Ridgeview Podcast: CME Series Ridgeview

In this podcast, Dr. Natalie Stoltman - a primary care physician with Lakeview Clinic, brings pearls and highlights around the topics of: behavior weight loss interventions in older adults, falls risk and increasing medications, chronic pain management in older adults, and current concepts of diabetes management in the post-acute and long-term care setting.
Enjoy the podcast.
Objectives:
Upon completion of this podcast, participants should be able to:
Summarize the latest standards in regards to care in geriatric medicine. Identify and review interventions targeting geriatric obesity. Identify falls risk enhancing drugs and ways for deprescribing. Summarize the updates provided related to chronic pain management in geriatrics. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org.
Click the link below, to complete the activity's evaluation.
CME Evaluation
(**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.) 

DISCLOSURE ANNOUNCEMENT 
The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws. 
It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented.
Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event.
Thank-you for listening to the podcast.
SHOW NOTES: 
*See the attachment for additional information. 
Major Themes:  deprescribing medications, poly pharmacy, individualization of care and a tailored approach, and the need for a multidisciplinary team.
Beyond Behavior Weight Loss Intervention in Older Adults
- Impact and Impairments
- How to begin: "diet takes on new connotation in the elderly"
- Weight loss interventions/behavior modifiations
- Weight loss interventions - medications
- Weight loss surgeries (Roux-n-y/Sleeve gastrectomy)
- Multidisciplinary team
Getting Rid of "FRIDS" or Fall Risk Increasing Drugs
-  More than 30% of older adults fall
- Deprescribing
Managing Chronic Pain in Older Adults
- Classification of pain (nociceptive /neuropathic /nociplastic)
- Pain evaluation
- Nonpharmocologic interventions
- Pharmacological
Current Concepts of Diabetes Management in the Post-Acute and Long-term Care Setting
- Patient

In this podcast, Dr. Jon Cole - an emergency medicine physician with Hennepin Healthcare and medical director with Minnesota Poison Control Center and Samantha Lee, PharmD - managing director with Minnesota Poison Control Center discuss the poison control system - past and present; along with a disscusion around toxicology - the big, the bad, and the ugly.
Enjoy the podcast.
Objectives:
Upon completion of this podcast, participants should be able to:
Describe the purpose of the Minnesota Poison Control Center, and how it works. Name the most common call types coming into MN Poison Control Center. Summarize the management of toxicological exposures for APAP, bupropion and calcium channel blockers. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org.
Click the link below, to complete the activity's evaluation.
CME Evaluation
(**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.) 

DISCLOSURE ANNOUNCEMENT 
The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws. 
It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented.
Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event.
Thank-you for listening to the podcast.
SHOW NOTES: 
*See the attachment for additional information. 
HISTORY of MN POISON CONTROL CENTER
TOXICOLOGY
Calcium Channel Blockers
- Diltiazem, Verapamil, Amlodipine
- Causes bad distributive shock
- Pulmonary edema is an issue
- Norepinephrine infusion is recommended in setting of shock with high dose insulin simultaneously
- "Red, white and blue" therapy for refractory Ca++ blocker overdose
- Activated charcoal - not for all patients, give if patient not at risk of aspiration for potentially lethal ingestions
Bupropion
- Chemical structure similar to amphetamine and bath salts
- Sympathomimetic effects (tachycardia, agitation, seizures, ultimately cardiogenic shock)
- Treatment with benzodiazepines - usually high dose - may need intubation
- Norepinephrine for cardiogenic shock
- ECMO may be needed
Sodium Nitrite
- Salt used to cure meats
- Internet suicide phenomenon
- Effect: Life threatening methemoglobinemia

In this podcast, Dr. Michelle Haroldson, a hospitalist and a sleep medicine physician with Ridgeview's Sleep Clinic, talks about sleep and why it is important, specific sleep conditions and various treatments.
Enjoy the podcast.
Objectives:
Upon completion of this podcast, participants should be able to:
Summarize the importance of sleep for physical health and wellness Identify barriers to (impacts upon) sleep Identify treatment options for sleep disorders. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org.
Click the link below, to complete the activity's evaluation.
CME Evaluation
(**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.) 

DISCLOSURE ANNOUNCEMENT 
The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws. 
It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented.
Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event.
Thank-you for listening to the podcast.
SHOW NOTES: 
*See the attachment for additional information. 
How do we break the cycle of burnout? Approximately 50% of burnout is present with clinicians prior to COVID.
Why sleep is important
- 1/3 of an individual's life is spent sleeping.
- Sleep is when the body resets, restores, and heals
- Higher mortality rates may occur with those who sleep less than 6 hrs a night.
- Optimal sleep window is 6.5 to 8.5 hours a night.
Stages of Sleep
- 4 stages (Light sleep, slow wave, dream sleep)
- Sleep architecture
-Shift work
REM sleep
- what happens during this sleep stage
Sleep conditions/disorders
- Narcolepsy
- Sleep walking
- Dream enactment
- Sleep apnea
- Sleep talking
- Snoring
- Kleine-Levin
Why see a sleep specialist
- People are paying attention to their sleep
- Sleep study
Impacts upon sleep
- Society's values on sleep
- Blue wave light
- Lack of sleep associated with major accidents
How to improve sleep
- Decide sleep is a priority
- Appropriate bedtime
- Decreasing exposure to blue wavelength light
- Remove light from sleeping environment
- Sleep temperature
- White noise
- Sleep zone
Medications that affect sleep (for better or wo

