Podcasts about aafp

How do you remove an embedded fishhook?   Check out the ALIEM page by Dr Riveros, Dr Kim and Dr Dyer   Check out the AAFP article by Dr Gammons and Dr Jackson   Link to the UpToDate page (subscription required)   Watch the Greatest Ever Try     www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice always consult your usual doctor 

Episode 84 – Assessing and Managing Inter-Cat Tension & Aggression Cases   This week, I saw a 2-cat, a 4-cat and an 8-cat home, all with diagnoses of inter-cat tension or inter-cat aggression. These cases can be really complex to work up and understanding the fine nuances of cat-cat sociability can be really challenging. In this episode, I share the things I think about and the questions I ask when I go into a multi-cat home with inter-cat tension or aggression. You'll hear me talk about severity of behaviour, covert and overt feline aggressive behaviours, how to discern play from hostile behaviours, why it is important to assess everyone in the home including the cats not obviously involved in aggressive events and some mistakes that caregivers commonly make when they are living with cats who are fighting.   Have a listen also to episodes 18 and 48 of this podcast to learn more about resources and the 5 Pillars of a Health Feline Environment, both of which are so important when it comes to inter-cat tension.   Here is the link to the 2024 AAFP Inter-Cat Tension Guidelines: Rodan, I., Ramos, D., Carney, H., DePorter, T., Horwitz, D. F., Mills, D., & Vitale, K. (2024). 2024 AAFP intercat tension guidelines: recognition, prevention and management. Journal of Feline Medicine and Surgery, 26(7), 1098612X241263465. https://journals.sagepub.com/doi/abs/10.1177/1098612X241263465   And, if you want to find out more about Feline Behaviour, Body Language, Communication, Social Relationships and more, then check out my amazing course:   LEARN TO SPEAK CAT – suitable for professionals and caregivers alike! https://katrin-jahn.mykajabi.com/learn-to-speak-cat   I really hope you enjoy this episode!   If you liked this episode of the show, The Pet Behaviour Chat, please LEAVE A 5-STAR REVIEW, like, share, and subscribe!   Facebook Group: Join The Veterinary Behaviour Community on Facebook   You can CONNECT with me: Website: Visit my website Trinity Veterinary Behaviour Instagram: Follow Trinity Veterinary Behaviour on Instagram Trinity Veterinary Behaviour Facebook: Join us on Trinity Veterinary Behaviour's Facebook page Trinity Veterinary Behaviour YouTube: Subscribe to Trinity Veterinary Behaviour on YouTube LinkedIn Profile: Connect with me on LinkedIn   Thank you for tuning in!

In the May episode of Chattering with International Cat Care, host Yaiza Gómez-Mejías introduces two expert-led conversations that bring the internal workings of the cat into sharp focus - from complications at birth to techniques for examining the feline fundus.First, Dr Petra Černá and Professor Danièlle Gunn-Moore discuss their JFMS article on dystocia and kitten mortality in pedigree cats. They describe the most common types of dystocia, reflect on breed-related risk factors, and share practical considerations from both clinical and breeding perspectives.Then, Dr Natalia Giannakopoulou and Dr Ben Blacklock offer hands-on advice from their recent Clinical Spotlight article on fundoscopy in cats. They cover how to build confidence with the ophthalmoscope, recommend suitable lenses for general practice, and explain how to approach the feline fundus methodically to avoid common diagnostic pitfalls.For further reading material please visit:Feline dystocia and kitten mortality up to 12 weeks in pedigree catsFundoscopy in cats: a practical guide and common findingsFor iCatCare Veterinary Members, full recordings of each episode of the podcast are available for you to listen to at portal.icatcare.org. To become an iCatCare Veterinary Member, or find out more about our Cat Friendly schemes, visit icatcare.orgHost:Yaiza Gómez-Mejías, LdaVet MANZCVS (Medicine of Cats) CertAP (SAM-F) Acr AVEPA, Veterinary Community Co-ordinatorSpeakers:Petra Černá, PhD DACVIM (SAIM) MANZCVS (Medicine of Cats), Feline medicine specialist, PhD candidate at Colorado State University, FIFe International and allbreed judge.Danièlle Gunn-Moore, BSc (Hon), BVM&S, PhD, MANZCVS (feline), FHEA, FRSB, FRCVS, RCVS Specialist in Feline Medicine, The Royal Dick School of Veterinary Studies and The Roslin Institute, University of EdinburghNatalia Giannakopoulou, DVM, PGCertSAO, MRCVS, Resident in Veterinary Ophthalmology (The Royal Dick School of Veterinary Studies)Ben Blacklock, BVSc, DipECVO, SFHEA, MRCVS, Senior Lecturer in Veterinary Ophthamology

Dr. Sarah Nosal, President-Elect of the American Academy of Family Physicians, discusses the importance of family physicians in regard to mental health; Amelia Poulin, ASTHO Assistant Director of Emerging Infectious Disease at ASTHO, explains why a Disease Intervention Specialist is so important; an ASTHO webinar today, May 22nd at 2 p.m. ET, explores how regional data ecosystems can power smarter public health decisions; and an ASTHO resource walks you through the best ways to integrate sustainability into your implementation of the Healthy Brain Initiative. National Alliance on Mental Illness Web Page: Mental Health Awareness Month American Academy of Family Physicians Web Page ASTHO Web Page: Prioritizing Cases and Contacts: Considerations for STI Programs During Emergency Response ASTHO Webinar: INSPIRE – Readiness - Building a Data-Ready Ecosystem for Public Health Response ASTHO Web Page: Integrating Sustainability Into Healthy Brain Initiative Implementation  

In the April episode of Chattering with International Cat Care, host Yaiza Gómez-Mejías introduces two conversations that highlight just how complex feline diagnostics can be.First, Dr Llibertat Real Sampietro discusses her JFMS Open Reports case study on fatal disseminated toxoplasmosis in an otherwise healthy cat. She outlines the parasite's transmission, the clinical signs that may raise suspicion, and the value of serology and PCR in confirming infection.Then, Dr Kelly St Denis is joined by Dr Frane Banovic to discuss the first of two JFMS Clinical Spotlight articles on immune-mediated skin disease in cats. Together, they explore how to recognise key patterns of disease and the practical role of cytology in reaching a diagnosis.For further reading material please visit:Fatal disseminated Toxoplasma gondii infection in a cat from Madrid, SpainFrane Banovic : Feline Immune-mediated skin disorders (Part One)Frane Banovic : Feline Immune-mediated skin disorders (Part Two)For iCatCare Veterinary Members, full recordings of each episode of the podcast are available for you to listen to at portal.icatcare.org. To become an iCatCare Veterinary Member, or find out more about our Cat Friendly schemes, visit icatcare.orgHost: Yaiza Gómez-Mejías, LdaVet MANZCVS (Medicine of Cats) CertAP (SAM-F) Acr AVEPA, Veterinary Community Co-ordinatorSpeakers:Llibertat Real Sampietro, DVM Acre AVEPA in Feline Medicine, Clínica Veterinaria Ayavet, Boadilla del Monte, Madrid, SpainKelly St. Denis, MSc, DVM, DABVP (Feline), Co-editor of the Journal of Feline Medicine and Surgery and JFMS Open Reports, St Denis Veterinary Professional Corporation, Powassan, Ontario, CanadaFrane Banovic, DVM, PhD, Diplomate ECVD, Associate Professor of Veterinary Dermatology in the Department for Small Animal Medicine and Surgery at the University of Georgia, College of Veterinary Medicine

In this episode of the Medical Nursing Podcast we're talking about a really common, commonly misunderstood and often frustrating disease - feline respiratory disease complex, aka FRDC or cat ‘flu. When I think about those ‘flu cases, I think back to sweating in PPE in a makeshift isolation room in my earlier nursing days, spending countless hours cleaning nasal discharge, creating steam baths outside of kennel doors, and tempting tiny kittens to eat. This is a disease that is MADE for nursing - there is so much we can do to support these patients. And as always, giving that great care starts with understanding what ‘flu is, and how we manage it - which is exactly what's waiting for you inside this episode. --- Resources mentioned in this episode:

In the March episode of Chattering with International Cat Care, host Yaiza Gómez-Mejías explores the nutritional management of comorbidities in cats and the specialisation of feline medicine.Yaiza interviews Dr Rachel Korman about the Australian and New Zealand College of Veterinary Scientists' feline chapter and its recognised postgraduate qualification. Dr Korman discusses the chapter's objectives, examination format, preparation strategies, and global reach.The episode also features Dr Cecilia Villaverde, who examines the challenges and strategies involved in dietary management for cats with multiple health conditions. She emphasises the importance of a thorough nutritional assessment and the complexities of balancing dietary needs in these cases.For further reading material please visit:ANZCVS Membership Exam on Medicine of Cats UKFeline Comorbidities: A nutritional approach to managementWSAVA Nutrition Toolkit For iCatCare Veterinary Members, full recordings of each episode of the podcast are available for you to listen to at portal.icatcare.org. To become an iCatCare Veterinary Member, or find out more about our Cat Friendly schemes, visit icatcare.orgHost: Yaiza Gómez-Mejías,LdaVet MANZCVS (Medicine of Cats) CertAP (SAM-F), Veterinary Community Co-ordinatorSpeakers:Rachel Korman, ​​BVSc, MANZCVS (Int Med), FANZCVS (Fel Med), Specialist in Feline Internal Medicine Cecilia Villaverde, BVSc, PhD, DECVCN, DACVIM (Nutrition), Diplomate (Nutrition) of the ACVIM (Board-Certified Veterinary Nutritionist®), Diplomate ECVCN (EBVS® European Specialist in Veterinary and Comparative Nutrition)

Discover the way ahead at Indiana Wesleyan University. Learn more here. Over 366 million adults worldwide are affected by symptoms of attention-deficit hyperactivity disorder which is a developmental disorder characterized by an ongoing pattern of inattention, hyperactivity, and feeling restless. Yet research suggests that women are often underdiagnosed in childhood because they do not display the hyperactive symptoms. In today's episode, Quinn sheds lights into some of the adult symptoms women with ADHD experience that often go undiagnosed. In the episode, Quinn teaches listeners: 1. What ADHD is and how's it diagnosed 2. The different subtypes of ADHD 3. Less known symptoms that lead to it being underdiagnosed in women Mind Renewal Tip: ADHD in women is less about being hyperactive and more about being overactive and the mental load. Scripture Renewal Tip: Jesus says, "Come to me, all you who are weary and burdened, and I will give you rest." Matthew 11:28-30 Resources: https://youtu.be/ohGLvsy4HCg?si=WxoUSUGRUfahKblitw https://www.aafp.org/dam/AAFP/documents/patient_care/adhd_toolkit/adhd19-assessment-table1.pdf Find out more from Hope For The Heart Here.

