Podcast appearances and mentions of ann intern med

Norton Healthcare's Parenting With You is the podcast that helps you keep your kids healthy and safe by providing practical, down to earth advice for parents of children of any age, from babies through the teen years. In this Episode: Revisting the Measles Unfortunately, the measles has been back in the news recently. In this episode our host, Dr Erin Frazier, speaks with pediatric infectious disease specialist Dr. Kristina Bryant. During the conversation, Dr's Frazier and Bryant cover all the ground parents need to know today regarding the measles. During today's discussion, a couple of research studies were mentioned: Madsen KM, Hviid A, Vestergaard M, Schendel D, Wohlfahrt J, Thorsen P, Olsen J, Melbye M. A population-based study of measles, mumps, and rubella vaccination and autism. N Engl J Med. 2002 Nov 7;347(19):1477-82. doi: 10.1056/NEJMoa021134 Hviid A, Hansen JV, Frisch M, Melbye M. Measles, Mumps, Rubella Vaccination and Autism: A Nationwide Cohort Study. Ann Intern Med. 2019 Apr 16;170(8):513-520. doi: 10.7326/M18-2101.   About Norton Children's Center for Prevention and Wellness A healthy kid is a happy kid. Norton Children's Prevention & Wellness provides resources to help you and your child build healthy habits. Established in 1991, the Office of Child Advocacy of Norton Children's Hospital, now Norton Children's Prevention & Wellness, takes an active leadership role in teaching healthy habits in children, including injury prevention and educating children and their families on healthy lifestyle choices. Advocacy and outreach educational programs are at the heart of the Norton Children's mission. Norton Children's Prevention & Wellness is funded through donations to the Norton Children's Hospital Foundation. Our efforts are focused around: ·      Safety and injury prevention ·      Promoting healthy lifestyles ·      Key community partnerships ·      Government relations Norton Children's Prevention and Wellness Classes:  https://nortonchildrens.com/prevention-wellness/classes-events/ Find a pediatrician go to https://nortonchildrens.com/locations/pediatrician-offices/  or call 502-629-KIDS, option 3.

For this special episode of the Astonishing Healthcare podcast, Andrew Barnell, CEO of Geneoscopy, joins Justin Venneri in the studio for an insightful discussion about colorectal cancer (CRC) screening in observance of National CRC Awareness Month! Andrew explains how he and his "very talented" sister, Erica Barnell, MD, PhD, co-founded Geneoscopy to develop diagnostic tests using RNA biomarkers extracted from stool samples. Their newly FDA-approved test, ColoSense™, provides a non-invasive alternative to traditional colonoscopies.Barnell highlights the rising incidence of CRC in younger adults, which prompted guideline changes to lower the recommended screening age to 45. He stresses the urgent need for increased screening awareness and greater access to screening tools, noting that employers can help overcome barriers to screening through education and by encouraging engagement in wellness programs. Other topics covered include:Over 135,000 people are diagnosed with CRC every year, and despite CRC being one of the most preventable cancers with good long-term survival rates following treatment, 50,000 people die from it annually. Preventive screenings are increasingly covered with no patient out-of-pocket costs, but insurers' expenses are rising.Increasing early screening is crucial: 30-40% of eligible individuals remain unscreened, particularly in the 45-49 age group.Geneoscopy's decentralized clinical trial and overall use of technology to conduct its pivotal FDA approval study virtually, which increased patient diversity and efficiency.Regulatory challenges remain: FDA approval is just one step; Medicare coverage and guideline inclusion are key hurdles.Bringing targeted therapy approaches to autoimmune diseases like IBD to improve patient outcomes and reduce costs is Geneoscopy's next goal.Related ContentMultitarget Stool RNA Test for Colorectal Cancer Screening. Barnell EK, Wurtzler EM, La Rocca J, et al. JAMA. 2023;330(18):1760–1768. doi:10.1001/jama.2023.22231Pharmacogenomics (PGx) 101: What You Need to Know for Rx ProgramsReference Materials/Other Links (courtesy of Geneoscopy)Projected Impact and Cost-Effectiveness of Novel Molecular Blood-Based or Stool-Based Screening Tests for Colorectal Cancer. Ladabaum U, Mannalithara A, Schoen RE, Dominitz JA, Lieberman D. Ann Intern Med. 2024 Dec;177(12):1610-1620. doi: 10.7326/ANNALS-24-00910. Epub 2024 Oct 29. PMID: 39467291.Colorectal Cancer—Patient Version. National Cancer Institute (NCI)Productivity savings from colorectal cancer prevention and control strategies. Bradley CJ, Lansdorp-Vogelaar I, Yabroff KR, Dahman B, Mariotto A, Feuer EJ, Brown ML. Am J Prev Med. 2011 Aug;41(2):e5-e14. doi: 10.1016/j.amepre.2011.04.008. PMID: 21767717; PMCID: PMC3139918.Follow Geneoscopy on LinkedInFor more information about Capital Rx and this episode, please visit Capital Rx Insights.

