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CME by the Bay Program Schedule

Schedule of Lectures

  1. Sepsis and Antibiotic Management [David Coffman, DO] ***
  2. Lymphedema - Pearls for the Osteopathic Primary Care Provider [Robert D. Stoffey, DO]
  3. Ocular Manifestation of System Conditions [Allen Boghossian, DO]
  4. Urinary Incontinence in the Female Patient [John Kowalczyk, DO, FACOS]
  5. Obesity: The Unnecessary Epidemic [Jeffrey Nelson, DO]
  6. Emotional Support of Front Line Workers [Thomas Horowitz, MPA, DO]
  7. Osteopathic Exercises to Promote Respiratory Health During COVID-19 [Miho Yoshida, DO, MA]
  8. OMM Vignette: Two Osteopathic Techniques for Improving Lymphatic Circulation - Rib Raising and Thoracic Diaphragm Myofascial Release [Krista Lund, DO]
  9. Telemedicine: Its role in securing revenue and patient access in private practice during and after a public health crisis [Habib Sadeghi, DO]
  10. Telemedicine in the COVID-19 Era [Gail Feinberg, DO, MEd, FACOFP, dist]
  11. 2021 Health Record Documentation [Michael Warner, DO]
  12. OMM Vignette: Suboccipital Release [Kim Wolf, DO] ***
  13. Ergonomics Evaluation and Intervention [Alexandra Myers, DO] ***
  14. A Sobering Reality: Behavioral and Mental Health in a Post Pandemic World [Elizabeth Barrera, DO]
  15. Essential Oils: Is there a scent of evidence? [Derrick Adams, DO]
  16. OMM Vignette: Upper Crossed C/T Spine [Carrie Janiski, DO] ***
  17. Acute Cannabis Toxicity in Children [Yoshihiro Ozaki, DO]
  18. ADHD or is It [Lawrence Suess, DO, PhD, FACN]
  19. Vaccination Hesitancy: Will COVID-19 help or hinder our battle against fear? [Shannon Cheffet, DO]
  20. Pediatric Considerations of COVID-19 [Prachi Singh, DO]
  21. OMM Vignette: OMT for COVID in Pediatric Populations [Kim Wolf, DO]
  22. SARSCoV2/COVID19 Clinical Presentation, Differential Diagnosis, and Emerging Treatments [Kenneth Whitlow, DO, FAAEM]
  23. Diabetes and COVID: What you need to know [Jay Shubrook, DO & Michael Hower, DO]
  24. Pandemics to Earthquakes: How to prepare your office, your patients and your family for the next disaster [Kenneth Cheng, DO]
  25. Biotensegrity Considerations in the Setting of Chronic Lumbopelvic Pain [Brett Lockman, DO] ***
  26. OMM Vignette: Low Back Pain [Brian Loveless, DO] ***
  27. OMM Vignette: Ankle Sprains [Brian Loveless, DO] ***

Click here to view Faculty Bios

 *** Lecture counts towards California's Pain/End-of-Life Requirement

Click here to view/download the CME by the Bay 2020 Companion Guide

 

Lecture Descriptions and Learning Objectives

Sepsis and Antibiotic Management
In 2019, cancer claimed 9.6 million deaths worldwide - and Sepsis killed 11 million people. Sepsis remains the #1 cause of death in the world, with higher mortality than cancer and heart disease combined. Yet healthcare providers remain perplexed by the correct definition of SIRS, Sepsis, and Septic Shock, which leads to late and sometimes inappropriate management of these sickest patients. I was honored to present my Sepsis Management lecture at the American College of Osteopathic Surgeons (ACOS) as a diplomate in April 2020, wherein I provided current updates on diagnosis and management of this persistent and virulent disease process that affects us all. I would invite all clinicians, students, and residents to attend.

Learning Objectives:

  1. Recognize and differentiate SIRS v. Sepsis v. Septic Shock
  2. Describe Appropriate Management of Sepsis Utilizing Source Control, Antibiotic Therapy, and De-escalation
  3. Describe Appropriate Management of Septic Shock Utilizing Fluids, Pressors, and Adjunct Therapies

[Back to Schedule]

 

Lymphedema - Pearls for the Osteopathic Primary Care Provider
Lymphedema is a very common but often unrecognized chronic entity. The attendees will receive a thorough, scientifically based presentation on lymphedema. Topics will include the definition of lymphedema and how it is most commonly diagnosed. The differential diagnosis of lymphedema will be discussed. Treatment options for lymphedema, both conservative and more advanced therapeutic options will be discussed. The primary care provider will receive pearls as to when he/she may consider referring a lymphedema patient to a dedicated lymphedema clinic.

