ACMT's Grand Rounds offer an in-depth and interactive platform for learning and discussion about issues that impact the research and practice of medical toxicology. Experts from within and outside medical toxicology will share their knowledge and experience and highlight areas for collaboration and mutual understanding.
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February 11, 2020
Remembrance of Things Passed: Using Urinalysis Results to Monitor Emerging Drug Use: DUF to EDDS
Presenter: Eric D. Wish, Ph.D., Director, Center for Substance Abuse Research (CESAR)
Learning Objectives:
- Explain the need for objective measures to identify emerging drugs
- Understand the value of urinalysis as part of a drug early warning system
- Discuss the need for a national system of expanded testing of specimens
December 16, 2019
Algal Toxins: Toxidromes, Molecular Mechanisms and Human Health Effects
Presenter: Mike Twiner, MD, PhD, Detroit Receiving Hospital and Harper University Hospital, Wayne State University
Learning Objectives:
- Review the most commonly encountered algal toxins that pose a threat to human health in North America.
- Understand the general toxidromes and geographical predominance of algal toxins that can help rapidly identify a poisoning event.
- Understand the basic mechanisms of action of the algal toxins and review the available treatments.
October 8, 2019
An Adolescent Male with Acute Hypoxemic Respiratory Failure
Presenter: Dr. Matthew McGraw, Assistant Professor of Pediatric Pulmonology, University of Rochester
Learning Objectives:
- Create a differential diagnosis for respiratory failure in an adolescent male
- Discuss causes of direct and indirect toxicity of e-cigarettes
- Identify areas of future research regarding lipid metabolism and pulmonary toxicology
August 13, 2019
Laboratory response to new psychoactive substances (NPS) exposure
Presenter: Roy Gerona, Ph.D., Assistant Professor, Department of Obstetrics/Gynecology and Reproductive Sciences, University of California, San Francisco
Learning Objectives:
- Define and differentiate NPS from traditional illicit drugs.
- Identify and discuss currently available laboratory testing to detect and confirm NPS in patient samples.
- Enumerate and discuss the unique requirements of NPS testing.
- Discuss the role of specialty laboratories and surveillance networks in addressing NPS exposure.
June 11, 2019
Pharmacotherapy Considerations for Patients on ECMO
Presenter: Amy L. Dzierba, Pharm.D., FCCM, FCCP, BCPS, BCCCP, Clinical Pharmacy Manager, Adult Critical Care, NewYork-Presbyterian Hospital
Learning Objectives:
- Explain altered pharmacokinetics in critically ill patients receiving extracorporeal membrane oxygenation (ECMO)
- Evaluate recent literature on the management of pain, agitation, and delirium in patients receiving ECMO
- Discuss ways to provide optimal antimicrobial therapy to patients receiving ECMO
April 9, 2019
ECMO in the Acutely Poisoned Patient
Presenter: Joshua C. Reynolds, MD, MS, Assistant Professor of Emergency Medicine, Michigan State University College of Human Medicine
Learning Objectives:
- Case presentation
- ECMO 101 – terminology, equipment, logistics
- Why consider poisoned patients for ECMO?
- Supporting evidence
- Can my institution do this?
Click hereFebruary 12, 2019
Herbal Toxicology
Presenter: Richard Ko, Pharm.D., Ph.D., Principal Food and Drug Consultant, Herbal Synergy
Learning Objectives:
- Have an overview knowledge of selective toxicity related to herbs
- Have an understanding of common herb-drug interactions and its related toxicity
- Learn and acquire tools to investigate herb toxicity
December 11, 2018
Inborn Errors of Metabolism that can Masquerade as Toxidromes
Presenter: Kara Pappas, MD, Clinical and Biochemical Geneticist, Children’s Hospital of Michigan; Assistant Professor of Pediatrics, Wayne State University School of Medicine
Learning Objectives:
- Clues that you are dealing with an inborn error of metabolism
- Recognizing cardinal features of organic acidemias, fatty acid oxidation disorders, and urea cycle disorders
- Diagnosis of inborn errors of metabolism
October 9, 2018
Developing a carbon monoxide poisoning antidote using an engineered scavenging molecule
Presenter: Jason Rose, MD, MBA - Assistant Professor of Medicine, University of Pittsburgh School of Medicine
Learning Objectives:
- Learn about the current management difficulties with the treatment of carbon monoxide poisoning
- Discussion about the concept of molecular carbon monoxide scavenging as a potential mechanism for treating CO poisoning
August 14, 2018
Cardiac Safety of Anti-Seizure and Anti-Depressant Drugs in Patients with Long QT Syndrome
Presenter: David S. Auerbach, Ph.D., Research Assistant Professor, Department of Medicine, Aab Cardiovascular Research Institute
Learning Objectives:
- Anti-seizure and anti-depressant drugs have ion channel altering properties, which may augment a patient’s risk of arrhythmias.
