CONFERENCE APPLICATIONS AND REPORTS · 2020-02-07 · 1 CONFERENCE APPLICATIONS AND REPORTS Applications Previously Approved November 6, 2019 through February 5, 2020 Internet CME

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CONFERENCE APPLICATIONS AND REPORTS Applications Previously Approved

November 6, 2019 through February 5, 2020 Internet CME – Enduring Materials Page 3

Acute Gastroenteritis in Children – An Update (1 Cat. 1) CHEMO Breast CX Coronaviruses Fluoroquinolone How to Spot a Common Stroke Zebra Imaging in Acute Stroke Intensive Care Medicine in 2050 Randomized Trials and Real-Life Registries in Acute Stroke Thrombectomy Robotics (UPDATE) Update on Domestic Violence

Regularly Scheduled Series (RSS) Page 41

Advanced Cardiac Life Support (ACLS) Two-day Provider Course and One-day Renewal Course (ACLS-R) (7/14 Cat. 1/ea)

Bethesda Breast Cancer Tumor Board (1 Cat. 1 ea.) Bethesda General Cancer Tumor Board (1 Cat. 1 ea.) Cardiac Cath & Cardiac Surgery Clinical Review (1 Cat 1/ea) Renewal GI Hepatobiliary Tumor Board (1.5 Cat. 1) GI Non-hepatobiliary Tumor Board (1 Cat. 1) MCI – Thoracic Oncology Tumor Board (1 Cat. 1 each) MCVI BHM Echo Lab Cases Review (1 Cat. 1/ea) – Renewal MCVI SMH Echo Lab Conference Series - Case Studies in Echocardiography (1 Cat. 1/ea) Noninvasive Vascular Lab (NIVL) Quality Improvement Committee Meeting (1 Cat. 1/ea) Pediatric Advanced Life Support (PALS) Two-day Provider Course and One-day Renewal Course (PALS-R)

(7/14 Cat. 1 / each) SMH Cardiology Journal Club (1 Cat. 1/ ea) – Renewal SMH NIVL Quality Committee Cases Review (1 Cat. 1)

Live Page 85 12.02.19 Homestead Hospital Conference Series: Don’t Believe Everything You Think (1 Cat. 1) 01.13.20 Multispecialty Grand Rounds – Treatment of Oropharynx Cancer: Past, Present and Future (1 Cat. 1) 01.14.20 Pediatric Multispecialty Conference: Evidence Based Pediatric Emergency Medicine - Are You Practicing It? (1 Cat. 1) 01.15.20 Conversations in Ethics – Ethical Challenges with Gender Dysphoria and Transgender (1 Cat. 1) 01.24.20 MCI Radiation Oncology Grand Rounds: Current and Future Research Directions of the NRG Oncology Head and Neck Committee (1 Cat. 1) 01.30.20 SMH Inpatient Physicians Grand Rounds: The Power of Sugar-Coated Stem Cells (1 Cat. 1) 02.04.20 Miami Cancer Institute – Multispecialty Grand Rounds: Causes and Consequences of Rearrangements in Cancer (1 Cat. 1) 02.10.20 Miami Cancer Institute – Multispecialty Grand Rounds: Head and Neck Cancer 2020: Respecting the Old, Welcoming the New (1 Cat. 1) 02.12.20 Clinician Excellence in a Time of Transformation (2 Cat. 1)

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02.13.20 Creating a High Reliability Culture: Path to Zero Harm (2 Cat. 1) 02.14.20 MCI Radiation Oncology Grand Rounds: Cardiac Effects of Breast Cancer Radiotherapy (1 Cat. 1) 02.19.20 Conversations in Ethics – The Science of Empathy (1 Cat. 1) 02.19.20 Anesthesia Conference Series: A-ACLS (1 Cat. 1) 02.25.20 MCI – Hem Onc Grand Rounds: The Evolving Landscape of Follicular Lymphoma 03.09.20 MCI – Multispecialty Grand Rounds: Update on Radiotherapy for Esophageal Cancer 03.20.20 MCI – Radiation Oncology Grand Rounds: Proton Therapy for Bone and Soft Tissue Sarcomas

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Internet CME – Enduring Materials

Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Acute Gastroenteritis in Children – An Update COURSE APPROVED: December 2019 COURSE EXPIRES: December 2021 CREDIT HOUR(S) APPLIED FOR: TARGET AUDIENCE: Pediatricians, Internists, Hospitalists, Pediatric Emergency Medicine Physicians, Emergency Medicine Physicians, Physician Assistants, Nurse Practitioners, Pharmacists, Respiratory Therapist, Psychologists, Nurses and all interested clinical care providers. CONFERENCE DIRECTOR: Jennifer Cheney, M.D. CME MANAGER: Katie Deane (Live/Online) EXPECTED NUMBER OF ATTENDEES: 0 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.

ARS Case Studies Didactic Lecture Enduring Material (DVD/Booklet) Internet Activity Enduring Material Internet Live Course (Live Webcast) Internet point-of-care activity Journal-based CME activity Learning from Teaching

Live activity Manuscript review activity Panel PI CME activity Question & Answer Regularly Scheduled Series Simulation Test item writing activity Other (specify)

COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. Acute gastroenteritis is one of the most common diseases worldwide. Viruses are recognized as important causes of this disease, particularly in children. Diagnosis of viral acute gastroenteritis is made largely on the basis of clinical signs and symptoms. Join us, as Dr. Tony Tavarez, describes the pathogenesis, epidemiology, etiology and clinical manifestations of viral gastroenteritis and presents current recommendations, including the AAP guidelines, for management of acute gastroenteritis in clinical practice. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.

DESIRABLE PHYSICIAN ATTRIBUTES/COMPETENCIES (C6) ABMS/ACGME: Patient care and procedural skills Medical knowledge Practice-based learning and improvement

Interpersonal and communication skills Professionalism Systems-based practice INSTITUTE OF MEDICINE: Provide patient-centered care Work in interdisciplinary teams

Employ evidence-based practice Apply quality improvement Utilize informatics INTERPROFESSIONAL EDUCATION COLLABORATIVE: Values/ethics for interprofessional practice

Roles/responsibilities Interprofessional communication Teams and teamwork

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PROFESSIONAL PRACTICE GAP (C2) The difference between what is (the “actual”) and what should be (the “ideal”).

What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Lack of routine clinical testing for viruses that cause acute gastroenteritis may limit clinician understanding of their pathogenesis, epidemiology, etiology and clinical manifestations in the pediatric patient. ► Better understanding of the relative role of specific viral causes of AGE among persons seeking medical care is needed to help guide clinical management. Indicate if the gap is related to need for change in either/or:

Knowledge and/or (Doctors do not know that they need to be doing something.) Competence and/or (Doctors do not know how to do it) Performance and/or (Doctors know how to do it but are noncompliant – or are not doing it properly.)

DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Clinicians recognize the clinical manifestations of viral gastroenteritis and apply current recommendations for management, including AAP guidelines, into clinical practice. Indicate what this activity is designed to change.

Designed to change competence Designed to change performance Designed to change patient outcomes

NEEDS ASSESSMENT RESOURCES – HOW ARE EDUCATIONAL NEEDS IDENTIFIED? (Check all that apply and explain below.)

Best practice parameters Consensus of experts Disease prevention (C12) Joint Commission initiatives (C12) Mortality/morbidity statistics National Patient Safety Goals National/regional data New diagnostic/therapeutic modality (C12) New or updated policy/protocol Patient care data Peer review data Process improvement initiatives (C16 & 21) Regulatory requirement Other need identified (Explain): _____________________________ Research/literature review

REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► Acute gastroenteritis is one of the most common diseases in humans worldwide. Viruses are recognized as important causes of this disease, particularly in children. In recent years, the availability of diagnostic tests, mainly immunoassays or molecular biology techniques, has increased our understanding of this group of viruses. (https://www.sciencedirect.com/science/article/pii/S1198743X1463113X) Wilhelmi, I., Roman, E., & Sanchez-Fauquier, A. (2003). Viruses causing gastroenteritis. Clinical microbiology and infection, 9(4), 247-262. ► Acute gastroenteritis (AGE), defined as diarrheal disease of rapid onset potentially accompanied by nausea, vomiting, fever, or abdominal pain, is a major cause of illness in the United States. Approximately 179 million episodes of AGE occur each year and result in ≈600,000 hospitalizations and 5,000 deaths (1,2). A specific etiology is attributed to only ≈20% of AGE cases, although viruses are recognized as the most common of the known agents (1,3). (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3381564/) Hall, A. J., Rosenthal, M., Gregoricus, N., Greene, S. A., Ferguson, J., Henao, O. L., ... & Widdowson, M. A. (2011). Incidence of acute gastroenteritis and role of norovirus, Georgia, USA, 2004–2005. Emerging infectious diseases, 17(8), 1381. ► Among children in the United States, acute gastroenteritis remains a major cause of morbidity and hospitalization, accounting for >1.5 million outpatient visits, 200,000 hospitalizations, and approximately 300 deaths/year. (https://stacks.cdc.gov/view/cdc/13471) Bresee, J. S., Duggan, C., Glass, R. I., & King, C. K. (2003). Managing acute gastroenteritis among children; oral rehydration, maintenance, and nutritional therapy.

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► Guarino, A., Ashkenazi, S., Gendrel, D., Vecchio, A. L., Shamir, R., & Szajewska, H. (2014). European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. Journal of pediatric gastroenterology and nutrition, 59(1), 132-152. Bibliography and Additional Resources:

EDUCATIONAL OBJECTIVES: Based on the gaps identified above, what are the learning objectives for this activity? Describe the performance* that should change if participants apply what they learn. *(or competence or patient outcome) Upon completion of this conference, participants should be better able to: Describe the pathogenesis, epidemiology, etiology and clinical manifestations of viral gastroenteritis. Implement current recommendations for management of viral gastroenteritis, including AAP guidelines, into clinical

practice. EVALUATION METHODS: Analyze the overall changes in competence, performance or patient outcomes as a result of this CME activity. (C11)

Changes in competence. Evaluation method: Baptist Health CME Evaluation Form Changes in performance. Evaluation method: Follow-up Survey

Provide 3-4 statements based on expected performance outcomes to be evaluated. Example: I have implemented the new Baptist Health policy explained in this CME activity.

Changes in patient outcomes. Evaluation method: Review of hospital, health system, public health data, etc. Other______________________

FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Ligio (Tony) Tavarez, M.D. Pediatric Emergency Medicine Baptist Hospital of Miami Faculty disclosure statement (as it should appear on course shell): Ligio (Tony) Tavarez, M.D., indicated that neither he nor his spouse/partner has relevant financial relationships with commercial interest companies, and he will not include off-label or unapproved product usage in her presentation or discussion. Non-faculty contributors and others involved in the planning, development and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No

CME Dept. Leadership and Staff CME Committee Conference Director Others (Conference Coordinator, Planning Group, etc.) ________________________________________

NON-EDUCATIONAL STRATEGIES: Explain what we are doing (CME or BHSF) – or what we could do – to enhance change as an adjunct (in addition to) to this CME activity. (C17) These would be tactics and tools to facilitate change that go beyond this CME activity. NOTE: Insert this information under course shell>>custom fields>>resources.

Process redesign or new protocol Reminders (posters, mailings, email blasts) New order sheets Other tools or tactics Explain: ________________________________________________

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

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

If yes, describe the collaborative efforts. This activity is planned in collaboration with Baptist Children’s Hospital to meet the educational needs they have identified. ch

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COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. ETHOS CONTENT YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title. External: Provider: Course video: Course handout: Quiz Questions DATE REVIEWED: REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

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Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Surgical Options for the Treatment of the Morbidly Obese COURSE APPROVAL August 2019 COURSE EXPIRATION: August 2022 CREDIT HOUR(S) APPLIED FOR: .75 Cat 1 TARGET AUDIENCE: Bariatric Surgeons, General Surgeons, Cardiologists, Family Medicine Physicians and other interested healthcare professionals. CONFERENCE DIRECTOR: CME MANAGER: Marie Vital Acle EXPECTED NUMBER OF ATTENDEES: 0 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description.

FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.






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What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Indicate what this activity is designed to change.




REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: Bibliography and Additional Resources: Centers for Disease Control and Prevention. (n.d.). Adult Obesity Facts. Retrieved from https://www.cdc.gov/obesity/data/adult.html World Health Organization. (2018). Obesity and overweight. Retrieved from https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight Sturm, R., & Hattori, A. (2013). Morbid obesity rates continue to rise rapidly in the United States. International journal of obesity (2005), 37(6), 889-891. doi:10.1038/ijo.2012.159

EDUCATIONAL OBJECTIVES: Based on the gaps identified above, what are the learning objectives for this activity? Describe the performance* that should change if participants apply what they learn. *(or competence or patient outcome) Upon completion of this conference, participants should be better able to:

• Explain Baptist Health’s experience with robotic gastric bypass and robotic sleeve gastrectomy. • Describe patient selection criteria, typical surgical outcomes and average recovery for both procedures. • Assess potential gastric bypass surgery complications in a primary care setting and implement appropriate

interventions. • Implement standard primary care follow-up after gastric bypass procedures.

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



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FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Anthony M. Gonzalez, M.D., FACS, FASMBS Assistant Professor of Surgery, FIU Wertheim College of Medicine Chief of Surgery, Baptist Hospital of Miami Medical Director of Bariatric Surgery, South Miami Hospital Program Director MIS/Bariatric Surgery Fellowship Miami, Fla. Faculty disclosure statement (as it should appear on course shell): Anthony M. Gonzalez, M.D., FACS, FASMBS, indicated that neither he nor his spouse/partner has relevant financial relationships with commercial interest companies, and he will not include off-label or unapproved product usage in his presentation or discussion. Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No






If yes, describe the collaborative efforts. ________________________________________________________ COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. ETHOS CONTENT YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title. External: Provider: 2019IEM143 Course video: Course handout: Quiz Questions DATE REVIEWED: REVIEWED BY: Accelerated Approval Executive Committee Live Committee

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APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Chemotherapy for Breast Cancer This module is part of the Breast Cancer for the Non-Oncologist: Supporting Your Patients through Diagnosis and Treatment parent course. DATE: Ongoing CREDIT HOUR(S) APPLIED FOR: 1.0 Cat. 1 Course Approval: December 2016; December 2018; December 2019 Course Expires: December 2020 TARGET AUDIENCE: Family Medicine Physicians, Ob/Gyns, Internal Medicine Physicians, Nurse Practitioners, Physician Assistants, Medical Students, Residents, Nurses, Respiratory Therapists, Lab Personnel and Social Workers. (gist – Capital letter: ex: Cardiologists, Emergency Medicine Physicians) CONFERENCE DIRECTOR: Arturo Fridman, M.D. CME MANAGER: Marie Vital Acle EXPECTED NUMBER OF ATTENDEES: 60 Annually CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. What is the current state of chemotherapy? Chemotherapy prevention? All of your questions are answered in an interview with our local experts, Grace Wang, M.D. and Sara Garrido, M.D. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified. Gatekeeper providers may not feel confident in their knowledge to support a patient newly diagnosed with Breast Cancer. This course will address what a non-oncologist should know regarding the various diagnostic tests, treatment interventions, psychological impact of a diagnosis and other common questions that may be addressed by these practitioners.

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What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Family medicine physicians, obstetrician/gynecologists and internal medicine physicians may not know how to guide their patients through a recent breast cancer diagnosis. This course will provide the non-oncologists will a comprehensive overview of the complete breast cancer continuum of care including diagnosis, imaging, treatment, surgery, psychological concerns and reconstruction. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Family medicine physicians, obstetrician/gynecologists and internal medicine physicians competently explain what breast cancer patients can expect as part of diagnosis, staging and treatment interventions and reconstruction. These gatekeeper practitioners are better prepared to refer patients with a recent diagnosis to appropriate local resources. Indicate what this activity is designed to change.




REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ►Please see below.


SEE BELOW EVALUATION METHODS: Analyze the overall changes in competence, performance or patient outcomes as a result of this CME activity. (C11)




FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Sara M. Garrido, M.D., FACP Interim Chief Medical Officer Oncologist and Hematologist Miami Cancer Institute Baptist Health Medical Group Oncology

Grace Wang, M.D.

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Oncologist and Hematologist Miami Cancer Institute Baptist Health Medical Group Oncology Faculty disclosure statement (as it should appear on course shell): Sara M. Garrido, M.D., FACP & Grace Wang, M.D., have indicated that they have no relevant financial relationships to disclose and that their discussion will not include mention of investigational or off-label usage. Non-faculty contributors and others involved in the planning, development and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No






If yes, describe the collaborative efforts. This meeting is planned in collaboration with the Miami Cancer Institute to address the needs of the non-oncologist, referring physician. COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. DATE REVIEWED: REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A Sara M. Garrido, M.D., FACP & Grace Wang, M.D. Module Title: Chemotherapy for Breast Cancer Learning objective: Delineate current adjuvant and neoadjuvant therapy recommendations considering genetic testing, estrogen receptor

and progesterone receptor results. Recognize available chemotherapy interventions available for breast cancer and the factors that influence the therapy

recommendation. References: Burstein, H. J., Temin, S., Anderson, H., Buchholz, T. A., Davidson, N. E., Gelmon, K. E., & Stearns, V. (2014). Adjuvant

endocrine therapy for women with hormone receptor–positive breast cancer: American Society of Clinical Oncology clinical practice guideline focused update. Journal of Clinical Oncology, 32(21), 2255-2269.

OVERVIEW: What is the current state of chemotherapy? Chemotherapy prevention? All of your questions are answered

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CME ACTIVITY TITLE: Update on Domestic Violence COURSE APPROVAL AND ANTICIPATED RELEASE DATE: February 1, 2020 COURSE EXPIRES: February 1, 2023 CREDIT HOUR(S) APPLIED FOR: 2 Cat. 1 CONFERENCE DIRECTOR: Rachel Rohaidy, M.D. TARGET AUDIENCE: Physicians, Psychologists (Instructional Level: Intermediate), Podiatrists, Advanced Registered Nurse Practitioners, Clinical Nurse Specialists, Licensed Practical Nurses and Registered Nurses licensed in the State of Florida. EXPECTED NUMBER OF ATTENDEES: 800 annually CHARGE: -0- LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. This course satisfies two hour domestic violence continuing education relicensure requirement for Florida allopathic physicians, podiatrists, psychologists, advanced practice registered nurses and nurses.

FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Non-compliance Lifestyle Resistance-to-change Financial/Lack of Insurance Physician: Non-compliance Resistance-to-change Communication Skills Financial Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or No Treatment Modalities Limited or No Diagnostic Modalities Other: ___________________________________________________________________________________________ BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.






What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2)

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► Doctors may not be adequately identifying and/or treating victims of domestic violence in their clinical practice. Due to inadequate recognition of domestic violence victims in physicians’ practices the Florida Board of Medicine and Florida Board of Psychology require 2 hours of Domestic Violence education for every third renewal period. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Doctors identify patients who are victims of domestic violence and refer patients to counseling and available support and protection programs. Indicate what this activity is designed to change.



Best practice parameters Consensus of experts Disease prevention (C12) Joint Commission initiatives (C12) Mortality/morbidity statistics National Patient Safety Goals National/regional data New diagnostic/therapeutic modality (C12) New or updated policy/protocol Patient care data Peer review data Process improvement initiatives (C16 & 21) Regulatory requirement Other need identified (Explain): Relicensure requirements Research/literature review

REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: The Florida Board of Medicine requires two hours of continuing medical education on Domestic Violence every third renewal period. The Florida Board of Psychology requires two hours of continuing psychological education on domestic violence must be completed every third biennial licensure renewal period. Florida Board of Psychology defines "Domestic violence" as any assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any criminal offense resulting in physical injury or death of one family or household member by another family or household member. (http://www.doh.state.fl.us/mqa/psychology/psy_ceu.html) Catalano, S. M. (2006). Intimate partner violence in the United States. Washington, DC: US Department of Justice, Office of Justice programs, Bureau of Justice Statistics. Chen, P. H., Rovi, S., Washington, J., Jacobs, A., Vega, M., Pan, K. Y., & Johnson, M. S. (2007). Randomized comparison of 3 methods to screen for domestic violence in family practice. The Annals of Family Medicine, 5(5), 430-435. MacMillan, H. L., Wathen, C. N., Jamieson, E., Boyle, M. H., Shannon, H. S., Ford-Gilboe, M., ... & McNutt, L. A. (2009). Screening for intimate partner violence in health care settings: a randomized trial. Jama, 302(5), 493-501. O’Doherty, L. J., Taft, A., Hegarty, K., Ramsay, J., Davidson, L. L., & Feder, G. (2014). Screening women for intimate partner violence in healthcare settings: abridged Cochrane systematic review and meta-analysis. Bmj, 348, g2913. O'Doherty, L., Hegarty, K., Ramsay, J., Davidson, L. L., Feder, G., & Taft, A. (2015). Screening women for intimate partner violence in healthcare settings. The Cochrane Library. García-Moreno, C., Hegarty, K., d'Oliveira, A. F. L., Koziol-McLain, J., Colombini, M., & Feder, G. (2015). The health-systems response to violence against women. The Lancet, 385(9977), 1567-1579.

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Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., ... & Marks, J. S. (2019). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 56(6), 774-786. Walters, M., Chen, J., & Breiding, M. (2011). National Intimate Partner and Sexual Violence Survey 2010: Findings on Victimization by Sexual Orientation. APA Criteria (Standard D): EDUCATIONAL OBJECTIVES: Describe what doctors will be able to do after they leave the classroom. What is the "take-away" that they can put into practice. What new strategies, tools, treatment plans, approaches, etc. will they be able to implement, utilize, do, etc. as a result of attending this CME activity?

Upon completion of this conference, participants should be better able to: Identify domestic violence victims and perpetrators in clinical practice. Determine the number of patients in a doctor’s office who are likely to be victims of domestic violence and the

number who are likely to be perpetrators of domestic violence. Recognize the cycle of violence, and assess where the patient’s domestic violence relationship fits into the cycle. Explain the legal system process experienced by victims and perpetrators. Differentiate domestic violence courts from others in the judicial system. Appropriately refer patients who are victims of domestic violence to counseling, victim support groups and

protection services. Utilize resources in the local community, such as domestic violence centers and other advocacy groups that

provide legal aid, shelter, victim counseling, or child protection services.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Rachel Rohaidy, M.D. Medical Director, Baptist Health Care & Counseling Psychiatrist, Baptist and South Miami Hospitals Baptist Health Medical Group Baptist Health South Florida Honorable Carroll J. Kelly Administrative Judge of the Domestic Violence Division of the Eleventh Judicial Circuit Court of Florida Faculty disclosure statement (as it should appear on course shell): Rachel Rohaidy, M.D. and The Honorable Carroll J. Kelly, indicated that neither they nor their spouse/partner have relevant financial relationships with commercial interest companies, and they will not include off-label or unapproved product usage in their presentation(s) or discussion(s). Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. Non-clinical content: All activities that are considered non-clinical must be vetted by the Department Director. If there is no opportunity to affect the content of CME concerning the products or services of a commercial interest, then there can be no relevant financial relationships or conflicts of interest. Both the following statements must apply. Reference SOP “Disclosures for Activities with Non-Clinical Content” for further instructions and necessary steps to ensure compliance.

CME Activity content is not related to products or services of commercial interests.

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CME Activity content is non-clinical. Disclosure statement on evaluation: Due to the non-clinical nature of the content discussed, the speakers have no relevant financial relationships to disclose. This CME activity will not cover content that would involve products or services of commercial interests. Therefore no opportunity exists for a conflict of interest based on the financial relationships of faculty and those persons in control of content. Since these relationships are not relevant, no disclosure information was collected. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No



Process redesign or new protocol Reminders (Posters, mailings, email blasts) New order sheets Other tools or tactics Explain: _Advice for victims handout for physicians, cycle of violence/hotline contact list poster, and domestic violence support groups list and contact list. COLLABORATION: Are we engaged in collaborative and cooperative projects with other stakeholders (internal or external) that are related to this CME activity? (C20)


If yes, describe the collaborative efforts. This course is planned in collaboration with Care and Counseling Services. (ETHOS CONTENT) YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title.