Learning Objectives:

  1. To Discuss and Learn the Definition of Lymphedema
  2. To Discuss a Differential Diagnosis for Lymphedema
  3. To Emphasize the Crucial Role of the Primary Care Provider in Early Identification of Your Patients who have Lymphedema
  4. To Discuss and Learn the Conservative Methods of Treating Lymphedema
  5. To Discuss and Learn the More Advanced Methods of Treating Lymphedema which may include Surgical Options
  6. To Discuss and Learn when a Primary Care Provider Might Consider Obtaining Consultation for his/her Lymphedema Patient.

[Back to Schedule]

 

Ocular Manifestation of System Conditions
The lecture will cover numerous systemic conditions and review how these conditions can present themselves in the eyes and help identify urgent situations.

Learning Objectives:

  1. Help general practitioners understand ocular manifestation of systemic conditions for early detection.

[Back to Schedule]

 

Urinary Incontinence in the Female Patient
An overview of Urinary Incontinence (UI), examining how to diagnose and treat the condition. We will also discuss medications that can cause UI, the challenges of treating patients with UI in the current environment, and when referring to a specialist is appropriate.

Learning Objectives:

  1. Understand the types of Urinary Incontinence (UI)
  2. Review Approach to Diagnosis
  3. Review of Treatment Options

[Back to Schedule]

 

Obesity: The Unnecessary Epidemic
Foundational Osteopathic philosophy identifies and treats disease and addresses the underlying cause. A challenge we face is the epidemic of obesity, as a leading cause of morbidity and mortality. At least 30 diseases are related to or directly caused by obesity, including NIDDM, hypertension, hypercholesterolemia, and associated cardiovascular disease. Obesity also increases susceptibility to Corona Virus, with high morbidity. It is inadequate to address obesity through diet, without addressing the underlying behaviors leading to weight gain. Without diet plus behavior modification 85% of patients regain their weight, leading to the unhealthy phenomena of yo-yo dieting. An effective plan for obesity was created by an Osteopathic counterpart 20 years ago, Dr. Wayne Scott Anderson, a critical care physician who developed a comprehensive approach through his Habits of Health System. This system delivers efficient weight loss and addresses obesogenic behaviors, by implementing micro-habits of health. Over 2 million patients have been successful with this program. The Habits of Health System is a productive business model, with significant income generation potential. Physicians could refer patients to a Certified Health Coach who will then guide patients through the program, or they could coach patients themselves, supplementing their income as a reward for serving patients. This model differs from our medical model of one on one patient care, directly trading time for money. Instead, there is exponential income generation and residual long-term financial growth. I have embraced this business model leading to time freedom, personal fulfillment through service, and substantial income generation, by presenting solutions to patients with the trilogy of healthy body, healthy mind and healthy finances.

Learning Objectives:

  1. Understand the contribution of obesity to our general morbidity (at least 30 different disease states are a direct cause of or are exacerbated by obesity including COVID-19).
  2. Understanding the common association between weight loss and rebound weight gain (yo-yo dieting).
  3. Discussing a comprehensive approach to obesity and its associated morbidity, through a structured plan which includes an efficient proven method of weight reduction, in combination with a system of gradually implemented micro-habits that address the unhealthy behaviors surrounding food, resulting in the potential for permanent and progressive optimized health and well-being.
  4. Discuss how effectively serving our patients, through this comprehensive plan to optimize their health and well-being, could also serve as a proven business model which has the potential to significantly augment the health care providers income stream, while developing a vehicle for retirement and time freedom

[Back to Schedule]

 

Emotional Support of Front Line Workers
Hopefully the medical team looks up to the physicians they work with. As such we must both lead by example and show our concern for the team. This has been a challenging event far beyond what most of us have experienced. We must learn to empathize with other front-line workers. Giving honest and truthful advice and guidance. And reassure that this is a different time. In a pandemic there are no emergencies that do not afford you taking reasonable precautions. As a lifeguard will tell you, lesson 1 is do not drown yourself. There is the need for a bit of role playing to analyze what reassures and what takes away confidence. A few war stories will prove some points.

