Podcasts about adverse outcomes

PT, PTA – this podcast may help you meet your continuing education requirements. Access Relias Academy to review course certificate information.    What's the best dose of therapeutic exercise for your patient with knee OA? In this podcast, Dr. Louise Thoma, a contributor to several clinical practice and consensus guidelines on the treatment of adults with OA, provides practical, evidence-based recommendations PTs and PTAs can use to integrate current evidence into clinical practice. How are we doing? Click here to give us feedback  (02:24) Key Takeaways (04:12) Research Findings in the Last Five Years (06:18) Communication: Words Can Be Harmful (17:48) Exercise Type: What Does the Evidence Say? (23:41) Intensity Recommendations (30:22) High Dose Versus Low Dose Exercise (33:06) Is High Impact Exercise Safe with Knee OA? (36:06) Delivery Mode: Does Evidence Support One Over Another? (38:28) Promoting Adherence to Exercise (42:13) Using Evidence to Inform Your Practice (45:24) Partnering with Evidence-Based Programs (47:23) Does Evidence Support Manual Therapy? (53:44) Interventions with Adverse Outcomes (55:43) Conclusion The content for this course was created by Louise Thoma, PT, DPT, PhD. The content for this course was created by Tiffany Shubert, PT, PhD. Here is how Relias can help you earn continuing education credits:  Access your Relias Library offered by your employer to see course certificate information and exam;   or   Access the continuing education library for clinicians at Relias Academy. Review the course certificate information, and if eligible, you can purchase the course to access the course exam and receive your certificate.  Learn more about Relias at www.relias.com.    Legal Disclaimer: The content of Stretch: Relias Rehab Therapy Education is provided only for educational and training purposes for healthcare professionals. The educational material provided in this podcast should not be used as medical advice to treat any medical condition in either yourself or others.  Resources  Arthritis Foundation® Walk with Ease: https://www.arthritis.org/health-wellness/healthy-living/physical-activity/walking/walk-with-ease

The place you live shapes who you become. Whether you move from Michigan to Florida or Arizona to Guam, it means getting used to a new home, school, and different kinds of food. When kids move from their original home to a new place, they mix together parts of both cultures to create their own unique "third culture." Psychologist Dr. Charles Warter, Psy.D., shares what he's learned from his studies to help parents understand how to handle moving with children. “Adverse Outcomes to Early Middle Age Linked With Childhood Residential Mobility” Am J Prev Med. Sept 2016 Charles Warter, Psy.D. - find him at Protected Roots Integrative Treatment Center Send your questions to hello@pediatriciannextdoorpodcast.com or submit at drwendyhunter.com Find products from the show on the shop page.  More from The Pediatrician Next Door: Website: drwendyhunter.com  Instagram: @the_pediatrician_next_door Facebook: facebook.com/wendy.l.hunter.75 TikTok: @drwendyhunter LinkedIn: linkedin.com/in/drwendyhunter This is a Redd Rock Music Podcast IG: @reddrockmusic www.reddrockmusic.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Moderator: BobbieJean Sweitzer, M.D. Participants: Scott Segal, M.D., M.H.C.M. and Jeffrey B. Cooper, Ph.D. Articles Discussed: A Quality Improvement Initiative to Reduce Adverse Effects of Transitions of Anesthesia Care on Postoperative Outcomes: A Retrospective Cohort Study Anesthesia Needs to Lead the Way in Safety—Again—through the Universal Adoption of Structured Handoffs

No matter how hard we try or how much we want a positive outcome, sometimes things are out of our control.  On this episode Dr. Sam and Dr. Robert discuss adverse outcomes.  It is part of the reality when dealing with illness, and Dr. Sam and Dr. Robert share times when they have had to deal with this difficult truth. Thanks for tuning in and as always, we take questions for upcoming podcasts at podcast@mybalto.com. We are happy to make an entire podcast about the topic or answer the question on a shorter segment, depending on the discussion! We video this podcast as well which you can join in on at myBalto's youtube channel!

Toxicology deciphers death like nothing else. Results determine time of death, location, and method. But, how does it work? Delving into the dark secrets of poisons, toxicology is the ultimate detective. Toxicologists like Dr Dimitri Gerostamoulos analyse hidden clues within biological samples, and help solve cases like murder investigations, unexplained deaths and drug overdoses. Toxicology acts as a window into crime both in time, and space.  Dr Dimitri Gerostamoulos is the Head of Forensic Science and Chief Toxicologist at the Victorian Institute of Forensic Medicine. Talking to host Kathryn Fox, Dimitri explains how toxicology works in an Australian context, and goes back to why he entered the world of forensics, and explores cases that have affected him and stayed with him throughout his career.  For more episodes, download the LiSTNR app.   See omnystudio.com/listener for privacy information.

Commentary by Dr. Valentin Fuster

https://psychiatry.dev/wp-content/uploads/speaker/post-12245.mp3?cb=1678882226.mp3 Playback speed: 0.8x 1x 1.3x 1.6x 2x Download: Impact of anxiety and depression across childhood and adolescence on adverse outcomes in young adulthood: a UK birth cohort study –Full EntryImpact of anxiety and depression across childhood and adolescence on adverse outcomes in young adulthood: a UK birth cohort study –

What impact does Glimperide have on cardiovascular mortality in patients with type 2 diabetes and chronic heart failure? Find out this and more in today's PVRoundup podcast.

Jeden Tag über 200 Tote durch Alkoholkonsum: Ein Genussmittel bei dem man sich nicht einbilden darf man täte etwas für seine Gesundheit, auch nicht mit dem Gläschen Rotwein. Alles Mythos. Zudem Jeder 8. Todesfall bei Menschen zwischen 20 und 64 Jahren war in den USA in den Jahren 2015 – 2019 auf die Folgen des Alkoholkonsums zurückzuführen. – Esser MB, Leung G, Sherk A, et al. Estimated Deaths Attributable to Excessive Alcohol Use Among US Adults Aged 20 to 64 Years, 2015 to 2019. JAMA Netw Open. 2022;5(11):e2239485. doi:10.1001/jamanetworkopen.2022.39485. Csengeri, Dora, Ngoc-Anh Sprünker, Augusto Di Castelnuovo, Teemu Niiranen, Julie Kk Vishram-Nielsen, Simona Costanzo, Stefan Söderberg, et al. 2021. “Alcohol Consumption, Cardiac Biomarkers, and Risk of Atrial Fibrillation and Adverse Outcomes.” European Heart Journal, January. https://doi.org/10.1093/eurheartj/ehaa953. Millwood, Iona Y., Robin G. Walters, Xue W. Mei, Yu Guo, Ling Yang, Zheng Bian, Derrick A. Bennett, et al. 2019. “Conventional and Genetic Evidence on Alcohol and Vascular Disease Aetiology: A Prospective Study of 500 000 Men and Women in China.” The Lancet 393 (10183): 1831–42. Patienten Wie Wir, der Podcast zur gleichnamigen ärztlich-initiierten Plattform für den Erfahrungs- und Wissensaustausch unter Patienten. Immer mit konkreten Tipps zur optimalen Behandlung oder noch besser Vorbeugung. Noch nicht bei PWW dabei? Dann werden Sie jetzt aktiv! Werden Sie Teil der Patienten Wie Wir-Community! Jetzt registrieren auf https://www.patientenwiewir.de. Sie sind schon bei PWW dabei? Dann Gruppe gründen, Fragen stellen, Fragen beantworten... … und empfehlen Sie diesen Podcast sowie PWW weiter. --- Send in a voice message: https://podcasters.spotify.com/pod/show/harald-hhw-schmidt/message

Physician coaches Dr. Michelle Chestovich and Dr Laura Fortner raise awareness of medical malpractice and adverse outcomes. Dr Fortner shares her story of being sued in her OBGYN practice and how she went from hardly surviving to thriving.Being served with a lawsuit is common in medicine and yet no one is talking about it which amplifies the shame around this topic. Learn how you can take steps to take care of you in the midst of these struggleDr Laura Fortner's website: https://www.themedmalcoach.The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/ilmNef

Drs. James DiNardo and Justin Bradley Long discuss the article “Postoperative Hematocrit and Adverse Outcomes in Pediatric Cardiac Surgery Patients: A Cross-sectional Study From the STS and CCAS Database Collaboration” published in the November 2021 issue of Anesthesia & Analgesia.

Editor's Summary by Gregory Curfman, MD, Deputy Editor of JAMA, the Journal of the American Medical Association, for the October 19, 2021 issue.