1) Medical Errors 2) Domestic Violence . External: Provider: Course video: Course handout:

Quiz Questions:

DATE REVIEWED: March 4, 2019 REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A FACULTY: Honorable Carroll J. Kelly Administrative Judge of the Domestic Violence Division of the Eleventh Judicial Circuit Court of Florida Courtroom Proceedings- Filing an Injunction Judge Carroll J. Kelley

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Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Intensive Care Medicine in 2050 COURSE APPROVAL January 2020 COURSE EXPIRATION January 2023 CREDIT HOUR(S) APPLIED FOR: TARGET AUDIENCE: Critical Care Physicians, Cardiologists, Surgeons, Anesthesiologists, Emergency Medicine Physicians, Nephrologists, Pulmonologists, Infectious Disease Physicians, Neurologists, Gastroenterologists, Hospitalists, Physician Assistants, Nurse Practitioners, Nurses, Respiratory Therapists, Pharmacists and other interested healthcare providers. CONFERENCE DIRECTOR: Gidel, l, M.D.,, Armaignac, Donna Lee, Ph.D., Martinez-Dubouchet, E., M.D. CME MANAGER: Katie Deane (Live)/Marie Vital Acle (Online) EXPECTED NUMBER OF ATTENDEES: 0 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. Critical care medicine in 2050: less invasive, more connected, and personalized. Given the rapid changes in this field, it is likely that critical care medicine in 2050 will bear little resemblance to the situation today. Here, the world renowned Jean-Louis Vincent, M.D., PhD, uses his extensive knowledge and expertise in critical care medicine to speculate, in general terms, on how this specialty and the ICU will be moving forwards over the next 30 years. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.





PROFESSIONAL PRACTICE GAP (C2)

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The difference between what is (the “actual”) and what should be (the “ideal”). What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Intensive care medicine at large is undergoing a scientific revolution in that the current state presumption that medicine is biology supported by data has evolved towards medicine is data science based on biology. We are currently at a once in a generation opportunity to capture data for transformation of clinical medicine and health care in the coming decades. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Physicians will to prepare for the next wave of medicine driven by data and sophisticated connected technology. Medical providers of the future will learn and develop competence in interpretation of artificial intelligence, machine learning and to deliver healthcare via connected sophisticated technologies. Providers will provide medicine inextricably linked with technology; assisted, augmented and autonomous intelligence continuum in partnership with patients as astute consumers. Indicate what this activity is designed to change.




REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: Bibliography and Additional Resources: ► Critical care medicine as a specialty in its own right has therefore existed for less than 40 years, but the changes that this field has witnessed over that time span have been enormous as our understanding of pathophysiological processes [e.g., of sepsis, acute respiratory distress syndrome (ARDS), circulatory shock] has improved, technology has enabled equipment to become smaller and more user-friendly, and changes in societal norms have encouraged a more human approach to hospital treatment (1). Given the rapid changes in this field so far, it is likely that critical care medicine in 2050 will again bear little resemblance to the situation today. Vincent, J. L., & Creteur, J. (2019). Critical care medicine in 2050: less invasive, more connected, and personalized. Journal of Thoracic Disease, 11(1), 335. ► Vincent, J. L., Slutsky, A. S., & Gattinoni, L. (2017). Intensive care medicine in 2050: the future of ICU treatments. ► Ranieri, V. M., Brodie, D., & Vincent, J. L. (2017). Extracorporeal organ support: from technological tool to clinical strategy supporting severe organ failure. Jama, 318(12), 1105-1106.

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Describe the projected evolution of intensive care medicine in terms of physical and organizational boundaries, equipment, patient demographics, staffing and process of care over the next 30 years.

Recognize the important role personalized medicine has on all aspects of care in the management of intensive care patients.

Address some of the problems related to preserving the human approach in light of evolving medical technology. Utilize these technological advances to complement – not replace – the human approach to care.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Jean-Louis Vincent, M.D., Ph.D. Professor of Intensive Care Médicine Université Libre de Bruxelles Dept. of Intensive Care, Erasme Univ Hospital Brussels, Belgium Faculty disclosure statement (as it should appear on course shell): Jean-Louis Vincent, M.D., Ph.D., indicated that neither he nor his spouse/partner has relevant financial relationships with commercial interest companies, and he will not include off-label or unapproved product usage in his presentation or discussion. Symposium Directors Louis T. Gidel, M.D., Ph.D., FCCP, Donna Lee Armaignac, Ph.D. APRN, CCNS, CCRN-K, and Eduardo Martinez-DuBouchet, M.D., have indicated that neither they nor their spouse/partner have relevant financial relationships with commercial interest companies. Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No






If yes, describe the collaborative efforts. The mission of the Baptist Health South Florida Adult Critical Care Best Practices Committee is to provide the best care to our critically ill patients and families by applying “conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients,” relying on sound wisdom

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and clinical expertise and patients’ and family’s desires. Application of these practices is aimed at achieving improved clinical outcomes, health and well-being for our patients and families. In addition the Committee is working on a system-wide initiative to accomplish overall mortality, length of stay, and cost reduction. This symposium is part of that initiative to help the Committee reach its patient care improvement goals. COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. ETHOS CONTENT YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title. External: Provider: Course video: Course handout: Quiz Questions DATE REVIEWED: REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: How to Spot a Common Stroke Zebra COURSE APPROVAL January 2020 COURSE EXPIRATION January CREDIT HOUR(S) APPLIED FOR: TARGET AUDIENCE: Adult and Pediatric Neurologists, Neurosurgeons, Stroke Neurologists, Neuroradiologists, Diagnostic Radiologists, Critical Care Physicians, Neurointensivists, Emergency Medicine Physicians, Internal Medicine Physicians, Interventional Neuroradiologists, Family Physicians, General Internists, Neuropsychologists, Critical Care and Neuroscience Nurses, Neurosurgery Nurses, Nurse Practitioners, Physical Therapists, Respiratory Therapists, Dietitians, Radiology Technologists, Clinical Pharmacists, Rehabilitation and Pain Management Specialists, as well as other specialists interested in the field of neuroscience. SYMPOSIUM DIRECTORS: Miami Neuro Symposium ■ Alberto Pinzon-Ardila, M.D., PH.D Bruno Gallo, M.D. Kevin Abrams, M.D. Italo Linfante, M.D. Felipe De Los Rios La Rosa, M.D. Guilherme Dabus, M.D. Karel Fuentes, M.D.

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Miami Neuro Nursing Jayme Strauss, MSN, RN, MBA, SCRN

Amy K. Starosciak, Ph.D. Kunal Patel, M.S., CNIM Daniel D’Amour, RN, BA, BSN, CEN, SCRN CME MANAGER: Isabel Rodriguez Morgan (Live)/ Marie Vital Acle (Online) EXPECTED NUMBER OF ATTENDEES: 0 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. Matthew Flaherty, M.D. utilizes a case-based discussion to identify rare causes of stroke. Clinicians will take away techniques to “spot a zebra”. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional capabilities Physician practice limitations Community service limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified. This activity will address the need for ways to support the translation of best practice and provision of effectiveness of interventions aimed at achieving changes in the management of CNS tumors, neuro imaging modalities, cerebrovascular diseases and neurocritical patient care.






What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ►The ever-growing practical issues confronting neurological disorders today creates a gap in interdisciplinary care among the diverse body of physicians and clinicians that interface in the fields of neurological diseases. Unless immediate action is taken, the neurological burden is expected to become even more serious in the future. Clinicians may not be familiar with rare causes of stroke and appropriate management in these rare cases. Indicate if the gap is related to need for change in either/or:

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Knowledge and/or (Doctors do not know that they need to be doing something.) Competence and/or (Doctors do not know how to do it.) Performance and/or (Doctors know how to do it but are noncompliant – or are not doing it properly.)

DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ►Physicians and clinicians will ensure a meaningful partnership among neuro specialty groups in order to better characterize the clinical presentation, evaluation, diagnosis, and treatment and continued follow-up of neurology patients to achieve optimal patient outcomes and exemplary programmatic outcome. Clinicians catch rare causes of stroke and implement appropriate treatment strategies. Indicate what this activity is designed to change.

Designed to change competence. Designed to change performance. Designed to change patient outcomes.


Best-practice parameters Consensus of experts Disease prevention (C12) Joint Commission initiatives (C12) Mortality/morbidity statistics National Patient Safety Goals National/regional data New diagnostic/therapeutic modality (C12) New or updated policy/protocol Patient care data Peer review data Process improvement initiatives (C16 & 21) Regulatory requirement Other need identified (Explain): This symposium meets the 4-8 hours of Research/literature review stroke education requirement

►BHM received certification as a Comprehensive Stroke Center by the Joint Commission in 2014 and has achieved the highest AHA/ASA “Get With The Guidelines Quality” award for 2019, the Gold Plus - Honor Roll Elite Plus award. This symposium will meet the 4-8 hours of stroke education requirement for medical and clinical staff groups (ED, ICU, eICU, Neuroscience, Neurology, Neuroradiology, Neurosurgery, Interventional Neuroradiology, Vascular, Internal Medicine and Neuro Rehab). The symposium will showcase the multidisciplinary treatment approach, incorporate education on the specific complex patient care and how it reflects on positive outcomes. REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ►JAMA Neurol. 2017 Sep; 74(9): 1048–1055. Published online 2017 Sep 11. Prepublished online 2017 Aug 7. doi: 10.1001/jamaneurol.2017.1668 Bibliography and Additional Resources: Zhang, A. J., Dhruv, P., Choi, P., Bakker, C., Koffel, J., Anderson, D., ... & Streib, C. (2018). A Systematic Literature Review of Patients With Carotid Web and Acute Ischemic Stroke. Stroke, 49(12), 2872-2876. Kim, S. J., Nogueira, R. G., & Haussen, D. C. (2019). Current understanding and gaps in research of carotid webs in ischemic strokes: a review. JAMA neurology, 76(3), 355-361. Navi, B. B., Reiner, A. S., Kamel, H., Iadecola, C., Okin, P. M., Tagawa, S. T., ... & DeAngelis, L. M. (2019). Arterial thromboembolic events preceding the diagnosis of cancer in older persons. Blood, 133(8), 781-789.


Identify several “rare” cause of stroke that most neurologists will encounter and review management of these conditions.




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FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Matthew Flaherty, M.D. Professor of Neurology University of Cincinnati Academic Health Center Cincinnati, Ohio Faculty disclosure statement (as it should appear on course shell): Matthew Flaherty, M.D., indicated that neither he is a consultant with Janssen Pharmaceuticals and is on the speakers bureau for CSL Behring, Janssen Pharmaceuticals and Portola Pharmaceuticals, and he will not include off-label or unapproved product usage in his presentation(s) or discussion(s). Non-faculty contributors and others involved in the planning, development and editing/review of the content have no relevant financial relationships to disclose. Symposium Directors: Miami Neuro Symposium ■ Alberto Pinzon-Ardila, M.D., PH.D - Speakers bureau with Sunovion and UCB

Kevin Abrams, M.D.- Consultant with Keystone Heart and shareholder with Cleerly and Keystone Heart. Felipe De Los Rios La Rosa, M.D. – No disclosure – relevant financial or other relationship. Guilherme Dabus, M.D. – Consultant with Microvention, Medtronic, Cernovus and Penumbra. Shareholder with Surpass Medical/Stryker, InNeuroCo, Medina Medical/Medtronic, eLum, Three Rivers Medical and RIST. Proctor with Medtronic.

Karel Fuentes, M.D. - No disclosure – relevant financial or other relationship. Bruno Gallo, M.D. – Grant/Research support – St. Jude Medical and Medtronic. Consultant with Surgimon, Inc. Speakers bureau with Teva, Acadia, Adamas and Sunovion. Italo Linfante, M.D. – Consultant with Medtronic and Stryker. Shareholder with InNeuroCo and Three Rivers Medical.

Miami Neuro Nursing Jayme Strauss, MSN, R.N., MBA, SCRN - No disclosure – relevant financial or other relationship.

Amy K. Starosciak, Ph.D.- No disclosure – relevant financial or other relationship. Kunal Patel, M.S., CNIM - No disclosure – relevant financial or other relationship. Daniel D’Amour, R.N., B.A., BSN, CEN, SCRN - No disclosure – relevant financial or other relationship.

RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No

CME Dept. leadership and staff CME Committee Conference director Others (i.e., conference coordinator, planning group, etc.) ________________________________________

NON-EDUCATIONAL STRATEGIES: Explain what we (CME or BHSF) are doing – or what we could do – to enhance change as an adjunct to this CME activity. (C17) These would be tactics and tools to facilitate change that go beyond this CME activity. NOTE: Insert this information under course shell>>custom fields>>resources.

Process redesign or new protocol Reminders (posters, mailings, email blasts) New order sheets Other tools or tactics Explain: Patient information

►BHSF Stroke Committee, a multidisciplinary medical and clinical staff meet bimonthly and review all stroke related doctor’s order sets on an annual basis to update with the latest evidence based clinical-guidelines. ►CEA/CAS doctor’s order sets were revised in May 2018 under the leadership of neurointerventional radiologists and vascular physicians to include evidence-based practice and topics being addressed at this symposium. ►BHM and BHSF stroke dashboards are updated to monitor performance on a monthly/quarterly basis to showcase primary and comprehensive stroke patient outcomes. ►BHSF Epilepsy Operational Committee, a multidisciplinary medical and clinical staff meets quarterly to review epilepsy related doctor’s order sets on an annual basis to update with the latest evidence-based clinical guidelines. ►Deep Brain Stimulation Multidisciplinary Team meets monthly to review patient cases for possible deep brain stimulation procedure; data are collected on each patient to follow up on patient outcomes.

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


If yes, describe the collaborative efforts. ________________________________________________________ ►The Miami Neuro Symposium is a collaborative project between the Baptist Health Neuroscience Center and the Department of CME to improve patient care via implementation of evidenced-based approaches to care of the neurologically impaired patient. COMMERCIAL SUPPORT: Indicate here if support will come from Baptist Health Foundation’s General Continuing Medical Education Fund. ETHOS CONTENT YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title. External: Provider: Course video: Course handout: Quiz Questions DATE REVIEWED: REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Randomized Trials and Real-Life Registries in Acute Stroke Thrombectomy COURSE APPROVAL February 2020 COURSE EXPIRATION February 2021 CREDIT HOUR(S) APPLIED FOR: TARGET AUDIENCE: Adult and Pediatric Neurologists, Neurosurgeons, Stroke Neurologists, Neuroradiologists, Diagnostic Radiologists, Critical Care Physicians, Neurointensivists, Emergency Medicine Physicians, Internal Medicine Physicians, Interventional Neuroradiologists, Family Physicians, General Internists, Neuropsychologists, Critical Care and Neuroscience Nurses, Neurosurgery Nurses, Nurse Practitioners, Physical Therapists, Respiratory Therapists, Dietitians, Radiology Technologists, Clinical Pharmacists, Rehabilitation and Pain Management Specialists, as well as other specialists interested in the field of neuroscience. SYMPOSIUM DIRECTORS: Miami Neuro Symposium ■ Alberto Pinzon-Ardila, M.D., PH.D Bruno Gallo, M.D.

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Kevin Abrams, M.D. Italo Linfante, M.D. Felipe De Los Rios La Rosa, M.D. Guilherme Dabus, M.D. Karel Fuentes, M.D. Miami Neuro Nursing Jayme Strauss, MSN, RN, MBA, SCRN

Amy K. Starosciak, Ph.D. Kunal Patel, M.S., CNIM Daniel D’Amour, RN, BA, BSN, CEN, SCRN CME MANAGER: Isabel Rodriguez Morgan (Live)/ arie Vital Acle (Online) EXPECTED NUMBER OF ATTENDEES: 200 annually CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. Organization of stroke systems of care is critical to ensure fast treatment. This course will discuss implications of randomized clinical trials in the treatment of acute stroke ad how patient selection for fast and effective recanalization impact patient outcomes. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional capabilities Physician practice limitations Community service limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified. This activity will address the need for ways to support the translation of best practice and provision of effectiveness of interventions aimed at achieving changes in the management of CNS tumors, neuro imaging modalities, cerebrovascular diseases and neurocritical patient care.






What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2)

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Practitioners may not be aware of the clinical implications that recent randomized trials have had in the treatment of acute stroke. ►The ever-growing practical issues confronting neurological disorders today creates a gap in interdisciplinary care among the diverse body of physicians and clinicians that interface in the fields of neurological diseases. Unless immediate action is taken, the neurological burden is expected to become even more serious in the future. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) Practitioners apply recommendations from randomized trials to improve patient outcomes in acute stroke. ►Physicians and clinicians will ensure a meaningful partnership among neuro specialty groups in order to better characterize the clinical presentation, evaluation, diagnosis, and treatment and continued follow-up of neurology patients to achieve optimal patient outcomes and exemplary programmatic outcome. Indicate what this activity is designed to change.




►BHM received certification as a Comprehensive Stroke Center by the Joint Commission in 2014 and has achieved the highest AHA/ASA “Get With The Guidelines Quality” award for 2019, the Gold Plus - Honor Roll Elite Plus award. This symposium will meet the 4-8 hours of stroke education requirement for medical and clinical staff groups (ED, ICU, eICU, Neuroscience, Neurology, Neuroradiology, Neurosurgery, Interventional Neuroradiology, Vascular, Internal Medicine and Neuro Rehab). The symposium will showcase the multidisciplinary treatment approach, incorporate education on the specific complex patient care and how it reflects on positive outcomes. REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ►Interv Neurol. 2018 Feb; 7(1-2): 26–35. Published online 2017 Oct 11. doi: 10.1159/000480353 Bibliography and Additional Resources:

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Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: A Fluoroquinolone Story: 1960’s to 2020’s CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 COURSE APPROVAL: February 2020 COURSE EXPIRES: February 2023 TARGET AUDIENCE: Physicians, advanced practice providers, physician assistants and advanced practice registered nurses, pharmacists, nurses, other interested healthcare professionals CONFERENCE DIRECTOR (Physician Lead): Stacey Baker, M.D. CONFERENCE COORDINATOR: Timothy P. Gauthier, Pharm.D., BCPS-AQ ID CME MANAGER: Marie Vital Acle, MPH, MCHES EXPECTED NUMBER OF ATTENDEES: 200 annually CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. Fluoroquinolones are widely used in clinical practice. These antimicrobials come with multiple safety concerns. This course will review scenarios where fluoroquinolones may be considered the drug of choice and when alternative medications should be considered the primary intervention. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.






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The difference between what is (the “actual”) and what should be (the “ideal”). What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Physicians may not be aware of several FDA-alerts that have recently been released about the safety of fluoroquinolones (FQs). Physicians may not know when and when not to use FQs. Physicians may not know what collateral damage is associated with FQs. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Physicians only use FQs when there is a specific reason to use one, when first line drugs are not reasonable options. Physicians appropriately identify clinical scenarios when FQs are appropriate or inappropriate. Physicians counsel patients regarding the potential unintended consequences of FQ use (side effects & ecological consequences). FQs are only used when other alternatives have been exhausted and providers document reason for FQ selection in their notes. Indicate what this activity is designed to change.




REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: BHSF Antimicrobial Stewardship FY-2020 Risk Assessment Tool, Baptist Health South Florida Antimicrobial Stewardship Program (BHSF ASP _ See below) U.S. Food and Drug Administration. Drug Safety Communication: FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics in certain patients. December 20, 2018. Lee CC, Lee MG, Chen YS, et al. Risk of Aortic dissection and aortic aneurysm in patients taking oral fluoroquinolone. JAMA Int Med 2015;175(11):1839-1847. Pasternak B, Inghammar M, Svanstrom H. Fluoroquinolone use and risk of aortic aneurysm and dissection: nationwide cohort study. BMJ. 2018;360:k678. Daneman N, Lu H, Redelmeier DA. Fluoroquinolones and collagen associated severe adverse events: a longitudinal cohort study. BMJ Open. 2015;5(11):e010077. Lee CC, Lee MG, Hsieh R, et al. Oral fluoroquinolone and the risk of aortic dissection. J Am Coll Cardiol. 2018;72(12):1369-1378. Howard DPJ, Banerjee A, Fairchild JF, et al. Age-specific incidence, risk factors and outcome of acute abdominal aortic aneurysms in a defined population. BJS 2015;102:907-915.

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Paterson, D. L. (2004). “Collateral damage” from cephalosporin or quinolone antibiotic therapy. Clinical Infectious Diseases, 38(Supplement_4), S341-S345.


Explain the history of fluoroquinolones in clinical practice and delineate safety concerns related to fluoroquinolones. Utilize the Food and Drug Administration guidelines on the appropriate use of fluoroquinolones in clinical practice. Counsel patients regarding the potential unintended consequences of fluoroquinolones. Document reason for fluoroquinolones accurately in the medical record when other alternatives have been exhausted.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Timothy P. Gauthier, Pharm.D., BCPS-AQ ID Antimicrobial Stewardship Program Manager Stacey Baker, M.D. Infectious Diseases Specialist Baptist Hospital of Miami Faculty disclosure statement (as it should appear on course shell): Stacey Baker, M.D. and Timothy P. Gauthier, Pharm.D., BCPS-AQ ID have indicated that neither their spouse/partner has relevant financial relationships with commercial interest companies, and they will not include off-label or unapproved product usage in their presentation(s) or discussion(s). Jorge Murillo, M.D. content reviewer is on the speakers’ bureau for Merck. All other non-faculty contributors, subcommittee members and content reviewers and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No






If yes, describe the collaborative efforts. Baptist Health South Florida Antimicrobial Stewardship Program (BHSF ASP)

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COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. (ETHOS CONTENT) YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title.

Question #1. Which one of the following is a side effect the FDA has issued an alert about for systemic Fluoroquinolones? A. Nephrotoxicity B. Ototoxicity C. Hypoglycemia including coma* D. Epistaxis Question #2. For which of the following indications has the FDA advised to restrict fluoroquinolones use? A. Uncomplicated urinary tract infection B. Acute sinusitis C. Acute bronchitis D. All listed answers are correct* Question #3. Compared to sulfamethoxazole-trimethoprim, fluoroquinolones can be expected to have a _________ resistance rate for E. coli. A. Lower B. Similar* C. Higher D. Neither drug class works against E. coli Question #4. Fluoroqinolones were first used in clinical practice in which decade? A. 1940s B. 1980s* C. 2000s D. 2010s Question #5. Nitrofurantoin is effective against E. coli approximately ____% of the time. A. 20% B. 40% C. 75% D. 95%* Question #6. Fluoroquinolones are considered in which of the following category for risk to cause Clostridium difficile infection? A. Low-Risk B. Medium-Risk C. High-Risk* D. Fluoroquinolone use never leads to C. difficile infection Question #7. If a patient experiences a side effect from a fluoroquinolone, they should do which one of the following actions? A. Continue the medication as prescribed and inform their prescriber at their convenience B. Reduce their dose by half, continue taking the medication for the full course prescribed C. Stop taking the medication and promptly contact their prescriber* D. Call poison control ASAP Question #8. Which of the following are risk factors for aortic aneurysm event or rupture when taking a fluoroquinolone? A. Low blood pressure B. Elderly persons* C. Chronic steroid use D. History of peripheral neuropathy Question #9. The recent CLSI breakpoint changes will cause ciprofloxacin and levofloxacin to be labeled as ________ more frequently/ A. Susceptible

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B. Intermediate C. Resistant* D. Indeterminate Question #10.Which of the following statement is most accurate regarding fluoroquinolones? A. Fluoroquinolones have limited clinical utility and should rarely be prescribed B. Fluoroquinolones have wide clinical utility and should be prescribed whenever possible C. Fluoroquinolones have wide clinical utility, but should be prescribed selectively* D. Fluoroquinolones have limited clinical utility, but are amongst the safest antimicrobials on the market

DATE REVIEWED: REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Imaging in Acute Stroke: Routine and Challenging Cases COURSE APPROVAL: February 2020 COURSE EXPIRATION: February 2022 CREDIT HOUR(S) APPLIED FOR: TBD TARGET AUDIENCE: Adult and Pediatric Neurologists, Neurosurgeons, Stroke Neurologists, Neuroradiologists, Diagnostic Radiologists, Critical Care Physicians, Neurointensivists, Emergency Medicine Physicians, Internal Medicine Physicians, Interventional Neuroradiologists, Family Physicians, General Internists, Neuropsychologists, Critical Care and Neuroscience Nurses, Neurosurgery Nurses, Nurse Practitioners, Physical Therapists, Respiratory Therapists, Dietitians, Radiology Technologists, Clinical Pharmacists, Rehabilitation and Pain Management Specialists, as well as other specialists interested in the field of neuroscience. SYMPOSIUM DIRECTORS: Miami Neuro Symposium ■ Alberto Pinzon-Ardila, M.D., PH.D Bruno Gallo, M.D. Kevin Abrams, M.D. Italo Linfante, M.D. Felipe De Los Rios La Rosa, M.D. Guilherme Dabus, M.D. Karel Fuentes, M.D. Miami Neuro Nursing Jayme Strauss, MSN, RN, MBA, SCRN

Amy K. Starosciak, Ph.D. Kunal Patel, M.S., CNIM Daniel D’Amour, RN, BA, BSN, CEN, SCRN CME MANAGER: Isabel Rodriguez Morgan (Live)/ Marie Vital Acle (Online)

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EXPECTED NUMBER OF ATTENDEES: 200 annually CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. We have moved from a time-based treatment to a tissue-based treatment for acute ischemic stroke. The interventional tools and outcomes have become so encouraging that there is now a paradigm shift from which patients benefit from treatment to which patients do we withhold treatment. Learn more during this imaging focused online course with Dr. Kevin Abrams. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional capabilities Physician practice limitations Community service limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified. This activity will address the need for ways to support the translation of best practice and provision of effectiveness of interventions aimed at achieving changes in the management of CNS tumors, neuro imaging modalities, cerebrovascular diseases and neurocritical patient care.






