Podcasts about Acute

Acute malnutrition has now reached famine levels in two more regions of North Darfur in Sudan, according to a new report from a UN-backed global hunger monitor.

Download my FREE macros guide: Nutrition 101 for Body Composition. Learn exactly how to set your protein, carbs, and fats for muscle building and fat loss using a flexible approach that works long-term: witsandweights.com/macros--Do carbs make you fat?Are spikes in blood sugar and insulin a problem for health or weight loss?Maybe you've been cutting carbs or tried keto or carnivore, yet your strength training progress has stalled, your recovery feels sluggish, and you're still not seeing the body composition results you want. The problem isn't your discipline. It's a fundamental misunderstanding of what insulin actually does (especially if you lift weights).Insulin is not a "fat-storage hormone" but a nutrient-partitioning hormone whose effects depend entirely on context: your training status, muscle mass, and energy balance. Learn how resistance training changes the way your body handles carbs, why lifters over 40 actually benefit from strategic insulin spikes, and how muscle tissue acts as a "sink" for glucose that determines where your nutrients go. It's not about eating unlimited carbs but understanding why carb tolerance is built through strength training and how to use that to your advantage, and to stop fearing spikes in blood sugar.Whether you want body recomp, trying to build muscle while losing fat, or wondering why your low-carb diet isn't working despite consistent strength training, this episode gives you an evidence-based framework to rethink your nutrition strategy. Plus, get a simple post-workout protocol that can improve your next-day training performance.Timestamps0:00 - Why carbs and insulin don't automatically cause fat gain3:20 - How training context changes what insulin does with your food7:25 - The real reason lifters fear carbs (and why it's misguided)11:55 - What insulin actually does (nutrient partitioning explained)18:40 - How carbs support muscle building, recovery, and strength training performance24:20 - Fat loss and insulin (why energy balance matters more than spikes)29:20 - Acute insulin spikes vs. chronic dysfunction (the critical difference for body recomp)

This week is all about how we can sometimes psych ourselves out of outr best performances without even knowing it! We chat about the science of bottling races and how it happens and how you might avoid it happening and what goes on, including our own experiences! Let us know what you think! ⁠Preloved Sports⁠ and please use code RUNNINGP20 to get 20% off purchases in the online shop! Here are links to articles we discussed; ⁠https://www.researchgate.net/publication/297695609_Nutrition_and_Athletic_Performance⁠ ⁠https://www.outsideonline.com/health/nutrition/endurance-athletes-protein-needs/⁠ ⁠McLellan, T.M., Pasiakos, S.M. & Lieberman, H.R. Effects of Protein in Combination with Carbohydrate Supplements on Acute or Repeat Endurance Exercise Performance: A Systematic Review. Sports Med 44, 535–550 (2014). https://doi.org/10.1007/s40279-013-0133-y⁠ Here is a link to support Paul's 100k x 10 challenge https://www.justgiving.com/page/paul-griffiths-5?utm_medium=FA&utm_source=CL Also why not join our Strava group for coaching tips and offers and much more! ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.strava.com/clubs/1414138/members⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ As always we go through our week of running and cover some recent race results, shout outs to listeners and some future topic suggestions. If you have any results you want us to cover or topics for future episodes, get in touch, or if you are interested in being coached by Paul (email Paul with 'podcast offer' to get a 10% coaching discount), please email us or connect on any social media. We will back every Monday with a new episode and here is how you can connect with us to help build the running partners community; email us at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠runningpartners@outlook.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Paul's running coach website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ www.paulgriffithsrunningcoach.com ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Alis Strava⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.strava.com/athletes/2163809 ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Ali's Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.instagram.com/twenty.six.point.two/?hl=en ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Ali's Facebook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ https://www.facebook.com/alison.griffiths.58/ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Paul's Strava⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.strava.com/athletes/10421356 ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Paul's Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.instagram.com/griffsrunning?igshid=NGVhN2U2NjQ0Yg== ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Paul's Facebook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ https://www.facebook.com/paul.griffiths.77312 ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Our YouTube channel⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ https://www.youtube.com/channel/UCwc3oBawuCiG-5ldXWfN-PQ Learn more about your ad choices. Visit podcastchoices.com/adchoices

Delaney Nolan on the town of Modeste and a new giant industrial park planned for the area. [...] Read More... from A town on the brink of extinction: Modeste is facing an acute concentration of industry as a proposed new development threatens to engulf it The post A town on the brink of extinction: Modeste is facing an acute concentration of industry as a proposed new development threatens to engulf it appeared first on The Lens.

🧭 REBEL Rundown 📌 Key Points 💨 HFNC met criteria for non-inferiority to BPAP for preventing intubation or death within 7 days in four of the five ARF subgroups.🧪 Bayesian dynamic borrowing increased power across subgroups but created variable certainty, especially in smaller groups such as COPD.🫁 The immunocompromised hypoxemia subgroup did not meet non-inferiority, leading to early trial stopping for futility.️ Rescue BPAP use, subgroup-specific exclusion criteria, and non-standardized BPAP delivery are important contextual factors that influence how subgroup results should be interpreted. Click here for Direct Download of the Podcast. 📝 Introduction Bilevel Positive Airway Pressure (BPAP) has long been a foundational modality in the management of acute respiratory failure (ARF), particularly in COPD exacerbations and cardiogenic pulmonary edema, where it can rapidly reduce work of breathing and improve gas exchange. It remains a core tool in our respiratory support arsenal.High-flow nasal cannula (HFNC), however, has expanded what we can offer patients by delivering many of the same physiologic benefits through a far more comfortable interface. With high flows, modest PEEP, and effective dead-space washout, HFNC can improve oxygenation and decrease work of breathing while preserving the ability to talk, cough, eat, and interact with staff and family. This combination of physiologic support and tolerability makes HFNC especially attractive in patients where comfort, anxiety, or cardiovascular stability are key considerations, and in settings where prolonged noninvasive support may be needed. Rather than competing with BPAP, HFNC broadens our options in ARF and allows us to better match the modality to the patient and their underlying disease process.The RENOVATE trial set out to answer a high-impact question across five distinct etiologic groups: Is HFNC non-inferior to BPAP (NIV) for preventing intubation or death in acute respiratory failure? 🧾 Paper Azoulay É, et al. High-Flow Nasal Oxygen vs Noninvasive Ventilation in Patients With Acute Respiratory Failure: The RENOVATE Randomized Clinical Trial. JAMA. 2025 PMID: 39657981 🔙Previously Covered On REBEL: HFNC: Part 1 – How It WorksHFNC: Part 2 – Adult and Pediatric IndicationsFLORALI and AVOID TrialFLORALI-2: NIV vs HFNC as Pre-Oxygenation Prior to IntubationThe Pre-AeRATE Trial – HFNC vs NC for RSI ️ What They Did CLINICAL QUESTION Is HFNC non-inferior to BPAP for rate of endotracheal intubation or death at 7 days in patients with acute respiratory failure due to a variety of causes? STUDY DESIGN Multicenter, randomized non-inferiority trial33 Brazilian hospitalsNov 2019 – Nov 2023Adaptive Bayesian hierarchical modeling with dynamic borrowingOpen label, outcome adjudicators blindedPatients were classified into 5 subgroups SUBGROUPS 1. Non-immunocompromised hypoxemiaSpO₂ < 90% on room air orPaO₂ < 60 mm Hg on room air plusIncreased respiratory effort (accessory muscle use, paradoxical breathing, thoracoabdominal asynchrony) orRespiratory rate > 25 breaths/min2. Immunocompromised hypoxemiaDefined as:Use of immunosuppressive drugs for >3 monthsOR high-dose steroids >0.5 mg/kg/dayOR solid organ transplantOR solid tumors or hematologic malignancies (past 5 years)OR HIV with AIDS / primary immunodeficiency3. COPD exacerbation with acidosisHigh clinical suspicion of COPD as primary diagnosisRR >25 with accessory muscle use, paradoxical breathing, and/or thoracoabdominal asynchronyABG: pH 454. Acute cardiogenic pulmonary edema (ACPE)Sudden onset dyspnea and rales± S3 heart soundNo evidence of aspiration, infection, or pulmonary fibrosisCXR consistent with pulmonary edema5. Hypoxemic COVID-19 (added June 2023)Added due to deviations between expected and observed outcome proportionsAny patient across the other 4 groups with PCR-confirmed SARS-CoV-2 infection in any of the above groups POPULATION Inclusion Criteria:≥18 yrs with ARF* in one of 5 pre-defined subgroups excluding COPD was defined by the following:Hypoxemia with SpO₂

Dr. Jeni Hayes, Senior Clinical Manager, Strategic Clinical Intelligence, and Dr. Heather Pace, Senior Clinical Manager, Ambulatory Care, join host Carolyn Liptak to discuss the Vizient Winter 2026 Spend Management Outlook, with a focus on pharmacy projections and key changes from prior outlooks. The episode also covers ambulatory care and self-administered drugs, biosimilar therapeutic insights, and dynamic pharmacy market forces.   Guest speaker:     Jeni Hayes, PharmD, BCPS   Senior Clinical Manager, Strategic Clinical Intelligence Vizient Spend Management Solutions   Heather Pace, PharmD   Senior Clinical Manager, Ambulatory Care Vizient Center for Pharmacy Practice Excellence     Host:   Carolyn Liptak, MBA, BS Pharm Pharmacy Executive Director, Regulatory Compliance & Revenue Integrity Center for Pharmacy Practice Excellence (CPPE) Vizient   00:05 — Introduction Announcer welcomes listeners to Verified Rx, produced by the Vizient Center for Pharmacy Practice Excellence.   00:14 — Episode Overview Host Carolyn Liptak, Pharmacy Executive Director at Vizient, introduces the Winter 2026 Spend Management Outlook (SMO). Focus areas: Pharmacy inflation projections Acute vs ambulatory care trends Provider-administered vs self-administered drugs Biosimilar therapeutic insights Dynamic pharmacy market forces shaping 2026–2030 Guests: Jeni Hayes, Senior Clinical Manager, Strategic Clinical Intelligence Heather Pace, Senior Clinical Manager, Ambulatory Care   01:09 — What Is the Spend Management Outlook (SMO)? Biannual Vizient publication projecting price trends across healthcare spend categories. Pharmacy headline: Inflation slightly lower than last edition Total spend still rising, driven by utilization growth and new technologies   01:49 — Top-Line Pharmacy Inflation Projection 2.84% projected drug inflation for purchases between July 2026 – June 2027. Down from 3.35% in the prior edition. Based on October 2024 – September 2025 wholesaler data. Heavily weighted toward highest-spend drugs. Contracted products show lower inflation; non-contract drugs still ~70% of spend.   02:45 — Inflation by Site of Care Acute Care 3.03% projected inflation Driven by: Sugammadex Kcentra Clotting factors Ambulatory Care 2.85% overall, but with key divergence: Provider-administered drugs: 3.35% Self-administered drugs: 2.43%   04:02 — Provider-Administered Drugs: What's Driving Growth Oncology infusions are the main drivers. Key agents: Keytruda Darzalex Faspro Continued growth due to: Expanded indications Increased outpatient infusion utilization Oncology split by site of care: Inpatient: High-cost CAR T (e.g., Yescarta) Outpatient: Infusions, bispecifics, emerging cellular therapies Emphasizes importance of site of care strategy.   05:14 — Self-Administered Drugs: Utilization Over Inflation Five key drivers: Autoimmune / inflammatory: Skyrizi, Dupixent, Rinvoq Diabetes / metabolic / weight loss: Ozempic, Wegovy, Mounjaro, Zepbound Spend growth fueled by: Media exposure Expanded indications Increased patient demand Opportunity for: Retail & specialty pharmacy optimization Margin capture Patient support (adherence, counseling, benefits investigation)   06:45 — New Section: Dynamic Pharmacy Market Forces (2026–2030) Seven strategic forces influencing pharmacy practice: Growth in specialty and cell & gene therapies Expansion of value- and outcomes-based contracting Siteofcare shifts toward ambulatory and home Digital transformation & automation Supply assurance and resilience Expanded pharmacist clinical scope & workforce models Regulatory and policy efforts to lower drug prices 340B changes IRA Medicare Part D negotiations   09:37 — Practical Takeaways for Pharmacy Leaders Use 2.84% inflation as a baseline — then customize using Vizient Pharmacy Analytics. Leverage segmented views to prioritize: Acute vs ambulatory strategies Provider-administered vs self-administered drugs Identify top spend movers and align them with long-term market forces. Consider: Specialty pharmacy expansion Site of care optimization   10:48 — Biosimilar Therapeutic Insights: 2025 Recap Heather Pace highlights: Shift from biosimilar approval to active adoption management. Ustekinumab (Stelara) as defining example: Multiple biosimilars Uptake driven by payer and PBM strategy Utilization varies widely based on: Formulary design Benefit alignment Biosimilars now actively steered, not passively adopted.   11:50 — Why Stelara Was a Turning Point PBM-developed, private-label biosimilars drove adoption. Net cost and copay design outweighed: Interchangeability status Manufacturer differentiation Sets expectations for future biologic launches.   12:25 — Operational Impact for Health Systems Expect payer-specific product preferences. Frequent switching will become routine. Key considerations: Siteofcare mandates Product presentation Supply chain logistics Billing & reimbursement complexity Clinical barriers are decreasing; workflow flexibility is critical.   13:09 — What to Expect From Biosimilars in 2026 Faster adoption timelines Earlier payer-driven switching Fewer preferred products Less reliance on reference product trial periods   13:45 — Biosimilars With Major 2026 Impact Eylea — multiple launches expected post-litigation Xolair — expansion into asthma/allergy and retail specialty Perjeta — oncology pathway disruption expected late 2026 / early 2027   15:01 — 2025 Biosimilars Impacting 2026 Ustekinumab (Stelara): broader formulary shifts Denosumab (Prolia, Xgeva): full year of impact; all interchangeable Eculizumab (Soliris): first rare-disease biosimilar entry   15:58 — FDA Biosimilar Guidance to Watch Late-2025 FDA guidance: Reduced reliance on clinical efficacy trials Greater emphasis on analytical similarity Aims to: Reduce development cost Accelerate market entry   16:26 — Interchangeability: Where Things Are Headed Moving toward expectation that all biosimilars are interchangeable. Shifts responsibility to: Payers Health systems Pharmacists managing transitions and education   17:17 — Biggest Shift in the Biosimilar Landscape Faster launches Larger scale adoption Payer strategy more influential than timing of approval Success depends on: Formulary fit Channel alignment Operational simplicity   17:41 — Final Biosimilar Insight Biosimilar strategies must be molecule-specific. One-size-fits-all approaches are no longer effective.   18:13 — Final Thoughts on the SMO Inflation projections are a starting point. Leaders should: Focus on top spend drugs Understand siteofcare and specialty drivers Translate projections into actionable budgets   18:40 — Resources Winter 2026 Spend Management Outlook available on Vizient's SMO Hub. Includes current and prior editions and related insights.   18:58 — Closing Carolyn thanks Jeni and Heather. Reminder to subscribe, like, and share feedback. Verified Rx is produced by the Vizient Center for Pharmacy Practice Excellence.   Links | Resources:  Vizient Spend Management Outlook webpage Vizient Winter 2026 Spend Management Outlook Vizient Biosimilars Therapeutic Insights   Subscribe Today! Apple Podcasts Spotify YouTube RSS Feed    