Learning Objectives:

  1. To learn physician's leadership role in critical times
  2. How to council and comfort those concerns
  3. Learn to take the emotional pulse of your organization

[Back to Schedule]

 

Osteopathic Exercises to Promote Respiratory Heath During COVID-19
This session will outline several osteopathic exercises that can promote respiratory health that can be taught to patients who are on isolation precautions and assessed and treated via telemedicine. It will address physician competence and patient care outcomes related to respiratory health during COVID-19 and application of osteopathic principles and practice.

Learning Objectives:

  1. Identify goals for osteopathic manipulative treatment (OMT) for respiratory infections
  2. Describe the impact of OMT on respiratory infections
  3. Demonstrate osteopathic exercises that can be taught to patients to promote respiratory health during COVID-19

[Back to Schedule]

 

OMM Vignette: Two Osteopathic Techniques for Improving Lymphatic Circulation - Rib Raising and Thoracic Diaphragm Myofascial Release
This session will provide a brief overview of the importance the lymphatic system has on health and the impact OMT can have on improving lymphatic circulation. Indications and contraindications for lymphatic techniques will be reviewed and the techniques of rib raising and thoracic diaphragm myofascial release will be demonstrated.
Learning Objectives:

  1. Explain the role of the lymphatic system in immunity and health
  2. Recognize the role of OMT in the promotion of lymphatic circulation
  3. Identify the indications and contraindications for rib raising and abdominal diaphragm release techniques
  4. Demonstrate rib raising and abdominal diaphragm myofascial release techniques

[Back to Schedule]

 

Telemedicine: Its role in securing revenue and patient access in private practice during and after a public health crisis
This presentation provides an overview of the financial and operational struggles experienced by private practice physicians during the statewide COVID-19 shutdowns earlier this year. To help mitigate financial losses and in some cases to save their businesses, physicians turned to telemedicine, many for the first time. Here we explore how physicians navigated that transition during the pandemic, the benefits and barriers of telemedicine to physicians and patients, and how it can be used as a safeguard for revenue streams in the event of a future crisis. Private practice is the medical sector that's driving the largest growth in telemedicine. As such, we will examine how the recent pandemic has changed the attitudes of physicians toward telemedicine, what more needs to be done to generate wider acceptance among doctors and patients, and why COVID-19 will almost certainly be the catalyst that finally makes it mainstream.

Learning Objectives:

  1. Understand the particular vulnerabilities private practice physicians face in a social shutdown and the necessity of a business model that can quickly adapt to changing times.
  2. Discern the difference between the various services and delivery mechanisms of telemedicine technology and how they integrate into the practice setting.
  3. Identify the benefits and barriers to telemedicine and how regulatory changes during and after COVID-19 are improving access for physicians and patients.
  4. Improve risk-management with best practices for information handling, storage, and transfer.
  5. Institute strategies that increase patient participation in telemedicine and help diversify income streams for future security.

[Back to Schedule]

 

Telemedicine in the COVID-19 Era
Medicare Part B covers a limited range of telehealth services, and the Centers for Medicare & Medicaid Services (CMS) provides guidelines for reporting these services using specific terminology. Understanding these terms is critical for both providers and originating sites to ensure eligibility, service delivery and proper reimbursement. The Centers for Medicare & Medicaid Services (CMS) recently released numerous waivers along with new rules for billing professional telehealth services during the public health emergency (PHE) of COVID-19. These changes, currently in place for the duration of the PHE, aim to ensure that patients have access to physicians and other qualified healthcare providers while remaining at home. There are several types of services available to all Medicare beneficiaries, including telehealth, virtual check-ins and telephone visits, e-visits and remote patient monitoring.

Learning Objectives:

  1. Review of the Medicare Part B coverage of telehealth services, and the Centers for Medicare & Medicaid Services (CMS) guidelines for reporting these services using specific terminology.
  2. Understanding these terms is critical for both providers and originating sites to ensure eligibility, service delivery and proper reimbursement.
  3. Understanding what changes were made due to Covid-19.

