Hi, good afternoon, everybody. Welcome to today's webinar. We're going to give it just a minute to let folks log on. We've got a pretty good audience today, and we're going to have quite a few people, so we're just going to give everybody just a minute here to be able to log on. Okay, I think I see a lot of people getting on the webinar. Thank you. Let's just go through some housekeeping items. Today's webinar is sponsored by Semmler Scientific. It's titled Preventing Disease and Improving Outcomes Through Early Detection of Peripheral Artery Disease, PAD, which will be presented by Dr. Sonia Turf. On your control panel, you're going to see a couple of different buttons. The chat button, you're going to find a link for today's presentation. You can download that, share that with your colleagues and coworkers, and if you've got any questions, all of those slides will be available to you once you download. During the presentation, if you have any questions, you can enter those into the Q&A section. The Q&A section will be monitored by the Semmler Scientific folks and MedAxiom team, and we'll be posting those at the end of the presentation. So if there are any that can be answered in the Q&A section itself, we'll do that. Otherwise, we'll post those to Dr. Turf and the Semmler team at the end of the presentation. So let's get started. We've got a good presentation today. So Dr. Turf will be sharing her patient successes in preventing amputation and disease progression. This program will discuss the importance of early detection of PAD in optimizing goal-directed medical treatment, risk factor management, and targeted appropriate awareness. Through review of case examples, Dr. Turf will illustrate the positive impact of volume-based PAD detection at the point of care and multidisciplinary coordinated care in patient outcomes. Dr. Sonia Turf is a vascular surgeon with over two decades of experience as an attending vascular surgeon, clinical director of vascular surgery, and surgical teaching faculty in academic, private, and hospital settings, including Christiana Care Hospital, St. Francis, and Wilmington hospitals. She completed her vascular fellowship at NYU Medical Center and has recently accepted a position as medical director at Memorial West in Florida. Dr. Turf has developed several vascular programs and initiatives, such as a vascular clinic nursing liaison program to improve patient care. She joined the Lebanon PA Veterans Hospital in 2022, where she is dedicated to veterans' cardiovascular health and launched a PAD early detection program. Dr. Turf is passionate about education, outreach, and improving vascular disease recognition and treatment for patients. So with that, we're going to get started. Dr. Turf, the floor is yours. Thank you. Thank you, Chris, and thank you to Semmler and MedAxiom for having me today. As you mentioned, PAD screening and identification of peripheral artery disease is so important. The American Heart Association came out in 2022 with a PAD National Action Plan, and I encourage anybody who has not visited the website to do so. They have incredible amount of information, both for providers and clinically, and lots of tools that you can use for PAD Action Kit. But the American Heart Association supports the diagnosis and early diagnosis of peripheral artery disease. As you know, it's a progressive atherosclerotic disease, leads to over 150,000 amputations per year. It's a preventable disease, yet underdiagnosed and undertreated. 50% of patients with peripheral artery disease are asymptomatic, and PAD is an independent outcomes indicator, carrying a threefold risk for mal if not treated adequately. Next slide, please. So when I got to the Lebanon Pennsylvania Veterans Administration Hospital, I was brought there because there was not a vascular surgery program. And the Veterans Administration, we'll talk about that a little bit later, has a PAVE program to prevent amputations. And there was a big need to identify veterans earlier for their peripheral artery disease in order to prevent amputation. We had a very alarming amputation rate that was pre-intervention, and this was also reflected by Dr. Alabi had evaluated the Atlanta VA Medical Center for her vascular patients and saw that almost 50% had had no vascular surgeon visit before having a lower extremity amputation. And over 30% of the veterans who had an amputation had no vascular assessment whatsoever. So we know the classic of veteran, higher risk of cardiovascular disease, higher risk of peripheral artery disease. But it's alarming that these patients had no idea they had vascular disease and weren't getting treated properly. She also noted that veterans that lived more than 13 miles from their primary care provider were less likely to receive vascular screenings. The logistics of having veterans who travel pretty far come to the hospital and then have to get scheduled for other testing or screening testing at a different time appears to be burdensome. We know from our information about veterans that there's a 20% lower ABI average indicating more severe disease than non-veterans. Veterans age 45 to 64 have a rate of vascular procedures 10 times those of the general population and macrovascular function impairment is worse in veterans