Welcome to the emDOCs.net podcast! Join us as we review our high-yield posts from our website emDOCs.net.Today on the podcast, Rachel Bridwell and Brit Long cover acute acetaminophen toxicity, as well as some evidence updates. To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play

Q-BANK: https://patreon.com/highyieldfamilymedicineVision screening guidelines (1:51),Blepharitis (4:58),Hordeolum (6:24),Chalazion (7:23),Conjunctivitis (8:15),Preseptal cellulitis vs orbital cellulitis (11:53),Corneal abrasions (13:39),Corneal ulcers (14:47),Eye trauma and chemical burns (16:43),Acute closed-angle glaucoma (17:59),Open-angle glaucoma (20:59),Anterior uveitis (22:07),Cataracts (23:23),Hypertensive retinopathy (24:57),Diabetic retinopathy (25:52),Age-related macular degeneration (27:19),Retinal detachment (29:21),Amaurosis fugax (30:15),Central retinal artery occlusion (31:01),Central retinal vein occlusion (31:58),Papilledema (32:52),Optic neuritis (34:01),Temporal arteritis (35:02),Practice questions (36:14)

Stress doesn't always feel like stress. Many people living with chronic stress symptoms are still functioning, coping, and getting through their days until suddenly they can't. In this episode of The Good Health Podcast, we explain why stress is not just psychological, but a biological load that affects your nervous system, hormones, sleep, digestion, immunity, and recovery long before burnout or breakdown appears.01:30 — Chronic Stress as a Physiological State04:25 — Acute vs Chronic Stress: What the Body Can Actually Handle08:00 — “I Feel Fine”: Why Chronic Stress Often Goes Unnoticed13:00 — 5 Early Signs of Maladaptive Stress Responses17:45 — How Chronic Stress Signalling Affects the Body22:00 — Regulation Before Optimisation: Supporting Stress ProperlyIf you've been pushing through, normalising symptoms, or wondering why rest doesn't seem to restore you anymore, this episode will help you recognise the early and subtle signs of chronic stress without self-blame or fear.RESOURCES: Grab all the links and resources mentioned in this episode at https://www.nicolegoodehealth.com/the-goode-health-podcast/episode-111DISCLAIMER: The content in this podcast and related website is not intended to be a substitute for medical advice. It is not intended to be used to diagnose or treat, instead it is designed to help educate and inspire. Always seek the advice of a professional medical practitioner or qualified health practitioner. Never ignore or disregard advice given to you based on information in this podcast or related website and do not delay in seeking medical advice.

This week Paul was due to talk about his 100k challenge, but this is delayed following an unfortunate football incident! The protein chat from last week has generated some feedback, so we delve into this in a bit more detail and other general training talk! Here are some links; Preloved Sports and please use code RUNNINGP20 to get 20% off purchases in the online shop! Here are links to articles we discussed; https://www.researchgate.net/publication/297695609_Nutrition_and_Athletic_Performance https://www.outsideonline.com/health/nutrition/endurance-athletes-protein-needs/ McLellan, T.M., Pasiakos, S.M. & Lieberman, H.R. Effects of Protein in Combination with Carbohydrate Supplements on Acute or Repeat Endurance Exercise Performance: A Systematic Review. Sports Med 44, 535–550 (2014). https://doi.org/10.1007/s40279-013-0133-y Here is a link to support Paul's 100k x 10 challenge https://www.justgiving.com/page/paul-griffiths-5?utm_medium=FA&utm_source=CL Also why not join our Strava group for coaching tips and offers and much more! ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.strava.com/clubs/1414138/members⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ As always we go through our week of running and cover some recent race results, shout outs to listeners and some future topic suggestions. If you have any results you want us to cover or topics for future episodes, get in touch, or if you are interested in being coached by Paul (email Paul with 'podcast offer' to get a 10% coaching discount), please email us or connect on any social media. We will back every Monday with a new episode and here is how you can connect with us to help build the running partners community; email us at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠runningpartners@outlook.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Paul's running coach website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ www.paulgriffithsrunningcoach.com ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Alis Strava⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.strava.com/athletes/2163809 ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Ali's Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.instagram.com/twenty.six.point.two/?hl=en ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Ali's Facebook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ https://www.facebook.com/alison.griffiths.58/ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Paul's Strava⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.strava.com/athletes/10421356 ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Paul's Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.instagram.com/griffsrunning?igshid=NGVhN2U2NjQ0Yg== ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Paul's Facebook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ https://www.facebook.com/paul.griffiths.77312 ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Our YouTube channel⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ https://www.youtube.com/channel/UCwc3oBawuCiG-5ldXWfN-PQ Learn more about your ad choices. Visit podcastchoices.com/adchoices

In this episode, Sonika and Gabe explore how pain is experienced differently across bodies and interpreted differently in conversations, with a focus on people living with Sickle Cell Disease. This conversation dips into acute and chronic pain, highlighting the challenge health communicators face in bringing the unseen aspects of someone's pain to light. This episode was recorded in October 2025.Follow us on LinkedIn

Not all listeners agree with Mark’s take on the anti-ICE protests — immigration raids are what they voted for, and that’s what they’re happy to be getting. Are the protesters being paid? And if so, by whom? The silent majority speaks! That is, via the KFI talkbacks. When Barack Obama was president, he was known as the “Deporter in Chief,” but he apparently did it in a much less violent manner. Miracle weightloss drugs like Ozempic and Wegovy that’ve been the darling of every fatty trying to drop a few pounds may have a few risky complications! Acute pancreatitis for one. Who knew minor celebrity Mark Thompson went on a date with Sheena Easton to the Kennedy Center! What do you say after a screening when the movie was terrible, but you have to interact with the filmmaker? Disgraced filmmaker Brett Ratner directed the “Melania” documentary. That last sentence has nothing to do with the first sentence.See omnystudio.com/listener for privacy information.

In this episode, Laura Hall explores Acute Mountain Sickness (AMS) and the underlying physiology that drives altitude illness. As atmospheric pressure falls with increasing elevation, the body struggles to absorb adequate oxygen, triggering symptoms that often begin as headache, nausea, fatigue, and a “hangover-like” malaise. While these early features are common and often benign, Laura highlights how AMS can progress to far more serious and potentially fatal conditions.The discussion moves into High Altitude Cerebral Oedema (HACE) and High Altitude Pulmonary Oedema (HAPE), outlining their distinct pathophysiology and clinical red flags. Listeners are guided through key diagnostic cues such as worsening ataxia, confusion, or altered behaviour in HACE, and breathlessness at rest, cough, and signs of fluid in the lungs in HAPE.Preventative strategies are also covered, including the importance of gradual ascent, appropriate hydration, and the role of pharmacological prophylaxis such as acetazolamide and, in selected cases, steroids. From a management perspective, Laura emphasises that descent and supplemental oxygen remain the cornerstone treatments for severe altitude illness.Crucially, this episode reinforces the need for clinical vigilance: not every unwell patient at altitude has altitude illness. Clinicians must maintain a broad differential diagnosis and avoid anchoring bias, ensuring that other serious medical conditions are not overlooked or misattributed to AMS, HACE, or HAPE. Read the blog post here: https://highadventurehealthcare.substack.com/p/acute-mountain-sicknessThis Podcast is sponsored by World Extreme Medicine.World Extreme Medicine provides internationally recognised education for clinicians and operators working in pre-hospital, remote, expedition, humanitarian, and high-risk environments. Their programmes focus on practical, experience-led learning, equipping professionals with the skills to make sound clinical and operational decisions when resources are limited, evacuation is delayed, and conditions are extreme.With courses covering expedition and wilderness medicine, hostile environments, dive medicine, human performance, leadership, and austere care, World Extreme Medicine brings together a global faculty with real-world experience from some of the most challenging settings on earth. To explore courses, free educational resources, and upcoming webinars, visit: ⁠www.worldextrememedicine.com

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Association Between Air Pollution and Monday Peak Mortality From Acute Myocardial Infarction.

