July 2015 Previously Approved Applications · · 2015-08-2806.25.15 Participation and Documentation Requirements for Teaching Physician Billing (1 ... TAVR Patient Care Team

CONFERENCE APPLICATIONS AND REPORTS Applications Previously Approved

June 15, 2015 to July 14, 2015

Regularly Scheduled Series (RSS) Weekly Transcatheter Valve Therapy Conference (1 Cat. 1 each) RENEWAL

2015-2016 SMH COPD Journal Club (1 Cat. 1/ each)

Sports Medicine Conference Series (1 Cat. 1/ ea)

Primary Care and Basic Science Sports Medicine Series (1 Cat. 1/ ea)

Center for Research and Grants Conference Series (1 Cat. 1)

South Miami Heart Center Pulmonary Hypertension Journal Club (1 Cat. 1/ea)

2015-2016 Lung Health Journal Club (1 Cat. 1 each)

Live CME

05.26.15 Conversations in Ethics: Ethics versus Compliance: Do we really need to talk about both? (1 Cat. 1)

06.09.15 The Art of Spine Care: Emerging Options in the Management of Musculoskeletal Disorders of the Spine (1 Cat. 1)

06.25.15 Promoting Physician Wellness: Recognizing the Signs of Fatigue and Sleep Deprivation Strategies for Alertness Management and Fatigue Mitigation (1 Cat. 1)

06.25.15 Participation and Documentation Requirements for Teaching Physician Billing (1 Cat. 1)

07.08.15 Mariners Hospital Conference Series: Common Misconceptions about Diagnosis and Treatment of Infectious Diseases (1 Cat. 1)

07.15.15 MCVI Research Grand Rounds: New MCVI Support System for Investigator Initiated Studies (1.5 Cat. 1)

09.18.15 Conversations in Ethics: Faith: Help or Hindrance to the Medical Professional? (1 Cat. 1)

09.19.15 Wound Care and Critical Limb Ischemia Symposium, 10th annual (6.75 Cat. 1)

10.17.15 Brain Injury Symposium, 21st Annual (11.5 Cat. 1)

10.25.15 Echocardiography Symposium, 34th Annual (11 Cat. 1)

11.14.15 Coronary CTA in the Emergency Department: Hand’s-on Workshop (16.75 Cat. 1)

12.11.15 The Art of Spine Care: Surgical Approaches to Low Back Pain (1 Cat. 1)

Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Weekly Transcatheter Valve Therapy Conference DATE/TIME: August 2015-August 2016 LOCATIONS: 5 BCVI (Alison McLaughlin) Every Tuesday, 7:30-8:30 a.m. 8/04/15; 8/11/15; 8/18/15; 8/25/15 9/01/15; 9/08/15; 9/15/15; 9/22/15; 9/29/15 10/06/15; 10/13/15; 10/20/15; 10/27/15 11/03/15; 11/10/15; 11/17/15; 11/24/15 12/01/15; 12/08/15; 12/15/15; 12/22/15; 12/29/15 01/05/16; 01/12/16; 01/19/16; 01/26/16 02/02/16; 02/09/16; 02/16/16; 02/23/16 03/01/16; 03/08/16; 03/15/16; 03/22/16; 03/29/16 04/05/16; 04/12/16; 04/19/16; 04/26/16 05/03/16; 05/10/16; 05/17/16; 05/24/16; 05/31/16 06/07/16; 07/14/16; 07/21/16; 07/28/16 07/05/16; 07/12/16; 07/19/16; 07/26/16 CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1/ea CONFERENCE DIRECTOR: Niberto Moreno, M.D. CONFERENCE COORDINATOR: Alison McLaughlin/ Maria-Gabriela Gonzalez TARGET AUDIENCE: TAVR Patient Care Team Members, physicians and nurses. In addition, describe how the content of the activity is aligned with the target learners' current or potential scope of practice (C4). This activity addresses professional practice gaps relevant to the TAVR patient care team. In addition, physicians that identify conditions and refer patients to a cardiovascular surgeon and those specialists to whom a cardiologist might refer for further evaluation or treatment. EXPECTED NUMBER OF ATTENDEES: 10-15 CHARGE: 0 TYPE OF MEETING (FORMAT): Must be appropriate to the setting, objectives and desired results (C5). Check all that apply. Live Didactic Lecture ARS

Question & Answer Case Studies Panel

Enduring Material Internet-Home Study Other (specify) Discussion

NEEDS ASSESSMENT RESOURCES- HOW ARE EDUCATIONAL NEEDS IDENTIFIED? (Check all that apply and explain in professional practice gap.)

Best practice parameters Consensus of experts Joint Commission initiatives Mortality/morbidity statistics National Pt Safety Goals National/regional data

New or updated policy/protocol Patient care data Peer review data Process improvement initiatives (C16 & 21) Research/literature review

Other (Explain): _____________________________ FACTORS OUTSIDE OUR CONTROL - List factors, outside our control and beyond learner performance that impact patient outcomes and contribute to the healthcare 'quality gap' being addressed. (C18) Patient: Non-compliance Lifestyle Resistance-to-change Financial/Lack of Insurance Physician: Non-compliance Resistance-to-change Communication Skills Financial Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or No Treatment Modalities Limited or No Diagnostic Modalities Other: New TAVR program at BCVI

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PROFESSIONAL PRACTICE GAP (C2) The difference between the current and optimal practices is the “practice gap” – this is what should be

addressed or ‘closed’ as a result of this CME activity. WHAT IS/ARE THE CURRENT PRACTICE* and/or THE PRACTICE GAP*? What are physicians doing (or not doing) that needs to change? Describe the practice gap. Physicians are currently not involved in a "community of practice" activity to discuss new knowledge in the context of previous and current experiences and translate the "new learnings" into clinical practice in the care of the cardiac patient who may benefit from a transcatheter aortic valve (TAVR) implantation for the treatment of severe symptomatic aortic stenosis (AS). WHAT IS THE OPTIMAL PRACTICE*? (In a 'perfect world', what would doctors be doing? What does optimal practice 'look like'?) Baptist Health TAVR patient care team participates regularly in a clinical review educational activity to remain current with up-to-date information on evidence-based practice and research findings. WHAT IS THE REASON FOR THIS GAP? Indicate if the gap is in physician:

Knowledge? (They do not know that they need to be doing something.) Competence? (They do not know how to do it) Performance? (They know how to do it but are non-compliant - or are not doing it properly)

DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) Will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? (Check all that apply.) *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) ► Baptist Health TAVR patient care team will formulate new optimal patient care strategies in cardiovascular medicine by translating evidence into practice. *REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► Adults learn most effectively when faced with meaningful problems they need to solve. Health professionals reflect on past experiences to frame important personal learning questions, reflection on action. They then seek information, including colleagues’ experiences. And think about how to apply it. When subsequently faced with a similar situation, health professionals then consider the applicability of the newly learned information, reflection in action, 3. Constructivist theories posit that learning occurs as individuals actively assimilate new knowledge with previous experience; 4 social learning theories hold that knowledge is shaped by interactions with respected others in similar environments or situations. Therefore it seems that case reviews, structured as social learning activities for discussing new knowledge in the context of previous and current experience, could lead to new learnings that might translate into clinical practice. Case-based, reflective, interactive sessions are more likely to impact practice than traditional didactic sessions. They allow individuals to share evidence, ideas, tacit (“how to”) knowledge, and practical experience in a safe environment for continuous learning. http://www.jcehp.com/vol28/2803price.asp ► Aortic valve replacement is the mainstay of treatment of symptomatic aortic stenosis (AS). Aortic valve replacement offers substantial improvements in symptoms and life expectancy. However, aortic valve surgery entails substantial risks for some patients with severe comorbidities, and for some considered at “extreme” risk, surgery is not appropriate. In others, technical limitations, eg, porcelain aorta, may mean that surgery is not feasible. Percutaneous aortic valvotomy was developed as a less invasive means to treat AS but has important limitations. Subsequently developed catheter-based techniques for aortic valve implantation may provide an alternative method for treating AS in patients with unacceptably high estimated surgical risks. A multidisciplinary team approach is recommended in approaching patients with symptomatic AS. Transcatheter aortic valve implantation (TAVI) techniques are rapidly evolving, and results of published trials suggest that TAVI is emerging as the standard of care in certain patient subsets, and a viable alternative to surgery in others. TAVI has been developed for the treatment of patients with severe symptomatic AS who have an unacceptably high estimated surgical risk, or in whom TAVI is preferred due to technical issues with surgery, eg, a porcelain aorta or prior significant mediastinal radiation, prior pericardiectomy with dense adhesions or prior sternal infection with complex reconstruction, or a patent left internal mammary graft lying beneath the sternum (as identified by computed tomography angiography). Thus, accurate estimation of the risk of surgical aortic valve replacement performed by an experienced cardiothoracic surgeon and multidisciplinary valve team is vital to appropriate evaluation of potential candidates for this emerging experimental procedure. Early outcomes were reported following retrograde implantation of the SAPIEN valve between November 2007 and January 2009 in 463 patients (mean age 82 years) with high estimated surgical risk (mean EuroSCORE 26). Major complications at 30 days included death (6.3 percent), stroke (2.4 percent), renal failure requiring dialysis (1.3 percent),

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and heart block resulting in permanent pacemaker implantation (6.7 percent). Vascular complications included access-related complications (17.9 percent), aortic dissection (1.9 percent), and non-access-related complications (1.1 percent). In an echocardiographic study of 88 patients undergoing retrograde SAPIEN valve implantation, the mean transaortic valve gradient fell from a preprocedure baseline of 39±14 mmHg to 9±3 mmHg one day after the procedure and was 11±4 two years later. Similar results were found in a multicenter study of retrograde implantation of a self-expanding stent valve (CoreValve) in 646 patients (mean age 81) with a mean EuroSCORE of 23. http://www.uptodate.com/contents/percutaneous-aortic-valvotomy-and-transcatheter-aortic-valve-implantation EDUCATIONAL OBJECTIVES: Upon completion of this conference, participants should be better able to: Review results from various transcatheter aortic-valve replacement (TAVR) surgery cases. Assess indications for proper patient selection for TAVR. Implement evidence-based strategies into clinical practice to improve care of the TAVR patient.

COMPETENCIES: What desirable physician attributes (e.g. professional competencies) set forth by national organizations of medicine (e.g.: IOM, ACGME, ABMS) does this activity address? (C6)

Patient Care Medical Knowledge Interpersonal and Communications Skills Professionalism Systems-based Practice Practice-based Learning and Improvement

EVALUATION METHOD(S): Analyze the overall changes in competence, performance, or patient outcomes as a result of this CME activity. (C11) List the planned method(s) of evaluation:

Baptist Health CME Evaluation Form (post-Conference) Follow-up Survey Review of Hospital, Health System or Other Data Other______________________

OUTCOMES MEASUREMENT: (List strategy measurement questions and/or other measurement plans.) (C11) ► As a result of what you learned at this conference what do you intend to do differently? What new strategies will you apply to your practice? _____________________________________________________________________________ ► If you do not plan to implement any new strategies learned at this conference, please list any barriers or obstacles that might keep you from doing so: _______________________________________________________________________ FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State) (If necessary, attach a list.) Moderator Coordinator: Niberto L. Moreno, M.D., FACS Alison McLaughlin Cardiothoracic Surgeon Interventional Services Chief of Cardiothoracic Surgery Baptist Cardiac & Vascular Institute Baptist Health Cardiac & Thoracic Surgical Group Baptist Cardiac & Vascular Institute Miami, Florida

RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3)

Yes No Medical Education Dept. Leadership and Staff Medical Education Committee Conference Director (see above) Others (i.e.: Conference Coordinator, Planning Group etc.)

COMMERCIAL SUPPORT: The Baptist Health Medical Education Department will not solicit or accept grants from commercial interests to support CME activities, thereby strengthening the CME Program's commitment to be independent and free of the influence of commercial interests. Indicate here if support will come from the Foundation general medical education fund. BARRIERS TO PHYSICIAN CHANGE: (C19) Is this activity focused on ‘overcoming, addressing, or removing barriers to physician change' applicable to our learners? Yes No If 'yes', list the barrier(s) identified and include relevant data and information about the barriers. OVERALL PROGRAM CHANGES: Does this CME activity reflect implementation (C14) of any interventions or changes that came about as a result of our overall CME program evaluation and analysis (C13) to meet the CME mission?

Yes No If yes, please describe the related CME program change. _________________________ And describe how the impact of the related program improvement will be measured and documented? (C15)

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NON-EDUCATION STRATEGIES: Explain what we are doing (MedEd or BHSF) -- or what we could do -- to enhance change as an adjunct (in addition to) to this CME activity? (C17) These would be tactics and tools to facilitate change that go beyond this CME activity.

Process redesign or new protocol Reminders (Posters, mailings, email blasts) New order sheets Other tools or tactics

Explain: _______________________________________________________________________________ COLLABORATION: Are we engaged in collaborative and cooperative projects with other stakeholders (internal or external) that are related to this CME activity? (C20)

Yes No Are we partnering with other organizations in a purposeful manner to achieve common interests? Yes No Are we collaborating with internal departments in a purposeful manner to achieve common interests?

If yes, list collaborative efforts related to this CME activity that support achievement of our CME Mission. ______________ This education is part of a collaboration with the Baptist Cardiac and Vascular Institute TAVR program. DATE REVIEWED: July 8, 2015 REVIEWED BY: Executive Committee Chairman

APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1

Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

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Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education

CME ACTIVITY TITLE: 2015-2016 COPD Multidisciplinary Journal Club DATE: Second Thursday of the Month, 12 noon – 1 p.m. August 13 September 10 October 8 November 12 December 10

January 14 February 11 March 10 April 14 May 12

June 9 July 14 August 11

LOCATION: South Miami Hospital CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1/ each

CONFERENCE DIRECTOR and Moderator: Rodney Benjamin, M.D. Coordinator: Mikki Thompson, RRT, MHA, FAARC Contact: Michele Dalce

TARGET AUDIENCE: COPD Committee Members, including nurses, respiratory therapists, pharmacists, social workers, dietitians and radiologic technologists. EXPECTED NUMBER OF ATTENDEES: 10-15 CHARGE: $0.00

TYPE OF MEETING (FORMAT):

Live Didactic Lecture ARS Question & Answer Case Studies

Panel Enduring Material Internet-Home Study Other Journal Club

TYPE OF MEETING (FORMAT): Must be appropriate to the setting, objectives and desired results (C5). Check all that apply. Live Didactic Lecture ARS


Enduring Material Internet-Home Study Other (specify)




Other (Explain): _____________________________ FACTORS OUTSIDE OUR CONTROL - List factors, outside our control and beyond learner performance that impact patient outcomes and contribute to the healthcare 'quality gap' being addressed. (C18) Patient: Non-compliance Lifestyle Resistance-to-change Financial/Lack of Insurance Physician: Non-compliance Resistance-to-change Communication Skills Financial Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or No Treatment Modalities Limited or No Diagnostic Modalities Other: ________________________________________________________________________

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addressed or ‘closed’ as a result of this CME activity. WHAT IS/ARE THE CURRENT PRACTICE* AND/OR THE PRACTICE GAP*? What are physicians doing (or not doing) that needs to change? Describe the practice gap. ► Physicians are currently not involved in a "community of practice" activity to discuss new knowledge in the context of previous and current experiences and translate the "new learnings" into clinical practice. WHAT IS THE OPTIMAL PRACTICE*? (In a 'perfect world', what would doctors be doing? What does optimal practice 'look like'?) ► South Miami Heart COPD Committee members will participate regularly in a journal club educational activity to remain current with up-to-date information on evidence-based practice and research findings. WHAT IS THE REASON FOR THIS GAP? Indicate if the gap is related to either/or:

Knowledge (Doctors do not know that they need to be doing something.) Competence (Doctors do not know how to do it) Performance (Doctors know how to do it but are non-compliant - or are not doing it properly.)

DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) And will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? (Check all that apply.) *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) ► South Miami Heart COPD committee members will formulate new optimal patient care strategies in cardiovascular medicine by translating evidence into practice. The goals of the journal club is to keep abreast of new knowledge, promote awareness of current research findings, stay familiar with the best current clinical research, encourage research utilization, improve patient outcomes, and network and improve interpersonal relationships with other healthcare providers and specialists. *REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► The Joint Commission's Management of the Patient with Chronic Obstructive Pulmonary Disease (COPD) Certification Program was developed through a collaborative partnership with the American Lung Association. The most successful COPD programs possess the following attributes: →Staff education requirements →The use of spirometry →Smoking cessation →Risk factor reduction →Patient education on self-management of COPD →Coordination of care The COPD specific requirements for this program were developed using: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2006) The American Thoracic Society/European Respiratory Society Standards for the Diagnosis and Management of Patients with COPD (updated 2005) as resources. The Joint Commission's Certificate of Distinction for Chronic Obstructive Pulmonary Disease recognizes organizations that make exceptional efforts to foster better outcomes for COPD patients. →Journal clubs are staples of graduate and continuing medical education. Adults learn most effectively when faced with meaningful problems they need to solve. Health professionals reflect on past experiences to frame important personal learning questions. They then seek information, including colleagues’ experiences, and think about how to apply it. When subsequently faced with a similar situation, health professions then consider the applicability of the newly learned information (reflection in action). Therefore, journal clubs structured as social learning activities for discussing new knowledge in the context of previous and current experience could lead to new learning that might translate into clinical practice. They allow individuals to share evidence, ideas, tacit (“how to”) knowledge, and practical experience in a safe environment for continuous learning. Facilitated interactive journal clubs focused on problems shared by attendees can be useful learning formats for translating evidence into practice and documenting barriers to evidence translation. This structure provides continuity between sessions and reinforce previous learning and gathered short term self reported practice change outcomes data.http://www.jcehp.com/vol28/2803price.asp

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Individuals actively involved in medical education consider journal clubs vital in bridging the gap between medical education and clinical practice. Journal clubs are also an accessible way of supporting lifelong learning. They help you to keep up to date with relevant literature and give you the confidence to formulate your own opinion on topics through critical analysis of the literature. Discussions and questions that may arise as a result can help you to understand scientific concepts and relate them to clinical practice, both essential to optimize patient care. http://www.medscape.com/viewarticle/714407_2 EDUCATIONAL OBJECTIVES Upon completion of this conference, participants should be better able to implement evidence-based strategies into their clinical practice to improve care of the COPD patient. COMPETENCIES: What desirable physician attributes (e.g. professional competencies) set forth by national organizations of medicine (e.g.: IOM, ACGME, ABMS) does this activity address? (C6)



Baptist Health CME Evaluation Form (post-Conference) Follow-up Survey Review of Hospital, Health System or Other Data Other quarterly evaluation

OUTCOMES MEASUREMENT: (List strategy measurement questions and/or other measurement plans.) (C11) ► As a result of what you learned at this conference what do you intend to do differently? What new strategies will you apply to your practice? _____________________________________________________________________________ ► If you do not plan to implement any new strategies learned at this conference, please list any barriers or obstacles that might keep you from doing so: _______________________________________________________________________ FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.)


Yes No CME Dept. Leadership and Staff CME Committee Conference Director (see above) Others (i.e.: Conference Coordinator, Planning Group etc.) Mikki Thompson and

COMMERCIAL SUPPORT: The Baptist Health Continuing Medical Education Department will not solicit or accept grants from commercial interests to support CME activities, thereby strengthening the CME Program's commitment to be independent and free of the influence of commercial interests. Indicate here if support will come from the Foundation general Continuing Medical Education fund. BARRIERS TO PHYSICIAN CHANGE: (C19) Is this activity focused on ‘overcoming, addressing, or removing barriers to physician change' applicable to our learners? Yes No If 'yes', list the barrier(s) identified and include relevant data and information about the barriers. OVERALL PROGRAM CHANGES: Does this CME activity reflect implementation (C14) of any interventions or changes that came about as a result of our overall CME program evaluation and analysis (C13) to meet the CME mission?

Yes No If yes, please describe the related CME program change. _________________________ And describe how the impact of the related program improvement will be measured and documented? (C15) NON-EDUCATION STRATEGIES: Explain what we are doing (CME or BHSF) -- or what we could do -- to enhance change as an adjunct (in addition to) to this CME activity? (C17) These would be tactics and tools to facilitate change that go beyond this CME activity.


Explain: _______________________________________________________________________________

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COLLABORATION: Are we engaged in collaborative and cooperative projects with other stakeholders (internal or external) that are related to this CME activity? (C20)


If yes, list collaborative efforts related to this CME activity that support achievement of our CME Mission. →This activity has been planned in collaboration with the SMH COPD Committee.

DATE REVIEWED: July 8, 2015 REVIEWED BY: Accelerated Approval Executive Committee Live Committee

APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1/each


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Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Sports Medicine Conference Series DATE: August 2015 to June 2016 TIME: 7-8 a.m. Application Expires: June 2016 LOCATION: Doctors Hospital, UHZ Conference Room CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 each CONFERENCE DIRECTOR: John Zvijac, M.D. AMA/PRA LEARNING FORMAT:

Live activity Enduring material Journal-based CME activity

Test-item writing activity Manuscript review activity PI CME activity

Internet point-of-care activity

TARGET AUDIENCE: Orthopedists, Physician Assistants and Athletic Trainers. EXPECTED NUMBER OF ATTENDEES: 15-20 CHARGE: 0 TYPE OF MEETING (FORMAT): Must be appropriate to the setting, objectives and desired results (C5). Check all that apply. Live Didactic Lecture ARS






Other (Explain): _Sports Medicine Fellowship Program Curriculum__ FACTORS OUTSIDE OUR CONTROL - List factors, outside our control and beyond learner performance that impact patient outcomes and contribute to the healthcare 'quality gap' being addressed. (C18) Patient: Non-compliance Lifestyle Resistance-to-change Financial/Lack of Insurance Physician: Non-compliance Resistance-to-change Communication Skills Financial Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or No Treatment Modalities Limited or No Diagnostic Modalities Other: ________________________________________________________________________


addressed or ‘closed’ as a result of this CME activity. WHAT IS/ARE THE CURRENT PRACTICE* AND/OR THE PRACTICE GAP*? What are physicians doing (or not doing) that needs to change? Describe the practice gap. ► The orthopedic sports medicine physician practice involves a wide range of sports-related musculoskeletal injuries, including some conditions not typically seen in everyday practice. Therefore physician practice may not consistently include adequate evaluation, treatment strategies and/or rehabilitation for every condition. Recommending return to play too soon can put patients at risk for re-injury and possible longer down time. WHAT IS THE OPTIMAL PRACTICE*? (In a 'perfect world', what would doctors be doing? What does optimal practice 'look like'?) ► Physicians appropriately evaluate and treat patients with a variety of sports injuries, confirming adequate healing or recovery has taken place to avoid risk of repeat injury. WHAT IS THE REASON FOR THIS GAP? Indicate if the gap is related to either/or:

Knowledge (Doctors do not know that they need to be doing something.) Competence (Doctors do not know how to do it)

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Performance (Doctors know how to do it but are non-compliant - or are not doing it properly.) DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) And will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? (Check all that apply.) *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) ►Physicians will implement strategies to determine appropriate evaluation, treatment and rehabilitation approaches to get athletes back into action as soon as possible without placing him/her at risk of repeat injury. *REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► Returning an athlete to sport participation is a complex and often difficult decision. The return-to-play (RTP) decision-making process within competitive sport is typically referred to as aggressive rehabilitation while avoiding increased risk to the athlete. This subjective description has not been further refined in the literature, and, as a result, there has been little progress toward identifying systematic approaches to clinical decision making in sport. The clinical decision-making process for RTP is a central component of the work of team clinicians and evidence suggests that reinjury may be 4 times more likely to occur compared with an initial injury.[1] One soccer study found that a previous ankle or knee sprain is associated with a 5-fold greater risk of sustaining a reinjury to one of these sites.[2] Similar results were found in studies of basketball and volleyball athletes where 70% to 80% of the ankle sprains sustained were recurrent injuries.[

Return-to-play decision making remains a complicated issue in sports medicine, as it is mulitfactorial in nature and potentially affects many players, from the athlete, team, coaches, and parents. Although further data are needed to understand RTP clinical decision making, it is likely, at this point, that a more granular definition of "clearance" would be helpful for quantitative analyses. Most sport medicine clinicians currently believe that factors affecting risk of injury are important, but some believe that other factors of potential importance to athletes should not be considered in RTP decision making.