with a 14% lower ABI. So next slide, please. So we knew that the job was going to be really providing education to primary care providers and providing education to the veterans themselves to help identify peripheral artery disease before it progressed to needing amputation. So this timeline is sort of the scale of having the risk factors, then having asymptomatic disease sort of toward the left-hand side, and then the progression where 80% of veterans who undergo amputation also have diabetes. Obviously risk factors for peripheral artery disease, similar to cardiovascular disease, age greater than 65, diabetes, smoking, family history, hyperlipidemia, and hypertension leading to asymptomatic PAD. And this is really, we were trying to target patients towards the left-hand side who had subclinical PAD or intermittent claudication versus waiting until they had breast pain, ulceration, gangrene, and undergoing amputation. Next slide. So the VHA directive that was first out in 2016 called PAVE, Prevention of Amputation in Veterans Everywhere, is a directive and a policy that mandates that there's a PAVE program in every VA facility. And every facility in the Veterans Administration Hospital operates as its own independent facility. So before I, I've worked at several VAs, but I did not realize that even though there's a national directive or a policy, how it's carried out is different at each location. So it is very location specific, how programs get rolled out. That's just how the VA does it. And but what is required in those, on those elements that are required in each individual program is an initial foot check conducted for at-risk populations and suspicious findings such as a wound, ulcers, poor nail care, et cetera, be referred to podiatrists for further evaluation, timely and appropriate referrals and follow-up, referring veterans with amputations to peer support programs if needed, and expanding on the support for veterans and developing a system at each individual facility to help identify and track veterans who've had amputations or who are at risk for amputations. So we were really focusing on identifying those veterans at risk because that really wasn't being done at facility. Next slide, please. So again, veterans have a higher pre-intervention amputation risk. Why? Uncontrolled risk factors, noncompliance with therapy, unrecognized PAD. Sometimes patients have a test that's positive. They have PAD, but they didn't know and they never got followed up on, delays in care due to scheduling issues due to logistics, travel time, et cetera. And as is true outside the VA, there is no true ownership of PAD in the VA system. Sometimes primary care would be following a patient with vascular disease or PAD. And sometimes the wound clinic would be watching patients. Sometimes it would be podiatry. Sometimes it would be vascular. Sometimes it would be cardiology. So what did we want to do? We want to identify PAD earlier in veterans and develop a screening program. Once PAD was diagnosed, we want to improve the intensity of medical management and follow-up, recognizing PAD earlier and wound and referrals earlier for intervention if needed, not waiting until it was too late and an amputation was required. And then also using screening program to improve community and provider awareness, incorporating primary care podiatry and wound clinics to improve the recognition of PAD to help pull those patients under the spotlight a bit. Next slide, please. So in screening for PAD, we came up with what are the needs that we had for our facility. We wanted it to be easy to use for the patient. We wanted the results to be easy to obtain and communicate to the provider and the patient. Some of the logistical problems that we have at Lebanon VA is patients are referred out for testing and it can take a few weeks to get the results back. Sometimes it goes to the primary care. It doesn't always go to the ordering provider and sometimes they don't know what to do with it and then it can be delayed getting back that information. We want any testing that we do to be accurate and reliable. We want it to be cost effective and minimal barriers to implement. As with starting any new project at the VA, there's a lot of barriers to making a change. It's a slow moving system. So we wanted it to sort of have minimal amount of barriers to start that program. Staffing was a big concern. Some of the staff at the Lebanon VA is very receptive to trying new things, but other staff was very shy about what they're going to do and taking on new roles. So we wanted it to be really clear who was going to be doing the testing, what was going to be involved, where we were going to do the testing, and how this was going to roll out. We also wanted to know when we did the test, who is going to own that result? Who is going to report it into the chart? Who is going to put in the credit for it? In our case at the VA, we get credit for our work, but we don't specifically bill for it. And then who is going to do the follow-up? So whatever the results are of the tests that we do, how are we going to make sure that those patients are actually followed up? Also, who would communicate the results to the patient and who determines the treatment plan? So next slide. So we