A structure to the acute abdomen and acute abdominal pain - what is acute abdomen, what are the causes of acute abdomen and the differential diagnosis of acute abdominal pain? Acute abdomen examination (causes by location) as well as history and acute abdomen signs and symptoms. We also take a look at how an acute abdomen is managed. PDFs available here: https://rhesusmedicine.com/pages/general-surgeryConsider subscribing (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Buy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is an acute abdomen? 0:23 Causes of acute abdomen / Causes of acute abdominal pain2:40 Diagnosis of acute abdomen / Diagnosis of acute abdominal pain - Causes of acute abdomen by location 4:35 Diagnosis of acute abdomen / Diagnosis of acute abdominal pain - History6:40 Acute abdomen physical exam / Acute abdominal pain physical exam8:17 Diagnosis of acute abdomen / Diagnosis of acute abdominal pain - Labs and Imaging10:01 Treatment of acute abdomen / Treatment of acute abdominal painLINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/Disclaimer: Please remember this video and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition. The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice.ReferencesMSD Manuals Professional Edition (2025) Acute abdominal pain. Reviewed/Revised Jul 2024; Modified Jul 2024. Available at: https://www.msdmanuals.com/en-gb/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/acute-abdominal-pain BMJ Best Practice (2025) Evaluation of acute abdomen. Last reviewed: 23 Dec 2025; Last updated: 22 Jul 2025. Available at: https://bestpractice.bmj.com/topics/en-us/503 BMJ Best Practice (2025) Acute appendicitis: symptoms, diagnosis and treatment. Last reviewed: 27 Dec 2025; Last updated: 17 Apr 2025. Available at: https://bestpractice.bmj.com/topics/en-gb/290 BMJ Best Practice (2025) Imaging and investigations for abdominal pain. Available at: https://bestpractice.bmj.com/topics/en-gb/787/diagnosis-approach NICE Guidelines NG156 (2025) Abdominal aortic aneurysm: diagnosis and management. Available at: https://www.nice.org.uk/guidance/ng156/chapter/recommendations

Peter Cowan and I discuss the surge in non-contact soft-tissue injuries of 49ers players and possible mechanisms including chronic magnetic field exposure from nearby electrical substation, circadian rhythm disruption causing mitochondrial dysfunction, impaired collagen repair and delayed healing.Peter Cowan is a software developer, health coach with an interest in applied circadian biology and EMF mitigating consultant. PODCAST SPONSORS

A cocaine-positive patient rolls into the OR and the monitors look fine—until twenty minutes after induction, when the blood pressure plummets. We unpack that swing from sympathetic surge to sudden crash through two real cases: an emergent trauma laparotomy complicated by asystole and a chronic intranasal user with profound hypotension that only responded to direct-acting vasopressors. From there, we connect the dots to the pharmacology that makes these events predictable and, with the right plan, manageable.We talk candidly about what matters before wheels-in: timing of last use, objective signs of toxicity, and targeted testing. You'll hear why urine screens can stay positive for weeks, why indirect agents like ephedrine can fail, and how phenylephrine or norepinephrine often become first-line choices. For regional anesthesia, we flag contamination risks and local anesthetic systemic toxicity concerns that call for dose adjustment and intralipid readiness. Chronic cocaine use adds another layer, including left ventricular dysfunction, myocardial infarction and fibrosis, and calcium dysregulation.Hospital policy and equity loom large. Automatic cancellations for cocaine positive patients can worsen pain, delay care, and disproportionately impact patients with limited access. We review current evidence suggesting many asymptomatic, cocaine-positive patients tolerate elective noncardiac surgery under general anesthesia with hemodynamics comparable to controls when vigilant management is in place. The takeaway: build flexible, evidence-informed pathways that prioritize patient safety without reflexive delays, and keep a rescue mindset with careful monitoring and direct vasopressors within reach. If this sparked ideas for your practice, subscribe, share with a colleague, and leave a review so more clinicians can find these insights.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/291-managing-anesthesia-risks-for-patients-with-acute-and-chronic-cocaine-use/© 2026, The Anesthesia Patient Safety Foundation

Show notes at pharmacyjoe.com/episode1099 In this episode, I'll discuss why glucocorticoids have no role in reversing the acute symptoms of anaphylaxis.

Dr Rafid Ahmed, consultant in Acute medicine , currently working in University Hospital of Derby and Burton NHS Foundation Trust, is walking us through clinical approach to acute shortness of breath.

Join us as we begin our two part discussion of Psychedelic Assisted Psychotherapy and Integration with Dr. Arayan Sarparast of the OHSU Psilocybin Education & Assessment Collaborative for Excellence (PEACE) Clinic and clinical research coordinator Will Lucas. This episode focuses primarily on counseling patients interested in Psychedelic Assisted Psychotherapy and harm reduction strategies when working with patients that have presented to the hospital with altered mental status after ingesting Psychedelic substances. We also discuss medico-legal issues surrounding psilocybin, primarily in the state of Oregon. Stay tuned for part 2 in which we will further dive into integration and psychotherapy after psychedelic experiences. Additional learning materials and resources for this episode can be found at: About Oregon Psilocybin Services:⁠https://www.oregon.gov/oha/ph/preventionwellness/pages/oregon-psilocybin-services.aspx⁠Kelan L. Thomas, B.E.S. Robert Jesse, Nicky J. Mehtani, Jennifer M. Mitchell & Brian T. Anderson (2023): Commentary: Evidence-Informed Recommendation to Achieve Approximate Parity in the Allowed Number of Doses for Common Psychedelics, Journal of Psychoactive Drugs, DOI: 10.1080/02791072.2023.2201244Bathje GJ, Majeski E and Kudowor M (2022) Psychedelic integration: An analysis of the concept and its practice.Front. Psychol. 13:824077. doi: 10.3389/fpsyg.2022.824077Carbonaro, T. M., Bradstreet, M. P., Barrett, F. S., MacLean, K. A., Jesse, R., Johnson, M. W., & Griffiths, R. R. (2016). Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences. Journal of Psychopharmacology, 30(12), 1268-1278.For any questions and feedback, please contact us at psychiatryexplored@gmail.com.

Join Digital Education Committee Chair and podcast host Michael S. Lloyd, MD, FHRS, and his guests Kelvin C. Chua, MBBS, MD, FHRS, CEPS-A, and Rahul N Doshi, MD, FHRS, for this week's Lead episode, which was recorded live at APHRS 2025 in Kyoto, Japan. This discussion will review recent evidence on the feasibility and safety of pulsed field ablation (PFA) for coronary sinus and left atrial appendage isolation, as well as mitral isthmus ablation, focusing on both acute and chronic outcomes. Panelists will examine procedural considerations, lesion durability, and safety signals highlighted in the study, and explore how these findings may inform evolving ablation strategies for complex atrial arrhythmias.   Learning Objectives Summarize the acute and chronic feasibility and safety outcomes of pulsed field ablation (PFA) for coronary sinus isolation, left atrial appendage isolation, and mitral isthmus ablation as reported in the study. Evaluate procedural techniques and lesion durability considerations associated with using PFA in anatomically complex atrial structures. Assess the potential clinical implications of these findings for incorporating PFA into ablation strategies for complex atrial arrhythmias, including patient selection and risk mitigation.   Podcast Contributors Michael S. Lloyd, MD, FHRS Kelvin C. Chua, MBBS, MD, FHRS, CEPS-A Rahul N Doshi, MD, FHRS   Host and Contributor Disclosure(s): K.C. Chua•Nothing to disclose. R. N. Doshi•Speaking/Teaching/Consulting/Authoring: Boston Scientific, Kestra Inc., Abbott, Impulse Dynamics USA    M. S. Lloyd •Honoraria/Speaking/Consulting: Medtronic, Agra MedTech, Circa Scientific •Membership on Advisory Committees: Boston Scientific   Article for Discussion

Get Started With Muscle Activation Techniques® To Loosen Your Tight & Achy Muscles Without Stretching: https://www.matschaumburg.com What do you do when your body flares up while living your life? Maybe you were shoveling snow and all of the sudden your back got tweaked. Or perhaps you were putting boxes up high on a shelf and all of a sudden your shoulder started to hurt. Or maybe walking down your stairs and your knee muscles felt like they were going to give out. Whatever flare up happens, having a plan of action to get your body back on course is critical to make sure you are able to continue living your life. So, what is your plan of action when these events happen? On this week's episode of the Exercise Is Health® podcast, we are laying out the exact plan of action we recommend to all of our clients when something comes up with their body. If you have ever had to spend weeks nursing your body back to health after something got flared up, listen up! What we share in this conversation can get you back to living your life to the fullest faster. Check out all the details in this week's episode! Ready to schedule your first Muscle Activation Techniques® session with us? Click here to get started: http://vagaro.com/muscleactivationschaumburg/services Looking for custom workout programming that gets designed to your exact specifications to build your strength and athleticism? Sign up for PRO Strength & Performance Programming: https://www.charliecates.com/programming Would you like to have our guidance implementing the 4 Exercise For Life Principles while you workout? Join the Exercise For Life Membership for free for 30 days! Just head to www.exerciseforlifestudios.com to get started! Did you find this episode helpful? Let us know by leaving us a rating and review on the following platforms: – Apple Podcasts: https://podcasts.apple.com/us/podcast/exercise-is-health/id1330420565 – Spotify: https://open.spotify.com/show/6H1CneHjsPiPStrAeFTP25?si=X1IuXkp0T1KCv3gCtt3j5g  Want to grab a free copy of our best-selling book, "The Exercise For Life Method"? Click here to order yours while copies are still available! www.exerciseforlifemethod.com Just cover the cost of shipping and handling to have it delivered right to you. Follow us on Instagram for more exercise tips and content about MAT here: – Muscle Activation Schaumburg: @muscleactivationschaumburg  – Julie Cates: @julcates  – Charlie Cates: @charliecates