Team Clinician Variability in Return-to-Play Decisions, Rebecca Shultz, PhD, Jennifer Bido, BA, Ian Shrier, MD, PhD, Willem H. Meeuwisse, MD, PhD, Daniel Garza, MD, Gordon O. Matheson, MD, PhD

Clin J Sport Med. 2013;23(6):456-461.

http://www.medscape.com/viewarticle/813501 EDUCATIONAL OBJECTIVES: Upon completion of this conference, participants should be better able to:

Discuss the etiology, mechanism of injury and assessment of various common sports related injuries. Describe surgical and non-surgical treatment options for these injuries. Implement new strategies for evaluation and treatment of the sports injury patient.





OUTCOMES MEASUREMENT: (List strategy measurement questions and/or other measurement plans.) (C11) ► As a result of what you learned at this conference what do you intend to do differently? What new strategies will you apply to your practice? ► If you do not plan to implement any new strategies learned at this conference, please list any barriers or obstacles that might keep you from doing so: _______________________________________________________________________ FACULTY: Fellows and Faculty, participating in the Sports Medicine Fellowship Program – To be Determined


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Yes No CME Dept. Leadership and Staff CME Committee Conference Director (see above) Others (i.e.: Conference Coordinator, Planning Group etc.)






If yes, list collaborative efforts related to this CME activity that support achievement of our CME Mission. ______________

The Sports Medicine CME Conference Series supports the Sports Medicine Fellowship Program, a collaborative initiative between UHZ Sports Medicine Institute, Baptist Health South Florida and the Florida International University Herbert Wertheim College of Medicine. Fellows are assigned lecture topics to research and present as part of the series. Medical staff members also lecture as part of the series. The series provides valuable education to the fellows as well as to physicians who may not regularly see these medical conditions in their private practices.

DATE REVIEWED: _07-21-2015____________REVIEWED BY: Executive Committee Chairman

APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 each _________

Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A CME ACTIVITY TOPICS CME activities may include, but are not limited to, the following topics.

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Ankle Sprain Ankle Instability Anterior Cruciate Ligament Biostatistics Bone Biology Concussion Assessment and Treatment Dislocated Shoulder Failed Articular Resurfacing Procedures Fluid Assessment and Treatment in Athletes Frozen Shoulder Knee Arthroplasty Lateral Epicondylitis Lisfranc Injuries Manual Therapy Techniques Meniscal Transplant MRI Assessment: Foot and Ankle/Shoulder/Spine/Knee Muscle Injury and Regeneration Nerve Injury and Repair Osteochondral Lesions of the Knee Partial Rotator Cuff Tears Posterior Cruciate Ligament Posterolateral Corner Principles of Sports Specific Rehabilitation Proximal Humerus Fractures Rehabilitation of Soft Tissue Injuries Rotator Cuff Fixation & Repair Scaphoid Fractures and Wrist Instability in Sports SLAP Lesions Sports Related Eye Injuries Therapeutic Modalities in Rehabilitation

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Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Primary Care and Basic Science Sports Medicine Series DATE: August 1, 2015 to July 31, 2016 TIME: 7-8 a.m. LOCATION: Doctors Hospital – UHZ Conference Room CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 each CONFERENCE DIRECTOR: John Uribe, M.D. AMA/PRA LEARNING FORMAT:




TARGET AUDIENCE: Orthopedists, Team Physicians, Primary Care Physicians, Pediatricians, Physicians in Training, Physician Assistants, Athletic Trainers, Physical Therapists, Exercise Physiologists, Nurses and other interested healthcare providers.

EXPECTED NUMBER OF ATTENDEES: 15-20 each CHARGE: 0 TYPE OF MEETING (FORMAT): Must be appropriate to the setting, objectives and desired results (C5). Check all that apply. Live Didactic Lecture ARS






Other (Explain): ACGME Program Requirements for Graduate Medical Education in Orthopedic Sports Medicine. FACTORS OUTSIDE OUR CONTROL - List factors, outside our control and beyond learner performance that impact patient outcomes and contribute to the healthcare 'quality gap' being addressed. (C18) Patient: Non-compliance Lifestyle Resistance-to-change Financial/Lack of Insurance Physician: Non-compliance Resistance-to-change Communication Skills Financial Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or No Treatment Modalities Limited or No Diagnostic Modalities Other: ________________________________________________________________________

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addressed or ‘closed’ as a result of this CME activity. WHAT IS/ARE THE CURRENT PRACTICE* AND/OR THE PRACTICE GAP*? What are physicians doing (or not doing) that needs to change? Describe the practice gap. ► In order to meet ACGME Competencies and requirements of a Sports Medicine fellowship program: ► Orthopedic sports medicine fellows must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care. ► Fellows must demonstrate competence in their knowledge of • Non-orthopaedic problems that occur in sports medicine and how to deal with those problems or how to refer them appropriately; • sports equipment, particularly protective devices intended to allow the athlete to continue to compete, including helmets, protective pads, knee braces, foot orthotics, and others not specifically named. WHAT IS THE OPTIMAL PRACTICE*? (In a 'perfect world', what would doctors be doing? What does optimal practice 'look like'?) ► Physicians accurately screen patients with a variety of health conditions and follow up with appropriate specialists when indicated. WHAT IS THE REASON FOR THIS GAP? Indicate if the gap is related to either/or:


DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) And will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? (Check all that apply.) *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) ► Physicians who have completed the sports medicine fellowship program will competently 1) identify non-orthopaedic “primary care” health conditions that occur in sports medicine and either treat or refer them appropriately; and 2) apply components of ACGME Competencies into the practice of orthopedic sports medicine including the basic sciences, quality improvement and patient safety initiatives and recognition/mitigation of fatigue and sleep deprivation. *REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► ACGME Competencies - The program must integrate the following ACGME competencies 1. Curriculum/Basic Science [Program Requirement IV.A.3.b)] All fellows must participate in didactic sessions devoted to the basic sciences, including anatomy, biomechanics, and biology of healing. 2. Curriculum/Primary Care [Program Requirement IV.A.3.c)] Instruction should also be provided in sports medicine issues in the areas of cardiology, dermatology, pulmonology, preventive medicine, pediatric and adolescent medicine, exercise physiology, environmental exposure, athletic populations, team physicians, and protective equipment (including braces). 3. Fellow Participation in Quality Improvement and Patient Safety Program [Common Program Requirement VI.A.3] The program director must ensure that residents are integrated and actively participate in interdisciplinary clinical quality improvement and patient safety programs. 4. Faculty and Resident Education to Recognize Signs of Fatigue and Sleep Deprivation [Common Program Requirement VI.C.1.a)] The program must educate all faculty members and residents to recognize the signs of fatigue and sleep deprivation. http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/116-127-333-342_sports_medicine_07012011.pdf

EDUCATIONAL OBJECTIVES: Upon completion of this conference series, participants should be better able to: Identify non-orthopedic “primary care” issues that occur in sports medicine specifically in the areas of cardiology,

dermatology, pulmonology, preventive medicine, pediatric and adolescent medicine, exercise physiology, environmental exposure, athletic populations, team physicians, and protective equipment (including braces).

Critically review and discuss treatment indications, clinical outcomes, evidence-based guidelines, complications, morbidity, and mortality.

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Link the pathophysiologic process and findings of clinical disorders to the appropriate diagnosis, treatment and management.

Determine when to refer to a specialist for follow-up care. Explain principles of biomechanics as well as terminology and application to orthopedic sports medicine. Apply specific required components of basic sciences to the practice of orthopedic sports medicine, including

biochemistry, biomechanics, embryology, immunology, microbiology, pathology, pharmacology, and physiology. Integrate interdisciplinary clinical quality improvement and patient safety principles into practice. Recognize the signs of fatigue and sleep deprivation and implement fatigue mitigation processes to manage the potential

negative effects on patient care.





OUTCOMES MEASUREMENT: (List strategy measurement questions and/or other measurement plans.) (C11) ► As a result of what you learned at this conference what do you intend to do differently? What new strategies will you apply to your practice? _____________________________________________________________________________ ► If you do not plan to implement any new strategies learned at this conference, please list any barriers or obstacles that might keep you from doing so: _______________________________________________________________________ FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) TO BE DETERMINED









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The Primary Care Sports Medicine Series supports the Sports Medicine Fellowship Program. The series provides valuable education to the fellows as well as to physicians who see athletes in their offices and must provide follow up to address any medical conditions.

DATE REVIEWED: 07-21-2015__________REVIEWED BY: Executive Committee Chairman

APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 each______

Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A CME ACTIVITY TOPICS Topics for the series from August 2015 – July 2016 will include but are not limited to the following:

Cardiology Dermatology Pulmonology Preventive Medicine Pediatric and Adolescent Medicine Exercise Physiology Environmental Exposure Athletic Populations Team Physicians Protective Equipment Pathology Biomechanics Basic Sciences – biochemistry, biomechanics, embryology, immunology, microbiology, pathology, pharmacology and

physiology Braces Anatomy


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CME ACTIVITY TITLE: 2015 - 2016 Center for Research & Grants - Research Rounds Series DATES: July, 2015 – July, 2016 (varies) TIME: 7:30-8:30 a.m. LOCATIONS: TBD CONFERENCE DIRECTOR: Thinh Tran, M.D. CONFERENCE CORRDINATOR: Debbie Eyerdam, BA, CCRC, CCRP CREDIT HOUR(S) APPLIED FOR: 1 Category 1 each TARGET AUDIENCE: All Research Investigators, including physicians, physician assistants and ARNPs.

EXPECTED NUMBER OF ATTENDEES: 15-20 attendees per lecture CHARGE: 0

TYPE OF MEETING (FORMAT): Must be appropriate to the setting, objectives and desired results (C5). Live Didactic Lecture ARS


Enduring Material Internet-Home Study Other (specify)_________

NEEDS ASSESSMENT RESOURCES- HOW ARE EDUCATIONAL NEEDS IDENTIFIED? (Check and explain.) Best practice parameters Consensus of experts Joint Commission initiatives Mortality/morbidity statistics National Pt Safety Goals National/regional data


Other (Explain): Education requirements for certified sleep center employees and physicians.

FACTORS OUTSIDE OUR CONTROL - List factors, outside our control and beyond learner performance that impact patient outcomes and contribute to the healthcare 'quality gap' being addressed. (C18) Patient: Non-compliance Lifestyle Resistance-to-change Financial/Lack of Insurance Physician: Non-compliance Resistance-to-change Communication Skills Financial Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or No Treatment Modalities Limited or No Diagnostic Modalities Other: ___________________________________________________________________________________________

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addressed or ‘closed’ as a result of this CME activity. WHAT IS/ARE THE CURRENT PRACTICE* AND/OR THE PRACTICE GAP*? What are physicians doing (or not doing) that needs to change? Describe the practice gap. ► For those physicians who have received limited instruction in research methods during the course of their medical training and little guidance on how to become a successful author of peer reviewed research publications, the process of getting started in research and following it through to the final dissemination of the information can be daunting. WHAT IS THE OPTIMAL PRACTICE*? (In a 'perfect world', what would doctors be doing? What does optimal practice 'look like'?) ► Physicians would be able to execute successful research and disseminate results to improve patient outcomes. WHAT IS THE REASON FOR THIS GAP? Indicate if the gap is related to either/or:


DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) And will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? (Check all that apply.) *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) ► Physicians will be able to execute scientifically sound research and disseminate the results to improve patient outcomes. (Topics to be included in this conference series may include, but are not limited to, the following):

End Note Peer- reviewed Journal Publishing Data Analysis Clinical Research HIPAA Privacy Rule and Research Leveraging Publicly Available Datasets to Conduct Research Delivering Research Presentations Study Design Interpretation of Quantitative Findings Big Data Developing a well-structured research manuscript

► REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: Physicians need to be able to assess the basic tenants of research, whether it is of their own design, participation in others research, or critically reviewing others publications, they need to be able to: a) formulate a research question, b) conduct a literature search to fine-tune the question, c) design a study and write a protocol that exemplifies scientific merit as well as the highest standards for the protection of human research subjects. Ultimately the physician should present and publish the results of this work and use this information to enhance his/her clinical knowledge that of his/her colleagues. http://www.hopkinsmedicine.org/gim/fellowship/clin_res_objec.html http://dsg.harvard.edu/courses/hst951/Spring02/951-23P.pdf EDUCATIONAL OBJECTIVES: Describe what doctors will be able to do after they leave the classroom. What is the "take-away" that they can put into practice. What new strategies, tools, treatment plans, approaches, etc. will they be able to implement, utilize, do, etc. as a result of attending this CME activity? Upon completion of this conference, participants should be better able to:

Recognize and apply best practice approaches and utilize available resources toward effective navigation of the various required phases of a clinical research study.

Additional objectives that may be covered based on topics

Implement best practice research guidelines for publishing statistics. Determine the study design that is best suited for your research.

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Access and utilize Baptist Health data for your research. Identify free database resources to complement your research Effectively navigate various aspects of the life cycle of a research study through the different phases. Delineate responsibilities of the research team members.



EVALUATION METHOD(S): Analyze the overall changes in competence, performance, or patient outcomes as a result of this CME activity. (C11) Planned method(s):


OUTCOMES MEASUREMENT: (List strategy measurement questions and/or other measurement plans.) (C11)

As a result of what you learned at this conference what do you intend to do differently? What new strategies will you apply to your practice? __________________________________________________________________

If you do not plan to implement any new strategies learned at this conference, please list any barriers or obstacles that might keep you from doing so: ____________________________________________

FACULTY: TBD RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3)

Yes No Medical Education Dept. Leadership and Staff Medical Education Committee Conference Director (see above) Others (i.e.: Conference Coordinator, Planning Group etc.) Planning

Committee: COMMERCIAL SUPPORT: The Baptist Health Medical Education Department will not solicit or accept grants from commercial interests to support CME activities, thereby strengthening the CME Program's commitment to be independent and free of the influence of commercial interests. Please indicate here if support will come from the Foundation general medical education fund. BARRIERS TO PHYSICIAN CHANGE: (C19) Is this activity focused on ‘overcoming, addressing, or removing barriers to physician change' applicable to our learners? Yes No If 'yes', list the barrier(s) identified and include relevant data and information about the barriers. OVERALL PROGRAM CHANGES: Does this CME activity reflect implementation (C14) of any interventions or changes that came about as a result of our overall CME program evaluation and analysis (C13) to meet the CME mission?

Yes No If yes, please describe the related CME program change. ____________________________. And describe how the impact of the related program improvement will be measured and documented? (C15) NON-EDUCATION STRATEGIES: Explain what we are doing (MedEd or BHSF) -- or what we could do -- to enhance change as an adjunct (in addition to) to this CME activity? (C17) These would be tactics and tools to facilitate change that go beyond this CME activity.


_______________________________________________________________________________ COLLABORATION: Are we engaged in collaborative and cooperative projects with other stakeholders (internal or external) that are related to this CME activity? (C20)


If yes, list collaborative efforts related to this CME activity that support achievement of our CME Mission. The Center for Research & Grants has undertaken an initiative to provide regular continuing medical education lectures on current medical research issues. DATE REVIEWED: June 24, 2015 REVIEWED BY: Executive Committee Chairman

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APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1.0

Continuing Psychology Education Credits: 1 N/A Continuing Dental Education Credits: # N/A

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CME ACTIVITY TITLE: 2015-2016 Lung Health Journal Club DATE: Second Tuesday of the Month, 12 noon – 1 p.m. July 14 August 11 September 8 October 13 November 10

December 8 January 12 February 9 March 8 April 12

May 10 June 14 July 12

LOCATION: South Miami Hospital, MCVI Conf. Rm, 2n Floor, 7:30-8:30 a.m. CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1/ each

CONFERENCE DIRECTOR and Moderator: Rodney Benjamin, M.D. Coordinator: Mikki Thompson, RRT, MHA, FAARC

TARGET AUDIENCE: Physicians, nurses, respiratory therapists, radiology technologists and pharmacists members of the Pulmonary Health Committee EXPECTED NUMBER OF ATTENDEES: 10-15 CHARGE: $0.00











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DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) And will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? (Check all that apply.) *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) ► South Miami Heart COPD committee members will formulate new optimal patient care strategies in cardiovascular medicine by translating evidence into practice. The goals of the journal club is to keep abreast of new knowledge, promote awareness of current research findings, stay familiar with the best current clinical research, encourage research utilization, improve patient outcomes, and network and improve interpersonal relationships with other healthcare providers and specialists. *REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► The Joint Commission's Management of the Patient with Chronic Obstructive Pulmonary Disease (COPD) Certification Program was developed through a collaborative partnership with the American Lung Association. The most successful COPD programs possess the following attributes: →Staff education requirements →The use of spirometry →Smoking cessation →Risk factor reduction →Patient education on self-management of COPD →Coordination of care The COPD specific requirements for this program were developed using: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2006) The American Thoracic Society/European Respiratory Society Standards for the Diagnosis and Management of Patients with COPD (updated 2005) as resources. The Joint Commission's Certificate of Distinction for Chronic Obstructive Pulmonary Disease recognizes organizations that make exceptional efforts to foster better outcomes for COPD patients. http://www.jointcommission.org/certification/chronic_obstructive_pulmonary_disease.aspx Journal clubs are staples of graduate and continuing medical education. Adults learn most effectively when faced with meaningful problems they need to solve. Health professionals reflect on past experiences to frame important personal learning questions. They then seek information, including colleagues’ experiences, and think about how to apply it. When subsequently faced with a similar situation, health professions then consider the applicability of the newly learned information (reflection in action). Therefore, journal clubs structured as social learning activities for discussing new knowledge in the context of previous and current experience could lead to new learning that might translate into clinical practice. They allow individuals to share evidence, ideas, tacit (“how to”) knowledge, and practical experience in a safe environment for continuous learning.

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Facilitated interactive journal clubs focused on problems shared by attendees can be useful learning formats for translating evidence into practice and documenting barriers to evidence translation. This structure provides continuity between sessions and reinforce previous learning and gathered short term self reported practice change outcomes data.http://www.jcehp.com/vol28/2803price.asp Individuals actively involved in medical education consider journal clubs vital in bridging the gap between medical education and clinical practice. Journal clubs are also an accessible way of supporting lifelong learning. They help you to keep up to date with relevant literature and give you the confidence to formulate your own opinion on topics through critical analysis of the literature. Discussions and questions that may arise as a result can help you to understand scientific concepts and relate them to clinical practice, both essential to optimize patient care. http://www.medscape.com/viewarticle/714407_2 EDUCATIONAL OBJECTIVES Upon completion of this conference, participants should be better able to implement evidence-based strategies into their clinical practice to improve care of the COPD patient. COMPETENCIES: What desirable physician attributes (e.g. professional competencies) set forth by national organizations of medicine (e.g.: IOM, ACGME, ABMS) does this activity address? (C6)






Yes No CME Dept. Leadership and Staff CME Committee Conference Director (see above) Others (i.e.: Conference Coordinator, Planning Group etc.) Mikki Thompson

and COMMERCIAL SUPPORT: The Baptist Health Continuing Medical Education Department will not solicit or accept grants from commercial interests to support CME activities, thereby strengthening the CME Program's commitment to be independent and free of the influence of commercial interests. Indicate here if support will come from the Foundation general Continuing Medical Education fund. BARRIERS TO PHYSICIAN CHANGE: (C19) Is this activity focused on ‘overcoming, addressing, or removing barriers to physician change' applicable to our learners? Yes No If 'yes', list the barrier(s) identified and include relevant data and information about the barriers. OVERALL PROGRAM CHANGES: Does this CME activity reflect implementation (C14) of any interventions or changes that came about as a result of our overall CME program evaluation and analysis (C13) to meet the CME mission?


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NON-EDUCATION STRATEGIES: Explain what we are doing (CME or BHSF) -- or what we could do -- to enhance change as an adjunct (in addition to) to this CME activity? (C17) These would be tactics and tools to facilitate change that go beyond this CME activity.