- It is important to understand the patient’s baseline risk of arrhythmias, and the mechanism(s) of drug action / off-target effects before initiating pharmacological therapies.
June 12, 2018
Principles of Adolescent Substance Use
Presenter: Brian Grahan, MD, PhD - Addiction Medicine/Internal Medicine/Quality Measurement, Hennepin Healthcare
Learning Objectives:
- Screen adolescents for substance use disorders with validated tools
- Apply a diagnostic framework to assess for possible substance use disorders
- Provide tailored interventions in clinic and acute settings
- Describe treatment options for adolescent alcohol and opioid use disorders
May 15, 2018
Billing and Reimbursement in 2018
Moderator: Timothy J. Wiegand, MD, FACMT -Director of Toxicology and of the Toxicology Consult Service at the University of Rochester Medical Center in Rochester, NY.
Presenter: Tracey Loveland, CMBS -Certified Medical Billing Specialist & Special Projects Coordinator, Emergency Associates.
Presenter: Rosalie Wratni, Director of Reimbursement, Emergency Associates
Learning Objectives:
- To describe how to implement effective billing and reimbursement in a Medical Toxicology practice
- To review how the new specialty code will impact billing and reimbursement for Medical Toxicology practice
- To provide an overview of ICD10 with relation to common Medical Toxicology billing opportunities
- To give an overview of the most common billing opportunities in an ED, hospital and clinic setting for a Medical Toxicologist
- To describe how to implement billing in a toxicology clinic including management of patients with addiction for a variety of diagnosis including with buprenorphine (Medication Assisted Treatment)
February 13, 2018
Cardiac Risk and Methadone: Clinically Significant Relationship?
Learning Objectives:
- The learner will be able to evaluate the relationship between methadone and the QTc interval
- The learner will become aware of current practice guidelines regarding methadone and cardiac safety
- The learner will weigh the clinical relevance of methadone’s role in precipitating events
December 12, 2017
Translational Research and Acetaminophen Toxicity
Learning Objectives:
- Understand the role of drug metabolism in acetaminophen liver injury.
- Review limitations of current diagnostic approaches.
- Understand basic principles of new diagnostics development for acetaminophen liver injury.
August 8, 2017
Capacity, Choice, Psychiatry, and the Neuroethics of (In)-Voluntary Treatment of an Acute Toxicology Patient
Learning Objectives:
- Outline the principles around informed consent, capacity, and medical necessity that inform the voluntary or involuntary treatment of an acute toxicology patient
- Discuss psychological themes in medical relationships that affect pathways to ethical care
- Introduce concepts from neuroscience that impact how we care for patients and how they choose that care
June 16, 2017
ECMO for the Poisoned Patient: Issues in Transport and Management
Learning Objectives:
- Describe the three components of an ECMO circuit
- Understand general indications and contraindications for ECMO support
- Describe use of venoarterial (VA) ECMO to support poisoning-related cardiogenic shock, and issues related to triage and transfer of ECMO candidates with severe poisoning
March 21, 2017
Oximes? I have not used them in a decade!
Learning Objectives:
- Describe the epidemiology of pesticide poisonings in India and Punjab
- Discuss the clinical experience with organophosphate poisonings in Punjab
- Discuss the use of oximes in the organophosphate poisoning
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February 14, 2017
Toxins and Disorders of Neuromuscular Transmission
Learning Objectives:
- Review clinical vignettes of acute weakness
- Review clinical presentation of NMJ toxins and how to differentiate the syndromes
- Discuss specific antitoxins and their indications, side effects
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December 13, 2016
A Blueprint for Toxicology Practice - Incorporating buprenorphine into bedside and clinic care
Learning Objectives:
- Describe the process for obtaining certification for prescribing buprenorphine for the treatment of opioid dependence.
- Describe the induction process for buprenorphine in the ED and hospital setting for use in opioid-dependent patients admitted with serious infections related to injection drug use.
- Describe the use of adjunctive medications (e.g. clonidine, hydroxyzine) during the transition from full opioid agonists onto buprenorphine products.
- Describe billing and reimbursement opportunities related to use of buprenorphine in the hospital and clinic setting.
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October 11, 2016
Toxicologic Testing Fentanyl Derivatives and Other Emerging Synthetics
Learning Objectives:
- Appreciate the opportunities and challenges inherent in advanced toxicologic testing for different novel synthetic psychoactive compounds
- Gather sufficient knowledge about the current state of available testing for synthetic psychoactives to make carefully measured applications to clinical practice
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August 9, 2016
Hyperammonemia: Approach to diagnosis and management
Learning Objectives:
- Review the basics of ammonia production and metabolism;
- Highlight the clinical features of hyperammonemia;
- Present a practical diagnostic algorithm for patients who present with acute ammonia elevations;
- Discuss current and future therapies aimed at both acute and chronic management of hyperammonemia
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June 14, 2016
Risk From Radiation Exposure Due to Medical Imaging
Learning Objectives:
- To understand safety culture’s influence on key radiation protection principles
- To discuss the current evidence and uncertainty around risk from ionizing radiation in medicine.