Estima-se que em torno de 15% da população mundial sofra de enxaqueca, com maior prevalência nas mulheres - e muitos sintomas, tais como aura, além de hipersensibilidade à luz, ao som e ao cheiro... Afinal, o que a ciência tem a dizer sobre o tema?Confira o papo entre o leigo curioso, Ken Fujioka, e o cientista PhD, Altay de Souza.>> OUÇA (60min 43s)Convidado: Dr. Fabiano Moulin de MoraesMédico neurologista pela Escola Paulista de Medicina da UNIFESP, onde é preceptor da residência em Neurologia. Membro titular da Academia Brasileira de Neurologia, Professor da Casa do Saber e Especialista em neurologia da cognição e do comportamento. Participou do Naruhodo Entrevista 48.* Naruhodo! é o podcast pra quem tem fome de aprender. Ciência, senso comum, curiosidades, desafios e muito mais. Com o leigo curioso, Ken Fujioka, e o cientista PhD, Altay de Souza.Edição: Reginaldo Cursino.http://naruhodo.b9.com.br*APOIO: INSIDERIlustríssima ouvinte, ilustríssimo ouvinte do Naruhodo, janeiro é tempo de recomeços - e o recomeço mais importante é o momento em que acordamos, todos os dias.Afinal, a escolha da manhã muda tudo:- Vestir a roupa de treino assim que acorda — mesmo treinando só à tarde — aumenta a chance de cumprir a meta.- Colocar uma peça inteligente para trabalhar ou criar conteúdo te coloca instantaneamente em modo produtivo e confiante.- Mesmo para ficar em casa, trocar o pijama por um look confortável e bonito muda o humor, a energia e a presença.Ou seja: a Insider entra no seu ritual matinal e acompanha sua rotina com naturalidade.Então use o endereço a seguir pra já ter o cupom NARUHODO aplicado ao seu carrinho de compras: são 10% de desconto, ou 15% de desconto caso seja sua primeira compra.>>> creators.insiderstore.com.br/NARUHODOOu clique no link que está na descrição deste episódio.E bons recomeços pra você!INSIDER: inteligência em cada escolha.#InsiderStore*REFERÊNCIASMigraine Triggers: An Overview of the Pharmacology, Biochemistry, Atmospherics, and Their Effects on Neural Networkshttps://pmc.ncbi.nlm.nih.gov/articles/PMC8088284/Migraine and cognitive dysfunction: a narrative reviewhttps://pmc.ncbi.nlm.nih.gov/articles/PMC11657937/Structural and Functional Brain Changes in Migrainehttps://pmc.ncbi.nlm.nih.gov/articles/PMC8119592/Migraine: Multiple Processes, Complex Pathophysiologyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC4412887/Migraine management: Non-pharmacological points for patients and health care professionalshttps://www.degruyterbrill.com/document/doi/10.1515/med-2022-0598/htmlIs there a causal relationship between stress and migraine? Current evidence and implications for managementhttps://pmc.ncbi.nlm.nih.gov/articles/PMC8685490/The Global Burden of Migraine: A 30-Year Trend Review and Future Projections by Age, Sex, Country, and Regionhttps://pmc.ncbi.nlm.nih.gov/articles/PMC11751287/Practical issues in the management of sleep, anxiety, and mood disorders in primary headacheshttps://pmc.ncbi.nlm.nih.gov/articles/PMC12221693/Differentiating Visual Symptoms in Retinal Migraine and Migraine With Aura: A Systematic Review of Shared Features, Distinctions, and Clinical Implicationshttps://pmc.ncbi.nlm.nih.gov/articles/PMC12380025/Current Trends in Pediatric Migraine: Clinical Insights and Therapeutic Strategieshttps://pmc.ncbi.nlm.nih.gov/articles/PMC11940401/Migrainehttps://www.nejm.org/doi/10.1056/NEJMra1915327Pratice guideline update summary: Acute treatment of migraine in children and adolescentshttps://www.neurology.org/doi/10.1212/WNL.0000000000008095Migraine aura as an artistic resource https://nah.sen.es/vmfiles/vol13/NAHV13N22025102_115EN.pdfMigraine aura as artistic inspiration.https://pmc.ncbi.nlm.nih.gov/articles/PMC1838881/Migraine as a source of artistic inspirationhttps://neuro.org.br/pdfs/RBN-59/RBN-594-DEZEMBRO/RBN-594-DEZEMBRO.pdf#page=44Migraine and risk of all-cause mortality and specific cause mortality: a systematic review and meta-analysishttps://pmc.ncbi.nlm.nih.gov/articles/PMC12534955/Comparative effects of drug interventions for the acute management of migraine episodes in adults: systematic review and network meta-analysishttps://pmc.ncbi.nlm.nih.gov/articles/PMC11409395/The impacts of migraine on functioning: Results from two qualitative studies of people living with migrainehttps://pmc.ncbi.nlm.nih.gov/articles/PMC10922598/Exploring the Hereditary Nature of Migrainehttps://pmc.ncbi.nlm.nih.gov/articles/PMC8075356/Transient receptor potential melastatin 8 (TRPM8) is required for nitroglycerin and calcitonin gene-related peptide induced migraine-like pain behaviors in micehttps://pmc.ncbi.nlm.nih.gov/articles/PMC9519811/Association between weather conditions and migraine: a systematic review and meta-analysishttps://link.springer.com/article/10.1007/s00415-025-13078-0Evaluation of Green Light Exposure on Headache Frequency and Quality of Life in Migraine Patients: A Preliminary One-way Cross-over Clinical Trialhttps://pmc.ncbi.nlm.nih.gov/articles/PMC8034831/CGRP — The Next Frontier for Migrainehttps://www.nvvg.nl/files/3306/CGRP%20—%20The%20Next%20Frontier%20for%20Migraine.pdfDigital Media Use in Adolescents with Migraine: A Topical Reviewhttps://link.springer.com/article/10.1007/s11916-025-01444-6Placebo Response in Acute and Prophylactic Treatment of Migrainehttps://www.neurologic.theclinics.com/article/S0733-8619(25)00068-4/abstractCalcitonin Gene–Related Peptide Inhibitors and Cardiovascular Events in Patients With Migrainehttps://www.neurology.org/doi/abs/10.1212/WNL.0000000000214479?casa_token=WccpvEByt0MAAAAA:LKbxQClihNe2WsrHRKBmteHftcUECeozPKYcnSQPjsBA0hlEvKExc2DvBgn-J5WwWyudd3QV1nluWwInsights from triggers and prodromal symptoms on how migraine attacks start: The threshold hypothesishttps://journals.sagepub.com/doi/10.1177/03331024241287224Elucidating the susceptibility genes between insomnia and migraine by integrating genetic data and transcriptomeshttps://link.springer.com/article/10.1186/s10194-025-02249-zThe experience of neck pain in people with migraine: A qualitative studyhttps://www.sciencedirect.com/science/article/pii/S1413355525003922?casa_token=9ct7RuiXWIgAAAAA:Sxlqh2wKO3-2l4ig9hzuXb92eJtttlM1Mdd3EId-5BfNQ2J8kpTn2iCd3tr6a0l58kyqDTDR7wThe impact of pain on memory: a study in chronic low back pain and migraine patients https://academic.oup.com/braincomms/article/8/1/fcaf486/8376909Migraine as a dynamic continuum during the life coursehttps://www.thelancet.com/journals/laneur/article/PIIS1474-4422(25)00441-7/abstractNaruhodo #447 - O que é AVC e como evitá-lo? #TodosPeloPirullahttps://www.youtube.com/watch?v=vRu9cet1TWMNaruhodo #236 - Por que temos dor de cabeça?https://www.youtube.com/watch?v=q8FtXVlSz1INaruhodo #345 - Por que às vezes sentimos as dores dos outros?https://www.youtube.com/watch?v=mKdMBCqy6XANaruhodo #145 - Por que a cabeça dói quando tomamos gelado?https://www.youtube.com/watch?v=qjq2Ds6YB-cNaruhodo #165 - Quando tomo antidepressivos continuo sendo eu mesmo?https://www.youtube.com/watch?v=dWyfUyHUiA4Naruhodo #62 - Existem doenças psicossomáticas?https://www.youtube.com/watch?v=etuFYdCAKe4Naruhodo #288 - Por que existe a menopausa?https://www.youtube.com/watch?v=3Ewwdi2guWgNaruhodo #339 - Por que as coisas parecem girar quando estamos bêbados?https://www.youtube.com/watch?v=YmK1Yq0mwW8Naruhodo #398 - Jejum intermitente funciona?https://www.youtube.com/watch?v=lTkWGFFkOLo*APOIE O NARUHODO!O Altay e eu temos duas mensagens pra você.A primeira é: muito, muito obrigado pela sua audiência. Sem ela, o Naruhodo sequer teria sentido de existir. Você nos ajuda demais não só quando ouve, mas também quando espalha episódios para familiares, amigos - e, por que não?, inimigos.A segunda mensagem é: existe uma outra forma de apoiar o Naruhodo, a ciência e o pensamento científico - apoiando financeiramente o nosso projeto de podcast semanal independente, que só descansa no recesso do fim de ano.Manter o Naruhodo tem custos e despesas: servidores, domínio, pesquisa, produção, edição, atendimento, tempo... Enfim, muitas coisas para cobrir - e, algumas delas, em dólar.A gente sabe que nem todo mundo pode apoiar financeiramente. E tá tudo bem. Tente mandar um episódio para alguém que você conhece e acha que vai gostar.A gente sabe que alguns podem, mas não mensalmente. E tá tudo bem também. Você pode apoiar quando puder e cancelar quando quiser. O apoio mínimo é de 15 reais e pode ser feito pela plataforma ORELO ou pela plataforma APOIA-SE. Para quem está fora do Brasil, temos até a plataforma PATREON.É isso, gente. Estamos enfrentando um momento importante e você pode ajudar a combater o negacionismo e manter a chama da ciência acesa. Então, fica aqui o nosso convite: apóie o Naruhodo como puder.bit.ly/naruhodo-no-orelo

We discuss the diagnosis and management of SCAPE in the ED. Hosts: Naz Sarpoulaki, MD, MPH Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/SCAPEv2.mp3 Download Leave a Comment Tags: Acute Pulmonary Edema, Critical Care Show Notes Core EM Modular CME Course Maximize your commute with the new Core EM Modular CME Course, featuring the most essential content distilled from our top-rated podcast episodes. This course offers 12 audio-based modules packed with pearls! Information and link below.  Course Highlights: Credit: 12.5 AMA PRA Category 1 Credits™ Curriculum: Comprehensive coverage of Core Emergency Medicine,  with 12 modules spanning from Critical Care to Pediatrics. Cost: Free for NYU Learners $250 for Non-NYU Learners Click Here to Register and Begin Module 1 The Clinical Case Presentation: 60-year-old male with a history of HTN and asthma. EMS Findings: Severe respiratory distress, SpO₂ in the 60s on NRB, HR 120, BP 230/180. Exam: Diaphoretic, diffuse crackles, warm extremities, pitting edema, and significant fatigue/work of breathing. Pre-hospital meds: NRB, Duonebs, Dexamethasone, and IM Epinephrine (under the assumption of severe asthma/anaphylaxis). Differential Diagnosis for the Hypoxic/Tachypneic Patient Pulmonary: Asthma/COPD, Pneumonia, ARDS, PE, Pneumothorax, Pulmonary Edema, ILD, Anaphylaxis. Cardiac: CHF, ACS, Tamponade. Systemic: Anemia, Acidosis. Neuro: Neuromuscular weakness. What is SCAPE? Sympathetic Crashing Acute Pulmonary Edema (SCAPE) is characterized by a sudden, massive sympathetic surge leading to intense vasoconstriction and a precipitous rise in afterload. Pathophysiology: Unlike HFrEF, these patients are often euvolemic or even hypovolemic. The primary issue is fluid maldistribution (fluid shifting from the vasculature into the lungs) due to extreme afterload. Bedside Diagnosis: POCUS vs. CXR POCUS is the gold standard for rapid bedside diagnosis. Lung Ultrasound: Look for diffuse B-lines (≥3 in ≥2 bilateral zones). Cardiac: Assess LV function and check for pericardial effusion. Why not CXR? A meta-analysis shows LUS has a sensitivity of ~88% and specificity of ~90%, whereas CXR sensitivity is only ~73%. Importantly, up to 20% of patients with decompensated HF will have a normal CXR. Management Strategy 1. NIPPV (CPAP or BiPAP) Start NIPPV immediately to reduce preload/afterload and recruit alveoli. Settings: CPAP 5–8 cm H₂O or BiPAP 10/5 cm H₂O. Escalate EPAP quickly but keep pressures to avoid gastric insufflation. Evidence: NIPPV reduces mortality (NNT 17) and intubation rates (NNT 13). 2. High-Dose Nitroglycerin The goal is to drop SBP to < 140–160 mmHg within minutes. No IV Access: 3–5 SL tabs (0.4 mg each) simultaneously. IV Bolus: 500–1000 mcg over 2 minutes. IV Infusion: Start at 100–200 mcg/min; titrate up rapidly (doses > 800 mcg/min may be required). Safety: ACEP policy supports high-dose NTG as both safe and effective for hypertensive HF. Use a dedicated line/short tubing to prevent adsorption issues. 3. Refractory Hypertension If SBP remains > 160 mmHg despite NIPPV and aggressive NTG, add a second vasodilator: Clevidipine: Ultra-short-acting calcium channel blocker (titratable and rapid). Nicardipine: Effective alternative for rapid BP control. Enalaprilat: Consider if the above are unavailable. Troubleshooting & Pitfalls The “Mask Intolerant” Patient Hypoxia is the primary driver of agitation. NIPPV is the best sedative. * Pharmacology: If needed, use small doses of benzodiazepines (Midazolam 0.5–1 mg IV). AVOID Morphine: Data suggests higher rates of adverse events, invasive ventilation, and mortality. A 2022 RCT was halted early due to harm in the morphine arm (43% adverse events vs. 18% with midazolam). The Role of Diuretics In SCAPE, diuretics are not first-line. The problem is redistribution, not volume excess. Diuretics will not help in the first 15–30 minutes and may worsen kidney function in a (relatively) hypovolemic patient. Delay Diuretics until the patient is stabilized and clear systemic volume overload (edema, weight gain) is confirmed. Disposition Admission: Typically requires CCU/ICU for ongoing NIPPV and titration of vasoactive infusions. Weaning: As BP normalizes and work of breathing improves, infusions and NIPPV can be gradually tapered. Take-Home Points Recognize SCAPE: Hyperacute dyspnea + severe HTN. Trust your POCUS (B-lines) over a “clear” CXR. NIPPV Immediately: Don’t wait. It saves lives and prevents tubes. High-Dose NTG: Use boluses to “catch up” to the sympathetic surge. Don’t fear the dose. Avoid Morphine: Use small doses of benzos if the patient is struggling with the mask. Lasix Later: Prioritize afterload reduction over diuresis in the hyperacute phase. Read More