looked at PAD testing guidelines from the American Heart Association, American College of Cardiology, and American Diabetes Association. And our veterans fit right in these categories. So we sort of use these as templates for who we were going to try to test for at-risk population, knowing that we were likely going to have pretty good numbers as far as positive results. Age under 50, if they had diabetes and another additional risk factor, such as smoking, hypertension, previous interventions. Age 50 to 64, if they had risk factors for atherosclerotic disease and a family history of PAD and chronic kidney disease, any of those things combined with that age group. And then anyone who was over 65 and anyone who had known atherosclerotic disease in other vascular beds. So people who had coronary stents or who had carotid disease, we would do the testing. From the American Diabetes Association, recommending to perform PAD testing in asymptomatic individuals with diabetes, age over 50, with any of those risk factors, presence of microvascular disease, foot complications, any end organ damage from diabetes. And also any patient who had diabetes for more than 10 years. So we knew we were going to deal with quite a significant amount of numbers at our hospital. Next slide, please. So how did we put all this together and come up with a plan to try to identify PAD earlier in our patients? We used the PAD National Action Plan as a guide and the PAVE program, and we wanted to raise awareness through professional education. So I did a lot of outreach to primary care, inpatient, the clinics, to nursing staff, to surgical staff, to the medical residents, to medical students, to talk about PAD, to talk about the systemic nature of PAD, medical management, to also reach out to pharmacy and hypertension clinic to try to raise up the education and get more people on our side for helping these patients really address their underlying risk factors. And then the second part was, how are we going to identify the veterans that had PAD and then manage the treatment? Once we had a plan, we had to come up with, well, how are we going to actually test? So next slide. The professional education that I mentioned, medical providers were educated, wound and podiatry providers and staff, we decided to go with Quantaflow for our testing. The podiatry providers, we had two Quantaflow devices at two of the sites. So the podiatrists were fairly familiar at those sites with Quantaflow, but it really wasn't being used for screening. It was being used as a diagnostic tool because our vascular lab had quite a big backup for testing that could take up to six weeks just to get an ABI or SLP PVR scheduled. So we decided to go with Quantaflow and we decided that we were going to have Quantaflow in all of the wound clinics and all five podiatry sites. So we put those in all those clinics and what we did was train the personnel at those clinics and the providers that were ordering the tests basically at point of care during their evaluation, the tests would be completed and the veterans were immediately informed of results and we had a very straightforward plan for treatment. If they had asymptomatic mild disease referred to the primary care provider for medical risk management and discussion, if they had significant risks and symptoms such as wounds or severe clonication, they generally would be referred for further evaluation with other vascular testing and obviously if they had a severe wound or a problem with healing, then they would be referred for a more urgent consult. So next slide. So this is just our care path, basically as part of the PAVE exam they would have a visual foot inspection. If there were significant concerns, then they would be obviously get the Quantaflow test and then sent to vascular. Also check for pulses if abnormal. Quantaflow test was performed and then based on that, either go for further testing or a CTA or evaluation depending on the severity of the concerns. So this was if they already had a wound or already had a significant disease. Next slide, please. The reason that we went with Quantaflow at our site was we have the option of basically using ABIs, but the training required limited accessibility for the staffing, the amount of time that it was going to require in the rooms and the lack of standards were really the limiting factors that we felt that that wasn't going to be as accurate. Of course, as a vascular surgeon, I can do ABIs, my nurses usually can do ABIs, so it wasn't a problem. We also had quite a significant amount of patients that had complained about having ABIs done. Because over 80% of the veteran population has diabetes, a lot of times their vessels are calcified, so ABIs are inaccurate with non-compressible vessels and the cuffs have to go up pretty tight. So we felt that that was going to be a concern at our site and we already had Quantaflow available, it was already approved to be used, so we just expanded on that program and felt like it really eliminated all of these concerns. Next slide. So a Quantaflow device, hopefully you're all familiar with how it looks and how it works, FDA approved, quick, easy, pain-free, ability to detect PAD in non-compressible vessels, no risks compared to using a low-pressure