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CME ACTIVITY TITLE: 2015-2016 Lung Health Journal Club DATE: Second Tuesday of the Month, 12 noon – 1 p.m. July 14 August 11 September 8 October 13 November 10

December 8 January 12 February 9 March 8 April 12

May 10 June 14 July 12

LOCATION: South Miami Hospital, MCVI Conf. Rm, 2n Floor, 7:30-8:30 a.m. CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1/ each

CONFERENCE DIRECTOR and Moderator: Rodney Benjamin, M.D. Coordinator: Mikki Thompson, RRT, MHA, FAARC

TARGET AUDIENCE: Physicians, nurses, respiratory therapists, radiology technologists and pharmacists members of the Pulmonary Health Committee EXPECTED NUMBER OF ATTENDEES: 10-15 CHARGE: $0.00











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DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) And will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? (Check all that apply.) *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) ► South Miami Heart COPD committee members will formulate new optimal patient care strategies in cardiovascular medicine by translating evidence into practice. The goals of the journal club is to keep abreast of new knowledge, promote awareness of current research findings, stay familiar with the best current clinical research, encourage research utilization, improve patient outcomes, and network and improve interpersonal relationships with other healthcare providers and specialists. *REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► The Joint Commission's Management of the Patient with Chronic Obstructive Pulmonary Disease (COPD) Certification Program was developed through a collaborative partnership with the American Lung Association. The most successful COPD programs possess the following attributes: →Staff education requirements →The use of spirometry →Smoking cessation →Risk factor reduction →Patient education on self-management of COPD →Coordination of care The COPD specific requirements for this program were developed using: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2006) The American Thoracic Society/European Respiratory Society Standards for the Diagnosis and Management of Patients with COPD (updated 2005) as resources. The Joint Commission's Certificate of Distinction for Chronic Obstructive Pulmonary Disease recognizes organizations that make exceptional efforts to foster better outcomes for COPD patients. http://www.jointcommission.org/certification/chronic_obstructive_pulmonary_disease.aspx Journal clubs are staples of graduate and continuing medical education. Adults learn most effectively when faced with meaningful problems they need to solve. Health professionals reflect on past experiences to frame important personal learning questions. They then seek information, including colleagues’ experiences, and think about how to apply it. When subsequently faced with a similar situation, health professions then consider the applicability of the newly learned information (reflection in action). Therefore, journal clubs structured as social learning activities for discussing new knowledge in the context of previous and current experience could lead to new learning that might translate into clinical practice. They allow individuals to share evidence, ideas, tacit (“how to”) knowledge, and practical experience in a safe environment for continuous learning. Facilitated interactive journal clubs focused on problems shared by attendees can be useful learning formats for translating evidence into practice and documenting barriers to evidence translation. This structure provides continuity between sessions

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and reinforce previous learning and gathered short term self reported practice change outcomes data.http://www.jcehp.com/vol28/2803price.asp Individuals actively involved in medical education consider journal clubs vital in bridging the gap between medical education and clinical practice. Journal clubs are also an accessible way of supporting lifelong learning. They help you to keep up to date with relevant literature and give you the confidence to formulate your own opinion on topics through critical analysis of the literature. Discussions and questions that may arise as a result can help you to understand scientific concepts and relate them to clinical practice, both essential to optimize patient care. http://www.medscape.com/viewarticle/714407_2 EDUCATIONAL OBJECTIVES Upon completion of this conference, participants should be better able to implement evidence-based strategies into their clinical practice to improve care of the COPD patient. COMPETENCIES: What desirable physician attributes (e.g. professional competencies) set forth by national organizations of medicine (e.g.: IOM, ACGME, ABMS) does this activity address? (C6)






Yes No CME Dept. Leadership and Staff CME Committee Conference Director (see above) Others (i.e.: Conference Coordinator, Planning Group etc.) Mikki Thompson and




Explain: _______________________________________________________________________________

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COLLABORATION: Are we engaged in collaborative and cooperative projects with other stakeholders (internal or external) that are related to this CME activity? (C20)






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CME ACTIVITY TITLE: Conversations in Ethics: Ethics versus Compliance: Do we really need to talk about both? DATE: Wednesday, July 8, 2015 TIME: 12:00 Noon - 1:00 p.m. LOCATION: BHM Auditorium CREDIT HOUR(S) APPLIED FOR: 1.0 Videoconferenced to: MH Exec Conf Room, WKBH CL 4 & 5, SMH CL E CONFERENCE DIRECTOR: Raúl de Velasco, M.D., FACP, Chairman, Baptist Health Bioethics Department CONFERENCE COORDINATOR: Rose Allen, R.N., M.S.M. /H.M., CHPN, Director, Bioethics & Palliative Care AMA/PRA LEARNING FORMAT:




TARGET AUDIENCE: Physicians, Psychologists, Nurses, Social Workers, Respiratory Therapists, Clergy, Pharmacist, Medical Students, Registered Dietitians and other interested healthcare professionals. EXPECTED NUMBER OF ATTENDEES: 60-80 CHARGE: 0 TYPE OF MEETING (FORMAT): Must be appropriate to the setting, objectives and desired results (C5). Check all that apply. Live Didactic Lecture ARS






Other (Explain): Bioethics Committee Request FACTORS OUTSIDE OUR CONTROL - List factors, outside our control and beyond learner performance that impact patient outcomes and contribute to the healthcare 'quality gap' being addressed. (C18) Patient: Non-compliance Lifestyle Resistance-to-change Financial/Lack of Insurance Physician: Non-compliance Resistance-to-change Communication Skills Financial Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or No Treatment Modalities Limited or No Diagnostic Modalities Other: ________________________________________________________________________

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addressed or ‘closed’ as a result of this CME activity. WHAT IS/ARE THE CURRENT PRACTICE* AND/OR THE PRACTICE GAP*? While most physicians and healthcare practitioners are compliant with organizational guidelines, they do not always have a clear distinction between ethics and law. Not understanding the differences may ultimately impact their practice and patient outcomes. WHAT IS THE OPTIMAL PRACTICE*? ► Physicians and healthcare practitioners are able to establish the differences between ethics and law, and they applying them accordingly to improve their practice and patient outcomes. WHAT IS THE REASON FOR THIS GAP? Indicate if the gap is related to either/or:


DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) And will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? (Check all that apply.) *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) ► Physicians and healthcare practitioners will be able to establish the differences between ethics and law, and they will identify the differences and apply them accordingly to ultimately improve their practice and patient outcomes. *REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► There is a difference between legal compliance and moral excellence. Few would choose a professional service, health care or otherwise, because the provider had a record of perfect legal compliance, or always following the letter of the law. There are many professional ethics codes, primarily because people realize that law prescribes only a minimum of morality and does not provide purpose or goals that can mean excellent service to customers, clients, or patients. ► Business ethicists have talked for years about the intersection of law and ethics. Simply put, what is legal is not necessarily ethical. Conversely, what is ethical is not necessarily legal. There are lots of legal maneuvers that are not all that ethical; the well-used phrase “legal loophole” suggests as much. ► Doing “good business” requires attention to ethics as well as law. Understanding the long-standing perspectives on ethics—utilitarianism, deontology, social contract, and virtue ethics—is helpful in sorting out the ethical issues that face us as individuals and businesses. Each business needs to create or maintain a culture of ethical excellence, where there is ongoing dialogue not only about the best technical practices but also about the company’s ethical challenges and practices. A firm that has purpose and passion beyond profitability is best poised to meet the needs of diverse stakeholders and can best position itself for long-term, sustainable success for shareholders and other stakeholders as well. SOURCE: “Corporate Social Responsibility and Business Ethics”, chapter 2 from the book The Legal Environment and Government Regulation of Business (v. 1.0). http://2012books.lardbucket.org/books/the-legal-environment-and-government-regulation-of-business/s05-corporate-social-responsibilit.html EDUCATIONAL OBJECTIVES Upon completion of this conference, participants should be better able to:

Identify the history behind the birth of corporate compliance and ethics.

Discuss how the distinction between compliant actions and unethical behavior has become increasingly difficult.

Clearly define the difference between ethics and compliance and their mutual importance with one another.

Identify the ethical issues related to noncompliance and unethical behavior.

Examine the potential impact of noncompliance in the healthcare world. COMPETENCIES: What desirable physician attributes (e.g. professional competencies) set forth by national organizations of medicine (e.g.: IOM, ACGME, ABMS) does this activity address? (C6)


Page 32 of 86



OUTCOMES MEASUREMENT: (List strategy measurement questions and/or other measurement plans.) (C11) ► As a result of what you learned at this conference what do you intend to do differently? What new strategies will you apply to your practice? _____________________________________________________________________________ ► If you do not plan to implement any new strategies learned at this conference, please list any barriers or obstacles that might keep you from doing so: _______________________________________________________________________ FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) SPEAKER: Ana Navarrete, R.N. Manager, Compliance Audit & Compliance Department Baptist Health South Florida








If yes, list collaborative efforts related to this CME activity that support achievement of our CME Mission. The CME Department collaborates with the Department of Bioethics and the Ethics Committee to present compelling healthcare issues for discussion in an educational forum.

DATE REVIEWED: REVIEWED BY: Executive Committee Chairman


Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A Script: EDITED SCRIPT

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The healthcare industry is one of the most highly regulated industries in the U.S., due to regulations ranging from those dealing with patient care to those dealing with submission of claims. Add to this the laws, rules and regulations that apply to any business, and the number of guidelines Baptist Health must follow becomes staggering. Ethics and compliance go hand-in-hand and ethical decision-making fosters employee morale, boosts brand reputation, encourages loyalty in customers and employees, and improves the bottom line.

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Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: The Art of the Spine: Physical Therapy Treatment of Low Back Pain – Optimal Timing for Optimal Outcomes DATE: Thursday, June 11, 2015 TIME: 6-7 p.m. LOCATION: BHM Classroom 5 CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 CONFERENCE DIRECTOR: Ronald Tolchin, D.O. AMA/PRA LEARNING FORMAT:




TARGET AUDIENCE: Hospitalists, General Internists, Family Practitioners, Emergency Medicine and Urgent Care Physicians, and other interested healthcare providers, nurses and physical therapists.

EXPECTED NUMBER OF ATTENDEES: 20-25 CHARGE: 0 TYPE OF MEETING (FORMAT): Must be appropriate to the setting, objectives and desired results (C5). Check all that apply. Live Didactic Lecture ARS







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addressed or ‘closed’ as a result of this CME activity. WHAT IS/ARE THE CURRENT PRACTICE* AND/OR THE PRACTICE GAP*? What are physicians doing (or not doing) that needs to change? Describe the practice gap. ► Physicians may not be aware of how to implement treatment plans that incorporate physical therapy to address low back pain. WHAT IS THE OPTIMAL PRACTICE*? (In a 'perfect world', what would doctors be doing? What does optimal practice 'look like'?) ► Physicians accurately assess patients with low back pain and determine which patients would benefit from the implementation of a treatment plan that includes physical therapy. WHAT IS THE REASON FOR THIS GAP? Indicate if the gap is related to either/or:


DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) And will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? (Check all that apply.) *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) ►Physicians implement most appropriate treatment plan for patients with low back pain and consider inclusion of early physical therapy to achieve optimal outcomes. *REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► Early physical therapy following a new primary care consultation was associated with reduced risk of subsequent health care compared with delayed physical therapy. Further research is needed to clarify exactly which patients with low back pain should be referred to physical therapy; however, if referral is to be made, delaying the initiation of physical therapy may increase risk for additional health care consumption and costs. Spine. 37(25):2114-21, 2012 Dec 1. http://ovidsp.tx.ovid.com/sp-3.14.0b/ovidweb.cgi?&S=KNNNFPFJHKDDMCPCNCLKNHDCEEHAAA00&Complete+Reference=S.sh.46%7c13%7c1 EDUCATIONAL OBJECTIVES: Upon completion of this conference, participants should be better able to: Assess therapeutic treatment options for low back pain. Examine correlation of early physical therapy implementation to reduced risk of subsequent healthcare costs. Implement an appropriate physical therapy treatment plan for low back pain patients.





OUTCOMES MEASUREMENT: (List strategy measurement questions and/or other measurement plans.) (C11) ► As a result of what you learned at this conference what do you intend to do differently? What new strategies will you apply to your practice? _____________________________________________________________________________ ► If you do not plan to implement any new strategies learned at this conference, please list any barriers or obstacles that might keep you from doing so: _______________________________________________________________________

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FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Laura Moulton, DPT Doctor of Physical Therapy Baptist Health South Florida








If yes, list collaborative efforts related to this CME activity that support achievement of our CME Mission. ______________ This CME activity was planned in collaboration with Baptist Health Neuroscience Center.

DATE REVIEWED: March 3, 2015 REVIEWED BY: Committee Chairman



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CME ACTIVITY TITLE: Participation and Documentation Requirements for Teaching Physician Billing DATE: Thursday, June 25, 2019 TIME: 5 – 6 p.m. LOCATION: WKBH – Surgical Services Conference Room CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 CONFERENCE DIRECTOR: AMA/PRA LEARNING FORMAT:




TARGET AUDIENCE: West Kendall Baptist Hospital GME faculty including: Family medicine practitioners, cardiologists, emergency medicine physicians, surgeons, hospitalists, Ob/Gyn’s, nephrologists, hematologists/oncologists, infectious disease specialists, gastroenterologists, neurologists, ENT’s, ophthalmologists, urologists, pulmonologists, critical care physicians, nurses, medical students, residents, fellows and other interested healthcare professionals. EXPECTED NUMBER OF ATTENDEES: 25 CHARGE: 0 TYPE OF MEETING (FORMAT): Must be appropriate to the setting, objectives and desired results (C5). Check all that apply. Live Didactic Lecture ARS







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addressed or ‘closed’ as a result of this CME activity. WHAT IS/ARE THE CURRENT PRACTICE* AND/OR THE PRACTICE GAP*? What are physicians doing (or not doing) that needs to change? Describe the practice gap. ► Physicians that supervise residents' and/or fellows' clinical practice may not be participating in a resident service to the extent required for teaching physician billing, and/or documenting the necessary note in the medical record to indicate the required level of participation for teaching physician billing occurred. WHAT IS THE OPTIMAL PRACTICE*? (In a 'perfect world', what would doctors be doing? What does optimal practice 'look like'?) ► Physicians that involve residents in the care of their patients should ensure that the necessary amount of teaching physician participation occurs, and documentation exists supporting this teaching physician involvement, prior to a teaching physician billing for the service. WHAT IS THE REASON FOR THIS GAP? Indicate if the gap is related to either/or:


DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) And will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? (Check all that apply.) *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) ►Physicians supervising residents implement appropriate teaching techniques when teaching physician billing and documenting in patients medical records to meet specific participation/performance requirements. *REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► ACGME Program Requirements for Graduate Medical Education in Internal Medicine The faculty must: II.B.1.a) devote sufficient time to the educational program to fulfill their supervisory and teaching responsibilities; and to demonstrate a strong interest in the education of residents, and (Core) II.B.1.b) administer and maintain an educational environment conducive to educating residents in each of the ACGME competency areas. (Core) II.B.1.c) provide advising for residents in the areas of educational goal-setting, career planning, patient care, and scholarship, and II.B.1.d) meet professional standards of behavior. (Core) II.B.2. The physician faculty must have current certification in the specialty by the American Board of Internal Medicine, or possess qualifications judged acceptable to the Review Committee. (Core) II.B.3. The physician faculty must possess current medical licensure and appropriate medical staff appointment. (Core) II.B.4. The nonphysician faculty must have appropriate qualifications in their field and hold appropriate institutional appointments. (Core) II.B.5. The faculty must establish and maintain an environment of inquiry and scholarship with an active research component. (Core) II.B.5.a) The faculty must regularly participate in organized clinical discussions, rounds, journal clubs, and conferences. II.B.5.b) Some members of the faculty should also demonstrate scholarship by one or more of the following: II.B.5.b).(1) peer-reviewed funding; (Detail) II.B.5.b).(2) publication of original research or review articles in peer reviewed journals, or chapters in textbooks; II.B.5.b).(3) publication or presentation of case reports or clinical series at local, regional, or national professional and scientific society meetings; or, II.B.5.b).(4) participation in national committees or educational organizations. https://www.acgme.org/acgmeweb/Portals/0/PFAssets/2013-PR-FAQ-PIF/140_internal_medicine_07012013.pdf ►Services Furnished by an Intern or Resident Within the Scope of an Approved Training Program Medical and surgical services furnished by an intern or resident within the scope of his or her training program are covered as provider services and Medicare pays for them through Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments. These services may not be billed or paid under the Medicare PFS. When interns or residents are in an approved program and training in a nonprovider setting, the services furnished are payable in one of the following ways: a. Through DGME and IME payments to the hospital(s), if, among other things, he or she: Provides patient care activities and the hospital(s) incurs salary and fringe benefits of the resident or intern during the time spent in the nonprovider setting; or b. For DGME purposes, spends time in certain nonpatient care activities in certain nonprovider settings and the hospital(s) incurs salary and fringe benefits of the resident or intern during the time he or she spent in the nonprovider setting; or

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c. Through the Medicare PFS if, in part, the regulations concerning the hospital’s receipt of DGME and IME payments are not met for the time spent in a nonprovider setting, and the time spent in the nonprovider setting is not counted by the hospital for DGME and IME payment purpose. http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Teaching-Physicians-Fact-Sheet-ICN006437.pdf EDUCATIONAL OBJECTIVES: Upon completion of this conference, participants should be better able to: Recognize situations in which the teaching physician billing rules apply. Summarize the specific documentation residents must record to demonstrate the required amount of teaching physician

participation/performance was rendered. Implement specific participation/performance requirements that exist for each type of resident service. Identify when pertinent billing requirements have been met by the teaching physician.





OUTCOMES MEASUREMENT: (List strategy measurement questions and/or other measurement plans.) (C11) ► As a result of what you learned at this conference what do you intend to do differently? What new strategies will you apply to your practice? _____________________________________________________________________________ ► If you do not plan to implement any new strategies learned at this conference, please list any barriers or obstacles that might keep you from doing so: _______________________________________________________________________ FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Seth Canterbury (pending title)





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If yes, list collaborative efforts related to this CME activity that support achievement of our CME Mission. ______________ This event is in collaboration with the West Kendall Baptist Hospital Graduate Medical Education Program.

DATE REVIEWED: 06.12.2015 REVIEWED BY: Executive Committee Chairman



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Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Promoting Physician Wellness: Recognizing the Signs of Fatigue and Sleep Deprivation Strategies for Alertness Management and Fatigue Mitigation DATE: Thursday, June 25, 2019 TIME: 4 – 5 p.m. LOCATION: WKBH – Surgical Services Conference Room CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 CONFERENCE DIRECTOR: Agueda Hernandez, M.D. AMA/PRA LEARNING FORMAT:




TARGET AUDIENCE: West Kendall Baptist Hospital GME faculty including: Family medicine practitioners, cardiologists, emergency medicine physicians, surgeons, hospitalists, Ob/Gyn’s, nephrologists, hematologists/oncologists, infectious disease specialists, gastroenterologists, neurologists, ENT’s, ophthalmologists, urologists, pulmonologists, critical care physicians, nurses, medical students, residents, fellows and other interested healthcare professionals. EXPECTED NUMBER OF ATTENDEES: 25 CHARGE: 0 TYPE OF MEETING (FORMAT): Must be appropriate to the setting, objectives and desired results (C5). Check all that apply. Live Didactic Lecture ARS







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addressed or ‘closed’ as a result of this CME activity. WHAT IS/ARE THE CURRENT PRACTICE* AND/OR THE PRACTICE GAP*? What are physicians doing (or not doing) that needs to change? Describe the practice gap. ► Physicians may not be aware of the signs of fatigue and sleep deprivation in residents and fellows. WHAT IS THE OPTIMAL PRACTICE*? (In a 'perfect world', what would doctors be doing? What does optimal practice 'look like'?) ► Physicians recognize the signs of fatigue and sleep deprivation in fellows and residents and properly address and mitigate them. WHAT IS THE REASON FOR THIS GAP? Indicate if the gap is related to either/or:


DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) And will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? (Check all that apply.) *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) ►Physicians supervising residents and fellows implement appropriate strategies to address issues of fatigue and sleep deprivation. *REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► With the growing attention paid to resident duty hours, there is an increasing need for research involving fatigue and practical ways to measure it. This study shows that residents who are measurably fatigued (both objectively and subjectively) may have difficulty utilizing vestibular input during quiet standing but can compensate by means of somatosensory and visual input. Laryngoscope. 2015 Feb;125(2):337-41. doi: 10.1002/lary.24792. Epub 2014 Jun 16. Balance as a measurement of fatigue in postcall residents. Cuthbertson DW1, Bershad EM, Sangi-Haghpeykar H, Cohen HS. http://www.ncbi.nlm.nih.gov/pubmed/24933004 EDUCATIONAL OBJECTIVES: Upon completion of this conference, participants should be better able to: Summarize medical literature supporting ACGME guidelines for work hour restrictions. Describe the impact of sleep loss and fatigue on cognitive function and fatigue. Recognize the signs of fatigue and sleep deprivation. Implement strategies for alertness management and fatigue mitigation.





OUTCOMES MEASUREMENT: (List strategy measurement questions and/or other measurement plans.) (C11) ► As a result of what you learned at this conference what do you intend to do differently? What new strategies will you apply to your practice? _____________________________________________________________________________ ► If you do not plan to implement any new strategies learned at this conference, please list any barriers or obstacles that might keep you from doing so: _______________________________________________________________________

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FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Dana O. Mato, Psy. D. (Pending)








If yes, list collaborative efforts related to this CME activity that support achievement of our CME Mission. ______________ This event is in collaboration with the West Kendall Baptist Hospital Graduate Medical Education Program.



Continuing Psychology Education Credits: # 1 N/A Continuing Dental Education Credits: # N/A

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Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: MCVI Research Grand Rounds: New MCVI Support System for Investigator Initiated Studies DATE: Wednesday, July 15, 2015 TIME: 5:30-7 p.m. LOCATION: 5MCVI Conf. Room CREDIT HOUR(S) APPLIED FOR: (1.5 Cat. 1) CONFERENCE DIRECTOR: Raul Herrera, M.D. AMA/PRA LEARNING FORMAT:




TARGET AUDIENCE: Physicians, nurses interested in or active in research, clinical research coordinators, research assistants and medical students and other interested healthcare professionals. EXPECTED NUMBER OF ATTENDEES: 30-40 CHARGE: 0 TYPE OF MEETING (FORMAT): Must be appropriate to the setting, objectives and desired results (C5). Check all that apply. Live Didactic Lecture ARS






Other (Explain): New system to be implemented. FACTORS OUTSIDE OUR CONTROL - List factors, outside our control and beyond learner performance that impact patient outcomes and contribute to the healthcare 'quality gap' being addressed. (C18) Patient: Non-compliance Lifestyle Resistance-to-change Financial/Lack of Insurance Physician: Non-compliance Resistance-to-change Communication Skills Financial Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or No Treatment Modalities Limited or No Diagnostic Modalities Other: New MCVI Research infrastructure and monitoring system.

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addressed or ‘closed’ as a result of this CME activity. WHAT IS/ARE THE CURRENT PRACTICE* AND/OR THE PRACTICE GAP*? What are physicians doing (or not doing) that needs to change? Describe the practice gap. ► Physicians may not be aware of the current MCVI research infrastructure changes that will enhance future research at MCVI. WHAT IS THE OPTIMAL PRACTICE*? (In a 'perfect world', what would doctors be doing? What does optimal practice 'look like'?) ► Physicians who perform research are able to assess new data and protocol monitoring systems, all within the regulatory responsibilities of being an investigator. WHAT IS THE REASON FOR THIS GAP? Indicate if the gap is related to either/or:


DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) And will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? (Check all that apply.) *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) ► Physicians who perform research will utilize new data and protocol monitoring systems, all within the regulatory responsibilities of being an investigator, to improve clinical research within MCVI. *REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► Case report form (CRF) is a specialized document in clinical research. It should be study protocol driven, robust in content and have material to collect the study specific data. Though paper CRFs are still used largely, use of electronic CRFs (eCRFS) are gaining popularity due to the advantages they offer such as improved data quality, online discrepancy management and faster database lock etc. Main objectives behind CRF development are preserving and maintaining quality and integrity of data. CRF design should be standardized to address the needs of all users such as investigator, site coordinator, study monitor, data entry personnel, medical coder and statistician. Data should be organized in a format that facilitates and simplifies data analysis. Collection of large amount of data will result in wasted resources in collecting and processing it and in many circumstances, will not be utilized for analysis. Apart from that, standard guidelines should be followed while designing the CRF. CRF completion manual should be provided to the site personnel to promote accurate data entry by them. These measures will result in reduced query generations and improved data integrity. It is recommended to establish and maintain a library of templates of standard CRF modules as they are time saving and cost-effective. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4170533/ EDUCATIONAL OBJECTIVES Upon completion of this conference, participants should be better able to: -Assess the new infrastructure being developed at MCVI to support investigator initiated research studies. -Examine advanced monitoring tools for assistance protocol and case report form development. COMPETENCIES: What desirable physician attributes (e.g. professional competencies) set forth by national organizations of medicine (e.g.: IOM, ACGME, ABMS) does this activity address? (C6)





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Juan M. Acuña, M.D., MSc. Associate Professor of Human and Molecular Genetics and Clinical Epidemiology Director, Division of Research and Information and Data Coordinating Center FIU Herbert Wertheim College of Medicine Miami, Florida Carrie Cameron Executive Director, Global CRO Services Clinlogix, LLC Ambler, Pennsylvania Carlos Granada VP Business Development, Emerging Technologies Clinlogix, LLC Ambler, Pennsylvania JeanMarie Markham, R.N., CCRA CEO, Clinlogix, LLC Ambler, Pennsylvania Moderator: Barry T. Katzen, M.D.








If yes, list collaborative efforts related to this CME activity that support achievement of our CME Mission. This activity was planned in collaboration with the MCVI Research Department.