This episode is also available as a blog post: http://donnyferguson.com/2021/09/17/study-cannabis-use-not-associated-with-adverse-outcomes-for-couples-undergoing-ivf%ef%bf%bc/ --- Send in a voice message: https://anchor.fm/donny-ferguson/message

With Thomas Luescher and Brian Halliday, National Heart and Lung Institute, London - UK Link to EHJ paper

Olá, bem-vindo à Tribo TDAH, o podcast com hiperfoco na sua vida! No quarto episódio da nossa nova série TDAH Explica falamos sobre a relação do Transtorno de Déficit de Atenção e Hiperatividade com problemas de tireoide em crianças, adolescentes, adultos e também durante a gravidez e como isso pode afetar nos nossos sintomas.#TDAH#TDAHpodcasters#PcDPodcasters#OPodcastÉDelas#MulheresPodcasters---**Seja um TDAHyper e ajude a Tribo TDAH a crescer!**- Tribo TDAH no Apoia.se https://apoia.se/tribotdah - Tribo TDAH no PicPay https://picpay.me/triboTDAH---**Links de referência**- Is It ADHD or a Thyroid Disorder? https://www.psychologytoday.com/intl/blog/here-there-and-everywhere/201706/is-it-adhd-or-thyroid-disorder- Is It ADD/ADHD or Thyroid Disease? http://ceril.net/index.php/articulos?id=614- ADHD and Thyroid Abnormalities: A Research Note https://acamh.onlinelibrary.wiley.com/doi/abs/10.1111/j.1469-7610.1995.tb01335.x- Attention-deficit hyperactivity disorder and thyroid function https://www.sciencedirect.com/science/article/abs/pii/S0022347605809473- Attention-deficit hyperactivity disorder and thyroid function https://pubmed.ncbi.nlm.nih.gov/8410504/- Maternal Thyroid Dysfunction During Pregnancy and the Risk of Adverse Outcomes in the Offspring: A Systematic Review and Meta-Analysis https://academic.oup.com/jcem/article-abstract/105/12/3821/5893988- The association between thyroid function biomarkers and attention deficit hyperactivity disorder https://www.nature.com/articles/s41598-020-75228-w- O que são biomarcadores? https://www.corporate.roche.pt/pt/inovacao-e-desenvolvimento0/ensaios-clinicos/ensaios-clinicos-para-profissionais-de-saude/o-que-sao-biomarcadores-.html- Could Mom's Thyroid Levels Influence ADHD in Kids? https://www.webmd.com/add-adhd/news/20201021/could-moms-thyroid-levels-influence-adhd-in-kids - Maternal Hypothyroidism Increases the Risk of Attention-Deficit Hyperactivity Disorder in the Offspring https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0040-1717073?utm_campaign=socialwhoosh-2020&utm_source=twitter&utm_medium=social&utm_content=20kak3_20b8um_20o4n8---**Episódios relacionados**- Tribo TDAH - TDAH Explica #01 - Por que TDAHs têm tanto medo de falhar? http://www.pqpcast.com/tribo-tdah/tdah-explica-1-medo-de-falhar- Tribo TDAH - TDAH Explica #02 - Por que TDAHs se sabotam? http://www.pqpcast.com/tribo-tdah/tdah-explica-2-autossabotagem- Tribo TDAH - TDAH Explica #03 - TDAHs podem viver sem medicação? http://www.pqpcast.com/tribo-tdah/tdah-explica-3-medicacao-terapia - Tribo TDAH - TDAH Entrevista #01 - Doutora Drag, vida acadêmica e LGBT http://www.pqpcast.com/tribo-tdah/tdah-entrevista-doutora-drag-lgbt-vida-academica- Tribo TDAH - TDAH Entrevista #02 - Dra. Ana Beatriz Barbosa Silva, Fiuk, cotidiano e sentimentos http://www.pqpcast.com/tribo-tdah/tdah-entrevista-ana-beatriz-barbosa-silva-fiuk-bbb- Tribo TDAH - TDAH Entrevista #03 - Carla Manso, maternidade, body positive e autoestima #OPodcastÉDelas2021 http://www.pqpcast.com/tribo-tdah/tdah-entrevista-3-carla-manso-maternidade-aceitacao-autoestima - Tribo TDAH #01 - TDAH, mitos e verdades http://www.pqpcast.com/blog/tribotdah-1-mitosverdades - Tribo TDAH #03 - TDAH e História http://www.pqpcast.com/blog/tribotdah-3-historia - Tribo TDAH #06 - TDAH e dopamina http://www.pqpcast.com/blog/tribotdah-6-dopamina- Tribo TDAH #07 - TDAH e criatividade http://www.pqpcast.com/blog/tribotdah-7-criatividade - Tribo TDAH #08 - TDAH e insônia http://www.pqpcast.com/blog/tribotdah-8-insonia- Tribo TDAH #42 - TDAH e sonhos (Parte 1) http://www.pqpcast.com/tribo-tdah/42-sonho-1 - Tribo TDAH #43 - TDAH e sonhos (Parte 2) http://www.pqpcast.com/tribo-tdah/43-sonho-2 - Tribo TDAH #44 - TDAH e sonhar acordado (maladaptive daydreaming) (Parte 1) http://www.pqpcast.com/tribo-tdah/44-sonhar-acordado-1 - Tribo TDAH #45 - TDAH e sonhar acordado (maladaptive daydreaming) (Parte 2) http://www.pqpcast.com/tribo-tdah/45-sonhar-acordado-2 - Tribo TDAH #54 - TDAH e procrastinação (Parte 1) http://www.pqpcast.com/tribo-tdah/54-procrastinar-1- Tribo TDAH #55 - TDAH e procrastinação (Parte 2) http://www.pqpcast.com/tribo-tdah/55-procrastinar-2- Tribo TDAH #21 - TDAH e motivação (parte 1) http://www.pqpcast.com/tribo-tdah/21-motivacao-1 - Tribo TDAH #22 - TDAH e motivação (parte 2) http://www.pqpcast.com/tribo-tdah/22-motivacao-2 - Tribo TDAH #09 - TDAH e rejeição http://www.pqpcast.com/blog/tribotdah-9-rejeicao- Tribo TDAH #19 - TDAH e perfeccionismo (parte 1) http://www.pqpcast.com/blog/tribotdah-19-perfeccionismo-1- Tribo TDAH #20 - TDAH e perfeccionismo (parte 2) http://www.pqpcast.com/blog/tribotdah-20-perfeccionismo-2- Tribo TDAH #35 - TDAH e trabalho (Parte 1) http://www.pqpcast.com/tribo-tdah/35-trabalho-1 - Tribo TDAH #36 - TDAH e trabalho (Parte 2) http://www.pqpcast.com/tribo-tdah/36-trabalho-2---Assine nosso Feed da Tribo TDAH http://www.pqpcast.com/tribo-tdah/?format=rss Spotify Tribo TDAH https://open.spotify.com/show/2bgtfNUQcF4ZgZZWKvBX2G Deezer Tribo TDAH https://www.deezer.com/us/show/1040242**Instagram**- Tribo TDAH (@tribotdah) https://www.instagram.com/tribotdah/ **Twitter**- Tribo TDAH (triboTDAH) https://twitter.com/TriboTDAH - #PodcasterProcura (@PodProcura) https://twitter.com/podprocura - Thata Finotto (@thata_finotto) https://twitter.com/thata_finotto **Facebook**- Página Tribo TDAH https://www.facebook.com/TriboTDAH - Página Podcaster Procura https://www.facebook.com/PodProcura/ **Telegram**- Canal #PodcasterProcura (@PodProcura) https://t.me/PodProcura Edição: Andrey Mattos https://twitter.com/andreymatttosApoio cultural: Kairós Soluções Empresariais http://kairoscorp.com.br/

The Journal of Rheumatology's Editor-in-Chief Earl Silverman discusses this month's selection of articles that are most relevant to the clinical rheumatologist. This month's Editor's Picks spotlight interview is with Dr. Ibrahim Almaghlouth. This month's selections also include: Almaghlouth, et al: Propensity Score Methods in Rare Disease: A Demonstration Using Observational Data in Systemic Lupus Erythematosus - https://doi.org/10.3899/jrheum.200254 Faye, et al: Risk of Adverse Outcomes in Hospitalized Patients With Autoimmune Disease and COVID-19: A Matched Cohort Study From New York City - https://doi.org/10.3899/jrheum.200989 Grosse, et al: Evaluation of Bone Erosions in Rheumatoid Arthritis: The Ultrasound Score for Erosions Versus the Modified Sharp/van der Heijde Score for Erosions - https://doi.org/10.3899/jrheum.200286 Liew, et al: Cardiovascular Risk Scores in Axial Spondyloarthritis Versus the General Population: A Cross-sectional Study - https://doi.org/10.3899/jrheum.200188 van Leeuwen, et al: Association Between Centromere- and Topoisomerase-specific Immune Responses and the Degree of Microangiopathy in Systemic Sclerosis - https://doi.org/10.3899/jrheum.191331 To read the full articles visit www.jrheum.org. Music by David Hilowitz

Pediatrician and epidemiologist Michael Kramer studies the long-term effects of pre-term births, including by Caesarean section or induced labour, as well as other adverse pregnancy outcomes such as still births and infant mortality. He will oversee these types of important population health studies as the director for the Centre for Outcomes Research and Evaluation at the Research Institute of the McGill University Health Centre. READ: Research institute puts Canada at the forefront of health care

What is Candor? How does it benefit patients and providers? Dr. Zacharias is joined by Dr. Sue Sgambati, the medical director at COPIC, to answer these questions and provide some insight. In this context, Candor refers to a framework that emerged out of efforts by the Agency for Healthcare Research and Quality (AHRQ) to encourage an environment that supports open, honest conversations with patients after adverse outcomes occur. It is also designed to investigate and learn from what happened, to address the patients' needs alongside providers' needs, and to disseminate any lessons learned in order to improve future outcomes. Dr. Sgambati talks about how COPIC guides providers through Candor, especially In Colorado and Iowa where there is legislation that formalizes this process, and some of the key lessons learned from managing these types of cases.  Podcast Email: wnlpodcast@copic.com