What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Practitioners may not be familiar with the paradigm shift of time-based treatment for acute ischemic stroke to tissue-based treatment. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3)

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►Physicians will implement appropriate treatment interventions based on imaging findings in patients with acute ischemic stroke. Indicate what this activity is designed to change.




►BHM received certification as a Comprehensive Stroke Center by the Joint Commission in 2014 and has achieved the highest AHA/ASA “Get With the Guidelines Quality” award for 2019, the Gold Plus - Honor Roll Elite Plus award. This symposium will meet the 4-8 hours of stroke education requirement for medical and clinical staff groups (ED, ICU, eICU, Neuroscience, Neurology, Neuroradiology, Neurosurgery, Interventional Neuroradiology, Vascular, Internal Medicine and Neuro Rehab). The symposium will showcase the multidisciplinary treatment approach, incorporate education on the specific complex patient care and how it reflects on positive outcomes. REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: Bibliography and Additional Resources: Srinivasan, A., Goyal, M., Azri, F. A., & Lum, C. (2006). State-of-the-art imaging of acute stroke. Radiographics, 26(suppl_1), S75-S95. Nogueira, R. G., Jadhav, A. P., Haussen, D. C., Bonafe, A., Budzik, R. F., Bhuva, P., ... & Sila, C. A. (2018). Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. New England Journal of Medicine, 378(1), 11-21. Albers, G. W., Marks, M. P., Kemp, S., Christensen, S., Tsai, J. P., Ortega-Gutierrez, S., ... & Sarraj, A. (2018). Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. New England Journal of Medicine, 378(8), 708-718. Kudo, K., Sasaki, M., Yamada, K., Momoshima, S., Utsunomiya, H., Shirato, H., & Ogasawara, K. (2009). Differences in CT perfusion maps generated by different commercial software: quantitative analysis by using identical source data of acute stroke patients. Radiology, 254(1), 200-209.


Examine the proper imaging workup in patients presenting with symptoms and signs of acute ischemic stroke. Recognize the advantages and disadvantages of CTA. Explain the pitfalls of CT perfusion.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Kevin Abrams, M.D. Clinical Associate Professor of Radiology

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Florida International University, Herbert Wertheim College of Medicine Chief of Radiology Medical Director of Neuroradiology Baptist Hospital of Miami Faculty disclosure statement (as it should appear on course shell): Kevin Abrams, M.D., indicated that he is a consultant with Keystone Heart and shareholder with Cleerly and Keystone Heart. He will not include off-label or unapproved product usage in his presentation or discussion. Non-faculty contributors and others involved in the planning, development and editing/review of the content have no relevant financial relationships to disclose. Symposium Directors: Miami Neuro Symposium ■ Alberto Pinzon-Ardila, M.D., PH.D - Speakers bureau with Sunovion and UCB

Kevin Abrams, M.D. (see above) Felipe De Los Rios La Rosa, M.D. – No disclosure – relevant financial or other relationship. Guilherme Dabus, M.D. – Consultant with Microvention, Medtronic, Cernovus and Penumbra. Shareholder with Surpass Medical/Stryker, InNeuroCo, Medina Medical/Medtronic, eLum, Three Rivers Medical and RIST. Proctor with Medtronic.

Karel Fuentes, M.D. - No disclosure – relevant financial or other relationship. Bruno Gallo, M.D. – Grant/Research support – St. Jude Medical and Medtronic. Consultant with Surgimon, Inc. Speakers bureau with Teva, Acadia, Adamas and Sunovion. Italo Linfante, M.D. – Consultant with Medtronic and Stryker. Shareholder with InNeuroCo and Three Rivers Medical.

Miami Neuro Nursing Jayme Strauss, MSN, R.N., MBA, SCRN - No disclosure – relevant financial or other relationship.

Amy K. Starosciak, Ph.D.- No disclosure – relevant financial or other relationship. Kunal Patel, M.S., CNIM - No disclosure – relevant financial or other relationship. Daniel D’Amour, R.N., B.A., BSN, CEN, SCRN - No disclosure – relevant financial or other relationship.


CME Dept. leadership and staff CME Committee Conference director Others (i.e., conference coordinator, planning group, etc.) ________________________________________

NON-EDUCATIONAL STRATEGIES: Explain what we (CME or BHSF) are doing – or what we could do – to enhance change as an adjunct to this CME activity. (C17) These would be tactics and tools to facilitate change that go beyond this CME activity. NOTE: Insert this information under course shell>>custom fields>>resources.

Process redesign or new protocol Reminders (posters, mailings, email blasts) New order sheets Other tools or tactics Explain: Patient information

►BHSF Stroke Committee, a multidisciplinary medical and clinical staff meet bimonthly and review all stroke related doctor’s order sets on an annual basis to update with the latest evidence based clinical-guidelines. ►CEA/CAS doctor’s order sets were revised in May 2018 under the leadership of neurointerventional radiologists and vascular physicians to include evidence-based practice and topics being addressed at this symposium. ►BHM and BHSF stroke dashboards are updated to monitor performance on a monthly/quarterly basis to showcase primary and comprehensive stroke patient outcomes. ►BHSF Epilepsy Operational Committee, a multidisciplinary medical and clinical staff meets quarterly to review epilepsy related doctor’s order sets on an annual basis to update with the latest evidence-based clinical guidelines. ►Deep Brain Stimulation Multidisciplinary Team meets monthly to review patient cases for possible deep brain stimulation procedure; data are collected on each patient to follow up on patient outcomes. COLLABORATION: Are we engaged in collaborative and cooperative projects with other stakeholders (internal or external) who are related to this CME activity? (C20)


If yes, describe the collaborative efforts. ________________________________________________________

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►The Miami Neuro Symposium is a collaborative project between the Baptist Health Neuroscience Center and the Department of CME to improve patient care via implementation of evidenced-based approaches to care of the neurologically impaired patient. COMMERCIAL SUPPORT: Indicate here if support will come from Baptist Health Foundation’s General Continuing Medical Education Fund. ETHOS CONTENT YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title. External: Provider: Course video: Course handout: Quiz Questions DATE REVIEWED: REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Coronaviruses CREDIT HOUR(S) APPLIED FOR: .50 Cat 1 TARGET AUDIENCE: Primary Care Physicians, Emergency Department Physicians, Hospitalists, Pediatricians, Internal Medicine Physicians, Infectious Disease Physicians, Nurse Practitioners, Physician Assistants and Nurses CONFERENCE DIRECTOR: Arturo Fridman, M.D. CME MANAGER: Marie Vital Acle, MPH, MCHES EXPECTED NUMBER OF ATTENDEES: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. Emerging respiratory viruses require enhanced surveillance and outbreak investigations for emerging pathogens. This course will explain how respiratory viruses – including novel Coronavirus (nCOV) – emerge and why they

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are a global threat to human health. Prof. Dr. Aileen M. Marty M.D., FCAP provides learners with the latest information on nCOV transmission and risk reduction strategies. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.






What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Practitioners may not be aware of the emergence of a new strain of coronavirus and pathogen incubation, transmission and treatment for this emerging pandemic. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Practitioners implement enhanced surveillance for emerging respiratory pathogens. Practitioners counsel patients on prevention techniques. Practitioners are able to quickly identify coronavirus cases and implement quarantine procedures in clinical practice. Indicate what this activity is designed to change.




REFERENCES supporting the current practice and/or the optimal practice and/or practice gap:

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Fehr, A. R., & Perlman, S. (2015). Coronaviruses: an overview of their replication and pathogenesis. In Coronaviruses (pp. 1-23). Humana Press, New York, NY. https://www.who.int/health-topics/coronavirus https://www.who.int/publications-detail/global-surveillance-for-human-infection-with-novel-coronavirus-(2019-ncov)


Explain how respiratory viruses – including novel Coronavirus (nCOV) emerge and why they are global threat to human health.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Prof. Dr. Aileen M. Marty M.D., FCAP Director, FIU Health Travel Medicine Program Vaccine Clinic Commander, Emergency Response Team Development Professor, Infectious Diseases, Department of Humanities, Health and Society Herbert Wertheim College of Medicine Voting Member, Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB) Voting Member, Board for the International Federation for Tropical Medicine Faculty disclosure statement (as it should appear on course shell): Prof. Dr. Aileen M. Marty M.D., FCAP indicated that neither she nor her spouse/partner has relevant financial relationships with commercial interest companies, and she will not include off-label or unapproved product usage in her presentation or discussion. The narrator and non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No






If yes, describe the collaborative efforts. ________________________________________________________

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COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. (ETHOS CONTENT) YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title.

1. Which of the following is correct regarding the new Coronavirus that has caused pneumonia in thousands of people?

a. It can only be spread by symptomatic persons b. It is an enveloped RNA virus c. It is more deadly than influenza d. Its genetic sequence is a mystery

2. The new Coronavirus, which currently has the nickname of 2019-nCoV has been documented to most commonly

produce which of the following combination of symptoms? a. Fever, nausea, runny nose, shortness of breath b. High fever, dry cough, malaise, fatigue, runny nose c. Shortness of breath, high fever, dry cough, malaise, fatigue d. Vomiting, high fever, shortness of breath, cough e. Vomiting, nausea, diarrhea, fatigue

3. Which of the following is correct regarding the 2019-nCoV?

a. It is a member of the betacoronavirus genera b. It is a member of the same genera of viruses that causes the common cold c. It is an RNA virus of the same family as influenza viruses d. A specific vaccine for 2019-nCoV has been available since mid-January 2020 e. SARS and MERS viruses spread at higher reproductive numbers than 2019-nCoV

4. Which of the following measures is most likely to contain the outbreak?

a. Avoiding mass gatherings in cities with active human-to-human transmission b. Hand hygiene methods, social distancing methods, practising healthy living c. Detection, isolation, and treatment of patients, with contact tracing d. Staying up to date on all vaccinations including flu vaccine and healthy living e. All of the above

DATE REVIEWED: January 27, 2020 REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

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Regularly Scheduled Series

Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Cardiac Cath and Cardiac Surgery Clinical Review DATE/TIME: Jan-Dec 2020, 7:30-8:30 a.m. LOCATIONS: BHM - 3rd Floor Gallery Conf. Room SMH – 2nd Floor MCVI Conf Rm. (Reina A. Benitez)

January 30, 2020 Feb. 27, 2020 March 26, 2020 April 23, 2020 May 28, 2020 June 25, 2020

July 23, 2020 August 27, 2020 September 24, 2020 October 22, 2020 November 19, 2020

CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1/ea CONFERENCE DIRECTOR: Ramon Lloret, M.D. ([email protected]) CONFERENCE COORDINATOR: Huguette / Regina A. Benitez CME MANAGER: Gabriela Fernandez EVENT TYPE:

Symposium Conference Series RSS Enduring Material

TARGET AUDIENCE: Invited Baptist Health Cardiologists, Cardiovascular Surgeons and Cardiac Cath Lab nurses, sonographers and radiology technologists. EXPECTED NUMBER OF ATTENDEES: 10-15 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. Baptist Health cardiologists and cardiac surgeons participate regularly in a clinical review educational activity to remain current with up-to-date information on evidence-based practice and research findings. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe.

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BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.





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

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

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

DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) Will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? (Check all that apply.) *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) ► Baptist Health cardiologists and cardiac surgeons will formulate new optimal patient care strategies in cardiovascular medicine by translating evidence into practice. Indicate what this activity is designed to change.



Best practice parameters Consensus of experts Disease prevention (C12) Joint Commission initiatives (C12) Mortality/morbidity statistics National Patient Safety Goals National/regional data New diagnostic/therapeutic modality (C12) New or updated policy/protocol Patient care data Peer review data Process improvement initiatives (C16 & 21) Regulatory requirement Other need identified (Explain): _____________________________

*REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► Adults learn most effectively when faced with meaningful problems they need to solve. Health professionals reflect on past experiences to frame important personal learning questions, reflection on action. They then seek information, including colleagues’ experiences. And think about how to apply it. When subsequently faced with a similar situation, health professionals then consider the applicability of the newly learned information, reflection in action, 3. Constructivist theories posit that learning occurs as individuals actively assimilate new knowledge with previous experience; 4 social

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learning theories hold that knowledge is shaped by interactions with respected others in similar environments or situations. Therefore it seems that case reviews, structured as social learning activities for discussing new knowledge in the context of previous and current experience, could lead to new learnings that might translate into clinical practice. Case-based, reflective, interactive sessions are more likely to impact practice than traditional didactic sessions. They allow individuals to share evidence, ideas, tacit (“how to”) knowledge, and practical experience in a safe environment for continuous learning. http://www.jcehp.com/vol28/2803price.asp Price, D. W., & Felix, K. G. (2008). Journal clubs and case conferences: from academic tradition to communities of practice. Journal of Continuing Education in the Health Professions, 28(3), 123-130. EDUCATIONAL OBJECTIVES: Upon completion of this conference, participants should be better able to:

Review results from various cath and cardiac surgery cases. Implement evidence-based strategies into clinical practice to improve care of the cardiac patient.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State) (If necessary, attach a list.) Moderators Ramon Lloret, M.D. Cardiologist Baptist and West Kendall Baptist Hospitals Faculty disclosure statement (as it should appear on course shell): Dr. Ramon Lloret has no commercial relationships to disclose. He will not include discussion of off-label (unapproved) usage. Individuals participating in this CME activity will identify any references to off-label product discussions and recommendations. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No

CME Dept. Leadership and Staff CME Committee Conference Director Others (Conference Coordinator, Planning Group, etc.) Huguette Acosta and Stacy Miller





If yes, describe the collaborative efforts. ________________________________________________________ COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. DATE REVIEWED: November 18, 2019 REVIEWED BY: Executive Committee Chairman

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Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: SMH Cardiology Journal Club 2020 CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 /each

DATE Time Location

Friday, January 24, 2020 12:00 pm- 1:00pm ED Conference room A&B

Spring Break 12:00 pm- 1:00pm ED Conference room A&B

3rd Friday, May 15, 2020 12:00 pm- 1:00pm ED Conference room A&B

Friday, September 25, 2020 12:00 pm- 1:00pm ED Conference room A&B

3rd Friday, November 20, 2020 12:00 pm- 1:00pm ED Conference room A&B

TARGET AUDIENCE: Cardiovascular Clinical Service Committee Members, including physicians and radiology technologists. CONFERENCE DIRECTOR and Moderator: Romeo Majano, M.D. CME MANAGER: Gabriela Fernandez EXPECTED NUMBER OF ATTENDEES: 20-30 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note keyword searches will pull from this description. Facilitated interactive journal clubs focused on problems shared by attendees can be useful learning formats for translating evidence into practice and documenting barriers to evidence translation. This structure provides continuity between sessions and reinforce previous learning and gathered short term self reported practice change outcomes data. SMH Cardiovascular Clinical Services Committee members with specialties in cardiology, vascular surgery, radiology and clinical leaders are invited to participate.

FACTORS OUTSIDE OUR CONTROL - List factors, outside our control and beyond learner performance that impact patient outcomes and contribute to the healthcare 'quality gap' being addressed. (C18) Patient: Non-compliance Lifestyle Resistance-to-change Cost of care/Lack of Insurance Physician: Non-compliance Resistance-to-change Communication Skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or No Treatment Modalities Limited or No Diagnostic Modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.

DESIRABLE PHYSICIAN ATTRIBUTES/COMPETENCIES (C6)

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ABMS/ACGME: Patient care and procedural skills Medical knowledge Practice-based learning and improvement Interpersonal and Communication Skills Professionalism Systems-based practice

INSTITUTE OF MEDICINE: Provide patient-centered care Work in interdisciplinary teams



PROFESSIONAL PRACTICE GAP (C2) The difference between what is (ACTUAL) and what should be (IDEAL).

What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► South Miami MCVI cardiologists do not participate on a journal club educational activity to keep current with up-to-date information on evidence-based practice and research findings. Indicate if the gap is related to need for change in either/or:

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

DESIRED OUTCOMES (GOAL): Answer one or more of the following questions. What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a 'perfect world', what would doctors be doing if this change were already implemented? What does optimal practice 'look like'? (C3) ► South Miami MCVI cardiologists will participate regularly in a journal club educational activity to remain current with up-to-date information on evidence-based practice and research findings. Indicated what this activity is designed to change.


NEEDS ASSESSMENT RESOURCES- HOW ARE EDUCATIONAL NEEDS IDENTIFIED? (Check all that apply and explain below.)

Best practice parameters Consensus of experts Disease prevention (C12) Joint Commission initiatives (C12) Mortality/morbidity statistics National Pt Safety Goals National/regional data New diagnostic/therapeutic modality (C12) New or updated policy/protocol Patient care data Peer review data Process improvement initiatives (C16 & 21) Regulatory requirement Other need identified (Explain): _____________________________ Research/literature review

REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► Journal clubs are staples of graduate and continuing medical education. Adults learn most effectively when faced with meaningful problems they need to solve. Health professionals reflect on past experiences to frame important personal learning questions. They then seek information, including colleagues’ experiences, and think about how to apply it. When subsequently faced with a similar situation, health professions then consider the applicability of the newly learned information (reflection in action). Therefore, journal clubs structured as social learning activities for discussing new knowledge in the context of previous and current experience could lead to new learning that might translate into clinical practice. They allow individuals to share evidence, ideas, tacit (“how to”) knowledge, and practical experience in a safe environment for continuous learning. Facilitated interactive journal clubs focused on problems shared by attendees can be useful learning formats for translating evidence into practice and documenting barriers to evidence translation. This structure provides continuity between sessions and reinforce previous learning and gathered short term self reported practice change outcomes data.http://www.jcehp.com/vol28/2803price.asp

EDUCATIONAL OBJECTIVES: Based on the gaps identified above, what are the learning objectives for this activity? Describe the performance* that should change if participants apply what they learn. *(or competence or patient outcome)

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Upon completion of this conference, participants should be better able to: -Implement evidence-based strategies into their clinical practice to improve care of the cardiac patient.

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

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

Quarterly Evaluations to include the following: ● As a result of what was discussed at this activity what do you intend to do differently? Identify at least two learning points that could be incorporated into your practice: _____________________ ● If you do not plan to implement any new strategies learned at this activity, please list any barriers or obstacles that might keep you from doing so: ____________________________________________ FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Romeo Majano, M.D. Cardiologist Baptist Health South Florida Faculty disclosure statement (as it should appear on course shell): Romeo Majano, M.D. has indicated he has no relevant financial relationships and his discussion will not include mention of investigational or off-label usage. Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No

CME Dept. Leadership and Staff CME Committee Conference Director Others (i.e.: Conference Coordinator, Planning Group etc.) ________________________________________

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

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



If yes, describe the collaborative efforts. SMH Cardiovascular Clinical Services Committee COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation general Continuing Medical Education fund. DATE REVIEWED: November 19, 2019 REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

47

Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: MCVI BHM Echo Lab Conference Series - Case Studies in Echocardiography DATE: 2020

DATE, TIME, LOCATION Monday October 21, 2019 5:30 PM, BHM 5 MCVI Side A&B, HH Board Room Monday January 20, 2020 5:30 PM, SMH Victor E. Clarke Center, Auditorium, HH Board Room Monday March 16, 2020 5:30 PM, BHM 5 MCVI Side A&B, HH Board Room Monday April 20, 2020 5:30 PM, SMH Victor E. Clarke Center, Auditorium, HH Board Room

CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 /ea CONFERENCE DIRECTOR/MODERATOR: Curtis Hamburg, M.D. CONFERENCE COORDINATOR: John Bayer/ Debbie Rodriguez LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



TARGET AUDIENCE: Echo Lab Committee Members and participating staff (Radiology Technologists, Nurses,

Sonographers) COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.





48

PROFESSIONAL PRACTICE GAP (C2) The difference between current practice (or performance) and optimal practice that we want to address with this

education.

Provide reference(s) in this section that support the current practice, the optimal practice and/or the practice gap(s). CURRENT PRACTICE: (What are they not doing or doing that needs to change?) Current practice shows that physicians and sonographers are struggling to apply best practices in echocardiography examinations for the cardiac patient. The rapid growth of echocardiography is a classic "good news/bad news" scenario. The bad news is that the examination has become quite sophisticated, and physicians and sonographers must struggle to keep up to date to provide state-of-the-art examinations. There is a learning curve for every new echocardiographic application. Physicians must put in sufficient time and effort to become expert in these new techniques. Like every other aspect of the practice of medicine, echocardiography must be taken seriously. Because the examination apparently does not produce any physical harm and is essentially painless, there is a tendency to let inadequately trained people perform and interpret echocardiograms. Having an echocardiographic expert and a clinical expert examine the same recording only provides added value to the test. (http://www.circ.ahajournals.org/cgi/content/full/93/7/1321) OPTIMAL PRACTICE: Physicians and sonographers will correlate clinical data and other modalities with echo results. Indicate what this activity is designed to change.




Echocardiography provides information about both the structure and the function of the heart, and this information is useful for establishing a diagnosis; assessing prognosis; and determining optimal therapy for several indications, including heart failure, ischemic heart disease, and valve disease. Echocardiography is noninvasive, is relatively inexpensive, and has few risks. http://www.acponline.org/clinical_information/journals_publications/ecp/marapr99/echocard.htm The evolution of echocardiography has been interesting and dramatic. The technology has grown and has become an integral part of the practice of cardiology. As with all technology, there are advantages and disadvantages. The principal disadvantage is the fact that education and training are imperative to provide high-quality examinations and proper interpretations. In addition, many of the diagnoses are still qualitative and subjective. The principal advantage is the amazing versatility of this technology. The wealth of information that can be provided both noninvasively with a transthoracic examination and invasively with either transesophageal or intravascular ultrasound is tremendous. The anatomic and physiological data provided frequently give definitive diagnoses. If performed properly and for the right reason, this test should be very cost effective and should be a major asset in the coming era of medical cost containment. There are many technological advances that should enhance this information. With technology such as digital recordings, it is hoped that the clinicians will have better access to these data and will be more comfortable in interacting with this important diagnostic tool. (http://www.circ.ahajournals.org/cgi/content/full/93/7/1321) WHAT IS THE REASON FOR THE GAP? What do we need to address in order to close the practice gap? (The Educational Need) Check one or more of the following: Knowledge Competence Performance

49

WHAT IS THE PRACTICE GAP? (C2) We need to improve physicians and sonographers competence to correlate clinical data and other modalities with echo results. EDUCATIONAL OBJECTIVES: Upon completion of this conference, participants should be better able to: Describe the roles of transesophageal echocardiography, stress echocardiography, 3-Dimensional echocardiography

and contrast echocardiography in clinical practice. Examine new technologies in the field of echocardiography. Discuss current controversies in echocardiography. Apply echocardiographic best practices strategies in clinical practice for routine and complex cardiovascular

disorders.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Faculty disclosure statement (as it should appear on course shell): Curtis Hamburg, M.D. has indicated he has no relevant financial relationships and his discussion will not include mention of investigational or off-label usage. Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No

CME Dept. Leadership and Staff CME Committee Conference Director Others (Conference Coordinator, Planning Group, etc.) Debbie Rodriguez





If yes, describe the collaborative efforts. MCVI Echo Lab Committee COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. DATE REVIEWED: November 19, 2019 REVIEWED BY: Executive Committee Chairman Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

50

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

CME ACTIVITY TITLE: Noninvasive Vascular Lab (NIVL) Quality Improvement Committee Meeting DATE/TIME: Jan-Dec 2020 LOCATIONS: 5MCVI Jan 8, April 8, September 9 and Nov. 11 CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1/ea CONFERENCE DIRECTOR: James Benenati, M.D. CONFERENCE COORDINATOR: Muhammad Hasan, MBBCH, RPVI, RVT / John Bayer MANAGER: Gabriela Fernandez ACTIVITY TYPE: RSS (No promotion/ No CEUs) TARGET AUDIENCE: PVL Committee Members. EXPECTED NUMBER OF ATTENDEES: 10-15 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. Baptist Health PVL Committee Members participate regularly in a clinical review educational activity to remain current with up-to-date information on evidence-based practice and research findings. Physicians and healthcare professionals members of the NIVL Quality Committee will correlate clinical data and other modalities with PVL cases. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.