When fatigue lingers, it can be a sign that the body's ability to produce energy isn't functioning the way it should. Could that be what's happening in your case?. In this episode, I'm joined by Dr. Scott Sherr to explain why energy dysfunction is so common in chronic illness, and how methylene blue is being used clinically to support mitochondrial function, oxidative stress balance, and detoxification.I also explain why this topic is especially relevant for people with thyroid and autoimmune conditions, based on what I see regularly in practice. We finish by discussing nervous system regulation, GABA support, and why calming the stress response is often necessary before energy can truly improve.If you've been feeling worn down despite “doing all the right things,” this episode will help you think differently about what your body may actually need.Episode Timeline: 00:02 – Episode Introduction01:43 – Dr. Scott's Background06:26 – When Hyperbaric Helps08:59 – Hyperbaric and Chronic Illness12:51 – What Is Methylene Blue13:10 – Why Methylene Blue Helps18:04 – Why Energy Breaks Down19:09 – Detox and Antioxidant Support23:09 – Antimicrobial Effects Explained26:59 – Acute vs Chronic Dosing29:20 – Methylene Blue for UTIs32:04 – Safety and Side Effects37:33 – Thyroid and Autoimmune Support38:55 – Energy Changes in Thyroid Patients41:54 – Who Should Not Use42:16 – Product Quality Differences51:55 – Understanding the GABA System52:41 – GABA, Anxiety, and Sleep59:49 – When GABA Support Helps1:03:06 – Final Thoughts and ResourcesAbout Dr. Scott Sherr: Is a Board-Certified Internal Medicine Physician certified to Practice Health Optimization Medicine (HOMe) and a Hyperbaric Oxygen Therapy (HBOT) specialist. His clinical practice is built on HOMe as its foundation, complemented by an integrative approach to hyperbaric oxygen therapy that incorporates cutting-edge and dynamic HBOT protocols, comprehensive laboratory testing (utilizing the HOMe framework), targeted supplementation, personalized practices, synergistic technologies (both new and ancient), and more.Connect with Dr. Scott Sherr: Dr. Scott Sherr's Personal Website - https://drscottsherr.com/ Instagram - https://www.instagram.com/drscottsherr/ Transcriptions  Website - https://www.instagram.com/troscriptionsInstagram - To learn more about the Hyperthyroid Healing Diet Challenge visit Savemythyroid.com/challenge2026  Free resources for your thyroid healthGet your FREE Thyroid and Immune Health Restoration Action Points Checklist at SaveMyThyroidChecklist.comHigh-Quality Nutritional Supplements For Hyperthyroidism and Hashimoto' s Have you checked out my new ThyroSave supplement line? These high-quality supplements can benefit those with hyperthyroidism and Hashimoto's, and you can receive special offers, along with 10% off your first order, by signing up for emails and text messages when you visit ThyroSave.com. Do You Want Help Saving Your Thyroid?Get free access to hundreds of articles and blog posts: https://www.naturalendocrinesolutions.com/articles/all-other-articles Watch Dr. Eric's YouTube channel: https://www.youtube.com/c/NaturalThyroidDoctor/videos Join Dr. Eric's Graves' disease and Hashimoto's group: https://www.facebook.com/groups/saveyourthyroid Take the Thyroid Saving Score Quiz: https://quiz.savemythyroidquiz.com/sf/237dc308 Read all of Dr. Eric's published books: http://savemythyroid.com/thyroidbooks Work with Dr. Eric: https://savemythyroid.com/work-with-dr-eric/

What's new when it comes to artificial intelligence (AI) and coding?Listen to the next edition of the long-running and popular Talk Ten Tuesday and learn from longtime RACmonitor and ICD10monitor contributing author Sharon Easterling.Sharon Easterling will continue her editorial series on artificial intelligence and medical record coding. The potential for AI in health information is both exciting and daunting as you'll learn.The popular Internet broadcast will also feature these additional instantly recognizable panelists, who will report more news during their segments:POV: Penny Jefferson, Manager of Coding & Clinical Documentation Integrity Services for the University of Davis Medical Center, is the new cohost of Talk Ten Tuesday. She will share her point of view (POV) during the broadcast.CDI Report: James S. Kennedy, president of CDIMD, will substitute for Cheryl Ericson and will provide an update on clinical documentation integrity (CDI).The Coding Report: Christine Geiger, Assistant Vice President of Acute and Post-Acute Coding Services for First Class Solutions, will report on the latest coding news.News Desk: Timothy Powell, ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.

The Tenpenny Files – Acute kidney failure emerges as a hidden driver of excess deaths in the Covid era, cutting across age and health status. Drawing on millions of death records, John Beaudoin examines hospital incentives, drug protocols, and statistical blind spots that obscure causality, while tracing how medical systems and courts fail to investigate, acknowledge, or address systemic harm...

True Crime Today's week in review covers the Mickey Stines case — a recusal motion that's frozen proceedings and an FBI analysis of how this shooting was preventable.Days before a critical hearing, Special Judge Christopher Cohron abruptly adjourned court. The defense had found video footage showing Cohron seated inches from Judge Kevin Mullins at a Kentucky Judicial Commission on Mental Health meeting — seven days before Mullins was shot to death in his chambers. Cohron never disclosed this. Defense attorneys Jeremy and Kerri Bartley argue that in a case entirely dependent on Stines' mental state, this undisclosed connection to the victim creates an appearance of bias that cannot stand. They cite Cohron's previous rulings blocking psychiatric evaluation from the bond hearing.But we also examined what the court filings reveal about the days before the shooting. Everyone saw the breakdown coming. Mickey Stines called dead relatives on his phone. Lost weight rapidly. Stopped sleeping. Displayed paranoia. His own staff pushed him to see a doctor. Acute stress reaction was the diagnosis. The response? Send him home — badge, gun, authority intact. Twenty-four hours later, Judge Mullins was shot nine times.Former FBI Special Agent Jennifer Coffindaffer exposed the structural failures. Kentucky has no red flag law. An elected sheriff cannot be suspended by subordinates. There was no mechanism to disarm him even as multiple people recognized he was in crisis. A civil lawsuit accuses sheriff's office employees of failing to warn Judge Mullins. Their defense claims Kentucky law imposed no duty to act.Stines has been held without bond for over fifteen months. No trial date. No death penalty decision. Case frozen.#MickeyStines #JudgeKevinMullins #TrueCrimeToday #ChristopherCohron #JenniferCoffindaffer #FBI #KentuckySheriff #SystemFailure #JudgeRecusal #WeekInReviewJoin Our SubStack For AD-FREE ADVANCE EPISDOES & EXTRAS!: https://hiddenkillers.substack.com/Want to comment and watch this podcast as a video? Check out our YouTube Channel. https://www.youtube.com/@hiddenkillerspodInstagram https://www.instagram.com/hiddenkillerspod/Facebook https://www.facebook.com/hiddenkillerspod/Tik-Tok https://www.tiktok.com/@hiddenkillerspodX Twitter https://x.com/tonybpodListen Ad-Free On Apple Podcasts Here: https://podcasts.apple.com/us/podcast/true-crime-today-premium-plus-ad-free-advance-episode/id1705422872

How to Stay Strong to 100: Longevity, Regenerative Medicine, and Mobility   Most people say they want to live a long life. Very few ask the better question: what kind of body and energy will I have at 80, 90, or 100? In this episode of Richer Soul, Dr. Tommy Rhee shares what he has learned from decades working with elite athletes, professional sports teams, and now patients using regenerative medicine and topical stem cell therapies. We talk about the realities of aging, why exercise is still the number one longevity tool, the hidden damage of chronic inflammation, and how emerging technologies might help us stay active and mobile much longer than previous generations.   Core Insights from the Conversation: Exercise Is the Foundation of Longevity. Consistent movement protects joints, improves circulation, and activates the body's natural repair systems. No supplement or therapy replaces exercise as a driver of long-term health. Chronic Inflammation Accelerates Aging. Acute inflammation heals. Chronic inflammation slowly breaks the body down, damaging joints, energy levels, and long-term mobility. Circulation Determines Recovery. Healing depends on flow. Healthy arterial, venous, and lymphatic circulation deliver nutrients and remove waste, allowing tissues to repair more efficiently. Regenerative Medicine Is Becoming Non-Invasive. Cell-free regenerative topical therapies aim to support healing without injections, downtime, or invasive procedures, making recovery more accessible earlier in the aging process. Longevity Requires a "Never Quit" Mindset. Health isn't built through perfection. It's built by continuing to move, eat well, and recover even when progress feels slow or uneven.   Money Learning from Dr. Tommy Rhee: Your health is one of the highest-ROI investments you can make. Dr. Tommy Rhee reinforces that prevention—consistent exercise, reducing inflammation, improving circulation, and supporting your body's natural repair systems—costs far less than the medical bills, downtime, and lost earning potential that come from neglect. Strong mobility and longevity aren't just physical assets; they protect your financial future by reducing long-term healthcare expenses and preserving your ability to work, create, and enjoy life.   Key Takeaway: You do not have to choose between living long and living well. With consistent movement, smarter food choices, better circulation, and an open mind toward regenerative therapies, you can build a body that still feels capable at 80, 90, or even 100. The most important piece is not perfection, it is refusing to quit on your health.   Bio: Dr. Tommy Rhee is a licensed sports chiropractor and pioneer in regenerative medicine with nearly two decades of experience working with elite and professional athletes. He has served as the official team chiropractor for the Tampa Bay Buccaneers and began his career at UCLA Athletics, treating Division I football, soccer, and track athletes. He is the Founder and CEO of RheeGen®, the world's first cell-free regenerative topical therapy, designed as a non-invasive alternative to injection-based stem cell procedures. Dr. Rhee is also the author of The Future of Regenerative Medicine, where he explores how topical stem cell technologies may reshape healing, recovery, and longevity. Known for blending sports medicine, biomechanics, and regenerative science, Dr. Rhee continues to practice in Tampa, Florida, helping patients and athletes stay active, recover faster, and move well as they age.   Links: Website: www.RheeGen.com Facebook: RheeGen: https://www.facebook.com/p/RheeGen-61552362351212/ Instagram: Rhee.gen: https://www.instagram.com/rhee.gen/ LinkedIn: https://www.linkedin.com/in/drtommyrhee/ Book: The Future of Regenerative Medicine: Unlocking the Potential of Topical Stem Cell Therapy:  https://a.co/d/2eUa3Zx   If this conversation sparked you to think differently about aging, here's your next step: choose one upgrade in movement, one upgrade in food, and one upgrade in recovery, and commit to them for the next 90 days. If you want help designing a richer life that includes long-term health, longevity, and purpose, connect with Rocky and explore what your own 100-year plan could look like.   #Longevity #HealthyAging #RegenerativeMedicine #StemCellTherapy #InflammationHealth #MobilityMatters #NitricOxide #CirculationHealth #HolisticWellness #AgingWell #PainFreeLiving #HealthOptimization #LiveTo100 #FunctionalHealth #WellnessJourney   Watch the full episode on YouTube: https://www.youtube.com/@richersoul Richer Soul Life Beyond Money. You got rich, now what? Let's talk about your journey to more a purposeful, intentional, amazing life. Where are you going to go and how are you going to get there? Let's figure that out together. At the core is the financial well-being to be able to do what you want, when you want, how you want. It's about personal freedom! Thanks for listening!   Show Sponsor: http://profitcomesfirst.com/   Schedule your free no obligation call: https://bookme.name/rockyl/lite/intro-appointment-15-minutes   If you like the show please leave a review on iTunes: http://bit.do/richersoul   https://www.facebook.com/richersoul http://richersoul.com/ rocky@richersoul.com   Some music provided by Junan from Junan Podcast   Any financial advice is for educational purposes only and you should consult with an expert for your specific needs.