In the February episode of Chattering With International Cat Care, host Yaiza Gómez-Mejías discusses the new consensus guidelines on the diagnosis and management of feline lower urinary tract disease in cats with authors Sam Taylor and Rachel Korman. They discuss the challenges and nuances of developing these guidelines and emphasize the importance of comprehensive history-taking for accurate diagnosis. Additionally, Sarah Ellis interviews Noema Gajdoš Kmecová, the winner of the International Cat Care Welfare Research Award, about her study on the Home Feline Stress Score (HFSS). Gajdoš explains how her research, inspired by a previous study, highlights the connection between physical and mental health in cats, advocating for a holistic approach to feline veterinary care. For further reading material please visit:2025 iCatCare consensus guidelines on the diagnosis and management of lower urinary tract diseases in cats.Development of the home feline stress score as a tool for assessing owner perception of stress in their cats at home (Pg 6 / e440) - This study inspired Noema and explores how owners can evaluate stress in their catsFor iCatCare Veterinary Members, full recordings of each episode of the podcast are available for you to listen to at portal.icatcare.org. To become an iCatCare Veterinary Member, or find out more about our Cat Friendly schemes, visit icatcare.orgHost: Yaiza Gómez-Mejías, LdaVet MANZCVS (Medicine of Cats) CertAP (SAM-F) Acr AVEPA, Veterinary Community Co-ordinatorSpeakers:Samantha Taylor, BVetMed(Hons), CertSAM, DipECVIM-CA, MANZCVS, FRCVS, Feline Medicine Specialist and ISFM Academy LeadRachel Korman, ​​BVSc, MANZCVS (Int Med), FANZCVS (Fel Med), Specialist in Feline Internal Medicine Sarah Ellis,BSc, PGDip, PhD,Head of Cat Wellbeing and Behaviour at International Cat Care, independent feline welfare educator, writer and consultant.Noema Gajdoš Kmecová, MVDr., PhD, Researcher at University of Veterinary Medicine and Pharmacy in Košice

In the January episode of 'Chattering with International Cat Care,' host Yaiza Gomez-Mejias interviews Emma LaVigne about her award-winning research on the treatment of feline infectious peritonitis (FIP) with GS and the effects of co-infection with feline leukemia virus (FELV). Emma shares her personal journey and motivation for the study, as well as the methods and results showing equivalent survival rates. The episode also revisits a discussion with Tamsin Durston on the stages of motivational interviewing, emphasizing pre-contemplation, contemplation, preparation, action, and maintenance, and how veterinarians can support clients throughout these stages.For further reading material please visit:Human Behaviour Change for LifeIf you're interested in reading Emmas full abstract, please contact communications@icatcare.org For ISFM members, full recordings of each episode of the podcast is available for you to listen to at portal.icatcare.org. To become an ISFM member, or find out more about our Cat Friendly schemes, visit icatcare.orgHost: Yaiza Gomez-Mejias, LdaVet MANZCVS (Medicine of Cats) CertAP (SAM-F) Acr AVEPA, Veterinary Community Co-ordinator.Speakers:Tamsin Durston, RVN, CAB, MSc Psych, Veterinary Nurse, Clinical Animal Behaviourist and Human Behaviour Change PractitionerEmma LaVigne, DVM, Small Animal Internal Medicine Resident at University of Florida & 2024 winner of Best Feline Abstract at the ISCAID Symposium

In the December episode of Chattering with ISFM, host Nathalie Dowgray explores how advancements in communication strategies and genetic science are shaping feline welfare.Yaiza Gomez-Mejias and Tamsin Durston discuss the benefits of positive psychology in veterinary care, highlighting how effective client communication and behaviour change can enhance the wellbeing of both animals and their caregivers. This episode features the first part of their conversation, with part two to follow in a future episode.In the second segment, Kelly St. Denis interviews Leslie Lyons about feline genetic testing. Their conversation uncovers the role of DNA variants, the importance of resources like OMIA for genetic insights, and the validation needed to ensure accurate testing. Together, they explore how these innovations contribute to tackling breed-specific health challenges and improving feline welfare overall. For further reading material please visit:Human Behaviour Change for LifeGenetic Testing: practical dos and don'ts for catsFor ISFM members, full recordings of each episode of the podcast is available for you to listen to at portal.icatcare.org. To become an ISFM member, or find out more about our Cat Friendly schemes, visit icatcare.orgHost: Nathalie Dowgray, BVSc, MANZCVS, PgDip, MRCVS, PhD, Head of ISFM, International Society of Feline Medicine, International Cat Care, Tisbury, Wiltshire, UK Speakers:Yaiza Gomez-Mejias, LdaVet MANZCVS (Medicine of Cats) CertAP (SAM-F) Acr AVEPA, ISFM Community Coordinator and Small Animal ClinicianTamsin Durston, RVN, CAB, MSc Psych, Veterinary Nurse, Clinical Animal Behaviourist and Human Behaviour Change PractitionerKelly St. Denis, MSc, DVM, DABVP (Feline), Co-editor of the Journal of Feline Medicine and Surgery and JFMS Open Reports, St Denis Veterinary Professional Corporation, Powassan, Ontario, CanadaLeslie Lyons, B.S., M.S., Ph.D., Gilbreath-McLorn Endowed Professor of Comparative Medicine, Veterinary Medicine & Surgery and JFMS Author

In today's VETgirl online veterinary continuing education podcast, we interview Tabitha Kucera, CCBC, RVT, KPA-CTP, VTS (Behavior) and owner of Chirrups and Chatter Behavior Consulting about the key takeaways for the 2024 AAFP Intercat Tension Guidelines: Recognition, Prevention, and Management Guidelines.

In the November episode of Chattering with ISFM, we're diving into the complexities of feline pain management to help you feel more empowered and informed. Our episode highlights the Journal of Feline Medicine and Surgery (JFMS) Special Collection 2024 on pain and pain management in cats, bringing together some of the latest research, insights, and expert perspectives in the field.To start, Yaiza Gomez-Mejias speaks with Sabrine Marangoni, who shares key findings from her award-winning study on pain behaviours in kittens undergoing ovariohysterectomy. They discuss the importance of recognizing subtle pain indicators in young cats, the effectiveness of multimodal analgesia approaches, and the broader implications of untreated pain.In the second half, Kelly St. Denis sits down with Mark Epstein, Co-Chair of the AAHA/AAFP 2014 Pain Management Guidelines Task Force, to explore the progress made in feline pain management. They discuss how the field has evolved, the persistent challenges veterinarians face in assessing and managing pain in cats, and what the future holds in terms of new research and treatments.For further reading material please visit:2024 ISFM FELINE CONGRESS ABSTRACTSCat Pain Management: YouTube ChannelJFMS Special Collection 2024: Pain and Pain Management In CatsFor ISFM members, full recordings of each episode of the podcast is available for you to listen to at portal.icatcare.org. To become an ISFM member, or find out more about our Cat Friendly schemes, visit icatcare.orgHost: Nathalie Dowgray, BVSc, MANZCVS, PgDip, MRCVS, PhD, Head of ISFM, International Society of Feline Medicine, International Cat Care, Tisbury, Wiltshire, UK Speakers:Yaiza Gomez-Mejias, LdaVet MANZCVS (Medicine of Cats) CertAP (SAM-F) Acr AVEPA, ISFM Community Coordinator and Small Animal ClinicianSabrine Marangoni, LdaVet MANZCVS (Medicine of Cats) CertAP (SAM-F) Acr AVEPA, ISFM Community Coordinator and Small Animal ClinicianKelly St. Denis, MSc, DVM, DABVP (Feline), Co-editor of the Journal of Feline Medicine and Surgery and JFMS Open Reports, St Denis Veterinary Professional Corporation, Powassan, Ontario, CanadaMark Epstein, DVM, DABVP, CVPP, Education Co-Chair at International Veterinary Academy of Pain Management, Co-Chair of the AAHA/AAFP 2014 Pain Management Guidelines Task Force

Episode 54 – Street Cats – Should we “Rescue” or “Home” them?   This is a big topic with many opinions to consider from different stakeholders. Nora and I chat about our experiences of this topic here in the UAE and about some of the cases we have seen where cats that previously lived on the street were brought into homes and developed Behaviour Problems as a result. We also chat about the unique characteristics of the Arabian Mau cat that is found in this part of the world and how their unique-ness affects their behavioural needs.   I talk about genetics, epigenetics and how the socialization period may affect some of these patients and Nora tells us all about her Arabian Mau cat, Freddie, and what he taught her. Find out also how the “5 Freedoms” framework helps us assess the welfare of our patients.   We understand that this is a controversial topic and that there are no right or wrong answers, however, we do need to always consider the welfare and quality of life of all our patients and indeed that animals that we invite into our homes and lives.   Here is the resource that I mention in the episode:   Ellis, S. L. H., Rodan, I., Carney, H. C., Heath, S., Rochlitz, I., Shearburn, L. D., Sundahl, E., & Westropp, J. L. (2013). AAFP and ISFM Feline Environmental Needs Guidelines. Journal of Feline Medicine and Surgery, 15(3), 219–230. https://doi.org/10.1177/1098612X13477537   If you liked this episode of the show, The Pet Behaviour Chat, please LEAVE A 5-STAR REVIEW, like, share, and subscribe!   Facebook Group: Join The Pet Behaviour Community on Facebook   You can CONNECT with me: Website: Visit my website Trinity Veterinary Behaviour Instagram: Follow Trinity Veterinary Behaviour on Instagram Trinity Veterinary Behaviour Facebook: Join us on Trinity Veterinary Behaviour's Facebook page Trinity Veterinary Behaviour YouTube: Subscribe to Trinity Veterinary Behaviour on YouTube LinkedIn Profile: Connect with me on LinkedIn   Thank you for tuning in!

In the October episode of Chattering with ISFM, host Nathalie Dowgray presents two detailed discussions on important feline health topics - gastrointestinal and renal health.First, Yaiza Gomez-Mejias interviews Sina Marsilio on feline chronic enteropathies, with a particular focus on gastrointestinal lymphoma and the diagnostic challenges of distinguishing small cell lymphoma from IBD. Marsilio discusses recent advances in the field, drawing from her recent work on the ACVIM consensus guidelines for ‘diagnosing and distinguishing low-grade neoplastic from inflammatory lymphocytic chronic enteropathies.' Later, Kelly St. Denis speaks with Jonathan Stockman about his JFMS Clinical Spotlight article, ‘Dietary Phosphorus and its Impact on Renal Disease in Cats'. They examine phosphorus metabolism, the risks associated with high-phosphorus diets, and effective strategies for managing phosphorus levels to support feline kidney health. For further reading material please visit:ACVIM consensus statement guidelines on diagnosing and distinguishing low-grade neoplastic from inflammatory lymphocytic chronic enteropathies in catsDietary Phosphorus and Renal Disease in cats: Where are we?For ISFM members, full recordings of each episode of the podcast is available for you to listen to at portal.icatcare.org. To become an ISFM member, or find out more about our Cat Friendly schemes, visit icatcare.orgHost: Nathalie Dowgray, BVSc, MANZCVS, PgDip, MRCVS, PhD, Head of ISFM, International Society of Feline Medicine, International Cat Care, Tisbury, Wiltshire, UK Speakers:Yaiza Gomez-Mejias, LdaVet MANZCVS (Medicine of Cats) CertAP (SAM-F) Acr AVEPA, ISFM Community Coordinator and Small Animal ClinicianSina Marsilio, Dr.med.vet., PhD, DACVIM (SAIM), DECVIM-CA, Assistant Professor of Medicine & Epidemiology at UC Davis.Kelly St. Denis, MSc, DVM, DABVP (Feline), Co-editor of the Journal of Feline Medicine and Surgery and JFMS Open Reports, St Denis Veterinary Professional Corporation, Powassan, Ontario, CanadaJonathan Stockman, DVM, DACVIM (Nutrition), Associate Professor in the Department of Clinical Veterinary Sciences & JFMS Author.