- To understand both qualitative and quantitative tools in appropriate use of medical imaging
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Click here for Dr. Salame-Alfie's bio
April 12, 2016
Global Health Activities at the CDC: The Global Health Security Initiative
Mr. Chris Duggar, Chief of Country Strategy and Implementation Branch, Division of Health Protection, CDC Center for Global Health
Dr. Vikas Kapil, Chief Medical Officer, CDC Center for Global Health
Dr. Ziad Kazzi, FACMT, Co-Chair, ACMT International Committee
Dr. Rais Vohra, FACMT, Co-Chair, ACMT International Committee
Learning Objectives:
- Describe the roles of CDC in Global Health
- Describe the Global Health Security Initiative
- Discuss the potential roles of medical toxicologists in Global Health
February 9, 2016
The Importance of the Toxicology Report in Understanding the Current Overdose Crisis
Learning Objective:
Evidence-based medical practice is the current standard of clinical practice. We believe that we now know why individuals are dying during the current overdose epidemic, but that is a matter of understanding the rapidly changing field of Forensic Toxicology and in interpreting an extremely complex laboratory document – the toxicology report. The presentation will discuss some of these complexities in the context of the current crisis as seen in the Commonwealth of Pennsylvania.
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October 13, 2015
Getting Your Research Written Up Despite a Busy Schedule
Research on academic writing has found that small changes in work habits can lead to large gains in productivity, as well as make writing more enjoyable. In this webinar, the audience will learn:
- The main findings of the research on writing and productivity
- Research-based tips and strategies to increase writing productivity and enjoyment of the writing process
- Why these strategies work through the evidence that supports their effectiveness
Dr. Hunter completed her Ph.D. in sociology at the University of Arizona, where she studied social aspects of science, academia, and work. She continued this line of research as a postdoctoral fellow at the University of Notre Dame, then expanded her work researching institutional and educational research at the University of Massachusetts Medical School. Dr. Hunter is currently the Program and Research Manager in the University of Arizona's Office of the Provost, where she works to support and facilitate faculty development, focusing on greater research publication productivity. She has published extensive research on factors that influence academics’ publications and citations over time. She has also investigated factors that contribute to collaboration in publications. Additionally, she has published extensively on medical education. Currently, she is designing a research project in which she will be investigating how writing interventions influence productivity and career satisfaction among faculty. August 11, 2015
Treatment of Chronic Pain with Opioids: Risk Management and Addiction
- Understand the opioid overdose and chronic pain epidemics
- Learn about risk management in opioid prescribing
- Learn more about opioid addiction and pain management in opioid addicted patients
Dr. Anne M Pylkas, MD is board certified in internal medicine and addiction medicine. She attended medical school at the University of Minnesota and completed her residency and addiction medicine training at Hennepin County Medical Center (HCMC) in Minneapolis. She is an Assistant Professor at the University of Minnesota, teaching medical students and residents. At HCMC, she treated opioid dependence in a methadone clinic setting and was a primary care provider for a medically and socially complex population. She also helped develop a curriculum for Chronic Opioid Treatment for Chronic Pain in Primary Care and Screening and Brief Intervention for primary care physicians. She now also works at HealthPartners Interventional Pain Clinic in St. Paul, treating complex chronic pain and addiction. She is the Medical Director of Sage Prairie Recovery, an outpatient chemical dependency treatment program in Burnsville, MN. June 9, 2015
Acute Liver Failure
Learning Objectives:
- Review the definitions and epidemiology of acute liver failure (ALF).
- Review of the causes of acute liver failure, with an emphasis on toxicology.
- Discuss cerebral edema as a complication of ALF.
- Management of patients with ALF, including extracorporeal devices.
Dr. Al-Khafaji is the medical director of the transplant intensive care unit at University of Pittsburgh Medical Center. He is an associate professor of critical care medicine at the University of Pittsburgh School of Medicine. He has authored and co-authored over 25 peer-reviewed articles and many book chapters. He is the editor of the book, Critical Care of Patients After Abdominal Transplant by Oxford Publishing Company. Dr. Al-Khafaji is involved in clinical trial studies conducted at the University of Pittsburgh on predictors of graft dysfunction after liver transplantation in patients with fulminant hepatic failure and evaluation of novel biomarkers from critically-ill patients at risk for acute kidney failure.