Send us a textDescription: An immersive reading of With Child by Genevieve Taggard with reflection on pregnancy, maternal mortality, pace, and isolation. Website:https://anauscultation.wordpress.comWork:With Childby Genevieve Taggard Now I am slow and placid, fond of sun,Like a sleek beast, or a worn one:No slim and languid girl—not gladWith the windy trip I once had,But velvet-footed, musing of my own,Torpid, mellow, stupid as a stone.You cleft me with your beauty's pulse, and nowYour pulse has taken body. Care not howThe old grace goes, how heavy I am grown,Big with this loneliness, how you alonePonder our love. Touch my feet and feelHow earth tingles, teeming at my heel!Earth's urge, not mine,—my little death, not hers;And the pure beauty yearns and stirs.It does not heed our ecstacies, it turnsWith secrets of its own, its own concerns,Toward a windy world of its own, toward starkAnd solitary places. In the dark,Defiant even now, it tugs and moansTo be untangled from these mother's bones.References:Goldenberg RL, McClure EM. Maternal mortality. Am J Obstet Gynecol. 2011 Oct;205(4):293-5. doi: 10.1016/j.ajog.2011.07.045. Epub 2011 Aug 4. PMID: 22083050; PMCID: PMC3893928.https://www.who.int/news-room/fact-sheets/detail/maternal-mortality Hoyert DL. Maternal mortality rates in the United States, 2023. NCHS Health E-Stats. 2025. DOI: https://dx.doi.org/10.15620/cdc/174577.Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians; Denberg TD, Barry MJ, Boyd C, Chow RD, Fitterman N, Harris RP, Humphrey LL, Vijan S. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514-530. doi: 10.7326/M16-2367. Epub 2017 Feb 14. PMID: 28192789.Moyer CA, Rounds J, Hannum JW. A meta-analysis of massage therapy research. Psychol Bull. 2004 Jan;130(1):3-18. doi: 10.1037/0033-2909.130.1.3. PMID: 14717648.

Summary This podcast episode delves into the complexities of radiation dermatitis, a common side effect of cancer treatment affecting up to 95% of patients. Dr. Shira Lipton discusses the prevalence, mechanisms, and phases of radiation damage, differentiating between acute and chronic radiation dermatitis. The episode emphasizes the importance of early intervention, patient management strategies, and the need for ongoing monitoring to mitigate long-term effects. Key takeaways include the significance of understanding patient risk factors and the role of multidisciplinary care in managing skin health during and after radiation therapy. Takeaways - Radiation dermatitis is a common side effect of cancer treatment. - Up to 95% of breast cancer patients experience skin reactions. - Understanding genetic factors can help identify high-risk patients. - Weight management can improve healing during radiation therapy. - Symptoms of radiation dermatitis typically worsen over time. - Moist desquamation is a severe form of radiation dermatitis. - Chronic changes can develop long after treatment ends. - Sun protection is essential for patients with radiation dermatitis. - Early intervention can prevent chronic complications. - Multidisciplinary care is crucial for effective management. Chapters 00:00 - Introduction to Radiation Dermatitis 02:48 - Understanding Radiation Dermatitis and Its Impact 05:41 - Acute vs. Chronic Radiation Dermatitis 08:28 - Management and Treatment Strategies 11:19 - Rare Complications and Long-term Effects 13:21 - Conclusion and Key Takeaways

Send comments and feedbackWhile as many as 1 in 3 first seizures are acute symptomatic seizures, these seizures receive relatively little attention during training. Dr. Ching Soong Khoo speaks with Dr. Marian Galovic about the etiology and management of acute symptomatic seizures and how they may inform outcomes and future epilepsy risk.Mentioned during the episode:The SeLECT Consortium predictepilepsy.com The SeLECT model of developing epilepsy after ischemic strokeThe CAVE model of developing epilepsy after hemorrhagic strokeThe 2HELPS2B score to identify patients most likely to benefit from prolonged EEG Sharp Waves episodes are meant for informational purposes only, and not as clinical or medical advice.Let us know how we're doing: podcast@ilae.org.The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Instagram, and LinkedIn.

Finances. Job performance. Relationship strife. All of those things impact your stress. Do you know how to handle it? In this episode of the All Pro Dad Podcast, host Ted Lowe is joined by BJ Foster and Bobby Lewis to talk about the plague of dad stress and how vital it is for men to manage it well. Why This MattersWhen you're stressed out, you're not at your best for your kids.Key Takeaways·      There's no single culprit: Finances, their jobs, and relationships are consistently listed as the top three stressors for men.·      There are 3 kinds of stress: Acute, episodic, and chronic. All three impact dads differently. ·      There are ways to deal with it: Methods like slow breathing and pausing help men manage their stress. ·      Short-term stress can be good: It helps your immune system fight. Stress Relief for Dads: Simple Mental Health Tips That Actually Work1. When you're stressed, breathe.2. Name your stress.3. Talk about it.4. Pour into yourselfImportant Episode Timestamps00:00 – 02:40 | Stressed-Out Dads and Teenage Reactions02:40 – 05:42 | “I'm More Stressed Than I Realize”05:42 – 07:03 | What Stress Really Is07:03 – 10:10 | The Top 3 Stressors for Men10:10 – 11:38 | The Work–Life Balance Spiral11:38 – 14:11 | When Your Stress Spills Onto Your Family14:11 – 16:48 | Kids Know When Dad Is Stressed—Even If He Doesn't16:48 – 20:26 | You're Modeling Stress Management20:26 – 23:50 | Real, Scientific Breathing23:50 – End | Becoming a Calmer DadAPD Pro Move:1) Practice breathing. Inhale twice and exhale slowly. 2) Find a trusted person you can lean on to talk about your stress.All Pro Dad Resources:Episode 31 – Tony Dungy: Is Work-Life Balance Even Possible?5 Things You Don't Need to Stress About as a DadHow to Reduce the Stress Level in Your LifeiMOM Feel WheelWe love feedback, but can't reply without your email address. Message us your thoughts and contact info!Connect with Us: Ted Lowe on LinkedIn Bobby Lewis on LinkedIn BJ Foster on LinkedIn Subscribe on Apple Podcasts Get All Pro Dad merch! EXTRAS: Follow us: Instagram | Facebook | X (Twitter)Join 200,000+ other dads by subscribing to the All Pro Dad Play of the Day. Get daily fatherhood ideas, insight, and inspiration straight to your inbox.This episode's blog can also be viewed here on AllProDad.com. Like the All Pro Dad gear and mugs? Get your own in the All Pro Dad store.Get great content for moms at iMOM.com

Persistent muscle strain caused by a vertebral subluxation leads to a shift in the inflammatory response.

Have you ever said, "I just don't feel like myself anymore" — even though your labs look normal? In this episode of the Health Fix Podcast, Dr. Jannine Krause breaks down why inflammation starts in the brain, how it drives fatigue, brain fog, cravings, hormone imbalance, and accelerated aging — and why 2026 is the year to stop suppressing symptoms and start correcting root causes. Inflammation isn't just a body problem. It's a brain health issue first. Your brain uses 20% of your daily calories, and when inflammation is present, it shifts into defensive mode, not performance mode. That's when clarity disappears, energy crashes, and nothing feels like it's working anymore.

It's time for 2025's festive fun! Practicing medicine can be a very visceral experience - and the English language can't always adequately capture the sights, sounds, smells. So Matt Morgan, intensivist and BMJ columnist, is creating medical neologisms, and joins us to share a few. Madhvi Joshi, a GP in London, has written about longevity science, and we hear how the “biohacking” of internet influencers like Bryan Johnson is making its way into the consultation. Navjoyt Ladher and Tim Feeny take us though this year's festive research, and are joined by Anupam Bapu Jena from Harvard, who has been looking at self censorship in the time of Trump, and Melanie de Lange, from the university of Bristol, who has been investigating the impact of daylight savings time. Reading list: A dictionary for medicine's unnamed moments https://www.bmj.com/content/391/bmj.r2476 Science of longevity medicine  https://www.bmj.com/content/391/bmj.r2536  Changes in diversity language in National Institutes of Health grant awards https://www.bmj.com/content/391/bmj-2025-087222  Acute effects of daylight saving time clock changes on mental and physical health in England https://www.bmj.com/content/391/bmj-2025-085962 

In this episode of Critical Matters, Dr. Sergio Zanotti discusses the management of acute type B aortic dissection. He is joined by Dr. Firas Mussa, a vascular surgeon and professor at McGovern Medical School at UTHealth Houston. Dr. Mussa also holds a joint appointment with Imperial College in London. Additional resources: Management of Acute Type B Aortic Dissection. FF Mussa and P Kougias. N Engl J of Med 2025: https://pubmed.ncbi.nlm.nih.gov/40902163/ 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. EM Isselbacher, et al. Circulation 2022: https://pubmed.ncbi.nlm.nih.gov/36322642/ Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) Reporting Standards for Type B Aortic Dissections. JV Lombardi, et al. J Vasc Surg 2020: https://pubmed.ncbi.nlm.nih.gov/32001058/ Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. INSTEAD-XL Trial. CA Nienaber, et al. Circ Cardiovasc Inter 2013: https://pubmed.ncbi.nlm.nih.gov/23922146/ Books mentioned in this episode: A Dangerous Liaison: A Revelatory New Biography of Simon de Beauvoir and Jean-Paul Satre. By Carole Seymour-Jones: https://bit.ly/3L0pIov A Time For All Things: The Life of Michael E. DeBakey. By Craig Miller, et al.: https://bit.ly/44B2uMw

Think different. Work different. Score different A 68-year-old man presents with progressive urinary hesitancy, weak stream, and nocturia over the past year. He denies dysuria, fever, or hematuria. Digital rectal examination reveals a smooth, symmetrically enlarged prostate. PSA is mildly elevated.Which of the following is the most likely diagnosis? A. Acute prostatitis B. Benign prostatic […] The post 148 PANCE Question Walkthroughs that to Train Thinking appeared first on Physician Assistant Exam Review.

