Western Occupational & Environmental Medical Association
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CME Webinars

Speaker: Vernon Williams, MD

Topic: Management of Concussion & Post-Concussion Syndrome

This presentation will provide an updated review of concepts related to the management of concussion and post-concussion syndrome. Previously, management was limited to “watchful waiting” with the concept that although many (if not most) concussive injuries resolve spontaneously, there are individuals who have prolonged and/or permanent symptoms. This “Post-Concussion Syndrome” was often viewed as a “new normal” for those individuals and management was limited to teaching compensatory strategies and attempts at treating symptoms. A more evolved approach is aimed at an aggressive assessment and search for treatable causes of ongoing symptoms with interventions aimed at amelioration and improvement, rather than watchful waiting and compensation.

Learning Objectives – Participants will be able to:

  • Identify the most common symptoms associated with prolonged concussion and Post-Concussion Syndrome
  • Identify options for treatment of most common symptoms associated with Post-Concussion Syndrome
  • Identify factors (modifying factors) associated with increased risk of prolonged symptoms and Post-Concussion Syndrome
  • Have awareness of evolving approaches and future directions for treatment of concussion and Post-Concussion Syndrome

Vernon B. Williams is a graduate of The University of Michigan’s prestigious Inteflex Accelerated Pre-Medical/Medical Program. He completed neurology residency at The University of Maryland in Baltimore and is board certified by the American Association of Psychiatry and Neurology. Dr. Williams joined the Kerlan-Jobe Orthopaedic Clinic in Los Angeles in 1997 where he is a consulting Team Physician to the Los Angeles Rams, Clippers, Dodgers, Kings, Sparks, Anaheim Ducks, and several southern California collegiate, high school, and elite club athletic programs. He is the Founding Director of The Center for Sports Neurology and Pain Medicine at the Kerlan-Jobe. In 2015, Governor Brown appointed him to the California State Athletic Commission Dr. Williams is an active educator on issues related to Sports Neurology and Concussion and is the Chair of the American Academy of Neurology Sports Neurology Section

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Speaker: Leslie Kim, MD

Topic: Knee Injuries: Pearls & Pitfalls

This presentation will highlight pertinent key points in evaluating and treating common–and some uncommon–knee conditions presenting to occupational medicine specialists. This will include identification of “red flags,” practical pointers on performing a knee examination, appropriate use of diagnostic studies, efficacy of certain treatment modalities, and timing of referral for orthopaedic consultation. Participants should be able to apply this information to more effectively and efficiently manage knee injuries in their practice.

Learning Objectives – Participants will be able to:

  • Recall key questions when obtaining the patient’s history of knee injury
  • Describe the knee anatomy and clinical correlation to the physical examination
  • Appropriately use diagnostic testing and treatment modalities for different knee conditions
  • Identify urgent knee conditions that require timely referral

Dr. Leslie Kim is a board certified orthopaedic surgeon in active general practice with sub-specialization in shoulder and knee arthroscopy. His special interests include sports medicine, workers compensation, forensic (medico-legal) orthopaedics, and health care innovation. Dr. Kim is a graduate of Stanford Medical School. He completed general surgery internship and orthopaedic surgery residency at UCLA. He also received post-graduate fellowship training in arthroscopic surgery, orthopaedic trauma in Munich Germany, and reconstructive surgery at Scripps Clinic. Following Dr. Kim’s formal training, he gained additional experience working at the Olympics and serving as a local college team physician, as well as expertise in the workers compensation system as medical director of a large statewide medical group. Dr. Kim is presently the chair of the orthopaedic surgery department at Mills-Peninsula Hospital in Burlingame, and on staff at Seton Medical Center.

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Speakers: Pamela Hymel, MD, MPH, FACOEM & T. Warner Hudson, MD, FACOEM, FAAFP

Topic: Integrating Health and Safety – Two Employer Solutions

Total Worker Health® is the integration of both workplace health promotion (health) and workplace health protection (safety).  Both Walt Disney Parks & Resorts and UCLA Occupational Health have approached their safety and health programs via strategic integration of important program components between the two departments. The background, rationale, program content, operational details, and results over 5 years from these two workplaces will be presented so others can consider how integrating their health and safety programs might positively impact their workers and workplaces. 

Learning Objectives – Participants will be able to:

  • List the basic concepts of NIOSH Total Worker Health Program®
  • Describe innovative ways two employers are integrating health and safety
  • Implement data that most effectively outlines program successes and areas of opportunity
  • Develop and design a focused hot spotter type wellness intervention
  • Operate a worker health program

Dr. Pamela Hymel is Chief Medical Officer for Walt Disney Parks and Resorts (WDPR) where she is responsible for integrating a segment wide health and well-being strategy. In her current role, she is responsible for the day-to-day operations of the onsite occupational health services centers, guest first aid locations, disability/accommodation management, drug screening, global occupational health issues and well-being strategy and programs for WDPR. Dr. Hymel served as President of the American College of Occupational Medicine (ACOEM) from 2009-2010 and was on their Board of Directors for over 10 years.

Dr. T. Warner Hudson has been Medical Director of UCLA Health System and Campus for 7 years and has worked across all UC on the focused wellness program for injured workers called Work Strong; on the steering committee of UCLA’s Healthy Campus Initiative,  and is currently working on new UC wide population health efforts. He spent 20 + years as a Corporate Medical Director and Director of Health Safety and Environment for multinational companies.  He was president of ACOEM in 2011-2012 and president of WOEMA in 2000-2001

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Speaker: Raymond Meister, MD

Topic: The California Medical Treatment Utilization Schedule (MTUS) – New Treatment Guidelines and Formulary

Doctors in California’s workers’ compensation system are required to provide evidence–based medical treatment.  The MTUS provides this evidence-based framework for the evaluation and treatment of injured workers. It includes a set of guidelines covering which treatments are effective for most work–related injuries and illnesses as well as a method for providing care outside of the MTUS treatment guidelines.  Additionally, a proposed MTUS Formulary has also recently been submitted for public comment and this presentation will cover the formulary as well.  Use of the MTUS is not only required by law, but will facilitate the approval of your treatment plans and improve outcomes of your patients.

Learning Objectives:

  • Define what the MTUS is and why it is critically important to the care of your patients.
  • Identify the guidelines in the MTUS and learn how to use recommendations found in the MTUS guidelines for your patients’ treatment.
  • Explain how to apply the MTUS Medical Evidence Search Sequence when considering recommendations found outside of the MTUS.
  • Identify highlights of the proposed MTUS Formulary.

Dr. Ray Meister has served as Executive Medical Director for DWC since June, 2016 and was an Associate Medical Director since 2014. Prior to joining DWC, Dr. Meister served as Public Health Medical Officer at the California Department of Public Health, Occupational Health Branch, from 2000 to 2014.