DATE REVIEWED: June 15, 2015 REVIEWED BY: Accelerated Approval Executive Committee Live Committee



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CME ACTIVITY TITLE: Conversations in Ethics: Faith: Help or Hindrance to the Medical Professional? DATE: Friday, September 18, 2015 TIME: 12:00 Noon - 1:00 p.m. LOCATION: Mariners Hospital Main Conf Room CREDIT HOUR(S) APPLIED FOR: 1 Cat 1 Videoconferenced to: BHM CL # 5, HH Auditorium, & WKBH CL 4 & 5 CONFERENCE DIRECTOR: Raúl de Velasco, M.D., FACP, Chairman, Baptist Health Bioethics Department CONFERENCE COORDINATOR: Rose Allen, R.N., M.S.M. /H.M., CHPN, Director, Bioethics & Palliative Care AMA/PRA LEARNING FORMAT:




TARGET AUDIENCE: Physicians, Psychologists, Nurses, Social Workers, Respiratory Therapists, Clergy, Pharmacists, Medical Students, Registered Dietitians and other interested healthcare professionals. EXPECTED NUMBER OF ATTENDEES: 20-30 CHARGE: 0 TYPE OF MEETING (FORMAT): Must be appropriate to the setting, objectives and desired results (C5). Check all that apply. Live Didactic Lecture ARS






Other (Explain): Bioethics Committee Request FACTORS OUTSIDE OUR CONTROL - List factors, outside our control and beyond learner performance that impact patient outcomes and contribute to the healthcare 'quality gap' being addressed. (C18) Patient: Non-compliance Lifestyle Resistance-to-change Financial/Lack of Insurance Physician: Non-compliance Resistance-to-change Communication Skills Financial Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or No Treatment Modalities Limited or No Diagnostic Modalities Other: ________________________________________________________________________

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addressed or ‘closed’ as a result of this CME activity. WHAT IS/ARE THE CURRENT PRACTICE* AND/OR THE PRACTICE GAP*? What are physicians doing (or not doing) that needs to change? Describe the practice gap. ► There is growing recognition that persistent pain is a complex and multidimensional experience stemming from the interrelationship among biological, psychological, social, and spiritual factors. Chronic pain patients use a number of cognitive and behavioral strategies to cope with their pain, including religious/spiritual forms of coping, such as prayer, and seeking spiritual support to manage their pain. This article will explore the relationship between the experience of pain and religion/spirituality with the aim of understanding not only why some people rely on their faith to cope with pain, but also how religion/spirituality may impact the experience of pain and help or hinder the coping process. We will also identify future research priorities that may provide fruitful research in illuminating the relationship between religion/spirituality and pain. http://www.ncbi.nlm.nih.gov/pubmed/17541817 WHAT IS THE OPTIMAL PRACTICE*? (In a 'perfect world', what would doctors be doing? What does optimal practice 'look like'?) ► Physicians recognize their own resistance to faith-related issues that come up during patient interactions, and utilize a framework to identify and address these issues. WHAT IS THE REASON FOR THIS GAP? Indicate if the gap is related to either/or:


DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) And will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? (Check all that apply.) *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) ► Physicians identify their resistance to faith-related issues and develop a framework to identify and address these issues. *REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► The present study explored in a sample of Flemish pain patients the role of prayer as a possible individual factor in pain management. The focus on prayer as a personal religious factor fits with the current religious landscape in Western-Europe where personal religious factors are more important than organizational dimensions of religion. Our study is framed in the transactional theory of stress and coping by testing first, whether prayer was related with pain severity and pain tolerance and second, whether cognitive positive re-appraisal was a mediating mechanism in the association between prayer and pain. We expected that prayer would be related to pain tolerance in reducing the impact of the pain on patient’s daily life, but not necessarily to pain severity. A cross-sectional questionnaire design was adopted in order to measure demographics, prayer, pain outcomes (i.e., pain severity and pain tolerance), and cognitive positive re-appraisal. Two hundred and two chronic pain (CP) patients, all members of a Flemish national patients association, completed the questionnaires. Correlational analyses showed that prayer was significantly related with pain tolerance, but not with pain severity. However, ancillary analyses revealed a moderational effect of religious affiliation in the relationship between prayer and pain severity as well as pain tolerance. Furthermore, mediation analysis revealed that cognitive positive re-appraisal was indeed an underlying mechanism in the relationship between prayer and pain tolerance. This study affirms the importance to distinguish between pain severity and pain tolerance, and indicates that prayer can play a role in pain management, especially for religious pain patients. Further, the findings can be framed within the transactional theory of stress and coping as the results indicate that positive re-appraisal might be an important underlying mechanism in the association between prayer and pain. http://link.springer.com/article/10.1007/s10865-011-9348-2 Additional Resources ►http://www.ncbi.nlm.nih.gov/pubmed/17541817 ► http://link.springer.com/article/10.1007/s10865-011-9348-2 EDUCATIONAL OBJECTIVES Upon completion of this conference, participants should be better able to:

Distinguish between spirituality and religion. Explain the impact of a patient’s faith on his or her understanding of the treatment process. Recognize one’s own potential resistance to managing faith-related issues that come up during patient interactions,

and develop a framework for identifying and addressing it. COMPETENCIES: What desirable physician attributes (e.g. professional competencies) set forth by national organizations of medicine (e.g.: IOM, ACGME, ABMS) does this activity address? (C6)


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OUTCOMES MEASUREMENT: (List strategy measurement questions and/or other measurement plans.) (C11) ► As a result of what you learned at this conference what do you intend to do differently? What new strategies will you apply to your practice? _____________________________________________________________________________ ► If you do not plan to implement any new strategies learned at this conference, please list any barriers or obstacles that might keep you from doing so: _______________________________________________________________________ FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) SPEAKER: Reverend Neil Skjoldal, M.Div., Ph.D., BCC Staff Chaplain Homestead and Mariners Hospitals









DATE REVIEWED: 7/1/2015 REVIEWED BY: Executive Committee Chairman


Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A Script: Few topics generate a stronger reaction than when faith and science collide. Some people are fervent in their personal faith, others much less so, and still others view faith as a hindrance to the work of the medical professional. Is it possible to have theological consensus in an age of spiritual confusion? Wouldn’t it be easier simply to ignore the whole subject while we do the important work of medicine? This presentation will seek to explore the significance of faith in our medical context as we provide care to the whole person.

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Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Podiatry Education

CME ACTIVITY TITLE: Wound Care and Critical Limb Ischemia 10th Annual Symposium: Beneath the Surface: An In-depth Focus DATE: Saturday, September 19, 2015 TIME: 7:30-4 p.m. LOCATION: The Ritz-Carlton Coconut Grove, Miami CREDIT HOUR(S) APPLIED FOR: 6.75 Cat. 1 CONFERENCE DIRECTOR: Abilio Coello, M.D., FACS, RPVI, Jason Hanft, DPM, FACFAS and Constantino Peña, M.D., FSIR, FAHA AMA/PRA LEARNING FORMAT:




Target Audience: Wound Care Specialists, Podiatrists, Vascular and Orthopedic Surgeons, Interventional Radiologists, General Surgeons, Orthopedists, Intensivists, Plastic Surgeons, Pulmonologists, Physiatrists, Cardiologists, Endocrinologists, Infectious Disease Specialists, Dermatologists, Undersea and Hyperbaric Medicine Specialists, Family Physicians, General Internists, Residents, Nurses, Physical Therapists, Occupational Therapists, Pharmacists, Radiologic Technologists, Hyperbaric Technologists, Respiratory Therapists and Registered Dietitians. EXPECTED NUMBER OF ATTENDEES: 250-300 CHARGE: Physicians $215, Nurses & Allied Health Professionals $175;

Baptist Health Employees $35; Students & Residents $35; Group Rate (3 or more) $125 for physicians $100 all others TYPE OF MEETING (FORMAT): Must be appropriate to the setting, objectives and desired results (C5). Check all that apply. Live Didactic Lecture ARS







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addressed or ‘closed’ as a result of this CME activity.

WHAT IS/ARE THE CURRENT PRACTICE* and/or THE PRACTICE GAP*? Physicians and the interdisciplinary healthcare team may not always know the appropriate referrals that should be made when initially assessing a patient with critical limb ischemia and/or wounds. The underlying vascular deficiencies that contribute to wounds are not consistently considered as part of patient’s treatment plans. Initially determining correct etiology of wounds can be a challenge for practitioners and incorrect assessments contribute to delays in patient care. Earlier determination of futile treatment followed by change in treatment approach and/or expedited referral to appropriate specialists will improve opportunity for best possible patient care outcomes. WHAT IS THE OPTIMAL PRACTICE*? Physicians’ first goal in limb ischemia and wound care is accurate diagnosis and evaluation to establish the most appropriate treatment approach. Physicians determine etiology of the wound and implement the minimum standard of initial intervention. Physicians differentiate non-acute ischemia from critical limb ischemia and accurately determine when to escalate cases to limb salvage. Physicians determine futile treatment and implement timely changes to treatment approach and/or referral to appropriate specialists that will improve opportunity for best possible patient care outcomes. WHAT IS THE REASON FOR THIS GAP? Indicate if the gap is in physician:

Knowledge? (They do not know that they need to be doing something.) Competence? (They do not know how to do it) Performance? (They know how to do it but are non-compliant - or are not doing it properly)

DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) Will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) Physicians will provide optimal care and achieve best outcomes when they consistently implement evidence-based methods of diagnosis, evaluation and treatment to effectively identify and manage patients with limb ischemia and/or wounds. *REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: SEE ATTACHED EDUCATIONAL OBJECTIVES: SEE ATTACHED





OUTCOMES MEASUREMENT: (List strategy measurement questions and/or other measurement plans.) (C11) ► As a result of what you learned at this conference what do you intend to do differently? What new strategies will you apply to your practice? _____________________________________________________________________________ ► If you do not plan to implement any new strategies learned at this conference, please list any barriers or obstacles that might keep you from doing so: _______________________________________________________________________ FACULTY: SEE ATTACHED RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3)

Yes No CME Dept. Leadership and Staff CME Committee

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Conference Director (see above) Others (i.e.: Conference Coordinator, Planning Group etc.) COMMERCIAL SUPPORT: The Baptist Health Continuing Medical Education Department will not solicit or accept grants from commercial interests to support CME activities, thereby strengthening the CME Program's commitment to be independent and free of the influence of commercial interests. Indicate here if support will come from the Foundation general Continuing Medical Education fund. BARRIERS TO PHYSICIAN CHANGE: (C19) Is this activity focused on ‘overcoming, addressing, or removing barriers to physician change' applicable to our learners? Yes No If 'yes', list the barrier(s) identified and include relevant data and information about the barriers. OVERALL PROGRAM CHANGES: Does this CME activity reflect implementation (C14) of any interventions or changes that came about as a result of our overall CME program evaluation and analysis (C13) to meet the CME mission?

Yes No If yes, please describe the related CME program change. _________________________ And describe how the impact of the related program improvement will be measured and documented? (C15) NON-EDUCATION STRATEGIES: Explain what we are doing (CME or BHSF) -- or what we could do -- to enhance change as an adjunct (in addition to) to this CME activity? (C17) These would be tactics and tools to facilitate change that go beyond this CME activity. Process redesign or new protocol Reminders (Posters, mailings, email blasts) New order sheets Other tools or tactics Explain: _____________________________________________ COLLABORATION: Are we engaged in collaborative and cooperative projects with other stakeholders (internal or external) that are related to this CME activity? (C20)


If yes, list collaborative efforts related to this CME activity that support achievement of our CME Mission. This meeting has been planned in collaboration with the Miami Cardiac & Vascular Institute’s Wound Center and Vascular Services. DATE REVIEWED: June 10, 2015 REVIEWED BY: Accelerated Approval Chairman Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 6.75 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A EDUCATIONAL OBJECTIVES and REFERENCES: Initial Wound Assessment Jason R. Hanft, DPM, FACFAS

Determine etiology of the wound and implement the minimum standard of initial intervention. Reference: Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes mellitus. The presence of an unhealed DFU increases the risk of infection, amputation and death. Low rates of DFU healing remain a challenge. Recognizing these issues, a consensus panel was recently convened to review the evidence and practicalities for the evaluation and treatment of patients with DFUs. This consensus panel seeks to provide clinicians with the clinical markers, evidence and recommendations that, used in conjunction with orderly decision-making and good clinical judgment, will advance the standard of care for the treatment of neuropathic DFUs. (Robert J. Snyder, Robert G. Frykberg, Lee C. Rogers, Andrew J. Applewhite, Desmond Bell, Gregory Bohn, Caroline E. Fife, Jeffrey Jensen, and James Wilcox (2014) The Management of Diabetic Foot Ulcers Through Optimal Off-Loading. Journal of the American Podiatric Medical Association: November 2014, Vol. 104, No. 6, pp. 555-567.) Practical Wound Care Management Dorothy (Dot) Weir, R.N., CWON, CWS

Implement evidence-based algorithm of care for timely wound management and decide when to utilize vascular intervention to improve patient outcomes

Optimal Practice Reference: Hartford Institute for Geriatric Nursing (HIGN). Pressure ulcer prevention. In: Evidence-based geriatric nursing

protocols for best practice. Boltz M, Capezuti E, Fulmer T, Zwicker D, editor(s). Evidence-based geriatric nursing protocols for best practice. 4th ed. New York (NY): Springer Publishing Company; 2012. p. 298-323.

Wound, Ostomy, and Continence Nurses Society (WOCN). Guideline for prevention and management of pressure ulcers. Mount Laurel (NJ): Wound, Ostomy, and Continence Nurses Society (WOCN); 2010 Jun 1. 96 p. (WOCN clinical practice guideline; no. 2). [341 references]

Pressure Ulcers: Update on National Standards

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Dorothy (Dot) Weir, R.N., CWON, CWS Discuss current national standards for pressure wound management. Refine preventive practices in challenging situations, and identify the limits of prevention.

Reference: Although pressure ulcer (PrU) development is now generally considered an indicator for quality of care, questions and concerns about situations in which they are unavoidable remain. Considering the importance of this issue and the lack of available research data, in 2010 the National Pressure Ulcer Advisory Panel (NPUAP) hosted a multidisciplinary conference to establish consensus on whether there are individuals in whom pressure ulcer development may be unavoidable and whether a difference exists between end-of-life skin changes and pressure ulcers. Thirty-four stakeholder organizations from various disciplines were identified and invited to send a voting representative. Of those, 24 accepted the invitation. Before the conference, existing literature was identified and shared via a webinar. A NPUAP task force developed standardized consensus questions for items with none or limited evidence and an interactive protocol was used to develop consensus among conference delegates and attendees. Consensus was established to be 80% agreement among conference delegates. Unanimous consensus was achieved for the following statements: most PrUs are avoidable; not all PrUs are avoidable; there are situations that render PrU development unavoidable, including hemodynamic instability that is worsened with physical movement and inability to maintain nutrition and hydration status and the presence of an advanced directive prohibiting artificial nutrition/hydration; pressure redistribution surfaces cannot replace turning and repositioning; and if enough pressure was removed from the external body the skin cannot always survive. Consensus was not obtained on the practicality or standard of turning patients every 2 hours nor on concerns surrounding the use of medical devices vis-à-vis their potential to cause skin damage. Research is needed to examine these issues, refine preventive practices in challenging situations, and identify the limits of prevention. (Ostomy Wound Management. 2011 Feb;57(2):24-37, Pressure ulcers: avoidable or unavoidable? Results of the National Pressure Ulcer Advisory Panel Consensus Conference.Black JM, Edsberg LE, Baharestani MM, Langemo D, Goldberg M, McNichol L, Cuddigan J; National Pressure Ulcer Advisory Panel.) Diabetic Foot Ulcers Adam Landsman, DPM, Ph.D., FACFAS Learning objectives:

Examine the roles of advanced biologics, including hyaluronic acid, and collagen in the treatment of diabetic foot ulcers (DFUs).

Assess the appropriate use of living cell therapy. Explore recent developments and newest options in advanced dressing and wound prep materials.

Optimal Practice Reference: Debridement should only be done by healthcare professionals from the multidisciplinary foot care team, using the technique that best matches their specialist expertise, clinical experience, patient preference, and the site of the ulcer. When choosing wound dressings, healthcare professionals from the multidisciplinary foot care team should take into account their clinical assessment of the wound, patient preference and the clinical circumstances, and should use wound dressings with the lowest acquisition cost. Offer off-loading for patients with diabetic foot ulcers. Healthcare professionals from the multidisciplinary foot care team should take into account their clinical assessment of the wound, patient preference and the clinical circumstances, and should use the technique with the lowest acquisition cost. Use pressure-relieving support surfaces and strategies in line with pressure ulcers (NICE clinical guideline 29) to minimize the risk of pressure ulcers developing. Diabetic foot problems. Inpatient management of diabetic foot problems. (Guideline.gov) Centre for Clinical Practice. Diabetic foot problems. Inpatient management of diabetic foot problems. London (UK): National Institute for Health and Clinical Excellence (NICE); 2011 Mar. 31 p. (Clinical guideline; no. 119). Chronic DFUs are a growing global health concern due to the implied high rates of morbidity and mortality. Standard-of-care modalities sometimes are not sufficient for some recalcitrant ulcers. The use of adjuvant topical therapies including advanced dressings and biologic therapies should be considered in patients whose DFU did not reduce in size after receiving standard care for a period of 4 weeks. These advanced treatments must be used in combination with standard care measures, including debridement, moist wound healing, offloading, and infection control. (Topical and biologic therapies for diabetic foot ulcers; http://www.ncbi.nlm.nih.gov/pubmed/23992899; Med Clin North Am. 2013 Sep;97(5):883-98. doi: 10.1016/j.mcna.2013.03.014. Epub 2013 May 18) A novel injectable scaffolding matrix (E-Matrix) has been developed to accelerate wound healing in diabetic foot ulcers. This porcine collagen-derived matrix is designed to mimic tertiary embryonic connective tissue and to stimulate fetal wound repair mechanisms including angiogenesis. In vitro and animal studies have indicated a beneficial effect on tissue growth and an acceptable safety profile. In this report, we describe the initial use of this product in a pilot study of six humans with chronic nonhealing diabetic foot ulcers. A dramatic initial response to injection was seen, with an average wound size reduction of 72% 2 weeks after injection. Randomized trials are underway to define the potential benefit of this new treatment modality for diabetic foot ulcers.http://www.ncbi.nlm.nih.gov/pubmed/15953042; Among lower extremity chronic wounds, heel ulcers present one of the greatest challenges to the wound care provider. The potential for these ulcers to progress to osteomyelitis of the calcaneus is well known. The concept of "what to take off the wound" is a known clinical axiom; however, extensive debridement or surgical reconstruction including a partial calcanectomy can significantly impair the patient's ambulation, balance, and overall functional mobility. Critical to the wound healing process is the need to replace damaged cells. The use of cellular therapy to achieve wound closure has added to the armamentarium

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of the wound care specialist. Among several commercially available advanced wound products, the Food and Drug Administration has approved only 1 living bilayered cell therapy (Apligraf) for use with standard therapy in the treatment of venous ulcers, as well as for full-thickness neuropathic diabetic foot ulcers. Apligraf has the capability to express multiple growth factors found in normal skin, thus potentially providing a biologically active matrix in the wound. http://www.ncbi.nlm.nih.gov/pubmed/18525250 Venous Ulcers Jose Almeida, M.D.

Identify venous ulcer etiology and determine whether interventional or non interventional treatment is necessary. Optimal Practice Reference: Peripheral vascular disease is common and often undiagnosed. Painful vascular ulcers and intermittent claudication greatly reduce mobility and quality of life. Screening for diagnosis is best accomplished by an ankle brachial index, whereas anatomic visualization of the arterial anatomy may be necessary to plan treatment. Vascular disease produces ulcers with a gangrenous appearance, which are resistant to topical treatments. Medical therapy has had limited success. Surgical correction of vascular insufficiency by bypass, angioplasty, or stenting improves outcomes when feasible. Supervised exercise rehabilitation is superior to both medical therapy and surgical therapy. (Clinics in Geriatric Medicine. 29(2):425-31, 2013 May.) Revascularization: BEST Trial James Benenati, M.D.

Examine the range of revascularization strategies for the treatment of patients with critical limb ischemia. Optimal Practice Reference: There are 120 medical centers participating in the BEST-CLI study. BEST-CLI is a prospective, multicenter, randomized, open label (two-arm), comparison trial to evaluate the effectiveness of best surgical (OPEN) compared to best endovascular (EVT) revascularization in patients with CLI. 2,100 subjects will be recruited from approximately 120 multidisciplinary vascular centers and practices in the US and Canada. BEST-CLI is funded by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH). Given that a variety of specialists treat CLI, a Specialty Principal Investigator (PI) is appointed, at every site, for each specialty that treats CLI and is participating in the trial. (Farber A, Rosenfield K, Menard M. The BEST-CLI Trial: a multidisciplinary effort to assess which therapy is best for patients with critical limb ischemia. Tech Vasc Interv Radiol. 2014; 17(3):221-224. Technologies Available for Successful and Improved Revascularization Alex Powell, M.D. and Adam Geronemus, M.D.

Identify technologies available to improve the safety and effectiveness of percutaneous revascularization. Optimal Practice Reference: Lower extremity peripheral arterial occlusive disease poses a unique challenge to traditional angioplasty-based endovascular therapies. The diffuse nature of lower extremity atherosclerotic disease, the presence of chronic total occlusions, poor distal runoff, and the presence of critical limb ischemia all have contributed to the disappointing results of balloon angioplasty for complex infrainguinal arterial disease. These challenges have spawned the development of a host of new technologies in an attempt to improve the safety and effectiveness of percutaneous revascularization for lower extremity peripheral arterial occlusive disease. Recent advances in available technologies include novel angioplasty balloons; nitinol stents, stent grafts, and drug-eluting stents; excisional, laser, and rotational atherectomy devices; devices for crossing total occlusions; true-lumen reentry devices; thrombectomy catheters; and embolic protection devices. (Overview of New Technologies for Lower Extremity Revascularization http://circ.ahajournals.org/content/116/18/2072.full) Diabetic Limb Salve or Amputation John S. Steinberg, DPM FACFAS

Explore important considerations regarding amputation decisions, assess survivability when choosing amputations and establish when amputation is the treatment of choice.

Optimal Practice Reference: A transtibial amputation (TTA) is associated with high morbidity and mortality, which suggests that the advantage of partial foot amputations should be investigated. Only transmetatarsal amputations at 1 and 3 years were statistically lower for mortality than TTA. Partial foot amputations at the other levels failed to show statistically improved survivorship. Transmetatarsal and Chopart's amputations had high ambulatory levels and the longest durability, which suggests that these amputations may provide some ambulatory advantage. (Foot & Ankle International. 33(9):707-16, 2012 Sep.) Diabetic foot disease frequently leads to substantial long-term complications, imposing a huge socioeconomic burden on available resources and health-care systems. Peripheral neuropathy, repetitive trauma, and peripheral vascular disease are common underlying pathways that lead to skin breakdown, often setting the stage for limb-threatening infection. Individuals with diabetes presenting with foot infection warrant optimal surgical management to affect limb salvage and prevent amputation; aggressive short-term and meticulous long-term care plans are required. In addition, the initial surgical intervention or series of interventions must be coupled with appropriate systemic metabolic management as part of an integrated, multidisciplinary team. Such teams typically include multiple medical, surgical, and nursing specialties across a variety of public and private health-care systems. (Journal of the American Podiatric Medical Association. 100(5):401-5, 2010 Sep-Oct.) Lower extremity amputation (LEA) is less common but is an extreme complication associated with diabetes and foot ulcer. In the U.S., nearly 80,000 LEAs are performed on diabetics each year. In 2005, the overall rate of hospital discharge for

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new LEA was about 4.3 per 1,000 people with diabetes compared with a rate of about 0.3 per 1,000 in the general population. (http://www.ncbi.nlm.nih.gov/books/NBK65149/) The number of hospital discharges for nontraumatic lower extremity amputation (LEA) with diabetes as a listed diagnosis started to increase from 55,000 in 1988 to 83,000 in 1997, and then decreased to 68,000 in 2009. From 1988 to 2009, the number of discharges increased by 24%. (http://www.cdc.gov/diabetes/statistics/lea/fig1.htm) Rapid-Fire Case Study Session: These sessions will provide attendees with an in-depth look at wound care and critical limb ischemia through real patient case scenarios. Join the discussion and learn how the experts tackled their most challenging cases.

Assess and diagnose limb ischemia and wounds to establish the most appropriate initial treatment approach and practical care management.

Recognize futile treatment and implement timely changes to treatment approach and/or referral to appropriate specialists that will improve opportunity for best possible patient care outcomes.