51


The difference between what is (the “actual”) and what should be (the “ideal”). What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Physicians are currently not involved in a "community of practice" activity to discuss new knowledge in the context of previous and current experiences and translate the "new learnings" into clinical practice in the care of the cardiac patient who may benefit from a peripheral vascular lab (PVL) procedure. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Baptist Health PVL Committee Members participate regularly in a clinical review educational activity to remain current with up-to-date information on evidence-based practice and research findings. Physicians will correlate clinical data and other modalities with PVL cases. Indicate what this activity is designed to change.




REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► Adults learn most effectively when faced with meaningful problems they need to solve. Health professionals reflect on past experiences to frame important personal learning questions, reflection on action. They then seek information, including colleagues’ experiences. And think about how to apply it. When subsequently faced with a similar situation, health professionals then consider the applicability of the newly learned information, reflection in action, 3. Constructivist theories posit that learning occurs as individuals actively assimilate new knowledge with previous experience; 4 social learning theories hold that knowledge is shaped by interactions with respected others in similar environments or situations. Therefore it seems that case reviews, structured as social learning activities for discussing new knowledge in the context of previous and current experience, could lead to new learnings that might translate into clinical practice. Case-based, reflective, interactive sessions are more likely to impact practice than traditional didactic sessions. They allow individuals to share evidence, ideas, tacit (“how to”) knowledge, and practical experience in a safe environment for continuous learning. http://www.jcehp.com/vol28/2803price.asp

► The vascular lab plays a central role in the evaluation of acute and chronic venous disease, including such conditions as DVT, venous stasis, varicose veins, lower extremity venous ulcers, and the evaluation before and after hemodialysis access. http://www.cardiosource.org/news-media/publications/cardiology-magazine/2013/07/acc-releases-new-auc-for-peripheral-vascular-ultrasound-and-physiological-testing.aspx EDUCATIONAL OBJECTIVES: Upon completion of this conference, participants should be better able to:

Review results from various vascular cases. Implement evidence-based strategies into clinical practice to improve care of the vascular patient.

52

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

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







FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State) (If necessary, attach a list.) Moderator James F. Benenati, M.D. Medical Director, Noninvasive Vascular Laboratory Program Director, Vascular/Interventional Radiology Fellowship Baptist Cardiac & Vascular Institute Facilitator: Muhammad Hasan, MBBCH, RPVI, RVT Peripheral Vascular Laboratory Baptist Cardiac & Vascular Institute Faculty disclosure statement (as it should appear on course shell): Dr. James Benenati has indicated he is a consultant for Penumbra, Gore, Cook, Bard and Merit. His discussion will not include mention of investigational or off-label usage. Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No

CME Dept. Leadership and Staff CME Committee Conference Director Others (Conference Coordinator, Planning Group, etc.) Wanda Ramos - Coordinator





If yes, describe the collaborative efforts. _MCVI South Miami Hospital Quality Committee COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. DATE REVIEWED: November 21, 2017 REVIEWED BY: Executive Committee Chairman Committee

53



CME ACTIVITY TITLE: Cardiac Cath and Cardiac Surgery Clinical Review DATE/TIME: Jan-Dec 2020, 7:30-8:30 a.m. LOCATIONS: BHM - 3rd Floor Gallery Conf. Room SMH – 2nd Floor MCVI Conf Rm. (Reina A. Benitez)

January 30, 2020 Feb. 27, 2020 March 26, 2020 April 23, 2020 May 28, 2020 June 25, 2020 July 23, 2020 August 27, 2020 September 24, 2020 October 22, 2020 November 19, 2020

CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1/ea CONFERENCE DIRECTOR: Ramon Lloret, M.D. ([email protected]) CONFERENCE COORDINATOR: Huguette / Regina A. Benitez CME MANAGER: Gabriela Fernandez EVENT TYPE:

Symposium Conference Series RSS Enduring Material

TARGET AUDIENCE: Invited Baptist Health Cardiologists, Cardiovascular Surgeons and Cardiac Cath Lab nurses, sonographers and radiology technologists. EXPECTED NUMBER OF ATTENDEES: 10-15 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.

ARS Case Studies Didactic Lecture Enduring Material (DVD/Booklet) Internet Activity Enduring Material Internet Live Course (Live Webcast) Internet point-of-care activity Journal-based CME activity Learning from Teaching Live activity Manuscript review activity Panel PI CME activity Question & Answer Regularly Scheduled Series Simulation Test item writing activity

Other (specify)

54

COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. Baptist Health cardiologists and cardiac surgeons participate regularly in a clinical review educational activity to remain current with up-to-date information on evidence-based practice and research findings. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.





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

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


DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) Will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? (Check all that apply.) *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) ► Baptist Health cardiologists and cardiac surgeons will formulate new optimal patient care strategies in cardiovascular medicine by translating evidence into practice. Indicate what this activity is designed to change.



55


*REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► Adults learn most effectively when faced with meaningful problems they need to solve. Health professionals reflect on past experiences to frame important personal learning questions, reflection on action. They then seek information, including colleagues’ experiences. And think about how to apply it. When subsequently faced with a similar situation, health professionals then consider the applicability of the newly learned information, reflection in action, 3. Constructivist theories posit that learning occurs as individuals actively assimilate new knowledge with previous experience; 4 social learning theories hold that knowledge is shaped by interactions with respected others in similar environments or situations. Therefore it seems that case reviews, structured as social learning activities for discussing new knowledge in the context of previous and current experience, could lead to new learnings that might translate into clinical practice. Case-based, reflective, interactive sessions are more likely to impact practice than traditional didactic sessions. They allow individuals to share evidence, ideas, tacit (“how to”) knowledge, and practical experience in a safe environment for continuous learning. http://www.jcehp.com/vol28/2803price.asp Price, D. W., & Felix, K. G. (2008). Journal clubs and case conferences: from academic tradition to communities of practice. Journal of Continuing Education in the Health Professions, 28(3), 123-130. EDUCATIONAL OBJECTIVES: Upon completion of this conference, participants should be better able to:

Review results from various cath and cardiac surgery cases. Implement evidence-based strategies into clinical practice to improve care of the cardiac patient.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State) (If necessary, attach a list.) Moderators Ramon Lloret, M.D. Cardiologist Baptist and West Kendall Baptist Hospitals Faculty disclosure statement (as it should appear on course shell): Dr. Ramon Lloret has no commercial relationships to disclose. He will not include discussion of off-label (unapproved) usage. Individuals participating in this CME activity will identify any references to off-label product discussions and recommendations. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No

CME Dept. Leadership and Staff CME Committee Conference Director Others (Conference Coordinator, Planning Group, etc.) Huguette Acosta and Stacy Miller


56




If yes, describe the collaborative efforts. ________________________________________________________ COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. DATE REVIEWED: November 18, 2019 REVIEWED BY: Executive Committee Chairman APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A


CME ACTIVITY TITLE: MCVI BHM Echo Lab Conference Series - Case Studies in Echocardiography DATE: 2020

DATE, TIME, LOCATION Monday October 21, 2019 5:30 PM, BHM 5 MCVI Side A&B, HH Board Room Monday January 20, 2020 5:30 PM, SMH Victor E. Clarke Center, Auditorium, HH Board Room Monday March 16, 2020 5:30 PM, BHM 5 MCVI Side A&B, HH Board Room Monday April 20, 2020 5:30 PM, SMH Victor E. Clarke Center, Auditorium, HH Board Room

CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 /ea CONFERENCE DIRECTOR/MODERATOR: Curtis Hamburg, M.D. CONFERENCE COORDINATOR: John Bayer LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.

ARS Case Studies Didactic Lecture Enduring Material (DVD/Booklet) Internet Activity Enduring Material Internet Live Course (Live Webcast) Internet point-of-care activity Journal-based CME activity Learning from Teaching Live activity Manuscript review activity Panel

PI CME activity Question & Answer Regularly Scheduled Series Simulation Test item writing activity Other (specify)

57

TARGET AUDIENCE: Echo Lab Committee Members and participating staff (Radiology Technologists, Nurses,

Sonographers and Respiratory Therapists) COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.





PROFESSIONAL PRACTICE GAP (C2) The difference between current practice (or performance) and optimal practice that we want to address with this education.

Provide reference(s) in this section that support the current practice, the optimal practice and/or the practice gap(s). CURRENT PRACTICE: (What are they not doing or doing that needs to change?) Current practice shows that physicians and sonographers are struggling to apply best practices in echocardiography examinations for the cardiac patient. The rapid growth of echocardiography is a classic "good news/bad news" scenario. The bad news is that the examination has become quite sophisticated, and physicians and sonographers must struggle to keep up to date to provide state-of-the-art examinations. There is a learning curve for every new echocardiographic application. Physicians must put in sufficient time and effort to become expert in these new techniques. Like every other aspect of the practice of medicine, echocardiography must be taken seriously. Because the examination apparently does not produce any physical harm and is essentially painless, there is a tendency to let inadequately trained people perform and interpret echocardiograms. Having an echocardiographic expert and a clinical expert examine the same recording only provides added value to the test. (http://www.circ.ahajournals.org/cgi/content/full/93/7/1321) OPTIMAL PRACTICE: Physicians and sonographers will correlate clinical data and other modalities with echo results. Indicate what this activity is designed to change.



Best practice parameters Consensus of experts Disease prevention (C12) Joint Commission initiatives (C12) Mortality/morbidity statistics National Patient Safety Goals National/regional data New diagnostic/therapeutic modality (C12)

58

New or updated policy/protocol Patient care data Peer review data Process improvement initiatives (C16 & 21) Regulatory requirement Other need identified (Explain): _____________________________ Research/literature review

Echocardiography provides information about both the structure and the function of the heart, and this information is useful for establishing a diagnosis; assessing prognosis; and determining optimal therapy for several indications, including heart failure, ischemic heart disease, and valve disease. Echocardiography is noninvasive, is relatively inexpensive, and has few risks. http://www.acponline.org/clinical_information/journals_publications/ecp/marapr99/echocard.htm The evolution of echocardiography has been interesting and dramatic. The technology has grown and has become an integral part of the practice of cardiology. As with all technology, there are advantages and disadvantages. The principal disadvantage is the fact that education and training are imperative to provide high-quality examinations and proper interpretations. In addition, many of the diagnoses are still qualitative and subjective. The principal advantage is the amazing versatility of this technology. The wealth of information that can be provided both noninvasively with a transthoracic examination and invasively with either transesophageal or intravascular ultrasound is tremendous. The anatomic and physiological data provided frequently give definitive diagnoses. If performed properly and for the right reason, this test should be very cost effective and should be a major asset in the coming era of medical cost containment. There are many technological advances that should enhance this information. With technology such as digital recordings, it is hoped that the clinicians will have better access to these data and will be more comfortable in interacting with this important diagnostic tool. (http://www.circ.ahajournals.org/cgi/content/full/93/7/1321) WHAT IS THE REASON FOR THE GAP? What do we need to address in order to close the practice gap? (The Educational Need) Check one or more of the following: Knowledge Competence Performance WHAT IS THE PRACTICE GAP? (C2) We need to improve physicians and sonographers competence to correlate clinical data and other modalities with echo results. EDUCATIONAL OBJECTIVES: Upon completion of this conference, participants should be better able to: Describe the roles of transesophageal echocardiography, stress echocardiography, 3-Dimensional echocardiography and

contrast echocardiography in clinical practice. Examine new technologies in the field of echocardiography. Discuss current controversies in echocardiography. Apply echocardiographic best practices strategies in clinical practice for routine and complex cardiovascular disorders.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Faculty disclosure statement (as it should appear on course shell): Curtis Hamburg, M.D. has indicated he has no relevant financial relationships and his discussion will not include mention of investigational or off-label usage. Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No

59

CME Dept. Leadership and Staff CME Committee Conference Director Others (Conference Coordinator, Planning Group, etc.) Debbie Rodriguez





If yes, describe the collaborative efforts. MCVI Echo Lab Committee COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. DATE REVIEWED: November 19, 2019 REVIEWED BY: Executive Committee Chairman Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: South Miami Hospital Pulmonary Hypertension Journal Club

DATES/ TIMES: 2020, First Wednesday of Every Other Month, 8 a.m. Jan 8 Feb 12 Mar 11 Apr 8 May 13 Jun 10 Jul 8

Aug 12 Sep 9 Oct 14 Nov 11 Dec 9

LOCATION: South Miami Hospital, MCVI Conference Room, 2nd Floor

CREDIT HOURS APPLIED FOR: 1 Cat. 1/each CONFERENCE DIRECTOR: Francisco Javier Jimenez-Carcamo, M.D., Ph.D. CONFERENCE COORDINATOR: Luella Reyes/ Robert P. Ramirez CME MANAGER: Gabriela Fernandez EVENT TYPE:

Symposium Conference Series RSS

60

Enduring Material AMA/PRA LEARNING FORMAT:

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

TARGET AUDIENCE: Physicians, ARNPs and RNs of the SMH Pulmonary Hypertension Clinic EXPECTED NUMBER OF ATTENDEES: 10-15 CHARGE: 0 TYPE OF MEETING (FORMAT): Must be appropriate to the setting, objectives and desired results (C5). Check all that apply.

Live Didactic Lecture ARS Question & Answer

Case Studies

Panel Enduring Material Internet-Home Study Other (specify)

Journal club review/discussion

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

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

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

61

Other (Explain): _____________________________

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


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

WHAT IS/ARE THE CURRENT PRACTICE* AND/OR THE PRACTICE GAP*? What are physicians doing (or not doing) that needs to change? Describe the practice gap. ► Physicians are currently not involved in a "community of practice" activity to discuss new knowledge in the context of previous and current experiences and translate the "clinical pearls" into clinical practice. WHAT IS THE OPTIMAL PRACTICE*? (In a 'perfect world', what would doctors be doing? What does optimal practice 'look like'?) ► Physicians will formulate new optimal patient care strategies in pulmonary hypertension care by translating evidence-based data presented into their clinical practice. WHAT IS THE REASON FOR THIS GAP? Indicate if the gap is related to either/or:

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

DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) And will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? (Check all that apply.) *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) ► Physicians participate in journal club discussions to share current, evidence-based treatment strategies that will improve their delivery of care. *REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► Journal clubs are staples of graduate and continuing medical education. Adults learn most effectively when faced with meaningful problems they need to solve. Health professionals reflect on past experiences to frame important personal learning questions. They then seek information, including colleagues’ experiences, and think about how to apply it. When subsequently faced with a similar situation, health professions then consider the applicability of the newly learned information (reflection in action). Therefore, journal clubs structured as social learning activities for discussing new knowledge in the context of previous and current experience could lead to new learning that might translate into clinical practice. They allow individuals to share evidence, ideas, tacit (“how to”) knowledge, and practical experience in a safe environment for continuous learning. Facilitated interactive journal clubs focused on problems shared by attendees can be useful learning formats for translating evidence into practice and documenting barriers to evidence translation. .http://www.jcehp.com/vol28/2803price.asp. EDUCATIONAL OBJECTIVE Upon completion of this conference, participants should be better able to implement evidence-based strategies into their clinical practice to improve delivery of care in pulmonary hypertension patients. COMPETENCIES: What desirable physician attributes (e.g. professional competencies) set forth by national organizations of medicine (e.g.: IOM, ACGME, ABMS) does this activity address? (C6)


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Quarterly Evaluations to include the following: ● As a result of what was discussed at this activity what do you intend to do differently? Identify at least two learning points that could be incorporated into your practice: _____________________ ● If you do not plan to implement any new strategies learned at this activity, please list any barriers or obstacles that might keep you from doing so: ____________________________________________

OUTCOMES MEASUREMENT: (List strategy measurement questions and/or other measurement plans.) (C11) MODERATOR: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Francisco J. Jimenez-Carcamo, M.D., Ph.D. Cardiologist, Baptist and South Miami Hospitals Miami, Florida Francisco J. Jimenez-Carcamo, M.D., Ph.D. indicated that he is a member of the Speakers’ Bureau for AKcea, Bayer, Actelion, Boston Scientific and United Therapeutics. Dr. Jimenez will not include off-label or unapproved product usage in his presentation(s) or discussion(s). Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3)

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

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

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

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

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

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

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Yes No Are we collaborating with internal departments in a purposeful manner to achieve common interests? If yes, list collaborative efforts related to this CME activity that support achievement of our CME Mission. This course was planned in collaboration with the Miami Cardiac & Vascular Institute at South Miami Hospital. DATE REVIEWED: November 26, 2019 REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Cat 1/each Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A


CME ACTIVITY TITLE: Thoracic Oncology Tumor Board DATE: Weekly – Wednesday TIME: 7:30-8:30 a.m. Approvals: Original approval: June 2010 to June 2011; Course renewed: January 2011; December 2011; December 2012; November 2013; November 2014, December 2016, November 2018 Course expires: November 2017, November 2018, November 2019, November 2020 CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 per tumor board CHARGE: 0 LOCATION: Miami Cancer Institute Boardroom – 3W280 South Miami- Videoconference, 5th floor training room (located between clinical lab and pathology. TARGET AUDIENCE: Medical Oncologists, Radiation Oncologists, Cardiothoracic Surgeons, Pathologists, Pulmonologists, Pharmacists, Nurses, Social Workers, Radiologic Technologists and Patient Care Facilitators and all personnel involved in the care of the lung cancer patient. EXPECTED NUMBER OF ATTENDEES: 20-25 per tumor board

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

Live Didactic Lecture ARS Question & Answer Case Studies

Panel Enduring Material Internet-Home Study Other (specify) Tumor Board_

. NEEDS ASSESSMENT RESOURCES- HOW ARE EDUCATIONAL NEEDS IDENTIFIED? (Check and explain.)

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

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

Other (Explain): _____________________________ COURSE DESCRIPTION: A multidisciplinary team approach to care is fostered through peer-to-peer discussion and collaboration. The team diagnosis and treatment, includes radiological, pathological findings and immunohistochemical testing, bridges these gaps across the continuum of care in order to enhance the overall quality of patient-centered care.

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


WHAT IS/ARE THE CURRENT PRACTICE* and/or THE PRACTICE GAP*? Standard of care may not always include a multidisciplinary team approach to diagnosis and treatment. Gaps in communication between healthcare providers and key specialists can at times delay optimal delivery of care in cancer patients. WHAT IS THE OPTIMAL PRACTICE*? Physicians collaborate in a multidisciplinary team in the management of their thoracic oncology patients to streamline optimal patient care. WHAT IS THE REASON FOR THIS GAP? Indicate if the gap is in physician:


DESIRED OUTCOMES (GOAL): What are the desired or expected outcomes of this conference? What should change or improve as a result of this CME activity? (C3) Will this result in a change in Competence? -or- Performance? -or- Patient Outcomes*? *(NOTE: If 'patient outcomes' is selected, there must be an achievable measurement plan.) ►Physicians present cases through the Thoracic Oncology Tumor Board when developing treatment plans for their thoracic oncology patients collaborating in multidisciplinary team approach. *REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ►The thoracic oncology multidisciplinary teams (MDT) are playing an increasing role in the management of thoracic malignancies. These teams have a great potential to improve the patient care and the health care system, however, they are faced by many challenges. To realize the full potential of these teams, a better understanding of their functions, roles, benefits and challenges from all involved including teams members and leadership is crucial. The multidisciplinary approach has become very crucial recently due to the ever-increasing complexity of medical knowledge and the huge wealth of information that is available to physicians, in addition to the complexity of the various medical procedures and interventions available for cancer care. Furthermore, the development of sub-specialization in

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very narrow medical disciplines has made specialist expertise and input more valuable. The MDT plays a critical role in the whole spectrum of cancer management including diagnosis, staging, treatment and palliative care. (Ann Thorac Med. 2008 Jan–Mar; 3(1): 34–37., Thoracic oncology multidisciplinary teams: Between the promises and challenges, doi: 10.4103/1817-1737.38395.) Baptist South Miami Regional Cancer Center received 294 new cases of lung cancer in 2009. EDUCATIONAL OBJECTIVES: Describe what doctors will be able to do after they leave the classroom. What is the "take-away" that they can put into practice. What new strategies, tools, treatment plans, approaches, etc. will they be able to implement, utilize, do, etc. as a result of attending this CME activity? Upon completion of this conference, participants should be better able to:

Implement optimal course of treatment for thoracic cancer patients. Utilize multiple disciplinary approaches to determine diagnosis and treatment options, including radiological

findings. Determine cancer staging using various imaging modalities of thoracic cancers. Promote a multidisciplinary team approach by bridging gaps across the continuum of care in order to enhance the

overall quality of patient-centered thoracic cancer care. MODERATOR: Paul Kaywin, M.D. CORE GROUP OFCONTRIBUTORS: Pathologists: Edwin Gould, M.D., Rajshri Shah, M.D. Douglas Reale, M.D., Norberto Cartagena, Daniel Rubin, M.D, Ronald Goerss, M.D., Christian Otrakji, M.D. and Niloofar Nasseri-Nik, M.D. Andrew Renshaw, M.D., Andrea Subhawong, M.D. Michaela Nguyen, M.D. Radiologist: Juan Carlos Batlle, M.D., Hao Vuong, M.D., Lawrence Elgarresta, M.D., Surya Chundru, M.D. Radiation Oncologist: Andre Abitbol, M.D., Allie Garcia-Serra, M.D.. Minesh Mehta, M.D., Michael Chuong, M.D., Marcio Fagundes, M.D. Steven Olszewski, M.D., Maria-Amelia Rodrigues, M.D. Cardiothoracic Surgeon: Mark Dylewski, M.D., John DeRosimo, M.D. Medical Oncologist: Federico Albrecht, M.D., Frances Behrmann, M.D., Fernando de Zarraga, M.D., Steven Fein, M.D., Leonard Kalman, M.D., Alberto Larcada, M.D., Antonio Muina, M.D., Lisa Reale, M.D., Michael Troner, M.D., Grace Wang, M.D. and Siddhartha Venkatappa M.D., Santiago Aparo, M.D., Victor Guardiola, M.D. ► Physician moderator takes responsibility for facilitating the discussion and ensuring that conversations are evidenced-based and do not promote commercial interests. They are also responsible for disclosing when off-label treatment approaches have been addressed. ► Annual disclosures are secured from core group of contributors. ►Continuing Medical Education Department representatives attend at least one tumor board per quarter. COMPETENCIES: What desirable physician attributes (e.g. professional competencies) set forth by national organizations of medicine (e.g.: IOM, ACGME, ABMS) does this activity address? (C6) COMPETENCIES (Desirable Physician Attributes as per IOM, ACCGME and ABMS):


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

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

OUTCOMES MEASUREMENT: (List strategy measurement questions and/or other measurement plans.) (C11) ► The following questions are included in quarterly evaluations to access impact on performance and patient outcomes. ▪ Please describe one or two instances where patient outcomes were influenced by strategies you implemented as a

result of the recommendations suggested at the Head and Neck Tumor Board. ▪ What have you done differently or what do you intend to do differently in the treatment of your patients as a result of

what you learned during the Head and Neck Conference Series? What new strategies have you or, or will you apply in your practice of patient care?

▪ If applicable, what obstacles prevented you from implementing new strategies learned at the Tumor Board meetings? ▪ If applicable, what has prevented you from presenting cases at the Head and Neck Tumor Boards? ▪ Comments about these Tumor Board meetings. ▪ Comments/Suggestions about the OVERALL Baptist Health CME Program.

MONITORING SYSTEM PROMOTIONAL MATERIALS: Created in compliance with ACCME criteria by Medical Education Department.

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MECHANISM FOR VERIFYING PHYSICIAN PARTICIPATION: Attendees are credited based on sign-in sheets provided for each lecture. Attendees are required to sign-in for credit. Disclosures are included on sign-in sheet. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3)

Yes No CME Program Manager: Marie Vital Acle Conference Director (see above) Medical Director Corporate Director Medical Education Committee Others (i.e.: Conference Coordinator, Department representative, etc.) Vanessa Garcia, Secretary

Annual disclosure forms are required from moderators, core group of contributors, CME program manager and on-site coordinator with department. (Criterion 7) COMMERCIAL SUPPORT: The Baptist Health Medical Education Department will not solicit or accept grants from commercial interests to support CME activities, thereby strengthening the CME Program's commitment to be independent and free of the influence of commercial interests. Please indicate here if support will come from the Foundation general medical education fund. BARRIERS TO PHYSICIAN CHANGE: (C19)Is this activity focused on ‘overcoming, addressing, or removing barriers to physician change' applicable to our learners? Yes No If 'yes', list the barrier(s) identified and include relevant data and information about the barriers. Lack of Insurance OVERALL PROGRAM CHANGES: Does this CME activity reflect implementation (C14) of any interventions or changes that came about as a result of our overall CME program evaluation and analysis (C13) to meet the CME mission? Yes No If yes, please describe the related CME program change. And describe how the impact of the related program improvement will be measured and documented? (C15) NON-EDUCATION STRATEGIES: Explain what we are doing (CME or BHSF) -- or what we could do -- to enhance change as an adjunct (in addition to) to this CME activity? (C17) These would be tactics and tools to facilitate change that go beyond this CME activity.