This week feature a Double Feature of Discussions. In our first discussion, author Larry Allen and Associate Editor Justin Grodin discuss the article "An Electronically Delivered, Patient-Activation Tool for Intensification of Medications for Chronic Heart Failure with Reduced Ejection Fraction: The EPIC-HF Trial." Then in our second discussion, author Benjamin Scirica and Associate Editor Sandeep Das discuss the Research Letter "Digital Care Transformation: Interim Report From the First 5000 Patients Enrolled in a Remote Algorithm-Based Cardiovascular Risk Management Program to Improve Lipid and Hypertension Control." TRANSCRIPT BELOW Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. We're your co-hosts, I'm Dr. Carolyn Lam associate editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, associate editor, director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr. Carolyn Lam: Dr. Greg, I really love these double features that we have in 2021. Let me tell you about the first one. We are going to be talking about the EPIC heart failure trial. That's the electronically delivered patient activation tool for intensification on medications in HFrEF. Very important results. Dr. Greg Hundley: Yes, Carolyn. And the second feature is going to evaluate an algorithm based cardiovascular risk management program to improve lipid and hypertension control. But before we get to the double feature, how about we grab a cup of coffee and start with some of the other articles in the issue? Dr. Carolyn Lam: My coffee is right here and I want to talk about, guess what? SGLT2 inhibitors again for this first paper. Dapagliflozin, as we know, reduces the risk of end stage renal disease in patients with chronic kidney disease. We saw that in the DAPA-CKD trial. However, the primary and secondary preventive effects of SGLT2 inhibitors on cardiovascular outcomes have not been studied in patients with chronic kidney disease, with and without diabetes. Dr. Greg Hundley: Well Carolyn, remind us a little bit, what were the end points in the DAPA-CKD trial? Dr. Carolyn Lam: Okay, well yes. DAPA-CKD as a reminder, randomized more than 4,000 participants with chronic kidney disease to dapagliflozin, 10 milligrams daily or placebo. The primary endpoint was a composite of sustained decline in GFR of more or equal to 50% or end stage kidney disease or kidney or cardiovascular death. The secondary end points were a kidney composite outcome, the composite of hospitalization for heart failure or cardiovascular death and all cause death. Now the current paper is a pre-specified subgroup analysis where authors led by Dr. John McMurray from University of Glasgow, divided patients into primary and secondary prevention subgroups according to the history of cardiovascular disease. And results showed that dapagliflozin reduced the risk of the primary composite outcome to a similar extent in the primary and secondary prevention groups. This was also true for the composite of heart failure hospitalization or cardiovascular death and all cause mortality. The combined cardio renal benefits of SGLT2 inhibitors in patients with chronic kidney disease with and without diabetes therefore are substantial, whether there is history of cardiovascular disease or not. Dr. Greg Hundley: Not very nice, Carolyn. Well, my paper comes from Dr. Pradeep Natarajan and his colleagues at the Massachusetts General Hospital. And Carolyn, this study evaluated whether premature menopause is associated with CHIP. For our listeners, CHIP stands for clonal hematopoiesis of indeterminate potential and it is the age related expansion of hematopoietic cells with leukemogenic mutations without detectable malignancy. And previously it's been shown associated with accelerated atherosclerosis. Dr. Carolyn Lam: Yikes. Greg, is pretty much our menopause associated with CHIP? Dr. Greg Hundley: Well Carolyn, the investigators, among 19,606 women, they identified 418 or 2.1% with natural premature menopause and 887 or four and a half percent with surgical premature menopause. Premature menopause, especially the natural premature menopause was independently associated with CHIP among post-menopausal women. Natural premature menopause, therefore may serve as a risk signal for predilection to develop CHIP and CHIP associated cardiovascular disease. Dr. Carolyn Lam: Interesting. Okay. Well, my next paper really provides the first evidence for endogenous induction of type-1 protein kinase A disulfide formation in the heart and this occurring after ischemia and re-profusion in both humans and mice. Dr. Greg Hundley: Ah Carolyn, so tell us more about this interesting paper. Dr. Carolyn Lam: Well, this is from Dr. Simon from University of Oxford and colleagues who used high spatial and temporal resolution imaging modalities in conjunction with an interesting redox dead type-1 protein kinase A knock-in mouse model and demonstrated that disulfide modification targets this type-1 protein kinase A to the lysosome where it acts as a gatekeeper for two poor channel mediated calcium release and prevents inappropriate triggering of calcium release from the sarcoplasmic reticulum. In the post ischemic heart, they found that inhibition of lysosomal calcium release by these oxidized molecules was crucial for limiting infarct size and preserving cardiac function during re-profusion. All this thus offering a novel target for the design of cardio-protective therapeutics. This is discussed in an editorial by Doctors Westenbrink, Nijholt, and deBoer from University Medical Center Groningen. Dr. Greg Hundley: Thanks, Carolyn. Very nice. Well, my last paper comes from Dr. Nicholas Marston and colleagues from the TIMI study group at Brigham and Women's Hospital of the Harvard Medical School. Carolyn, genome wide association studies have identified single nucleotide polymorphisms or SNIPs that are associated with an increased risk of stroke. The authors sought to determine whether a genetic risk score could identify subjects at higher risk for ischemic stroke after accounting for traditional clinical risk factors across five trials involving the spectrum of cardiometabolic disease. Dr. Carolyn Lam: Interesting. And these genetic risk scores are very hot. What did they find? Dr. Greg Hundley: Thanks, Carolyn. Among 51,288 subjects across the five trials, a total of 960 subjects had an ischemic stroke over a median follow-up of two and a half years. Across a broad spectrum of subjects with cardiometabolic disease, a 32 SNIP genetic risk score was a strong, independent predictor of ischemic stroke. In patients with atrial fibrillation, but lower CHA2DS2-VASc two scores, the genetic risk score identified patients with risk comparable to those with higher CHA2DS2-VASc two scores. Dr. Carolyn Lam: Wow, that really is impressive. Well, guess what? We've got some other articles in today's issue. There's a beautiful White Paper about the definitions and clinical trial design principles for coronary artery chronic total occlusion therapies and this from the CTOARC consensus recommendations by Dr. Rinfret and colleagues from McGill University. There's a Research Letter entitled, The Randomized Control Trial to Evaluate the Effect of Dapagliflozin on Left Ventricular Diastolic Function in Patients with Type II Diabetes. And this is from Dr. Hong and colleagues from Yonsei University College of Medicine in Korea. Dr. Greg Hundley: Thanks, Carolyn. Well I have an exchange of letters from Doctors Albiero and Xie regarding the previously published paper, Patent Foramen Ovale Could be a Source of Paradoxical Embolism and Lead to Adverse Outcomes in Hospitalized Patients with COVID-19 Pneumonia and DVTs.” There's also a Perspective piece to the 2020 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease from Dr. Bavry. And finally Carolyn, Dr. Tung has an ECG Challenge entitled, “Narrowing the Differential Diagnosis for a Wide Complex Tachycardia.” Well, how about we get on to both of our double features. Dr. Carolyn Lam: Let's go, Greg. Dr. Greg Hundley: Well listeners, we are here for our first feature discussion and we have with us today, Dr. Larry Allen from University of Colorado and our own associate editor, Dr. Justin Grodin from University of Texas Southwestern Medical School in Dallas, Texas. Welcome gentlemen. Larry, could you walk us through the background that really formulated your hypothesis? And then what was the hypothesis that you wanted to test with your study? Dr. Larry Allen: Well, thanks again for having me. I'm a heart failure doctor. The research group that I work with has spent a lot of time on patient empowerment and think about medication prescribing for HFrEF as shared decision making. Thinking about this as a discussion between the patient and me, rather than me deciding what to do. As you know, patients are now coming into the office because they've seen direct to consumer advertising around medications, but typically those are very biased. They're advertisements that are for only patented drugs. And what I'm really trying to think about is what is my patient's overall regimen in terms of heart failure? Dr. Larry Allen: And so we developed a tool which was a three minute video to tell patients that they should come into their visit and be excited to have discussions about their medicines and then a one page checklist that basically said, "Here's what an optimal regimen of medicines looks like for a patient with heart failure and reduced ejection fraction and nobody's really on a perfect regimen, but these are all the possibilities that you could have." Our hypothesis was that if we delivered that to patients before the clinic visit, that it would lead to better prescribing of these drugs. Essentially we imparted on a randomized trial within our healthcare system to do that and that's what we're discussing today, the results of the EPIC heart failure trial. Dr. Greg Hundley: Very nice, Larry. Tell us a little bit, what patients did you enroll in your trial? And then what outcomes did you work to assess? Dr. Larry Allen: We're part of the UC Health System, which has 12 hospitals, but a number of cardiology clinics across the front range of Colorado. Our entire system is on a single instance of the EPIC electronic health record so we're now able to essentially automatically identify all the patients in our system who have HFrEF. We generated lists of patients who had HFrEF who were going to see a cardiology provider in clinic and then we identified them ahead of time, enrolled them in the study prospectively. And the enrollment was for them to agree to be randomized in the study and then for us to be able to collect data on them. Dr. Larry Allen: The patients were kind of a wide range of HFrEF. They were an average of 65 years old, about 70% of the patients were male and reflected the race and ethnicity of Colorado with 11% Blacks and about 7% Hispanics. And everybody in the study had an ejection fraction of 40% or less on their last echocardiogram or other recent cardiac study. And then they were randomized to either get this three minute video sent to them as an email or as a text link that kicked them over to the one page checklist. And then we had them come in. A 145 patients came to clinic having got the information and a 145 patients just came to clinic like usual. Dr. Greg Hundley: Very nice. What did you find, Larry? What were your results? Dr. Larry Allen: Yeah, so we found not surprisingly that the majority of patients who were in usual care had no change to their medical regimen. What we found in the patients who received the EPIC heart failure three minute video and checklist, we saw about a 19% absolute increase in intensification of guideline directed medical therapy. And then we found that most of that was actually an increase in beta blocker dose prescribing. To some extent, the cheapest therapy that could be increased on a drug that people are already on. Dr. Greg Hundley: Very good. Well Justin, we'll turn to you. Help us put the results from Larry's work in the context of A, management of patients with heart failure and reduced ejection fraction and then also B, tell us a little bit about what attracted you to this article and maybe even where you see some of this going next. Dr. Justin Grodin: Thanks, Greg. And Larry, obviously I want to echo Greg's comments by thanking you for your submission. This was a paper that we thought obviously very highly of. Greg, for your first point, we've got novel therapies, but really one of the major issues now is not can we find a newer, better drug? I think we've all come to this realization, it's scalability and implementing these therapies into our regular practice, like beta blockers, RAS inhibitors and mineralocorticoid receptor antagonists. And as Larry said, the problem now is not the quality of our therapies, it's really scaling it and getting it to everyone. It's also increasing these therapies to optimum dosages in patients that can tolerate it over time. Dr. Justin Grodin: And then, to answer your second question, I think some of the things that struck us by this was that this is a wonderfully simple intervention that