SYMPOSIUM DIRECTORS Jason R. Hanft, DPM, FACFAS Symposium Director Podiatrist, Baptist, Doctors and South Miami Hospitals Director, Podiatric Education and Director of Research, South Miami Hospital Adjunct Professor, Rosalind Franklin University, Temple University and Barry University Diplomate, American Board of Podiatric Surgery Chief Science Officer, Doctors Research Network South Miami, Florida Abilio Coello, M.D., FACS, RPVI Symposium Director Vascular Surgeon Baptist, Doctors, Homestead and West Kendall Hospitals Miami, Florida Constantino Peña, M.D., FSIR, FAHA Symposium Director Diagnostic Radiologist Vascular & Interventional Radiologist Baptist, Doctors, Homestead, South Miami and West Kendall Hospitals Baptist Outpatient Services Miami, Florida BAPTIST HEALTH FACULTY Jose I. Almeida MD, FACS, RPVI, RVT Vascular Surgeon, Doctors Hospital Voluntary Professor of Surgery University of Miami Miller School of Medicine Medical Director, Miami Vein Center Managing Member, Vascular Device Partners James F. Benenati, M.D. Diagnostic, Vascular and Interventional Radiologist Miami Cardiac & Vascular Institute, Baptist, South Miami, Doctors, Homestead and West Kendall Baptist Hospitals Adam Geronemus, M.D. Diagnostic Radiologist Vascular and Interventional Radiology Miami Cardiac & Vascular Institute Alex Powell, M.D. Diagnostic Radiologist Vascular and Interventional Radiology Baptist, Doctors, Homestead, South Miami and West Kendall Baptist Hospitals Baptist Outpatient Services Libby Watch, M.D. Vascular Surgeon Baptist, Doctors, Homestead, and West Kendall Hospitals

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Baptist Outpatient Services GUEST FACULTY Adam Landsman, DPM, Ph.D., FACFAS Assistant Professor of Surgery Harvard Medical School Chief, Division of Podiatric Surgery Cambridge Health Alliance Cambridge, Massachusetts John S. Steinberg, DPM, FACFAS Associate Professor, Department of Plastic Surgery, Georgetown University School of Medicine Program Director, MedStar Washington Hospital Center Podiatric Residency Co-Director, Center for Wound Healing, MedStar Georgetown University Hospital Washington, D.C. Dorothy (Dot) Weir, R.N., CWON, CWS Director of Wound Care for Osceola Regional Medical Center Co-Editor of Today's Wound Clinic Kissimmee, Florida SCHEDULE 7:30 a.m. Registration, Continental Breakfast and Exhibits 8:00 a.m. Welcome and Introductions

Abilio Coello, M.D., Jason Hanft, DPM, and Constantino Peña, M.D. 8:10 a.m. Initial Wound Assessment

Jason Hanft, DPM 8:45 a.m. Diabetic Foot Ulcers Adam Landsman, DPM 9:20 a.m. Venous Ulcers Jose Almeida, M.D. 9:45 a.m. Roundtable Session – All Faculty Moderator: Jason Hanft, M.D. 10:00 a.m. Break and Exhibits 10:20 a.m. Rapid-Fire Case Study Session: In-depth Look at Assessment Moderator: Constantino Peña, M.D. 10:40 a.m. Diabetic Limb Salvage or Amputation John S. Steinberg, DPM 11:15 a.m. Rapid-Fire Case Study Session: In-depth Look at Escalation of Care Libby Watch, M.D. 11:35 a.m. Revascularization Evaluation Abilio Coello, M.D., and Constantino Peña, M.D. 12:00 noon Lunch and Exhibits 1:00 p.m. Revascularization and the BEST Trial James Benenati, M.D. 1:25 p.m. Techniques Available for Successful Revascularization Alex Powell, M.D. 1:50 p.m. Technology Available for Improved Revascularization

Adam Geronemus, Constantino Peña,M.D. 2:10 p.m. Revascularization or Amputation: Making the Decision

Abilio Coello, M.D. 2:20 p.m. Rapid-Fire Case Study Session: Revascularization Moderator: Constantino Peña, M.D. 2:45 p.m. Practical Wound Care Management

Dorothy (Dot) Weir, R.N. 3:15 p.m. Pressure Ulcers: Update on National Standards Dorothy (Dot) Weir, R.N. 3:45 p.m. In-depth Focus on Nursing Care With Dot Weir, R.N.

Moderator: Constantino Peña Jason Hanft, DPM 4:00 p.m. Adjourn

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Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: 21s Annual Brain Injury Symposium DATE: Oct. 17-18, 2015 TIME: See attached agenda LOCATION: J.W. Marriott Hotel, Brickell CREDIT HOUR(S) APPLIED FOR: 11.5 Cat. 1 (Saturday: 7.5 Sunday: 4.0) CONFERENCE DIRECTOR: Bradley Aiken, M.D. and Richard Hamilton, Ph.D. AMA/PRA LEARNING FORMAT:




TARGET AUDIENCE: Neurologists, Psychologists, Psychiatrists, Physiatrists, General Internists, Family Practice Physicians, Physical Therapists and Assistants, Occupational Therapists and Assistants, Speech-Language Pathologists, Nurses, Social Workers, Pharmacists and Athletic Trainers.

EXPECTED NUMBER OF ATTENDEES: 150 CHARGE: $400 two day course $200 two day course (Baptist Health employees) $ 275 Saturday only $150 Sunday TYPE OF MEETING (FORMAT): Must be appropriate to the setting, objectives and desired results (C5). Check all that apply. Live Didactic Lecture ARS







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addressed or ‘closed’ as a result of this CME activity. WHAT IS/ARE THE CURRENT PRACTICE* AND/OR THE PRACTICE GAP*? ► Physicians may not be aware of and/or do not consistently implement the most current assessment and treatment modalities for patients with traumatic and non-traumatic brain injuries. WHAT IS THE OPTIMAL PRACTICE*? (In a 'perfect world', what would doctors be doing? What does optimal practice 'look like'?) ► Physicians implement evidence-based treatment protocols when treating patients with brain injuries to achieve optimal patient outcomes and quality of life indicators. WHAT IS THE REASON FOR THIS GAP? Indicate if the gap is related to either/or:


DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) And will this result in a change in x Competence? -or- xPerformance? -or- Patient Outcomes*? (Check all that apply.) *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) ► Physicians implement evidence-based treatment strategies based on current research for the assessment and treatment of patients with brain injuries. *REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► Traumatic brain injury (TBI) is a public health problem of major proportions. Each year, more than 230,000 people in the United States alone sustain a TBI, resulting in hospitalization and potential life-long disability due to a complex variety of cognitive, physical, and emotional sequelae. J Head Trauma Rehabil. 2010 Sep–Oct; 25(5): 375–382. doi: 10.1097/HTR.0b013e3181d27fe3 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939167/ ►Recent research has advanced our understanding of the biomechanics, neurophysiology, clinical presentation, rehabilitation and expected outcomes associated with acquired brain injury. Collectively, this body of work should translate directly to evidence-based methods for clinical evaluation, management and, ultimately, improved outcome. Ragnarsson et al., J. Head Trauma Rehab. 2006; 21-5: 379-87. EDUCATIONAL OBJECTIVES: Upon completion of this conference, participants should be better able to: See attached





OUTCOMES MEASUREMENT: (List strategy measurement questions and/or other measurement plans.) (C11) ► As a result of what you learned at this conference what do you intend to do differently? What new strategies will you apply to your practice? _____________________________________________________________________________ ► If you do not plan to implement any new strategies learned at this conference, please list any barriers or obstacles that might keep you from doing so: _______________________________________________________________________ FACULTY: See attached


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DATE REVIEWED: REVIEWED BY: Executive Committee Chairman

APPROVED: YES NO Credits: AMA/PRA Category 11.75 Credits: # 1

Continuing Psychology Education Credits (Florida Only): #11.75 N/A Continuing Dental Education Credits: # N/A

Agenda Saturday, October 17, 2015 7:15 a.m. Breakfast and Registration 8:00 a.m. Welcome and Introductions

Bradley Aiken, M.D. 8:15 a.m. Preparing NeuroTrauma Patients for Neurorehabilitation: Do We Need to Do More to Assure

Successful Outcomes? Gregory J. O'Shanick, M.D. 9:45 a.m. Break and Exhibits 10:00 a.m. Agitation and Fatigue after Traumatic Brain Injury in the Adult Patient

Gemayaret Alvarez Gonzalez, M.D. 11:00 a.m. Yoga as an Adjunctive Treatment for Brain Injury Rehabilitation Bobbi Goldin 12noon Lunch 1 p.m. Amnestic Syndromes Richard Hamilton, Ph.D. 2 p.m. Dementia Update: Clinical and Research Approaches to Diagnosis and Treatment of Dementia

David Racher, M.D. 3 p.m. Break and Exhibits 3:15 p.m. Neurofeedback and Brain Injury Intervention

Steven M. Warner, Ph.D. 4:15 p.m. Assessment and Treatment of Vestibular Disorders after a Traumatic Brain Injury Lida Rivera-Perez, P.T., C/NDT 5:15 p.m. Adjourn

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Sunday, October 18, 2015 7:15 a.m. Registration and Breakfast 8:00 a.m. Imaging in Acute Stroke- What Matters and Why It Matters

Kevin J. Abrams, M.D. 9 a.m. Neuromuscular Electrical Stimulation for Upper Limb Rehabilitation After Stroke (Part 1)

Jayme S. Knutson, Ph.D. 9:45 a.m. Break and Exhibits 10:00 a.m. Neuromuscular Electrical Stimulation for Upper Limb Rehabilitation After Stroke (Part 2)

Jayme S. Knutson, Ph.D. 10:45 a.m. The Future is Now: Robotics in Rehabilitation

Avrielle Rykman Peltz, M.A., OTR/L 11:45 a.m. Can I Drive After my Head Injury

Isabel B. Maestu, OTR/L 12:15 p.m. Adjourn Faculty Kevin J. Abrams, M.D. Medical Director, Neuroradiology and Magnetic Resonance Imaging Baptist Hospital Neuroscience Center Neuroradiologist, Baptist, Doctors,Homestead and South Miami Hospitals Clinical Associate Professor, Department of Radiology Florida International University Herbert Wertheim College of Medicine Miami, Florida Bradley M. Aiken, M.D. Symposium Co-director Medical Director, Department of Rehabilitation Baptist Hospital Brain Injury Programs Miami, Florida Gemayaret Alvarez Gonzalez, M.D. Assistant Professor of Physical Medicine & Rehabilitation Department of Physical Medicine & Rehabilitation University of Miami Miller School of Medicine Miami, Florida Bobbi Goldin Founder/Director – The Yoga Institute Miami, Florida Richard A. Hamilton, Ph.D. Symposium Co-director Clinical Director, Department of Rehabilitation Baptist Hospital Brain Injury and Concussion Programs Miami, Florida Jayme S. Knutson, Ph.D. Director of Research Department of Physical Medicine and Rehabilitation Case Western Reserve University Cleveland, Ohio Isabel B. Maestu, OTR/L Occupational Therapist Baptist Outpatient Center Miami, Florida Lida Rivera-Perez, P.T., C/NDT Physical Therapist Baptist Hospital of Miami Miami, Florida

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Avrielle Rylman Peltz, M.A., OTR/L Sr. Clinical Research Administrator Robotics and Virtual Reality Co-Founder and Chief Operating Officer of the Restorative Neurology Clinic White Plains, New York Gregory J. O’Shanick, M.D. Adjunct Clinical Professor of Psychiatry and Behavioral Sciences Keck School of Medicine University of Southern California Clinical Professor Marietta College , Physician Assistant Program Marietta, Ohio Medical Director Emeritus Brain Injury Association of America Vienna, Virginia Steven M. Warner, Ph.D. Psychologist Miami, Florida EDUCATIONAL OBJECTIVES: Upon completion of this conference, participants should be better able to: Gregory J. O’Shanick, M.D. Preparing NeuroTrauma Patients for Neurorehabilitation: Do We Need to Do More to Assure Successful Outcomes? Educational Objectives:

Cite foundational criteria needed to recommend neurorehabilitation after neurotrauma. List treatment methods that can be implemented to enhance readiness for neurorehabilitation. Implement neurophysiological interventions, including pharmacology, in preparation for neurorehabilitation.

Reference: Improving physiologic readiness for behavioral intervention in the post-acute and community re-entry phases following neurotrauma has potential to improve both the efficiency and durability of these efforts. NeuroRehabilitation, 2014, 34(4):637-643. http://europepmc.org/abstract/MED/24820165 Gemayaret Alvarez Gonzalez, M.D. Agitation and Fatigue after Traumatic Brain Injury in the Adult Patient Educational Objectives:

Describe the pathophysiology of agitation and fatigue. List factors contributing to post traumatic agitation and fatigue.

Reference: Fatigue is a common and debilitating phenomenon experienced by individuals with traumatic brain injury (TBI) that can negatively influence rate and extent of functional recovery by reducing participation in brain injury rehabilitation services and increasing maladaptive lifestyle practices. The underlying mechanisms of TBI-related fatigue are not entirely understood and focused research on symptom reduction or prevention is limited. Neuropsychological and physiological correlates of fatigue following traumatic brain injury. Brain Injury. 28(4):389-97, 2014.

http://ovidsp.tx.ovid.com/sp-3.15.1b/ovidweb.cgi?&S=OLBHFPHDMFDDDLJMNCKKCAFBJHHKAA00&Complete+Reference=S.sh.23%7c1%7c1 Bobbi Goldin Yoga as an Adjunctive Treatment for Brain Injury Rehabilitation Educational Objectives:

Explore the rationale and mechanisms of implementing yoga poses as an adjunctive treatment to conventional physical therapy for patients who have suffered neurological injuries.

Explain the benefit of corrective postural alignment and movement control for patients with neurological injuries. Discuss criteria for appropriate referrals and identify candidates for whom yoga can be a beneficial adjunctive

treatment. Reference: Our review of medical literature found that yoga has been widely used for health promotion and disease prevention and as a possible treatment modality for neurological disorders. Yoga has also been used as an adjunctive treatment modality for carpal tunnel syndrome, multiple sclerosis, epilepsy, post-stroke paresis, and neuropathy of type two diabetes. Ongoing

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research is underway for treatment of fibromyalgia, headache, migraine, Parkinson's disease, chronic back pain, and many other disorders. The therapeutic value of yoga in neurological disorders. Ann Indian Acad Neurol. 2012 Oct-Dec; 15(4): 247–254. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548360/ Richard Hamilton, Ph.D. Amnestic Syndromes Educational Objectives:

Describe the neuroanatomical and neuropsychological aspects of memory loss associated with traumatic brain injuries (TBI).

Implement appropriate assessment methods in order to identify patients suffering from memory loss. Reference: The recognition, ongoing assessment, and appropriate management of patients in PTA (Post Traumatic Amnesia) represents an important initial step in the rehabilitation process for individuals with TBI. It is recommended that individuals assessed as being in PTA should be managed in a safe, quiet, and consistent environment, with monitoring of effects of activities and visitors on agitation and fatigue, and flexible sleep opportunities provided. Use of sedation including neuroleptics should be minimized. Journal of Head Trauma Rehabilitation Issue: Volume 29(4), July/August 2014, p 307–320 http://ovidsp.tx.ovid.com/sp-3.15.1b/ovidweb.cgi?&S=LFHOFPLEKBDDPKJNNCKKJHJCJMCMAA00&Link+Set=S.sh.23%7c1%7csl_10 David Racher, M.D. Dementia Update: Discussion of the Latest Clinical and Research Approaches to Diagnosis and Treatment of Dementia Educational Objectives:

Classify healthy cognitive aging and apply dementia protection strategies. Apply evidence-based clinical neurobiological criteria differentiating Alzheimers from other common dementias

including vascular dementia, frontotemporal degeneration, Parkinson’s and dementia with Lewy Bodies. Reference: Symptoms of memory loss are caused by a range of cognitive abilities or a general cognitive decline, and not just memory. Clinicians can diagnose the syndromes of dementia (major neurocognitive disorder) and mild cognitive impairment (mild neurocognitive disorder) based on history, examination, and appropriate objective assessments, using standard criteria such as Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. They can then diagnose the causal subtypes of these syndromes using standard criteria for each of them. Brain imaging and biomarkers are making progress in the differential diagnoses among the different disorders. Treatments are still mostly symptomatic. Clinics in Geriatric Medicine. 30(3):421-42, 2014 Aug. http://ovidsp.tx.ovid.com/sp-3.15.1b/ovidweb.cgi?&S=LFHOFPLEKBDDPKJNNCKKJHJCJMCMAA00&Complete+Reference=S.sh.47%7c4%7c1 Steven M. Warner, Ph.D. Neurofeedback and Brain Injury Intervention Educational Objectives:

Identify appropriate patients who would benefit from brain retraining. Design treatment plans implementing the use of medical equipment to retrain brain injury patients to improve patient

outcomes. Reference The Flexyx Neurotherapy System (FNS), a novel variant of EEG biofeedback, was adapted for intervention with seven treatment-refractory Afghanistan/Iraq war veterans, and brought about significant decreases in bothersome neurobehavioral and posttraumatic stress symptoms. FNS may help ameliorate mixed trauma spectrum syndromes. Journal of Neuropsychiatry & Clinical Neurosciences. 24(2):237-40, 2012 Mar 1. http://ovidsp.tx.ovid.com/sp-3.8.1a/ovidweb.cgi?&S=CGGDFPIBFADDLGKONCOKKHDCMLMIAA00&Complete+Reference=S.sh.49%7c3%7c1 Lida Rivera-Perez, P.T., C/NDT Assessment and Treatment of Vestibular disorders after a Traumatic Brain Injury Educational Objectives:

Assess patients demonstrating vestibular dysfunction after a TBI, and implement an appropriate vestibular rehabilitation treatment plan to improve patient outcomes.

Reference Patients with mTBI and concussion commonly have complaints of vertigo, dizziness, and imbalance. Vestibular rehabilitation can decrease dizziness and vertigo and improve static and dynamic balance through implementation of exercises targeting the patients’ specific impairments. NeuroRehabilitation 32 (2013) 519–528 DOI:10.3233/NRE-130874 IOS Press http://www.researchgate.net/profile/Bryan_Hujsak/publication/236642399_Vestibular_rehabilitation_following_mild_traumatic_brain_injury/links/0deec539efac77ad81000000.pdf

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Sunday, October 18, 2015 Kevin J. Abrams, M.D. Imaging in Acute Stroke- What Matters and Why It Matters Educational Objectives:

Compare clinical indications for CT angiography and CT perfusion in the acute stroke patient. Accurately assess and diagnose patients with large vessel occlusion after an acute stroke. Assess the value and pitfalls of CT perfusion when treating acute stroke patients.

Reference Advances in technology and software applications have contributed to new imaging modalities and strategies in the evaluation of patients with suspected acute cerebral infarction. Routine computed tomography (CT) and magnetic resonance imaging (MRI) have been the standard studies in stroke imaging, which have been complemented by CT and MR angiography, diffusion-weighted MR imaging, and cerebral perfusion studies, while conventional angiography is typically reserved for intra-arterial therapy. American Journal of Medicine. 126(5):379-86, 2013 May. http://ovidsp.tx.ovid.com/sp-3.15.1b/ovidweb.cgi?&S=LFHOFPLEKBDDPKJNNCKKJHJCJMCMAA00&Complete+Reference=S.sh.52%7c2%7c1 Jayme S. Knutson, Ph.D. Neuromuscular Electrical Stimulation for Upper Limb Rehabilitation After Stroke (Part 1) Neuromuscular Electrical Stimulation for Upper Limb Rehabilitation After Stroke (Part 2) Educational Objectives:

Describe neuromuscular electrical stimulation (NMES) modalities for upper limb treatment of stroke patients. Distinguish between neuroprosthetic and neurotherapeutic purposes of NMES. List the benefits of contralateral controlled Functional Electrical Stimulator.

Reference Neuromuscular electrical stimulation (NMES) has recently received considerable attention as a therapeutic intervention option for stroke rehabilitation. Several studies have suggested therapeutic effects of NMES, with induced repetitive movement exercises conducted with the goal of facilitating motor relearning for motor recovery of the paretic upper limb and reduction of spasticity. American Journal of Physical Medicine & Rehabilitation Issue: Volume 93(6), June 2014, p 503–510 http://ovidsp.tx.ovid.com/sp-3.15.1b/ovidweb.cgi?&S=NCDDFPGPAHDDNKEANCKKKFOBKIAEAA00&Link+Set=S.sh.23%7c6%7csl_10 Avrielle Rykman Peltz, M.A., OTR/L The Future is NOW – Robotics in Rehabilitation Educational Objectives:

List the benefits of repetitive motion using robotic technology which assists with neuroplasticity. Identify new and emerging technologies for neurologically impaired patients and implement them as objective

measuring tools. Reference The use of robots in rehabilitation seems not only a desirable innovation but perhaps also an inevitable one. Rehabilitation is inherently a labor-intensive process and has historically been heavily reliant on individualized therapy programs provided by highly skilled therapists. At the same time, the science of rehabilitation has resulted in an imperative to provide greater amounts of therapy. By enlisting the plasticity of the human nervous system, outcomes in stroke, traumatic brain injury, spinal cord injury, and other neurologic conditions can be enhanced. Repeated practice of skilled movements appears to play a key role in stimulating this plasticity, and the field of rehabilitation needs to find ways to deliver this repetitive practice efficiently. American Journal of Physical Medicine & Rehabilitation Issue: Volume 91(11) Supplement 3, November 2012, p S199–S203 http://ovidsp.tx.ovid.com/sp-3.15.1b/ovidweb.cgi?&S=NCDDFPGPAHDDNKEANCKKKFOBKIAEAA00&Link+Set=S.sh.47%7c4%7csl_10 Isabel B. Maestu, OTR/L Can I Drive After my Head Injury? Educational Objectives:

Determine when it’s appropriate and safe to refer a stroke patient to community resources to assist with regaining independence and return to driving.

Reference The ability to drive is frequently compromised after severe TBI. Specific rehabilitation of this complex activity should be a main goal of social reintegration programs in this population. Journal of Head Trauma Rehabilitation Issue: Volume 27(3), May/June 2012, p 210–215 http://ovidsp.tx.ovid.com/sp-3.15.1b/ovidweb.cgi?&S=NCDDFPGPAHDDNKEANCKKKFOBKIAEAA00&Link+Set=S.sh.53%7c3%7csl_10

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CME ACTIVITY TITLE: Echocardiography Symposium 34th Annual DATE: Friday and Saturday – September 25-26, 2015 LOCATION: Trump National Doral, Miami, Florida TIME: Friday, 8:00 a.m. – 5:00 p.m. and Saturday, 8:00 a.m. – 12:30 p.m. SYMPOSIUM DIRECTOR: Michael D. Ozner, M.D. CREDIT HOUR(S) APPLIED FOR: 11 Cat. 1 AMA/PRA LEARNING FORMAT:

Live activity Test-item writing activity Internet point-of-care activity Enduring material Manuscript review activity Journal-based CME activity PI CME activity

TARGET AUDIENCE: Cardiologists, cardiovascular surgeons, interventional cardiologists and sonographers In addition, describe how the content of the activity is aligned with the target learners' current or potential scope of practice (C4). This activity addresses professional practice gaps relevant to physicians in the practice of cardiology and cardiac surgery. In addition, those specialists to whom a cardiologist might refer for further evaluation or treatment, are also included in the target audience, as are related members of the hospital care team, i.e.: sonographers, etc.