Dr. Meister is boarded in Occupational Medicine having done his residency at UCSF.  He earned a Master of Public Health degree from the University of California, Berkeley School of Public Health and a Doctor of Medicine degree from the University of Southern California School of Medicine. He has been a faculty member at the University of California, San Francisco since 1998 and is currently an Associate Clinical Professor.

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Speaker: Matthew Zahn, MD

TOPIC: Outbreak of Mycobacterial Infections in a Dental Clinic 

In the fall of 2017, the Orange County Health Care Agency responded to an outbreak of atypical mycobacterial infection in the patient population of a local dental clinic.  Over 60 children were hospitalized due to this outbreak, which is the largest dental mycobacterial outbreak reported in this country.  Aspects discussed will include assessment and testing of the facility water system, assessment of dental provider practices, and the epidemiology of community outbreaks of atypical mycobacterial infection.

Learning Objectives – Participants will be able to:

  • Become familiar with environmental sources of atypical mycobacterial infection.
  • Learn the basics of assessing water systems for potential mycobacterial contamination.
  • Review the epidemiologic progression of an outbreak of mycobacterial infection.

Dr. Matthew Zahn currently serves as Medical Director of the Division of Epidemiology and Assessment for the Orange County Health Care Agency. Dr. Zahn received his doctorate in medicine from St. Louis University School of Medicine. From 2004 through 2011, he served as Medical Director for the Louisville Metro Department of Public Health and Wellness. During that time, he also served as an Assistant Professor of Pediatric Infectious Disease at the University of Louisville School of Medicine. He has served on multiple national public health committees, including currently serving as the National Association of County and City Health Officials (NACCHO) liaison to the CDC’s Advisory Committee on Immunization Practices.

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Speaker: Robert L. Goldberg, MD, FACOEM

TOPIC: The California DWC Formulary: An Introduction

The 2017 implementation of the California DWC drug formulary will impact care for hundreds of thousands of injured workers. Thus great attention has been turned to the current draft regulations, which add an important layer of clinical context to guide drug therapy. The formulary is notably linked to the California Medical Treatment Utilization Schedule (MTUS) and driven by the American College of Occupational and Environmental Medicine (ACOEM) treatment guidelines. The DWC adoption of a closed drug formulary grounded in such high-quality evidence-based guidelines will place drug therapy decisions within the context of the injury or condition being treated, rather than the availability of the medication alone. Dr. Robert Goldberg will speak to the development of the DWC formulary, its potential clinical and cost benefits, provide insight into its functionality and application, and discuss important considerations for implementation.

Learning Objectives – Participants will be able to:

  • Summarize the development of the formulary from evidence-based occupational medical treatment guidelines
  • Explain the potential clinical and cost benefits of a closed drug formulary supported by evidence-based guidelines
  • Describe the considerations that are important to the successful implementation and adoption of a state-based formulary
  • Describe the functionality of the formulary and the supporting tools to make prescribing decisions for injured workers

Dr. Robert Goldberg is the Chief Medical Officer of Healthesystems and the developer of the ACOEM/Reed formulary. Board -certified in Occupational Medicine and a former Vice-Chair, Occupational Medicine of the American Board of Preventive Medicine, he is a nationally-recognized expert in the prevention and treatment of work-related injuries. He is also a Past-President of ACOEM and WOEMA and was a Professor of Medicine and the Residency Director in the Division of Occupational and Environmental Medicine at UCSF.

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Speaker: James Van den Bogaerde, MD

TOPIC: Work-Related Elbow Injuries – Diagnosis and Management

This webinar will focus on common work related elbow injuries – both traumatic and degenerative. I will discuss the clinical presentation of a variety of elbow conditions and review evidence-based management strategies. The presentation should improve your ability diagnose and treat common elbow injuries and be aware of less common elbow conditions, as well.

Learning Objectives – Participants will be able to:

  • Become familiar with the most common elbow injuries
  • Be aware of less common sources of elbow pathology
  • Appropriately diagnose elbow injuries
  • Recall how age, gender and occupation may affect the differential diagnosis
  • Review evidence-based treatment options

Dr. Van den Bogaerde (pronounced ‘van den bogard’) is a sports medicine specialist and director of the Sports Medicine Fellowship at UC Davis Orthopaedics and Sports Medicine. His practice focuses on shoulder and elbow arthroscopy and reconstruction. He provides medical coverage for the US Ski Team, Sacramento Republic FC (soccer), and local university and junior college football teams.

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Speaker: Eric Wood, MD, MPH

TOPIC: Maintaining Board Certification in Occupational Medicine

The American Board of Preventive Medicine (ABPM) administers the Maintenance of Certification (MOC) program for Diplomates Board Certified in Occupational Medicine. MOC consists of four parts: I) Professionalism and Professional Standing, II) Lifelong Learning and Self-Assessment, III) Assessment of Knowledge, Judgment, and Skills, and IV) Improvement in Medical Practice. This webinar is designed to help Occupational Medicine physicians understand the requirements for maintaining ABPM Board Certification, important timelines, and assistance in finding resources to meet those requirements.

Learning Objectives – Participants will be able to:

  • Review the origins and evolving nature of Maintenance of Certification (MOC)
  • Describe and define the Four Parts of Continuous Certification
  • Identify timelines to meet MOC requirements
  • Provide resources for achieving MOC requirements

Dr. Eric Wood is Director of Occupational Medicine at the Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), University of Utah. He also serves as the Director of the Occupational and Environmental Medicine Residency program at the University of Utah. He completed residency training in Family Medicine and Occupational Medicine and is Board-Certified in both disciplines. He has broad training and experience in occupational health having begun his career as an Industrial Hygienist working for both OSHA and private consulting to address and mitigate a wide spectrum of occupational health risks among workers. His current academic responsibilities include education and training of occupational medicine residents, graduate students, medical students, and other health professionals; research with a focus on Occupational Health and Wellness among Commercial Truck Drivers, and Work-Related Musculoskeletal Disorders; and consultation and clinical practice of occupational medicine. He is Co-Chair of the NIOSH NORA Transportation, Warehousing and Utility (TWU) Sector Council. Dr. Wood is a Director of the American Board of Preventive Medicine (ABPM), and he serves as Chair of the ABPM Maintenance of Certification Committee.

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Speaker: Paul Papanek, MD, MPH, FACOEM

TOPIC: Workplace Violence Prevention – Healthcare and Elsewhere

The webinar will review the epidemiologic sources of our data on workplace violence as an occupational health problem, and will focus particularly on violence in healthcare settings with a discussion of the upheavals caused by changes in both prison policy and forensic mental health practices. Using a recent Federal OSHA guidance document and experience from new standard setting in California, the talk will suggest strategies for prevention.