cuff and can be performed by ancillary staff. We had both medical assistants, LPNs, and nurses do the testing, and it was a point of care. Basically, it could be added on to essentially any exam in just a couple minutes and we would get a report. The report was filed right into the patient's chart and we just added in an interpretation note in our charting system and it just worked very seamlessly. We could refer back to those and follow up with patients, and as you see, very sensitive and specificity are great with good accuracy. So next slide, please. So this first case presentation was actually a 75-year-old female. She had a significant history of smoking, two packs per day, and had a one-year history of non-healing wound on her leg that was from an originally traumatic event. But she had had the wound sort of getting worse, getting better over the period of time. Her history is significant for coronary disease without intervention, no previous MI. She does have a history of COPD, multiple myeloma, and spinal stenosis. She really wasn't too active because of that. No history of hyperlipidemia or diabetes, and no hypertension. She had undergone an SLP-PVR when she first presented to one of the wound clinics, the outline clinic, and this was interpreted as normal because it was greater than one. And that was about a year prior to our getting involved. And basically, she had been treated as a venous wound with compression, but it became unbearable for her to tolerate any compression. The wound just never healed, and then eventually got worse. And she was seen by a different provider at the wound clinic, and a quantum flow test was completed. Next slide. So on the right-hand side, this is what your quantum flow report will look like. The top of that would be the patient information and clinical history, such as age, smoking history, diabetes, hypertension. It prints right out on the report with the demographics. And to the left was her wound. So on that quantum flow test result, this can be printed immediately right after the test is completed. The test basically was done right in the clinic. And one of the reasons that she really didn't have any other follow-up is that she actually was like, it hurt so bad to have the ABI test done, because she did have edema. It doesn't look too bad. She's, she's quite thin. But she didn't want to have any more compression done on her legs. And she was really frightened of getting anything done to her leg, even just like wound dressing changes. But she did agree to the quantum flow after we explained to her, did it on her finger and then moved to her legs. And this was her result. So you can see on that upper right-hand side, the left foot has a pretty dampened wave forms. And her result was 0.35, which is if you look under the potential recommendations, she would be considered high risk due to her wound and that moderate disease. So next slide. She ended up going for an angiogram with ended up getting through the lesion and intervening. So the initial angiogram shows complete SFA occlusion that's flush at the origin, but reconstituted above knee pop. And I was able to get through that with a wire and drug code, a balloon angioplasty. And our final imaging shows two good vessels to the foot and the perineal kind of tapers off, but she had immediate relief of her pain. Next slide, please. And she really healed up quite quickly about a month post-op. She was already really well granulated in and was just very happy. She ended up quitting smoking for several months and then sort of started sneaking again. But yeah, we were very happy with her results and really that quantum flow kind of turned things around once her vascular disease was identified. Next slide. The second patient isn't quite as dramatic. Also a 75-year-old. He was a male, history of smoking one pack a day, history of hyperlipidemia, hypertension, on medication, okay, compliance. I think his blood pressure was like in the one 50s when he came in. And basically he got referred for pain in his calves with walking. His wife was, wanted him to be able to join her on their walks, felt like he was very limited on what he could do. And she really wanted to get something done. She said, because he really was lagging behind. He does have a history of degenerative disc disease in his back, but really didn't have any back pain, no wounds on his legs. So right then in the office, we did a quantum flow test. Again, the top of it, the clinical part is removed, but basically he had pretty mild disease and we really, he wasn't on an aspirin a day and he really just wasn't doing too much as far as an exercise program. So we really actually had just a lot of talk about his risk factors that he had PAD that, you know, if things continue to progress and he continued to smoke and not take care of himself, that it could lead to interventions and amputation. So that was sort of a wake up call to him. And once we start medical management and talk about a walking program, and we went over that and started an aspirin on him, we had a follow-up about six weeks out to see how he was progressing. And he said, you know, he had already cut back to, um, just maybe about five cigarettes a day and he was walking every day. So, um, we actually reevaluated