EXPECTED NUMBER OF ATTENDEES: 350+ REGISTRATION CHARGES: Physicians: $339 BHSF Employees $60 ($35 Fri – $25 Sat) Non BHSF: $159 *Groups of 3 or more physicians who register together are eligible for a discount. TYPE OF MEETING (FORMAT): Must be appropriate to the setting, objectives and desired results (C5). Check all that apply.

Live Didactic Lecture ARS


Enduring Material Internet-Home Study Other



New or updated policy/protocol/guidelines Patient care data Peer review data Process improvement initiatives (C16 & 21) Research/literature review

Other (Explain). Intersocietal Accreditation Commission (IAC) Education requirement for doctors and sonographers affiliated with accredited echo lab.

FACTORS OUTSIDE OUR CONTROL - List factors, outside our control and beyond learner performance that impact patient outcomes and contribute to the healthcare 'quality gap' being addressed. (C18) Patient: Non-compliance Lifestyle Resistance-to-change Financial/Lack of Insurance Physician: Non-compliance Resistance-to-change Communication Skills Financial Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or No Treatment Modalities Limited or No Diagnostic Modalities Other:

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addressed or ‘closed’ as a result of this CME activity.

WHAT IS/ARE THE CURRENT PRACTICE* and/or THE PRACTICE GAP*? What are physicians doing (or not doing) that needs to change? Describe the practice gap. Echocardiography is rapidly evolving as a diagnostic modality with indications for more complex procedures. Physicians need regular education in order to keep up with this pace and provide optimal patient care. References The increased use of echocardiography is related to a certain extent to the new available modes (tissue Doppler imaging, strain imaging, speckle tracking imaging, three-dimensional mode, etc.), to the emerging indications (study of myocardial viability and resynchronization, etc.), as well as to the advent of new approaches (intracardiac echo, portable echo, etc.). This fact had a dramatic impact on echocardiography use and potential misuse. Echocardiography must be achievable within a consistent existing framework of clinical standards in current cardiological practice, in order to yield a better clinical outcome, to prevent potential misuse and to preserve resources. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3914997/ WHAT IS THE OPTIMAL PRACTICE*? (In a 'perfect world', what would doctors be doing? What does optimal practice 'look like'?) Physicians competently utilize state-of-the-art echocardiography applications to provide high-quality procedures that are safer, faster, improve patient outcomes, and allow physicians to treat an increasing complex group of patients. References The strengths of echocardiography remain the quantification of cardiac structure and function by a noninvasive technique that is free of ionizing radiation, relatively inexpensive, universally available, and mobile enough to be performed in almost any venue. Efforts must be made to demonstrate that echocardiography quantified parameters correlate with or improve care decisions and outcomes. In particular, the echocardiography community should pursue efforts to satisfy regulatory requirements for establishing the value and practicality of a few select, quantitatively important echocardiographic biomarkers (such as LV ejection fraction and LV mass) by enacting education and policy strategies to ensure their consistency and reproducibility regardless of equipment, patient, or time scanned. http://asecho.org/wordpress/wp-content/uploads/2013/05/roadmap.pdf

WHAT IS THE REASON FOR THIS GAP? Indicate if the gap is in physician: Knowledge? (They do not know that they need to be doing something.) Competence? (They do not know how to do it) Performance? (They know how to do it but are non-compliant - or are not doing it properly)

DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this symposium? What should change or improve as a result of this CME activity? (C3) Will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? (Check all that apply.) *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.)

Knowledge? (They do not know that they need to be doing something.) ► Echocardiography is rapidly evolving as a diagnostic modality with indications for more complex procedures. Physicians need regular education in order to keep up with this pace and provide optimal patient care.

Competence? (They do not know how to do it) ► Physicians competently utilize state-of-the-art echocardiography applications to provide high-quality procedures that are safer, faster, improve patient outcomes, and allow physicians to treat an increasing complex group of patients.

Performance? (They know how to do it but are non-compliant - or are not doing it properly) ► Physicians will competently apply state-of-the-art echocardiography research and advances to provide high-quality examinations and accurate interpretations of echocardiogram findings. COMPETENCIES: What desirable physician attributes (e.g. professional competencies) set forth by national organizations of medicine (e.g.: IOM, ACGME, ABMS) does this activity address? (C6)

Patient Care Medical Knowledge Interpersonal and Communications Skills Professionalism Systems-based Practice Practice-based Learning and Improvement Other: Intersocietal Accreditation Commission (IAC)

Education requirement for doctors and sonographers affiliated with accredited echo lab. EVALUATION METHOD(S): Analyze the overall changes in competence, performance, or patient outcomes as a result of this CME activity. (C11) List the planned method(s) of evaluation:

Baptist Health CME Evaluation Form Follow-up Survey Review of Hospital, Health System or Other Data Other______________________

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OUTCOMES MEASUREMENT: (List strategy measurement questions and/or other measurement plans.) (C11) Follow-up Survey ►As a result of your participation at this symposium, which of the following new strategies have you implemented in your practice? (Check all that apply) – (Performance based questions will be asked on the follow-up survey taken from the educational objectives) ►As a result of your participation at this symposium, how many patients have you impacted by what you learned at the symposium? __1-5 __6-10 __Over 10 ►As a result of what you learned at this symposium what do you intend to do differently? What new strategies will you apply to your practice? ►If you do not plan to implement any new strategies learned at this conference, please list any barriers or obstacles that might keep you from doing so. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3)

Yes No Medical Education Dept. Leadership and Staff Medical Education Committee Conference Director (see above) Others (i.e.: Conference Coordinator, Planning Group etc.)

COMMERCIAL SUPPORT: The Baptist Health Continuing Medical Education Department will not solicit or accept grants from commercial interests to support CME activities, thereby strengthening the CME Program's commitment to be independent and free of the influence of commercial interests. Indicate here if support will come from the Foundation general medical education fund. BARRIERS TO PHYSICIAN CHANGE: (C19) Is this activity focused on ‘overcoming, addressing, or removing barriers to physician change' applicable to our learners? Yes No If 'yes', list the barrier(s) identified and include relevant data and information about the barriers. ► Rapid pace of changes in the utilization of Echocardiography. http://www.asecho.org/files/EGI.pdf OVERALL PROGRAM CHANGES: Does this CME activity reflect implementation (C14) of any interventions or changes that came about as a result of our overall CME program evaluation and analysis (C13) to meet the CME mission?



Explain: COLLABORATION: Are we engaged in collaborative and cooperative projects with other stakeholders (internal or external) that are related to this CME activity? (C20)


If yes, list collaborative efforts related to this CME activity that support achievement of our CME Mission. Maintenance of Echo Lab standards to provide optimal patient care. ► In order to provide highest standards of care the Miami Cardiac & Vascular Institute and South Miami Heart Center Echo Labs maintain accreditation through the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL). The ICAEL requires physicians working in the Echo lab to complete 15 hours of category 1 CME courses on echo-related topics every 3 years in order to maintain competence with state-of-the-art diagnosis and evaluation echocardiographic applications. This symposium will help Baptist Health physicians; staff and the Echo Lab meet these requirements. ► An Echo Lab Committee made up of physicians and techs meet quarterly at BHM and SMH to review cases. CME is provided. DATE REVIEWED: May 15, 2015 REVIEWED BY: Executive Committee Chairman



FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State)

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Michael Ozner, M.D., FACC, FAHA Symposium Director Medical Director, Center for Prevention and Wellness, Baptist Health South Florida Miami, Florida Gerard P. Aurigemma, M.D. Professor of Medicine and Radiology, UMass Medical School Director, Non-Invasive Cardiology, UMass Memorial Medical Center Worcester, Massachusetts Blasé A. Carabello, M.D. Chair, Cardiology Mount Sinai Beth Israel Medical Director of the Heart Valve Center, Mount Sinai Hospital New York, New York Sanjiv Kaul, M.D., FACC, FASE, FAHA, FRCP Ernest C. Swigert Chair of Cardiovascular Medicine Professor of Medicine and Radiology CEO of the Knight Cardiovascular Institute Associate Dean, School of Medicine Oregon Health and Science University Portland, Oregon Steven J. Lester, M.D., FACC, FRCPC, FASE Associate Professor of Medicine, Mayo Clinic College of Medicine Associate Chair of Medicine for Innovation Chair of Innovation and Entrepreneurship, Mayo Clinic Arizona Scottsdale, Arizona Humberto Machado, M.D. Director of the Echocardiography Department, Mercy-HCA Hospital Miami, Florida Maurice E. Sarano, M.D. Professor of Medicine, Mayo Clinic Rochester, Minnesota William Stewart, M.D., FACC, FASE Associate Professor of Medicine Cleveland Clinic Lerner College of Medicine of the Case Western Reserve University Cleveland, Ohio James D. Thomas, M.D., FASE, FACC Director, Center for Heart Valve Disease Director, Academic Affairs Bluhm Cardiovascular Institute Northwestern Memorial Hospital Professor of Medicine, Northwestern University Chicago, Illinois Lead Scientist for Ultrasound, NASA Past-President, American Society of Echocardiography

SCHEDULE Friday, September 25 (7.0) 7:30 a.m. Registration, Continental Breakfast and Visit Exhibits 7:55 a.m. Welcome and Opening Remarks Michael Ozner, M.D, Humberto Machado, M.D.

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Case-based Approach Session Moderator: Michael Ozner, M.D. 8:00 a.m. Hemodynamics in the Echo Lab Gerard P. Aurigemma, M.D. 8:30 a.m. Mitral Regurgitation: When to Operate Blasé A. Carabello, M.D. 9:00 a.m. Aortic Stenosis: Area-gradient Mismatch Steven J. Lester, M.D. 9:30 a.m. Tricuspid Regurgitation: The Forgotten Valve Disease Maurice E. Sarano, M.D. 10:00 a.m. Break and Visit Exhibits 10:30 a.m. Panel Discussion With Audience Participation

Evaluation of Valvular Heart Disease: The Winner Is…..Cath, CT, MRI or Echo? The Winner Is…..Cath, CT, or Echo?

Moderator: Humberto Machado, M.D. Panel: Maurice E. Sarano, M.D., Blasé A. Carabello, M.D., Steven J. Lester, M.D., Sanjiv Kaul, M.D., William Stewart, M.D. 11:00 a.m. Analysis of the Mitral Valve for Surgical or Catheter Repair James D. Thomas, M.D. 11:30 a.m. Imaging in Preparation for Repair of the Aortic Valve, Aortic Root or Left Ventricular Outflow Tract William Stewart, M.D. 12:00 noon Lunch Rapid-fire Case Reports Session Moderator: Humberto Machado, M.D. 1:15 p.m. Chest Pain Evaluation in the Emergency Department Sanjiv Kaul, M.D. 1:45 p.m. “Hey Doc! …Got a “Dear John’ Letter”, My Heart Is Broken!” (Takotsubo Cardiomyopathy) Gerard P. Aurigemma, M.D. 2:15 p.m. The Clinical Utility of Echo in Atrial Fibrillation James D. Thomas, M.D. 2:45 p.m. Organic and Functional Mitral Regurgitation: Does it Make a Difference? Maurice E. Sarano, M.D. 3:15 p.m. Break and Visit Exhibits 3:45 p.m. Constriction or Restriction: That Is the Question Gerard P. Aurigemma, M.D. 4:15 p.m. Heart Failure, Thick LV and Low-voltage EKG Steven J. Lester, M.D. 4:45 p.m. Myocardial Contrast Echo: State-of-the-Art Sanjiv Kaul, M.D. 5:15 p.m. Adjourn Saturday, September 26 (4.0) Session Moderator: Humberto Machado, M.D. 7:50 a.m. Registration, Continental Breakfast and Visit Exhibits 8:20 a.m. Welcome and Introductions Michael Ozner, M.D, Humberto Machado, M.D. 8:30 a.m. Right Ventricular Size and Function Steven J. Lester, M.D. 9:00 a.m. Quantifying Myocardial Mechanics: Today and in the Future James D. Thomas, M.D. 9:30 a.m. Myxomatous Valve Diseases: Physiologic Insights by 3-D Echo Maurice E. Sarano, M.D. 10:00 a.m. Break and Visit Exhibits 10:30 a.m. Panel Discussion With Audience Participation Ejection Fraction: The Beginning of the End or the End of the Beginning?

Panel: Gerard P. Aurigemma, M.D., James D. Thomas, M.D., Blasé A. Carabello, M.D., Sanjiv Kaul, M.D., Steven J. Lester, M.D.

11:00 a.m. Hypertrophic Cardiomyopathy Steven J. Lester, M.D. 11:30 a.m. Diastolic Dysfunction: Heart Failure with Preserved Ejection Fraction – Fact or Fiction? Gerard P. Aurigemma, M.D. 12:00 noon 3-D Echo in Valvular Heart Disease William Stewart, M.D.

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12:30 p.m. Hemodynamics in the Era of Advanced Echo/Doppler: Do We Still Need Cath? Blasé A. Carabello, M.D. 1:00 p.m. Adjourn

EDUCATIONAL OBJECTIVES: Describe what doctors will be able to do after they leave the classroom. What is the "take-away" that they can put into practice. What new strategies, tools, treatment plans, approaches, etc. will they be able to implement, utilize, do, etc. as a result of attending this CME activity? Friday, September 25 (7.0) As a result of these presentations, participants should be better able to: • Explain the physiology behind the basic hemodynamic measurements made in everyday echocardiography, such as stroke volume, Bernoulli equation and continuity equation. • Assess diastolic function assessment • Assess the timing of surgical intervention in asymptomatic patient with chronic mitral regurgitation. • Distinguish primary and secondary mitral regurgitation. • Decipher the cause of area-gradient mismatch so as to best counsel aortic stenosis patients on the most ideal treatment strategy. • Recognize the etiology and quantification of tricuspid regurgitation and define its prognosis. • Recognize aortic stenosis among symptomatic and asymptomatic patients to diagnose and determine its severity. • Describe the clinical findings of aortic stenosis to determine whether further hemodynamic assessment is necessary. • Compare invasive and non-invasive techniques for mitral valve repair. • Diagnose and manage patients undergoing surgery for repair of bicuspid aortic regurgitation, hypertrophic cardiomyopathy, or valve resuspension in patients with ascending aortic dilation. • Determine prognosis in chest pain patients without ST segment elevation. • Recognize the role of assessing myocardial perfusion and regional function in acute myocardial ischemia. • Recognize the various echocardiographic phenotypes associated with stress cardiomyopathy. • Describe diastolic function in stress cardiomyopathy. • Examine the usefulness of transesophageal echocardiography (TEE) for predicting thromboembolism. • Recognize the anatomic features of functional and organic mitral regurgitation (MR). • Determine the physiologic differences in MR severity. • Define the approaches to interventional and surgical treatment of MR. • Explore how the etiology of pericardial constriction has changed over the recent decades and examine why the diagnosis may have important therapeutic implications. • Review the pathophysiologic differences between constrictive pericarditis and restrictive cardiomyopathy. • Recognize the differential diagnosis in patients with increased left ventricular wall thickness, and explain how echocardiography can be used to help narrow down the etiology. • Describe coronary microcirculation, and recognize the utility of microbubbles in diagnosis and treatment. Saturday, September 26 (4.0) As a result of these presentations, participants should be better able to: • Recognize the strengths and limitations of the echocardiographic evaluation of right ventricular size and function, and implement appropriate recommended guidelines. • Identify the diagnostic accuracy of different strain and strain rate variables and their reproducibility in various disease states. • Determine the extent to which strain and strain rate measurements can enhance patient management and improve postoperative outcomes. • Recognize the dynamic nature of mitral regurgitation in Myxomatous diseases. • Describe the physiologic difference in mitral annular function. • Identify the link between 3D physiology and surgical repair. • Explain the role of diastolic dysfunction in producing symptomatic heart failure in patients with a normal ejection fraction and discuss optimal treatment options. • Cite echocardiographic features and imaging requirements for a diagnosis of hypertrophic cardiomyopathy, and outline the basic management strategies. • Assess contemporary ultrasound tools to diagnose diastolic dysfunction. • Determine how to better target abnormalities of patients with heart failure to reduce the substantial burden of morbidity and mortality. • Recognize the value of 3-D echo for pre-surgical planning, intra-procedural guidance, and post-procedural assessment of valvular heart disease. • Cite specific examples demonstrating the role of hemodynamics as an integral part of Cardiology.

Topic Specific References and Educational Objectives

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Friday, September 25 (7.0) 8-8:30am Hemodynamics in the Echo Lab (30 min) Gerard P. Aurigemma, M.D. As a result of this presentation, participants should be better able to: • Explain the physiology behind the basic hemodynamic measurements made in everyday echocardiography, such as stroke volume, Bernoulli equation and continuity equation. • Assess diastolic function assessment References supporting this talk

Cardiac and systemic Hemodynamics have been historically in the domain of invasive cardiology, but recent advances in real-time 3-Dimensional echocardiography (RT3D echo) provide a reliable measurement of ventricular volumes, allowing to measure a set of hemodynamic parameters previously difficult or impossible to obtain with standard 2D echo. RT-3D echo allows a non invasive, comprehensive assessment of cardiac and systemic Hemodynamics, offering insight access to key variables – such as increased systemic vascular resistances in hypertensive and reduced ventricular-arterial coupling in heart failure patients. ►http://www.medscape.com/viewarticle/771309 ►Gerard P. Aurigemma, MD, Michael R. Zile, MD, William H. Gaasch, MD Am Heart J. 2004;148(3) ►Circulation. 2015 Mar 17;131(11):1031-4. doi: 10.1161/CIRCULATIONAHA.114.011424. Echo-Doppler hemodynamics: an important management tool for today's heart failure care. Beigel R1, Cercek B1, Siegel RJ1, Hamilton MA2. ►Contractile behavior of the left ventricle in diastolic heart failure: with emphasis on regional systolic function. Aurigemma GP, Zile MR, Gaasch WH. Circulation. 2006 Jan 17;113(2):296-304. 8:30-9am Mitral Regurgitation: When to Operate (30 min) Blasé A. Carabello, M.D. As a result of this presentation, participants should be better able to: • Assess the timing of surgical intervention in asymptomatic patient with chronic mitral regurgitation. • Distinguish primary and secondary mitral regurgitation. References supporting this talk In assessing the patient with chronic MR, it is critical to distinguish between chronic primary (degenerative) MR and chronic secondary (functional) MR, as these 2 conditions have more differences than similarities. In chronic primary MR, the pathology of ≥1 of the components of the valve (leaflets, chordae tendineae, papillary muscles, annulus) causes valve incompetence with systolic regurgitation of blood from the left ventricle to the LA (Table 13). The most common cause of chronic primary MR in developed countries is mitral valve prolapse, which has a wide spectrum of etiology and presentation. Younger populations present with severe myxomatous degeneration with gross redundancy of both anterior and posterior leaflets and the chordal apparatus (Barlow's valve). Alternatively, older populations present with fibroelastic deficiency disease, in which lack of connective tissue leads to chordal rupture. The differentiation between these 2 etiologies has important implications for operative intervention. Other less common causes of chronic primary MR include IE, connective tissue disorders, rheumatic heart disease, cleft mitral valve, and radiation heart disease. If the subsequent volume overload of chronic primary MR is prolonged and severe, it causes myocardial damage, HF, and eventual death. Correction of the MR is curative. Thus, MR is “the disease.” ►http://circ.ahajournals.org/content/129/23/2440.long ►Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM 3rd, Thomas JD. 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease: Executive Summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014 Jun 10;129(23):2440-92. The timing of surgical intervention in asymptomatic or mildly symptomatic patients with mitral regurgitation has always been a difficult clinical dilemma, especially with current options of valve replacement or valve repair. Symptomatic status should be carefully assessed and may depend upon either atrial fibrillation or progressive left ventricular dysfunction. In the asymptomatic patient, it is difficult to justify a role for intense medical therapy. The patient who develops atrial fibrillation does require a long-term anticoagulation therapy, and valve repair might be considered in this patient. Sinus rhythm may be restored with early surgical intervention, thereby reducing complications of thromboembolism or anticoagulant therapy. ►http://www.ncbi.nlm.nih.gov/pubmed/8186576 9-9:30am Aortic Stenosis: Area-gradient Mismatch (30 min) Steven J. Lester, M.D. As a result of this presentation, participants should be better able to: • Decipher the cause of area-gradient mismatch so as to best counsel aortic stenosis patients on the most ideal treatment strategy. References supporting this talk

The clinical severity of aortic stenosis (AS) is based largely on symptoms. However, AS severity is primarily determined by estimating the aortic valve area (AVA) and pressure gradients (∆P). Conditions may arise in which there is a mismatch in

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severity between AVA and ∆P determinations secondary to errors in measurement and/or assumption, alterations of flow, or variations in the magnitude of pressure recovery. The cause of discrepancy between area and gradient determinations must be deciphered so as to best counsel patients on the most ideal treatment strategy. ►http://www.medscape.com/medline/abstract/23278313 ►Aortic valve stenosis: to the gradient and beyond--the mismatch between area and gradient severity. Abbas AE, Franey LM, Goldstein J, Lester S. J Interv Cardiol. 2013 Apr;26(2):183-94. doi: 10.1111/joic.12004. Epub 2012 Dec 30. ►The role of jet eccentricity in generating disproportionately elevated transaortic pressure gradients in patients with aortic stenosis. Abbas AE, Franey LM, Lester S, Raff G, Gallagher MJ, Hanzel G, Safian RD, Pibarot P. Echocardiography. 2015 Feb;32(2):372-82. doi: 10.1111/echo.12712. Epub 2014 Aug 20 9:30-10am Tricuspid Regurgitation: The Forgotten Valve Disease (30 min) Maurice E. Sarano, M.D. As a result of this presentation, participants should be better able to: • Recognize the etiology and quantification of tricuspid regurgitation and define its prognosis. References supporting this talk

The tricuspid valve has been taken as a non-critical valve in terms of acute or late mortality in a number of conditions. Tricuspid functional regurgitation is a cause of late operations with an increased morbidity. A number of techniques have been described and used in clinical practice in the past forty years and include simple suture techniques and the use of support for annuloplasty with the use of different types of prosthetic rings. The experience accumulated over the years indicates that tricuspid annuloplasty is mandatory to improve late results, which are superior, in general, to replacement of the valve. The tricuspid valve continues to be a surgical challenge. ►http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3563560/ ►Topilsky Y, Khanna A, Le Tourneau T, Park S, Michelena H, Suri R, Mahoney DW, Enriquez-Sarano M. Clinical context and mechanism of functional tricuspid regurgitation in patients with and without pulmonary hypertension. Circ Cardiovasc Imaging. 2012;5:314-323 ►Topilsky Y, Nkomo VT, Vatury O, Michelena HI, Letourneau T, Suri RM, Pislaru S, Park S, Mahoney DW, Biner S, Enriquez-Sarano M. Clinical outcome of isolated tricuspid regurgitation. JACC Cardiovasc Imaging. 2014;7:1185-1194 10:30-11am Panel Discussion With Audience Participation – Aortic Stenosis: The Winner is…..Cath, CT or Echo? (30 min) Moderator: Humberto Machado, M.D. Panel: Maurice E. Sarano, M.D., Blasé A. Carabello, M.D., Steven J. Lester, M.D., Sanjiv Kaul, M.D., William Stewart, M.D. As a result of this presentation, participants should be better able to: • Recognize aortic stenosis among symptomatic and asymptomatic patients to diagnose and determine its severity. • Describe the clinical findings of aortic stenosis to determine whether further hemodynamic assessment is necessary. References supporting this talk Aortic stenosis is the obstruction of blood flow across the aortic valve. Among symptomatic patients with medically treated moderate-to-severe aortic stenosis, mortality from the onset of symptoms is approximately 25% at 1 year and 50% at 2 years. Symptoms of aortic stenosis usually develop gradually after an asymptomatic latent period of 10-20 years. Two-dimensional and Doppler echocardiography is the imaging modality of choice to diagnose and determine the severity of aortic stenosis. In general, cardiac catheterization is not necessary to determine the severity of aortic stenosis. However, in instances in which clinical findings are not consistent with echocardiogram results, cardiac catheterization is recommended for further hemodynamic assessment. ►http://emedicine.medscape.com/article/150638-workup ►Clavel MA, Malouf J, Michelena HI, Suri RM, Jaffe AS, Mahoney DW, Enriquez-Sarano M. B-type natriuretic peptide clinical activation in aortic stenosis: Impact on long-term survival. J Am Coll Cardiol. 2014;63:2016-2025 ►Clavel MA, Messika-Zeitoun D, Pibarot P, Aggarwal S, Malouf J, Aaroz P, Michelena HI, Cueff C, Larose E, Capoulade R, Vahanian A, Enriquez-Sarano M. The complex nature of discordant severe calcified aortic valve disease grading: New insights from combined doppler-echocardiographic and computed tomographic study. J Am Coll Cardiol. 2013;In Press ►Clavel MA, Pibarot P, Messika-Zeitoun D, Capoulade R, Malouf J, Aggarval S, Araoz PA, Michelena HI, Cueff C, Larose E, Miller JD, Vahanian A, Enriquez-Sarano M. Impact of aortic valve calcification, as measured by mdct, on survival in patients with aortic stenosis: Results of an international registry study. J Am Coll Cardiol. 2014;64:1202-1213 11-11:30am Analysis of the Mitral Valve for Surgical or Catheter Repair (30 min) James D. Thomas, M.D. As a result of this presentation, participants should be better able to: • Compare invasive and non-invasive techniques for mitral valve repair. References supporting this talk