Process redesign or new protocol Reminders (Posters, mailings, email blasts) New order sheets Other tools or tactics COLLABORATION: Are we engaged in collaborative and cooperative projects with other internal or external stakeholders that are related to this CME activity? (C20) Are we collaborating in partnership with other organizations in a purposeful manner to achieve common interests? Yes No If yes, list collaborative efforts related to this CME activity that support achievement of our CME Mission. Regularly Scheduled Series foster collaboration across multiple specialties treating specific medical conditions. Patient care and interdisciplinary communication are improved through these types of educational meetings. DATE REVIEWED: Original Approval:__ _________ ______ Course renewal approval: _________________ REVIEWED BY: EXECUTIVE COMMITTEE CHAIRMAN APPROVED: YES NO Category 1 Credits: 1 Continuing Psychology Education credits: _0__ Revised January 5, 2011

Revised December 6, 2011

Revised November 13, 2012





Revised November 6, 2018 Revised November 13, 2019

Form Rev. 030316

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CME ACTIVITY TITLE: Bethesda General Cancer Tumor Board DATE: See Attached Schedule TIME: 12:00 Noon CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 each

LOCATION: Rad/Onc Conference Room, Bethesda Health City, Entrance A LIVE WEBCAST TARGET AUDIENCE: Medical Oncologists, Radiation Oncologists, General Surgeons, Pathologists, Radiologists, Pharmacists, Nurses, Social Workers, Radiologic Technologists, Patient Care Facilitators and all personnel involved in the care of the cancer patient. CONFERENCE DIRECTOR: Felix Rodriguez, MD CME MANAGER: Katie Deane CONFERENCE COORDINATOR: Diana Slone, CTR EXPECTED NUMBER OF ATTENDEES: 15-20 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.


Live activity Manuscript review activity Panel PI CME activity Question & Answer Regularly Scheduled Series Simulation Test item writing activity Other (specify) Tumor Board

COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. A multidisciplinary team approach to care is fostered through peer-to-peer discussion and collaboration. The team diagnosis and treatment, includes radiological, pathological findings and immunohistochemical testing, bridges these gaps across the continuum of care in order to enhance the overall quality of patient-centered cancer care. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.

DESIRABLE PHYSICIAN ATTRIBUTES/COMPETENCIES (C6) ABMS/ACGME: Patient care and procedural skills Medical knowledge Practice-based learning and improvement Interpersonal and Communication Skills Professionalism Systems-based practice INSTITUTE OF MEDICINE: Provide patient-centered care Work in interdisciplinary teams

Employ evidence-based practice Apply quality improvement Utilize informatics

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov

"General" Tumor Board Clayton Conference Room

South 12:00 PM

14 11 10 7 5 2 14 11 6 3

28 25 24 21 19 16 30

28 25 22 20 17

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INTERPROFESSIONAL EDUCATION COLLABORATIVE: Values/ethics for interprofessional practice



What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Standard of care may not always include a multidisciplinary team approach to diagnosis and treatment. Gaps in communication between healthcare providers and key specialists can at times delay optimal delivery of care for cancer patients. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Physicians present cases to the Cancer Tumor Board when developing treatment plans for their cancer patients collaborating in multidisciplinary team approach. A Quarterly Evaluation Summary of all attendees will assess impact on patient outcomes. Indicate what this activity is designed to change.




REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► Care for cancer is increasingly complex and often requires specialized expertise from multiple disciplines. Tumor board reviews provide a multidisciplinary approach to treatment planning that involves doctors from different specialties reviewing and discussing the medical condition and treatment of patients ( 1 ). They serve to educate providers, to increase shared appreciation of different specialists’ perspectives on the approach to specific cancers, and to assist in management decisions for specific patients, although the functions may vary. Tumor boards have been an accepted and established part of the care of cancer patients for decades ( 2 ). They are perceived to be so important that the American College of Surgeon’s Commission on Cancer Program accreditation requires cancer programs to have a multidisciplinary cancer conference that prospectively reviews cases and discusses management decisions ( 3 ). Keating, N. L., Landrum, M. B., Lamont, E. B., Bozeman, S. R., Shulman, L. N., & McNeil, B. J. (2013). Tumor boards and the quality of cancer care. Journal of the National Cancer Institute, 105(2), 113-121. ► Bethesda Cancer Program: analytic cases (cases diagnosed and treated at Bethesda) 1,035 based on 2017 data

EDUCATIONAL OBJECTIVES: Based on the gaps identified above, what are the learning objectives for this activity? Describe the performance* that should change if participants apply what they learn. *(or competence or patient outcome) Upon completion of this conference, participants should be better able to: Implement optimal course of treatment for cancer patients. Utilize multiple disciplinary approaches to diagnosis and treatment options, including radiological findings, pathological

findings and immunohistochemical testing.

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Determine cancer staging using various imaging modalities. Promote a multidisciplinary team approach by bridging gaps across the continuum of care in order to enhance the overall

quality of patient-centered cancer care.

CONTENT: case-based, cancer conference presentation and discussion. Each conference includes presentation of patient cases and diagnostic findings, options for genetic testing, nurse navigation findings, and a multidisciplinary peer-to-peer discussion to determine optimal treatment plan.

Discussion will include treatment modalities for surgery, chemotherapy, and radiation both in combination or alone based on patient prognosis and evidence-based treatment guidelines.

The entire general cancer multidisciplinary team will discuss their specialty as it pertains to the diagnosis and treatment of cancer. The multidisciplinary team includes surgeons, radiologists, pathologists, medical oncologists, and radiation oncologists.

Cancer staging according to appropriate guidelines (AJCC or SEER) Treatment consensus will be recorded on individual cancer forms by nurse navigator or cancer registry staff

Potential Topics for General Cancer Tumor Board

Non small cell lung cancer Adenocarcinomas, Types of pleural invasion EGFR mutation Treatment for lung cancer Treatment for colon cancer Treatment for bladder Kidney cancer Mediastinal dissection Neuroendocrine carcinoma (NEC) Carcinomas in polyps Maintenance therapy Rare or unusual cancer sites

METS melanoma Chemoradiotherapy Acute myeloid leukemia B-cell lymphoma Treatment for ovarian cancer Management of Renal cell carcinoma Advance treatment for bladder cancer Radiation management Surgical management of bladder cancer Intravesical chemotherapy Ablation Subsequent treatment for clear cell

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FORMAT Case presentation/s: Findings from patients’ diagnostic tests are shared with the group as well as pertinent

patient history. Peer-to-peer discussion: Treatment plans are developed based on multispecialty discussion.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) MODERATOR: Felix Rodriguez, M.D. CORE GROUP OF CONTRIBUTORS Pathologists: Jennifer Olivella, D.O. Radiologists: Carol Adami, M.D., Darlene Da Costa, M.D., Ariana Alvarez, M.D. Radiation Oncologists: Alicia Gittleman, M.D., James Parsons, M.D. Surgeon: Jonathan Waxman, M.D., Lynn Geoffrey, M.D., Jessica L. Buicko, M.D. Medical Oncologists: Felix Rodriguez, M.D., Mindy Bohrer, M.D. Genetics Professional: Jessica McAfee, ARNP-BC, Dawn Blackshear Nurse Navigation: Sharon Scruggs, R.N., Michele Goldberg, R.N. Planning Committee Members: Diana Slone, CTR, Polli Svoboda, RHIT ► Physician moderators take responsibility for facilitating the discussion and ensuring that conversations are evidenced-based and do not promote commercial interests. They are also responsible for disclosing when off-label treatment approaches have been addressed. ►A department coordinator supports these efforts. ► Annual disclosures are secured from core group of contributors. DISCLOSURES: In accordance with the Standards of Commercial Support of the Accreditation Council for Continuing Medical Education (ACCME), which requires balance, independence, objectivity and scientific rigor in all CME programming, Baptist Health has identified and resolved conflicts of interest of all individuals that control CME content, including faculty, planners and members of the Continuing Medical Education Committee and the Continuing Medical Education Department. Dr. Carol Adami has indicated that she, is on the speakers’s bureau for Myriad Genetics. All other contributors and all core group members have indicated that they have no significant financial relationship with commercial interest to disclose. Dr. Adami has indicated that her discussion will not include mention of investigational or off-label usage. In addition, all other moderators do not anticipate comments will include discussion of unapproved off-label use of any products. Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No




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If yes, describe the collaborative efforts. ________________________________________________________ This tumor board is planned in collaboration with the Bethesda Hospitals’ Cancer Program. Tumor boards foster collaboration across multiple specialties treating specific medical conditions. Patient care and interdisciplinary communication are improved through these types of educational meetings. COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. (ETHOS CONTENT) YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title.

CME ACTIVITY TITLE: Bethesda Breast Cancer Tumor Board DATE: See Attached Schedule TIME: 12:00 Noon CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 each

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

7 4 3 14 12 9 7 4 1 13 10 8

21 18 17 31

28 26 23 21 18 15 29

27

LOCATION: Rad/Onc Conference Room, Bethesda Health City, Entrance A LIVE WEBCAST TARGET AUDIENCE: Medical Oncologists, Radiation Oncologists, Breast Cancer Surgeons, General Surgeons, Pathologists, Radiologists, Gynecologists, Pharmacists, Nurses, Social Workers, Radiologic Technologists, Patient Care Facilitators and all personnel involved in the care of the breast cancer patient. CONFERENCE DIRECTOR: Raul Arroyo, M.D. CME MANAGER: Katie Deane EXPECTED NUMBER OF ATTENDEES: 15-20 CHARGE: 0

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LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.


Live activity Manuscript review activity Panel PI CME activity Question & Answer Regularly Scheduled Series Simulation Test item writing activity Other (specify) Tumor Board

COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. A multidisciplinary team approach to care is fostered through peer-to-peer discussion and collaboration. The team diagnosis and treatment, includes radiological, pathological findings and immunohistochemical testing, bridges these gaps across the continuum of care in order to enhance the overall quality of patient-centered breast cancer care. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.


Interpersonal and Communication Skills Professionalism Systems-based practice INSTITUTE OF MEDICINE: Provide patient-centered care Work in interdisciplinary teams




What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Standard of care may not always include a multidisciplinary team approach to diagnosis and treatment. Gaps in communication between healthcare providers and key specialists can at times delay optimal delivery of care for cancer patients. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Physicians present cases to the Breast Cancer Tumor Board when developing treatment plans for their breast cancer patients collaborating in multidisciplinary team approach. A Quarterly Evaluation Summary of all attendees will assess impact on patient outcomes. Indicate what this activity is designed to change.

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REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► A multidisciplinary focus entails prevention, diagnosis and treatment had led to significant strides in the reduction of breast cancer incidence and mortality. Additionally, breast cancer management has become increasingly complex, requiring comprehensive assessment and review of multiple issues that include the role of genetic testing, imaging and breast magnetic resonance imaging, surgical and reconstructive options, and a variety of new adjuvant therapies. It has become more evident that a multidisciplinary team approach that involves a spectrum of breast experts is necessary to provide optimal care to patients. This team includes medical oncologists, breast radiologists, breast pathologists, surgical breast specialists, radiation oncologists, geneticists, and primary care physicians. (Mayo Clin Proc. A Multidisciplinary Approach to the Management of Breast Cancer, Part 1: Prevention and Diagnosis, 2007;82(8):999-1012) ► Bethesda Cancer Program: Breast Cancer local incidence estimate for 2019: 1096

EDUCATIONAL OBJECTIVES: Based on the gaps identified above, what are the learning objectives for this activity? Describe the performance* that should change if participants apply what they learn. *(or competence or patient outcome) Upon completion of this conference, participants should be better able to: Implement optimal course of treatment for breast cancer patients. Utilize multiple disciplinary approaches to diagnosis and treatment options, including radiological findings, pathological

findings and immunohistochemical testing. Determine cancer staging using various breast imaging modalities. Promote a multidisciplinary team approach by bridging gaps across the continuum of care in order to enhance the

overall quality of patient-centered breast cancer care.

CONTENT: Case-based, tumor board presentation and discussion. Each meeting includes presentation of patient cases, diagnostic findings and a peer-to-peer discussion to determine optimal treatment plan.

Treatment modalities to be discussed include surgery, chemotherapy and radiation both in combination or alone based on patient prognosis.

The entire breast cancer multidisciplinary team will discuss their specialty area as it pertains to the diagnosis and treatment of breast cancer including discussion of test findings. The team includes oncologists, radiologists, surgeons, radiation oncologists and pathologists.

Breast cancer is staged according to American Joint Commission on Cancer guidelines which use Primary Tumor (T), Regional Lymph Nodes (N), and Distant Metastasis (M) to establish a Stage Grouping.

A team approach to care is fostered through peer-to-peer discussion and collaboration for treatment plan development and follow-up through participation in tumor boards.

Potential Topics for Breast Cancer Tumor Board

Multidisciplinary discussion for breast cancer treatment Appropriate TNM staging RAD/ONC options Breast reconstruction Genetic testing

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FORMAT

Case presentation/s: Findings from patients’ diagnostic tests are shared with the group as well as pertinent patient history.

Peer-to-peer discussion: Treatment plans are developed based on multispecialty discussion. EVALUATION METHODS: Analyze the overall changes in competence, performance or patient outcomes as a result of this CME activity. (C11)




FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) MODERATOR: Raul Arroyo, M.D. CORE GROUP OF CONTRIBUTORS Pathologists: Kenneth Bengtson, M.D., Jennifer Olivella, D.O. Radiologists: Carol Adami, M.D., Darlene Da Costa, M.D., David O’Connor, M.D., Ariana Alvarez, M.D. Radiation Oncologists: Alicia Gittleman, M.D., James Parsons, M.D. Surgeon: L. Raul Arroyo, M.D., Medical Oncologists: Mindy Bohrer, M.D., Felix Rodriguez-Pinero, M.D., Jacy Villa, M.D., Miguel Araneo, M.D. Genetics Professional: Jessica McAfee, ARNP-BC, Dawn Blackshear, MSN, APRN, FNP-BC Planning Committee Members: Diana Slone, CTR, Polli Svoboda, RHIT ► Physician moderators take responsibility for facilitating the discussion and ensuring that conversations are evidenced-based and do not promote commercial interests. They are also responsible for disclosing when off-label treatment approaches have been addressed. ►A department coordinator supports these efforts. ► Annual disclosures are secured from core group of contributors. DISCLOSURES: In accordance with the Standards of Commercial Support of the Accreditation Council for Continuing Medical Education (ACCME), which requires balance, independence, objectivity and scientific rigor in all CME programming, Baptist Health has identified and resolved conflicts of interest of all individuals that control CME content, including faculty, planners and members of the Continuing Medical Education Committee and the Continuing Medical Education Department. Dr. Carol Adami has indicated that she, is on the speakers’s bureau for Myriad Genetics. All other contributors and all core group members have indicated that they have no significant financial relationship with commercial interest to disclose. Dr. Adami has indicated that her discussion will not include mention of investigational or off-label usage. In addition, all other moderators do not anticipate comments will include discussion of unapproved off-label use of any products. Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No


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If yes, describe the collaborative efforts. ________________________________________________________ This tumor board is planned in collaboration with the Bethesda Hospitals’ Cancer Program. Tumor boards foster collaboration across multiple specialties treating specific medical conditions. Patient care and interdisciplinary communication are improved through these types of educational meetings. COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. (ETHOS CONTENT) YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title.


CME ACTIVITY TITLE: Advanced Cardiac Life Support (ACLS) Two-day Provider Course and One-day Renewal Course (ACLS-R) DATE: January 2020- December 2020 See Attached Schedule – Dates Subject to Change TIME: Day One: 8 a.m. – 4:30 p.m. (Registration 7:30 am) Day Two: 8 a.m. – 4:30 p.m. (Registration 7:30 am) CREDIT HOUR(S) APPLIED FOR: Two day provider course (14 Cat. 1) One day renewal course (7 Cat. 1) LOCATION: Baptist Health Clinical Learning Center, 8530 SW 124 Avenue, Miami, FL, 33183 or Bethesda Hospital West 9655 W Boynton Beach Blvd, Boynton Beach, FL 33472. (Based on availability) TARGET AUDIENCE: Physicians, nurses and paramedics CONFERENCE DIRECTOR: Arturo Fridman, M.D. CONFERENCE COORDINATOR: Claudia Rodriguez, MPHM, MSN, BSN, RN, CEN CME MANAGER: Katie Deane EXPECTED NUMBER OF ATTENDEES: 30 CHARGE: Two-day course – Physicians $210 One-day course – Physicians $150 (The cost of the textbook is included in the registration fee for all courses except skills checks.) LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.

ARS Case Studies

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Didactic Lecture Enduring Material (DVD/Booklet) Internet Activity Enduring Material Internet Live Course (Live Webcast) Internet point-of-care activity Journal-based CME activity Learning from Teaching Live activity

Manuscript review activity Panel PI CME activity Question & Answer Regularly Scheduled Series Simulation Test item writing activity Other (specify) Hands on Workshop

COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. Advanced Cardiovascular Life Support (ACLS) Provider Course is designed for healthcare providers who either direct or participate in the resuscitation of a patient, whether in or out of the hospital. In this course you will enhance your skills in the treatment of arrest and peri-arrest patients through active participation in a series of simulated cardiopulmonary cases. Baptist Health is an American Heart Association (AHA) Certified Training Center. Course Prerequisites: Providers who take the ACLS Providers Course must be proficient in the following:

Performing BLS CPR skills using the 2015 AHA Guidelines for CPR and ECC. Must be able to Demonstrate Basic ECG interpretation. Must be able to demonstrate knowledge of pharmacological concepts and competent administration of Cardiac drugs

used during ACLS. Performing the BLS Primary Survey and the ACLS Secondary Survey.

Prior to attending the course participants must successfully complete the ACLS pretest from the AHA website and print the certificate of completion; a minimum score as per AHA guidelines should be achieved. The Certificate of Completion must be submitted at the live course (no exceptions.) All treatment modalities taught in ACLS courses (such as medication administration, defibrillation, pacing, etc.) must be within the participant’s scope of professional practice. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.





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The difference between what is (the “actual”) and what should be (the “ideal”). What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► The ACLS Two-day Provider Course and One-day Renewal Course are required to maintain ACLS certification, which is a pre-requisite for certain credentialing and job requirements. ► Advanced cardiovascular life support (ACLS) guidelines have evolved over the past several decades based on a combination of scientific evidence of variable strength and expert consensus. The American Heart Association (AHA) developed the most recent ACLS guidelines in 2010 using the comprehensive review of resuscitation literature performed by the International Liaison Committee on Resuscitation (ILCOR), and these were updated in 2015 [4-8]. (https://www.uptodate.com/contents/advanced-cardiac-life-support-acls-in-adults?source=search_result&search=ACLS&selectedTitle=1~150) ► Heart.org Part 7: Adult Advanced Cardiovascular Life Support: Web-based Integrated 2010 & 2015 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-7-adult-advanced-cardiovascular-life-support/ ► Neumar RW, Shuster M, Callaway CW, et al. Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132:S315. ►Link MS, Berkow LC, Kudenchuk PJ, et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132:S444. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Through the ACLS course, healthcare providers will enhance their skills in the treatment of the adult victim of a cardiac arrest or other cardiopulmonary emergencies. ACLS emphasizes the importance of basic life support CPR to patient survival; the integration of effective basic life support with advanced cardiovascular life support interventions; and the importance of effective team interaction and communication during resuscitation. (AHA Course Description) ► Successful completion of this course is determined by the evaluation of the participants cognitive and psychomotor skills, as recommended by the AHA, utilizing the case-based approach recommended in the ACLS instructors’ manual and the core material from the Textbook of Advanced Cardiac Life Support. Indicate what this activity is designed to change.



Best practice parameters Consensus of experts Disease prevention (C12) Joint Commission initiatives (C12) Mortality/morbidity statistics National Patient Safety Goals National/regional data New diagnostic/therapeutic modality (C12) New or updated policy/protocol Patient care data Peer review data Process improvement initiatives (C16 & 21) Regulatory requirement Research/literature review Other need identified (Explain): The ACLS Two-day Provider Course and One-day Renewal Course are required to

maintain ACLS certification, which is a pre-requisite for certain credentialing and job requirements.


Recognize and initiate early management of peri-arrest conditions that may result in cardiac arrest or complicate resuscitation outcome.

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Demonstrate proficiency in providing BLS care, including prioritizing chest compressions and integrating Automatic External Defibrillator (AED) use.

Manage cardiac arrest until return of spontaneous circulation (ROSC), termination of resuscitation, or transfer of care.

Identify and treat ischemic chest pain and expedite the care of patients with acute coronary syndromes. Recognize other life-threatening clinical situations, such as stroke, and provide effective initial care and transfer to

reduce disability and death. Demonstrate effective communication as a member or leader of a resuscitation team and recognize the impact of

team dynamics on overall team performance.


Changes in competence. Evaluation method: Baptist Health CME Evaluation Form and successful completion of the course exam and hands-on performance requirements.

Changes in performance. Evaluation method: Follow-up Survey Provide 3-4 statements based on expected performance outcomes to be evaluated. Example: I have implemented the new Baptist Health policy explained in this CME activity.


FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) TBD Faculty disclosure statement (as it should appear on course shell): RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3)

Yes No CME Dept. Leadership and Staff CME Committee Conference Director Others (Conference Coordinator, Planning Group, etc.) ________________________________________


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



If yes, describe the collaborative efforts. Baptist Health is an AHA Certified Training Center. The CME Department collaborates with the Clinical Learning department, the AHA CTC Instructors to accommodate recredentialing requirements by the Medical Staff Offices. _ COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. (ETHOS CONTENT) YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title. DATE REVIEWED: REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 7/14 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

ACLS Course Outline: 7.0 hours Small Group Teaching Stations – Video-led demonstration with instructor-led practice and testing of:

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Day 1 Day 2 BLS & ACLS Primary-Secondary Surveys Acute Coronary Syndrome Management of Respiratory Arrest Acute Ischemic Stroke Resuscitation Team Concept "Putting It All Together” Technology Review Question & Answer session Cardiac Arrest Algorithm Written Exam Tachycardia Algorithm Megacode Testing

ACLS-R Course Outline: 7.0 hours Small Group Teaching Stations – Video-led demonstration with instructor-led practice and testing of: BLS & ACLS Primary-Secondary Surveys Management of Respiratory Arrest CPR Competency and Practice Technology review Megacode and Resuscitation Team Concept Putting It All Together Written test Megacode Testing Course evaluations & CEU's / CME (MD) Course Completion Requirements: For participants who meet ALL course prerequisites and are eligible to receive a course completion eCard:

Participate in, practice, and complete all learning stations.

Pass the 1-rescuer CPR/AED testing station.

Pass the Megacode testing station.

Pass the written test with a minimum score of 84%. Attendance Requirements: Students must attend all sessions of the course and pass all the skills tests and the written test to receive a completion eCard. The class starts promptly at 8 a.m. unless otherwise indicated. No one will be allowed in class after 8:00 a.m. No exceptions!

Materials: Agendas ACLS written examinations Paper copy of the entrance exam ACLS Megacode skills check-off sheet AHA ACLS Provider text ACLS Provider course completion eCard At least 1 adult manikin per 3 students EZ-IO Face Shields - 1 for every student AED trainer, Simulator Airway equipment (BVM, NPA, OPA's, etc.) 1 defibrillator/monitor per station Course Evaluation forms

2020 SCHEDULE - Pending

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Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Pediatric Advanced Life Support (PALS) Two-day Provider Course and One-day Renewal Course (PALS-R) DATE: January 2020 – December 2020 See Attached Schedule – Dates Subject to Change TIME: Day One: 8 a.m. – 4:30 p.m. (Registration 7:30 am) Day Two: 8 a.m. – 4:30 p.m. (Registration 7:30 am) CREDIT HOUR(S) APPLIED FOR: Two day provider course (14 Cat. 1) One day renewal course (7 Cat. 1) LOCATION: Baptist Health Clinical Learning Center, 8530 SW 124 Avenue, Miami, FL, 33183 TARGET AUDIENCE: Physicians, nurses and paramedics CONFERENCE DIRECTOR: Arturo Fridman, M.D. CONFERENCE COORDINATOR: Claudia Rodriguez, MPHM, MSN, BSN, RN,CEN CME MANAGER: Katie Deane EXPECTED NUMBER OF ATTENDEES: 30 CHARGE: Two-day course – Physicians $210 One-day course – Physicians $150 (The cost of the textbook is included in the registration fee for all courses except skills checks.) LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.