Learning Objectives – Participants will be able to:

  • Identify the mental health diagnoses associated with the highest risk of violent injuries to health care staff
  • Identify at least two authoritative resources for learning more about workplace violence prevention
  • State at least two strategies for decreasing episodes of workplace violence in healthcare settings

Dr. Paul Papanek is a graduate of UCSD Medical School, and took both his Family Medicine Residency and his MPH degree at UCLA. He is Board Certified in Occupational Medicine, and served as a Public Health Chief for LA County Health Department for 9 years, and as Chief of Occupational Medicine at the Kaiser Hospital in Los Angeles for about 15 years. He is currently a Public Health Medical Officer with Cal/OSHA, and has served on the WOEMA and ACOEM Boards.   He lives in Southern California, but has accumulated quite a few Frequent Flier miles.

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Speaker: CAPT Lisa Arnold, MSN, BSN, NP

TOPIC: Coping with Medical Errors: Mistakes Happen

Acknowledging medical errors and discussing unanticipated outcomes with patients is an essential skill for every healthcare provider.  It is also mandated by the Joint Commission on Accreditation of Healthcare Organizations.  After the apology, there is another issue to address:  How do we as physicians cope with our own guilt and doubt?  Medical errors have two victims:  patient and provider.  Join Captain Lisa Arnold for a live webinar presentation on Disclosure Training and Providers as Second Victims.

Learning Objectives – Participants will be able to:

  • Describe the impact of adverse events on the healthcare “system”
  • Summarize the history of the Department of Defense’s healthcare resolution program
  • Describe the legal considerations of disclosures and the “provider as a second victim” phenomenon

CAPT Lisa Arnold served twenty-four years in the Navy as a Pediatric Nurse Practitioner and is currently the Special Assistant to the Commander, Navy Medicine West, for Healthcare Resolutions.  CAPT Arnold is responsible for implementing the Healthcare Resolutions Program, a non-legal venue that attempts to resolve healthcare issues following unexpected outcomes of care, poor quality of care and in cases of medical error.  The process promotes organizational transparency and integrity with full disclosure, recognition of system vulnerabilities, and a commitment to process improvements.  Her previous positions leading to her selection for this program include:  role as a licensed independent practitioner, Head Patient Relations Naval Medical Center San Diego; DOD/VA Federal Recovery Coordinator.  CAPT Arnold lives in San Diego and is adjunct faculty, Masters Entry to Nursing Program, University of San Diego and National University.

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Speaker: Thuong D. Vo, MD

Topic: Comprehensive Pain Management

As Occupational Medicine specialists and primary care providers, we receive a steadily increasing number of referrals of patients already taking narcotics, and/or with significant injuries that may necessitate the initiation of same. How can we ensure that we are appropriately applying the Guidelines? Learn more by joining us for Comprehensive Pain Management Webinar provided by Dr T. Vo.

Learning Objectives – Participants will be able to:

  • Further understanding of the mechanisms of chronic non-malignant pain
  • Assessment prior to initiation of opioid therapy
  • Multidisciplinary approaches to the management of chronic pain
  • Common medications used to treat chronic pain

Dr. T. Vo is board certified in Pain Medicine, Anesthesiology, Age Management Medicine and is also certified in Aesthetic Medicine. He received his MD from the University of Rochester School of Medicine & Dentistry, his BS in Biochemistry, and his BA in Chemistry, both from the University of Rochester. Dr. Vo completed his fellowship in Pain Management from UCLA, and residency programs in Anesthesiology and General Surgery from University of Rochester Strong Memorial Hospital.

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Speaker: Dallin DeMordaunt, MD

TOPIC: Early Management of Occupational Low Back Pain

Low back pain is the most common occupational medical complaint that occupational health providers and primary care physicians encounter. These injuries can be challenging to manage in the acute and subacute stages. Health care providers will learn the key elements of evaluating and treating early low back injuries including typical occupational activity modifications. They also will learn what symptoms and signs suggest additional diagnostic work up. This presentation will help providers be more effective in managing this frequent medical issue in the future.

Learning Objectives – Participants will be able to:

  • Recognize the prevalence and expense of occupational low back injuries
  • Describe the steps for performing a history and examination for low back pain
  • Recognize the “red flags” of low back pain that require further diagnostic work up
  • Recall when and what imaging/tests are indicated early on in low back pain
  • Describe what treatments are usually indicated for most acute and subacute low back injuries
  • Recommend what occupational activity modifications are usually indicated for acute and subacute low back injuries

Dr. Dallin DeMordaunt is a Physiatrist — Board Certified in Physical Medicine and Rehabilitation, Sports Medicine, and Electrodiagnostic Medicine. He has worked in Reno, Nevada for 10 years at Sierra Regional Spine Institute and at Concentra Occupational Centers, and serves as assistant clinical professor for the University of Nevada School of Medicine. Dr. DeMordaunt specializes in the diagnosis and non-surgical treatment of musculoskeletal, nerve injuries and pain syndromes. He coordinates and directs appropriate therapies for work and non-work related injuries, and utilizes peripheral, interventional spine injections and electrodiagnostic testing. Dr. DeMordaunt resides in Reno, Nevada with his wife and four kids and spends his free time enjoying the outdoors around Lake Tahoe and the Sierra Mountains.

CREDIT: WOEMA is accredited by the Institute of Medical Quality/California Medical Association to provide continuing medical education for physicians. WOEMA takes responsibility for the content, quality, and scientific integrity of this CME activity.

WOEMA designates this live internet activity, when combined with completion and submission of the on-line questionnaire, for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This credit may also be applied to the CMA Certification in Continuing Medical Education.

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Speaker: Margaret Ryan, MD, MPH

TOPIC: Vaccines for International Travel: Special Focus on the Pacific Region

Many professionals travel to the Pacific region as part of an increasingly world-connected workforce. Understanding infectious disease risks specific to these regions is important in occupational medicine. This webinar will address specific, current recommendations for the prevention of Hepatitis A and B, Influenza, Japanese Encephalitis, Polio, Rabies, and Typhoid. General recommendations for travel safety and addressing contemporary worker concerns, before and after Pacific region travel, will also be discussed.

Learning Objectives – Participants will be able to:

  • Describe vaccine-preventable infectious disease risks of importance in the Pacific region, including Hepatitis A and B, Influenza, Japanese Encephalitis, Polio, Rabies, and Typhoid
  • Summarize current recommendations for vaccination in preparation for travel to the Pacific region
  • Apply an understanding of vaccine information, including precautions and contraindications, to appropriately protect workers who travel to the Pacific region

Dr. Margaret Ryan is an occupational and preventive medicine physician who lives in San Diego, California. She completed her education at Johns Hopkins University, George Washington University, and the Uniformed Services University. Dr. Ryan served in the US military for more than 25 years, retiring as a Navy Captain in 2011. While in the military, she led several large epidemiologic projects focused on recruit health, vaccine-preventable infectious disease, and reproductive health. She has authored or co-authored more than 130 contributions to the peer-reviewed literature. Dr. Ryan is currently the Medical Director of the Defense Health Agency Immunization Regional Office in San Diego. She is also an adjunct Professor at the University of California San Diego, where she supports the preventive medicine residency and teaches occupational and environmental health to undergraduate students.