Severe acute brain injury presents acute and longitudinal challenges. Addressing total pain involves managing physical symptoms and providing emotional, social, and spiritual support to enhance quality of life for patients and their families. In this episode, Kait Nevel, MD, speaks with Claire J. Creutzfeldt, MD, author of the article "Neuropalliative Care in Severe Acute Brain Injury and Stroke" in the Continuum® December 2025 Neuropalliative Care issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Liewluck is a professor in the department of neurology at the University of Washington in Seattle, Washington. Additional Resources Read the article: Neuropalliative Care in Severe Acute Brain Injury and Stroke With Dr. Claire Creutzfeldt Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @IUneurodocmom Guest: @cj_creutzfeldt Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Nevel: Hello, this is Dr Kait Nevel. Today I'm interviewing Dr Claire Creutzfeldt about her article on neuropalliative care in severe acute brain injury and stroke, which appears in the December 2025 Continuum issue on neuropalliative care. Claire, welcome to the podcast, and please introduce yourself to the audience. Dr Creutzfeldt: Thanks, thanks for having me. Yeah, I'm an associate professor of neurology at the University of Washington. I'm a stroke neurologist and palliative care researcher and really have focused my career on how we can best integrate palliative care principles into the care of patients with severe stroke and other neurocritical illness. Dr Nevel: Wonderful. Well, I'm looking forward to talking to you today about your excellent article that I really enjoyed reading. To get us started, can you tell us what you feel is the most important takeaway from your article for the practicing neurologist? Dr Creutzfeldt: Yeah. You know, I think one is always a little biased by what one is working on currently. And I think what I'm most excited about or feel more strongly about is this idea that stroke and severe acute brain injury are not an event, but really a chronic illness that people are left with usually for the rest of their lives, that change their life radically. And I think that education, research funding, also the clinical setting, current healthcare models aren't set up for that. And this idea that severe acute brain injury, you know, should be viewed as a lifelong condition that requires support across all ranges of goals of care. So curative, restorative, palliative and end-of-life care. Dr Nevel: Yeah, I love that part of your article, how you really highlighted that concept. And I think obviously that's something that we see in neurology and learn, especially as we transition out of our residency stages. But I think especially for the trainees listening, can sometimes be hospital inpatient-heavy, if you will, that kind of you can lose sight of that, that these acute strokes, severe acute brain injury, it turns into a chronic illness or condition that patients are dealing with lifelong. Dr Creutzfeldt: Often what we do in a very acute setting is like, is really cool and sexy and like, we can cure people from their stroke if they come, you know, at the right time with the right kind of stroke to the right hospital. And often the symptoms that people come in with much later on are harder to treat and address, partly because the focus in education, clinical and research just hasn't been as much on that time. Dr Nevel: Yeah, absolutely. So, can you talk to us about this concept of total pain? What does it mean, and how do we incorporate this concept into the way that we view our approach, our patient care? Dr Creutzfeldt: Total pain is a very old word, but it's sort of coming back into fashion in the palliative care world because it really describes all those sources of suffering or sources of distress, like, beyond what we sort of really think of as sort of the physical symptoms in recovery of stroke. As many of you know, palliative care often thinks in this multidimensional way of the physical distress, physical pain, but also psychological, emotional, social and spiritual, existential. And both- we sort of created sort of a figure that incorporates all of them and also includes both patients and their family members. They share some of these sources of distress, but they also have distinct ones that need to be addressed. And at the core of that total pain is what we need to provide, is sort of optimal communication and goals-of-care prognosis. Dr Nevel: Yeah, I'm thinking about all of those aspects and not just focusing on one. How does the disease trajectory of severe acute brain injury and stroke play a role in the palliative care approach? And how should we kind of going back to that original point of this idea of severe acute brain injury being an acute event and then oftentimes turning into kind of a chronic condition? How does that play a role in how we address palliative care with our patients, or kind of the stages of palliative care with our patients? Dr Creutzfeldt: Yeah, I think several things, especially for neurologists, is the more traditional palliative care illnesses, like cancer or congestive heart failure, illnesses where people are diagnosed when they're still functioning at a relatively high level and tend to have time to consider their prognosis and their goals of care in the end of life wishes and to meet with palliative care and to consider their personhood. Who am I? What's most important for me? And stroke, people with stroke, they not only present at their worst, they meet us at their worst, at a time when the patient themselves usually can't speak for themselves, when their personhood has been stripped from them. And then as providers, we, you know, we often really just get that one opportunity to get the conversation right and to guide people towards, you know, what we would call optimal and goal-concordant care. So, the challenges are many. I do think that the burden of these early conversations is on neurologists and really requires the neurologists to show compassion, to learn communication skills, think really hard about how you want to communicate prognosis and goals of care early on, because it's going to color people's experiences and decisions longitudinally. You asked about, sort of, this trajectory. And I do think it's important to think about, you know, what really happens even after the thrombectomy or even after we discharge people, especially from the ICU. Because for us, often after sort of day five or six, you know, we're sort of done. We're thinking about secondary stroke prevention. And, you know, how do I get the patient to rehab or out of the hospital? For the patients and families, this is when it really all just starts. You know, this is when they- when they're first memories are usually, you know, they hardly remember that acute setting. And so, when they are medically stable, we're done with the acute blood pressure treatment where we've removed the Foley, we've made a decision about nutrition. For us that tends to be a time where we let go a little; for patients and families that tends to actually be the time when they have to think about how am I going to live with this and what are the next several months or years going to look like? And so being there for them is important. Dr Nevel: That's such a, I think, important point, that when we have our plan in place, we know medically what the plan is for that patient and we're starting to step back, think about rehab or discharge. That's when oftentimes more quote-unquote "reality" steps in for patients and families about what their future is going to look like. Dr Creutzfeldt: And medical stability is not even close to neurological stability. And so, they are still in the middle of real prognostic uncertainty, and often waxing and waning symptoms or new symptoms coming up for them. Like pain, you know, post thalamic pain syndrome, just as an example, tends to be something that doesn't develop until later. Dr Nevel: Right, right. Absolutely. And since you touched on this concept of prognostic uncertainty, and, you know, that's something that's so challenging in severe acute brain injury, especially the early days when you talk about this, you know, that things tend to become a little bit more certain as more time passes. But these are really hard conversations because a lot of times feel like big decisions that need to be made early on, you know? Dr Creutzfeldt: Huge! Dr Nevel: Sometimes things like trach and PEG and things like that. How do you approach that conversation? I know you talk about that a little bit in your article. You touch on that, some of the, kind of, strategies or concepts that we use in palliative care to approach this prognostic uncertainty with patients. Dr Creutzfeldt: Yeah, I think the challenge is to balance this acknowledging uncertainty with still being able to guide the families and allow them to trust you. So, there are a few things that I have said in the past, and I have taught in the past, and I don't use anymore. They include sentences like I don't have a crystal ball, for example. Nobody was asking you for one. The other one that I want us to avoid, I think, is the sentence we are terrible at prognosticating. Because what I have seen is that that sentence carries on for families. And families at nine months are still saying, well, you guys are terrible at prognosticating. That's what you told me. First of all, it's all relative, and relative to non-neural providers---even at this time using Google and AI, we're actually quite good at prognosticating. It's just that a wide range early on. So that's how I would change that sentence is, early on after stroke, the range of possible outcomes is still very wide. And so, you've communicated uncertainty without saying I have no idea what I'm doing, which is not true. That is in order to help families be able to trust you and also to trust the person who comes after you, because we all know that a week or two after admission, we do know a lot more. And if we told them on day one that we're terrible at prognosticating, it's hard to sort of build that trust again later. You also asked about, you know, communication strategies. And I think it's this range of possible outcomes that I think is a good guideline for us to work on. And that range, sort of like a confidence interval, is still very wide early on. And as we collect more information over time, both about the clinical scenario that is evolving in front of us and about the patient who we are learning more about over time, this confidence interval becomes smaller. And that's where this idea of the best case/worst case scenario sort of conversation, for example, comes from: that range of possible outcomes. Dr Nevel: So, what to you is most challenging about palliative care for patients with severe acute brain injury and stroke? Dr Creutzfeldt: I think the biggest challenge in stroke care is balancing restorative and curative care with palliative and end-of-life. And that is especially early on when sort of everything is possible, when patients and families want to hear the good news and, I think, are also quite willing to hear the bad news, and probably should. So, I think that that communication is hard when, you know, really we want to provide goal-concordant care. We want to make sure that people get that care that is most important to them and can meet the outcomes that are most important to them. Dr Nevel: Yeah, agree. What is most rewarding? Dr Creutzfeldt: I think these patients and families have enormous needs and are extremely grateful if they can find someone that they can trust and who can guide them and who will stick with them. And when I say someone, I think that can be a team. That always depends on how we communicate. In the ideal world, it would be the same person following someone over time, the patient and the family over time. But in our current healthcare system, we're usually moving on from one place to another and being able to communicate with the people that come after you. Telling the family that you're a team and supporting them through that, I think, is really important. Dr Nevel: Yeah. And like you touched upon, patients and families, I think oftentimes they're looking for, you mentioned, you know, the sharing and communication and they're looking for information. Dr Creutzfeldt: You know, what's really rewarding is working with a team. And health care has really excelled at that. And I think we have a lot done from them is that it's not always the MD that family needs. And we have a lot of people at our side, and I think we need more of them. Chaplains, social workers; psychologists, actually, I think; and nurses or- in an ideal world, would really work together to support these multidisciplinary, multidimensional symptoms. Dr Nevel: Yeah. I think it benefits both the patient and the care team, too. Dr Creutzfeldt: Absolutely! Dr Nevel: It's helpful to be part of a team. You know, there's camaraderie in that and, like, a shared goal, and I think the thought is rewarding, too. Dr Creutzfeldt: If we really try and think about severe stroke as a chronic illness or severe acute brain injury as a chronic illness not unlike cancer, then if you think about the systems that have been built for cancer where an entire team of providers follows the patient and their family member over time, I think we need that, too. Dr Nevel: Yeah, I agree. That point, every member of the team has overlapping things, but has a slightly individual role to a degree too, which is also helpful to the patient and the family. You talked about this a little bit in your article, and I want to hear more from you about what we know about healthcare disparities in this area of medicine and in providing palliative care for patients with severe acute brain injury and stroke. Dr Creutzfeldt: Yeah, I think actually a lot of the huge decisions that we make, especially early on, are highly variable. And can identify people by various things, whether it's their race or ethnicity or sex or age, or even where they live in the United States. But decisions tend to be made differently. And so, just as an example, we know that I think people who identify as black, for sure, are less likely to receive the acute, often life-saving interventions like TNK or thrombectomy and more likely to undergo longer-term, life-prolonging treatment like PEG and trach. That seems true, after adjusting for clinical severity and things like that. And so disparities like that may be based on cultural preferences or well-informed decisions, and then we can support them. But of course, unfortunately there's a clear idea when we see, often, unexplained variability that a lot is due to uninformed decisions and poor communication and possibly racism in certain parts. And that is, of course, something that has to be addressed. Dr Nevel: Yeah, absolutely. What are future areas of research in this area? I know you do a lot of research in this area and I'd love to hear about some of it and what you think is exciting or kind of new and going to change the way we think about things, perhaps. Dr Creutzfeldt: I think every aspect of stroke continues to be exciting and just, you know, our focus of today and my research is on palliative care. I mean, obviously, the things we can do in rehab these days have to be embraced, and the acute stuff. But I think this longitudinal support, an ideally longitudinal multidisciplinary support for patients and families, requires more research. I think it will help us with prognosis. It will help us with communicating things early on and learning more about sort of multidimensional symptoms of these patients over time. That requires more research. And then, how can we change the healthcare system---in a sustainable way, obviously---to maximize quality of life for the survivors and their families? Dr Nevel: Going back to that total pain again, making sure that we're incorporating that longitudinally. Dr Creutzfeldt: I think there are currently 94 million people worldwide living with the aftermath of a stroke. I joined a stroke survivor support group recently. People are supporting each other that have that had their stroke, like, 14 years ago and are still in that just to show that this is not one and done. People are still struggling with symptoms afterwards and want support. Dr Nevel: Before we close out, is there anything else that you'd like to add? Dr Creutzfeldt: Your questions have all been great, and I think one observation is that we've talked a lot about, sort of, new ideas of the need for longitudinal care for patients after severe stroke. There's still a ton for all of us to do to optimize the care we provide in the very acute setting, to optimize the way we communicate in the very acute setting. To make sure we are, for example, providing the same message as our team members and providing truly compassionate goal-concordant care from the time they hit the emergency room throughout. Including time-limited trials, for example. Dr Nevel: Well, thank you so much for chatting with me today about your article on this really important topic. Again, today I've been interviewing Dr Claire Creutzfeldt about her article on neuropalliative care in severe acute brain injury and stroke, which appears in the December 2025 Continuum issue on neuropalliative care. Be sure to check out Continuum Audio episodes from this and other issues. And as always, to our listeners, please check out the article. It's great, highly recommend. And thank you to our listeners for joining us today. And thank you so much, Claire, for sharing your expertise with us today. Dr Creutzfeldt: Thanks for having me. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Court filings in the Mickey Stines case reveal a chilling reality: everyone saw the breakdown coming — and no one had the power to stop it. An elected Kentucky sheriff spiraled publicly. He called dead relatives on his phone. Lost weight rapidly. Stopped sleeping. Displayed paranoia. His own staff pushed him to see a doctor. The diagnosis? Acute stress reaction. The response? Send him home — with his badge, his gun, and his authority untouched. Twenty-four hours later, Judge Kevin Mullins was shot nine times in his own chambers. In this deep-dive, retired FBI Special Agent Jennifer Coffindaffer exposes the structural failures that allowed this to happen. Kentucky has no red flag law. An elected sheriff cannot be suspended by subordinates. There was no mechanism to disarm him — even as multiple people recognized he was in crisis. We examine the civil lawsuit accusing sheriff's office employees of failing to warn Judge Mullins, and their defense that Kentucky law imposed no duty to act. Is that legally sound? Is it morally defensible? This isn't just a tragedy — it's a systems failure. One that raises terrifying questions about authority, mental health, and what happens when the person in crisis sits at the very top of the chain of command. #MickeyStines #JudgeMullins #JenniferCoffindaffer #TrueCrime #SystemicFailure #MentalHealthCrisis #HiddenKillers #FBIAnalysis #KentuckyCase Want to comment and watch this podcast as a video? Check out our YouTube Channel. https://www.youtube.com/@hiddenkillerspod Instagram https://www.instagram.com/hiddenkillerspod/ Facebook https://www.facebook.com/hiddenkillerspod/ Tik-Tok https://www.tiktok.com/@hiddenkillerspod X Twitter https://x.com/tonybpod Listen Ad-Free On Apple Podcasts Here: https://podcasts.apple.com/us/podcast/true-crime-today-premium-plus-ad-free-advance-episode/id1705422872