truly does empower patients. The majority of our interventions to optimize medical therapy has been targeting the physicians, the APP, the nurses, et cetera. This is beautiful in that it empowers the patient and we are putting the ball in their court. And I think to kind of dovetail with your third question, this is a health system clinical trial and I think that tells us a few things. I think one, it provides the framework on how one could perhaps implement that in their health systems. And we'll have to see if this is something that could translate to other health systems across the country or multiple centers. But I think really the intrigue with this work is that it all comes back to empowering the patients. Dr. Greg Hundley: Very nice. Dr. Larry Allen: Greg, I wanted to just add one thing that in the heart failure community, there's this argument going back and forth about whether the lack of optimization of guideline directed medical therapies is due to intolerance or whether it's due to therapeutic inertia. And one of the things I like about this study is on face value, we're empowering patients, but the fact that by asking patients to get involved in prescribing decisions, I think one of the take home messages is that this is partially about therapeutic inertia and that as clinicians, we have a lot of things we're dealing with. And if patients come in to the clinic visit and they're motivated to make these changes actually, we can intensify the therapy. Dr. Greg Hundley: Very good. Larry and Justin, both one at a time here quickly, in the last minute that we have, what do you see as the next study, Larry, that needs to be performed in this space? Dr. Larry Allen: I see two things quickly. One is, as Justin mentioned, validating that this kind of intervention, while simple can be pragmatically deployed in other health systems and in other contexts. The second thing is how do we integrate this kind of small intervention with the larger overall care of patients? One of the concepts that I've talked a lot about over the years with others, including Len Stevenson, is this concept of an annual heart failure review, where rather than seeing people on multiple short visits where we tackle small issues, we actually create a little bit of time to stand back and take a global view of heart failure therapy and how that heart failure therapy fits into the goals of care for the patient, the other medical problems they have and where they're headed. Dr. Greg Hundley: Very good. Justin, anything? Dr. Justin Grodin: Greg, I have to agree with Larry. I think he hit the nail on the head with his first comment. At least for me from an editorial standpoint is really we like to see how generalizable this is and really this implemented in other health systems. I think that's the logical next step. I can tell you, at least from our discussions at our medical center about this manuscript since it's been published at Circulation is, is there something like this we could implement in our own health system? Or in the health systems that we're affiliated with? Dr. Larry Allen: And I would just add that this research and the intervention was funded by the American Heart Association under the strategically focused research network for heart failure and so we've made the interventions public they're online at the research website we have, patientdecisionaid.org. Dr. Greg Hundley: Well fantastic. Well listeners, we want to thank Dr. Larry Allen from University of Colorado and our associate editor, Dr. Justin Grodin from UT Southwestern, for bringing us this article, demonstrating a process that facilitates patient physician interactions to improve the administration of guideline based therapy to patients with heart failure and reduced ejection fraction. And so we're going to wind up this feature discussion and we will head to our next feature. Dr. Greg Hundley: And we have with us Dr. Benjamin Scirica from Brigham and Women's Hospital and our own associate editor, Dr. Sandeep Das from UT Southwestern. Benjamin, could you tell us a little bit about the background information that you used to formulate your hypothesis that you wanted to test for this study? Dr. Benjamin Scirica: Thanks so much first for the invitation. It's a great honor to obviously be in Circulation and to be part of this podcast. We started with the recognition that in our practice, which is similar, I think to a lot of the United States, we are not doing as good a job as we could in terms of care for a lot of the chronic cardiovascular conditions we see. And hypertension and high cholesterol are one of those clear areas where we know there are very good guidelines with clear indication for therapy in specific situations and that these drugs that are available are predominantly generic. But when we looked at our registries, we found that we were not doing as well as we thought. We felt that there are a lot of reasons for that. Dr. Benjamin Scirica: A lot of it was based on the fact that for something good to happen, the right thing to happen, you have to have a patient and a doctor in the same room, the doctor has to recognize that there's a problem. They have to know that there is something they can do about it. They have to be able to convince the patient or educate the patient that they should start this new therapy. They have to know how to start the therapy and then have the ability to follow up and make sure that there is longitudinal care for these chronic diseases. Dr. Benjamin Scirica: And that's a lot to ask for any of us when we have 15 minutes to see the patient, we may only see the patient a couple times a year at most. And so we felt that our hypothesis is, could we design a program, would be delivered remotely, that would not require a doctor in the middle of all of these decisions and that we could scale by using lower cost resources, non-licensed healthcare coordinators or navigators and pharmacists who could follow very clear treatment algorithms to be able to identify patients and prescribe the right medicines to patients at the right time, based on their cardiovascular risk. Dr. Greg Hundley: What was your study design? And what was your study population? Dr. Benjamin Scirica: This is an active, ongoing quality improvement program where our hypothesis is that by doing this, we could improve patients' lipids and cholesterol prescriptions compared to prior. And we did some analysis and we saw that a lot of these patients had not been on optimal therapy for many years, even though they've been in our system. With the limitations of not having randomization, we identified these patients and through different clinics in the different hospitals, and would either have patients referred to us by providers or more commonly go and find them within the registries and identify the patients and contact them and have them enter our program where they would usually take somewhere between eight to 12 weeks to be actively managed, to get to their goals and then they'd enter a maintenance program. The report that we do now is that the story of the first 5,000 patients who we enrolled in our program of whom about 35% were still in management at the time we presented these ongoing results. Dr. Greg Hundley: Roughly how old were these participants? And what was the breakdown in terms of gender or sex distribution? Dr. Benjamin Scirica: We found that about 12% were over 75 years old, a little over half were female. We had 71% who are non-Hispanic Caucasian and 8% who were non-English speaking. In terms of their cardiovascular risks, about a third of the patients had established cardiovascular disease, about a quarter of the patients had diabetes and about a third had an LDL of more than 190 milligrams per deciliter, but no history of ASCVD or diabetes. And then for hypertension, we really would take anybody whom the physician felt required further blood pressure management, because their blood pressure was over 130 over 85. Dr. Greg Hundley: And what did you find? Dr. Benjamin Scirica: We found that of the 5,000 patients that we enrolled, about 4,000 were in the lipid program, a little over 1,400 we're in the hypertension program, so some patients were in both programs and in the lipid patients, in those patients who achieved maintenance, we increased lipid therapy, any lipid lowering therapy, from about 78% up to 97%. And that was predominantly through statins but we doubled the use of ezetimibe from 9% to 17%. We saw a small increase in PCSK9 inhibitor use from 1% to 3%. And if we looked at LDL reductions, it was a 52 milligram per deciliter reduction in LDL from an average LDL of a 125 down to 73 in those folks who achieved maintenance. For blood pressure, again, in those patients whom we successfully treated who are about 600 patients, we saw a 14 millimeter systolic blood pressure reduction and a seven millimeter mercury diastolic blood pressure reduction. Dr. Greg Hundley: Wow. Well Sandeep, what drew your attention to this? And then also, how do you put the context of these results with others that really are working in this wing of data science in cardiovascular medicine? Dr. Sandeep Das: Great question. We have a large body of literature that suggests that the use of these fantastic evidence based therapies like statins, like blood pressure medications is poor and we really struggle to improve those numbers. I wanted to applaud Ben and his group for really taking on, in a robust way, an important topic and subject. The other thing that really attracted me to this study, there was a hypertension expert here named Ron Victor back when I first started as a fellow. Fantastic researcher and he did a project called Colloquia called the Barbershop Project about leveraging pharmacists and barbers to improve the blood pressure control of African American men in the community. Dr. Sandeep Das: The idea is that you get out there, you got to go to where the patients are rather than expecting them to come to you. And you got to figure out ways to engage them, activate them, get them to participate in their own care. A fantastic study, but the one thing that always, we discuss that study, the thing that always jumps out is, well how do you scale it? How do you use it in a real practice? To me was also a very exciting aspect to this. The goal is to take steps to generalize from clinical trials to real world practice, because we got to get this to patients. Dr. Greg Hundley: Very nice. Well Ben, coming back to you, what do you see as next steps for your research here? And then even in the field? Dr. Benjamin Scirica: The first is, are there other disease areas we can do this in? I think the second part is how to test different techniques to try to improve the ability to scale it to broader populations and keep the cost down. And I think it is a combination of trying to find the right tools, whether they're digital or not and the right techniques to be able to activate patients, educate them, such that they are asking the question, "How come I'm not on these medicines? How come I'm not on this?" And I think we could do a lot in terms of AB testing in there. The part that I think is challenging in these healthcare studies and quality improvement studies, is that randomization would be great. How can we do it streamline? Do we need to get consent? Can it just be that approved drug A can be tested against approved drug B because there is clear equipoise. And I think by doing that, we could lower the bar for really pragmatic randomization in practice and be able to have much more rapid cycles of improvement and optimization on therapy. Dr. Greg Hundley: Very good. Sandeep, do you have anything to add? Dr. Sandeep Das: I'll echo Dr. Scirica's called arms here that we need to have a way to do this, do trials in this space pragmatically. I agree with that strongly. I did have a few thoughts on next directions. I work in a population of the urban poor of Dallas County with a lot of my clinical time and these patients have poor health literacy so I think that one question, not question but suggestion or comment to Ben and his group would be to think hard about how you would expand this to lower resource setting or to people that would be a little harder to reach. And even as sort of an aspirational goal, how do you expand it into the community? The other question that I would have is how much of this can we get by with adherence interventions? It's one thing to prescribe, but it's another thing to figure out how to get people to adhere to meds. Dr. Greg Hundley: Very nice. Well listeners, we want to thank Dr. Ben Scirica for Brigham and Women's and Dr. Sandeep Das from UT Southwestern, bringing us this really interesting research that has been providing early results of a remotely delivered pharmacist led lipid and hypertension management strategy that dramatically increased medication compliance and improved hypertension control and lipid management. Dr. Greg Hundley: On behalf of Carolyn and myself, we want to wish you a great week and we will catch you next week on the run. Dr. Greg Hundley: This program is copyright of the American Heart Association, 2021.  