Episode 178: Social Media in MedicineDr. De Luna and Dr. Song explain the role of social media in medical education and how online journal clubs have become more useful in recent years.  Dr. Arreaza offers insights into our role as educators and sources of truth.Written by Patrick De Luna, MD. Comments by David Zheng Song, MD, and Hector Arreaza, MDYou are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Intro to episode (voiceover): Get ready to listen to a great conversation between three doctors diving into the impact of social media on medicine. It's no secret that social media shapes our lives—not just as professionals, but also as humans and members of our society. Every second, new information floods our feeds, and with the rise of artificial intelligence, it's becoming harder to separate fact from fiction. As doctors, we have a crucial role in clearing up confusion and supporting evidence-based practices. You'll hear insightful tips from Dr. De Luna, Dr. Song, and Dr. Arreaza—but remember, you also have a role in spreading the truth, you must be a reliable source of online truth and correct misinformation quickly. Also, use reliable sources, recommend fact-check websites, including Snopes, and FactCheck.org, and avoid “back-and-forth” arguing about fake news online, because as you keep arguing, fake news will continue to spread.Social Media in Medicine.Patrick: Social media has helped both physicians and patients obtain and expand their knowledge of medicine. This role in medical knowledge expansion has been more prevalent since the COVID-19 pandemic, especially in the form of podcasts (like this one), medical content creators, and personalities.  This growing medium has helped physicians to deliver medical knowledge in an efficient, but layman, format which can become a great outreach and educational tool. Arreaza: This podcast was created 3 days before the lockdown. It has been an educational tool for those who record and hopefully for those who listen to us.Patrick: In today's episode, we will explore a little about how this more accessible approach to medical learning has shaped our medical education landscape. We'll explore a recent study that shows the breakdown of how social media is used among medical professionals and the concerns that physicians have about medical education through social media. We will discuss how platforms such as X/Twitter have “Journal Club” threads and their implications. Furthermore, will discuss how online personalities have been able to bring medical education discussion to the broader population, and what we can learn from their work. David: Who is your favorite medical educator?Patrick: Dr. Mike (YouTube FM), Dr. Glaucomflecken (ophthalmologist comedian), and HealthyGamerGG (gamer), and yours?David: Curbsiders (THE internal medicine podcast)Arreaza: I like Dr. Glaucomflecken as well. He is a comedian but he is becoming a little more political. The AFP podcast is my favorite.David: We will explore and discuss how we could make quality and accurate medical education content and, hopefully, mitigate concerns about creating future educational content for physicians and patients alike. Analysis of Healthcare Professional Social Media UsePatrick: Social media has traditionally been used to share about your social life (posting pictures of your cat and family vacation), stay up to date on news and what is happening among your peers, as well as (for some select folks) a platform for content creation and a means of a career. Healthcare professionals also participate in social media in the same manner. David: Some social media users are called “influencers”. Arreaza: The term “influencer” is becoming a somewhat negative term online because many “influencers” are giving a bad reputation to that term, to the point that many prefer to be called “content creator.”Patrick: In a recent study published in Taylor and Francis' Medical Education Online, 72.1% of the participants reported use of social media to some degree. Out of the 72%, 11.5% of the surveyed report using social media sites exclusively for professional purposes, 22.8% for strictly personal use, and 65.7% for both. David: The most used social media platforms among healthcare workers were Facebook at 70%, YouTube 58%, LinkedIn 52%, Instagram 42%, Twitter (now called X) 27%, TikTok 10%, and Reddit at 5% among those surveyed. Those are 6 different media, which ones do you currently use, Patrick?Patrick: [Add response]. 20.4% of the surveyed indicated they use clinically focused social media platforms as well. This same survey found that respondents specializing in addiction medicine, family medicine, pediatrics, and psychiatry were more likely to use social media for continued professional development as compared to other specialties. David: Social media among the participants was highly used for staying informed with medical news and actively participating in medical discussions online, especially about medical management and treatments. Of note, the data is based on a population that skews more toward physicians and medical professionals who have practiced for more than 15 years. Arreaza: Doximity is one of those platforms that I have used in the past, and it contains interesting articles but they have to be read “with a grain of salt,” because they are editorials.The “New Journal Club” OnlinePatrick: Multiple residency programs report using social media as a form of engagement about published journal articles and updates to medical practice. Medical education may benefit from the implementation of social media and similar platforms as a medium for professional development, according to an analysis performed by Medical Education Online. The use of social media among many physicians has changed from content consumption (passive) to active participation in furthering medical education. David: This is reflected heavily in how platforms such as X (formerly known as Twitter), have become a forum towards a new form of “Journal Club”.Tweet Threads can now be utilized for further publication discussion in an open online space.  Good examples of this can be found among Twitter feeds from publication sites like the New England Journal of Medicine or #IDJClub (Before their move to Meta's Threads in November 2023). The Infectious Disease Journal Club, using the handle @IDJClub, published a study in May 2022 highlighting the impact of 20 months of journal club hosting through Twitter.Patrick: The authors of the study state that it may be harder for physicians outside of academic circles to have opportunities for well-scaffolded discussions and continued maintenance of critical appraisal skills. Due to an explosion of questionable medical literature during to COVID-19 pandemic (AKA fake news), they report a higher need for avenues to keep the practice of critical appraisal, thus we need to expand journal club access outside of academic sites.Arreaza: From May 19, 2019 – August 7, 2021, the @IDJClub account was followed by almost 9,500 followers from 114 countries and hosted 31 journal club posts and discussions. During the study, they found data that shows a decrease in participation in journal clubs use in residencies, as well as a lack of expert hosts to lead those discussions. Patrick: In addition to the increased accessibility, the survey makes a case that online interdisciplinary journal clubs can be an effective tool to update medical professionals and for practicing critical appraisal of the research studies. 75% of respondents believed that they learned more from these #IDJClub discussions than in their traditional journal club forums (if such forums were available to their respective programs). A case is made where it could be reflective of easier access, the make-up of how the publication is presented, and how the overall journal club is run. Concerns and Challenges to AvoidDavid: As well-intended and useful as these platforms for medical education can be, some authors from AAFP recommend that we be mindful of problems that can occur from misapplied use. Patrick: One problem that has been brought to the AAFPs' attention is potential society and licensing board actions. Medical boards, such as our own California Medical Board, can sanction physicians, uphold practice restrictions, or even take away physician licenses due to unprofessional behavior in social media content creation. This is especially worrisome if posting scientifically misleading or untrue claims.David: One example was an incident here in Bakersfield where 2 physicians used YouTube to post the results of COVID-19 tests at their urgent care during the peak of the pandemic. They misled the public in stating the disease did not have serious ramifications as the CDC stated. Due to the large number of viewers, the physicians were censured by medical societies due to their distribution of biased and unfounded information to the public. Patrick: AAFP authors suggest that for medical statements and discussions posted on social media for general patient education, it is recommended to add hyperlinks or direct sources with any online interaction in-so-that it better qualifies accuracy. If it's unverifiable, it would be best to add written caveats about the information's non-verifiability or that it is in the process of continued research. Patrick: At this time, there is some effort made by social media platforms to help indicate that the post is made by a reputable source. For example, when a licensed medical professional posts on YouTube, there are information panels that appear that will give context to the health content that is viewed. At the time of this episode, YouTube also currently allows channels to apply to be indicated as a licensed medical professional in the channel's posts. The applicants are examined by three different medical societies: the Council of Medical Specialty Societies (CMSS), the National Academy of Medicine (NAM), and the World Health Organization (WHO) to standardize how health education should be shared online. David: An example being Dr. Lin of Common Sense Family Doctor, an online medical blog for patients and physician education. In his statement to AAFP, he states that he wanted to post educational content twice a week, however, it required 3 to 4 hours a week to create. This can be time-consuming and distracting from other responsibilities.Arreaza: Social media can change mind. What other concerns do you think should be considered when physicians try to educate patients in an online environment?Social Media Platforms to Teach Medicine to the Greater Public Patrick: In general, social media platforms can be used to educate the public. One AAFP panel of authors wrote that some key points are important to consider when creating online content that is meant for public use.We must define our goals toward the subset population we are directing the education towards. Is it providing general health education? Is it promoting a practice? Is this used to advocate for a cause?We must consider who our audience is. For example, if our goal is to create a professional message to incite political or societal change towards public health policy, it would be best to utilize platforms that involve policymakers, political leaders, and/or patients that can inform them of what we want to achieve. Focus on general topics. These can include topics such as viral medical discussion trends on platforms like TikTok (ex. Ozempic), fitness and wellness, nutrition, or topics that you yourself have interest or expertise in. This can lead to the production of original content such as informatic YouTube series', podcasts such as this one, or discussion threads. AAFP recognizes that this can become a creative outlet for physicians and can reduce burnout.ConclusionPatrick: We can see the transformative impact of social media on medical education, and how it's further evolved since the COVID-19 pandemic. We explored how platforms like Twitter have redefined traditional journal clubs, making scholarly discussions more accessible across global medical communities. Moreover, we examined the role of influential medical content creators in bridging the gap between healthcare professionals and the general public. Patrick: While social media presents unprecedented opportunities for disseminating medical knowledge, our discussion also highlighted the challenges, including the need for accuracy in content, navigating professional conduct, and addressing algorithmic biases that can influence online interactions.Patrick As we conclude, it's evident that social media has revolutionized medical education by fostering broader engagement and democratizing access to knowledge. However, both physicians and content creators must uphold ethical standards and ensure the accuracy of information shared online. By navigating these challenges thoughtfully, we can harness its full potential as a powerful tool for advancing medical education and improving health outcomes in our local communities. ____________________This week we thank Hector Arreaza, Patrick De Luna, and David Zeng Song. Audio editing by Adrianne Silva. Intro by Raj Ajudia, MSIII. Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________Links:Topf, Joel M., Introduction: Social Media and Medical Education Come of Age, Seminars in Nephrology, Volume 40, Issue 3, 247 – 248. https://www.seminarsinnephrology.org/article/S0270-9295(20)30043-7/fulltextNguyen BM, Lu E, Bhuyan N, Lin K, Sevilla M. Social Media for Doctors: Taking Professional and Patient Engagement to the Next Level. Fam Pract Manag. 2020;27(1):19-14. https://www.aafp.org/pubs/fpm/issues/2020/0100/p19.htmlIserson KV, Derse AR, Delpier M. Navigating the Hazards of Social Media. Fam Pract Manag. 2022;29(3):15-20. https://www.aafp.org/pubs/fpm/issues/2022/0500/p15.htmlVan Ravenswaay L, Parnes A, Nisly SA. Clicks for credit: an analysis of healthcare professionals' social media use and potential for continuing professional development activities. Med Educ Online. 2024 Dec 31;29(1):2316489. doi: 10.1080/10872981.2024.2316489. Epub 2024 Feb 15. PMID: 38359156; PMCID: PMC10877644. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10877644/Doctor Mike, YouTube Channel, https://www.youtube.com/@DoctorMikeDr. Glaucomflecken, YouTube Channel, https://www.youtube.com/@DGlaucomfleckenHealthyGamerGG, YouTube Channel, https://www.youtube.com/@HealthyGamerGGGet info on health-related content, Google Support, https://support.google.com/youtube/answer/9795167Apply to be a source in YouTube health features, YouTube Help, https://support.google.com/youtube/answer/12796915Theme Song: Works All The Time by Dominik Schwarzer, License #5924333, PremiumBeat.com.  