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Speaker: John R. Balmes, MD

TOPIC: Can Your Shortness of Breath Patient Work? Evaluation of Respiratory Impairment & Disability

Chronic respiratory disease due to cigarette smoke and occupational or environmental exposures is a leading cause of disability worldwide. Physicians thus are not uncommonly asked to evaluate the impact of a respiratory disease on a patient’s daily activities, including the ability to work. Despite the prevalence of chronic respiratory disease and the need to evaluate resulting disability, many physicians feel ill equipped to assess functional respiratory impairment. This webinar presentation will provide information about the concepts of impairment, disability and handicap; the impairment evaluation schemes required by different agencies; the default AMA impairment classification scheme; and some specific case examples of application of the AMA respiratory impairment guidelines. The information presented will enhance physician knowledge about why, when, and how to perform a respiratory impairment evaluation.

Learning Objectives – Participants will be able to:

  • Differentiate impairment from disability and handicap
  • Understand the physician’s role in disability assessment
  • Apply the AMA guidelines for respiratory impairment evaluation

Dr. Balmes is Professor of Medicine at UCSF and Professor of Environmental Health Sciences in the School of Public Health at UC Berkeley.  He is an Attending Physician in the UCSF Division of Occupational and Environmental Medicine and the Division of Pulmonary and Critical Care Medicine at San Francisco General Hospital.  He was recently named Acting Director of the UC Berkeley-UCSF Joint Medical Program.  He was appointed Physician Member of the California Air Resources Board in 2008.  Dr. Balmes has been studying the effects of occupational and environmental agents on respiratory and cardiovascular health for 35 years.

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Speaker: Paul K. Blake, PhD, CHP

TOPIC: Radiation Dose Assessment of the US DOD Population Following the Fukushima Daiichi Release

On March 11, 2011, the most powerful earthquake ever recorded near Japan occurred followed by a devastating tsunami.  The tsunami led to station blackout conditions at the Fukushima Daiichi Nuclear Power Station resulting in reactor core meltdowns for Units 1, 2, and 3 with subsequent loss of containment and releases of radioactive materials to the environment.  At the request of the Government of Japan, the U.S. Department of Defense (DOD) launched a humanitarian assistance and disaster relief operation.  This operation was unique in in that nearly 75,000 DOD-affiliated individuals were potentially exposed to this radiation source.  Webinar participants will learn how DOD determined the health risk to its population, via a radiation dose assessment, and how this information was effectively communicated.

Learning Objectives – Participants will be able to:

  • Describe how a radiation dose assessment may lead to a population health determination
  • Identify radiological data suitable for performing an individual’s dose assessment following a nuclear reactor meltdown
  • Recall which radionuclides released from a nuclear reactor meltdown are of greatest concern to potentially exposed populations
  • Describe how radiation doses from a reactor release may effectively be communicated to the public

Paul Blake manages the Nuclear Test Personnel Review Program, Defense Threat Reduction Agency (DTRA), Fort Belvoir, VA.  DTRA safeguards America and its allies from weapons of mass destruction by providing capabilities to reduce, eliminate, and counter the threat, and mitigate its effects.  He leads the Department of Defense (DOD)’s efforts to confirm participation and reconstruct radiation doses for atomic veterans in support of Department of Veterans Affairs and the Department of Justice radiogenic disease compensation claims. He also led DOD’s radiation dose assessment of its affiliated population following the radiological release of the Fukushima Daiichi Nuclear Power Station in 2011.

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Speaker: Christian Sandrock, MD, MPH, FCCP

TOPIC: Ebola: From the Basis of Origin & Disease Amplification Through Healthcare Worker Protection

Ebola is a longstanding disease with periodic outbreaks. Most outbreaks are relatively contained within smaller countries and geographic regions. However, the most recent outbreak in West Africa is unprecedented in scope and magnitude, with direct impacts across the globe. Thousands have died, and even under standard protections in developed, resource-rich hospitals, disease transmission has occurred to healthcare workers. This webinar will examine the origins of Ebola, particularly at the animal-human interface, the anatomy of this recent outbreak, and some initial solutions and protections for healthcare workers and other individuals traveling to infected regions.

Learning Objectives – Participants will be able to:

  • Determine the initial origin and disease amplification factors of the current outbreak in West Africa
  • Identify the origins of Ebola and other filoviridae, including animal reservoirs
  • Summarize basic and advanced PPE measures for healthcare workers
  • Describe the risks and protective mechanisms for transmission for travelers to outbreak regions

Dr. Christian Sandrock graduated from Georgetown University School of Medicine and earned a Masters of Public Health degree from Lund University in Lund, Sweden. Dr. Sandrock completed his Fellowship in both Infectious Diseases and Pulmonary & Critical Care Medicine at the University of California, Davis. Currently, Dr. Sandrock is an Associate Professor of Clinical Medicine in the Division of Pulmonary/Critical Care Medicine, the Division of Infectious Diseases and the Department of Internal Medicine at the University of California, Davis School of Medicine. Dr. Sandrock has clinical interests in respiratory infections, community-acquired and viral pneumonia, and ICU-acquired infections. His research interests include emerging infectious diseases at the animal and human interface, particularly respiratory infections such as avian influenza, SARS, and other diseases acquired by humans.

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Speaker: Kent E. Pinkerton, PhD

TOPIC: Climate Change and Public Health

There is an increasing concern of how a changing world environment is affecting global public health. Climate change is contributing to increased population exposure to aeroallergens and secondary pollutants associated with adverse cardiorespiratory health effects. This presentation is designed for physicians, scientists and health care providers to gain a better understanding of the public health effects of climate change and to support evidence-based global health policy.

Learning Objectives – Participants will be able to:

  • Understand the global issues surrounding environmental and climate changes that impact on respiratory and public health
  • Understand how physicians and basic scientists may become more involved in addressing environmental issues associated with climate change
  • Implement the tools to address climate change in the treatment of patients

Kent E. Pinkerton is Professor of Pediatrics in the School of Medicine and Professor of Anatomy, Physiology and Cell Biology in the School of Veterinary Medicine at the University of California, Davis.  He serves as Director of the Center for Health and the Environment at UC Davis.  Dr. Pinkerton has authored more than 200 articles and book chapters on the health effects of ambient air pollutants (ozone and particles), combustion-generated particles, environmental tobacco smoke and engineered nanomaterials.  He has served as Chair of the Environmental and Occupational Health Assembly and the Environmental Health Policy Committee for the American Thoracic Society.  He co-chaired the ATS Workshop on Climate Change and Human Health (2012) and is co-editor of the book, Global Climate Change and Public Health (Humana Press, 2014).

