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Equitable tele-neurologic care starts with first identifying disparities, then identifying how to overcome them – learn about both with Dr. Lee Schwamm on the latest ANA Investigates. Series 3, Episode 11. Featuring: Guest: Dr. Lee Schwamm, C Miller Fisher Endowed Chair in Vascular Neurology and the Director of the Center for TeleHealth at Massachusetts General Hospital, Professor of Neurology at Harvard Medical School and Vice President for Digital Patient Experience at the Mass General Brigham Health System. Interviewer/Producer: Amanda Jagolino-Cole, Director of the UT Teleneurology Division at McGovern Medical School at the University of Texas Health Science Center in Houston. Disclosures: None

Dr. Darren Schneider and Dr. Joseph Mills recently participated in the Vascular Leaders Forum: Drug Elution in Peripheral Artery Disease (PAD): A Critical Analysis from a Multispecialty Consortium on March 1-2, 2019 and take time tell us what they heard and how it has impacted their practice. Darren Schneider, MD (@VascularMD) is Chief of Vascular and Endovascular Surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.  He completed his training and was on faculty at the University of California, San Francisco and has extensive experience in minimally invasive vascular procedures and research interests in the design and development of endovascular devices for the treatment of aortic aneurysm and peripheral arterial diseases. Disclosures: None. Joseph Mills, MD (@jmills1955) is Professor and Chief of the Division of Vascular Surgery & Endovascular Therapy at the Baylor College of Medicine.  He has held numerous leadership positions in vascular surgery, is co-editor for Rutherford’s Vascular Surgery and is most well known for his work in developing the WIfI wound criteria for critical limb ischemia. Disclosures: None (04:15) Risk of Death Following Application of Paclitaxel‐Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials (11:30) FDA UPDATE: Treatment of Peripheral Arterial Disease with Paclitaxel-Coated Balloons and Paclitaxel-Eluting Stents Potentially Associated with Increased Mortality - Letter to Health Care Providers (12:30) Coronary stents - SPIRIT trial

Course: Newborn Care and Delivery Room Management Part 2 – Cardiology  Course Director: Tony R Tarchichi M.D.  - Assistant Professor in Dept of Pediatrics Course Director: Arcangela Balest M.D. - Assistant Professor in Dept of Pediatrics  Course Director: Guarav Arora M.D. - Associate Professor in Dept of Pediatrics   Disclosures: None   This Podcast series was created for Pediatric Hospitalists or those healthcare professionals who take care of hospitalized children.    This episode is on Newborn Care and Delivery Room Management Part 2 – Cardiology . As always there is free CME credit of up to 1 AMA category 1 for listening to this podcast and going to the Univ of Pitt site. See the link below.     ______________________________________________________ Objectives: Upon completion of this activity, participants will be able to: Review literature on infants in newborn nursery with only murmur. Review Pulse ox screening in newborn nursery. Review management of cyanotic newborn born and differentiating congenital heart disease vs primary pulmonary vs persistent pulmonary hypertension of the newborn as the cause. ______________________________________________________ Released:  8/10/2018,   Reviewed 8/10/2018, Expire: 8/10/2019   If you are new to the Internet-based Studies in Education and Research (ISER) website (which is how you will get your CME credit), you will first need to create an account:   Step 1. Create an Account https://www.hsconnect.pitt.edu/HSC/home/create-account.do   If you have used the ISER website in the past, you can click on the link below and then log onto in order to complete the evaluation for this training:   Step 2. To access the test for CME credit: https://cme.hs.pitt.edu/ISER/servlet/IteachControllerServlet?actiontotake=loadmodule&moduleid=19613   Accreditation Statement: The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.   The University of Pittsburgh School of Medicine designates this enduring material for a maximum of  (1)  AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Course: Neonatal Drug Withdrawl Course Director: Tony R Tarchichi M.D.  - Assistant Professor in Dept of Pediatrics Course Director: Arcangela Balest M.D. - Assistant Professor in Dept of Pediatrics    Disclosures: None   This Podcast series was created for Pediatric Hospitalists or those healthcare professionals who take care of hospitalized children.    This episode is on Neonatal Drug Withdrawl . As always there is free CME credit of up to 1 AMA category 1 for listening to this podcast and going to the Univ of Pitt site. See the link below.      _______________________________________________________________ Objectives: Upon completion of this activity, participants will be able to: Recognize how the opioid crisis is increasing Neonatal drug withdrawal. Recognize toxicity and withdraw states of neonates from prescription and drugs of abuse in the mother. Review options for treatment for neonatal drug withdrawal. • Released:  3/28/2018,   Reviewed 3/28/2018, Expire: 3/28/2019   If you are new to the Internet-based Studies in Education and Research (ISER) website (which is how you will get your CME credit), you will first need to create an account:   Step 1. Create an Account https://www.hsconnect.pitt.edu/HSC/home/create-account.do   If you have used the ISER website in the past, you can click on the link below and then log onto in order to complete the evaluation for this training:   Step 2. To access the test for CME credit: https://cme.hs.pitt.edu/ISER/servlet/IteachControllerServlet?actiontotake=loadmodule&moduleid=19055   Accreditation Statement: The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.   