In this episode of Chattering with ISFM, Nathalie Dowgray interviews Dr Hugo Swanstein about his JFMS Clinical Spotlight article on Feline-Friendly Point of Care Ultrasound (POCUS). We also return to Dr Sarah Ellis and Dr Daniel Mills for Part Two of their conversation on the use of pheromones in cats.Dr Ellis and Dr Mills delve into the methods of delivering pheromones in veterinary care, how to use them effectively, and the scepticism surrounding these products. They clarify the differences between pheromones and odour therapy, while touching on the industry's lack of regulation.Later, Dr Dowgray and Dr Swanstein discuss the practical application of feline-friendly POCUS, with Dr Swanstein explaining its differences from formal ultrasound exams. He shares tips for integrating POCUS into daily practice, emphasising its value beyond emergency cases and how it can be mastered with brief, regular practice. He also addresses concerns about time and cost, highlighting POCUS's efficiency and affordability, and advocates for training the entire veterinary team, including technicians, in its use. For further reading material please visit:Pheromonatherapy: Theory and applicationsStress and Pheromonatherapy in Small Animal Clinical BehaviourJFMS Clinical Spotlight Article: Feline Friendly POCUS, How to implement it into your daily practiceFor ISFM members, full recordings of each episode of the podcast is available for you to listen to at portal.icatcare.org. To become an ISFM member, or find out more about our Cat Friendly schemes, visit icatcare.orgHost: Nathalie Dowgray, BVSc, MANZCVS, PgDip, MRCVS, PhD, Head of ISFM, International Society of Feline Medicine, International Cat Care, Tisbury, Wiltshire, UK Speakers: Sarah Ellis, BSc, PGDip, PhD, Head of Cat Wellbeing and Behaviour at International Cat Care, independent feline welfare educator, writer and consultant.Daniel Mills, BVSc PhD CBiol FRSB FHEA CCAB Dip ECAWBM(BM) FRCVS, Professor of veterinary behavioural medicine & RCVS, European and ASAB recognised specialist in clinical animal behaviourHugo Swanstein, Cand Med Vet, Doctor of Veterinary Medicine & JFMS Published Author

Did you know that the rate of new HIV infections among Black women is 10 times that of white women and four times that of Latina women. Why is this the case? Thanks to HealthyWomen with support from Merck, we're having an essential conversation about HIV and how we must protect ourselves from contracting the virus. OUr guest this week Dr. Ada Stewart breaks down all the facts plus ways that people are now living longer with HIV.You don't want to miss this conversation!Listen and learn:How HIV diagnosis and treatment has changed over the past few decadesThe rumors abouht HIV that are completely false - and the truths we all need to knowProtection and the information we need to share with our girlfriendsHow we must advocate with our health care providers to ensure we're getting testedListen now and share your iTunes review with us!Follow now

Join us as we discuss the fascinating world of feline communication, exploring howcats use chemical signals to interact with their environment and each other. Additionally, we shall shed light on a rational approach to using gastroprotectants in cats, providing invaluable insights for veterinary practitioners.In Part One of our discussion, Dr Sarah Ellis and Dr Daniel Mills talk about thecomplexities of pheromone use in cats, emphasising the differences between scents and pheromones and their impact on emotional processing. They also highlight the importance of understanding pheromones in assessing feline behaviour. Part Two of their discussion will be available in next month's episode, so make sure you're signed up to Chattering With ISFM on your preferred podcast platform if you don't want to miss out!Following this, Dr Kelly St. Denis and Dr Katie Tolbert discuss Dr Tolbert's JFMS Clinical Spotlight article on the rational use of gastroprotectants in cats. They cover the risks of using these medications, especially the differences in how cats and dogs metabolise drugs, and the potential benefits of soluble fibres in preventing GI ulceration. They also address the careful use of gastric acid suppressants and gastroprotectants in clinical practice, with a focus on patient comfort and proper administration.For further reading material please visit:Pheromonatherapy: Theory and applicationsStress and Pheromonatherapy in Small Animal Clinical BehaviourJFMS Clinical Spotlight Article: A Rational Approach To The Use Of Gastroprotectants In CatsFor ISFM members, full recordings of each episode of the podcast is available for you to listen to at portal.icatcare.org. To become an ISFM member, or find out more about our Cat Friendly schemes, visit icatcare.orgHost:Nathalie Dowgray, BVSc, MANZCVS, PgDip, MRCVS, PhD, Head of ISFM, International Society of Feline Medicine, International Cat Care, Tisbury, Wiltshire, UKSpeakers:Sarah Ellis, BSc, PGDip, PhD, Head of Cat Wellbeing and Behaviour at International Cat Care, independent feline welfare educator, writer and consultant.Daniel Mills, BVSc PhD CBiol FRSB FHEA CCAB Dip ECAWBM(BM) FRCVS, Professor of veterinary behavioural medicine & RCVS, European and ASAB recognised specialist in clinical animal behaviourKelly St. Denis, MSc, DVM, DABVP (Feline), Co-editor of the Journal of Feline Medicine and Surgery and JFMS Open Reports, St Denis Veterinary Professional Corporation, Powassan, Ontario, CanadaKatie Tolbert, DVM, Ph.D., DACVIM (SAIM, SA nutrition), Clinical Associate Professor in Small Animal & Comparative Gastroenterology & JFMS Author.

In this episode, Dr. Assibey is joined by CAFP's Justice Through Equity, Diversity, and Inclusion (JEDI) Committee co-chairs, Drs. Shannon Connolly and Melissa Campos to discuss how and why the committee was formed, the work being done by this committee to focus CAFP's work with the JEDI lens.  Guests: Dr. Shannon Connolly, MD, FAAFP (she/her) is the Associate Medical Director at Planned Parenthood of Orange and San Bernardino Counties. Dr. Connolly offers Adult primary care with a focus on sexual and reproductive health, and gender-affirming care. She is Chair of CAFP's JEDI Committee, as well as Past President of the CAFP Board. Dr. Connolly also serves on the AAFP Commission on DEI in Family Medicine. Dr. Connolly identifies as Asian American, and an immigrant to the US. Melissa Campos, MD (she/her) identifies as Mexican-American. Dr. Campos is the Associate Program Director at Scripps Chula Vista Family Medicine Residency and a Physician for San Ysidro Health. She practices full spectrum family medicine, inpatient, OB, SNF, and clinic. Dr. Campos is Vice-Chair of the JEDI Committee, and Past-President of the San Diego Chapter of CAFP.. Rob Assibey, MD, FAAFP (he/him) identifies as Ghanaian American. Dr. Assibey is the Associate Program Director at San Joaquin General Hospital Family Medicine Residency Program. He practices full spectrum family medicine with an emphasis on street medicine, addiction medicine, SNF. Dr. Assibey is the District 8 Director on the CAFP Board, and a member of the JEDI Committee. Resources: Find more information about CAFP's Justice Through Equity, Diversity and Inclusion Committee at familydocs.org/jedi. Find more information about Family Medicine POP! (August 23-25, 2024 in Costa Mesa, CA) at www.familydocs.org/pop. Read the article by Drs. Connolly and Campos published in the California Family Physician magazine at www.familydocs.org/cfp.  CAFP's Online Education is Homeroom: https://education.familydocs.org  AAFP links EveryONE Project: https://www.aafp.org/family-physician/patient-care/the-everyone-project.html Center for Diversity and Health Equity: https://www.aafp.org/family-physician/patient-care/the-everyone-project/aafp-center-for-diversity-and-health-equity.html Neighborhood Navigator: https://www.aafp.org/family-physician/patient-care/the-everyone-project/neighborhood-navigator.html  CAFP's Committee page: https://www.familydocs.org/committees  CAFP's local chapter page: https://www.familydocs.org/chapters The Family Docs Podcast is hosted by Rob Assibey, MD.   The Family Docs podcast is developed, produced, and recorded by the California Academy of Family Physicians. The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the views or positions of any entities they represent or the California Academy of Family Physicians. More information at www.familydocs.org/podcast. Visit the California Academy of Family Physicians online at www.familydocs.org. Follow us on social media: Twitter - https://twitter.com/cafp_familydocs  Instagram - https://www.instagram.com/cafp_familydocs  Facebook - https://www.facebook.com/familydocs   

This week on Faisel and Friends, we are discussing Fixing the Foundation: Rebuilding with Lifestyle Medicine. Faisel and Dan are talking with Karen Johnson, PhD, Vice President of Practice Advancement at the AAFP, and Dr. Padmaja Patel, President-Elect at the American College of Lifestyle Medicine.Our conversation explores addressing patient concerns through lifestyle behaviors, having policy conversations to shift the mindset away from fee-for-service norms, and providing high quality care despite misaligned quality measures.Read the paper by Johnson and Dr. Patel here!

Topic: New AAFP/ISFM guidelines for chronic NSAID use in cats Part 2Guest: Dr. Kelly StDenis, renowned veterinarianSummary:Discusses signs of chronic pain in cats, often mistaken for normal aging.Explains what NSAIDs are and how they can help manage feline pain.Dives into the recently released AAFP/ISFM guidelines for the safe and effective use of chronic NSAIDs in cats.Provides information for cat owners concerned about their pet's chronic pain.

In this episode of the Experience Strategy Podcast, we're joined by Brian Edwards. VP of Membership at the American Academy of Family Physicians (AAFP), to explore the unique challenges and opportunities of applying customer experience strategy within associations and membership-based organizations. Brian shares his insights on establishing common ground around the mission to navigate the complex governance structures, developing a segmentation approach that honors members' needs at different stages, looking outside the association space for inspiration on retaining members and driving satisfaction, and using experience management frameworks to prioritize initiatives and focus on core competencies. With his extensive background in customer experience and operations leadership, primarily in the healthcare industry, Brian brings a wealth of knowledge and a passion for continuously improving the experiences of those around him. For access to this episode's transcripts, please click here.    

In the podcast with Dr. Kelly StDenis, she delves into the new guidelines from AAFP regarding the chronic use of NSAIDs in cats. Dr. StDenis discusses the importance of these guidelines in managing feline pain and the potential risks associated with long-term NSAID usage in cats. She provides insights into alternative pain management strategies and emphasizes the need for careful monitoring when using NSAIDs in feline patients.

In this podcast with Dr. Kelly StDenis, she delves into the new guidelines from AAFP regarding the chronic use of NSAIDs in cats. Dr. StDenis discusses the importance of these guidelines in managing feline pain and the potential risks associated with long-term NSAID usage in cats. She provides insights into alternative pain management strategies and emphasizes the need for careful monitoring when using NSAIDs in feline patients. A must know for cat owners.

Do you like seeing your patients happy? Do you like additional revenue? Do you like to be able to make quick and informed medical decisions for your patients? Does it please you to reduce the risk of complication rates when performing injections? If you answered yes to any or all of these questions, Point-of-Care Ultrasound (POCUS) is for you! POCUS is a vital tool that has been used for decades in the emergency medicine / critical care setting for bedside diagnosis. With advancements in technology driving down the size of the systems, as well as price, we are now at a point where Family and Internal Medicine practices can effectively and affordably integrate bedside ultrasound into their workflow, improving time to diagnosis and patient satisfaction.  Over the past year while at conferences and tradeshows, we have heard some recurring comments about why practitioners have not yet integrated ultrasound into their practices. We would like to shine some light on these misconceptions for practices not currently reaping the benefits of in-house ultrasound. Join us in The Sonography Lounge for this great episode where we break through the common myths and misconceptions of POCUS and discuss the benefits and tactics of integrating it into your practice. Below are just a few highlights of what will be discussed in this episode: POCUS is reimbursable, for both Diagnostic AND interventional use POCUS can deliver immediate diagnostic answers to improve patient rapport and decrease time to treatment. Ultrasound Systems are portable, with battery powered options available  Some ultrasound systems have AI integrated to aid in diagnostics and labeling POCUS can be performed by not only the practice physician(s) but also trained staff such as NP's and PA's, Etc.  POCUS can be an integral part in adding revenue streams for procedures requiring guidance such as prolotherapy, PRP, adipose derived stem cells, etc (image documentation of a needle is reimbursable)  POCUS can improve your patients health through regular screenings while also adding an additional revenue stream to your practice Ultrasound Reimbursement / CPT Codes: The information needed to be fully reimbursed for POCUS is easily found with an internet search. The AAFP has a great resource, linked below: https://www.aafp.org/pubs/fpm/issues/2020/1100/p33.html Most ultrasound equipment companies are also doing a great job at keeping up to date on the current reimbursement guidelines and codes. A few are linked below for easy reference: Clarius Reimbursement Guides Kosmos (EchoNous) Reimbursement Guide Fujifilm Sonosite Reimbursement Guides Philips Ultrasound Reimbursement Guides Butterfly Reimbursement Guide   The Sonography Lounge: https://thesonographylounge.podbean.com/   Gulfcoast Ultrasound Institute (Training materials and programs): www.gcus.com Upcoming POCUS Hands-On Courses POCUS Online Courses Private Courses: 1-2 People  Custom Group Training: (Get your whole team trained at your facility)   Certification Agencies: American Board of Emergency Medicine (ABEM): https://www.abem.org/public Sonographer / Physician: American Registry of Diagnostic Medical Sonography (ARDMS): www.ardms.org Physicians: Alliance for Physician Certification & Advancement (APCA): www.APCA.org Point of Care Healthcare Providers: Point of Care Certification Academy (POCUS): www.pocus.org Sonographer / Physician: Cardiovascular Credentialing International (CCI): www.cci-online.org   Find an accredited long term Ultrasound Program: https://www.caahep.org/Students/Find-a-Program.aspx

Most group practices will add thousands in revenue monthly with the G2211 code. Listen for details. Here is a great link from the AAFP.

