CME Webinars – 2014

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

Aired on December 17, 2014

Speaker: Christian Sandrock, MD, MPH, FCCP

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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TOPIC: Climate Change and Public Health

Aired on October 29, 2014

Speaker: Kent E. Pinkerton, PhD

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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TOPIC: Occupational Neurology Fitness for Duty in Safety Sensitive Workers
Aired on August 27, 2014

Speaker: Jonathan Rutchik, MD, MPH, FACOEM

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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TOPIC: Hypertension Update: New JNC8 Guidelines vs. Old Federal Motor Carrier Safety Regulations (49 CFR 391.41 (b)(6))
Aired on June 25, 2014

Speaker: Joel Handler, MD

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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TOPIC: Latent TB diagnosis with the Quantiferon Assay- Providing Answers and Raising Questions
Aired on April 23, 2014 

Speaker: Madeline Slater, MD

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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TOPIC: Opioid Prescribing: New FDA Labeling and New Guidelines
Aired on February 26, 2014

Speaker: Scott Fishman, MD

Description: 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.

Learning Objectives – Participants will be able to:

  • Understand the legal issues that relates to pain
  • Understand emerging legislation related to pain
  • Understand areas where law and practice may conflict

Dr. Scott M. Fishman is Professor and the Charles and Patricia Fullerton Endowed Chair of Pain Medicine, Chief of the Division of Pain Medicine, and Executive Vice Chair for the Department of Anesthesiology and Pain Medicine at the University of California, Davis. His medical degree is from the University of Massachusetts Medical School. Formal clinical training is in Internal Medicine (Greenwich/Yale University School of Medicine) and Psychiatry (Massachusetts General/Harvard Medical School).

Dr. Fishman lectures on all aspects of pain control including preventing prescription drug abuse. Dr. Fishman has authored many peer-reviewed articles in medical journals, book chapters, and other scholarly reviews. He is senior editor of the journal Pain Medicine and serves on the editorial boards of other medical journals.

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