Regurgitant mitral valves can be repaired with standard open surgical techniques in the vast majority of patients. The results of mitral repair are durable and are generally accepted to be superior to mitral replacement with regard to left ventricular function and patient outcome. Since the early work of Carpentier, most advances in mitral repair have involved minimizing surgical trauma by achieving repair via smaller and smaller chest wall incisions. Total endoscopic repair of the mitral valve is

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now possible with the assistance of robotic technology, but the physiologic insult of cardiopulmonary bypass is still present. Catheter based techniques may someday allow resolution of mitral regurgitation without incisions or cardiopulmonary bypass, but this field is in its infancy. Real-time 3D echocardiography has provided superior imaging and structural understanding of the mitral valve and this technology will accelerate the development of transcatheter techniques as well. ►http://www.medscape.com/viewarticle/708552_7 11:30-12:00 noon Imaging in Preparation for Repair of the Aortic Valve, Aortic Root or Left Ventricular Outflow Tract (30 min) William Stewart, M.D. As a result of this presentation, participants should be better able to: • Diagnose and manage patients undergoing surgery for repair of bicuspid aortic regurgitation, hypertrophic cardiomyopathy, or valve resuspension in patients with ascending aortic dilation. References supporting this talk

Elective repair of aneurysms involving the ascending aorta and aortic root is performed with predictably low operative risk. Complex procedures such as composite valve-graft replacement or valve-sparing root reconstruction carry an expected mortality rate of less than 4%, with surprisingly few Perioperative complications. Cardiac reoperations such as coronary artery bypass grafting (CABG) and valve replacement currently carry little increase in risk above a first-time operation. However, re-operative surgery on the ascending aorta continues to challenge cardiac surgeons. The mortality rate associated with these complex reconstructions is at least 3 times higher than it is for the initial surgery. Complications after such procedures also occur with disappointingly high frequency, leading to substantial morbidity and delayed recovery. ►http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3233333/

Percutaneous intervention for valvular heart disease is becoming a reality and is one of the fastest growing fields in interventional cardiology. As exposure and visualization are critical for surgical repair or replacement, adequate imaging is crucial for transcatheter interventions where direct visualization is not possible. X-ray and ultrasound are the fundamental modalities for imaging in this situation, although magnetic resonance related imaging is under development. In this review, we describe the use of fluoroscopic, computed tomographic, and echo imaging for rapidly evolving percutaneous valve technologies with a focus on providing clinical pearls and perspective on each imaging tool. ►http://www.sciencedirect.com/science/article/pii/S0146280610000150 1:15-1:45pm TEE for the Evaluation of Chest Pain in the Echo in the Emergency Department (30 min) Sanjiv Kaul, M.D. As a result of this presentation, participants should be better able to: • Determine prognosis in chest pain patients without ST segment elevation. • Recognize the role of assessing myocardial perfusion and regional function in acute myocardial ischemia. References supporting this talk Accurate assessment of chest pain in the emergency department requires a thorough knowledge of the differential diagnosis and appropriate use of diagnostic tools. It is essential not to miss an aortic dissection, pulmonary embolus, or acute myocardial infarction, and to avoid over treating pericarditis or musculoskeletal pain. Transthoracic echocardiography (TTE) is often underutilized in this setting. TTE has the advantages of being readily accessible, portable, noninvasive, and fast; it may detect significant findings that are misdiagnosed or not detected on initial clinical evaluation. ►http://www.uptodate.com/contents/transthoracic-echocardiography-for-the-evaluation-of-chest-pain-in-the-emergency-department 1:45-2:15pm “Hey Doc! …Got a ‘Dear John’ Letter – My Heart Is Broken!” (Takotsubo Cardiomyopathy) (30 min) Gerard P. Aurigemma, M.D. As a result of this presentation, participants should be better able to: • Recognize the various echocardiographic phenotypes associated with stress cardiomyopathy. • Describe diastolic function in stress cardiomyopathy. References supporting this talk Takotsubo cardiomyopathy (TCM) is a transient cardiac syndrome that involves left ventricular apical akinesis and mimics acute coronary syndrome. It was first described in Japan in 1990 by Sato et al. Patients often present with chest pain, have ST-segment elevation on electrocardiogram, and elevated cardiac enzyme levels consistent with a myocardial infarction. However, when the patient undergoes cardiac angiography, left ventricular apical ballooning is present and there is no significant coronary artery stenosis. ►http://emedicine.medscape.com/article/1513631-overview ►Medeiros K, O'Connor MJ, Baicu CF, Fitzgibbons TP, Shaw P, Tighe DA, Zile MR, Aurigemma GP. Systolic and diastolic mechanics in stress cardiomyopathy. Circulation. 2014 Apr 22; 129(16):1659-67. View in: PubMed ►Mehta NK, Aurigemma G, Rafeq Z, Starobin O. Reverse takotsubo cardiomyopathy: after an episode of serotonin syndrome. Tex Heart Inst J. 2011; 38(5):568-72. ►Standard and advanced echocardiography in takotsubo (stress) cardiomyopathy: clinical and prognostic implications.

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Citro R, Lyon AR, Meimoun P, Omerovic E, Redfors B, Buck T, Lerakis S, Parodi G, Silverio A, Eitel I, Schneider B, Prasad A, Bossone E. J Am Soc Echocardiogr. 2015 Jan;28(1):57-74. doi: 10.1016/j.echo.2014.08.020. Epub 2014 Oct 1. 2:15-2:45pm The Clinical Utility of Echo in Atrial Fibrillation (30 min) James D. Thomas, M.D. As a result of this presentation, participants should be better able to: • Examine the usefulness of transesophageal echocardiography (TEE) for predicting thromboembolism. References supporting this talk

Atrial fibrillation is the most common of the cardiac arrhythmias and is associated with high risk of stroke and systemic thromboembolism. ►http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3345880/

Nearly all patients presenting with their first episode of AF will benefit from transthoracic (surface) echocardiographic (TTE) evaluation of left atrial size, left ventricular systolic function, and mitral valve morphology and function. A more selected subgroup may benefit from the additional information obtained from transesophageal echocardiographic (TEE) evaluation for left atrial thrombi to allow for early cardioversion if no thrombi are identified ►http://www.uptodate.com/contents/role-of-echocardiography-in-atrial-fibrillation 2:45-3:15 Organic and Functional Mitral Regurgitation: Why Make a Difference? (30 min) Maurice E. Sarano, M.D. As a result of this presentation, participants should be better able to: • Recognize the anatomic features of functional and organic mitral regurgitation (MR). • Determine the physiologic differences in MR severity. • Define the approaches to interventional and surgical treatment of MR. References supporting this talk Functional mitral regurgitation (MR) is generally caused by annular enlargement secondary to left ventricular dilatation and/or papillary muscle displacement due to left ventricular remodeling. Right ventricular pacing is an uncommon cause of functional MR. Some degree of functional MR is almost always present in patients with severe dilated cardiomyopathy, regardless of etiology. The severity of functional MR in patients with systolic dysfunction may be a predictor of mortality. All patients with functional MR and heart failure due to systolic dysfunction should receive standard therapy that includes an angiotensin converting enzyme (ACE) inhibitor or angiotensin II receptor blocker, a beta blocker, an aldosterone antagonist, digoxin, and a diuretic. Isolated mitral valve repair or replacement for severe MR secondary to ventricular dilatation in the presence of severe LV systolic dysfunction is not generally recommended since there is no proven mortality benefit. Cardiac resynchronization therapy (CRT) improves survival in selected patients with systolic heart failure and QRS duration ≥150 msec. CRT may reduce functional MR in some patients, particularly those with nonischemic cardiomyopathy. ►http://www.uptodate.com/contents/functional-mitral-regurgitation#H22402150 ►Grigioni F, Enriquez-Sarano M, Zehr KJ, Bailey KR, Tajik AJ. Ischemic mitral regurgitation: Long-term outcome and prognostic implications with quantitative doppler assessment. Circulation. 2001;103:1759-1764 ►Quantitative grading of mitral regurgitation is a powerful predictor of the clinical outcome of asymptomatic mitral regurgitation. Patients with an effective regurgitant orifice of at least 40 mm2 should promptly be considered for cardiac surgery. Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, Detaint D, Capps M, Nkomo V, Scott C, Schaff HV, Tajik AJ. Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N Engl J Med. 2005;352:875-883 3:45-4:15 Constriction or Restriction: That Is the Question (30 min) Gerard P. Aurigemma, M.D. As a result of this presentation, participants should be better able to: • Explore how the etiology of pericardial constriction has changed over the recent decades and examine why the diagnosis may have important therapeutic implications. • Review the pathophysiologic differences between constrictive pericarditis and restrictive cardiomyopathy. References supporting this talk The underlying etiology of pericardial constriction has changed over recent decades. Whereas in the past many patients presented with severe and global calcification of the pericardium secondary to tuberculosis, patients are now more likely to develop pericardial constriction after Mediastinal irradiation or cardiac surgery (often in conjunction with myocardial involvement). Conclusion: Diagnosis has important therapeutic implications. Clinical Presentation similar: RHF historical etiologies helpful, but not diagnostic. A thick pericardium is not necessarily constrictive. A restrictive process may constrict Echo and Hemodynamic features may overlap. ►http://heart.bmj.com/content/95/17/1380.extract ►Echocardiographic diagnosis of constrictive pericarditis: Mayo Clinic criteria. Welch TD, Ling LH, Espinosa RE, Anavekar NS, Wiste HJ, Lahr BD, Schaff HV, Oh JK. Circ Cardiovasc Imaging. 2014 May;7(3):526-34. doi: 10.1161/CIRCIMAGING.113.001613. Epub 2014 Mar 14.

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►Biventricular mechanics in constrictive pericarditis comparison with restrictive cardiomyopathy and impact of pericardiectomy. Kusunose K, Dahiya A, Popović ZB, Motoki H, Alraies MC, Zurick AO, Bolen MA, Kwon DH, Flamm SD, Klein AL. Circ Cardiovasc Imaging. 2013 May 1;6(3):399-406. doi: 10.1161/CIRCIMAGING.112.000078. Epub 2013 Mar 26. PMID:23532508 4:15-4:45pm Heart Failure, Thick LV and Low-voltage EKG (cardiac amyloidosis) (30 min) Steven J. Lester, M.D. As a result of this presentation, participants should be better able to: • Recognize the differential diagnosis in patients with increased left ventricular wall thickness, and explain how echocardiography can be used to help narrow down the etiology. References supporting this talk Cardiac amyloidosis is a manifestation of one of several systemic diseases known as the amyloidosis. This uncommon disease is probably under diagnosed, and even when a diagnosis of amyloidosis of the heart is made, the fact that there are several types of amyloid, each with its unique features and treatment, is often unrecognized. This can lead to errors in management and in the information conveyed to the patient. ►http://circ.ahajournals.org/content/112/13/2047.long ►J Am Soc Echocardiogr. 2013 Dec;26(12):1397-406. doi: 10.1016/j.echo.2013.08.026. Epub 2013 Oct 3. Systolic function reserve using two-dimensional strain imaging in hypertrophic cardiomyopathy: comparison with essential hypertension. Badran HM1, Faheem N, Ibrahim WA, Elnoamany MF, Elsedi M, Yacoub M. ►J Am Soc Echocardiogr. 2014 Aug;27(8):888-95. doi: 10.1016/j.echo.2014.04.015. Epub 2014 May 27. Application of a parametric display of two-dimensional speckle-tracking longitudinal strain to improve the etiologic diagnosis of mild to moderate left ventricular hypertrophy. Phelan D1, Thavendiranathan P2, Popovic Z1, Collier P1, Griffin B1, Thomas JD1, Marwick TH3. 4:45-5:15pm Myocardial Contrast Echo: State of the Art (30 min) Sanjiv Kaul, M.D. As a result of this presentation, participants should be better able to: • Describe coronary microcirculation, and recognize the utility of microbubbles in diagnosis and treatment. References supporting this talk Molecular imaging with contrast ultrasound relies on the detection of targeted microbubbles or other acoustically active nanoparticles. The feasibility of targeting ultrasound contrast agents to disease-related markers and for non-invasively evaluating the molecular profile of disease in animal models has been firmly established. The technique is now being applied as a high-throughput research tool that can define pathophysiological processes in both the spatial and temporal domains. Initial steps are currently being made toward the development of targeted agents suitable for clinical application of this versatile technique. ►http://www.sciencedirect.com/science/article/pii/S0958166907000055 Despite 25 years of research and development, MCE is not yet used routinely as a clinical tool, for which there are several reasons. First, no ultrasound contrast agent has yet been approved for myocardial opacification in the United States. The second and most important reason is that currently there is no reimbursement for MCE. In comparison, SPECT is compensated handsomely. It is also true that the learning curve for MCE is steep, and _1 person (a sonographer and an assistant/physician) is required to perform a good-quality study. Furthermore, it involves placing an intravenous line, which in many states requires the services of a registered nurse who may not be readily available. However, a fair compensation for performing and interpreting the study is likely to result in its rapid adoption. The future of molecular imaging with MCE as a clinical entity appears uncertain at the moment. ►http://www.ncbi.nlm.nih.gov/pubmed/18625905 Saturday, September 26 (4.0) 8:30-9am Right Ventricular Size and Function (30 min) Steven J. Lester, M.D. As a result of this presentation, participants should be better able to: • Recognize the strengths and limitations of the echocardiographic evaluation of right ventricular size and function, and implement appropriate recommended guidelines. References supporting this talk Right ventricular function plays an important role in determining cardiac symptoms and exercise capacity in chronic heart failure. It is known that right ventricle has complex anatomy and physiology. Echocardiography can assess sufficiently right ventricular structure and function and also suggest prognosis in pulmonary hypertension patients, especially with the use of modern imaging techniques. Finally, the new imaging modality of real time three dimensional echocardiography is interchangeable to cardiac magnetic resonance in reproducibility and accuracy. ►http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3209589/ ►2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy European Heart Journal (2014) 35, 2733–2779 ►2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy J Am Coll Cardiol 2011;58:e212– 60.

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9-9:30am Quantifying Myocardial Mechanics: Today and in the Future (30 min) James D. Thomas, M.D. As a result of this presentation, participants should be better able to: • Identify the diagnostic accuracy of different strain and strain rate variables and their reproducibility in various disease states. • Determine the extent to which strain and strain rate measurements can enhance patient management and improve postoperative outcomes. References supporting this talk Measurement of myocardial deformation provides important quantitative information on global and regional myocardial function. It is thus likely that echocardiographic evaluation of strain and SR will increasingly be incorporated into clinical practice. That said, the technique is relatively new, and more research will be required to identify the diagnostic accuracy of different strain and SR variables and their reproducibility in various disease states. Future studies will also determine the extent to which strain and SR measurements can enhance patient management and improve postoperative outcomes. ►http://journals.lww.com/anesthesia-analgesia/subjects/Heart/Fulltext/2014/03000/Perioperative_Assessment_of_Myocardial_Deformation.11.aspx 9:30-10am Myxomatous Valve Diseases: Physiologic Insights by 3D Echo (30 min) Maurice E. Sarano, M.D. As a result of this presentation, participants should be better able to: • Recognize the dynamic nature of mitral regurgitation in Myxomatous diseases. • Describe the physiologic difference in mitral annular function. • Identify the link between 3D physiology and surgical repair. References supporting this talk Real-time 3-dimensional transesophageal echocardiography provides insights into normal, dynamic mitral annulus function with early-systolic area contraction and saddle-shape deepening contributing to mitral competency. MVD annulus is also dynamic but considerably different with loss of early-systolic area contraction and saddle-shape deepening despite similar magnitude of ventricular contraction, suggestive of ventricular-annular decoupling. Subsequent area enlargement may contribute to mitral incompetence. After mitral repair, MVD annulus remains dynamic without systolic saddle-shape accentuation. Thus, real-time 3-dimensional transesophageal echocardiography provides new insights that allow the refining of mitral pathophysiology concepts and repair strategies. ►http://www.circ.ahajournals.org/content/121/12/1423.full 10:30-11am Panel Discussion With Audience Participation – Ejection Fraction: The Beginning of the End or the End of the Beginning? (30 min) Panel: Gerard P. Aurigemma, M.D., James D. Thomas, M.D., Blasé A. Carabello, M.D., Sanjiv Kaul, M.D., Steven J. Lester, M.D. As a result of this presentation, participants should be better able to: • Explain the role of diastolic dysfunction in producing symptomatic heart failure in patients with a normal ejection fraction and discuss optimal treatment options. References supporting this talk

A reduced left ventricular ejection fraction measured by echocardiography in a patient with clinical features of heart failure demonstrates that the patient has a cardiac abnormality and that the clinical picture is, in fact, due to heart failure. As such, a reduced ejection fraction (< 0.30 or 0.35) has been used as entry criteria for almost all the large clinical trials that guide our therapy of patients with heart failure. However, it has been recently recognized that a substantial and increasing proportion of patients with heart failure have a normal ejection fraction (> 0.50). Such patients are typically elderly women with systolic hypertension. These patients are subject to the sudden development of pulmonary congestion (flash pulmonary edema). The finding of heart failure in patients with a normal ejection fraction has focused attention on the role of diastolic dysfunction in producing symptomatic heart failure. The optimal treatment of patients with heart failure and normal ejection fraction has not yet been defined, but the control of systolic hypertension and the avoidance of fluid overload are important. ►http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2394690/ 11-11:30am Hypertrophic Cardiomyopathy (30 min) Steven J. Lester, M.D. As a result of this presentation, participants should be better able to: • Cite echocardiographic features and imaging requirements for a diagnosis of hypertrophic cardiomyopathy, and outline the basic management strategies. References supporting this talk Hypertrophic cardiomyopathy is a common inherited cardiovascular disease present in one in 500 of the general population. It is caused by more than 1400 mutations in 11 or more genes encoding proteins of the cardiac sarcomere. Although

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hypertrophic cardiomyopathy is the most frequent cause of sudden death in young people (including trained athletes), and can lead to functional disability from heart failure and stroke, the majority of affected individuals probably remain undiagnosed and many do not experience greatly reduced life expectancy or substantial symptoms. Clinical diagnosis is based on otherwise unexplained left-ventricular hypertrophy identified by echocardiography or cardiovascular MRI. While presenting with a heterogeneous clinical profile and complex pathophysiology, effective treatment strategies are available, including implantable defibrillators to prevent sudden death, drugs and surgical myectomy (or, alternatively, alcohol septal ablation) for relief of outflow obstruction and symptoms of heart failure, and pharmacological strategies (and possibly radiofrequency ablation) to control atrial fibrillation and prevent embolic stroke. A subgroup of patients with genetic mutations but without left-ventricular hypertrophy has emerged, with unresolved natural history. Now, after more than 50 years, hypertrophic cardiomyopathy has been transformed from a rare and largely untreatable disorder to a common genetic disease with management strategies that permit realistic aspirations for restored quality of life and advanced longevity. ►http://www.ncbi.nlm.nih.gov/pubmed/22874472 ►2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy European Heart Journal (2014) 35, 2733–2779 ►2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy J Am Coll Cardiol 2011;58:e212– 60. 11:30-12 noon Diastolic Dysfunction: Heart Failure with Preserved Ejection Fraction – Fact or Fiction? (30 min) Gerard P. Aurigemma, M.D. As a result of this presentation, participants should be better able to: • Assess contemporary ultrasound tools to diagnose diastolic dysfunction. • Determine how to better target abnormalities of patients with heart failure to reduce the substantial burden of morbidity and mortality. References supporting this talk

Heart failure with preserved ejection fraction is a major and growing public health problem in Europe and the USA, currently representing half of all patients with HF. Despite improvements in disease understanding, there are no treatments of proven benefit. Advances in diagnostic algorithms, imaging, and invasive assessment will allow for more accurate and earlier diagnosis, so that therapies may be implemented earlier in disease progression, where potential for benefit may be higher. While important advances have been made in our understanding of the haemodynamic and cellular pathophysiology of diastolic and non-diastolic mechanisms of disease, further research is urgently required to determine how to better target these abnormalities to reduce the substantial burden of morbidity and mortality in this form of HF, which is reaching epidemic proportions. ► http://www.medscape.com/viewarticle/739371_5 The ejection fraction has proved to be a robust measurement for epidemiological purposes but in individuals it is highly unsatisfactory—it is dependent on many variables including most importantly afterload. Furthermore it tends to reflect mainly circumferential fibre shortening and takes little account of long axis function. In fact, studies of long axis shortening using the mitral valve ring have shown that maximal systolic excursion by M mode echocardiography or peak systolic velocity by tissue Doppler imaging are remarkably sensitive indicators of systolic performance. ►http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767942/ ►Echocardiographic evaluation of diastolic function can be used to guide clinical care. Little WC, Oh JK. Circulation. 2009 Sep 1;120(9):802-9. doi: 10.1161/CIRCULATIONAHA.109.869602. No abstract available. PMID: ►Diastolic heart failure can be diagnosed by comprehensive two-dimensional and Doppler echocardiography. Oh JK, Hatle L, Tajik AJ, Little WC. J Am Coll Cardiol. 2006 Feb 7;47(3):500-6. Epub 2006 Jan 18. Review. PMID: ►Developing therapies for heart failure with preserved ejection fraction: current state and future directions. Butler J, Fonarow GC, Zile MR, Lam CS, Roessig L, Schelbert EB, Shah SJ, Ahmed A, Bonow RO, Cleland JG, Cody RJ, Chioncel O, Collins SP, Dunnmon P, Filippatos G, Lefkowitz MP, Marti CN, McMurray JJ, Misselwitz F, Nodari S, O'Connor C, Pfeffer MA, Pieske B, Pitt B, Rosano G, Sabbah HN, Senni M, Solomon SD, Stockbridge N, Teerlink JR, Georgiopoulou VV, Gheorghiade M. JACC Heart Fail. 2014 Apr;2(2):97-112. doi: 10.1016/j.jchf.2013.10.006. Review. PMID: 12-12:30pm 3-D Echo in Valvular Heart Disease (30 min) William Stewart, M.D. As a result of this presentation, participants should be better able to: • Recognize the value of 3-D echo for pre-surgical planning, intra-procedural guidance, and post-procedural assessment of valvular heart disease. References supporting this talk

Significant advances in 3-dimensional echocardiography (3-DE) technology have ushered its use into clinical practice. The recent advent of real-time 3DE using matrix array transthoracic and transesophageal transducers has resulted in improved image spatial resolution, and therefore, enhanced visualization of the patho-morphological features of the cardiac valves. Three-dimensional echocardiography provides unique perspectives of valvular structures by presenting “en face” views of valvular structures, allowing for a better understanding of the topographical aspects of pathology, and a refined definition of the spatial relationships of intracardiac structures. Three-dimensional echocardiography makes available indices not described by 2D

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echocardiography and has been demonstrated to be superior to 2D echocardiography in a variety of valvular disease scenarios. ►http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499936/ 12:30-1pm Hemodynamics in the Era of Advanced Echo/Doppler: Do We Still Need Cath? Blasé A. Carabello, M.D. As a result of this presentation, participants should be better able to: • Cite specific examples demonstrating the role of hemodynamics as an integral part of Cardiology. References supporting this talk

In the new era of cardiac catheterization, there is no longer a routine cardiac catheterization. Patients enter the laboratory after a battery of noninvasive tests has failed to yield the diagnosis on structural heart disease, and there is every expectation that the patient will leave the catheterization laboratory with a firm diagnosis. To accomplish this, a goal-oriented approach must be undertaken with meticulous attention to detailed skills that may not have been developed during fellowship. In many cases, it will be necessary to retrain cardiologists in the art of cardiac catheterization, emphasizing pitfalls in pressure recording and in maneuvers performed in the catheterization laboratory to sort out difficult hemodynamic problems. In this way, we can ensure that our patients will receive the full benefits of an invasive evaluation. ►http://www.circ.ahajournals.org/content/125/17/2138.full ►Nishimura RA, Carabello BA. Hemodynamics in the cardiac catheterization laboratory of the 21st century. Circulation 2012 May 1;125(17):2138-50.

Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Coronary CTA in the Emergency Department: A Hands-on Workshop – Seventh Annual DATE: Saturday-Sunday, November 14-15, 2015 LOCATION: Fontainebleau Miami Beach, Florida TIME: Saturday AM Session, 7:00 a.m.–6:00 p.m. Sunday AM Session 7:00 a.m. – 6:00 p.m. EXPECTED NUMBER OF ATTENDEES: 30-40 SYMPOSIUM DIRECTOR: Ricardo Cury, M.D. CREDIT HOUR(S) APPLIED FOR: 16.75 Cat. 1 AMA/PRA LEARNING FORMAT:

Live activity Test-item writing activity Internet point-of-care activity Enduring material Manuscript review activity Journal-based CME activity PI CME activity

TARGET AUDIENCE: Radiologists, Cardiologists, Emergency Medicine Physicians, Hospitalists, Family Physicians, Internists, Physician Assistants, Nurse Practitioners, Nurses, Radiology Technologists Describe how the content of the activity is aligned with the target learners' current or potential scope of practice (C4). This activity addresses professional practice gaps relevant to physicians in the practice of radiology, emergency and trauma medicine. In addition, physicians who may refer for further evaluation or treatment, are also included in the target audience, as are related members of the hospital or physician’s care team, i.e.: radiology technologists, nurse practitioners, nurses, etc. REGISTRATION CHARGES: Entire Course: Physicians: $1,295* *Emergency Radiology Sunday Session Included in the Workshop charge *Group discounts available for three or more physicians who register together. TYPE OF MEETING (FORMAT): Must be appropriate to the setting, objectives and desired results (C5). Check all that apply.


Panel Enduring Material Internet-Home Study Other (Hands-on Workshop)

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New or updated policy/protocol/guidelines Patient care data Peer review data Process improvement initiatives (C16 & 21) Research/literature review Other (Explain)

FACTORS OUTSIDE OUR CONTROL - List factors, outside our control and beyond learner performance that impact patient outcomes and contribute to the healthcare 'quality gap' being addressed. (C18) Patient: Non-compliance Lifestyle Resistance-to-change Financial/Lack of Insurance Physician: Non-compliance Resistance-to-change Communication Skills Financial Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or No Treatment Modalities Limited or No Diagnostic Modalities Other:

PROFESSIONAL PRACTICE GAP (C2)

The difference between the current and optimal practices is the “practice gap” – this is what should be addressed or ‘closed’ as a result of this CME activity.

WHAT IS/ARE THE CURRENT PRACTICE* and/or THE PRACTICE GAP*? What are physicians doing (or not doing) that needs to change? Describe the practice gap. Physicians in the Emergency Department or Chest Centers do not consistently use Coronary Computed Tomography Angiography (CCTA) and triple rule-out protocol to diagnose, risk-stratify and clarify causes of acute coronary syndrome. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879291/ References Acute chest pain is the second most frequent reason for patient visits to the emergency department in the United States; however, only a small minority of those patients ultimately receives a diagnosis of acute coronary syndrome (ACS). To improve diagnostic accuracy and cost-effectiveness, various strategies including chest pain units, novel cardiac biomarkers, and noninvasive cardiac imaging have been proposed. Recent guidelines have highlighted that the primary goal of this approach is exclusion of ACS and other serious conditions rather than detection of coronary artery disease (CAD). The routine evaluation of acute chest pain in most centers in the United States includes admission to a hospital or chest pain unit to rule out ACS with the use of serial electrocardiography and cardiac biomarkers. In selected patients, stress testing with or without imaging may be used for further risk stratification. Such an approach may avoid the inadvertent discharge of a patient who has ACS, but is time-consuming and costly and is associated with a prolonged length of stay. http://content.onlinejacc.org/article.aspx?articleid=1569174 Other Sources http://radiology.rsna.org/content/245/2/577.full http://www.medpagetoday.com/MeetingCoverage/ACC/31864 WHAT IS THE OPTIMAL PRACTICE*? (In a 'perfect world', what would doctors be doing? What does optimal practice 'look like'?) Physicians use CCTA to rapidly risk-stratify patients in order to accurately exclude the presence of coronary artery disease in patients presenting to the ED or chest pain center with acute chest pain and possible myocardial ischemia. Physicians engage their patients in conversations about reducing inappropriate tests and procedures with a goal of improving care and avoiding harm.http://archive.constantcontact.com/fs106/1101901294184/archive/1112518279212.html References Previous studies demonstrated that coronary computed tomography angiography (CCTA) is a rapid and accurate technique to exclude the presence of CAD. Furthermore, the immediate and future likelihood of cardiac events in patients with no or minimal CAD is extremely low for patients with nonacute chest pain. In light of these favorable test characteristics, several single-center and more recently, multicenter studies have demonstrated the feasibility, safety, and accuracy of CCTA in the ED. http://content.onlinejacc.org/article.aspx?articleid=1569174 WHAT IS THE REASON FOR THIS GAP? Indicate if the gap is in physician:

Knowledge? (They do not know that they need to be doing something.) Competence? (They do not know how to do it) Performance? (They know how to do it but are non-compliant - or are not doing it properly) Knowledge

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►Physicians tend to be conservative, resulting in many unnecessary admissions of patients without acute chest pain. On the other hand (in some cases) patients with chest pain discharged from the hospitals emergency department will have either a myocardial ischemia or an episode of unstable angina within 30 days.

Competence ► Physicians need to effectively diagnose and evaluate patients presenting to the ED or Chest Pain Center with subtle or unsual chest pain with a goal of improving care and avoiding harm.

Performance ►Physicians should include - and health systems should implement - a competent program with quality-driven guidelines that includes CCTA imaging and triple rule-out protocol to risk-stratify and clarify causes of acute coronary syndrome in patients presenting to the ED or Chest Pain Center. DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) Will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? (Check all that apply.) *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) ►Physicians will embrace CCTA and triple rule-out protocol as the noninvasive triage tool of choice in the ER or Chest Pain Center, for patients presenting with acute chest pain and possible MI, significantly improving quality of care, cost-effectiveness and medico-legal liability.

Topic-specific Professional Practice Gaps for the Sunday PM Session at the end of this CME application. COMPETENCIES: What desirable physician attributes (e.g. professional competencies) set forth by national organizations of medicine (e.g.: IOM, ACGME, ABMS) does this activity address? (C6)


Other Competencies: Eligibile for level-certification by ACR or AHA/ACC for the CBCCT exam EVALUATION METHOD(S): Analyze the overall changes in competence, performance, or patient outcomes as a result of this CME activity. (C11) List the planned method(s) of evaluation:


OUTCOMES MEASUREMENT: (List strategy measurement questions and/or other measurement plans.) (C11) ►Since, and as a result of your participation at the workshop, which of the following new strategies have you implemented in your practice? (Check all that apply) – (Performance based questions will be asked on the follow-up survey taken from the educational objectives) ►Since, and as a result of your participation at this workshop, how many patients have you impacted by what you learned at the activity? __1-5 __6-10 __Over 10 ►Since, and as a result of what you learned at this workshop what do you intend to do differently? What new strategies will you apply to your practice? ►If you do not plan to implement any new strategies learned at this conference, please list any barriers or obstacles that might keep you from doing so?



COMMERCIAL SUPPORT: The Baptist Health Continuing Medical Education Department will not solicit or accept grants from commercial interests to support CME activities, thereby strengthening the CME Program's commitment to be independent and free of the influence of commercial interests. Indicate here if support will come from the Foundation general medical education fund. BARRIERS TO PHYSICIAN CHANGE: (C19) Is this activity focused on ‘overcoming, addressing, or removing barriers to physician change' applicable to our learners? Yes No If 'yes', list the barrier(s) identified and include relevant data and information about the barriers. OVERALL PROGRAM CHANGES: Does this CME activity reflect implementation (C14) of any interventions or changes that came about as a result of our overall CME program evaluation and analysis (C13) to meet the CME mission?


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Explain: ►Baptist Health South Florida’s Hospitals’ Emergency Departments offer extensive surveillance programs that track emergency department time to coronary CTA performance, interpretation and results. The emergency departments analyze this data to review patient outcome in the hospitals. ►BHSF encourages all cardiologists and radiologists to read the "Five Things Physicians and Patients Should Question" lists at www.choosingwisely.org, and to engage their patients in conversations about reducing inappropriate tests and procedures with a goal of improving care and avoiding harm. http://archive.constantcontact.com/fs106/1101901294184/archive/1112518279212.html COLLABORATION: Are we engaged in collaborative and cooperative projects with other stakeholders (internal or external) that are related to this CME activity? (C20)


If yes, list collaborative efforts related to this CME activity that support achievement of our CME Mission. ►A collaborative acute chest pain program is in place in Baptist Hospital involving emergency physicians. DATE REVIEWED: June 1, 2015 REVIEWED BY: Executive Committee Chairman


Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A FACULTY (Name, Specialty and/or Title(s), Institution(s), City, State) Ricardo C. Cury, M.D., FAHA, FSCCT Workshop Director Director of Cardiac Imaging, Baptist Hospital and Miami Cardiac & Vascular Institute Clinical Associate Professor in Radiology, Herbert Wertheim College of Medicine, Florida International University Miami, Florida Juan Carlos Batlle, M.D. Diagnostic Radiologist, Baptist, South Miami, Doctors, Homestead and West Kendall Hospitals Miami, Florida Robert P. Beecham, M.D. Diagnostic Radiologist, Baptist, South Miami, Doctors, Homestead and West Kendall Hospitals Miami, Florida Roberto Cury, M.D. Medical Director, Cardiac CT and MRI Samaritano Hospital São Paulo, Brazil Elliot K. Fishman, M.D. Professor of Radiology, Surgery and Oncology Director of Diagnostic Imaging and Body CT Johns Hopkins Hospital Baltimore, Maryland Smita Patel, MBBS, MRCP, FRCR Assistant Professor of Radiology University of Michigan Ann Arbor, Michigan Constantino S. Peña, M.D. Medical Director, Vascular Imaging, Miami Cardiac & Vascular Institute Diagnostic Radiologist Baptist, Doctors, Homestead and South Miami Hospital and Baptist Outpatient Services Miami, Florida

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EDUCATIONAL OBJECTIVES: Describe what doctors will be able to do after they leave the classroom. What is the "take-away" that they can put into practice. What new strategies, tools, treatment plans, approaches, etc. will they be able to implement, utilize, do, etc. as a result of attending this CME activity?

Saturday and Sunday, November 14 & 15 Hands-on Workshop Upon completion of this workshop, participants should be better able to: ● Effectively utilize coronary computed tomography angiography (CTA) and triple rule-out CT protocol to properly diagnose, detect and evaluate emergency department patients with acute chest pain or other symptoms suggestive of coronary artery syndrome. ● Apply the basic and more advanced interpretation principles of coronary CTA datasets. ● Explain the relationship between coronary CTA findings and the clinical outcome of patients with acute chest pain. ● Utilize the appropriate noninvasive studies to assess risk of acute coronary syndrome. ● Cite the benefits and limitations of electrocardiogram, biomarkers and imaging. ● Implement essential components of patient preparation for CTA. ● Formulate radiation reduction strategies based on scanning methods. ● Determine which emergency room patients will benefit most from assessment with CTA. ● Identify the benefits and drawbacks of utilizing CTA imaging studies. ● Detect and differentiate CTA appearances of acute conditions of the abdominal aorta. ● Diagnose and treat life-threatening causes of chest pain. ● Determine when coronary CTA and triple rule-out may be an alternative and useful diagnostic study in a select group of emergency department patients. Sunday, November 15 Emergency Radiology As a result of these presentations, participants should be better able to: ● Detect important cardiac findings on non-gated chest CT. ● Recognize cardiac pathology and anatomy relevant to emergency department imaging. ● Implement a dedicated clinical pathway to triage chest pain patients in the emergency department. ● Compare strengths and weaknesses of coronary CTA angiography for assessment of chest pain in the emergency department. ● Compare imaging modalities in patients with possible acute aortic syndromes. ● Analyze the standard protocol of unenhanced and contrast-enhanced chest CTA. ● Recognize the current role of CT for the diagnosis of pulmonary thromboembolic disease. ● Identify artifacts and pitfalls on helical CT pulmonary angiography that may cause errors in interpretation. ● Recognize the role of CT/CTA in the evaluation of musculoskeletal trauma. ● Optimize protocol design for CT data acquisition and post processing. ● Identify key CT findings and potential pitfalls of vascular injury.

SCHEDULE Coronary CTA in the Emergency Department: A Hands-on Workshop - Seventh Annual Saturday, November 14 (8 Cat. 1) 7:30 a.m. Registration, Continental Breakfast and Visit Exhibits 7:55 a.m. Welcome and Introductions Ricardo C. Cury, M.D. 8:00 a.m. Lectures: The Basics; the Evidence; “How To”; Clinical Pathways; Reporting Ricardo C. Cury, M.D., Juan Batlle, M.D. 9:00 a.m. Cases 1-8 10:00 a.m. Break 10:30 a.m. Cases 9-16 12:30 p.m. Lunch 1:30 p.m. Live Case from Baptist Hospital Moderator: Ricardo Cury, M.D. 2:30 p.m. Cases 17-24 3:30 p.m. Break 4:00 p.m. Cases 25-32 6:00 p.m. Adjourn Sunday, November 15 (4.5 Cat. 1) 8:00 a.m. Registration, Continental Breakfast and Visit Exhibits 8:30 a.m. Cases 33-40 9:30 a.m. Break 10:00 a.m. Cases 41-50 1:00 p.m. Adjourn CCTA Workshop 15th Annual Emergency Radiology Symposium: What You Need to Know to Get You Through the Night Sunday, November 15 (4.25 Cat. 1) Body Imaging I

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2:00 a.m. Registration and Tea Time 3:00 a.m. Welcome and Introduction

Myer Roszler, M.D. 3:15 p.m. Cardiac Imaging for the ED Radiologist

Juan Battle, M.D. 4:00 p.m. How to implement Coronary CTA in the ED

Ricardo Cury, M.D. 4:45 p.m. CTA of Acute Aortic Syndromes

Constantino Peña, M.D. 5:30 p.m. Imaging of Acute Pulmonary Embolism

Smita Patel, MBBS, MRCP, FRCP 6:15 p.m. CT of Musculoskeletal Trauma: Emphasis on Vascular Injury

Elliot Fishman, M.D. 7:00 p.m. Questions and Answers 7:30 p.m. Adjourn

Topic-specific Professional Practice Gaps Sunday PM Session Emergency Radiology Sunday, November 15 (4.25 Cat. 1) Juan Carlos Batlle, M.D. Cardiac Imaging for the ED Radiologist Educational Objectives As a result of this presentation, participants should be better able to: ● Detect important cardiac findings on non-gated chest CT. ● Recognize cardiac pathology and anatomy relevant to emergency department imaging. References

Pertinent reportable cardiac findings on non-electrocardiography (ECG)-gated chest CT examinations have become easier to detect given recent advancements in multidetector CT technology. However, those findings are easily overlooked on routine chest CT without ECG gating given residual inherent cardiac motion artifact and non-cardiac indications. ►http://www.ncbi.nlm.nih.gov/pubmed/23436832 Ricardo Cury, M.D. How to implement Coronary CTA in the ED As a result of this presentation, participants should be better able to: ● Implement a dedicated clinical pathway to triage chest pain patients in the emergency department. ● Compare strengths and weaknesses of coronary CTA angiography for assessment of chest pain in the emergency department. References ►Cury RC, Feuchtner GM, Batlle JC, Peña CS, Janowitz W, Katzen BT, Ziffer JA. Triage of patients presenting with chest pain to the emergency department:implementation of coronary CT angiography in a large urban health care system. AJR Am J Roentgenol. 2013 Jan;200(1):57-65. ►Cury RC, Budoff M, Taylor AJ. Coronary CT angiography versus standard of care for assessment of chest pain in the emergency department. J Cardiovasc ComputTomogr. 2013 Mar-Apr;7(2):79-82. ►Maroules CD, Blaha MJ, El-Haddad MA, Ferencik M, Cury RC. Establishing a successful coronary CT angiography program in the emergency department: official writing of the Fellow and Resident Leaders of the Society of Cardiovascular Computed Tomography (FiRST). J Cardiovasc Comput Tomogr. 2013 May-Jun;7(3):150-6. Constantino Peña, M.D. CTA of Acute Aortic Syndromes As a result of this presentation, participants should be better able to: ● Compare imaging modalities in patients with possible acute aortic syndromes. ● Analyze the standard protocol of unenhanced and contrast-enhanced chest CTA. References

Acute aortic syndromes include aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, and ruptured aortic aneurysm. This group of illnesses presents similarly and has incidence estimates of two to four cases per 100,000 people per yea. Rapid and accurate diagnosis is essential to improve survival because acute aortic dissection has a pre- and in-hospital mortality rate of 20% and 30%, respectively. Several imaging modalities can be used, including MRI and transesophageal echocardiography, but CT has emerged as the first choice given its availability, speed, and accuracy with sensitivity and specificity approaching 100%. Unenhanced and contrast- enhanced CT angiography (CTA) of the chest and abdomen is the standard protocol. Unenhanced imaging aids in the diagnosis of acute intramural hematoma, whereas contrast enhanced CTA enables visualization of the dissection flap. ►http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3685820/

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Smita Patel, MBBS, MRCP, FRCP Imaging of Acute Pulmonary Embolism As a result of this presentation, participants should be better able to: ● Recognize the current role of CT for the diagnosis of pulmonary thromboembolic disease. ● Identify artifacts and pitfalls on helical CT pulmonary angiography that may cause errors in interpretation. References

Major advances in computed tomography (CT) technology, specifically multidetector CT (MDCT) with vastly improved spatial and temporal resolution, have led to a surge in the diagnosis of acute pulmonary embolism (PE) using computed tomography pulmonary angiography (CTPA). ►http://circimaging.ahajournals.org/content/3/4/491.full ►Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) [practice guideline]. Eur Heart J 29:2276-2315, 2008. Elliot Fishman, M.D. CT of Musculoskeletal Trauma: Emphasis on Vascular Injury As a result of this presentation, participants should be better able to: ● Recognize the role of CT/CTA in the evaluation of musculoskeletal trauma. ● Optimize protocol design for CT data acquisition and post processing. ● Identify key CT findings and potential pitfalls of vascular injury. References

Traumatic injuries are the leading cause of death in adults < 45 years of age. The diagnostic work-up of those patients is challenging, complex and requires a structured and interdisciplinary workflow. Multidetector CT (MDCT) is considered the imaging modality of choice due to remarkable technical developments in recent years. Besides the evaluation of cranial, chest, and abdominal injuries, MDCT allows for integrated imaging of musculoskeletal trauma within a single CT examination. ►http://www.ncbi.nlm.nih.gov/pubmed/24101177 ►Multidetector CT and three-dimensional CT angiography of upper extremity arterial injury. Fritz J, Efron DT, Fishman EK. Emerg Radiol. 2014 Dec 11. [Epub ahead of print] ►State-of-the-art 3DCT angiography assessment of lower extremity trauma: typical findings, pearls, and pitfalls. Fritz J, Efron DT, Fishman EK. Emerg Radiol. 2013 Jun;20(3):175-84

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Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: The Art of Spine Care: Surgical Approaches to Low Back Pain DATE: Thursday, November 12, 2015 TIME: 6-7 p.m. LOCATION: BHM Classroom 5 CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 CONFERENCE DIRECTOR: Ronald Tolchin, D.O. AMA/PRA LEARNING FORMAT:




TARGET AUDIENCE: Hospitalists, General Internists, Family Practitioners, Emergency Medicine and Urgent Care Physicians, and other interested healthcare providers, nurses and physical therapists EXPECTED NUMBER OF ATTENDEES: 20-25 CHARGE: 0 TYPE OF MEETING (FORMAT): Must be appropriate to the setting, objectives and desired results (C5). Check all that apply. Live Didactic Lecture ARS








addressed or ‘closed’ as a result of this CME activity. WHAT IS/ARE THE CURRENT PRACTICE* AND/OR THE PRACTICE GAP*? What are physicians doing (or not doing) that needs to change? Describe the practice gap. ► Physicians are not aware of the surgical options available when treating patients with various spine disorders. WHAT IS THE OPTIMAL PRACTICE*? (In a 'perfect world', what would doctors be doing? What does optimal practice 'look like'?) ► Physicians initiate a patient-centered treatment plan discussing the latest breakthroughs in spine surgery including minimally invasive techniques and there outcomes. WHAT IS THE REASON FOR THIS GAP? Indicate if the gap is related to either/or:


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DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) And will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? (Check all that apply.) *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) ► Physicians discuss surgical options with patients in the management of spinal disorders. *REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► The results from an overview on surgical interventions for low back disorders need to be used together with an overview of conservative interventions. Only then physicians will have a complete overview of the evidence for all possible treatment options for low back disorders. Such an overview could be implemented in clinical guidelines which could be used for counseling of the individual patient. Eur Spine J. 2013 Sep; 22(9): 1936–1949. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3777049/ EDUCATIONAL OBJECTIVES: Upon completion of this conference, participants should be better able to: Suggest surgical options and approaches to spine surgery according to given diagnosis. Compare and explain the differences between minimally invasive spine surgery and open approaches to spine surgery.





OUTCOMES MEASUREMENT: (List strategy measurement questions and/or other measurement plans.) (C11) ► As a result of what you learned at this conference what do you intend to do differently? What new strategies will you apply to your practice? _____________________________________________________________________________ ► If you do not plan to implement any new strategies learned at this conference, please list any barriers or obstacles that might keep you from doing so: _______________________________________________________________________ FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Justin M. Sporrer, M.D. Neurosurgeon Baptist and Doctors Hospitals





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If yes, list collaborative efforts related to this CME activity that support achievement of our CME Mission. ______________ This CME activity was planned in collaboration with Baptist Health Neuroscience Center.




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