Live activity Manuscript review activity Panel PI CME activity Question & Answer Regularly Scheduled Series Simulation Test item writing activity Other (specify) Hands on Workshop

COURSE DESCRIPTION: Pediatric Advanced Life Support (PALS) Provider Course is designed for HealthCare providers who either direct or participate in the resuscitation of a child, whether in or out of hospital. In this course you will enhance your skills in the treatment of arrest and peri-arrest patients through active participation in a series of simulated cardiopulmonary cases. Baptist Health is an American Heart Association (AHA) Certified Training Center. Course Prerequisites: Providers who take the PALS Providers Course must be proficient in the following:

Performing BLS CPR skills using the 2015 AHA Guidelines for CPR and ECC. Demonstrating basic EKG interpretation. Demonstrate knowledge of pharmacological concepts and competent administration of cardiac drugs used during

ACLS. Performing the BLS Primary Survey and the PALS Secondary Survey.

Prior to attending the course participants must successfully complete the PALS pretest from the AHA website and print their certificate of completion; a minimum score as per AHA guidelines must be achieved. The Certificate of Completion must be submitted at the live course (no exceptions.) All treatment modalities taught in PALS courses (such as medication administration, defibrillation, pacing, etc.) must be within the participant’s scope of professional practice.

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The difference between what is (the “actual”) and what should be (the “ideal”). What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ►The PALS Two-day Provider Course and One-day Renewal Course are required to maintain PALS certification, which is a pre-requisite for certain credentialing and job requirements. ► The American Heart Association (AHA) PALS program provides a structured approach to the assessment and treatment of the critically ill pediatric patient [1,2]. The AHA guidelines for pediatric resuscitation were updated in 2015 to reflect advances and research in clinical care using new evidence from a variety of sources ranging from large clinical trials to animal models. The clinician should primarily focus on prevention of cardiopulmonary failure through early recognition and management of respiratory distress, respiratory failure, and shock that can lead to cardiac arrest from hypoxia, acidosis, and ischemia. (https://www.uptodate.com/contents/pediatric-advanced-life-support-pals?search=The%20American%20Heart%20Association%20(AHA)%20PALS%20program%20provides%20a%20structured%20approach%20to%20the%20assessment%20and%20treatment%20of%20the%20critically%20ill%20pediatric%20patient&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#references) ► https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-12-pediatric-advanced-life-support/ Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Through the PALS course, healthcare providers will enhance their skills in the treatment of the pediatric victim of a cardiac arrest or other cardiopulmonary emergencies. PALS emphasizes the importance of basic life support CPR to patient survival; the integration of effective basic life support with advanced cardiovascular life support interventions; and the importance of effective team interaction and communication during resuscitation.(AHA Course Description) ► Successful completion of this course is determined by the evaluation of the participants cognitive and psychomotor skills, as recommended by the AHA, utilizing the case-based approach recommended in the PALS instructors’ manual and the core material from the Textbook of Pediatric Advanced Life Support. Indicate what this activity is designed to change.


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Best practice parameters Consensus of experts Disease prevention (C12) Joint Commission initiatives (C12) Mortality/morbidity statistics National Patient Safety Goals National/regional data New diagnostic/therapeutic modality (C12) New or updated policy/protocol Patient care data Peer review data Process improvement initiatives (C16 & 21) Regulatory requirement Research/literature review Other need identified (Explain): The ACLS Two-day Provider Course and One-day Renewal Course are required to

maintain ACLS certification, which is a pre-requisite for certain credentialing and job requirements.


Understand and be able to perform the systematic approach to pediatric assessment, including general, primary, secondary and tertiary assessments.

Demonstrate proficiency in providing BLS care, including prioritizing chest compressions and integrating Automatic External Defibrillator (AED) use.

Use the assess-categorize-decide-act approach to assessment and management of the seriously ill child.

Recognize and manage a child in respiratory distress or failure and/or compensated or hypotensive shock.

Recognize and manage a child with life-threatening bradyarrhythmia, tachyarrhythmia or arrest rhythm.

Demonstrate effective communication as a member or leader of a resuscitation team and recognize the impact of team dynamics on overall team performance.

Demonstrate proper technique for intraosseous (IO) access and fluid bolus administration.

Perform as a team leader or team member in simulated cases.

Demonstrate appropriate use of electrical therapy, including defibrillation and synchronized cardioversion.


Changes in competence. Evaluation method: Baptist Health CME Evaluation Form and successful completion of the course exam and hands-on performance requirements.

Changes in performance. Evaluation method: Follow-up Survey Provide 3-4 statements based on expected performance outcomes to be evaluated. Example: I have implemented the new Baptist Health policy explained in this CME activity.


FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) TBD Faculty disclosure statement (as it should appear on course shell): RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No



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

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If yes, describe the collaborative efforts. Baptist Health is an AHA Certified Training Center. The CME Department collaborates with the Clinical Learning department, the AHA CTC Instructors to accommodate recredentialing requirements by the Medical Staff Offices. COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. (ETHOS CONTENT) YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title. DATE REVIEWED: REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 7/14 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A PALS Course Outline: 7.0 hours Small Group Teaching Stations – Video-led demonstration with instructor-led practice and testing of: Day 1 Day 2 Welcome and Introductions Core Case Discussions and Simulations Course Organization Video Respiratory PALS Science Overview Video Core Case Discussions and Simulations Shock CPR/AED Practice and Testing Jeopardy Review Game Rhythm Disturbances/Electrical Therapy "Putting It All Together" Scenario Practice Vascular Access Station Written Exam Resuscitation Team Concept Video Megacode & Core case testing Core Case Simulation Cardiac PALS-R Course Outline: 7.0 hours Small Group Teaching Stations – Video-led demonstration with instructor-led practice and testing of: Welcome and Introductions "Putting It All Together" Scenario Practice Course Organization Video Written Exam PALS Science Overview Video Megacode & Core case testing Management of Respiratory Emergencies CPR/AED Practice and Testing Rhythm Disturbances/Electrical Therapy Skills Vascular Access Skills Station Resuscitation Team Concept Video Course Completion Requirements:

For participants who meet ALL course prerequisites and are eligible to receive a course completion eCard: Participate in, practice and complete all learning stations. Pass the CPR/AED testing station. Pass two PALS core case tests as a team leader. Pass the closed-book written test with a minimum score of 84%.

Attendance Requirements:

Students must attend all sessions of the course and pass all the skills tests and the written test to receive a completion eCard. The class starts promptly at 8 a.m. No one will be allowed in class after that time. No exceptions!

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Materials: Agendas PALS written examinations AHA PALS Provider text PALS Provider Course completion card At least 1 CPR manikin

per 3 students AED trainer Airway equipment (BVM, NPA, OPAs, etc.) 1 defibrillator/monitor per station Course Evaluation forms EZ-IO

2019 SCHEDULE - Pending

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LIVE CME Activities Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education

CME ACTIVITY TITLE: Homestead Hospital Conference Series: Don’t Believe Everything You Think DATE: December 2, 2019 TIME: 12 noon – 1:00 p.m. CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 LOCATION: Homestead Hospital, Physicians’ Dining Room TARGET AUDIENCE: Hospitalists, Emergency Medicine Physicians, Hematologists, House Physicians, Physicians Assistants, Nurse Practitioners, Pharmacists, Nurses, Laboratory Personnel and all other interested healthcare providers. CONFERENCE DIRECTOR: Mark Rosenthal, M.D. CME MANAGER: Katie Deane EXPECTED NUMBER OF ATTENDEES: 20-25 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. Awareness and understanding of medical errors have expanded rapidly during the past decade. The patient safety movement works to promote safer healthcare through system solutions, however diagnostic errors have received relatively little attention. Diagnostic errors are estimated to occur in 10% to 15% of patient encounters. Cognitive errors contribute to over half of diagnostic errors and are associated with significant morbidity. Join us to hear Dr. Abby Spencer describe key concepts in patient safety education and differentiate between systems errors and common cognitive errors. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.





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The difference between what is (the “actual”) and what should be (the “ideal”). What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Current initiatives to address diagnostic errors tend to focus on system issues and neglect to address the cognitive errors that contribute to over half of clinical diagnostic errors. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Clinician are able to differentiate between system errors and cognitive errors. ► Clinicians promote safer healthcare by recognizing and addressing the role cognitive errors play in patient safety initiatives. Indicate what this activity is designed to change.




REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► Educating physician trainees in the principles of quality improvement (QI) and patient safety (PS) is a national imperative. Few faculty are trained in these disciplines, and few teaching institutions have the resources and infrastructure to develop faculty as instructors of these skills. Myers, J. S., Tess, A., Glasheen, J. J., O’Malley, C., Baum, K. D., Fisher, E. S., ... & Wiese, J. (2014). The quality and safety educators academy: fulfilling an unmet need for faculty development. American Journal of Medical Quality, 29(1), 5-12. ► Diagnostic errors are estimated to occur in 10% to 15% of patient encounters. Cognitive errors contribute to over half of diagnostic errors and are associated with significant morbidity. Despite this, given the sharp-ended nature of discussing cognitive errors, educational initiatives tend to focus on system issues and fail to address the equally important cognitive component. However, addressing all contributing factors to diagnostic errors is crucial to optimizing patient safety, especially in cognitive fields such as internal medicine. Developing curricula to address cognitive errors through highlighting cognitive biases and teaching clinical reasoning and metacognitive strategies is crucial to a robust graduate medical education system. Mehdi, A., Foshee, C., Green, W., & Spencer, A. (2018). Cognitive autopsy: a transformative group approach to mitigate cognitive bias. Journal of graduate medical education, 10(3), 345-347. ► During the past decade, awareness and understanding of medical errors have expanded rapidly, with an energetic patient safety movement promoting safer health care through “systems” solutions. Efforts have focused on translating evidence into practice, mitigating hazards from therapies, and improving culture and communication. Diagnostic errors have received relatively little attention. Although the science of error measurement is underdeveloped, diagnostic errors are an important source of preventable harm.1-3

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Newman-Toker, D. E., & Pronovost, P. J. (2009). Diagnostic errors—the next frontier for patient safety. Jama, 301(10), 1060-1062.


Describe key concepts in patient safety education. Differentiate between systems errors and cognitive errors. Define common cognitive errors.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Abby L Spencer M.D., MS, FACP Director, Internal Medicine Residency Program Associate Professor of Medicine, Cleveland Clinic Lerner College of Medicine Cleveland Clinic Cleveland, Ohio Faculty disclosure statement (as it should appear on course shell): Abby L Spencer M.D., MS, FACP indicated that neither she nor her spouse/partner has relevant financial relationships with commercial interest companies, and she will not include off-label or unapproved product usage in her presentation or discussion. Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No






If yes, describe the collaborative efforts. ________________________________________________________ COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. (ETHOS CONTENT) YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title. ► Good and Bad Medical Record Documentation: From Claims Management to Optimal Patient Care Outcomes ► Medical Errors: Promoting a Culture of Patient Safety

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DATE REVIEWED: REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A CME ACTIVITY TITLE: MCVI Grand Rounds: ATTR Cardiac Amyloidosis - Towards Earlier Diagnosis and Treatment

DATE: Wednesday, December 4, 2019 TIME: 6-7 p.m. CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 LOCATION: 5MCVI and Live Webcast TARGET AUDIENCE: Cardiologists, Interventional Cardiologists, Cardiothoracic Surgeons, Interventional Radiologists, Pulmonologists, General Internists, Primary Care Physicians, Intensivist, General Surgeons, Anesthesiologists, Emergency Medicine Physicians, Hospitalists, Nurses, Radiologic Technologists, Pharmacists and other interested healthcare providers. CONFERENCE DIRECTOR: MCVI CME Advisory Committee CME MANAGER: Gabriela Fernandez EXPECTED NUMBER OF ATTENDEES: 30-40 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. Transthyretin cardiac amyloidosis (ATTR-CA) demonstrates progressive, potentially fatal, and infiltrative cardiomyopathy caused by extracellular deposition of transthyretin-derived insoluble amyloid fibrils in the myocardium. Two distinct types of transthyretin (wild type or variant) become unstable, and misfolding forms aggregate, resulting in amyloid fibrils. ATTR-CA, which has previously been underrecognized and considered to be rare, has been increasingly recognized as a cause of heart failure with preserved ejection fraction among elderly persons. With the advanced technology, the diagnostic tools have been improving for cardiac amyloidosis. Recently, the efficacy of several disease-modifying agents focusing on the amyloidogenic process has been demonstrated. ATTR-CA has been changing from incurable to treatable. Nevertheless, there are still no prognostic improvements due to diagnostic delay or misdiagnosis because of phenotypic heterogeneity and co-morbidities. Thus, it is crucial for clinicians to be aware of this clinical entity for early diagnosis and proper treatment. Join Dr. David Wolinsky, as he provides strategies to optimize treatment to improve patient outcomes.

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What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Despite advances in medical therapy for some types of pulmonary hypertension, surgical pulmonary endarterectomy, also referred to as pulmonary thromboendarterectomy, remains the only potentially curative option for patients with chronic thromboembolic pulmonary hypertension. Physicians in the care of patients with pulmonary hypertension need to be familiarized with the potential causes, management options, and how to effectively identify patients who will benefit from surgery. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Physicians in the care of patients with pulmonary hypertension are familiar with the potential causes, management options, and how to effectively identify patients who will benefit from pulmonary thromboendarterectomy surgery. Indicate what this activity is designed to change.




REFERENCES supporting the current practice and/or the optimal practice and/or practice gap:

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Transthyretin cardiac amyloidosis (ATTR-CA) demonstrates progressive, potentially fatal, and infiltrative cardiomyopathy caused by extracellular deposition of transthyretin-derived insoluble amyloid fibrils in the myocardium. Two distinct types of transthyretin (wild type or variant) become unstable, and misfolding forms aggregate, resulting in amyloid fibrils. ATTR-CA, which has previously been underrecognized and considered to be rare, has been increasingly recognized as a cause of heart failure with preserved ejection fraction among elderly persons. With the advanced technology, the diagnostic tools have been improving for cardiac amyloidosis. Recently, the efficacy of several disease-modifying agents focusing on the amyloidogenic process has been demonstrated. ATTR-CA has been changing from incurable to treatable. Nevertheless, there are still no prognostic improvements due to diagnostic delay or misdiagnosis because of phenotypic heterogeneity and co-morbidities. Thus, it is crucial for clinicians to be aware of this clinical entity for early diagnosis and proper treatment. https://www.ncbi.nlm.nih.gov/pubmed/31553132


Recognize the myriad presentations of Transthyretin Cardiac Amyloidosis (ATTR-CA). Effectively implement referral processes to increase early detection of cardiac amyloid. Utilize TTcPYP imaging to diagnose ATTR-CA. Optimize treatment, including disease-modifying therapy, to improve outcomes.




Recognize potential causes for pulmonary hypertension. Evaluate surgical and non-surgical treatment options for the management of pulmonary hypertension. Effectively identify patients who will benefit from pulmonary thromboendarterectomy surgery. Changes in patient outcomes. Evaluation method: Review of hospital, health system, public health data, etc. Other______________________

FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) David Wolinsky, M.D., FACC, MASNC Section Head, Nuclear Cardiology Director, Cardiac Amyloid Center Cleveland Clinic Florida Weston, Florida Faculty disclosure statement (as it should appear on course shell): David Wolinsky, M.D indicated that he is a consultant for Astellas and AKCEA, and he is a member of the Speakers’ Bureau for Astellas, AKCEA and Alnylam. He will not include off-label or unapproved product usage in his presentation or discussion. MCVI Planning Committee Members Disclosures: James Benenati, M.D., indicated that he is a consultant for Penumbra and Bard. He is also a stock shareholder for Penumbra and Scientia. Barry Katzen, M.D. has indicated that he is a consultant for Boston Scientific, Phillips Medical, W.L. Gore and Bard. Dr. Theodore Feldman has indicated that he is a member of the Speakers’ Bureau for Regeneron, Sanofi, Boehringer Ingeldeim, and Novartis. Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No


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If yes, describe the collaborative efforts. _MCVI and BHSF Cardiothoracic Medical Group COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. (ETHOS CONTENT) YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title. DATE REVIEWED: October 28, 2019 REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

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Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Pediatric Multispecialty Conference: Evidence Based Pediatric Emergency Medicine - Are You Practicing It? DATE: January 14, 2020 TIME: 6-7 p.m. CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 LOCATION: BHM Auditorium WEBCAST: Record Only TARGET AUDIENCE: Pediatricians, Internists, Hospitalists, Pediatric Emergency Medicine Physicians, Emergency Medicine Physicians, Physician Assistants, Nurse Practitioners, Pharmacists, Respiratory Therapists, Psychologists, Nurses and all interested clinical care providers. CONFERENCE DIRECTOR: Jennifer Cheney, M.D. CME MANAGER: Katie Deane EXPECTED NUMBER OF ATTENDEES: 40-50 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. The pediatric practitioner has the special and important responsibility to utilize diagnostic guidelines and clinical best practice for patients presenting with a multitude of ailments, injuries and diseases. The rapidly evolving state of evidence based medicine makes it particularly challenging in pediatrics because of the broad nature and depth of knowledge required across all medical subspecialties. Please join us to hear Dr. Richard Cantor, discusses how to implement and best utilize evidence base data in pediatric emergency medicine. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.





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The difference between what is (the “actual”) and what should be (the “ideal”). What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Pediatricians are uniquely responsible for diagnosing and managing a wide spectrum of medical conditions at varying stages. They are burdened and challenged with maintaining competencies and adopting best practice models across a variety of medical subspecialty areas. Short of being an expert on everything, there are common knowledge gaps of best practices - resulting in some inconsistencies in quality of care. The rapidly evolving state of medicine including publication of data that frequently is at odds with the current practice norms makes it particularly challenging in pediatric medicine because of the broad nature and depth of knowledge required across all medical subspecialties. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Pediatricians will provide optimal care and achieve best outcomes when they implement evidence-based methods of diagnosis and treatment to effectively manage common and important problems in the pediatric and adolescent populations. Indicate what this activity is designed to change.




REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► Bressan, S., Andreola, B., Cattelan, F., Zangardi, T., Perilongo, G., & Da Dalt, L. (2010). Predicting severe bacterial infections in well-appearing febrile neonates: laboratory markers accuracy and duration of fever. The Pediatric infectious disease journal, 29(3), 227-232. ► Wilkinson, M., Bulloch, B., & Smith, M. (2009). Prevalence of occult bacteremia in children aged 3 to 36 months presenting to the emergency department with fever in the postpneumococcal conjugate vaccine era. Academic Emergency Medicine, 16(3), 220-225. ► Danino, D., Rimon, A., Scolnik, D., Grisaru-Soen, G., & Glatstein, M. (2015). Does extreme leukocytosis predict serious bacterial infections in infants in the post-pneumococcal vaccine era? The experience of a large, tertiary care pediatric hospital. Pediatric emergency care, 31(6), 391-394. ►De, S., Williams, G. J., Hayen, A., Macaskill, P., McCaskill, M., Isaacs, D., & Craig, J. C. (2015). Republished: value of white cell count in predicting serious bacterial infection in febrile children under 5 years of age. Postgraduate medical journal, 91(1073), 493-499. ► Bonadio, W., Huang, F., Natesan, S., Okpalaji, C., Kodsi, A., Sokolovsky, S., & Homel, P. (2016). Meta-analysis to determine risk for serious bacterial infection in febrile outpatient neonates with RSV infection. Pediatric emergency care, 32(5), 286-289.

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►Bradley, J. S., Byington, C. L., Shah, S. S., Alverson, B., Carter, E. R., Harrison, C., ... & St Peter, S. D. (2011). The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clinical infectious diseases, 53(7), e25-e76. ►Ralston, S. L., Lieberthal, A. S., Meissner, H. C., Alverson, B. K., Baley, J. E., Gadomski, A. M., ... & Phelan, K. J. (2014). Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics, 134(5), e1474-e1502.

EDUCATIONAL OBJECTIVES: Based on the gaps identified above, what are the learning objectives for this activity? Describe the performance* that should change if participants apply what they learn. *(or competence or patient outcome) Upon completion of this conference, participants should be better able to: Identify and accurately diagnose most common complaints that present in the Pediatric Emergency department. Utilize diagnostic guidelines and clinical best practice for pediatric patients presenting with fevers, UTIs respiratory

issues, viral GI issues and other common pediatric emergency complaints. Recognize the role evidence based medicine plays in pediatric emergency medicine.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Richard Cantor, M.D. Professor of Emergency Medicine and Pediatrics Section Chief, Pediatric Emergency Medicine Director, Pediatric Emergency Medicine Fellowship Emeritus Director, Upstate Poison Control Center Golisano Children’s Hospital Syracuse, New York Faculty disclosure statement (as it should appear on course shell): Richard Cantor, M.D., indicated that neither he nor his spouse/partner has relevant financial relationships with commercial interest companies, and he will not include off-label or unapproved product usage in her presentation or discussion. Non-faculty contributors and others involved in the planning, development and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No






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If yes, describe the collaborative efforts. This activity is planned in collaboration with Baptist Children’s Hospital to meet the educational needs they have identified. COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. (ETHOS CONTENT) YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title. DATE REVIEWED: REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # 1 N/A Continuing Dental Education Credits: # N/A

Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Conversations in Ethics – Ethical Challenges with Gender Dysphoria and Transgender DATE: Wednesday, January 15, 2020 TIME: 6pm – 8pm CREDIT HOUR(S) APPLIED FOR: 2 Cat. 1 LOCATION: BHM Auditorium. VC to WKBH Cl. 4 & 5, MH Exec. Conf. Rm, SMH Classroom E, and Webcast TARGET AUDIENCE: Physicians, Psychologists, Physician Assistants, Nurse Practitioners, Nurses, Social Workers, Respiratory Therapists, Clinical Chaplains, Pharmacists, Medical Students, Registered Dietitians and other interest healthcare professionals. CONFERENCE DIRECTOR: Ana Viamonte-Ros, MD, MPH CONFERENCE COORDINATOR: Rose Allen, DNP, MSM/HM, RN, CHPN, Director, Bioethics Program CME MANAGER: Katie Deane EXPECTED NUMBER OF ATTENDEES: 50-100 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.

ARS Case Studies Didactic Lecture Enduring Material (DVD/Booklet) Internet Activity Enduring Material Internet Live Course (Live Webcast) Internet point-of-care activity Journal-based CME activity Learning from Teaching Live activity

Manuscript review activity Panel PI CME activity Question & Answer Regularly Scheduled Series Simulation Test item writing activity Other (specify)

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COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. For the past two millennia, we have known about transgender communities around the world, however, over the past 20 years, most western countries have seen an explosion in the number of people identifying as transgender/gender non-conforming. With advances in modern science, we now have better understanding of the genetic factors, differences in brain structures, and sex hormones receptors of these individuals. There are pivotal ethical questions to address regarding the diagnosis, treatment, surgical interventions, and complex fertility issues of transgender/gender non-conforming children and adolescents. Please join us as Dr. Alejandro Diaz discusses modern science advances and the pivotal ethical challenges in working with this unique patient population. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.






The difference between what is (the “actual”) and what should be (the “ideal”). What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Clinical providers may not be familiar with common risk factors transgender adolescent have that increase their risk of self-harm behavior. ► Clinical providers may not be familiar with enhance protective factors that may reduce the likelihood this population of vulnerable youths will engage in self-harm, non-suicidal self-injury, and suicide attempts. ► Clinicians may not be familiar with the recommended multidisciplinary approach to gender affirmation treatment for Gender-dysphoric/gender-incongruent adolescents. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Clinical providers address risk factors and utilize enhance protective factors that may reduce the likelihood this population of vulnerable youths will engage in self-harm, non-suicidal self-injury, and suicide attempts. ►Clinical providers follow current guidelines for the multidisciplinary approach in the diagnosis, treatment and follow up of Gender-dysphoric/gender-incongruent adolescents.

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Indicate what this activity is designed to change.