Can integrating spirituality get you better health results?  What does the world of evidence-based medicine say about that?   I'm joined by Dr. Dan Kuckel on the podcast today to share his expert-level knowledge on this topic. Dr. Kuckel's article The Spiritual Assessment in the AAFP Journal opened my mind to deeper integration of spirituality, medicine, and weight loss and it will for you, too.    If you are a patient wondering about discussing spirituality with your health care provider or a provider wondering how important these discussions are in medicine, you can't miss this episode.   As Dr. Kuckel shares, there is a disconnect between the two... and a place for growth and healing when we open the door to healthy communication.  You can read Dr. Kuckel's AAFP article by clicking here. The yellowed-highlighted copy still sits on my desk.    If you are ready to create the true Healthy You, mentally, physically, and spiritually, I've got a brand new opportunity coming in the Lively Lady Club. Click here to find out more. 

The pelvic examination is a standard component of the annual gynecologic visit despite limited evidence supporting its utility. Pelvic examinations can be a source of discomfort and anxiety for some patients seeking routine health care, whereas, for others, they can offer reassurance. In 2018, the ACOG released CO 754 on "The Utility of and Indications for Routine Pelvic Examination". What does the AAFP, ACP, and ACOG say about "routine" pelvic examinations in low-risk, nonpregnant, and asymptomatic women? Why do they say what they do? In this episode, we will summarize a new publication from Obstetrics & Gynecology which was just released yesterday (November 9, 2023) which validates these professional societies' guidelines/stances.

Guests Gwen Klinkner, DNP, RN, BC-ADM, CDCES, FADCES, and Melissa Magwire, RN, MSN, CDCES describe how to help patients with diabetes navigate behavior change principles to achieve glucose management including nutrition and exercise. They also examine pharmacotherapies for weight loss with glucose-lowering medications.CE Link: pcna.net/podcast/euglycemiaSURMOUNT Trials: https://www.nejm.org/doi/full/10.1056/NEJMoa2206038 ADCES: https://www.diabeteseducator.org/PNCA.net AHA.org Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes: doi: 10.1136/bmj.321.7258.405Comprehensive Management of Cardiovascular Risk Factors for Adults With Type 2 Diabetes: AHA Scientific Statement: doi:10.1161/CIR.0000000000001040Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the ADA, ADCES, AND, AAFP, AAPA, AANP, APhA: doi:10.1177/0145721720930959See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Matt McGlasson, DVM, CVPM, is a passionate, customer-focused leader in the Animal Health industry with over 17 years of experience in leading multiple hospitals through creative clinic management, professional development, and quality improvement. He has a successful track record of establishing innovative care systems, mentoring programs, and social media marketing initiatives to boost brand awareness and humanize Veterinary Medicine. Within his current role as chief medical officer, he built and rolled out a mentoring program to help the transition for first-year doctors, including effective goal-setting, communication skills, financial advising from a CFP, doctor best practices, and other personal and professional development topics. McGlasson is a Certified Fear Free Practitioner, Certified “Cat Friendly Veterinarian” by AAFP, and a member of the AVMA, VHMA, and AAFP. He currently serves as the Northern Kentucky Representative on the Executive Board of the KVMA and serves on the Veterinary Advisory Board for BasePaws, and the Editorial Advisory Board of dvm360 magazine.  As a Certified Veterinary Practice Manager, he represents a group of fewer than 40 DVMs in the United States with the CVPM certification. His articles have been featured in dvm360 magazine and he has spoken at national veterinary conferences on the topics of practice management, practice culture, and finding joy in veterinary medicine. In 2022, he was awarded the Veterinary Hero Award in the category of Practice Management from dvm360. Throughout McGlasson's career, he also seeks to bring personality and fun to the animal health industry. He has redefined methods for content development and education within the industry by operating engaging veterinary-themed social media accounts and amassing over 1.2 million followers with well over 150 million video views. McGlasson is passionate about growing and supporting the future leaders of our profession. He believes that veterinary professionals will thrive if given the opportunity to be a part of a healthy culture and have continuous support. 

Episode 152: ALS FundamentalsFuture Dr. Rodriguez explains the symptoms of ALS, including UMN and LMN symptoms. Dr. Arreaza discusses the principles of symptomatic treatment by primary care. This is a brief introduction to ALS.  Written by Adraina Rodriguez, MSIV, Ross University School of Medicine.  You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Arreaza: It is rare but you may encounter it and you should be able to identify the most common symptoms. ALS Challenge in 2014: Ice bucket challenge. Adriana: Patrick Quinn was an ALS patient and activist who created the ICE Bicket Challenge and helped raise US$220 million for medical research.Arreaza: What is ALS?Adriana: ALS stands for Amyotrophic Lateral Sclerosis, formerly known as Lou Gehrig's Disease. It is the most common form of acquired motor neuron disease. ALS is a progressive, incurable neurodegenerative motor neuron disorder with Upper motor neuron (UMN) and/or Lower motor neuron symptoms that cause muscle weakness, disability, and eventually death. There is no single diagnostic test that can confirm or entirely exclude the diagnosis of motor neuron disease. Arreaza: When should you suspect ALS in a patient?Adriana: The classic patient presentation is insidious, slowly progressive, and unremitting UMN and/or LMN symptoms present in one of four body segments - cranial/bulbar, cervical, thoracic, and lumbosacral - followed by spread to other segments over a period of months to years. Arreaza: What would you see on the physical exam when the Patient is in the clinic? There is a system to send signals from your brain to your muscles. It involves basically two neurons: Upper and lower motor neurons. The UMN goes from your cerebral cortex to your spinal cord and there it connects to a lower motor neuron through synapsis. The LMN then sends the signal to your muscles, causing contraction or relaxation. Tell us about the UMN and LMN symptoms.Adriana:LMN Symptoms: Weakness, Fasciculations, Muscular atrophy, Decreased muscle tone (flaccidity) and reduced or absent reflexes. UMN Symptoms: Increased tone and increased extremity deep-tendon reflexes, presence of any reflexes in muscles that are profoundly weak and wasted, pathological reflexes (crossed adductors, jaw jerk, Hoffman sign, Babinski sign 50%), syndrome of pseudobulbar affect (inappropriate laughing, crying, forced yawning).Arreaza: What are important factors to help narrow your differential to ALS?Multifocal motor neuropathy, cervical radiculomyelopathy, benign fasciculations, inflammatory myopathies, post-polio syndrome, monomelic amyotrophy, hereditary spastic paraplegia, spinobulbar muscular atrophy, myasthenia gravis, hyperthyroidism, and many others.There are pertinent negatives to look out for: Usually negative neuropathic or radiculopathic pain, sensory loss, sphincter dysfunction, ptosis, or extraocular muscle dysfunction (20-30% positive sensory symptoms or “pins and needles” and “electricity” in the affected limbs).Note: Cognitive dysfunction does not exclude ALSArreaza: What are the diagnostic criteria for ALSAdriana: Gold Coast Criteria 2019 proposed over El Escorial criteria:Progressive upper and lower motor neuron symptoms and signs in one limb or body segment, ORProgressive lower motor neuron symptoms and signs in at least two body segments, ANDAbsence of electrophysiologic, neuroimaging, and pathologic evidence of other disease processes that might explain the signs of lower and/or upper motor neuron degeneration.Arreaza: What diagnostic tests should be ordered for further evaluation?Adriana: Electrodiagnostic studies: Electromyogram and nerve conduction studies (EMG and NCS)Laboratory testing: creatine phosphokinase up to 1000u/LNeuroimaging: to exclude other causes mainly. Brain MRI whenever bulbar disease is present. Cervical and lumbosacral spine MRI for LMN findings in the arms and legs.Genetic testing: FALS 10% of ALS defect in C9ORF72 gene that makes motor neuron and brain nerve cell protein, the exact cause is unknown. Arreaza: Finally, how do you treat ALS?Adriana: Disease-modifying treatment: Riluzole is recommended for all patients with ALS. Shown to prolong survival and slow functional deterioration. The mechanisms of action that reduce glutamate-induced excitotoxicity: 1) inhibit glutamic acid release, 2) non-competitive block of N-methyl-D-aspartate (NMDA) receptor-mediated responses, 3) direct action on the voltage-dependent sodium channel. Arreaza: Riluzole is given 50 mg by mouth twice a day. It may cause drowsiness or somnolence, hepatic injury: Not recommended for patients with elevation of transaminases >5 times the upper limit of normal. It is recommended to monitor for hepatic injury and discontinue if there is evidence of liver dysfunction, such as hyperbilirubinemia.Adriana: Symptom-based management is the mainstay of treatment. You may involve a multidisciplinary team to treat the symptoms. For example: palliative, hospice, respiratory function management (Noninvasive Positive Pressure Ventilation vs mechanical ventilation.Arreaza: PCPs may be in charge of managing symptoms because you are the closest provider to the patient. Wherever available, it is recommended to refer your ALS patients to a specialized center. Many patients do not have availability to an ALS center or a neurologist, but they have you to manage their symptoms or complications.Adriana: Dysphagia: It is a common and distressing symptom. It is suggested PEG tube placement for patients with ALS with normal or moderate respiratory function who have dysphagia. It is controversial, some studies found no benefit on survival or quality of life and other studies suggest that it is safe to give a high-carb, hypercaloric diet to ALS patients. Arreaza: Spasticity: Use medications such as baclofen and tizanidine may be helpful, and botulinum injections are an option for those who are not responding to oral muscle relaxants. Adriana: Sialorrhea: Use medications such as atropine, hyoscyamine, amitriptyline, and scopolamine. If these medications are not effective or tolerated, used botox injections into the salivary glands. It is considered safe and useful for treating sialorrhea in patients with ALS. Botox is not only for wrinkles!Arreaza: There are many other symptoms that will require management, but you are invited to review your preferred source of information such as Up to Date, AAFP, or the ALS Association website. ______________________________Conclusion: Now we conclude episode number 152, “ALS Fundamentals.” You heard from future Dr. Rodriguez that ALS can present with upper motor neuron symptoms, such as spastic muscles and hyperreflexia; or lower motor neuron symptoms, such as flaccid and weak muscles. Some other symptoms include dysphagia, shortness of breath, difficulty talking, fatigue, thick mucus, and pseudobulbar affect. Dr. Arreaza explained that primary care physicians are in a special situation to help diagnose and treat the symptoms of ALS, especially in communities with limited access to an ALS center. You may need to involve a multidisciplinary team to improve the quality of life and possibly the survival of ALS patients. This week we thank Hector Arreaza and Adriana Rodiguez. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Galvez-Jimenez, Nestor and Colin Quinn, Symptom-based management of amyotrophic lateral sclerosis, Up To Date, updated on July 31, 2023. https://www.uptodate.com/contents/symptom-based-management-of-amyotrophic-lateral-sclerosis. Royalty-free music used for this episode: Good Vibes: Sky's The limit, downloaded on July 20, 2023 from https://www.videvo.net/ 