Dr. Jeff Varnell, a surgeon and COPIC physician risk manager, is the guest for this episode that focuses on addressing adverse outcomes through COPIC's 3Rs and CANDOR Programs. Dr. Varnell has managed the 3Rs (Recognize, Respond, and Resolve) process and highlights its origins and goals of maintaining the physician-patient relationship and improving the quality of medical care. He also talks about how 3Rs and CANDOR try to move away from an adversarial approach to one that guides physicians through managing difficult patient conversations and using best practices for disclosure that includes open and honest conversations. In addition, Dr. Varnell points to the positive results that have emerged from 3Rs and how these benefit both patients and physicians. Podcast email: wnlpodcast@copic.com

Many people have resorted to steaming using hot water, herbs and mixtures of western medicine and oils to fight Covid-19 infections. Some believe this could cure or kill the virus, while on the other hand, medical practitioners have warned of possible adverse outcomes in some cases.

En el episodio #26 estuvimos con:

To take care of others we first need to take care of our-selves. Yet dentists rarely take time off for themselves when they need it. How can we do our best work when sick? Dr Annalene Weston is well known for her work in Burnout and Mental Health for dentists and it is our pleasure to have her on the What I wish I Knew podcast again to share something she sees dentists making the mistake of time and time again, not taking care of yourself. The concept of the Third Space resonated strongly with me as did much of what she had to say in this episode. I hope you take as much from this as I did. The post TIP#19: Adverse Outcomes with Dr Annalene Weston – What I Wish I Knew appeared first on Dental Head Start.

Episode 16: Snoop That HeadacheThe sun rises over the San Joaquin Valley, California, today is June 12, 2020. The results of the DAPA-HF (Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure Trial) were presented in November 2019. If you haven’t heard about it, here you have it: In patients with Heart Failure with reduced Ejection Fraction, both WITH and WITHOUT Type 2 Diabetes, dapagliflozin plus standard therapy reduced the risk of worsening Heart Failure events and Cardiovascular death and improved symptoms. Did you hear that? It improved heart failure outcomes in patients WITH and WITHOUT diabetes. This certainly opens a new window for potential use of SGLT-2 inhibitors in patients WITHOUT diabetes.On May 8, the CDC reported a significant decline in childhood immunizations since March. Let’s remember to prioritize well-child visits for patients who need vaccinations. As family physicians, we play an essential role in prevention, and we need to avoid the resurgence of preventable communicable diseases.  Welcome to Rio Bravo qWeek, the podcast of the Rio Bravo Family Medicine Residency Program, recorded weekly from Bakersfield, California, the land where growing is happening everywhere.The Rio Bravo Family Medicine Residency Program trains residents and students to prevent illnesses and bring health and hope to our community. Our mission: To Seek, Teach and Serve. Sponsored by Clinica Sierra Vista, Providing compassionate and affordable care to patients throughout Kern and Fresno counties since 1971. “The roots of education are bitter, but the fruit is sweet” –Aristotle.Going to school and learning requires effort, patience, and perseverance, but the consequences of your determination will be well worth it. Dear residents, you will learn something new every day of your lives, even if you don’t realize it. Today we will learn even more from one of our sweetest and smartest residents. Welcome Monica Kumar, thanks for being here with us. I understand you were working nights, but now you are rested and refreshed. Who are you?Question number 1: Who are you?My name is Monica and I am a second-year family medicine resident at the Rio Bravo Family Medicine Residency Program. So, a little bit about me, I was born in Malaysia, a small country located in Southeast Asia. In 2004, my parents and I moved to Bakersfield, California, a place I now call home. I went to Bakersfield High for high school and then graduated from UC Berkeley with a major in Integrative Biology. After undergrad, while trying to plan out the rest of my life career wise, I worked as an air testing chemist for a year, which made me want to run as far away as I can from being stuck in a lab, so I ran all the way to the beautiful island of Saint Marten to pursue a career in Medicine. After finishing medical school, I was very fortunate I was able to return home to learn and serve the community that has given me so many opportunities. For fun, I love playing badminton and ping pong, flying kites, walking my dog, gardening, going on adventures, and binge watching romantic comedies and horror movies on Netflix. Question number 2: What did you learn this week?So, after working multiple shifts in the ED while wearing the N95 for about 7-9 hours consistently and walking around with a daily headache, I thought it was only appropriate for me to talk a little bit about headaches, particularly the indications for imaging, assessment and management of headaches in the outpatient setting. I have had numerous patients who have come to clinic repeatedly complaining of headaches and, though we all have gotten headaches in our lifetimes, we often forget how debilitating it can be for patients who cannot find an appropriate treatment regimen to control their symptoms. There is a fine balance about when to treat headaches. We should not overuse medications because overuse can worsen migraine and tension headaches, but at the same time not controlling repeated headaches can result in central sensitization and transformation to chronic headaches that are intractable and difficult to treat. When to treat headaches First, we should perform a thorough interview of the patient presenting with frequent headaches. We have to ask about •   Associated symptoms: nausea, vomiting, photophobia, neck tenderness•   Duration of episodes and frequency•   Aggravating and alleviating factors (if the headache is worse with activity or light, or if there is any improvement with noise avoidance)•   Inquire about the intensity, location and quality of the pain •   Medications utilized and its effectivenessNext, we have to perform a thorough, focused physical exam carefully examining head, neck, eyes including fundoscopy, evaluating extraocular movements, visual fields, assessing sinus tenderness and gait Some labs to consider: CBC, CMP, ESR to evaluate for temporal arteritisThe next big question is when is imaging indicated. Being family physicians we do not want to expose our patients to excessive procedures and radiation but we have to find a fine balance by considering the pros and cons. The American Headache Society and American Academy of Neurology recommend the use of the mnemonic SNOOP to guide in the decision of obtaining further imaging The mnemonic SNOOP can be used to think about secondary causes of headaches and the need for imaging. S in snoop stands for Systemic symptoms and Secondary risk factors. You want to inquire if the patient has been experiencing fevers, chills, weight loss OR if they have a history of HIV or cancer.N in snoop is for Neurologic symptoms. Ask the patient if they have experienced any confusion, impaired alertness or alteration in consciousness of mentation. The presence of neurologic symptoms should prompt immediate evaluation for focal nervous system lesion.O stands for Onset: is the headache sudden, abrupt.O in snoop is for Older. A new onset or progressive headache in an older patient >50 years of age requires further investigation.P in the mnemonic stands for Papilledema.Per the American Headache Society and the American Academy of Neurology, if imaging is indicated at the outpatient setting always order an MRI without contrast instead of a CT. A CT should mainly be used in an emergent situation to r/o hemorrhage. Non-pharmacologic TreatmentReduce stressors, exercise, meditate, keep a headache journal.Address lifestyle issues such as poor sleep, lack of exercise, smoking, obesity, caffeine use in triggering headachesThe US Headache Consortium strongly recommends relaxation training with or without thermal biofeedback and cognitive behavior therapy for the treatment of migrainesOf note, patients with frequent headaches require both prophylactic and acute pharmacologic treatments. Question Number 3: Why is this knowledge important?Since headaches are one of the most common complaints we as family medicine physicians encounter, it is very important that we do not miss secondary causes of headaches which can be life threatening. Question number 4: How did you get that knowledge?After SNOOPing around AAFP articles pertaining to the treatment and management of headaches in the outpatient setting, I stumbled across the SNOOP mnemonic and thought it would help me and my fellow colleagues remember the indications for imaging and the danger signs that can prevent us from missing a life-threatening diagnosis Question number 5: Where did you get that knowledge?The information discussed was condensed from various AAFP articles titled “Frequent headaches: evaluation and management” “Migraine Headache Prophylaxis” as well as UpToDate’s headache article. That’s all for this week, stay tuned for the treatment and management which will be covered during our next episode with Dr Brito, hope you have a nice rest of your week.  Speaking Medical: Formication or delusional infestationby Dr Gina ChaForMication, with an M, (not to be confused with forNication with an N, which is consensual sexual intercourse between two unmarried people). ForMication is one of the terms used to describe the sensation of small insects crawling on (or under) the skin. Formication comes from the Latin word formica, which means ant. A patient with formication perceives the sensation as “real”, they have a fixed, delusion that they are infested by bugs, that’s why we also call it delusional infestation. Primary delusional infestation is a psychiatric disorder which cannot be treated only by reasoning with the patient that he or she is not infested by bugs. Delusional infestation is the most common form of monosymptomatic hypochondriac psychosis. Formication can also be secondary to substance abuse (methamphetamine, cocaine), or substance withdrawal (alcohol and benzodiazepines). Do not confuse formication with pruritus or paresthesias, which can be explained by an organic cause, but formication has a heavy psychiatric component. Espanish Por Favor: Chorro by Dr Claudia CarranzaHi this is Dr Carranza on our section Espanish por favor. This week’s word is cabeza. Cabeza means head, this word comes from Latin root “caput” which literally means head. Patients can come to you with the complaint: “Doctor, me duele la cabeza” or “Doctor, tengo pesadez de cabeza”, which means “Doctor, my head hurts” or “Doctor, my head feels heavy”. You can then continue the interview and ask about timing, duration, exact location, prior trauma, and associated symptoms, just like Dr Kumar eloquently explained before.  Now you know the Espanish word of the week, “CABEZA”. For your Sanityby Drs Lisa Manzanares, Gina Cha and Alyssa Der Mugrdechian—What is the medical term for owning too many dogs? A RoverdosePatient: Doctor, someone decided to graffiti my house last night!Doctor: So, why are you telling me?Patient: I can’t understand the writing, was it you?_______________Now we conclude our episode number 16 “Snoop That Headache”, Dr Kumar talked about how to determine if a headache needs imaging evaluation. Remember, SNOOP stands for Systemic and Secondary risk factors, Neurologic symptoms, Onset, Older, and Papilledema. ForMication (with an M) is used to describe the sensation of bugs crawling on or under the skin. It is an unusual symptom for a psychiatric or neurologic illness. This week we taught you the spanish word cabeza, which means head, so now you know what your patient is talking about when they said they have pain in their cabeza.This is the end of Rio Bravo qWeek. We say good bye from Bakersfield, a special place in the beautiful Central Valley of California, United States, a land where growing is happening everywhere.If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. Our podcast team is Hector Arreaza, Alyssa Der Mugrdechian, Gina Cha, Lisa Manzanares, and Monica Kumar. Audio edition: Suraj Amrutia. See you soon! ___________________________References:Zoler, Mitchel L., “Heart Failure, Dapaglifozin Equally Effective for Those with and without Diabetes”, Family Practice News, Vol. 49, No. 12, December 2019.Santoli JM, Lindley MC, DeSilva MB, et al. Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration — United States, 2020. MMWR Morb Mortal Wkly Rep 2020;69:591–593. DOI: http://dx.doi.org/10.15585/mmwr.mm6919e2external iconWalling, Anne, MB, ChB, “Frequent Headaches: Evaluation and Management”, Am Fam Physician. 2020 Apr 1;101(7):419-428. https://www.aafp.org/afp/2020/0401/p419.htmlHa, Hien, PharmD, and Gonzalez, Annika, “Migraine Headache Prophylaxis”, Am Fam Physician. 2019 Jan 1;99(1):17-24. https://www.aafp.org/afp/2019/0101/p17.htmlWootton, Joshua, MDiv and col., “Evaluation of headache in adults”, UpToDate, https://www.uptodate.com/contents/evaluation-of-headache-in-adults?search=headache&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1, accessed on 6/11/2020.     