Best practice parameters Consensus of experts Disease prevention (C12) Joint Commission initiatives (C12) Mortality/morbidity statistics National Patient Safety Goals National/regional data New diagnostic/therapeutic modality (C12) New or updated policy/protocol Patient care data Peer review data Process improvement initiatives (C16 & 21) Regulatory requirement Other need identified (Explain): _BHSF Bioethics Program Requested__ Research/literature review

REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► In a new study, 30 percent of transgender youth report a history of at least one suicide attempt, and nearly 42 percent report a history of self-injury, such as cutting. The study also discovered a higher frequency of suicide attempts among transgender youth who are dissatisfied with their weight. "Our study provides further evidence for the at-risk nature of transgender youth and emphasizes that mental health providers and physicians working with this population need to be aware of these challenges," says Claire Peterson, PhD, a psychologist at Cincinnati Children's and lead author of the study. "Dissatisfaction with one's appearance and the drive to look different from one's sex assigned at birth is central to gender dysphoria -- the feeling that your gender identity is different from that at birth." (https://www.sciencedaily.com/releases/2016/08/160831110833.htm) ► Clinicians and school personnel who encounter transgender/GNC adolescents are well-positioned to address factors that increase risk of self-harm behavior (e.g., mental health problems, history of abuse, relationship violence, bullying and teasing victimization, running away from home, and substance use). They also should enhance protective factors that may reduce the likelihood transgender/GNC youth will engage in NSSI and/or attempt suicide such as facilitating connections to prosocial adults within and outside one’s family, implementing policies and practices that ensure students’ feel safe at school, and encouraging academic excellence. (https://www.tandfonline.com/doi/abs/10.1080/13811118.2018.1430639) Taliaferro, L. A., McMorris, B. J., Rider, G. N., & Eisenberg, M. E. (2019). Risk and protective factors for self-harm in a population-based sample of transgender youth. Archives of suicide research, 23(2), 203-221. ► Gender affirmation is multidisciplinary treatment in which endocrinologists play an important role. Gender-dysphoric/gender-incongruent persons seek and/or are referred to endocrinologists to develop the physical characteristics of the affirmed gender. They require a safe and effective hormone regimen that will (1) suppress endogenous sex hormone secretion determined by the person’s genetic/gonadal sex and (2) maintain sex hormone levels within the normal range for the person’s affirmed gender. (https://academic.oup.com/jcem/article/102/11/3869/4157558) Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., ... & T’Sjoen, G. G. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 102(11), 3869-3903.

EDUCATIONAL OBJECTIVES: Based on the gaps identified above, what are the learning objectives for this activity? Describe the performance* that should change if participants apply what they learn. *(or competence or patient outcome) Upon completion of this conference, participants should be better able to: Examine the genetic factors, differences in brain structures, and sex hormones receptors of transgender individuals. Identify common risks and enhanced protective factors that may reduce self-harm behavior among transgender

individuals. Review available pharmacological and surgical treatments offered to transgender individuals.



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FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Alejandro Diaz, M.D. Pediatric Endocrinologist Nicklaus Children’s Hospital Assistant Professor of Pediatrics Herbert Wertheim College of Medicine Florida International University Faculty disclosure statement (as it should appear on course shell): Alejandro Diaz, M.D., indicated that neither he nor his spouse/partner has relevant financial relationships with commercial interest companies, and he will not include off-label or unapproved product usage in his presentation or discussion.

Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose.







If yes, describe the collaborative efforts. The CME Department and the BHSF Bioethics Committee collaborate to improve healthcare provider competencies and practice by addressing areas of ethical concern or interest (as determined by the Bioethics Committee) through compelling and engaging continuing education activities. COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. (ETHOS CONTENT) YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title. ► ETHICAL AND MEDICAL CHALLENGES: ACCESS TO FERTILITY SERVICES BY TRANSGENDER PERSONS DATE REVIEWED: REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

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Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Miami Cancer Institute – Multispecialty Grand Rounds: Treatment of Oropharynx Cancer: Past, Present and Future DATE: Monday, January 13, 2020 TIME: 7:30- 8:30 a.m. CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 LOCATION: Miami Cancer Institute – Tumor Board Room 3N110 TARGET AUDIENCE: Oncologists, Radiation Oncologists, Hematology Oncologists, Radiation Therapists, General Surgeons, General Practitioners, Obstetrics and Gynecologists, Oncologists, Radiation Oncologists, Nurses, Social Workers, Patient Navigators and all other interested healthcare professionals. CONFERENCE DIRECTOR: Guilherme Rabinowits, M.D. CME MANAGER: Eleanor Abreu EXPECTED NUMBER OF ATTENDEES: 50-60 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. There are three main treatment options for oral and oropharyngeal cancer: surgery, radiation therapy and therapies using medication. During this conference Dr. Bhisham Chera will discuss treatment paradigms and the many rapidly changing options for patients with HPV-associated oropharyngeal squamous cell carcinomas. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.





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The difference between what is (the “actual”) and what should be (the “ideal”). What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Treatment paradigms and options are rapidly changing and expanding for patients with HPV-associated oropharyngeal squamous cell carcinomas. There is a knowledge gap related to the understanding and appropriate application of the emerging treatment options. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Physicians will use novel biomarkers to guide treatment options and select the best treatment option for their patients. Indicate what this activity is designed to change.




REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: Clinical outcomes with a de-intensified chemoradiotherapy regimen of 60 Gy intensity-modulated radiotherapy with concurrent low-dose cisplatin are favorable in patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma. Neither neoadjuvant chemotherapy nor routine surgery is needed to obtain favorable results with de-escalation. Chera BS, Amdur RJ, Green R, Shen C, Gupta G, Tan X, Knowles M, Fried D, Hayes N, Weiss J, Grilley-Olson J, Patel S, Zanation A, Hackman T, Zevallos J, Blumberg J, Patel S, Kasibhatla M, Sheets N, Weissler M, Yarbrough W, Mendenhall W. Phase II Trial of De-Intensified Chemoradiotherapy for Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma. J Clin Oncol. 2019 Oct 10;37(29):2661-2669. doi: 10.1200/JCO.19.01007. Epub 2019 Aug 14. PMID: 31411949 https://www.ncbi.nlm.nih.gov/pubmed/31411949


Implement de-intensified treatment plans for patients with HPV-associated oropharyngeal carcinoma. Identify the clinical utility of circulating HPVDNA.



Provide 3-4 statements based on expected performance outcomes to be evaluated. Example: I have implemented the

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new Baptist Health policy explained in this CME activity. Changes in patient outcomes. Evaluation method: Review of hospital, health system, public health data, etc. Other______________________

FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Faculty disclosure statement (as it should appear on course shell): Bhisham Chera, M.D. Associate Professor Associate Chair for Clinical Operations & Improvement Director of Patient Safety & Quality Department of Radiation Oncology University of North Carolina Bhisham Chera, M.D., indicated that neither he is a stock shareholder with Naveris. He will not include off-label or unapproved product usage in his presentation(s) or discussion(s). Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No






If yes, describe the collaborative efforts. ________________________________________________________ COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. (ETHOS CONTENT) YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title. DATE REVIEWED: REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

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Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: MCI Radiation Oncology Grand Rounds - Current and Future Research Directions of the NRG Oncology Head and Neck Committee. DATE: Friday, January 24, 2020 TIME: 12 – 1 p.m. CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 LOCATION: Miami Cancer Institute – Radiation Oncology Conference Room – 1 N 612

TARGET AUDIENCE: Radiation Oncologists, Medical Oncologists, Oncology surgeons and Radiologists NOTE: Due to limited space, this conference is open to Baptist Health affiliated Medical Staff and Clinical Employees. CONFERENCE DIRECTOR: Michael Chuong, M.D. CME MANAGER: Eleanor Abreu EXPECTED NUMBER OF ATTENDEES: 20-40 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. The term head and neck cancer may refer exclusively to cancers arising from the upper aerodigestive tract or more broadly to any malignancy originating in the head and neck region. During this conference participants will be able to identify the best patients for de-escalation trial in HPV+ oropharyngeal carcinoma and apply biomarkers to clinical trial design. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.






What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2)\

► Current practice of locoregionally advanced head and neck cancers (HNC) primarily involves a

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combination of two of more of the following treatments: surgery, radiotherapy and chemotherapy. The optimal combination has been established in some HNC but not in others. In addition, the role of immune checkpoint therapy (IO) in combination of these standard therapies are unknown. To improve survival and decrease treatment-related toxicity for HNC, optimal therapy needs to be established and the role of IO needs to be evaluated

Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Physicians will implement the role of immune checkpoint therapy needs. Indicate what this activity is designed to change.




REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: Previous studies indicate that the benefit of therapy depends on patients' risk for cancer recurrence relative to noncancer mortality (ω ratio). We sought to test the hypothesis that patients with head and neck cancer (HNC) with a higher ω ratio selectively benefit from intensive therapy. Patients with HNC with a higher ω score selectively benefit from intensive treatment. A nomogram was developed to help select patients for intensive therapy. Clin Cancer Res. 2019 Dec 1;25(23):7078-7088. doi: 10.1158/1078-0432.CCR-19-1832. Epub 2019 Aug 16. https://www.ncbi.nlm.nih.gov/pubmed/31420360


Identify the best patients for de-escalation trials in HPV+ oropharyngeal carcinoma. Apply biomarkers to clinical trial design. Implement the optimal treatment strategy for patients who cannot tolerate cisplatin chemotherapy. Determine the optimal treatment strategy for patients with postoperative high risk HNC.



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FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Faculty disclosure statement (as it should appear on course shell): Quynh-Thu Le, M.D., FACR, FASTRO Katharine Dexter McCormick & Stanley McCormick Memorial Professor Professor and Chair Department of Radiation Oncology Stanford University Quyn –Thu Le, M.D., indicated that neither he nor his spouse/partner has relevant financial relationships with commercial interest companies, and he will not include off-label or unapproved product usage in his presentation(s) or discussion(s). Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No






If yes, describe the collaborative efforts. ________________________________________________________ Collaboration with the Miami Cancer Institute – Radiation Oncology Department. COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. (ETHOS CONTENT) YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title. DATE REVIEWED: REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

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Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: SMH Inpatient Physicians Grand Rounds: The Power of Sugar-Coated Stem Cells DATE: January 30, 2020 TIME: 7 a.m. – 8 a.m. CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 LOCATION: SMH, Victor Clarke Building, Classroom E/F TARGET AUDIENCE: South Miami Hospital Hospitalists, Physicians Assistants and Advance Practice Register Nurses CONFERENCE DIRECTOR: Ariel Eduardo Moses, M.D. CME MANAGER: Katie Deane EXPECTED NUMBER OF ATTENDEES: 20-25 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. Research on stem cells continues to advance but, as with many expanding fields of scientific inquiry, this research raises questions almost as rapidly as it generates new discoveries. Join us to hear Stem Cell expert Robert Sackstein, M.D., Ph.D., provide an understanding of Stem Cell Biology and describe how the utility of glycoscience enables stem cell therapeutics to be used in clinical practice. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.






What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Physicians may not be aware of the current and future opportunities stem cells present for several different clinical applications.

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Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Physicians recognize and appropriately utilize stem cell therapeutics in clinical practice. Indicate what this activity is designed to change.




REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► Despite significant advances in the pharmacotherapy of glycemia control, T1D is still associated with significant morbidity and mortality, and it continues to pose a major public health burden demanding innovative treatment strategies 1, 2. Cell-based immunomodulatory therapy has emerged as a promising approach in the treatment of T1D 3. Because of their immunomodulatory properties, safety profile, easy acquisition, and robust ex vivo expansion, mesenchymal stem cells (MSCs) have become the most rapidly growing cell therapy for the treatment of various refractory immune-mediated diseases including T1D 4-7. In preclinical models using nonobese diabetic (NOD) mice, we and others have recently reported that systemically administered MSCs have utility in dampening autoimmune diabetes 8-13. However, the benefits of MSC therapy in reversal of hyperglycemia were temporary, highlighting a pressing need to develop strategies to improve the effectiveness of MSC-based therapy for T1D 6. (https://stemcellsjournals.onlinelibrary.wiley.com/doi/full/10.1002/stem.1948) Abdi, R., Moore, R., Sakai, S., Donnelly, C. B., Mounayar, M., & Sackstein, R. (2015). HCELL expression on murine MSC licenses pancreatotropism and confers durable reversal of autoimmune diabetes in NOD mice. Stem cells, 33(5), 1523-1531. ► Mesenchymal stem cells (MSCs) hold much promise for cell therapy due to their convenient isolation and amplification in vitro, multilineage differentiation ability, tissue-repairing trophic effects, and potent immunomodulatory capacity 1, 2. In particular, because MSCs are precursors of bone-forming osteoblasts, these cells have drawn great interest for treatment of systemic bone diseases such as osteoporosis or osteogenesis imperfecta. However, to achieve this goal, it is first necessary to optimize osteotropism of intravascularly administered MSCs. (https://stemcellsjournals.onlinelibrary.wiley.com/doi/full/10.1002/stem.2435) Dykstra, B., Lee, J., Mortensen, L. J., Yu, H., Wu, Z. L., Lin, C. P., ... & Sackstein, R. (2016). Glycoengineering of E-Selectin Ligands by Intracellular versus Extracellular Fucosylation Differentially Affects Osteotropism of Human Mesenchymal Stem Cells. Stem Cells, 34(10), 2501-2511. ► LÓPEZ-LUCAS, M. D., Pachon-Pena, G., GARCÍA-HERNÁNDEZ, A. M., Parrado, A., Sanchez-Salinas, D., Garcia-Bernal, D., ... & Molina-Molina, M. (2018). Production via good manufacturing practice of exofucosylated human mesenchymal stromal cells for clinical applications. Cytotherapy, 20(9), 1110-1123.


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Describe stem cell biology and its use in clinical practice. Examine the utility of glycoscience to enable stem cell therapeutics.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Robert Sackstein, M.D. Dean and Senior Vice President for Health Affairs, and Professor Florida International University Miami, Florida Faculty disclosure statement (as it should appear on course shell): Robert Sackstein, M.D. indicated that he is a consultant for The BioBox and Bio-Techne; and that he is owner and stack shareholder for Warrior Therapeutics LLC., , and he will not include off-label or unapproved product usage in his presentation or discussion. Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No






If yes, describe the collaborative efforts. Planned in collaboration with the South Miami Hospital Inpatient Physician Group. COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. (ETHOS CONTENT) YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title. DATE REVIEWED: REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

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CME ACTIVITY TITLE: Clinician Excellence in a Time of Transformation DATE: February 12, 2020 TIME: 6 p.m. – 8 p.m. CREDIT HOUR(S) APPLIED FOR: 2 Cat. 1 LOCATION: Hilton Miami Dadeland TARGET AUDIENCE: Physicians, Psychologist, Physician Assistants, Advance Practice Registered Nurses. CONFERENCE DIRECTOR: Ana M. Viamonte Ros, M.D., MPH CME MANAGER: Katie Deane EXPECTED NUMBER OF ATTENDEES: 150 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. Clinician burnout meets criteria for being an epidemic in health care, and yet while numerous authors describe burnout as a growing epidemic, there is little consensus on exactly what burnout is, how to mobilize against it, and what strategies to implement for treatment. Please join us for this special evening event to hear one of health care’s most acclaimed thought leaders, Dr. Thomas H. Lee, discuss the major drivers of burnout in clinicians and outline multifaceted approaches to address these drivers. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.





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The difference between what is (the “actual”) and what should be (the “ideal”). What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Burnout meets criteria for being an epidemic in health care. It affects a growing proportion of clinicians and other personnel, and there is an element of contagion. ► The quality and safety of patient care, and indeed the very vitality of our health care systems, depend heavily on high-functioning physicians. Yet recent data have revealed an extraordinarily high — and increasing — prevalence of physician burnout, defined as emotional exhaustion, interpersonal disengagement, and a low sense of personal accomplishment. In light of compelling evidence that burnout negatively affects patient care, health care leaders are rightly alarmed and are searching for answers. https://catalyst.nejm.org/physician-well-being-efficiency-wellness-resilience/ Bohman, B., Dyrbye, L., & Sinsky, C. (2017). Physician well-being: the reciprocity of practice efficiency, culture of wellness, and personal resilience. NEMJ Catalyst website. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Clinicians are able to identify common themes of physicians who are highly motivated by their clinical work. ► Clinicians are able to describe the major drivers of burnout and can implement multifaceted approaches to address the drivers of burnout. Indicate what this activity is designed to change.




REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► Lee, T. H. (2019). The Good Doctor: What It Means, How to Become One, and How to Remain One. McGraw Hill Professional. ► Burnout meets criteria for being an epidemic in health care. It affects a growing proportion of clinicians and other personnel, and there is an element of contagion—ie, clinicians who are burned out increase the risk that others around them feel the same. Two recent studies published in JAMA demonstrate the extent of this epidemic and provide insight into its risk factors and complexity. Collectively, these data make the case that health care systems will not find a single magic bullet that cures burnout; instead, as with most epidemics, progress will occur through a multifaceted approach. Lee, T. H., & Mylod, D. E. (2019). Deconstructing Burnout to Define a Positive Path Forward. JAMA internal medicine, 179(3), 429-430. ► The term burnout has taken on meaning far beyond what is understood about it as an actual diagnosis or even a syndrome. The medical profession has taken a self-reported complaint of unhappiness and dissatisfaction and turned it into

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a call for action on what is claimed to be a national epidemic that purportedly affects half to two-thirds of practicing physicians. Schwenk, T. L., & Gold, K. J. (2018). Physician burnout—a serious symptom, but of what?. Jama, 320(11), 1109-1110.


Identify the common themes in the work approaches of clinician who are highly motivated by their clinical work. Describe the major drivers of burnout in clinicians. Implement multifaceted approaches to address the drivers of burnout and strategies to for treatment.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Thomas H. Lee, M.D. Chief Medical Officer Press Ganey Boston, Massachusetts Faculty disclosure statement (as it should appear on course shell): Thomas H. Lee, M.D., indicated that neither he nor his spouse/partner has relevant financial relationships with commercial interest companies, and he will not include off-label or unapproved product usage in his presentation or discussion. Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No






If yes, describe the collaborative efforts. ________________________________________________________ COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund.

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(ETHOS CONTENT) YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title. DATE REVIEWED: REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Creating a High Reliability Culture: Path to Zero Harm DATE: February 13, 2020 TIME: 8 a.m. – 10 p.m. CREDIT HOUR(S) APPLIED FOR: 2 Cat. 1 LOCATION: Hilton Miami Dadeland TARGET AUDIENCE: Physicians, Psychologists, Physician Assistants, Advance Practice Registered Nurses, and Senior Executive Leaders. (Specifically: Vice Presidents, Medical Executive Committee, Medical Directors, Chief Medical Officers, and Department Chiefs.) CONFERENCE DIRECTOR: Ana M. Viamonte Ros, M.D., MPH CONFERENCE DIRECTOR: Mark Hauser, M.D. CONFERENCE DIRECTOR: Sergio Segarra M.D. M.B.A. FACEP CME MANAGER: Katie Deane EXPECTED NUMBER OF ATTENDEES: 150 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. The path to zero harm is the commitment to creating a high reliability culture. The siloed perspective on performance improvement is giving way to a holistic perspective of excellence, embracing safety, technical distinction, empathy and coordination. This holistic excellence requires an engaged workforce that takes pride in high reliability in delivering care the way they believe it should be. Please join us for this special event to hear one of health care’s most acclaimed thought leaders, Dr. Thomas H. Lee, provide his perspective on creating a high reliability culture. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe.

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BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.






What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Improving performance and accountability depends on having a shared goal that unites the interests and activities of all stakeholders. In health care, however, stakeholders have myriad, often conflicting goals, including access to services, profitability, high quality, cost containment, safety, convenience, patient-centeredness, and satisfaction. Lack of clarity about goals has led to divergent approaches, gaming of the system, and slow progress in performance improvement. Porter, M. E. (2010). What is value in health care. N Engl J Med, 363(26), 2477-2481. ► Most U.S. health care leaders believe that the viability of their organization requires improving the economic value of the care it provides, but they feel overwhelmed by the task of transforming the organizational culture to support that goal. If we think of culture as a process in which tensions between social values are resolved, rather than as a fixed state, an approach to such transformation becomes easier to envision. ► Physicians may not have a clear understanding of the role culture plays in creating a High Reliability organization. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Physicians and healthcare teams apply principles to create high-reliability healthcare culture. Indicate what this activity is designed to change.




REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► Lee, T. H., & Duckworth, A. L. (2018). Organizational Grit. HARVARD BUSINESS REVIEW, 96(5), 98-105. ► Nurok M, Lee TH. Transforming culture in health care. N Engl J Med. 2019 (in press)

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► Health care organizations that are struggling to reorient themselves toward delivery of higher value care often identify culture as their greatest barrier. As with any diagnostic process, accuracy and precision are essential. Despite health care’s widespread embrace and frequent use of the concept of “culture,” its meaning is far from clear. The relationship between culture and desired outcomes is similarly murky. If culture change is essential to providing higher-value care, we will have to think clearly about what we mean by culture and how it can be transformed to achieve desired goals. Most U.S. health care leaders believe that the viability of their organization requires improving the economic value of the care it provides, but they feel overwhelmed by the task of transforming the organizational culture to support that goal. If we think of culture as a process in which tensions between social values are resolved, rather than as a fixed state, an approach to such transformation becomes easier to envision. Nurok, M., & Lee, T. H. (2019). Transforming Culture in Health Care.


Describe the nature of the work involved in culture change. Outline approaches to the development of “organizational grit.” Think through goals to grow the organizational culture at Baptist Health.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Thomas H. Lee, M.D. Chief Medical Officer Press Ganey Boston, Massachusetts Faculty disclosure statement (as it should appear on course shell): Thomas H. Lee, M.D., indicated that neither he nor his spouse/partner has relevant financial relationships with commercial interest companies, and he will not include off-label or unapproved product usage in his presentation or discussion. Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No





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Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Miami Cancer Institute – Multispecialty Grand Rounds: Head and Neck Cancer 2020: Respecting the Old, Welcoming the New. DATE: Monday, February 10, 2020 TIME: 7:30- 8:30 a.m. CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 LOCATION: Miami Cancer Institute – Tumor Board Room 3N110 TARGET AUDIENCE: Oncologists, Radiation Oncologists, Hematology Oncologists, Radiation Therapists, General Surgeons, General Practitioners, Obstetrics and Gynecologists, Oncologists, Radiation Oncologists, Nurses, Social Workers, Patient Navigators and all other interested healthcare professionals. CONFERENCE DIRECTOR: Guilherme Rabinowits, M.D. CME MANAGER: Eleanor Abreu EXPECTED NUMBER OF ATTENDEES: 50-60 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description.

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Dr. Robert I. Haddad’s research has focused on the use of biologic agents and combined modality sequential and concurrent chemoradiotherapy in head and neck cancer. During this lecture he will discuss immune biomarker and genomic testing in head and neck cancer. Dr. Haddad will also address the survivorship of head and neck cancer. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.






What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Physicians may not know how to incorporate the role of chemotherapy and radiation in locally advanced disease. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Physicians will implement multi-disciplinary care when treating patients with head and neck cancer. Indicate what this activity is designed to change.




REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: Human papillomavirus (HPV) has been identified as a risk factor for oropharyngeal squamous cell carcinoma (OPSCC) and a cause of the recent dramatic rise in the incidence of this disease. HPV-positive OPSCC typically affects a younger

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population and has no validated screening test. This study aims to outline the common presenting signs of HPV-positive OPSCC. Laryngoscope. 129(4):877-882, 2019 04. http://ovidsp.dc2.ovid.com/sp-4.03.0b/ovidweb.cgi?&S=FNKNFPPLEBEBPMLGIPBKLHOGFNMDAA00&Complete+Reference=S.sh.49%7c1%7c1&Counter5=SS_view_found_complete%7c30194702%7cmedf%7cmedline%7cmedl&Counter5Data=30194702%7cmedf%7cmedline%7cmedl


Implement sequential and concurrent chemoradiotherapy in head and neck cancer. Assess and identify the role of immunotherapy in head and neck cancer. Identify HPV and oropharynx cancer.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Faculty disclosure statement (as it should appear on course shell): Robert Haddad M.D. Division Chief, Head and Neck Oncology Program Institute Physician Dana Farber Cancer Institute Professor of Medicine Harvard Medical School Robert Haddad, M.D., indicated that neither he has received grant/research support from Merck, BMS, Genetech, Pfizer, Astra Zeneca and GSK. He has also served as a consultant with Merck, BMS, Genetech, Pfizer, Astra Zeneca, GSK, Celgene and Eisai. He will not include off-label or unapproved product usage in his presentation(s) or discussion(s). Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No





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If yes, describe the collaborative efforts. ________________________________________________________ COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. (ETHOS CONTENT) YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title. DATE REVIEWED: ____________REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: MCI Radiation Oncology Grand Rounds- Cardiac Effects of Breast Cancer Radiotherapy DATE: February 14, 2020 TIME: 12 – 1p.m. CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 LOCATION: Miami Cancer Institute – Radiation Oncology Conference Room – 1 N 612 TARGET AUDIENCE: Radiation Oncologists, Medical Oncologists, Oncology surgeons and Radiologists NOTE: Due to limited space, this conference is open to Baptist Health affiliated Medical Staff and Clinical Employees CONFERENCE DIRECTOR: Michael Chuong, M.D. CME MANAGER: Eleanor Abreu EXPECTED NUMBER OF ATTENDEES: 20-40 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



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COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. Cardiac toxicity has been implicated as the primary reason for excess non-breast cancer mortality in early breast cancer radiotherapy studies. Refinements in radiotherapy techniques have allowed for a considerable reduction of this risk in the majority of breast cancer patients. During this conference Dr. Correa will discuss the importance of background cardiac irradiation from breast cancer radiotherapy. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.