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Speaker: Jonathan Rutchik, MD, MPH, FACOEM

Occupational Neurology Fitness for Duty in Safety Sensitive Workers

Occupational Medicine practitioners are often faced with challenging decisions when a patient with nonindustrial neurological conditions requests a return to work. Many of these are commercial drivers, police officers, fire fighters, hazardous waste workers, or aviation pilots where there is a potential safety risk to self or others.  In fact the newest FMCSA, NFPA and FAA regulations require clearance from a “neurologist who understands the functions and demands of commercial driving.”  In this presentation, Dr. Jonathan Rutchik, an ACOEM fellow, Associate Professor in Occupational Medicine at UCSF and physician board certified in both Neurology and Occupational Medicine will discuss neurological conditions such as head trauma, stroke and seizure, multiple sclerosis, tremor and medication use in patients with safety sensitive positions.   The participant will become familiar with the algorithms necessary when evaluating these patients and when a neurologist consultation is necessary.

Learning Objectives – Participants will be able to:

  • Define safety sensitive positions in the workplace, the American Disabilities Act (ADA) and which neurological conditions are commonly of concern in this arena
  • Define the most important issues regarding neurological conditions and an employee’s risk to self or others
  • Interpret how neuroepidemiology can help with predicting risk in neurological patients so as to appropriately judge their fitness in an era of the ADA

Dr. Jonathan Rutchik is a physician board certified in both neurology and occupational and environmental medicine.  An ACOEM fellow and Associate Professor at UCSF, he evaluates and treats injured workers and those exposed to industrial or environmental agents in his private practice in 5 locations in the San Francisco bay area.  Dr. Rutchik also provides expert consulting on various topics related to Occupational and Environmental Neurology and Clinical Neurotoxicology including fitness for duty in commercial drivers, firefighters, police and aviators as well as disability and chronic pain and neurological trauma.

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Speaker: Joel Handler, MD

Hypertension Update: New JNC8 Guidelines vs. Old Federal Motor Carrier Safety Regulations (49 CFR 391.41 (b)(6))

Hypertension recommendations have changed with the new Joint National Committee on High Blood Pressure (JNC8) evidence-based guideline, and are finding their way into general practice.  It is important for primary care practitioners to understand the rationale for the new guideline.  Delivery of care is dependent upon accurate blood pressure measurement, and participants will learn to avoid common errors.

Learning Objectives – Participants will be able to:

  • Recognize the JNC8 recommendations for the treatment of hypertension
  • Identify and avoid common errors in blood pressure measurement
  • Explain the elements of protocoled care that are associated with a high rate of hypertension control

Dr.  Joel Handler has been the national Kaiser Permanente Clinical Hypertension Lead since 2006, and since 2005 has been the southern California Kaiser Permanente region hypertension lead. In these roles he is responsible for the development and periodic review of hypertension treatment guidelines as well as their implementation. He created a referral clinic for resistant hypertension in 1992 and sees KP patients throughout southern California. Dr. Handler is currently certified in internal medicine, critical care medicine, geriatrics, and is an American Society of Hypertension Specialist in Clinical Hypertension. In 2011 he became a Fellow of the American Society of Hypertension. In his daily clinical practice, he sees intensive care unit patients in the mornings, as well as a primary care panel and hypertension referral patients in the afternoons.

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Speaker: 
Madeline Slater, MD

Aired on April 23, 2014 – Available until April 24, 2017

Latent TB diagnosis with the Quantiferon Assay- Providing Answers and Raising Questions 

Despite the all-time low incidence of tuberculosis (TB) in the United States, large numbers of U.S. healthcare workers (HCWs) are screened routinely for latent TB infection (LTBI). IFN-gamma release assays (IGRAs), such as the QuantiFERON-TB Gold In-Tube (Qiagen/Cellestis, Carnegie, Australia) test (QFT) and T-spot (Oxford Immunotec, UK) are increasingly replacing the tuberculin skin test (TST) for occupational screening. More than 70 U.S. medical institutions have adopted the QFT assay to serially test hundreds of thousands of hospital employees each year. In principle, IGRAs have equivalent sensitivity compared with the TST, with improved specificity in bacille Calmette-Guérin vaccinated individuals and individuals with nontuberculous mycobacterial infection. Additionally, IGRAs improve the logistics and economics of TB screening because, unlike the TST, they do not require trained readers, a return visit, or baseline two-step testing for annual screening. However, in practice, IGRA results have proved more dynamic in serial testing than anticipated. Early adopters of the QFT assay for occupational screening are now reporting major concerns with interpretation of the high conversion and reversion rates using the manufacturer’s recommended cutoff of simple negative to positive change.

Learning Objectives – Participants will be able to:

  • To define IGRAs and describe how they are performed
  • To define performance characteristics of IGRAs and compare to those of the TST
  • To review guidelines on the usage of IGRAs and discuss clinical scenarios
  • To describe the observed variability in serial testing; to list potential sources of variability; to describe quality assurance measures to minimize variability
  • To outline areas of clinical uncertainty

Dr. Slater is currently a senior postdoctoral fellow for the Infectious Diseases Division at Stanford University School of Medicine. She has focused the past years primarily on IGRA research and has published multiple highly regarded journal articles from studies conducted both domestically and abroad. Clinically, she works as a TB and STD physician for the San Mateo Department of Public Health. Additionally, she serves as a consultant to the CDC on a large-scale project in Thailand and Vietnam evaluating latent TB acquisition in health care workers.

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Speaker: 
Scott Fishman, MD

Opioid Prescribing: New FDA Labeling and New Guidelines

Duration: 00:60:00

This webinar will review current data and recommendations/guidelines from regulators and professional societies on the use of opioids and chronic pain. The risk vs. benefit analysis will be framed as an essential element of treatment decisions and thus emphasis will be placed on close attention to current data of risks compared with the benefits associated with chronic opioid prescribing. Recommendations from regulatory organizations including the recent labelling of chronic opioids by the FDA as well as recently revised model policy on opioid prescribing by the Federation of State Medical Boards will be reviewed.