him. I saw him about a year later and, um, no progression of disease. And he actually had, um, completed his walking program. He was doing really well, felt much healthier and much better with exercising a couple of days a week and walking every day. Um, and really felt like he didn't have a lot of limitations. So we were very happy with that scenario, even though it wasn't as dramatic as the first case. Thank you. So next slide. Um, bottom line is we want to test for PAD early, um, so that we can identify the disease, address the risk factors and prevent patient from ever getting to the point of requiring intervention. Next slide. Um, so Dr., um, Smuldren out of, um, Nevada looked at, um, Medicare Advantage plan that did, um, screen for PAD. And these were patients that were specifically looked at that had PAD screening with Quantaflow with no known history of vascular disease, no wounds and, um, 13, almost 14,000 patients, no previous diagnosis and almost a third had a positive PAD screening results. Um, they also looked at those patients at one year and three years later and found that 60 to 70%, um, had an increased risk of one year, all cause mortality and, um, or major cardiac event and 40 to 50% at three years, um, increased risk of mortality and, um, cardiac event. So these are huge numbers of patients that could be affected, um, and positively, um, benefited from getting a screening test. So these were patients that had no idea they had PAD, got the screening test and could have been impacted. If they're not impacted, then their mortality and, uh, cardiac events go up. So this is like a very important look at people that could benefit all patients from screening and identifying, and identifying PAD early. Next slide. Um, so they expanded this look, um, to almost 200,000 patients in over 45 states on really similar results, um, looking at patients that had no previous PAD diagnosis. And this is a screening, um, event with the Quantaflow 27.7% had a positive PAD screening result. So all cause mortality was 20% higher, a major cardiac event greater than 20% higher and major adverse limb, limb event was more than threefold risk. So these are large numbers of patients that with a screening program could potentially be impacted if you can start medical management earlier. So next slide. So how can you start a PAD program at your institution? And I kind of put together, um, thoughts on how, what we did and what would work to apply to any other institution, whether it was at a VA program or in a private practice or in a hospital setting. Um, whoever is going to be the site leader or clinical thought leader has to pull together all of the different areas and kind of own PAD in that space, um, and figure out how you're going to delegate some of the tasks to other people who are on your team to try to provide, um, bigger base of, of people who are out there working to try to get the word out. We want to educate providers and patients on PAD and then how you're going to train your staff and providers on Quantaflow, which is pretty straightforward with their program. Um, use Quantaflow to test in your organization and with the VA, we had, um, a lot of positive results from our Quantaflow screening because we already had a known risk population with 80% higher incidence of diabetes for the veterans, et cetera. Um, we want to identify and invite patients who we know would be at risk. So you can look at the, uh, one of the earlier slides, American Heart Association, um, numbers or, uh, American Diabetes Association, and use those as kind of guides for your institution and your population. Um, once the screening has identified peripheral artery disease, you want to really work on intensifying, um, your risk factor management for PA positive individuals. On the veteran that I had, he said it really hit home that he could possibly lose his leg. Um, and that's what motivated him to quit smoking. I mean, I obviously wasn't the first provider to tell him that smoking is bad for him and he should quit smoking. So sometimes having paper that shows, Hey, I don't have enough circulation to my legs really makes that difference that motivates patients to take their cholesterol medicine. And I explain like, you know, you're taking a statin because that's fat floating around in your bloodstream and clogging up. Um, just having that visual effect of knowing that they could have an amputation is really, um, frightful to some patients and it motivates them to be compliant with their management. Um, also once a patient's identified to have peripheral artery disease, we want to circle back and make sure that their coronary, uh, disease and other vascular spaces have also been evaluated. Um, those patients that might need carotid screening or aneurysm screening, um, or EKGs in some cases that may not, well, I don't have any chest pain, but you're not walking either. They need to be evaluated. So it really helps to address all those concerns when you've spotlighted that they have peripheral artery disease, that they're more likely to say, yes, I want to be checked for the other things. And then finally, I think the biggest part is to track your improvements. So what were your goals at the beginning? Is it to raise awareness? Is it to prevent, um, you