The University of Pittsburgh School of Medicine designates this enduring material for a maximum of  (1)  AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Course: Newborn and Delivery Room Care Part 1 - from the PHM Core Competencies Course Director: Tony R Tarchichi M.D.  - Assistant Professor in Dept of Pediatrics Course Director: Arcangela Balest M.D. - Assistant Professor in Dept of Pediatrics    Disclosures: None   This Podcast series was created for Pediatric Hospitalists or those healthcare professionals who take care of hospitalized children.    This episode is on Newborn and Delivery Room Care Part 1 - from the PHM Core Competencies . As always there is free CME credit of up to 1.5 AMA category 1 for listening to this podcast and going to the Univ of Pitt site. See the link below.      _______________________________________________________________ Objectives: Upon completion of this activity, participants will be able to: Review the personnel and describe the role for everyone needed in the delivery room describe the skills necessary to be an effective leader. Review Group B Streptococci screen in mother and early infection concerns and management in a newborn. Review neonatal hypoglycemia and management. • Released:  3/2/2018,   Reviewed 3/2/2018, Expire: 3/2/2019   If you are new to the Internet-based Studies in Education and Research (ISER) website (which is how you will get your CME credit), you will first need to create an account:   Step 1. Create an Account https://www.hsconnect.pitt.edu/HSC/home/create-account.do   If you have used the ISER website in the past, you can click on the link below and then log onto in order to complete the evaluation for this training:   Step 2. To access the test for CME credit: https://cme.hs.pitt.edu/ISER/servlet/IteachControllerServlet?actiontotake=loadmodule&moduleid=18973     Accreditation Statement: The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.   The University of Pittsburgh School of Medicine designates this enduring material for a maximum of  (1.5)  AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Course: Flu vaccine update and Oseltamivir discussion Course Director: Tony R Tarchichi M.D.  - Assistant Professor in Dept of Pediatrics Course Director: John Williams M.D. - Professor in Dept of Pediatrics   Disclosures: None   This Podcast series was created for Pediatric Hospitalists or those healthcare professionals who take care of hospitalized children.    This episode is on Flu vaccine update and Oseltamivir discussion. As always there is free CME credit of up to 1 AMA category 1 for listening to this podcast and going to the Univ of Pitt site. See the link below.      _______________________________________________________________ Objectives: Upon completion of this activity, participants will be able to: Discuss this year’s flu vaccine and how effective it is. Discuss Oseltamivir and review the literature on its effectiveness against the flu virus Review the CDC recommendations regarding Oseltamivir usage in pediatrics. • Released:  12/23/2017,   Reviewed 12/23/2017, Expire: 12/23/2018   If you are new to the Internet-based Studies in Education and Research (ISER) website (which is how you will get your CME credit), you will first need to create an account:   Step 1. Create an Account https://www.hsconnect.pitt.edu/HSC/home/create-account.do   If you have used the ISER website in the past, you can click on the link below and then log onto in order to complete the evaluation for this training:   Step 2. To access the test for CME credit: https://cme.hs.pitt.edu/ISER/servlet/IteachControllerServlet?actiontotake=loadmodule&moduleid=18393   Accreditation Statement: The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.   The University of Pittsburgh School of Medicine designates this enduring material for a maximum of  (1)  AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Course: Child Abuse - Review from the PHM Core Competencies Course Director: Tony R Tarchichi M.D.  - Assistant Professor in Dept of Pediatrics Course Director: Rachel Berger M.D. - Professor in Dept of Pediatrics   Disclosures: None   This Podcast series was created for Pediatric Hospitalists or those healthcare professionals who take care of hospitalized children.    This episode is on Child Abuse - Review from the PHM Core Competancies. As always there is free CME credit of up to 1.25 AMA category 1 for listening to this podcast and going to the Univ of Pitt site. See the link below.      _______________________________________________________________ Objectives: Upon completion of this activity, participants will be able to: To understand the definition of Child Abuse & how federal and state law affects it. To review the appropriate workup for a child suspected of child abuse To review child protective services and how they work, their limitations and how our interaction with them affects how they can protect a child. To review the core competencies on child abuse for pediatric hospital medicine. • Released:  12/10/2017,   Reviewed 12/10/2017, Expire: 12/10/2018   If you are new to the Internet-based Studies in Education and Research (ISER) website (which is how you will get your CME credit), you will first need to create an account:   Step 1. Create an Account https://www.hsconnect.pitt.edu/HSC/home/create-account.do   If you have used the ISER website in the past, you can click on the link below and then log onto in order to complete the evaluation for this training:   Step 2. To access the test for CME credit: https://cme.hs.pitt.edu/ISER/servlet/IteachControllerServlet?actiontotake=loadmodule&moduleid=18313     Accreditation Statement: The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.   The University of Pittsburgh School of Medicine designates this enduring material for a maximum of  (1.25)  AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Course: Pediatric Community Acquired Pneumonia Course Director: Tony R Tarchichi M.D.  - Assistant Professor in Dept of Pediatrics, University of Pittsburgh School of Medicine. Course Director: Samir Shah M.D. - Professor of Pediatrics at the University of Cincinnati College of Medicine and Director of Division of Hospital Medicine and an Attending Physician in Hospital Medicine and Infectious Diseases at Cincinnati Children’s Hospital Medical Center.      Disclosures: None   This Podcast series was created for Pediatric Hospitalists or those healthcare professionals who take care of hospitalized children.    This episode is on Pediatric Community Acquired Pneumonia. As always there is free CME credit of up to 1.25 AMA category 1 for listening to this podcast and going to the Univ of Pitt site. See the link below.      _______________________________________________________________ Objectives: Upon completion of this activity, participants will be able to: Review the pediatric community acquired pneumonia guidelines. Review when blood cultures are appropriate in managing inpatient pneumonia. Review the micro-biological causes of community acquired pneumonia for the pediatric inpatient. • Released:  09/27/2017,  Reviewed 09/27/2017, Expire: 09/27/2018   If you are new to the Internet-based Studies in Education and Research (ISER) website (which is how you will get your CME credit), you will first need to create an account:   Step 1. Create an Account https://www.hsconnect.pitt.edu/HSC/home/create-account.do   If you have used the ISER website in the past, you can click on the link below and then log onto in order to complete the evaluation for this training:   Step 2. To access the test for CME credit: Pediatric Hospital Medicine - Pediatric Community Acquired Pneumonia https://cme.hs.pitt.edu/ISER/servlet/IteachControllerServlet?actiontotake=loadmodule&moduleid=17853 Accreditation Statement: The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.   The University of Pittsburgh School of Medicine designates this enduring material for a maximum of  (1.25)  AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.   Read more at http://pedhospmed.libsyn.com/#s85rxlC3ohA8FKwX.99

Course: Choosing Wisely in Pediatrics- Safely Doing Less Course Director: Tony R Tarchichi M.D.  - Assistant Professor in Dept of Pediatrics, University of Pittsburgh School of Medicine Course Director: Ricardo Quinonez M.D. - Associate Professor in Dept of Pediatrics, Baylor College of Medicine,    Disclosures: None   This Podcast series was created for Pediatric Hospitalists or those healthcare professionals who take care of hospitalized children.    This episode is on Choosing Wisely in Pediatrics- Safely Doing Less. As always there is free CME credit of up to 1.25 AMA category 1 for listening to this podcast and going to the Univ of Pitt site. See the link below.      _______________________________________________________________ Objectives: Upon completion of this activity, participants will be able to: Identify and be able to explain errors of omission & errors of commission. Define and identify Overuse.  Explain the term Over-Diagnosis and how it affects health care expenditures and patient care.  • Released:  07/01/2017,   Reviewed 07/01/201, Expire: 07/01/2018   If you are new to the Internet-based Studies in Education and Research (ISER) website (which is how you will get your CME credit), you will first need to create an account:   Step 1. Create an Account https://www.hsconnect.pitt.edu/HSC/home/create-account.do   If you have used the ISER website in the past, you can click on the link below and then log onto in order to complete the evaluation for this training:   Step 2. To access the test for CME credit: https://cme.hs.pitt.edu/ISER/servlet/IteachControllerServlet?actiontotake=loadmodule&moduleid=17453 Accreditation Statement: The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.   The University of Pittsburgh School of Medicine designates this enduring material for a maximum of  (1.25)  AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity. Read more at http://pedhospmed.libsyn.com/#uyIftLmBscC9LQBM.99