In this special podcast, discussions occur around the impact of physician burnout. Dr. Michelle LeClaire, a critical care physician with Minnesota VA Medical Center, discusses her first hand account of provider burnout, how burnout is measured, how we can affect change with physician champions and wellness programs, moral distress, residue, injury and gender discrepancies in medicine, and discussions occur around the culture, healthcare organizations, patient complexity, and how a pandemic can affect and lead to burnout. 
Enjoy the podcast.
Objectives:
Upon completion of this podcast, participants should be able to:
Identify hallmarks of burnout and implications of burnout in clinicians. Define moral distress and moral injury. Describe gender discrepancies in medicine and burnout rates among gender. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org.
Click the link below, to complete the activity's evaluation.
CME Evaluation
(**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.) 

DISCLOSURE ANNOUNCEMENT 
The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws. 
It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented.
Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event.
Thank-you for listening to the podcast.
SHOW NOTES: 
*See the attachment for additional information. 
How do we break the cycle of burnout? Approximately 50% of burnout is present with clinicians prior to COVID.
Mini Z
Asks 10 questions:
1.  Overall  "I am satisfied with my current job."
2. "I feel a great deal of stress because of my job."
3. "Using your own definition of 'burnout', please circle one of the following answers below:
      a) I enjoy my work. I have no symptoms of burnout.
      b) I am under stress and don't always have as much energy as I did, but I don't feel burned out.
      c) I am definately burning out and have one or more symptoms of burnout (e.g. emotional exhaustion).
      d) the symtpms of burnout that I am experiencing won't go away. I think about work frustrations a lot.
      e) I feel completly burned out. I am

This podcast, Dr. Lucas Dingman and Dr. Cady Welch, emergency medicine physicians with EMPAC and Ridgeview, discuss six articles on various topics related to emergency medicine, as part of this first ED journal review.
Enjoy the podcast.
Objectives:
Upon completion of this podcast, participants should be able to:
Identify emergency medicine journal articles that may be potentially practice-changing Describe how to rule out a pulmonary embolism (PE) in the emergency department using the YEARS criteria and age adjusted d-dimer. Differentiate when antibiotics for treating diverticulitis is warranted. Describe the benefits of using a small percutaneous catheter chest tube for treating a traumatic hemothorax. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org.
Click the link below, to complete the activity's evaluation.
CME Evaluation
(**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.) 

DISCLOSURE ANNOUNCEMENT 
The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws. 
It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented.
Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event.
Thank-you for listening to the podcast.
SHOW NOTES: 
*See the attachment for additional information. 
Study #1: 
Efficacy and Safety of Nonantibiotic Outpatient Treatment in Mild Acute Diverticulitis (DINAMO-study) A Multicentre, Randomised, Open-label, Noninferiority Trial
- DINAMO study & diverticulitis
- Multicenter, randomized, open label, non-inferiority trial (Nov.2016 - Jan.2020)
- 480 randomized participants  and put into two groups
- Results: admission to hospitals, ED revisits, no complications, no major significant findings
- Nonantibiotic outpatient treatment of mild acute diverticulitis is safe and effective and is not inferior to current standard treatment.
Study #2: 
Anterior–Lateral Versus Anterior–Posterior Electrode Position for Cardioverting Atrial Fibrillation
- EPIC Atrial Fibrilation ( EPIC AF)
- Two positions for pad placement for cardioverting patients
- Multicenter, randomized, open label trial
- 467 randomized patients, sch

This podcast, Dr. Peter Eckman, a cardiologist and heart failure specialist, with Minneapolis Heart Institute, discusses heart failure and why it is an extensive medical issue.
Enjoy the podcast.
Objectives:
Upon completion of this podcast, participants should be able to:
Recognize heart failure as a problematic clinical disease and its morbidity and mortality that leads to comprehensive medical management. Identify and describe optimal contemporary medical therapy for heart failure. Describe novel options for heart failure. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org.
Click the link below, to complete the activity's evaluation.
CME Evaluation
(**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.) 

DISCLOSURE ANNOUNCEMENT 
The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws. 
It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented.
Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event.
Thank-you for listening to the podcast.
SHOW NOTES: 
*See the attachment for additional information. 
Heart Failure (HF)
- Can occur without congestion or fluid retention
- Characterized by fatigue, fluid retention, SOB, PND, orthopnea
- We should consider the same urgency for heart failure as patients with CAD and CA.
Heart Failure Preserved/Reduced Ejection Fraction (HFpEF/HFrEF)
- HFpEF is a Preserved Ejcetion Fraction over about 50%
- HFpEF - congestive phenotype more of a fluid retention
      - an exercise intolerant phenotupe where the patient becomes intolerant of exercise induced dyspnea.
      - Pulm HTN phenotype
      - Increased pressure in the heart that gets transmitted to the lungs
- HRrEF is Reduced EF is usually below 40%

Medications
- 4 classes of medications (MRAs, BB, SGLT2, ARNIs)
- Treatment with mineralocorticoid receptor antagonists (MRAs) has been demonstrated to improve clinical outcomes in patients with HFrEF with mild to severe symptoms and also in patients with left ventricular dysfunciton after myocardial infarction.
- SGLT2 inhibitors reduced the risk of cardiovascular death and hospitalizatio