know, in our case, it was to try to address patients with vascular disease before leading to amputation. Um, and you know, to track that and say, how many people have we intervened on and not sent out for amputee, you know, sent out with emergency amputations or, or, um, what have you. So really tracking your improvements is a big part of it. Um, and then you can go back and say, Hey, you know, we were screening the high risk population. Let's make sure we're tracking patients that we screened and had mild disease. And what are we doing with that? How are they complying with their medical therapy? So there's all different ways of looking at how you're going to track what you've done and then go back and present those results and think about those results and how you can improve. Um, next slide. So in summary, um, our potential benefits of early PAD detection, we want to close the gaps in care and improve individual outcomes for vet, for patients, their veterans or non-veterans, increase early detection of chronic cardiovascular disease, identify individuals who would benefit the most from intensivate intensification of cardiovascular risk factor management, increase prescribing of guideline directed medical therapies for cardiovascular risk factor management, improve patient engagement with the medical treatment and healthy lifestyle compliance. And next slide. Next slide. We want to lengthen the runway for our medical therapy to work, to prevent progression for the disease. So for asymptomatic early PAD, smoking cessation, um, self foot exam, preventative foot care, control their diabetes and risk factors and their glucose control and keep up with vaccinations, symptomatic perforated disease. Um, we want to address, um, their treatment as far as a walking program, anti-platelet, um, wound prevention strategies and referral early. Um, so that if they do get a wound that there's no delay in getting them to a specialist that can intervene on their care. Okay. And I think I'm going to turn it over to Chris for some questions and I appreciate your time. And if you have any questions, you can feel free to email me, um, and reach out to me. I'm happy to answer and help. I've worked in private practice for a hospital and also through the VA system. So I have a, a variety of experiences through different systems. And if I can help, I'd be glad to. Thank you, Dr. Turf. That was excellent. And, uh, I think, uh, I've already got quite a few questions. So I think, uh, starting a PAD program could be something that is, uh, of interest to our members. I'd like to bring on Jessica Murphy. Jessica is the senior medical liaison for Semler Scientific. I'll ask her to join us for some of these questions again, as a reminder, if you do have any questions, please go to the Q and A section on the website, uh, on the zoom site there. And, uh, you can pose your questions there. And I've already got a few that have come in. Um, Dr. Turf, I believe this is for you regarding case example, number one, why do you think the patient's underlying arterial disease was missed for so long? Um, well, in her case, she didn't have a lot of risk factors for vascular disease. Um, I mean, except for the fact that she was a smoker and I think, um, you know, she was hesitant to get reevaluated for, um, with ABIs. So, um, that was part of the issue, but also just that people that weren't really familiar with a non-compressible ABI and what that would look like. Um, and that I think was the biggest factor for her. I mean, her foot wasn't blue remodeled. She had a wound in a non-typical area for vascular disease. So, um, I think that's why it just got kind of missed. Um, but thankfully the Quantaflow, this is exactly, you know, when a non-compressible vessel that it will pick up disease that an ABI will miss. So it was very fortunate that, um, we had that program and we're able to help her. Okay. Here's another question. How do you bill for this test? Well, um, just there, there's a huge, uh, difference in different geographical and clinical settings. So if anybody wants to email me, I can speak to my experience, but I would definitely defer to your coding specialist and your billing specialist. So your local Medicare edit, uh, coding edits, um, you know, it, it, it can be very confusing and there's not one straight answer. So I'll just say leave it at that. Okay. Um, what kind of training did your staff go through to learn how to perform and interpret the Quantaflow test? Oh, the training with Semmler is really straightforward. Um, they have an all online didactic training and they do have, um, certification through the ANAB. Um, and that was really, um, seamless for our staff, um, at all levels of clinical staff. Okay. Um, how would you suggest cardiology, cardiology practice implement a PAD program? Is Quantaflow practical in an independent cardiology group? Um, well, so Quantaflow could be used in several ways if you wanted to improve your identification of vascular disease. Um, I think if you already have a vascular lab, um, the thing that I think helped when I was in private practice and had a vascular lab, Quantaflow helped, um, to very quickly identify, uh, that there was a problem. Cause I would see sometimes wound patients or patients who I suspected had