Episode 150: Re-update on COVID Vaccines and Cervical CancerCOVID vaccines have been updated (again). The bivalent m-RNA COVID-19 vaccines are no longer authorized in the US. Sabrina explains that the monovalent COVID-19 vaccines will be available soon to target XBB lineage and more. Future Dr. Rodriguez explains the USPSTF cervical cancer screening guidelines. Dr. Arreaza adds comments and insight.  You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Celebrating our episode 150.Written by Hector Arreaza, MD.In our previous episode, we gave you an update on COVID-19 vaccines, but we need to give a new update. This is the risk you take when you try to become a news agency instead of an educational podcast, so you need to keep giving updates, and we'll tell you about the newest change in COVID-19 vaccines in a few minutes. This is episode number 150! And I wanted to take a moment to celebrate this milestone. Our first episode was released a few days before the lockdown for COVID-19 on March 3, 2020. Those were gloomy days. I was excited about having a weekly podcast, but I also was overwhelmed by COVID-19. I remember considering putting a hold on the podcast, but I decided to continue. We had a few episodes about COVID-19 and, as expected for a novel disease, we made some mistakes. For example, we gave the wrong recommendations to not wear a mask at the very beginning of the lockdown, but that was the initial recommendation. However, I got to accentuate the positive, I'm proud that we were probably the first place to report hiccups as a symptom of COVID. Soon I realized it would be impossible to keep up with the daily changes in recommendations and updates on COVID, so we focused on other topics, and it has been a great experience so far. This podcast was created for the Rio Bravo residents, and thankfully the medical students have become the main collaborators of this program. I have enjoyed every second I have spent with all our guests, including residents, nurses, medical assistants, specialists, scientists, and of course medical students. I feel very fortunate to have reviewed many relevant topics of family medicine with you. A colleague once mentioned to me that I may run out of topics, but I think it is impossible to run out of topics in family medicine, don't you think? So, I'm hoping to continue bringing to you brief discussions and pearls of knowledge every week. Now, let's listen to Sabrina.Re-update on COVID-19 Vaccines.Written by Sabrina Hawatmeh, MSIII, Ross University School of Medicine.Hi, my name is Sabrina Hawatmeh, I'm a 3rd-year medical student from Ross University School of Medicine. I'm so excited to be here today, huge thank you to Dr. Arreaza for having me here today! As mentioned by Dr. Arreaza, during our episode 149 we gave you an update on COVID-19 vaccines and now today it's time for a new update. Most recently, Pfizer/BioNTech and Moderna have updated their vaccines to target specific strains of the virus, and the American Academy of Family Physicians has given its approval to federal actions allowing the use of these updated vaccines for the Fall/Winter of 2023. The decision follows FDA approval for these vaccines for children and adults aged 12 and older, as well as CDC recommendation of emergency use authorization for children aged 6 months to 11 years. The AAFP's Board Chair, Sterling Ransone, M.D., accepted the recommendation to approve these actions as of September 14th, 2023. The vaccines may be available soon for administration. Bivalent vaccines were the most recent formula administered for immunization. Studies had shown that there was continued protection against circulating sublineages of Omicron and XBB.1.5. However, the vaccine effectiveness against Omicron decreases over time. Neutralizing antibody titers against XBB sublineages via bivalent vaccines are lower compared to titers induced by the matched BA.4/BA.5 sublineage. So, it makes sense that all this data suggested that vaccine modification be directed toward more closely matched strain composition to current circulating sublineages. I also think it's worth noting that the original version of Omicron is no longer circulating—neither is the original strain of the SARS-CoV-2 virus. For that reason, updated vaccines were created by Moderna and Pfizer/BioNTech, so the bivalent vaccines are no longer authorized for use in the United States. The updated vaccine recommendations include eligibility criteria for different age groups, regardless of previous vaccination status, and specify the number of doses needed. The CDC has also updated its vaccine recommendations, especially for moderately or severely immunocompromised individuals. The new vaccines are monovalent mRNA vaccines, designed to protect against omicron subvariant, XBB 1.5. While the subvariant XBB.1.5 is the target of the vaccines, the expectation is that they will offer immunization against multiple current strains. (XXB lineage, EG.5.1 (Eris), Fl.1.5.1 (Fornax), BA.2.86). Moderna (randomized controlled trial of 101 individuals) and Pfizer (mouse studies) evidence suggests that the vaccines will also serve to protect against the new mutated subvariant that has recently sparked some concern, BA.2.86. As a reminder, FDA granted emergency use authorization for Novavax COVID-19 vaccine, Adjuvant in July 2022 for the prevention of COVID-19 pneumonia in patients aged 12 and older. Now the updated Novavax formula for 2023-2024 (targeting the XBB strain) was authorized by CDC on September 12, 2023, but it is still under review by the U.S. FDA for emergency use authorization for individuals aged 12 and older. When authorized, Novavax's protein-based vaccine will be the only non-mRNA COVID vaccine available in the U.S. These updated vaccines are expected to be covered by most public and private insurance plans, but concerns have been raised about uninsured individuals having to pay out of pocket for the vaccines, which cost $120 to $130. The AAFP urged the government to ensure equitable access and financial support for primary care practices offering these vaccines.Cervical Cancer Screening Guidelines. Written by Adriana Rogriguez, MSIV, Ross University School of Medicine.Arreaza: Cervical canceris the 3rd most common gynecological cancer in the US. For 2023, the American Cancer Society estimates that about 13,000 new cases of cervical cancer will be diagnosed, and more than 4,000 women will die this year. Cervical cancer was once one of the most fatal types of cancer in women, but the mortality rate has been significantly decreased with the increased use of pap smears and the HPV test. Adriana: Another fun fact is that cervical cancer is the only cancer preventable by a vaccine—the HPV vaccine.Arreaza: Why is cervical cancer screening important?Adriana: Cervical Cancer screening is very important as it reduces mortality due to cervical disease. Intervention at early stages reduces the development of squamous cell carcinoma or adenocarcinoma of the cervix due to HPV. In fact, studies have shown that in resource-poor settings, one cervical screening reduces the incidence of cervical cancer by up to 50%. Arreaza: What would prevent a patient from wanting to get a Pap smear?Adriana: Many things can and do deter a patient from obtaining their cervical cancer screening. Patient discomfort and the psychosocial consequences of performing these screenings such as anxiety should be taken into consideration. Personal example. Also, a patient may be concerned about the costs, the effects of false-positive results, the risks of treatment during pregnancy (ex., increased risk/o 2nd-trimester pregnancy loss, PPROM, preterm delivery, perinatal mortality). Arreaza: We should mention the cultural implications of a pap smear in a 21-year-old who is considered a “virgin”. Some cultures try to preserve the hymen intact as a sign of purity. You can address this concern with your patients and explain that a hymen is not always present, it may be easily ripped by sports, biking, tampon use, and more. A small speculum may be used for your patients who have never been sexually active at age 21. Arreaza: We perform screening BEFORE we diagnose a disease. The age of diagnosis of cervical cancer is age 50, most patients fall between 35 and 45 years old. How can we determine who is at risk and needs a pap smear? Adriana: When looking at cervical screening guidelines and recommendations, we are looking at the patient who is: At average risk for cervical disease – a patient who is asymptomatic, immunocompetent, and has had all previous cervical cancer screening results within normal limit.At sufficiently low-risk for cervical disease and can return to routine age-based screening: 

The plasticity of primary care, in the new value-based era, embodies remarkable adaptability, innovation, and responsiveness to evolving community health needs. As our understanding of health and well-being expands, primary care stands as the first line of defense, ready to transform and customize its services to address the unique challenges faced by diverse populations. This flexibility allows primary care providers to pivot swiftly, whether it's in responding to public health crises, addressing disparities in healthcare access, or integrating innovative technologies into daily practice. In embracing this plasticity, primary care not only becomes a cornerstone of community health but also a powerful catalyst for positive change, driving us closer to the goal of a healthier, more equitable society. In this week's episode of the Race to Value, we are joined by R. Shawn Martin, Executive Vice President and Chief Executive Officer for the American Academy of Family Physicians. The AAFP is the medical specialty organization representing 129,600 family physicians and medical students nationwide. Shawn Martin works with the AAFP Board of Directors on the mission, strategy and vision for the AAFP and provides representation to other organizations, including medical, public, and private sectors. He is nationally recognized for his thoughtful leadership on a range of healthcare and workforce issues. While his career portfolio has focused on numerous health care and public-policy issues, he is best known for his extensive work on the development and implementation of primary care delivery and payment models. In this episode, we discuss such things as payment reforms in primary care, the industry impact of primary care consolidation, physician-led ACOs, the new Making Care Primary (MCP) payment model and the need for multipayer collaboration, health equity, rural healthcare transformation, physician workforce challenges, and the future implications of AI on the medical profession. With leadership from Shawn and his constituents throughout the primary care ecosystem, we are well-positioned for transformation in the race to value! Episode bookmarks: 01:30 The plasticity of primary care and how it can evolve to meet community health needs in the new value era. 02:30 Introduction to R. Shawn Martin, the Executive Vice President and Chief Executive Officer for the American Academy of Family Physicians. 04:45 People who have access to advanced primary care tend to have better health, receive timelier diagnoses, and get more prompt treatment when it is needed. 05:30 The U.S. spends only 5-7% of its healthcare dollars on primary care — less than half of the 14% average in Western European countries. 06:00 AAFP Advocacy Priorities:  Fighting for Family Medicine! 07:00 Shawn discusses the need for additional investment in primary care at a national level. 08:30 The misalignment of fee-for-service in the primary care setting. 09:00 “Appropriate investment in primary care, coupled with a prospective payment model, will transform both patient experience and care team performance.”   09:45 PCP Infrastructure Investments + Rapid Transition to Value-Based Care = Primary Care Transformation 10:45 Vertical integration of primary care can lead to higher prices and costs, including insurance premiums, without improving care quality or patient outcomes. 11:30 Site-of-service payment differentials create uneven playing field between independent practices and hospital-owned primary care. 12:00 Shawn's congressional testimony to the Senate Finance Committee on the “Consolidation and Corporate Ownership in Health Care” 13:00 The Medicare program created siloed benefits between hospitals and physicians, and these design flaws created incongruencies in system economics and patient health outcomes. 14:30 The inability of independent physician practices to survive on the regulatory framework of the modern healthcare system.

In this episode of MGMA's Ask An Advisor podcast, we feature Senior Advisor Cristy Good talking about best practices for building out sign-on and retention bonuses at medical practices. MGMA Resources discussed: MGMA Stat on Bonuses: https://www.mgma.com/mgma-stats/after-a-year-of-pandemic-tumult-medical-practices-consider-bonuses-to-attract-top-talent MGMA Stat on Nurse Recruitment: https://www.mgma.com/mgma-stats/nurse-recruitment-and-hiring-after-the-great-resignation-still-a-major-challenge More Resources: Labor Market: https://www.shrm.org/resourcesandtools/hr-topics/compensation/pages/employers-rely-on-incidental-bonuses-amid-tight-labor-market.aspx SHRM: https://www.shrm.org/resourcesandtools/hr-topics/compensation/pages/incidental-bonuses-alternative-rewards.aspx AAFP: https://www.aafp.org/pubs/fpm/issues/2022/0500/p5.html Investopedia on Retention: https://www.investopedia.com/terms/r/retention-bonus.asp Retention and Bonuses: https://www.workhuman.com/blog/retention-bonus-agreement/ HBR on Bonuses: https://hbr.org/2023/02/do-retention-bonuses-pay-off SPONSOR: PDS (Practice Data Solutions): Unlock the full potential of your healthcare data with Practical Data Solutions! Benchmarks take on new meaning when blended with Key Performance Indicators like Expense, Productivity, Scheduling and Patient satisfaction data. Optimize your reporting to make better decisions with PDS analytics. Discover how at https://pds-online.com/ WE WANT TO HEAR FROM YOU Let us know if there's a topic you want us to cover or an expert you would like us to interview. Email us at podcasts@mgma.com. If you have opportunities and resources you'd like to share with MGMA members, go to Marketing with MGMA to find out how you can connect with the MGMA audience.

Mark Su is a board certified family physician of 20 years. He founded Personal Care Physicians as a functional medicine practice north of Boston in 2014, and a national virtual consulting practice, Functional Medicine Consulting Group, in 2021. He is currently serving as president of ISEAI, and also a member of the IFM, ILADS, and AAFP. Mark is driven to educate patients and empower them with choices in treatment planning.  He's now equally driven to scale root cause medicine to help "more patients get better, faster", collaborating with like-mission minded colleagues, health coaches, and other allied health professionals.Website:https://iseai.org/resources/https://www.drmarksu.com/You can find Dr. Jen's mold and gut health protocols here.