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Speaker: 
Chunbai Zhang, MD, MPH

Screening and Diagnosis of Obstructive Sleep Apnea (OSA) Among Commercial Motor Vehicle (CMV) Operators

Duration: 00:60:00

Obstructive Sleep Apnea (OSA), a syndrome defined by breathing abnormalities during sleep, can lead to fatigue and excessive daytime sleepiness (EDS) with an increased risk of motor vehicle crashes. Identifying commercial motor vehicle (CMV) operators with unrecognized OSA during DOT exam is a major public health challenge. While in-lab sleep study polysomnogram (PSG) is the gold standard for diagnosis of OSA, portable monitors (PMs) are being used as potentially lower cost and more accessible alternatives. Most occupational physicians are not familiar with the diagnostic challenges of OSA in the DOT examinee population: sensitivity and specificity; the cost-benefit ratio of the PMs versus PSG; potential barriers from human factors; and evolving technological advancement. Human factors that alter test accuracy are a major concern among commercial drivers motivated to gain/maintain employment. This talk will help outline past and current literature on the diagnostic and screening tools of OSA during DOT exam for occupational physicians and practitioners.

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Speaker: 
David Rempel, MD, MPH, FACOEM

Chronic Upper Back and Neck Pain in Workers: Stretching, Strengthening, or Ergonomics? The Answers are In

Duration: 00:60:00

In the past 4 years, a number of high quality randomized controlled trials, have been conducted in Europe that evaluate the effectiveness of strengthening, stretching or standard care on the treatment chronic neck and upper back pain in workers. The successful interventions can be incorporated into worksite health promotion programs. In addition, recent laboratory and field studies have identified workstation interventions that can reduce neck and shoulder pain among computer users. These interventions may be especially important for your laptop and mobile device users.

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Speaker: 
Mary C. Townsend, DrPH

Spirometry Testing in Occupational Health Programs: OSHA Best Practices for Healthcare Professionals

Duration: 00:60:00

Occupational spirometry testing is often performed to comply with OSHA regulations and industry requirements. However, the technical quality of such testing is often mediocre, producing inaccurate results, and the interpretation of test results often fails to follow best practice guidelines. To address both of these problems, OSHA has recently released a Guidance Document on Spirometry Testing in Occupational Health Programs: Best Practices for Healthcare Professionals. OSHA was strongly influenced by ACOEM’s 2011 Spirometry Update. This session summarizes key points of the OSHA guidance to familiarize occupational medicine practitioners with this new reference.

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Speaker: 
Marius Koga, MD

Cultural Considerations in Subclinical PTSD in Law Enforcement Officers

Duration: 00:60:00

Half of the traumatized OIF/OEF veterans fear that receiving treatment would harm their careers. Another 65% believe they would be considered weak for seeking help and would lose their peers’ confidence. Since few employers disclose up-front their policies regarding pre-existing mental conditions and thresholds for disqualification, veterans seeking employment after military service as police officers and firefighters tend to hide their scars. The daily hazards of police work make this an occupation extremely vulnerable to PTSD especially in veterans with a subthreshold condition. This epidemic is not well researched, recognized, treated, or even admitted. Although screening tools, such as the Clinician Administered PTSD Scale (CAPS), exist to evaluate levels of PTSD severity, almost no law enforcement agency reports using one. Cultural considerations in evaluating and treating enforcement officers are important both for research and for training of primary care physicians, nurses, and HR departments of law enforcement agencies.

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Speaker: 
Judith Martin, MD

Opioids and the Pain/Addiction Interface

Duration: 00:60:00

In view of recent increase in non-medical use and overdose deaths related to opioid prescription drugs, physicians who treat chronic pain are facing the challenge of changing practice to address diversion and addictive disorders while managing pain. This session will help clinicians who treat chronic pain with opioids to be better skilled at talking to a patient about a positive urine toxicology test, be consistent in supporting clinic policies about refills of opiates, and be able to explain to patients why practices are changing with respect to opioid use.

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Speaker: 
Dennis Shusterman, MD, MPH

Green Chemistry / Safer Alternatives: An Emerging Paradigm for Worker Protection?

Duration: 60:00:00

Traditional regulatory approaches to chemical hazard control in the workplace rely upon permissible exposure limits (PELS). While the PEL approach is effective in many cases, rule-making has not kept pace with the introduction of new chemicals into commerce. Further, for some chemicals, worker intoxications continue to occur despite the adoption of rigorous standards. We examine three case studies of the failure of existing chemical policies to protect workers, and argue that substitution of safer alternatives is an under-utilized process. The participant will develop an appreciation for up-stream regulation as a complementary measure to PELs in worker protection.

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Speaker: 
Jordan Firestone, MD, PhD, MPH

What to Watch for in Traumatic Brain Injury

Duration: 00:60:00

Traumatic Brain Injury (TBI) is an important problem in OEM. It may affect workers of any age and in any profession. In this webinar, Dr. Firestone will review the newest information related to the prevention, evaluation, and management of TBI

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Speaker: 
Michael Kosnett, MD, MPH

Therapeutic Use and Misuse of Metal Chelation Therapy

Duration: 00:60:00

The prompt use of chelating agents to treat acute, life-threatening intoxication is an indication that is largely supported by experimental animal data and limited clinical research. Although chelating agents administered for chronic intoxication may accelerate the excretion of heavy metals, their therapeutic efficacy in terms of decreased morbidity and mortality is largely unestablished. Recent investigations suggest that their use in such settings might be associated with deleterious effects. The use of post-chelation challenge urinary metal excretion as a basis to identify patients who will derive therapeutic benefit from chelation has not been validated.

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Speaker: 
Bernard R. Blais, MD, FACOEM, FAAO, FACS

Occupational Ophthalmology: How to Fulfill the Visual Requirements of the ADA and ADAA Disability Act And Amendments

Duration: 00:60:00

The Occupational Medicine Provider encounters vision screenings as part of numerous occupational health examinations. It is important to understand the regulatory requirements and ADA/ADAAA considerations involved with vision screenings. This webinar is intended to increase awareness of the medical-legal and regulatory complexities relating to vision qualifications for occupational positions, and to help Occupational Medicine Providers become more familiar with the wide array of tools used in visual acuity testing and color vision testing, while maintaining compliance with ADA/ADAAA.

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Speaker: 
Heather P. Lampel, MD MPH

Occupational Dermatology

Duration: 00:60:00

The Occupational Medicine Provider may encounter unique occupational skin conditions. It is important to be able to identify these conditions and provide proper diagnosis and treatment. This lecture is intended to help the Occupational Medicine Provider become more comfortable with diagnosing and treating occupational contact dermatitis, and will become familiar with common allergens in the workplace. Patch testing will be discussed and treatment options will be explored.

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Speaker: 
Michael Erdil, MD, FACOEM

Lumbar Spinal Fusion in Workers Compensation: Can We Help Patients to Make Better Decision?