[Back to Schedule]

 

2021 Health Record Documentation
Health record documentation policies are experiencing unprecedented change. The biggest change will occur January 1, 2021 when documentation of the outpatient History shifts from a provider responsibility to a patient and ancillary staff member duty. This presentation shows the result of documentation research and medical student training. Starting 2021, healthcare delivery is about to radically change. Imagine patients and ancillary medical staff members gathering all History documentation so it is all ready for the provider before she enters the encounter? Like a surgeon entering the surgical theatre, all providers should have an opportunity to enter E/M services with everything in order. CMS is changing health record documentation policies because they know the current system is flawed. We currently expect our physicians to be data entry clerks rather than clinicians practicing at the top of their license. Initiated by CMS’ Patients Over Paperwork initiative, new rules, which were made Final in November 2018, will reduce provider administrative/clerical burden when performing Evaluation and Management (E/M) services in the outpatient setting. This presentation showcases the results of a 3½ hour bootcamp training course delivered to TUC osteopathic medical students to help them prepare for 2021. The course frames emerging policy changes through the lens of Core Competencies: Systems-Based Practice and Practice-Based Learning & Improvement. SBP asks "WHY”, where PBLI asks “HOW?” Throughout the course, a series of IRB research approved surveys captured student viewpoints and monitored change throughout the educational experience. This presentation speaks to the business of medicine, specifically, health record documentation/scoring/coding, but extends further. Physician frustration with unreasonable health record policies impacts wellness, burnout and job satisfaction. This presentation is hopeful with clear action plans.

Learning Objectives:

  1. Learn why the current health record documentation system is broken
  2. Appreciate CMS's Patient Over Paperwork initiative as a way to fix the system
  3. Learn how documenting the History will soon be a duty of patients and staff
  4. Learn how to reduce administrative/clerical duties during office visits
  5. Envision being able to gain greater satisfaction while practicing osteopathic medicine

[Back to Schedule]

 

OMM Vignette: Suboccipital Release
This will provide a brief review of the suboccipital release and condylar decompression techniques. We will review pertinent indications and contraindications, literature that supports the use of the technique, and modifications to consider.

Learning Objectives:

  1. Discuss indications and contraindications for suboccipital release and condylar decompression
  2. Reminder of pertinent anatomy, including autonomic nervous system
  3. Demonstrate two new techniques

[Back to Schedule]

 

Ergonomics Evaluation and Intervention
This presentation will review how to complete an ergonomic evaluation and will provide insight into the diagnosis and treatment of common injuries associated with poor ergonomics and overuse.

Learning Objectives:

  1. Utilize Osteopathic Medical principles for patient care
  2. Learn the principles of good ergonomics
  3. Learn how to do an ergonomic assessment
  4. Develop a plan to adjust the ergonomics for the patients (and yourself!)
  5. Initiate a treatment plan to mitigate the most common issues that ail workers using sub-optimal ergonomics

[Back to Schedule]

 

A Sobering Reality: Behavioral and Mental Health in a Post Pandemic World
This lecture is meant to educate health professionals of the behavioral and mental health implications related to the pandemic. It outlines screening, identifying and treating emotional health needs in order to prevent or curtail substance use disorders. The lecture also discusses alcohol use disorder, opiate use disorder, and violence/suicide in substance use disorders. It also discusses mental health disorders such as anxiety, depression and PTSD and how they can affect substance use disorders. Offers evidence-based treatment addictions in all ages including pregnancy.

Learning Objectives:

  1. Outline the prevalence of substance abuse and risk factors to substance use disorders
  2. Discuss and evaluate the current pandemic and the behavioral health implications to consider in patient care
  3. Understanding the complexity of social struggle in behavioral and physical health (social determinants of health)
  4. Explain screening, identification and treatment of substance use disorders and mental health crisis
  5. Show the use of novel treatment and strategies in substance use abuse and disorders

[Back to Schedule]

 

Essential Oils: Is there a scent of evidence?
An evidence-based review of essential oil and (most importantly) their side effects that are largely never discussed.