Commentary by Dr. Valentin Fuster

Moderator: Marianne Novelli, MD, FACP, FHM References: Predictive Accuracy of Frailty Tools for Adverse Outcomes in a Cohort of Adults 80 Years and Older: A Decision Curve Analysis A New Functional Classification Based on Frailty and Disability Stratifies the Risk for Mortality Among Older Adults: The FRADEA Study Translating Frailty Research Into Clinical Practice: Insights From the Successful Aging and Frailty Evaluation Clinic

Executive Editor Michael Roy speaks with Arthur Robin Williams, M.D., M.B.E., and Mark Olfson, M.D., M.P.H., about their research on adverse health outcomes following discontinuation of buprenorphine among Medicaid beneficiaries who were retained for variable periods beyond 6 months. How buprenorphine helps patients, and factors affecting the use of this medication [2:50] Are there any quality measures for buprenorphine or for the treatment of opioid use disorder more generally? [7:48] What the authors aimed to achieve in the study [10:59] How the authors determined what methods to use in the study [13:51] Main findings with regard to adverse health outcomes after patients discontinued buprenorphine [16:22] Implications of the results [19:01] What further studies should explore with regard to treatment for opioid use disorder [21:50] Takeaways for researchers, clinicians, and other mental health professionals [23:06] Be sure to let your colleagues know about the podcast, and please rate and review it on Apple Podcasts, Google Play, Stitcher, Spotify, or wherever you listen to it. Subscribe to the podcast here. Listen to other podcasts produced by the American Psychiatric Association. Browse articles online. Also visit the online edition of this month’s Journal to watch a video of Deputy Editor Daniel S. Pine, M.D., present highlights from the issue. Follow the Journal on Twitter. E-mail us at ajp@psych.org

In this episode of The Brave Enough Show, your host, Dr. Sasha Shillcutt talks with Dr. Stacia Dearmin, founder of ThrivePhysician.com, a resource and support system for Physicians facing adverse outcomes and Malpractice litigation. They speak about the experience of malpractice litigation, the impact of adverse patient outcomes on us physicians and what led Dr. Dearmin to create Thrive Physician. 

In this episode of The Brave Enough Show, your host, Dr. Sasha Shillcutt talks with Dr. Stacia Dearmin, founder of ThrivePhysician.com, a resource and support system for Physicians facing adverse outcomes and Malpractice litigation. They speak about the experience of malpractice litigation, the impact of adverse patient outcomes on us physicians and what led Dr. Dearmin to create Thrive Physician.

Dr. Stacia Dearmin can help us get through adverse patient outcomes and malpractice litigation. She has been through it herself. She is a speaker, coach, consultant and blogger on the topic. She went to medical school at Case Western Reserve and has a masters in religion and ethics from Vanderbilt. She did her residency in pediatrics at Akron Children’s Hospital and worked as a general pediatrician for a few years. She has worked as a pediatric emergency medicine physician since 2004. After working at Case Western Rainbow Babies, she is back at Akron Children’s Hospital. She is the founder of thrivephysician.com, where she focuses exclusively on the well-being of physicians facing adverse outcomes and malpractice litigation. Her experience in practice raised her awareness of the deep pain and isolation that physicians experience after an adverse outcome or in the midst of a lawsuit. She alleviates that isolation and provides insight and support around some of the toughest experiences many physicians will face in their careers. She draws on her personal story to illuminate the experience for physicians and to educate about the needs of physician defendants. We start out discussing the statistics about how frequently physicians are sued and why we never talk to each other about it. Her own experience with an adverse outcome and lawsuit led to the creation of thrivephysician.com. We learn about the second victim and how being a second victim can take its toll on physicians especially amidst the isolation put upon us by the legal system. We learn how to start recovering. She has created a course to help us at deposition. "Deposition Magic" is a new course designed to give physician-defendants exactly what they need to know to soar at their own deposition. In a series of brief, friendly videos, you'll explore the nature and purpose of deposition, the goals and tactics of the opposing attorney, and most importantly, the high-integrity mindset and strategies that will serve you as a physician-defendant. Together, we'll exchange confusion and anxiety for clarity and calm, and help you to level the playing field at deposition. Available to you online on-demand, "Deposition Magic" confers up to 3 hrs Category I CME. Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com Please be sure to leave a five-star review, a nice comment and SHARE!!!

This is part two of the interview with Dr. Stacia Dearmin. She builds on the idea of the physician’s second victim status in bad outcome and potentially in litigation. The plaintiff’s attorney can weaponize our empathy against us after a bad outcome and she teaches us how to defend against that. She builds on ideas on how to recover that were discussed in the first episode. She is a speaker, coach, consultant and blogger on the topic. She went to medical school at Case Western Reserve and has a masters in religion and ethics from Vanderbilt. She did her residency in pediatrics at Akron Children’s Hospital and worked as a general pediatrician for a few years. She has worked as a pediatric emergency medicine physician since 2004. After working at Case Western Rainbow Babies, she is back at Akron Children’s Hospital. She is the founder of thrivephysician.com, where she focuses exclusively on the well-being of physicians facing adverse outcomes and malpractice litigation. Her experience in practice raised her awareness of the deep pain and isolation that physicians experience after an adverse outcome or in the midst of a lawsuit. She alleviates that isolation and provides insight and support around some of the toughest experiences many physicians will face in their careers. She draws on her personal story to illuminate the experience for physicians and to educate about the needs of physician defendants. She has created a course to help us at deposition. "Deposition Magic" is a new course designed to give physician-defendants exactly what they need to know to soar at their own deposition. In a series of brief, friendly videos, you'll explore the nature and purpose of deposition, the goals and tactics of the opposing attorney, and most importantly, the high-integrity mindset and strategies that will serve you as a physician-defendant. Together, we'll exchange confusion and anxiety for clarity and calm, and help you to level the playing field at deposition. Available to you online on-demand, "Deposition Magic" confers up to 3 hrs Category I CME. Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com Please be sure to leave a five-star review, a nice comment and SHARE!!!