Duration: 00:60:00

Low back pain is one of the most common conditions evaluated by occupational medicine physicians. Approximately 80-90% of the adult population will experience an episode of low back pain temporarily limiting activities during their lifetime, and perhaps 7% of the population note chronic low back pain. Low back pain is a major factor contributing to health care costs, lost work productivity and disability. Recent studies have noted a significant rise in complex lumbar spine fusion surgery to treat chronic pain from degenerative disc disease. Surgeons and patients often overestimate expected benefit from spinal surgery. Despite the proliferation of lumbar fusion and instrumentation, rates of low back disability have not declined. Surgical complications, hardware issues, repeat surgeries contribute to post-fusion disability and cost. Of concern, approximately 2/3 of patients treated with lumbar fusion may continue to be disabled at 2 years post surgery, and opioids prescribed post-fusion pose a considerable risk for subsequent mortality. Recent randomized trials have suggested equivalent outcomes for non-operative treatment of lumbar spine degenerative disc disease vs. fusion without these significant post-operative risks. Therefore, occupational medicine physicians must play a more prominent role in patient education before and after spine surgery referral to assist patients with making informed choices. This session will overview the supportive scientific evidence and guidelines including Cochrane, ACOEM, ODG for lumbar spine fusion vs. non-operative care for the treatment of degenerative disc disease, explain potential adverse outcomes from lumbar fusion, and discuss strategies to assist occupational medicine physicians with patient education and decision making when faced with treatment recommendations for lumbar fusion.

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Speaker: 
Robert Harrison, MD, MPH

Vaccinations in Health Care: Influenza and Other Current Issues

Duration: 00:60:00

A work group of the National Vaccine Advisory Committee (NVAC) has recommended in a draft report announced December 15 that health care facilities should require health care personnel to receive influenza vaccination to ensure patient safety (see http://www.hhs.gov/nvpo/nvac/subgroups/nvac_adult_immunization_work_group.pdf). The report recommends that if a facility or an employer cannot achieve the Healthy People 2020 vaccination coverage rate of 90% or better, the most effective mechanism to rapidly reach and maintain this goal is to institute a mandatory vaccination policy. The Federal Occupational Safety and Health Administration and the Service Employees International Union have noted their opposition to a universal mandate in comments on the draft report. The full NVAC committee will meet to review and vote on the draft report on February 7-8, 2012. In addition, beginning in 2013 the Center for Medicare and Medical Services (CMS) will require reporting of aggregate influenza vaccination data through the National Healthcare Safety Network as a quality measure for hospital reimbursement. Occupational health practitioners should be aware of these developments in light of their current institutional policies regarding influenza vaccination, and consider making decisions about programs based on currently available data on efficacy. Legal and ethical implications should also be considered in formulating policies and procedures.

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Speaker: 
Steven Feinberg, MD, MPH & Scott Levy, MD, MPH, FACOEM

Opioid Use Guidlines for Chronic Pain Treatment

Duration: 00:60:00

According to the California Workers’ Compensation Institute there is considerable variation in the prescribing patterns of physicians in the workers compensation arena. This variation leads to a significant burden on the workers’ compensation system by driving the costs of medications, prolonging disability, and increasing the duration of claims. In the recent past there was a concerted effort to increase the use of narcotic medications and to avoid “under-treatment” of pain. The belief at the time was that the risk of addiction to narcotic medications was very low for all patients in pain. This has been shown to be incorrect as evidenced by the escalation in the numbers of people addicted to prescription pain medications and/or made dysfunctional due to use of these substances, as well as the increased numbers of related deaths. Despite this evidence, barriers to change still exist. These include the fear of litigation as well the fact that, until recently, there was a lack of evidence-based guidelines designed for primary care providers prescribing opioid prescription medications. This webinar is designed to help office-based providers best manage patients with work-related injuries who may require opioid medications.

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Speaker: 
Sheetal Desai, MD, MSEd

Fibromyalgia

Duration: 00:60:00

Fibromyalgia is a condition that is difficult for many to understand. Many physicians do not believe it is a true condition, and most patients feel that “it is in their head”. These beliefs are due to a poor understanding of Fibromyalgia, which in turn results in inappropriate diagnosis and treatment of the condition. It is a cause of considerable morbidity to patients, and has high indirect costs to healthcare. Dr. Desai will give an overview of the 21st century understanding of Fibromyalgia and the significant research that has been done on this condition, which shows that Fibromyalgia truly is a condition that is literally “in the patient’s head”!

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Speaker: 
Scott Levy, MD, MPH, FACOEM

Obstructive Sleep Apnea and the Commercial Driver: Understanding the Controversy and Applying Screening Criteria

Duration: 00:60:00

There is a high prevalence of Obstructive Sleep Apnea (OSA) in commercial drivers and screening for this medical condition is important to insure safety. OSA increases the risk of crashes and effective treatment is available. However, many practitioners do not regularly screen for OSA, and there is considerable controversy amongst the medical community on the criteria for sleep apnea screening. The controversy exists for several reasons but most importantly is the absence of a set of screening criteria which both the medical community adopts as the “gold standard” and the Department of Transportation and/or Federal Motor Carrier Safety Administration embraces. In order to make an educated decision regarding screening for OSA in the commercial driver population, practitioners need to have a good understanding of the pathophysiology of the condition, as well as a firm grasp of the associated health consequences, including the risk of motor vehicle accidents.

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Speaker: 
Jeffrey Anshel, OD, FAAO

Visual Ergonomics in the Workplace

Duration: 00:60:00

The visual symptoms that computer workers experience are the most obvious expression of the shortcomings in the ergonomics and visual characteristics of the worker. Because of the high visual demands of the computer task and the visual shortcomings of many operators, vision problems and symptoms are very frequent among computer workers. Most studies indicate that visual symptoms occur in 75-90% of computer workers1-3; by comparison a study released by the National Institute of Occupational Safety and Health (NIOSH)4 showed that 22% of computer workers have musculoskeletal disorders. A large survey of optometrists5 indicated that 10 million primary care eye examinations are annually given in this country primarily because of visual problems at computers- not a small public health issue!

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Speaker: 
Thomas McKone, PhD and James Seward, MD, MPP

Public and Worker Health Impacts from the Fukushima Nuclear Plant Accident

Duration: 00:01:00

The speakers will provide a basis for understanding the radioactive releases at the Fukushima Daiichi nuclear plants and discuss the types of radionuclear exposures involved. They will cover the accident sequence, emissions inventories, actual releases, potential health effects, exposure limits, and protective responses, including the use of prophylactic potassium iodide. There will be ample time for audience questions.

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Speaker: 
Paul Papanek, MD, MPH, FACOEM

Occupational Medicine Practice in the New Era of Health Care Reform

Duration: 00:60:00

The next three years will see implementation of the new health care reform bill, the Patient Protection and Affordable Care Act of 2010 (PP-ACA). As a result, the practice of Occupational Medicine is likely to change. Parallels can be drawn from the changes that occurred in Occupational Medicine when national health care was implemented in many countries of the European Union. Specific provisions in the PP-ACA bill, especially those related to employer-sponsored Health Plans may predict practice changes. Other aspects for Occupational Medicine are also likely to occur as a result of other anticipated regulatory changes related to the Medical Home and OSHA regulations. These changes are likely to include reimbursement for preventive services in Occupational Medicine.