From the WEDI Archives: Dr. Steve Waldren, Vice President and Chief Medical Informatics Officer of the American Academy of Family Physicians discusses how AAFP's Innovation Lab has embraced the power of artificial intelligence to aid their physicians with numerous functions and processes. 

Thomas Campanella is a healthcare executive focused on educating the wider healthcare community on how the industry really works.    Thomas is also a voracious writer, podcaster, and regular webinar host regarding the topic of healthcare economics.   If you're a physician just now starting in the industry and want to learn how the healthcare machine works - this is the episode for you and Thomas is the man to talk to!   Enjoy!   Links:   Thomas Bio Articles referenced:   ◦ Healthcare Economics 101: https://www.linkedin.com/pulse/health-economics-101-guide-understanding-bigger-well-campanella/    ◦ We need more physician leaders...  https://www.linkedin.com/pulse/physicians-where-you-we-need-your-leadership-thomas-campanella/    ◦ About Tom's healthcare journey:  https://www.linkedin.com/pulse/my-healthcare-journey-thomas-campanella/    ◦ The importance of primary care physicians:  https://www.linkedin.com/pulse/primary-care-physicians-key-providing-value-based-thomas-campanella/    ◦ AAFP pointing out problems with direct primary care model https://www.aafp.org/pubs/fpm/issues/2016/0900/p10.html    Contact Finance for Physicians   Finance for Physicians    To schedule a call with one of our awesome planners, book HERE.

Episode 139: What is PCOS      Future Dr. Salimi explains the pathophysiology, signs, and symptoms of PCOS. Diagnostic criteria and the basics of treatment are also discussed. Dr. Arreaza adds some comments about the treatment of obesity.  Written by Elika Salimi, MS3, Western University of Health Sciences, College of Osteopathic Medicine of the Pacific. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Hello there! My name is Elika and I am a third-year medical student at Western University of Health Sciences. Today I will be talking to you about polycystic ovary syndrome AKA PCOS.Do you have a female patient in her reproductive years with irregular menstrual cycles, or no menstrual cycles at all? Is she unable to conceive a child? Did she have an unexpected diagnosis of diabetes? Does she have more acne than she would like, or has hair in unwanted or unexpected areas such as her chin?Does she have a hard time losing weight? If you answered YES to many of these questions, it is possible that your patient is suffering from polycystic ovary syndrome also known as PCOS, which is one of the most common endocrine disorders in women. Pathophysiology:The exact pathophysiology behind this syndrome is unknown; however, per the American College of Obstetricians and Gynecologists committee, some studies have shown a strong association between PCOS and obesity. In a woman with obesity disorder, the excess adipose tissue ends up increasing peripheral estrogen synthesis and as a result, there is a decrease in peripheral sensitivity to insulin which means many of these women tend to have hyperinsulinemia. To be more detailed, it is important to mention that during these anovulatory cycles, the increase in estrogen, which is also unopposed estrogen with a lack of progesterone, can lead to endometrial hyperplasia and consequently increase the risk of endometrial carcinoma.Clinical Features: Unless there is a clear history and physical or if perhaps there was an incidental ultrasound finding of polycystic ovaries, the diagnosis of PCOS is not exactly black-and-white. That is why it is important to increase awareness so that women can put the pieces of the puzzle together and come in to get evaluated. Multiple cysts in ovaries can present in patients without PCOS, and they are common in teenagers. To use the multiple cysts as part of the diagnosis, the patient has to be 2 years after menarche (AAFP). Some of these clinical symptoms typically start during adolescence displaying menstrual irregularities such as she could've had her period and then stopped getting it or she has a very delayed onset of her menstrual cycle. It is also possible to have spotty menstrual cycles also known as breakthrough bleeding or menorrhagia. And very important to many women, she could be infertile or have difficulties conceiving.She could also have diabetes because of insulin resistance that comes with the metabolic syndrome that develops with PCOS, which is also increased if she has obesity. This obesity disorder going hand in hand with the metabolic syndrome, can also increase the risk of having sleep apnea, which could affect the quality of her sleep, finding herself more fatigued than she should be after adequate hours of rest. Other symptoms include skin conditions such as hirsutism which is basically male pattern hair growth in women in areas such as the upper lip, chin, around the umbilicus, back, or even buttocks. She could also have male pattern hair loss on the head or too much acne or oily skin or acanthosis nigricans which are these brown/velvety hyperpigmented streaks on the neck or axilla, or groin. She could also find herself more depressed or anxious.Diagnosis:The diagnostic criteria and treatments are mainly addressed in the Journal of Clinical Endocrinology & Metabolism, an evidence-based guideline for the assessment and management of polycystic ovary syndrome, and the American Family Physician Journal:The diagnosis of PCOS requires the presence of at least two criteria that are not due to any other endocrine disorder such as thyroid disease or hyperprolactinemia, or other. 1) Periods of oligo-ovulation and or anovulation which means she's either having very low ovulatory cycles or she's not ovulating at all. 2) hyperandrogenism and this could be based on her clinical features or laboratory studies showing elevated testosterone levels or LH to FSH ratio and 3) Seeing enlarged and/or polycystic ovaries on a pelvic ultrasound. This means that the pelvic ultrasound shows an ovarian volume of equal to or greater than 10 mL and/or there's multiple cystic follicles that are about 2 to 9 mm in one or both of her ovaries which also usually tend to have a string of pearls appearance.So, if you have 2 out of the 3, you have PCOS. There are ways to confirm that there is in fact hyperandrogenism by doing lab studies and this could mean that her testosterone levels are elevated, or her androstenedione is elevated as well as elevated dehydro-epi-androsterone sulfate (DHEAS) and of course we need to rule out pregnancy and other endocrine disorders as I mentioned earlier. However, if the clinical picture of hyperandrogenism is there then that fulfills the diagnostic criteria for PCOS even if the serum antigen levels are normal. This also applies to an elevated LH:FSH ratio of typically greater than 2 to 1 which is also a characteristic finding of most patients with PCOS but this is not exactly necessary for diagnosis. We also don't need to find cystic follicles in order to diagnose PCOS. Treatment: In family medicine practices and even OB/GYN practice for PCOS the most common recommendation for all patients is to encourage them to increase their physical activity (exercise) and eat healthy and try to consider behavioral modifications to have a target BMI of ideally less than 25 kg/m² because this can reduce estrone production in adipose tissue.Then we are thinking about ways to treat patients who are not planning to conceive versus those that are. For those patients that are not planning to conceive the goal is to regulate their menstrual cycles and irregularities as well as their hyperandrogenism and to treat the comorbidities as well to overall improve their quality of life.The first line treatment for hyperandrogenism to try to regulate menstrual cycle abnormalities is combined oral contraceptives also known as birth control pills. This also reduces endometrial hyperplasia which in turn can decrease the risk of endometrial carcinoma as mentioned earlier and it can reduce menstrual bleeding and you can reduce acne and try to assist with the hirsutism as well. As mentioned earlier, PCOS can also go hand-in-hand with insulin resistance or hyperinsulinemia and therefore we can also use metformin that can improve menstrual irregularities but also address the metabolic side of this as well. Summary: Diet, exercise, combined oral contraceptives, and metformin.Some other more controversial medications to treat hyperandrogenism could be potassium-sparing diuretics such as spironolactone that also inhibits 17-a-hydroxylase or finasteride which is a 5-alpha-reductase inhibitor and flutamide which is an androgen receptor blocker. The mentioned examples are typically for those people that can't really tolerate combined oral contraceptives. Other things to consider for those that are suffering from obesity syndrome are to possibly consider bariatric surgery if of course the criteria are met, and this is on a case-by-case basis. Bariatric surgery may be an answer to many of our metabolic problems that's why it is now called metabolic surgery. For patients who are planning to conceive the goal is to manage their comorbidities such as weight loss but also to try to induce ovulation.Now the first-line therapy for inducing ovulation is a medication called letrozole which is an aromatase inhibitor that in turn reduces estrogen production stimulating FSH secretion and ultimately inducing ovulation, not to get too heavily into the weeds of how these medications work, but basically it improves pregnancy and live birth rate outcomes in patients who are infertile because of the fact that they have anovulatory cycles or a.k.a. they are not ovulating.Then we also have clomiphene which is just an alternative to letrozole and has a different mechanism of action but it also stimulates ovulation by more particularly causing a pulsatile secretion of GnRH and in turn increasing FSH and LH as well, and this medication might be actually preferred over metformin monotherapy in women that are suffering from obesity syndrome who also have anovulatory infertility. However, apparently, clomiphene can cause more chance of multiple gestations versus letrozole.Also, letrozole is preferred over clomiphene to induce ovulation because of a higher rate of live births, but we have the risk of multiple pregnancies with both these methods. Let's talk about the second-line therapies.As mentioned earlier we have this 2 to 1 ratio of FSH to LH in women with PCOS or at least a good amount of them. We said that that is not required to diagnose this disorder but we can also give women exogenous FSH plus human menopausal gonadotropin, but this is really a second-line treatment for ovulation induction and typically we go for second-line treatments if first-line therapies aren't successful. But I will mention that using this exogenous gonadotropin is very expensive and it requires you to have access to specialized healthcare facilities and constant ultrasound monitoring so this may just not be feasible for many people but if you have the resources and it's affordable for you then exogenous gonadotropins are actually preferred over clomiphene and metformin therapy.Metformin can also use as a second-line monotherapy for fertility treatments and this in combination with clomiphene can increase pregnancy rates, especially in women who are suffering from obesity disorder, and of course, this is first-line therapy for insulin resistance.Now if we're talking about an invasive type of procedure for infertility it would be laparoscopic ovarian drilling which basically, we use a laser beam or surgical needle to reduce ovarian tissue to decrease its volume and try to reduce androgen production. Doing this can cause a hormone shift that can induce FSH secretion and ultimately improve ovarian function as well. This is also a second-line treatment for ovulation induction, but it can be performed as a first line if other indications for laparoscopy are present. Third-line therapy would be in vitro fertilization which means that basically we take mature eggs from ovaries and then we fertilize them with sperm in a lab and then the fertilized egg or the embryo is transferred to a uterus to be implanted.For the management of hirsutism, the first-line therapy is usually non-pharmacological and that's electrolysis or light-based hair removal with laser or photo-epilation. For acne, we can consider benzoyl peroxide or topical antibiotics if necessary.Final thoughts: Now I know that was a ton of information but ultimately, we are trying to make women more aware of PCOS and let them know that they are not alone, also we are trying to reduce complications such as cardiovascular problems, diabetes, endometrial cancer, infertility or even pregnancy loss. The best we can do is try to educate more women because many are suffering from this condition and they have no idea. Again, my name is Elika Salimi, and I am a third-year medical student. If you have any questions, you can reach me at elika.salimi@westernu.edu.___________________________Conclusion: Now we conclude episode number 139, “What is PCOS.” Future Dr. Salimi explained that patients with Polycystic Ovary Syndrome present with: Hyperandrogenism, Oligo-ovulation or anovulation, and multiple cysts in ovaries. If your patient meets 2 out of the 3 criteria, then you can confidently give the diagnosis of PCOS. Dr. Arreaza reminded us that by treating obesity you are also treating PCOS. This week we thank Hector Arreaza and Elika Salimi. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology..ACOG Practice Bulletin No. 194: Polycystic Ovary Syndrome..Obstet Gynecol.2018; 131(6): p.e157-e171.doi:10.1097/AOG.0000000000002656Hoeger KM, Dokras A, Piltonen T.Update on PCOS: Consequences, Challenges, and Guiding Treatment.The Journal of Clinical Endocrinology & Metabolism.2020; 106(3): p.e1071-e1083.doi:10.1210/clinem/dgaa839Williams T, Mortada R, Porter S.Diagnosis and Treatment of Polycystic Ovary Syndrome..Am Fam Physician.2016; 94(2): p.106-13.pmid: 27419327.Legro RS, Arslanian SA, Ehrmann DA, et al.Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline.J Clin Endocrinol Metab.2013; 98(12): p.4565-4592.doi:10.1210/jc.2013-2350.International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018.https://www.monash.edu/__data/assets/pdf_file/0004/1412644/PCOS_Evidence-Based-Guidelines_20181009.pdf 

Matt McGlasson is a passionate, customer-focused leader in the Animal Health industry with over 17 years of experience in leading multiple hospitals through creative clinic management, professional development, and quality improvement. He has a successful track record of establishing innovative care systems, mentoring programs, and social media marketing initiatives to boost brand awareness and humanize Veterinary Medicine.  Matt brings a versatile skill set that allows him to transform any role he steps into. His collection of experience also differentiates him because he has led and grown other professionals in a variety of different environments.   Within his current role as Chief Medical Officer & Medical Director, he built and rolled out a mentoring program to help the transition for first-year doctors, including effective goal-setting, communication skills, financial advising from a CFP, doctor best practices, and other personal and professional development topics.    Dr. McGlasson is a Certified Fear Free Practitioner, Certified “Cat Friendly Veterinarian” by AAFP, and a member of the AVMA, VHMA, and AAFP.  He currently serves as the Northern Kentucky Representative on the Executive Board of the KVMA, serves on the Veterinary Advisory Board for BasePaws, and the editorial advisory board for dvm360.  As a Certified Veterinary Practice Manager, he represents a group of fewer than 40 DVMs in the United States with the CVPM certification.   His articles have been featured in dvm360 magazine and he has spoken at national veterinary conferences on the topics of practice management, practice culture, social media utilization, and finding joy in veterinary medicine.  