Learning Objectives:

  1. Understand how oils are regulated and labeled
  2. Review credible studies sourced from PubMed on uses of oils in dermatology
  3. Raise awareness of potential side effects and possible therapeutic misadventures with oil usage

[Back to Schedule]

 

OMM Vignette: Upper Crossed C/T Spine
Review and demonstration of techniques.

[Back to Schedule]

 

Acute Cannabis Toxicity in Children
Acute cannabis use is an emerging medical issue in the pediatric medicine. Although more than half of states in the US legalized a medical use of cannabis, we still have the limited understanding of medical cannabis use in the pediatric population. As a pediatric hospitalist, I have taken care of more pediatric patients with acute cannabis toxicity including cannabinoid hyperemesis syndrome each year. Since the pediatric population has more access to marijuana, I feel it is imperative to identify the current evidences of medical cannabis use in the pediatric patients and discuss marijuana use and acute cannabis toxicity in children with the primary care physicians.

Learning Objectives:

  1. Identify the proposed mechanisms of action of cannabis.
  2. Discuss the current evidences of medical cannabis use in children.
  3. Describe signs and symptoms of acute cannabis toxicity including cannabinoid hyperemesis syndrome
  4. Describe treatment options for acute cannabis toxicity

[Back to Schedule]

 

ADHD or is It
ADHD is one of the most common mental illnesses and probably the most misunderstood. This presentation will provide the DSM 5 definition, followed by the differential diagnosis, treatment strategies and when to refer. An understanding of pharmacology and legal parameters in treatment will be part of discussion. Nonpharmacological treatment will also be presented.

Learning Objectives:

  1. Learn to generate a differential diagnosis for ADHD.
  2. Based on the differential diagnosis, participants will be able to choose how they will proceed with a work-up for ADHD.
  3. Critically analyze ADHD work up results to determine direction of treatment at the end of the presentation.
  4. Name the different types of ADHD based on the DSM 5.

[Back to Schedule]

 

Vaccination Hesitancy: Will COVID-19 help or hinder our battle against fear?
In 2019, the World Health Organization identified vaccination hesitancy as one of the top ten threats to global health. “Immunization is one of the most cost-effective public health interventions to date, averting an estimated 2 to 3 million deaths every year.” The infamous study by, the now discredited Dr. Wakefield in 1998, only amplified the century-old resistance and distrust from patients about the potential risks of life-saving vaccines. An example of the impact of this growing fear is that the US ranks 114th in the world for MMR vaccination rates for 1-year old children. This 92% vaccination rate falls short of providing herd immunity, which has manifested in multiple measles outbreaks in the past few years. Since the COVID 19 pandemic was declared a national state of emergency resulting in the need for social distancing, physicians and leaders in healthcare have growing concerns about how this will impact vaccination rates. The CDC Vaccine Tracking System and Vaccines for Children (VFC) program have noticed a concerning decline in the purchase of vaccines since the onset of the pandemic. In this discussion, we will look back on how the seed of vaccination fear was planted, what factors encouraged these fears to grow and how to utilize the epidemiologic impact widely publicized by COVID-19 to help parents and patients redevelop trust in the benefits of vaccination.

Learning Objectives:

  1. Understand the century-old history of vaccination hesitancy
  2. Understand the most common reasons attributed to vaccination hesitancy
  3. Summarize the vaccination rates in the United States before COVID 19 pandemic
  4. Assess the current data available on vaccinations rates and the impact social distancing has had on routine vaccination
  5. Assess the possible benefits and obstacles that have resulted from the COVID 19 pandemic

[Back to Schedule]

 

Pediatric Considerations of COVID-19
The goal of the talk is to develop an understanding of COVID-19 in pediatric population, the pandemic’s implications and consequences beyond the disease, and its effect on various socioeconomic groups. In addition, impact of COVID-19 across various dimensions in society rise in domestic abuse and child abuse will be discussed.

Learning Objectives:

  1. Understanding the epidemiology of Pediatric COVID19
  2. Clinical manifestations
  3. Diagnosis
  4. Health disparities associated with COVID-19
  5. Ethical dilemmas associated with COVID pandemic

[Back to Schedule]

 

OMM Vignette: OMT for COVID in Pediatric Populations
This will provide a brief look about considerations for performing OMT in a pediatric population with a diagnosis of COVID. We will review pertinent anatomy, literature that supports the work, and discuss unique anatomy and technique modifications for pediatric populations.