In this special episode of the View, Dr. Peter Block and Dr. Deepak Bhatt discuss highlights from Day 1 of AHA.19, including the Dapagliflozin and Prevention of Adverse-Outcomes in HF Trial (DAPA-HF), the Colchicine Cardiovascular Outcomes Trial (COLCOT), and the International Study Of Comparative Health Effectiveness With Medical And Invasive Approaches (ISCHEMIA) trials.

Adverse outcomes, we all know they happen but how do we handle them, record them and avoid them in the first place? The discussion then moves to (Patient Recorded Outcome Measures) PROMS. Patient optimisation is then discussed. Exercise, could it be so effective because it works as an anti inflammatory? A deep dive into the research on that is contained in this conversation. The RELIEF trial is discussed as the team get into a discussion about what a patient sees as a good outcome. How do we communicate the risks, possible benefits and limitations, of surgery to patients? The "P.R.E.P." website mentioned is here: https://www.prepwell.co.uk/ Desiree Chappell and Joff Lacey are presenting with their guests Dr Mark Edwards, Consultant in Anaesthesia and Perioperative Medicine at The University Hospital Southampton NHS Foundation Trust and Professor Gerard Danjoux, Consultant in Anaesthesia and Sleep Medicine at South Tees Hospitals NHS Foundation Trust.

The July 2019 supplement of the The Bone and Joint Journal consists of papers from The Knee Society. In this episode, Mr Andrew Duckworth interviews Dr Noam Shohat, who is the lead author of one of the articles published in this supplement. The article "Fructosamine is a better glycaemic marker compared with glycated haemoglobin (HbA1C) in predicting adverse outcomes following total knee arthroplasty: a prospective multicentre study" was the recipient of the 2019 John Insall award.Click here to read the articleClick here to view the table of contents for The Knee Society supplement

Adverse outcomes, we all know they happen but how do we handle them, record them and avoid them in the first place? The discussion then moves to (Patient Recorded Outcome Measures) PROMS. Patient optimisation is then discussed. Exercise, could it be so effective because it works as an anti inflammatory? A deep dive into the research on that is contained in this conversation. The RELIEF trial is discussed as the team get into a discussion about what a patient sees as a good outcome. How do we communicate the risks, possible benefits and limitations, of surgery to patients? The "P.R.E.P." website mentioned is here: https://www.prepwell.co.uk/ Desiree Chappell and Joff Lacey are presenting with their guests Dr Mark Edwards, Consultant in Anaesthesia and Perioperative Medicine at The University Hospital Southampton NHS Foundation Trust and Professor Gerard Danjoux, Consultant in Anaesthesia and Sleep Medicine at South Tees Hospitals NHS Foundation Trust.

Dr. Thomas Knight talks to Dr. Pennell about a major issue in cancer care: financial toxicity. Read the related article.   Hello, and welcome back to the ASCO Journal of Oncology Practice podcast. This is Dr. Nate Pennell, medical oncologist at the Cleveland Clinic and consultant editor for the JOP. The rising costs of medical care is on everyone's mind these days. But while policymakers or physicians tend to discuss this more of as a societal or economic problem, the real consequences of the high costs of cancer care are ultimately being felt by our patients. But how do we measure the financial burdens of cancer care? And how does this impact our patients' lives and ultimately their outcomes from treatment? Today, we're going to be talking about a new paper titled, Financial Toxicity in Adults With Cancer Adverse Outcomes in Noncompliance, published in the November 2018 JOP. Joining me for this podcast is Dr. Greg Knight, medical oncologist at the Levine Cancer Institute in Charlotte, North Carolina. Greg, thanks so much for joining me today. Thank you so much for having me. So I thought this was a really interesting paper. Can we just start with a little bit of terminology? So what do you mean when you're talking about financial toxicity? I've heard people use this term bandied about. I think it's a term that oncologists are used to dealing with. And obviously, we know that health care is expensive. But this implies that there is a harmful element to this. Yeah, sure. The term financial toxicity is still a relatively new term. We first started to use it probably around 2013. Dr. Zafar at Duke published a paper first looking at this in terms of the costs and the harm to patients. And the idea behind it is we want to be able to quantify what we're doing in terms of harm to the patient with the costs of treatment. As oncologists, one of the things that we're really good at is grading toxicities. So we worry about nausea. We worry about neuropathy. We worry about hair loss. But one of the things that we weren't very good at was also looking at the harm we were doing to patients with the costs of our treatment. And when I refer to cost of treatment, this term actually encompasses a lot, in terms of not just what we usually think of, which is offices, it's medications, hospitalizations, all those bills that they get from us, but there's other costs that go along with having a cancer diagnosis. Those are things like transportation, clothing, lost wages, child care. All of these things are impacting our patients. And we need to quantify this because it does have implications on their treatment and how they're going to do. Well, that makes perfect sense. And I think that's something relatable to everyone who's treating cancer patients today. Can you give us a little bit of an idea of the magnitude of this issue in the United States? Is there existing data before your particular study came out? There were some both small scale papers and some large database looking papers. And the general consensus was, at the time when we started this study was about 1/3 of patients are going to have severe or catastrophic financial difficulties associated with their treatment. Wow. That's a huge number. So why don't you tell me a little bit about your study and what was the intention of the study and how did you go about it. One of the things we really wanted to do with this study, which was part of a much larger study we had at the University of North Carolina, was we wanted to evaluate both prevalence of this financial toxicity. Because again, there had been some database studies. There had been some smaller scale studies. But we wanted to get actual patient reported data on the prevalence of this financial toxicity and in a wide variety of cancers. But we also really wanted to look and see other things. How did it impact health services? Basically what are targets that we could intervene on to try to improve this? And so really with this study, what we did was we went into the clinics of all of the oncology clinics at UNC, and we embedded researchers in there and approached pretty much any patient that came to the clinic. Wildly successful actually, we had over 52% of our approached individuals actually enrolled in our study. And then within two weeks of that enrollment, we had interviews conducted by our staff using basically a computer assisted telephone interview. Now as I said, this was part of a much larger project. And what we were trying to do was basically get this comprehensive database of both clinical and interview data. And then we paired that with biologic specimens and tumor tissue. However, our piece of it was we were really trying to delve down on this financial question and then look at quality of life and how it impacted their care. Are their existing instruments that look at financial toxicity? Or is this built into existing PRO surveys? At the time when we started this, there actually was not. Dr. De Souza at the University of Chicago actually developed the cost measure, basically posted that after we had started with us. Having said that, and I love the cost measure. I think it's a fantastic. It's a nine question survey basically looking at grading financial toxicity. One of the things that we really were hoping to do with our primitive attempts at this was to find maybe one question things we can do in a busy clinic to try to identify high risk populations. And so with this one what we used was actually a statement from the PSUA team, which was, you have to pay for more medical care than you can afford. And then patients were asked to respond to the statement basically strongly agree, agree, uncertain, disagree, or strongly disagree. And we dichotomized them as basically exhibiting financial toxicity if you strongly or agreed with that statement, or not exhibiting financial toxicity with any other response. That sounds like a pretty clear and straightforward question. Was there like a free form portion where they could talk about, did this affect their ability to take their medicines, or go to doctor visits, things like that? There was. And we actually did a couple of different things. So we both did standardized questionnaires, so we did things like the fact GP, which is looking at multiple facets of patient well-being. We also looked at other health related quality of life issues. We also had developed our own access to health care questionnaire, which was looking at certain things like, were you having problems getting to your appointments? Are you being able to pay for your medications? We did several questions about paying for lab tests, paying for office visits. And then also, we really wanted to make sure that we knew if the reason you were missing these things was because of cost, or if there were other reasons. Because obviously, we don't want to attribute this all to cost if that's not what's causing the harm. OK, yeah. So it sounds like a lot of information gathered. So what did you find? In our study, we had almost 2,000 participants. And we had over a quarter, so 26% agreed or strongly agreed that they had to pay more for medical care than they could afford, which is in line with other studies. I would have thought it might have been higher than that. But it sounds like this is a nice validation that your survey was a pretty accurate instrument, even with such a simple question. Unfortunately, what we found is that when you take this population, the population that tells us that they are having financial toxicity by our definition, what we were finding was much higher rates of noncompliance. And that was a very scary thing when you're talking about cancer patients. Our patients who had reported financial toxicity were much more likely to report needing but unable to afford prescriptions, over-the-counter medications. They were also reporting noncompliance due to cost concerns for medical care like doctor's visits, medical tests, mental health care. All these things for the majority of patients undergoing active chemo is a really scary thing. And there's been some really good research in this area recently. There was a recent study where they were looking at imatinib and CML, and it found that individuals who had copayments greater than $53 a month were 70% more likely to discontinue within six months. So it's real world implications of this concept. Absolutely. And were there any other factors that were associated with financial toxicity, things that you might be able to use to screen or predict for this? In terms of the predictor, we basically validated what it had been thought of before, which is that there were certain factors that seem to be more predictive for exhibiting financial toxicity. The ones that we really know of are age less than 65 years, being non-white race, less education. All of those things had been previously described. It was nice to see with a large population model that we could validate those findings that would have been found in smaller studies. But it does seem that those patients are at much higher risk for financial difficulties. Yeah, and the less than 65 is interesting to me. So I assume that that's probably related to Medicare coverage, that that somehow makes it less of a financial burden. That's what it looks like. And I think that, obviously, Medicare is a nice protection for a lot of our patients over the age of 65, in that they don't see a lot of some of the costs our younger patients, especially our underinsured patients see. However, there was a recent study where individuals with cancer that were insured by Medicare alone were incurring mean out-of-pocket costs that were 1/4 of their household income. So I would say even though they have probably less bills for a lot of those patients, they're on fixed income. There is not other income coming in. So a lot of the folks over the age of 65 are still having financial toxicity even with the better insurance coverage. Did you look at insurance coverage in this? Was that a variable in the analysis? It was not. It was one of those things that when you go back and you wish you would have done it at the time. We felt like we had covered every single base. And it actually was a thing where we thought we were going to be able to pull that data from a database. But ultimately, we were unable to do it. It's now built into every model going forward. But we unfortunately did not have that data. So you did a great job of identifying these patients and all the consequences of the financial toxicity. So what are we to take from this? Presumably, the idea would be to try to figure out a way to intervene on these patients. So what can we do? Yeah, I think that, I mean, obviously, the first step is to identify the problem. And I think that that's always an issue. There's been multiple surveys of oncologists who feel it feels very wrong to discuss costs with patients. I think that we get very wrapped up in the science. And we have the latest and greatest drug that we just know is going to work. But obviously, drugs are getting more expensive plus all the treatment time and coming to and from the hospital, and basically outpatient versus inpatient chemotherapy. All these things need to be thought of when you're thinking about your treatment plans. Having said that, once identified, if you're screening your patients for this, there are specific areas it seems like we can intervene. In our study, what we found was there were pretty interveneable reasons people were saying that they were having problems with their care. They include things like not having transportation, a lack of insurance, the inability to pay for travel. They can't take time off work. They don't have child care. These are things that are specific issues that they're having, that with foundational support, with local and community support, you can usually intervene on. But you really do need to identify them. I know our group and the group out in Washington has done some research in the use of trained financial navigators to help patients. And that group in Washington has shown fantastic results saving a lot of money annually for these patients. And in our group, we've also done things like treatment plans based on where you live. So can we get you treatment close to home? And if not, how can we get ride share? How can we get gas cards? Can we do things to help you? And then also, I mean, again, there are actually a decent amount of foundational money out there if you're looking for it. There are groups out there that are there to help. But again, like I said, a lot of times, we just miss the problem. Yeah. I mean, I know that I feel vastly unqualified to discuss costs of care with my patients. Oftentimes, I really don't even have a good idea of how much things cost. But it sounds like there ought to be a way to screen patients right up front beyond simply what their level of insurance is to see if they might benefit from these extra services. And then it's important for cancer centers to have these kind of interventions to be able to help provide with transport and identify patients who would benefit from that foundational help. So I don't know how broadly available those kinds of services. I know we have them there. And your cancer center is actually run by our old boss, who used to run our cancer center, Dr. Raghavan. So I'm not surprised that you might have those as well. Is this something that is broadly available in oncology offices throughout the country? It's not. I mean, honestly, it is not. And one of the things that I'm kind of one of my big pushes in terms of the research is that I think that everyone has their own issue that they're very passionate about. And I think that we could survey patients until the cows come home about different issues and try to identify patients at risk. And so one of things we've really tried to do is a couple of things. Number one is to identify specific questions, especially in this case and some of our other studies, one or two question surveys where we can identify patients that are at very high risk for having these difficulties and identify that subset of population. And then one of the things that we're actually also working on in association with a couple other foundations and a couple of national organizations is we are actually hoping at some point to be able to start to roll out telemedicine, tele financial counseling basically and internet and other programs. There's a pilot going on in Boston right now. There's another program we're going to be rolling out here in January, where we are trying to intervene on the problem even just from financial planning standpoint. There's a large amount of patients who it doesn't matter where you are in terms of your financial situation, financial planning is incredibly important. You could have a lot of money in the bank and good insurance, and then you get hit with a cancer diagnosis. And you're trying to figure out what you're going to do with your assets, versus a lot of our patients, which are you now can't work. And there's no money coming in. How are the bills going to be paid? How are you going to basic budget? Again, I think this is going to resonate with everyone who treats cancer, no matter where you are. Because a big segment of our patients really struggle with this. And while it might not be immediately visible, if you dig down a little bit, it's not hard to find. Well, Greg, thanks so much for talking to me today. Thank you. And I also want to thank all our listeners out there who joined us for this podcast. The full text of the paper is available online now at ASCOpubs.org/journal/jop in the November 2018 issue. This is Dr. Nate Pennell for the Journal of Oncology Practice signing off.