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Speaker: 
Dennis Pocekay, MD, MPH, Retired from The Kaiser Permanente Medical Group, Inc.

Exercise as Medicine

Duration: 00:60:00

Exercise benefits both employees and employers. “Exercise as Medicine” is intended to update providers on the multiple beneficial effects of exercise on health, disease, and mortality. We will also explore how exercise might best be incorporated into employer wellness programs. Most importantly, the presentation will emphasize exercise history as a vital sign. Learning Objectives: -Define “physical activity” (PA) vs “fitness”. -List the US Dept. of Health and Human Services (USDHHS) 2008 Physical Activity Recommendations. -Discuss the relationship of these factors to health care costs and to overall mortality, as well as to work injury and delayed recovery. -Describe how this information impacts worksite health promotion.

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Speaker: 
Vincent A. DeLeo, MD, Chairman, Department of Dermatology, St. Luke’s Roosevelt & Beth Israel Medical Centers, New York City

Occupational Contact Dermatitis

Duration: 00:60:00

Contact Dermatitis is one of the most common occupational diseases. In this webinar, Dr. DeLeo will discuss irritant and allergic forms of the disease. This will include the diagnosis and treatment of the disease. Learning Objectives: -The recognition of morphology of Contact Dermatitis. -To discern differences between irritant and Allergic Contact Dermatitis. -To understand the methods for diagnosing Contact Dermatitis. -To learn the common allergens in Contact Dermatitis. -To recognize the setting for various allergens in the workplace.

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Speaker: 
Lorne Direnfeld, MD, FRCP, Neurologist, Diplomate, American Board of Psychiatry and Neurology

Mild Traumatic Brain Injury

Duration: 00:60:00

According to the CDC, there are about 1.5 million people with a traumatic brain injury (TBI) each year in the US. Approximately 90% of these cases are mild injuries. Almost half were seen only in the clinic, physician office, or not at all. TBI is a leading cause of disability, especially among young adults. Additionally, it is an important concern to the occupational health care pratitioner. Work-related TBIs constitute an estimated 45-50% of all TBIs, with the incident varying by specific occupation. Participants in this webinar will learn the criteria for the diagnosis of TBI and will gain heightened awareness of the importance of physician/healthcare provider interaction and the outcome of patients with mild TBI including avoiding iatrogenic disability. A case example will be presented to illustrate this and other issues.

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Speaker: 
Constantine Gean, MD, MBA, MS, FACOEM, Regional Medical Director, Liberty Mutual Insurance Company

To Work or Not to Work – The Costs of Absenteeism and Presenteeism

Duration: 00:58:00

Determining appropriate return to work status is a complex issue that must be addressed by all physicians, regardless of specialty. Not only must the timing of return to work be addressed, but ancillary issues such as modified duty, part time work, or necessary accommodations need to be examined. OEM Physicians are often called upon by patients and employers for their expertise in this arena. The complexity is increased by the number of stakeholders in the return-to-work process: patient, physician, managers, supervisors, human resources (if the absence from employment is work related), then adjuster and insurance company. Many studies document the need for improvement in the overall process. An article in January JOEM by Dowd et al reveals that “early reintegration of early reintegration of injured workers back into the workforce could result in substantial reductions of medical expenditures.” Another article in the February Journal of Occupational Rehabilitation by Ikezawa et al. reveals significant inconsistencies and variability in Physician return-to-work orders for back pain. We will discuss and suggest practice improvements on this critical topic during the webinar on June 17, 2010.

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Speaker: 
Paul J. Papanek, Jr., MD, MPH, Occupational Health Service, Los Angeles Medical Center, Kaiser on the Job

Occupational Lead Poisoning: New Guidelines for Clinical Management

Duration: 00:53:40

(1) The California Dept. of Public Health published a new Guidance Document in 2008 on acceptable blood lead levels, which occupational physicians should be familiar with. It’s key changes are: (a) Blood lead levels should be kept below 20 mcg/dl (b) Physicians can use Medical Removal Protections to accomplish this. (2) Brief overview of lead toxicity and clinical presentation (3) Epidemiology of lead poisoning in California, using So. California data (4) Other clinical approaches founded in the OSHA Lead Standard (5) Predictions for changes to the OSHA Lead Standard

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Speaker: 
Gideon Letz, MD, MPH, Medical Director, State Compensation Insurance Fund

Overuse of Narcotics in the California Workers’ Comp System: A Payer’s Perspective and Suggested Interventions

Duration: 00:39:42

It is well known that a small percentage of WC claims are responsible for a disproportionate percentage of the overall costs in the system. Surprisingly, most of these high cost cases are not severe injuries. They are mostly minor strain/sprain diagnoses with disability duration greater than expected – so called “delayed recovery” cases. The cause of the unexpected disability and failure to recover is related to various psycho-social issues that involve the patient, his/her employer, treating physician and claims administrator. Most of these patients develop some form of chronic musculoskeletal pain that is often mismanaged because the treatment fails to address the non-medical context of the injured worker’s claim. Typically, these patients are treated with chronic opiate medications, often in continually escalating does without any sign of functional improvement. Return to work is delayed and they become more and more isolated from their employer, co-workers and even family and friends. The results are disastrous both in terms of cost and human suffering. A first step in turning these cases around is detoxification from narcotic and other CNS depressant medications, combined with cognitive behavioral therapy and daily exercise, particularly aerobic activity. But a more effective strategy involves early identification of patients at high risk for delayed recovery and specifically intervening with proven multidisciplinary treatment.

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Speaker: 
Deborah Gold, MPH, CIH, Senior Safety Engineer, Cal/OSHA

Cal-OSHA ATD Standard

Duration: 00:42:30

California recently enacted the first occupational safety and health standard to protect employees against aerosol transmissible diseases. This presentation will include the background of the standard and how it relates to other infection control and occupational safety and health guidelines. The presentation will also discuss requirements relevant to medical practices, and the role of physicians in providing medical services under the standard.

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Speaker: 
Rupali Das, MD, MPH, FACOEM, California Department of Public Health (CDPH)

Pyrethroid Pesticides: Hidden Hazard

Duration: 00:37:10

Pyrethroid pesticides are widely used for pest control in both occupational and residential settings. Often marketed as safe, the adverse effects of pyrethroid pesticides are under-appreciated. Occupational and environmental health practitioners are likely to encounter patients exposed to pyrethroids. This webinar will provide critical information to guide practice. Learning objectives: Report pesticide illness; Describe why occupational illness due to pyrethroids is a concern; Recognize settings where exposure to pyrethroid pesticides may occur: Identify potential health consequences of exposure to pyrethroid pesticides; Manage workers exposed to pyrethroid pesticides.

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