Court filings in the Mickey Stines case reveal a chilling reality: everyone saw the breakdown coming — and no one had the power to stop it. An elected Kentucky sheriff spiraled publicly. He called dead relatives on his phone. Lost weight rapidly. Stopped sleeping. Displayed paranoia. His own staff pushed him to see a doctor. The diagnosis? Acute stress reaction. The response? Send him home — with his badge, his gun, and his authority untouched. Twenty-four hours later, Judge Kevin Mullins was shot nine times in his own chambers. In this deep-dive, retired FBI Special Agent Jennifer Coffindaffer exposes the structural failures that allowed this to happen. Kentucky has no red flag law. An elected sheriff cannot be suspended by subordinates. There was no mechanism to disarm him — even as multiple people recognized he was in crisis. We examine the civil lawsuit accusing sheriff's office employees of failing to warn Judge Mullins, and their defense that Kentucky law imposed no duty to act. Is that legally sound? Is it morally defensible? This isn't just a tragedy — it's a systems failure. One that raises terrifying questions about authority, mental health, and what happens when the person in crisis sits at the very top of the chain of command. #MickeyStines #JudgeMullins #JenniferCoffindaffer #TrueCrime #SystemicFailure #MentalHealthCrisis #HiddenKillers #FBIAnalysis #KentuckyCase Want to comment and watch this podcast as a video? Check out our YouTube Channel. https://www.youtube.com/@hiddenkillerspod Instagram https://www.instagram.com/hiddenkillerspod/ Facebook https://www.facebook.com/hiddenkillerspod/ Tik-Tok https://www.tiktok.com/@hiddenkillerspod X Twitter https://x.com/tonybpod Listen Ad-Free On Apple Podcasts Here: https://podcasts.apple.com/us/podcast/true-crime-today-premium-plus-ad-free-advance-episode/id1705422872

Court filings in the Mickey Stines case reveal a chilling reality: everyone saw the breakdown coming — and no one had the power to stop it. An elected Kentucky sheriff spiraled publicly. He called dead relatives on his phone. Lost weight rapidly. Stopped sleeping. Displayed paranoia. His own staff pushed him to see a doctor. The diagnosis? Acute stress reaction. The response? Send him home — with his badge, his gun, and his authority untouched. Twenty-four hours later, Judge Kevin Mullins was shot nine times in his own chambers. In this deep-dive, retired FBI Special Agent Jennifer Coffindaffer exposes the structural failures that allowed this to happen. Kentucky has no red flag law. An elected sheriff cannot be suspended by subordinates. There was no mechanism to disarm him — even as multiple people recognized he was in crisis. We examine the civil lawsuit accusing sheriff's office employees of failing to warn Judge Mullins, and their defense that Kentucky law imposed no duty to act. Is that legally sound? Is it morally defensible? This isn't just a tragedy — it's a systems failure. One that raises terrifying questions about authority, mental health, and what happens when the person in crisis sits at the very top of the chain of command. #MickeyStines #JudgeMullins #JenniferCoffindaffer #TrueCrime #SystemicFailure #MentalHealthCrisis #HiddenKillers #FBIAnalysis #KentuckyCase Want to comment and watch this podcast as a video? Check out our YouTube Channel. https://www.youtube.com/@hiddenkillerspod Instagram https://www.instagram.com/hiddenkillerspod/ Facebook https://www.facebook.com/hiddenkillerspod/ Tik-Tok https://www.tiktok.com/@hiddenkillerspod X Twitter https://x.com/tonybpod Listen Ad-Free On Apple Podcasts Here: https://podcasts.apple.com/us/podcast/true-crime-today-premium-plus-ad-free-advance-episode/id1705422872

Acute cases aren't always simple — and there's often more to think about than you might realize.In Part 2 of this special conversation on Strange, Rare & Peculiar, Denise and Alastair explore the art of clinical decision-making in homeopathy for acute care. From case tools like LoCoMoCo (Location, Complaint, Modality, Concomitant) and CLAMS (Condition, Location, Aetiology, Modality, Sensation), to key concepts from the Organon, they break down what it really takes to prescribe well in acutes.You'll hear:Why understanding the complete symptom is the foundation of good prescribingWhat makes a symptom strange, rare, and peculiar (Aphorism 153)Why Hahnemann insisted we do the work — even in “simple” acute casesWhy AHE students receive intensive training in acute prescribing — and why that matters

In this episode, we review the high-yield topic of ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Acute Alcohol Withdrawal⁠⁠ from the Psychiatry section at ⁠⁠⁠⁠Medbullets.com⁠⁠⁠⁠⁠⁠Follow⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets

Send us a textIn this episode of Causes or Cures, Dr. Eeks speaks with Dr. Zohar Rubinstein, a clinical psychologist, researcher and trauma expert about an early and deeply sensitive study examining how different substances may have influenced early trauma responses among survivors of the October 7 Nova music festival attack.Many survivors had taken substances just hours before the traumatic event — including classic psychedelics, MDMA, cannabis, alcohol, or none at all. Dr. Rubinstein's team approached this research with extreme care, focusing on respect, consent, and the ethical challenges of studying trauma in real time.Together, they discuss:Why Dr. Rubinstein became interested in studying trauma at the moment it happens, not years laterHow the research team worked respectfully with survivors in the aftermath of mass traumaThe challenges of studying real-world substance use without lab-verified dosingWhy survivors who had taken classic psychedelics reported lower anxiety and fewer early PTSD symptoms compared with other groupsHow timing and state of consciousness during trauma may influence how the brain encodes memory and fearWhat we can, and cannot, conclude from an early, observational studyWhy these findings do not justify self-experimentation, but may justify further controlled researchWhat mental health professionals and policymakers should take away from this workHow doing trauma research has shaped Dr. Rubinstein's own understanding of resilience and healingThis conversation does not promote psychedelic substance use. Instead, it explores how brain state, context, and timing may shape trauma responses, and why studying these questions responsibly matters.Content note: This episode discusses trauma related to the October 7 attacks. Listener discretion is advised.Disclaimer: This episode is for informational purposes only and does not constitute medical or mental health advice.Dr. Zohar Rubinstein, PhD, is a clinical psychologist, trauma specialist, and organizational psychologist. He is a founding member of the Interdisciplinary Master's Program in Emergency and Disaster Management at the Faculty of Medicine at Tel Aviv University, where he lectures on trauma, resilience, and mental health in emergency settings. His research focuses on trauma, testimony, and resilience, including how individuals and societies process extreme events. Dr. Rubinstein developed an intensive short-term group intervention model for treating traumatic casualties and has led multidisciplinary research collaborations on trauma across psychology, history, and architecture. Work with me? Perhaps we are a good match. You can contact Dr. Eeks at bloomingwellness.com.Follow Eeks on Instagram here.Or Facebook here.Or X.On Youtube.Or TikTok.SUBSCRIBE to her WEEKLY newsletter here! (Now featuring interviews with top experts on health you care about!)Support the show

In this episode of the NCS Podcast Hot Topics series, host Richard Choi, DO, FNCS, speaks with Katharina Busl, MD, MS, FNCS, division chief of neurocritical care at the University of Florida and assistant editor for Neurocritical Care journal, about transfusion strategies in patients with acute brain injury. They discuss recent randomized trials and a new systematic review examining restrictive versus liberal red blood cell transfusion thresholds across traumatic brain injury, intracerebral hemorrhage and subarachnoid hemorrhage. Their conversation highlights the physiologic rationale behind transfusion, challenges in interpreting trial and meta-analysis data, and how overlapping hemoglobin ranges complicate bedside decision-making. Dr. Busl also shares how this evolving evidence is influencing clinical practice and the importance of individualized transfusion decisions. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

How Conventional Medicine Is Ruining Our Kids | Dr. Larry PalevskyTurn online alignment into an offline community — join us at TheWayFwrd.com to connect with like-minded people near you.We're watching an entire generation of children get sicker, and the medical system still won't admit it's out of answers. Parents see it. Practitioners see it. And the gap between real-world patterns and the official explanations around childhood illness keeps widening.In this episode, Dr. Larry Palevsky breaks down the observations that pushed him to question the pediatric model from within. Standard protocols weren't helping. Some interventions were making symptoms worse. And the infection-based framework he was trained to follow simply didn't explain the chronic inflammation, neurodevelopmental issues, or immune dysregulation showing up in real kids.Looking for clarity, he stepped outside the conventional lane—into nutrition, Chinese medicine, chiropractic, reiki, herbology, and other holistic approaches that offered a fuller picture of children's health. That search opened deeper questions about vaccine ingredients, aluminum adjuvants, immune overload, environmental toxicity, and whether our definition of “infection” actually matches what's happening inside children's bodies.This conversation is for anyone who already knows the system is breaking kids—and wants the language, context, and coherence to understand why, and what truly supports long-term health.You'll Learn:[00:00:00] Introduction[00:06:23] The lost art of Clinical Medicine[00:07:38] The emergency room revelation about ear infections and antibiotics[00:12:21] Discovering the concept of "the body has the innate capacity to heal"[00:17:09] Using reiki in the delivery room to save babies[00:23:24] The pivotal moment a mother asked about mercury in vaccines[00:26:42] The premature baby saved by fish oil[00:33:14] Why Dr. Larry stopped vaccinating and started educating[00:42:18] The troubling science of aluminum adjuvants in vaccines[01:03:08] Three brain regions where nanoparticles travel[01:06:29] What sorbitol in MMR might actually be doing[01:18:21] Why vaccines are "safe and effective" is the wrong debate[01:24:10] The real contagion theory no one talks about[01:34:07] Acute illness is rarely an infection[01:48:42] The 15-year-old diagnosed with autism who actually had addiction[01:41:59] The autism debate, diagnostic labels, and the dozen causes of brain injury in children[02:04:26] The parenting advice that sounds cruel but builds resilience[02:08:40] What "making children well again" actually requires [02:22:15] Symptoms are just the body doing its job[02:16:53] The two-part vision: reforming pediatrics and reclaiming allopathic medicineResources Mentioned:Danish Study on 1.2 Million Children Settles the Vaccine-Autism Debate | ArticleCan You Catch A Cold? By Daniel Roytas | BookFind more from Dr. Larry Palevsky:Dr. Palevsky | WebsiteDr. Palevsky | InstagramFind more from Alec:Alec Zeck | InstagramAlec Zeck | XThe Way Forward | InstagramThe Way Forward is Sponsored By:Designed for deep focus and well-being. 100% blue light and flicker free. For $50 off your Daylight Computer, use discount code: TWF50New Biology Clinic: Redefine Health from the Ground UpExperience tailored terrain-based health services with consults, livestreams, movement classes, and more. Visit www.NewBiologyClinic.com and use code TheWayForward for $50 off activation. Members get the $150 fee waived

In today's VETgirl online veterinary continuing education podcast, we review a recent paper by Rogg et al titled “Frequency and Progression of Azotemia During Acute and Chronic Treatment of Congestive Heart Failure in Cats,” which was published in the Journal of Veterinary Internal Medicine in 2025. After all, many of us are taught that we are “between a rock and a hard place” when it comes to ailing hearts and kidneys. We've always been taught not to give too much furosemide to cats in congestive heart failure (CHF), right? Not only are we worried about shriveling up the cats and their pre-load, but we're worried about shriveling up their kidneys too! Tune in to find out more!