This podcast covers the JBJS issue for July 2018. Featured are articles covering Percutaneous Needle Fasciotomy Versus Collagenase Treatment for Dupuytren Contracture; recorded commentary by Dr. Slater; Postoperative Glucose Variability Associated with Adverse Outcomes of Total Joint Arthroplasty; Risk-Based Hospital and Surgeon-Volume Categories for Total Hip Arthroplasty; recorded commentary by Dr. Vail; Alpha Defensin and C-Reactive Protein in the Diagnosis of Periprosthetic Joint Infection.

This podcast covers the JBJS issue for July 2018. Featured are articles covering Percutaneous Needle Fasciotomy Versus Collagenase Treatment for Dupuytren Contracture; recorded commentary by Dr. Slater; Postoperative Glucose Variability Associated with Adverse Outcomes of Total Joint Arthroplasty; Risk-Based Hospital and Surgeon-Volume Categories for Total Hip Arthroplasty; recorded commentary by Dr. Vail; Alpha Defensin and C-Reactive Protein in the Diagnosis of Periprosthetic Joint Infection.

Adverse outcomes, we all know they happen but how do we handle them, record them and avoid them in the first place? The discussion then moves to (Patient Recorded Outcome Measures) PROMS. Patient optimisation is then discussed. Exercise, could it be so effective because it works as an anti inflammatory? A deep dive into the research on that is contained in this conversation. The RELIEF trial is discussed as the team get into a discussion about what a patient sees as a good outcome. How do we communicate the risks, possible benefits and limitations, of surgery to patients? Also in this piece, find out about a fascinating community-based multimodal prehabilitation service. Desiree Chappell and Joff Lacey are presenting with their guests Dr Mark Edwards, Consultant in Anaesthesia and Perioperative Medicine at The University Hospital Southampton NHS Foundation Trust and Professor Gerard Danjoux, Consultant in Anaesthesia and Sleep Medicine at South Tees Hospitals NHS Foundation Trust. Join in the debate: contact@topmedtalk.com

Teddy Wilson Staff Reporter at Rewire News joined me to talk about the special session and its impact on Texans.

This week we review 1) Time to Appendectomy Outcomes: Serres SK, Cameron DB, Glass CC, Graham DA, Zurakowski D, Karki M, Anandalwar SP, Rangel SJ. Time to Appendectomy and Risk of Complicated Appendicitis and Adverse Outcomes in Children. JAMA Pediatr. Published online June 19, 2017. doi:10.1001/jamapediatrics.2017.0885 2) Which Diets Work: Aragon AA, Schoenfeld BJ, Wildman R, et al. International society of sports nutrition position stand: diets and body composition. J Int Soc Sports Nutr. 2017;14:16. 3) Laughter and opioid release: Manninen, Sandra, Lauri Tuominen, Robin I. Dunbar, Tomi Karjalainen, Jussi Hirvonen, Eveliina Arponen, Riitta Hari, Iiro P. Jääskeläinen, Mikko Sams, and Lauri Nummenmaa. "Social Laughter Triggers Endogenous Opioid Release in Humans." The Journal of Neuroscience 37.25 (2017): 6125-131. Web. Welcome to TalkingMed, the podcast where we discuss current medical news. Contact: talkingmedpodcast@gmail.com Twitter: @TalkingMedPod Song credit: Night Owl by Broke For Free from the Free Music Archive, used under CCBY Attribution License, modified from the original. Disclaimer: The information presented on this podcast are our own personal views, opinions, and research on the subject matter and do not represent those of our institution or our department. Anything discussed on this podcast should not be considered medical advice. Please contact a professional if you have any medical concerns. All content found on TalkingMed, including text, images, audio, or other formats were created for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have learned it from TalkingMed. Under no circumstances shall Vivek, Stephen, TalkingMed, any guests or contributors to the podcast or blog, or any employees, associates, or affiliates of TalkingMed be responsible for damages arising from use of the podcast or blog. This podcast or blog should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast or blog. You hereby acknowledge that nothing contained on TalkingMed shall constitute financial, investment, legal and/or other professional advice and that no professional relationship of any kind is created between you and the TalkingMed. You hereby agree that you shall not make any financial, investment, legal and/or other decision based in whole or in part on anything contained on TalkingMed. Nothing on TalkingMed or included as a part of TalkingMed should be construed as an attempt to offer or render a medical opinion or otherwise engage in the practice of medicine. If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately.  The content may contain health- or medical-related materials or discussions regarding sexually explicit disease states. If you find these materials offensive, you may not want to use this content.

Listen as Melissa Parkerton, MA of the Oregon Patient Safety Commission, discusses the new Early Discussion and Resolution (EDR) program.  EDR offers patients (or their representatives) and their healthcare facilities or providers a process for having an open, caring, and confidential conversation if serious physical injury or death occurs during healthcare. Click here to learn more […]

A study in the July issue of Gastroenterology sheds new light on adverse outcomes associated with drug-induced liver injury. Dr. Kuemmerle speaks with author Dr. Robert J. Fontana