What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Physicians may not be aware of the cardiac effects of breast cancer radiotherapy, and/or of the optimal raidation dose to reduce incidential cardiac irradiation and/or radiation techniques on how to achieve this. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Breast cancer radiotherapy will be delivered with radiation techniques which result in low cardiac radiation doses. This would significantly reduce the rist of women developing radiation-associated cardiac disease. Indicate what this activity is designed to change.




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Research/literature review REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► Radiotherapy reduces the absolute risk of breast cancer mortality by a few percentage points in suitable women but can cause a second cancer or heart disease decades later. We estimated the absolute long-term risks of modern breast cancer radiotherapy. J Clin Oncol. 2017 May 20; 35(15): 1641–1649. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5548226/


Summarize the background and importance of incidental cardiac irradiation from breast cancer radiotherapy. Apply evidence of cardiac risk by radiation dose and optimal cardiac dose-volume limits. Implement cardiac-sparing radiotherapy techniques.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Faculty disclosure statement (as it should appear on course shell): Candace Correa, M.D. Medical Director Radiation Oncology Unity Point Health Candace Correa, M.D. has indicated she has no relevant financial relationships and her discussion will not include mention of investigational or off-label usage. Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No






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If yes, describe the collaborative efforts. ________________________________________________________ Collaboration with the Miami Cancer Institute – Radiation Oncology Department. COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. DATE REVIEWED: REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Anesthesia Conference Series: A-ACLS DATE: February 19, 2020 TIME: 7 – 8 a.m. CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 LOCATION: Baptist Hospital Auditorium TARGET AUDIENCE: Anesthesiologists, Certified Registered Nurse Anesthetists, Anesthesia Assistants and Surgeons. CONFERENCE DIRECTOR: Luis de la Cruz, M.D. CME MANAGER: Katie Deane EXPECTED NUMBER OF ATTENDEES: 40 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. Cardiac arrest in the peri-operative setting is relatively rare, and for numerous reasons, knowing when to initiate CPR can be difficult. Formulation of an appropriate differential diagnosis and rapid application of targeted interventions are critical for good patient outcome. Join us to hear Dr. Gerald Maccioli: identify the rare and complex pre-arrest, circulatory crises that require immediate response; and provide principles of monitoring and management of ventilation, gas trapping, and resuscitation to hemodynamic instability and cardiac arrest.

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What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► ACLS guidelines outline treatment for an established cardiac arrest. A-ACLS aims at treating pre-arrest clinical situations that may cause cardiac arrest. A-ACLS provides guidelines for specific clinical scenarios in the operating room and goes beyond traditional ACLS guidelines. ► Periprocedural cardiac arrest (PPCA) can differ greatly in etiology and treatment from what is described by the American Heart Association advanced cardiac life support algorithms, which were largely developed for use in out-of-hospital cardiac arrest and in-hospital cardiac arrest outside of the perioperative space. Specifically, there are several life-threatening causes of PPCA of which the management should be within the skill set of all anesthesiologists. However, previous research has demonstrated that continued review and training in the management of these scenarios is greatly needed and is also associated with improved delivery of care and outcomes during PPCA. (https://www.ingentaconnect.com/content/wk/ane/2018/00000126/00000003/art00028) Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Physicians and Allied Health Professionals incorporate this knowledge into their clinical practice with the goal of preventing cardiac arrests and improving outcomes ► Physicians formulate an appropriate differential diagnosis and rapidly apply targeted interventions resulting in good patient outcome. Physicians utilize resuscitation algorithms that include the evaluation and management of common causes leading to cardiac in the perioperative setting. Practicing anesthesiologists have a working knowledge of these algorithms to maximize good outcomes. (https://www.ingentaconnect.com/content/wk/ane/2018/00000126/00000003/art00028) Indicate what this activity is designed to change.



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REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► Moitra, V. K., Einav, S., Thies, K. C., Nunnally, M. E., Gabrielli, A., Maccioli, G. A., ... & McEvoy, M. D. (2018). Cardiac arrest in the operating room: resuscitation and management for the anesthesiologist: part 1. Anesthesia & Analgesia, 126(3), 876-888. ► McEvoy, M. D., Thies, K. C., Einav, S., Ruetzler, K., Moitra, V. K., Nunnally, M. E., ... & Dobson, G. (2018). Cardiac arrest in the operating room: part 2—special situations in the perioperative period. Anesthesia & Analgesia, 126(3), 889-903.


Identify rare and complex, pre-arrest, circulatory crises that require immediate response in the perioperative setting.

Manage various forms of shock, which may cause cardiac arrest. Apply principles of monitoring and management of ventilation, gas trapping, and resuscitation to hemodynamic

instability and cardiac arrest. Outline treatment for common tachy- and bradydysrhythmias. Manage special causes of cardiac arrest including anaphylaxis, gas embolism, fat embolism, cement implantation

syndrome and malignant hyperthermia.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Gerald Maccioli, M.D., MBA, FCCM, FACA Chief Quality Officer Envision Healthcare Plantation, Florida Faculty disclosure statement (as it should appear on course shell): Gerald Maccioli, M.D. indicated that neither he nor his spouse/partner has relevant financial relationships with commercial interest companies, and he will not include off-label or unapproved product usage in his presentation or discussion. Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No


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If yes, describe the collaborative efforts. The CME Department is collaborating with the Department of Anesthesia, through the Chief, to address through CME selected perioperative management topics for which an educational need has been identified through case reviews. COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. (ETHOS CONTENT) YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title. DATE REVIEWED: REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Conversations in Ethics – The Science of Empathy DATE: Wednesday, February 19, 2020 TIME: 12 noon – 1pm CREDIT HOUR(S) APPLIED FOR: 1.0 LOCATION: BHM 5-MCVI. VC to HH Boardroom, MH Exec. Conf. Rm and SMH Classroom F LIVE WEBCAST TARGET AUDIENCE: Physicians, Psychologists, Physician Assistants, Nurse Practitioners, Nurses, Social Workers, Respiratory Therapists, Clinical Chaplains, Pharmacists, Medical Students, Registered Dietitians and other interest healthcare professionals. CONFERENCE DIRECTOR: Ana Viamonte-Ros, MD, MPH, Medical Director, Palliative Care & Bioethics CONFERENCE COORDINATOR: Rose Allen, DNP, MSM/HM, RN, CHPN, Director, Bioethics Program CME MANAGER: Katie Deane EXPECTED NUMBER OF ATTENDEES: 50-100 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.



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COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. The benefits of empathy in medical practice include improved patient satisfaction and health outcomes. However, empathy not only affects satisfaction and outcomes, but has significant effects on healthcare providers as well. Please join us as Nancy Eklund, M.D., explores the psychology and physiology of empathy and provides strategies to implement empathic skills into clinical practice. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.






What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► The benefits of clinical empathy in medical practice include improved patient satisfaction and adherence to treatment recommendations, more accurate diagnoses, reduced distress, improved health outcomes and fewer medical errors and malpractice claims. To enhance empathy in patient-clinician dyads, the welfare of both must be taken into consideration, however the well-being of today’s primary care physicians is in peril. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Providers implement empathic skills into clinical practice that enhance patient-clinician relationship while balancing clinician well-being, meaningful work and sense of coherence. Indicate what this activity is designed to change.



Best practice parameters Consensus of experts Disease prevention (C12) Joint Commission initiatives (C12) Mortality/morbidity statistics National Patient Safety Goals National/regional data New diagnostic/therapeutic modality (C12) New or updated policy/protocol Patient care data

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Peer review data Process improvement initiatives (C16 & 21) Regulatory requirement Other need identified (Explain): _BHSF Bioethics Program Requested__ Research/literature review

REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: ► Empathy plays a critical interpersonal and societal role, enabling sharing of experiences, needs, and desires between individuals and providing an emotional bridge that promotes pro-social behavior. This capacity requires an exquisite interplay of neural networks and enables us to perceive the emotions of others, resonate with them emotionally and cognitively, to take in the perspective of others, and to distinguish between our own and others’ emotions. Studies show empathy declines during medical training. Without targeted interventions, uncompassionate care and treatment devoid of empathy, results in patients who are dissatisfied. They are then much less likely to follow through with treatment recommendations, resulting in poorer health outcomes and damaged trust in health providers. Cognitive empathy must play a role when a lack of emotional empathy exists because of racial, ethnic, religious, or physical differences. Healthcare settings are no exception to conscious and unconscious biases, and there is no place for discrimination or unequal care afforded to patients who differ from the majority culture or the majority culture of healthcare providers. Much work lies ahead to make healthcare equitable for givers and receivers of healthcare from all cultures. Self- and other-empathy leads to replenishment and renewal of a vital human capacity. If we are to move in the direction of a more empathic society and a more compassionate world, it is clear that working to enhance our native capacities to empathize is critical to strengthening individual, community, national, and international bonds. Riess, H. (2017). The science of empathy. Journal of patient experience, 4(2), 74-77. ► Riess, H. (2015). The impact of clinical empathy on patients and clinicians: understanding empathy's side effects. AJOB Neuroscience, 6(3), 51-53.


Explain the physiology of empathy and describe its physical and psychological modifiers. Define and differentiate empathy, sympathy, and compassion. Describe the benefits empathy has on patients, healthcare providers, and health systems. Implement empathic skills into clinical practice.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Nancy Eklund M.D. Miami Center for Holistic Healing Chair, South Miami Clinical Ethics Committee Baptist & South Miami Hospitals Faculty disclosure statement (as it should appear on course shell): Nancy Eklund M.D., indicated that neither she nor her spouse/partner has relevant financial relationships with commercial interest companies, and she will not include off-label or unapproved product usage in her presentation or discussion. Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No

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If yes, describe the collaborative efforts. The CME Department and the BHSF Bioethics Committee collaborate to improve healthcare provider competencies and practice by addressing areas of ethical concern or interest (as determined by the Bioethics Committee) through compelling and engaging continuing education activities. COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. (ETHOS CONTENT) YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title. ► DATE REVIEWED: REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: Miami Cancer Institute – The Evolving Landscape of Follicular Lymphoma DATE: February 25, 2020 TIME: 8 – 9 a.m. CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 LOCATION: Miami Cancer Institute – Tumor Board Room – 3N110 TARGET AUDIENCE: This educational program is directed toward hematologists, oncologists, pathologists, radiation oncologists, palliative care staff, oncology, hematology nurses, pharmacists and other allied healthcare care team members interested in the treatment of patients with hematologic malignancies CONFERENCE DIRECTOR: Guenther Koehne, M.D. CME MANAGER: Eleanor Abreu EXPECTED NUMBER OF ATTENDEES: 40-50 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.

ARS Case Studies Didactic Lecture Enduring Material (DVD/Booklet) Internet Activity Enduring Material

Internet Live Course (Live Webcast) Internet point-of-care activity Journal-based CME activity Learning from Teaching Live activity

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Manuscript review activity Panel PI CME activity Question & Answer

Regularly Scheduled Series Simulation Test item writing activity Other (specify)

COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. Follicular lymphoma is a cancer that affects white blood cells called lymphocytes. They help your body fight infections. During this conference Dr. Matthew Matasar discusses the awareness of available prognostic models and their limitations. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.






What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Physicians may not be aware or how to assess prognostics, first-line therapy, relapsed vs. refractory therapy or knowledge of emerging therapies and integration of emerging therapies in clinical practice. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Physicians will implement prognostication using currently clinically available models; appropriate patient selection and treatment assignment for patient subtypes. Indicate what this activity is designed to change.



Best practice parameters Consensus of experts Disease prevention (C12) Joint Commission initiatives (C12) Mortality/morbidity statistics National Patient Safety Goals National/regional data New diagnostic/therapeutic modality (C12) New or updated policy/protocol Patient care data Peer review data Process improvement initiatives (C16 & 21)

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Regulatory requirement Other need identified (Explain): _____________________________ Research/literature review

REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: Follicular lymphoma (FL) is a heterogeneous disease with varying prognosis owing to differences in clinical, laboratory, and disease parameters. Although generally considered incurable, prognosis for early- and advanced-stage disease has improved because of therapeutic advances, several of which have resulted from elucidation of the biologic and molecular basis of the disease. The choice of treatment for FL is highly dependent on patient and disease characteristics. Several tools are available for risk stratification, although limitations in their routine clinical use exist. For limited disease, treatment options include radiotherapy, rituximab monotherapy or combination regimens, and surveillance. Treatment of advanced disease is often determined by tumor burden, with surveillance or rituximab considered for low tumor burden and chemoimmunotherapy for high tumor burden disease. Treatment for relapsed or refractory disease is influenced by initial first-line therapy and the duration and quality of the response. Presently, there is no consensus for treatment of patients with early or multiply relapsed disease; however, numerous agents, combination regimens, and transplant options have demonstrated efficacy. Although the number of therapies available to treat FL has increased together with an improved understanding of the underlying biologic basis of disease, the best approach to select the most appropriate treatment strategy for an individual patient at a particular time continues to be elucidated. This review considers prognostication and the evolving treatment landscape of FL, including recent and emergent therapies as well as remaining unmet needs. Follicular Lymphoma: Recent and Emerging Therapies, Treatment Strategies, and Remaining Unmet Needs. Matasar MJ, Luminari S, Barr PM, Barta SK, Danilov AV, Hill BT, Phillips TJ, Jerkeman M, Magagnoli M, Nastoupil L, Persky D, Okosun J. PMID: 31346132 http://theoncologist.alphamedpress.org/content/24/11/e1236.short


Identify available prognostic models and their limitations. Define the role and risks of obintuzumab-based therapy for FL in first-line and relapsed settings. Summarize the failure of PFS24 failure as prognostic model and implications for therapeutic decision-making. Identify targeted agents including lenalidomide and copanlisib in the treatment of FL.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Faculty disclosure statement (as it should appear on course shell): Matthew Matasar, M.D. Associate Member Lymphoma Service Memorial Sloan Kettering Cancer Center Matthew Matasar, M.D., indicated that neither he nor his spouse/partner has relevant financial relationships with commercial interest companies, and he will not include off-label or unapproved product usage in his presentation(s) or discussion(s). Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose.

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CME ACTIVITY TITLE: Miami Cancer Institute – Update on Radiotherapy for Esophageal Cancer DATE: March 9, 2020 TIME: 7:30 – 8:30 a.m. CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 LOCATION: Miami Cancer Institute – Tumor Board Room 3N110 TARGET AUDIENCE: Oncologists, Radiation Oncologists, Hematology Oncologists, Radiation Therapists, General Surgeons, General Practitioners, Obstetrics and Gynecologists, Oncologists, Radiation Oncologists, Nurses, Social Workers, Patient Navigators and all other interested healthcare professionals. CONFERENCE DIRECTOR: Guilherme Rabinowits, M.D. CME MANAGER: Eleanor Abreu EXPECTED NUMBER OF ATTENDEES: 50-60 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.

ARS Case Studies Didactic Lecture Enduring Material (DVD/Booklet) Internet Activity Enduring Material Internet Live Course (Live Webcast)

Internet point-of-care activity Journal-based CME activity Learning from Teaching Live activity Manuscript review activity Panel

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PI CME activity Question & Answer Regularly Scheduled Series

Simulation Test item writing activity Other (specify)

COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. Esophageal cancer is severe illness leading usually to death. Radical surgery is the most successful treatment but most patients are not operable at the time of diagnosis. For these patients external beam radiotherapy with or without concurrent chemotherapy offers the best choice for cure or palliation. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.






What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Management of esophageal cancer requires multidisciplinary collaboration with multimodality therapy in order to achieve optimal outcomes. Some patients do not receive appropriate multidisciplinary input and therapy. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Esophageal cancer patients should be evaluated in a multidisciplinary manner and receive multimodality therapy when appropriate in order to achieve optimal outcomes. Multimodality therapy typically includes radiotherapy. Indicate what this activity is designed to change.



Best practice parameters Consensus of experts Disease prevention (C12) Joint Commission initiatives (C12) Mortality/morbidity statistics National Patient Safety Goals National/regional data New diagnostic/therapeutic modality (C12) New or updated policy/protocol Patient care data

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Peer review data Process improvement initiatives (C16 & 21) Regulatory requirement Other need identified (Explain): _____________________________ Research/literature review

REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: Initial results of the ChemoRadiotherapy for Oesophageal cancer followed by Surgery Study (CROSS) comparing neoadjuvant chemoradiotherapy plus surgery versus surgery alone in patients with squamous cell carcinoma and adenocarcinoma of the oesophagus or oesophagogastric junction showed a significant increase in 5-year overall survival in favour of the neoadjuvant chemoradiotherapy plus surgery group after a median of 45 months' follow-up. In this Article, we report the long-term results after a minimum follow-up of 5 years. Lancet Oncol. 2015 Sep;16(9):1090-1098. doi: 10.1016/S1470-2045(15)00040-6. Epub 2015 Aug 5. https://www.ncbi.nlm.nih.gov/pubmed/26254683


Implement the role of trimodality therapy (neoadjuvant chemotherapy followed by surgery) for esophageal cancer. Assess the role of definitive chemoradiotherapy for esophageal cancer. Identify the role of palliative radiotherapy for esophageal cancer.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Faculty disclosure statement (as it should appear on course shell): Christopher L. Hallemeier, M.D. Radiation Oncologist Mayo Clinic Rochester, Minnesota Christopher L. Hallemeier, M.D., indicated that neither he nor his spouse/partner has relevant financial relationships with commercial interest companies, and he will not include off-label or unapproved product usage in his presentation(s) or discussion(s). Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No



Process redesign or new protocol Reminders (posters, mailings, email blasts) New order sheets

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



Applicable Credits: AMA Category 1 Continuing Psychology Education Continuing Dental Education CME ACTIVITY TITLE: MCI Radiation Oncology Grand Rounds – Proton Therapy for Bone and Soft Tissue Sarcomas DATE: Friday, March 20, 2020 TIME: 12 – 1p.m. CREDIT HOUR(S) APPLIED FOR: 1 Cat. 1 LOCATION: Miami Cancer Institute – Radiation Oncology Conference Room – 1 N 612 TARGET AUDIENCE: Radiation Oncologists, Medical Oncologists, Oncology surgeons and Radiologists NOTE: Due to limited space, this conference is open to Baptist Health affiliated Medical Staff and Clinical Employees. CONFERENCE DIRECTOR: Michael Chuong, M.D. CME MANAGER: Eleanor Abreu EXPECTED NUMBER OF ATTENDEES: 0 CHARGE: 0 LEARNING FORMAT: Must be appropriate to achieve objectives and desired results (C5). Check all that apply.

ARS Case Studies Didactic Lecture Enduring Material (DVD/Booklet) Internet Activity Enduring Material Internet Live Course (Live Webcast) Internet point-of-care activity Journal-based CME activity Learning from Teaching Live activity Manuscript review activity Panel PI CME activity Question & Answer Regularly Scheduled Series Simulation Test item writing activity Other (specify)

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COURSE DESCRIPTION: This short summary will be used on course shell. Please note that keyword searches will pull from this description. Proton therapy has successfully been used to treat a variety of sarcomas with a low incidence of side effects. This means that higher doses of radiation can be used to treat bone and soft tissue sarcomas, and that these higher doses will cause minimal damage to other healthy tissues. During this conference participants will understand optimal integration of radiation therapy with surgery and systemic therapy for none and soft tissue sarcoma. FACTORS OUTSIDE OUR CONTROL – List factors outside our control and beyond the learner performance that impact patient outcomes and contribute to the healthcare “quality gap” being addressed. (C18) Patient: Noncompliance Lifestyle Resistance to change Cost of care/Lack of insurance Physician: Noncompliance Resistance to change Communication skills Reimbursement issues Resources: Institutional Capabilities Physician Practice Limitations Community Service Limitations State of Science: Limited or no treatment modalities Limited or no diagnostic modalities Other: Please describe. BARRIERS TO PHYSICIAN CHANGE: (C19) Briefly explain how this activity addresses the barriers/factors identified.

DESIRABLE PHYSICIAN ATTRIBUTES/COMPETENCIES (C6) ABMS/ACGME: Patient care and procedural skills Medical knowledge Practice-based learning and improvement Interpersonal and communication skills Professionalism Systems-based practice INSTITUTE OF MEDICINE: Provide patient-centered care Work in interdisciplinary teams




The difference between what is (the “actual”) and what should be (the “ideal”). What is the current professional practice gap? What are physicians doing (or not doing) that needs to change? Describe the current state of knowledge, skill, competence, practice and/or clinical/patient outcomes. (C2) ► Some patients with high risk bone sarcomas (generally axial tumors) do not receive radiation therapy at the time of initial treatment or are irradiated with inadequate radiation fields or doses, leaving them at higher risk for local recurrence. Some patients are managed with surgery in cases where a non-surgical approach with high-dose proton-based radiation may be a better treatment option. Indicate if the gap is related to need for change in either/or:


DESIRED OUTCOMES (GOAL): Answer one or more of the following questions: What are the desired or expected outcomes of this conference? What is expected to change or improve as a result of this CME activity? In a “perfect world,” what would doctors be doing if this change were already implemented? What does optimal practice “look like”? (C3) ► Appropriately selected patients are radiated at the optimal time with optimal fields and doses. Indicate what this activity is designed to change.



Best practice parameters Consensus of experts

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Disease prevention (C12) Joint Commission initiatives (C12) Mortality/morbidity statistics National Patient Safety Goals National/regional data New diagnostic/therapeutic modality (C12) New or updated policy/protocol Patient care data Peer review data Process improvement initiatives (C16 & 21) Regulatory requirement Other need identified (Explain): _____________________________ Research/literature review

REFERENCES supporting the current practice and/or the optimal practice and/or practice gap: Negative surgical margins are uncommon for spine sarcomas; hence, adjuvant radiotherapy (RT) may be recommended but tumor dose may be constrained by spinal cord, nerve, and viscera tolerance. J Surg Oncol. 2014 Aug;110(2):115-22. doi: 10.1002/jso.23617. Epub 2014 Apr 19. https://www.ncbi.nlm.nih.gov/pubmed/24752878


Implement appropriate optimal integration of radiation therapy with surgery and systemic therapy for bone and soft tissue sarcomas.

Identify potential non-surgical treatment options for patients with axial sarcomas where results with surgery have been sub-optimal.





FACULTY: (Name, Specialty and/or Title(s), Institution(s), City, State. For more than 2, include list at end of application.) Faculty disclosure statement (as it should appear on course shell): Thomas F. DeLaney, M.D. Andres Soriano Professor of Radiation Oncology, Harvard Medical School Radiation Oncologist, Department of Radiation Oncology Associate Medical Director- Francis H. Burr Proton Therapy Center Co-Director, Center for Sarcoma and Connective Tissue Oncology Massachusetts General Hospital Boston M.A. Thomas F. DeLaney, M.D., indicated that neither he nor his spouse/partner has relevant financial relationships with commercial interest companies, and he will not include off-label or unapproved product usage in his presentation(s) or discussion(s). Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. RELEVANT FINANCIAL RELATIONSHIPS: List individuals in control of the content of this CME activity (other than faculty). Note: When using electronic evaluations, disclosure statements for faculty must be included on course landing pages. Have all relevant financial interests been identified and resolved? (C7; SCS 2.1, 2.2, 2.3) Yes No


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If yes, describe the collaborative efforts. ________________________________________________________ Collaboration with the Miami Cancer Institute – Radiation Oncology Department. COMMERCIAL SUPPORT: Indicate here if support will come from the Foundation’s general Continuing Medical Education fund. (ETHOS CONTENT) YOU MAY ALSO BE INTERESTED IN: List names of up to two courses with similar target audiences. Please list complete course title. DATE REVIEWED: REVIEWED BY: Accelerated Approval Executive Committee Live Committee APPROVED: YES NO Credits: AMA/PRA Category 1 Credits: # 1 Continuing Psychology Education Credits: # N/A Continuing Dental Education Credits: # N/A

Documents

CONFERENCE APPLICATIONS AND REPORTS · 2020-02-07 · 1 CONFERENCE APPLICATIONS AND REPORTS Applications Previously Approved November 6, 2019 through February 5, 2020 Internet CME