This week our intrepid team of primary care physicians (Kate Rowland, Henry Barry, Gary Ferenchick and Mark Ebell) discuss treatment of resistant depression in older adults, recognizing and managing angry and disruptive patients, the best way to settle a cranky infant, and the AAFP 2022 Guideline on BP targets in adults with hypertension.

You want passion? You got it in this month's edition of The Family Doctor: Lessons Learned, Wisdom Shared." Hear Dr White talk with Dr Conrad Flick who practices in Raleigh and serves as Co-President and Co-Medical Director of Community Care Physician Network (CCPN) in North Carolina. Dr Flick is a former President of the NCAFP and former Board Member of the AAFP. Medical students and residents just beginning their careers and contemplating their futures will be particularly motivated by Dr Flick's love for patient care and the virtues of Family Medicine. Thank you for listening and for sharing with your friends and colleagues! 

A lot has changed for managers and organizations over the last three years. So, what can be done to successfully navigate those changes so that managers can be successful and organizations can continue to thrive?The American Academy of Family Physicians (AAFP) is designing a new framework for their managers to help them better understand what they can be doing to intentionally lead their staff.This inspiring conversation with Paula Matthews from AAFP is a fantastic way to wrap up our Making Managing Manageable series.If you are just wrapping up season eight, now is a great time to subscribe to the podcast. You can get even more RedThread content by joining our membership community. Try it out for free for seven days to see what we're all about!You will want to hear this episode if you are interested in...The rapid-fire questions [5:32]Paula's role at AAFP [9:17]What has changed for managers over the last three years [10:10]What managers will return to [14:00]What sets good managers and not-so-good managers apart [15:40]Why managers are struggling today [18:24]AAFP's new manager framework [20:20]How they implement their training framework [26:25]How to empower employees to take control of their tasks [27:33]The lightning round questions [34:19]The role of leadership development [35:45]Resources & People MentionedSeason 0 - Is Purpose Working?Connect with Paula MatthewsAAFPConnect With Red Thread ResearchWebsite: Red Thread ResearchOn LinkedInOn FacebookOn TwitterSubscribe to WORKPLACE STORIES

Welcome to the 2 View - Episode 24 Welcome to Episode 24 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 24 of “The 2 View” – New street drug xylazine/"tranq," app for EM coding changes, FPL injuries, hemorrhoids. Molnupiravir Butler CC, Hobbs FDR, Gbinigie OA, et al. Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial. Lancet. PubMed. NIH: National Library of Medicine, National Center for Biotechnology Information. Published January 28, 2023. Accessed February 21, 2023. https://pubmed.ncbi.nlm.nih.gov/36566761/ Molnupiravir. COVID-19 Treatment Guidelines. NIH. Last Updated: September 26, 2022. Accessed February 21, 2023. https://www.covid19treatmentguidelines.nih.gov/therapies/antivirals-including-antibody-products/molnupiravir/ Easy Emergency Medicine Coding Calculator American Medical Association. 2023 Emergency Medicine Coding Guide. MDCalc. Accessed February 21, 2023. https://www.mdcalc.com/calc/10454/2023-emergency-medicine-coding-guide CPT Evaluation and Management (E/M) Code and Guideline Changes. Ama-assn.org. AMA: American Medical Association. Accessed February 21, 2023. https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf Graham. 2023 Emergency Medicine Level of Service/Billing Guidelines Overview. Published December 31, 2022. Accessed February 21, 2023. https://www.youtube.com/watch?v=WuV8O3SuXJI The Center for Medical Education. Documentation Changes that Can Help Your Practice. Published August 16, 2022. Accessed February 21, 2023. https://www.youtube.com/watch?v=gHLBjzQt4vo Xylazine DEA Joint Intelligence Report. The Growing Threat of Xylazine and its Mixture with Illicit Drugs. U.S. Department of Justice Drug Enforcement Administration. Dea.gov. Published October 2022. Accessed February 21, 2023. https://www.dea.gov/sites/default/files/2022-12/The%20Growing%20Threat%20of%20Xylazine%20and%20its%20Mixture%20with%20Illic it%20Drugs.pdf FDA warns about the risk of xylazine exposure in humans. Fda.gov. FDA. Published November 8, 2022. Accessed February 21, 2023. https://www.fda.gov/media/162981/download Hoffman J. Tranq dope: Animal Sedative Mixed with Fentanyl Brings Fresh Horror to U.S. Drug Zones. The New York Times. Published January 7, 2023. Accessed February 21, 2023. https://www.nytimes.com/2023/01/07/health/fentanyl-xylazine-drug.html. National Institute on Drug Abuse. Xylazine. National Institute on Drug Abuse: Advancing Addiction Science. Published April 21, 2022. Accessed February 21, 2023. https://nida.nih.gov/research-topics/xylazine Overdose C on O. Toxicity of Xylazine and How It Impacts People Who Use Drugs by Dr. Joseph D'Orazio. Published June 15, 2022. Accessed February 21, 2023. https://www.youtube.com/watch?v=Rqpf0jIuyCo Flexor Pollicis Longus and Other Thumb Injuries Gault D. A review of repaired flexor tendons. J Hand Surg Br. ScienceDirect. Published October 1987. Accessed February 21, 2023. https://www.sciencedirect.com/science/article/abs/pii/0266768187901811 Urbaniak JR. Repair of the flexor pollicis longus. Hand Clin. Europe PMC. Published February 1, 1985. Accessed February 21, 2023. https://europepmc.org/article/med/3912396 Hemorrhoids Procedure Review: Thrombosed Hemorrhoids. EM:RAP. EM:RAP.ORG. Published April 2018. Accessed February 21, 2023. https://www.emrap.org/episode/emrapliveapril/procedurereview Zuber TJ. Hemorrhoidectomy for Thrombosed External Hemorrhoids. Am Fam Physician. AAFP. Published 2002. Accessed February 21, 2023. https://www.aafp.org/pubs/afp/issues/2002/0415/p1629.html Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

We have the awesome Dr. Mike Lappin with us, the most frequent guest on our podcast! We are discussing what you can catch from your cat, i.e., zoonosis. Mike is the One Health Grand Poobah at WSAVA. They have an official connection with AAFP, not the feline one but the American Association of Family Practitioners. The purrpodcast is happy to be the first media outlet to cover this pre-announcement. What a fun episode.

Dr. Ada Steward is an inspiration to us all. As the first African American female president of the AAFP, she was born into the Cleveland housing projects and rose to success against all odds. Her story is one of determination, hard work, and perseverance through adversity. Listen to her inspiring journey from humble beginnings to a place of power and leadership in this uplifting podcast. Be inspired by Dr. Ada Steward's remarkable story - Listen Now!

In 2023, changes to coding will be coming for the inpatient and nursing home settings.  These changes will mimic the changes made on the outpatient side in 2021.  In this episode, we cover the coding changes to time based or medical decision making. In the episode, we mention the AAFP universal coding template, located here. https://www.aafp.org/dam/AAFP/documents/journals/fpm/universal%20coding%20tool.pdf In the story you may have missed, we talk about a Canadian paramedic that experienced likely what is the biggest fear in healthcare. This episode is sponsored by Eko Health.  Learn more about their digital stethoscopes at www.ekohealth.com and use code JSP for $50 off your order.   This episode is sponsored by CBD Stat.  Learn more about their high quality, THC free CBD oil.  They offer a 40% discount for healthcare workers at www.cbdstat.care/healthcare and for our listeners that aren't in healthcare you can use code JSP20 at checkout for 20% off your order.  www.cbdstat.care Just Some Podcast Social Media www.facebook.com/justsomepodcast www.twitter.com/justsomepodcast www.instagram.com/justsomepodcast Huge shoutout to Falcon Five-O for use of their music "Hard Living" and "Failure's Not the Same Without You"!

Dr. Susan and Dr. Jolle discuss the new AAFP magazine focusing on feline pain and mental health. We love this new magazine, and it is available for AAFP members. So time to become a member @catfriendlyhomes @catvets

Matt McGlasson is a passionate, customer-focused leader in the Animal Health industry with over 17 years of experience in leading multiple hospitals through creative clinic management, professional development, and quality improvement. He has a successful track record of establishing innovative care systems, mentoring programs, and social media marketing initiatives to boost brand awareness and humanize Veterinary Medicine.  Matt brings a versatile skill set that allows him to transform any role he steps into. His collection of experience also differentiates him because he has led and grown other professionals in a variety of different environments. Within his current role as Chief Medical Officer & Medical Director, he built and rolled out a mentoring program to help the transition for first-year doctors, including effective goal-setting, communication skills, financial advising from a CFP, doctor best practices, and other personal and professional development topics.    Dr. McGlasson is a Certified Fear Free Practitioner, Certified “Cat Friendly Veterinarian” by AAFP, and a member of the AVMA, VHMA, and AAFP.  He currently serves as the Northern Kentucky Representative on the Executive Board of the KVMA, serves on the Veterinary Advisory Board for BasePaws, and the editorial advisory board for DVM360. As a Certified Veterinary Practice Manager, he represents a group of fewer than 40 DVMs in the United States with the CVPM certification.  His articles have been featured in DVM360 magazine and he has spoken at national veterinary conferences on the topics of practice management, practice culture, social media utilization, and finding joy in veterinary medicine.   Throughout Matt's career, he also seeks to bring personality and fun to the animal health industry. He has redefined methods for content development and education within the industry by operating engaging veterinary-themed social media accounts and amassing over 500,000 followers with well over 70 million video views. Matt's work and insights have been featured on 22 Words, KaleSalad, Chewy's Social Media Sites, The Daily Mall, The Dodo, VetCandy, VetXInternational, Inspiremore.com, Cuddly, and many other prominent social media accounts. Matt has also been featured on the "Making Sense of Pets" Podcast, VetCandy Podcast, and has conducted multiple TV & Radio interviews celebrating the human-animal bond.  Matt is passionate about growing and supporting the future leaders of our profession. He believes that veterinary professionals will thrive if given the opportunity to be a part of a healthy culture and have continuous opportunities to grow.  The work that we all do in this profession has a life-changing impact on those we serve and deserves to be celebrated.   

Dr. Susan and Dr. Jolle are back live from beautiful Kansas. We discuss a new magazine from AAFP, the American Association of Feline Practitioners. This new magazine will be available for all AAFP members for free and we also think about open access vs paid journal subscriptions