April 14, 2015
Telemedicine 2015
Learning Objectives:
- Understand the different forms of telemedicine and tele-health being clinically utilized here and throughout the U.S.
- Review the legal challenges to implementing and managing a telemedicine program.
- Review of the financial opportunities and challenges of telemedicine
Marc T. Zubrow, M.D., FACP, FCCP, FCCM, is currently the Vice President for Telemedicine and Medical Director of eCare at the University of Maryland Medical System and Associate Professor of Medicine at the University of Maryland School of Medicine.
A graduate of University of Pennsylvania and Jefferson Medical College in Philadelphia, Pa., Dr. Zubrow completed his internal medicine residency at the Lankenau Hospital also in Philadelphia. He went on to complete a fellowship in pulmonary medicine at the University of Pittsburgh, Pittsburgh, Pa. He is board certified in internal medicine, pulmonary and critical care medicine.
After leaving fellowship, Dr. Zubrow practiced pulmonary and critical care medicine in Greensburg, PA for 5 ½ years before moving to Wilmington, DE and the Christiana Care Health System. Dr. Zubrow has had a variety of roles and responsibilities including: director of MICU at Christiana Hospital, director of ICU at Wilmington Hospital, director of critical care medicine as well as leading multiple clinical care teams (Rapid Response Team, Sepsis Alert Team (winner of the 2008 Joint Commission Codman Award), and the nationally recognized Code Blue system). Prior to moving to the University of Maryland Medical System he was the director of Critical Care Medicine, medical director for the tele-ICU, eCare, and medical director of Flexible Monitoring at Christiana Care Health System.
Dr. Zubrow assumed the role of Medical Director of Maryland eCare in 2008. This innovative project
provides tele-ICU support to six rural hospitals in Maryland. It has been the recipient of multiple awards for healthcare innovation.
Dr. Zubrow has served as ACCP Governor for the state of Delaware as well as on a variety of committees at both local and national levels. He was the chairperson of the tele-ICU committee for the Society of Critical Care Medicine2012-2013. He is a fellow of the American College of Physicians, American College of Chest Physicians and American College of Critical Care Medicine. He has been honored with several teaching awards and clinical excellence recognition as well as being listed in the “Best Doctors in America.” In January 2009, he was named by HealthLeaders Magazine as one of “HealthLeaders 20: People are who meeting challenges to make healthcare better.”
February 17, 2015
Health Effects of Radon Exposure
Learning Objectives:
- Main questions and issues surrounding radon
- Radon properties and radiation dosimetry
- Radon pharmacokinetics
- Primary health endpoints to consider in radon exposures:
- Cardiovascular, ocular, renal, respiratory, and reproductive consequences
- Cancer (epidemiologic studies and new confounders)
Sam received a BS in chemical engineering and an MS in health physics (medical and environmental options) from Georgia Tech. As senior health physicist at the Agency for Toxic Substances and Disease Registry, he is the chemical manager for health effects documents on radioactive materials and several metals (e.g., radium, radon, and uranium). On a pro bono basis, he manages or consults on the decommissioning of CDC radiation facilities. In 1994-1996 while at the EPA National Air and Radiation Environmental Laboratory, he developed health effects documents regarding uranium mill tailings sites, oversaw decommissioning of a facility that studied nuclear fallout uptake in cattle, and represented EPA labs on a multi-agency effort that developed MARSSIM (the U.S. standard for releasing previously contaminated radiation sites). In 1993-1994 he managed the radiation safety office at Emory University. Prior to that, Sam worked at Charleston Naval Shipyard in various capacities, starting as a nuclear engineer, becoming Radiation Safety Officer for industrial radiography and instrument calibration activities, and finally as manager of the environmental monitoring program and radiation analytical laboratory. The facility overhauled and refueled nuclear-powered warships, homeported squadrons of fast attack and ballistic missile submarines, and included two nuclear reactors for operator training.
Sam is a Certified Health Physicist by the American Board of Health Physics. Since 2007, he has represented DHHS by chairing the Medical Radiation Workgroup of the Interagency Steering Committee on Radiation Standards. He was CDC liaison to the Nuclear Regulatory Commission during the Fukushima-Daiichi nuclear accident response (2011-2012). He is a U.S. Delegate to the International Radiation Protection Association (2012-2016), Fellow of the Health Physics Society (HPS), and has held HPS positions on their Board of Directors (2011-2014), as president of the Charleston Chapter (1991-1993) and Atlanta Chapter (2003-2004), on the Laboratory Accreditation Policy Committee (member 1993-1996, 1999-2002, and chair 2003-2011), and on the Research Needs Committee (member 2000-2003). Sam and his wife, Nancy, live in Cumming. He installed a radon abatement system on their home during construction.