PAD, and I can get that test right at the point of care. Um, and then we could move to either going directly to CTA or directly to angiogram based on the Quantaflow test. Um, if you already have a vascular lab and you're really just interested in getting patients identified with vascular disease, and then refer to you, um, a really good thing I think would be getting in the hands of local podiatrists and primary care doctors, um, because they sometimes, um, feel intimidated sending a patient with just based on their physical exam, um, to a, to a specialist. So, um, it's nice to have a test that they can do in their office. And usually, like I said, depending on the local area, they could bill for it, um, that they can then say, Hey, I have a patient who has pain and I want to send to you and they have a severe result or they have an abnormal result. And then you can take it from there and go to the next specialty level. So there's different ways. Um, you can also use Quantaflow in the community. Um, the big studies that we talked about were with Medicare Advantage plans, um, that did the screening to help identify and risk factor, um, identification. But, um, you know, so it depends how you want to use that. You can use Quantaflow, um, to frack your results as well. So if you do an intervention, you want to see that there's been improvement in their blood flow, or you see a patient, um, in the office and, and you're like, this just doesn't sound, you know, their, their doctor doesn't sound as good as it, as it did before you can do a Quantaflow. And that really is very objective to track, um, track your, your flow that way. But I'm happy if anybody has a specific question, um, I'm happy to, uh, to speak to that just probably has to be done through email. Yeah. So, um, if we could put up, uh, Dr. Turp's contact information, again, if anybody has any questions, you can go through the Q and A, uh, button on the bottom and pose them. We'll wait for just another minute to see if anybody does have any other additional questions. In the meantime, I want to let everybody know that we are recording this session. We will be pushing this out to the entire membership. So you will have access to this entire presentation. And again, in the chat feature, there is a link that you can, um, uh, download these slides and share them with your colleagues. So as we wait to see if we've got any other questions, uh, Dr. Turp or Jessica, do you have any closing comments? I would just like to thank everybody for, um, attending today. Of course, similar scientific, our, uh, contact information is listed here on the slide, a phone number and email address. If you have any additional questions about Quantaflow or how you could get started with a Quantaflow PAD program, feel free to reach out to us. And thank you so much to Dr. Turp who's put on a wonderful presentation. And it's so gratifying to see the benefit of Quantaflow in those patients and, you know, potentially not only saving life and saving limb, but, um, continuing to facilitate the PAVE program and additional outreach for their patients. So we're really happy to see those results. That's awesome. Thanks, Jessica. Go ahead, Dr. Thanks, Chris. Um, I really appreciate you guys having me and I can't stress enough that having a test that you can give the results right to the patient right then that they know what it is, and you can really discuss, um, those results with them and how it impacts their engagement in their own care. It's just, you know, so, so many times when as providers we're distanced from a result, even if you show them, you know, a CAT scan or you show them a test, um, that they don't really do like, oh, it just looks like blobs on the screen. But to really just say, we're measuring your toes versus your fingers, and here's where we are. And, you know, where we are is something that you can do something about, um, is just really impactful for those patients. And, you know, this is exactly what the American Heart Association wants is for us to raise the level of awareness. Um, you know, in our country, we have a lot of patients who undergo amputations because they've never been diagnosed with peripheral artery disease. And not only that, but have cardiac disease that maybe they weren't having symptoms from that could have been diagnosed if we knew they had risk factors because they had their PAD identified. So those studies that Dr. Smojan did were fantastic. Um, and I think really highlighted information that we really need to incorporate. So whether it's in your own practice or getting it into your hospital system for more primary care and podiatry to do, I think there's just such a great role for something that's as easy as a Quantaflow test, um, that'll really, really benefit patients. Thank you, Dr. Turf. Uh, thank you to the Semler Scientific team for all those, uh, MedAxium. Please feel free to, uh, uh, seek them out when they're at, they'll be with us exhibiting at the Denver Fall Conference in October. So hopefully we'll see you all there. And once again, thank you very much for joining us today. Have a great day. Thank you, Chris.

Dr. Sonia Turf

webinar

Peripheral Artery Disease

PAD

early detection

Quantaflow testing

risk factor management

patient outcomes