Learning Objectives:

  1. Literature review of OMT to treat respiratory conditions
  2. Unique pediatric anatomy to consider
  3. Neat modifications for some “classic” techniques
  4. Good techniques for respiratory illnesses

[Back to Schedule]

 

SARSCoV2/COVID19 Clinical Presentation, Differential Diagnosis, and Emerging Treatments
A look at the epidemiology of COVID19, with a review of infection stages. Management of COVID19 patients, including clinical presentations and treatment options will also be discussed.

Learning Objectives:

  1. Understand the basic epidemiology of SARSCoV2
  2. Review the mutation and transmission of SARSCoV2
  3. Discuss the importance of PPE in SARSCoV2

[Back to Schedule]

 

Diabetes and COVID: What you need to know
COVID-19 has changed medicine forever. People with diabetes are more like to get sick from COVID and suffer from serious complications. In this session we will explore the interface between these 2 conditions and discuss ways to reduce risk. We will also review best practices for sick day management for those with diabetes.

Learning Objectives:

  1. Discuss why people with diabetes are at risk for COVID
  2. Explore ways to reduce COVID risk
  3. Discuss diabetes medications as they relate to COVID
  4. Review sick day management for patient with diabetes

[Back to Schedule]

 

Pandemics to Earthquakes: How to prepare your office, your patients and your family for the next disaster
This is a presentation on disaster preparedness for medical practices, and for one's own family. Actionable steps will include how to prepare patients in the event of a practice disruption. Disaster preparedness references and printable handouts will be included with the presentation.

Learning Objectives:

  1. Be able to evaluate for disaster risk for your area
  2. Understand the basics of disaster preparedness
  3. Recognize the unique needs of the healthcare setting during a disaster
  4. Provide actionable information to your staff, your patients and your family on preparedness
  5. Develop and practice an appropriate response plan to actual and perceived disaster

[Back to Schedule]

 

Biotensegrity Considerations in the Setting of Chronic Lumbopelvic Pain
Despite our foundation in and treatment with osteopathic manipulation, chronic low back pain still debilitates many of our patients. They often get labeled with "Non-specific low back pain”, lumbago, chronic sciatica, or SI joint pain with limited lasting benefit from standard treatment regimens, yet they're non-surgical. What next? Busy clinic days combined with patients' overlapping pain patterns from multiple pain generators only confound matters and make accurate and timely diagnosis difficult. This lecture hopes to shed light on quicker and more accurate diagnostic protocols, osteopathic manipulation and exercise prescription to alleviate common biotensegrity dysfunctions. It will then translate these considerations to new and effective minimally invasive options should conservative care fail.

Learning Objectives:

  1. Possess a better under understanding of and most current treatment options for chronic lumbopelvic pain.
  2. Be able to differentiate chronic low back pain from posterior pelvic pain.
  3. Understand the etiology, patterns, and treatment protocols for lumbar axial spine pain
  4. Understand the etiology and patterns of posterior pelvic pain
  5. Understand the spectrum of conservative to invasive options available to them and their patients including in-office osteopathic treatments, image-guided needle interventions, regenerative medicine, and minimally invasive surgical options for refractory cases.

[Back to Schedule]

 

OMM Vignette: Low Back Pain
Backward sacral torsions are a common finding in acute low back pain. This session will review a rapid assessment of backward sacral torsions and present a combined treatment and home exercise to aid the physician in their management of these patients.

Learning Objectives:

  1. Review the mechanics of sacral torsions
  2. Rapidly assess the functional position of a sacrum using minimal data sets
  3. Apply a treatment to the sacral torsion dysfunction
  4. Teach the patient a home exercise with which they can self-manage their back pain

[Back to Schedule]

 

OMM Vignette: Ankle Sprains
Inversion injuries are the most common ankle sprains. Patients will often present with residual swelling and limitations of motion even after the pain has improved. We will review the function anatomy of inversion ankle sprains and treat 3 key locations for dysfunction in the ankle complex.

Learning Objectives:

  1. Review the functional anatomy of inversion ankle sprains
  2. Assess 3 key areas for dysfunction creating swelling and limitations of range of motion
  3. Apply treatments for each dysfunctional region to improve range of motion

[Back to Schedule]

 

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