Course: Pediatric Hospice & Palliative Care Review from the PHM Core Competencies Course Director: Tony R Tarchichi M.D.  - Assistant Professor in Dept of Pediatrics Course Director: Scott Maurer M.D. - Associate Professor in Dept of Pediatrics   Disclosures: None   This Podcast series was created for Pediatric Hospitalists or those healthcare professionals who take care of hospitalized children.    This episode is on Pediatric Hospice & Palliative Care from the PHM Core Competancies. As always there is free CME credit of up to 1.25 AMA category 1 for listening to this podcast and going to the Univ of Pitt site. See the link below.      _______________________________________________________________ Objectives: Upon completion of this activity, participants will be able to: Discuss the differences between Palliative & Hospice Care.  Discuss the differences between interdisciplinary care and multidisciplinary care.  Discuss local, regional & national resources for pediatric palliative & hospice care that are accessible to patients, caregivers, and healthcare providers.  • Released:  05/4/2017,   Reviewed 05/4/2017, Expire: 05/4/2018   If you are new to the Internet-based Studies in Education and Research (ISER) website (which is how you will get your CME credit), you will first need to create an account:   Step 1. Create an Account https://www.hsconnect.pitt.edu/HSC/home/create-account.do   If you have used the ISER website in the past, you can click on the link below and then log onto in order to complete the evaluation for this training:   Step 2. To access the test for CME credit: https://cme.hs.pitt.edu/ISER/servlet/IteachControllerServlet?actiontotake=loadmodule&moduleid=17233   Accreditation Statement: The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.   The University of Pittsburgh School of Medicine designates this enduring material for a maximum of  (1.25)  AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Course: Acute Hematogenous Osteomyelitis. Course Director: Tony R Tarchichi M.D.  - Assistant Professor in Dept of Pediatrics Course Director: Michael Green, M.D., M.P.H - Professor in Dept of Pediatrics   Disclosures: None   This Podcast series was created for Pediatric Hospitalists or those healthcare professionals who take care of hospitalized children.    This episode is on Acute Hematogenous Osteomyelitis with a focus on treatment - prolonged IV vs early transition to oral therapy. As always there is free CME credit of up to 1.0 AMA category 1 for listening to this podcast and going to the Univ of Pitt site. See the link below.       _______________________________________________________________ Objectives: Upon completion of this activity, participants will be able to: •   Internet-based Studies in Education and Research Review the epidemiology, clinical findings and diagnostic testing for Acute Hematogenous Osteomyelitis. Complete a literature review on IV versus early transition to oral therapy for Acute Hematogenous Osteomyelitis Determine when an infectious disease consult is important. • Released:  01/13/2017,   Reviewed 01/13/2017, Expire: 01/05/2018   If you are new to the Internet-based Studies in Education and Research (ISER) website (which is how you will get your CME credit), you will first need to create an account:   Step 1. Create an Account https://www.hsconnect.pitt.edu/HSC/home/create-account.do   If you have used the ISER website in the past, you can click on the link below and then log onto in order to complete the evaluation for this training:   Step 2. To access the test for CME credit: https://cme.hs.pitt.edu/ISER/servlet/IteachControllerServlet?actiontotake=loadmodule&moduleid=16552   Accreditation Statement: The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.   The University of Pittsburgh School of Medicine designates this enduring material for a maximum of  (X.x)  AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.  

Summary: Fifty four percent of physicians report at least one symptom of burnout. On this episode Dr. Philip Kroth an Internist and Chief of Clinical Informatics from the University of New Mexico schools us on how electronic health records (EHR) relate to burnout and tips to promote physician wellness. Miss this episode and you might get burned...out. I refuse to apologize for that pun. Enjoy!   Clinical Pearls: *Check out the article by Shanafelt below to view breakdown of burnout by specialty. *24/7 access to EHRs is a double-edged sword. You have to protect your own time. *Turn off email alerts. *Limit your screen time when off the clock. Kids are only allowed 1 hour per day! *Take the EHR training and become a MASTER. *Keep in mind these four domains related to burnout and try to mitigate your risk. Health information technology and documentation burden Stress versus control and support. You need to balance the “seesaw” Health policy and regulation (e.g. ACOs, MACRA) Physician culture of endurance (e.g. giving yourself an IV when sick instead of going home) Disclosures: None reported. Links from the Show: 1. Article by Shanafelt finding burnout in 54 percent of physicians. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014 Shanafelt, Tait D. et al. Mayo Clinic Proceedings , Volume 90 , Issue 12 , 1600 - 1613 2. Turnover of primary care doctors cost about $250,000 in 1991! Buchbinder, SB et al. Estimates of Costs of Primary Care Physician Turnover. Am J Manag Care. 1999 Nov;5(11):1431-8. 3. Maslach Burnout Inventory http://www.mindgarden.com/117-maslach-burnout-inventory 4. Volkswagen stops sending emails in the evening. http://www.bbc.com/news/technology-16314901