be included in this template. And so what's nice is as soon as I finish this, it's automatically saved as a PDF, both on this tablet. But more importantly, it is saved back to a laptop or desktop computer. And I'm going to tell you in a second how we can put the tablet together with your EMR and basically have your documentation burden fall off a cliff in a really nice way. INTERLUDE So before we do that, I just want to take a break, introduce myself. My name is Alan. I am the Chief Operating Officer here at ICE. This is Leadership Thursday. We talk all things small business management, practice management ownership, tips and tricks. I am the lead faculty in our fitness athlete division, so you'll see me on Fridays for Fitness Athlete Fridays, and also the lead faculty in our practice management division, where we talk about all things related to practice management in our brick by brick course. It is leadership Thursday, that means it's gut check Thursday. This one, very simple, 30-20-10, toes to bar, paired with single arm devil's press. Rx weight for gentlemen, a 35 pound dumbbell. Ladies, a 20 pound dumbbell. And then just to make it hurt a little bit worse, you're gonna do a 400 meter run after each round. I tested that workout last weekend. I think I came in somewhere around 11 minutes. So not as fast and intense as last week. And then our Brick by Brick course starts up again on October 2nd. That class always sells out. Our current cohort is finishing up week six, talking about Medicare, talking about documentation, doing a deep dive into the stuff that we're gonna talk about. SYNCING NOTES TO YOUR EMR So how do we put our knowledge that we need to do documentation, it needs to be electronically available, with something like the Remarkable tablet. And the nice thing about Remarkable, like we talked about, is that when you finish a document on the tablet, and you close it out, it automatically syncs via the cloud to an app on your laptop or desktop computer, and that document is available immediately. So our previous documentation system, we would still do paper body charts, we would come back to our EMR, and we would hand type our notes. And that was okay. That maybe took three to five minutes for daily note, maybe 10 minutes for initial evaluation. That is all gone now, right? Because we have our body chart on the, on the remarkable and now we're doing electronically and it is updating to our computer in real time. What does that mean? That means we no longer need to come back to the computer and hand type our notes. It also means for maybe some of you that we're doing that and maybe taking a picture of your body chart or scanning it into your printer, that is okay. But again, that is a lot of burden, right? That's a couple more minutes per patient. What's great about Remarkable is that document, that body chart is available immediately as a PDF on your desktop that you can simply upload into the patient's chart on your EMR. And so now our documentation, all of the boxes of our soap note just says see PDF from this date, right? We are no longer typing. That carries over from daily visit to daily visit, see PDF this date, see PDF this date. And in that patient's chart of that date is August 1st, 2024, August 7th, 2024. And it is a PDF copy of the body chart and it is HIPAA compliant, right? It's electronically available and it has all the stuff that documentation needs to be sound and legally compliant, right? It has a subjective, it has objective, it has assessment, it has plan, it has some itemized treatment to justify if we're gonna bill insurance, for example, why we're billing insurance and for how much. And so for us, switching to this system has reduced our total documentation load to about five minutes per day, which is really, really, really incredible when you think about it. We already had given two hours in the workday for admin time, following up with patients, documentation, that sort of thing, and now that administrative burden has reduced down to about five minutes a day. And so that's just extra time that our therapists have that's not spent typing stuff that they have already written down on a paper body chart anyways. What's nice about this, this remarkable system is that you can take it into the treatment room and it looks no different than if you have a body chart on a clipboard or something like that. It's not as intrusive as a laptop. Obviously it's not as annoying as typing, right? just chipping away and typing as somebody's trying to talk to you. It's very, very low maintenance and it's really awesome. Now, what are the cons of this? There are some cons. They are expensive. They're about $500. I have asked for a coupon. I have asked if they do volume discounts. They do not do any of that. They know what they're doing. So there is a con of the price. And then the other con is that this thing is really kind of worthless outside of this specific niche, right? Unless you happen to want to journal on it, unless you happen to hand write a lot of other stuff in your life that you also wish could be available immediately electronically, the remarkable doesn't have a lot of value for you. That being said, We love how nice it writes. It writes the same as paper. We love that because it really can't do anything else, it has a super long battery life as well. So we have transitioned our documentation system to that and we're very, very happy with it. So with documentation, HIPAA law requires that we do documentation for every single patient, that there is a penalty if we don't do that, and that we should probably follow that unless we wanna get in trouble. But there are different ways to think about doing documentation other than just typing forever into those boxes on your EMR. That this might seem like a step backwards, because we're writing now, but because of the technology that powers the Remarkable, because it is available instantly as an electronic PDF, and can significantly speed up your documentation time. So give it a shot. The company's name is literally remarkable. Look it up. There are a lot of other competitors emerging as well. And I'm sure in the next couple of years, we'll see more of these become prevalent. Writing on these has on electronic devices has been around for a while. Many of you may remember the Palm Pilot. However, you know, it had a two inch screen and you couldn't read what you wrote. So this is a significant step forward. The writing is beautiful. We're very happy with it. And if you try it out, let me know how it goes. So make your documentation remarkable. Hope you have an awesome Thursday, a great weekend. Have fun with Gut Check Thursday. See you later, everybody. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.