Show Notes for Episode 42 of “The 2 View” – Pink cocaine, holiday heart syndrome, pertussis, research updates on Zepbound and Semaglutide, and much more. Segment 1 – Pink cocaine What is Pink Cocaine? Dea.gov. DEA: United States Drug Enforcement Administration. https://www.dea.gov/pink-cocaine What is Pink Cocaine? Poison.org. POISON CONTROL: National Capital Poison Center. https://www.poison.org/articles/pink-cocaine Segment 2 – Holiday heart syndrome Blackburn R, Ajetunmobi O, Mc Grath-Lone L, et al. Hospital admissions for stress-related presentations among school-aged adolescents during term time versus holidays in England: weekly time series and retrospective cross-sectional analysis. BJPsych Open. Cambridge University Press. Cambridge Core. Published November 19, 2021. https://www.cambridge.org/core/journals/bjpsych-open/article/hospital-admissions-for-stressrelated-presentations-among-schoolaged-adolescents-during-term-time-versus-holidays-in-england-weekly-time-series-and-retrospective-crosssectional-analysis/924EE2CD1A8CFAC30E7090674FCEAF72 Carey M, Al-Zaiti S, Kozik T, Pelter M. Holiday Heart Syndrome. ECG Puzzler. Researchgate.net. AJCC: American Journal of Critical Care. American Association of Critical-Care Nurses. https://www.researchgate.net/profile/Mary-Carey/publication/260446497HolidayHeart_Syndrome/links/573dda6308ae298602e6d0b1/Holiday-Heart-Syndrome.pdf Ettinger P, Wu C, De La Cruz Jr C, Weisse A, Ahmed S, Regan T. Arrhythmias and the “Holiday Heart”: Alcohol associated cardiac rhythm disorders. Sciencedirect.com. ScienceDirect. American Heart Journal. https://www.sciencedirect.com/science/article/abs/pii/000287037890296X Greenspon AJ, Schaal SF. The “holiday heart”: electrophysiologic studies of alcohol effects in alcoholics. Ann Intern Med. PubMed. NIH: National Library of Medicine: National Center for Biotechnology Information. Published February 1983. https://pubmed.ncbi.nlm.nih.gov/6824246/ Jain A, Yelamanchili V, Brown K, Goel A. Holiday Heart Syndrome. Nih.gov. NIH: National Library of Medicine: National Center for Biotechnology Information. Updated January 16. 2024. https://www.ncbi.nlm.nih.gov/sites/books/NBK537185/ Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. AHA | ASA Journals. Published November 30, 2023. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193 Segment 3 – Pertussis CDC. About Whooping Cough. Whooping Cough (Pertussis). Updated April 2, 2024. https://www.cdc.gov/pertussis/about/index.html Center for Drug Evaluation, Research. FDA Drug Safety Communication: Death resulting from overdose after accidental ingestion of Tessalon (benzonatate) by children under 10 years of age. FDA: U.S. Food and Drug Administration. Published June 28, 2019. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-death-resulting-overdose-after-accidental-ingestion-tessalon Pertussis. Who.int. World Health Organization. https://www.who.int/health-topics/pertussis Simma L, Gesch M. Eyelid Ecchymoses and Subconjunctival Hemorrhage in Pertussis. N Engl J Med. Published December 11, 2024. https://www.nejm.org/doi/full/10.1056/NEJMicm2409052 Something sweet – Research updates: Zepbound and Semaglutide Ernst D. Zepbound Approved for Obstructive Sleep Apnea in Patients With Obesity. Monthly Prescribing Reference. MPR: Medical Professionals Reference. Published December 20, 2024. https://www.empr.com/news/zepbound-approved-for-obstructive-sleep-apnea-in-patients-with-obesity/?utmsource=eloqua&utmmedium=email&utmcampaign=NWLTRMPRTOPTDrug-DatabaseSS-LAS-LI1-LI2-9654122924_AL&hmemail=1f%2FJfEV7hN5vJr6vg%2FQRqK0NA6IXtyO3&sha256email=092493d8223fdfa40d9e995176d13e5fc5b5211674db9deb440c025fd462c80c&hmsubid=&nid=1639413404&elqtrack=True Semaglutide shows promise as a potential alcohol use disorder medication. Research Update. Nih.gov. NIH: National Institute on Alcohol Abuse and Alcoholism. Published March 13, 2024. https://www.niaaa.nih.gov/news-events/research-update/semaglutide-shows-promise-potential-alcohol-use-disorder-medication Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share! Looking forward to another year together!

Eileen Egan, DNP, FNP-C, BC-ADM, CDCES, FADCES joins The Huddle to share her expertise about the interplay between weight and glycemic management in people with Type 2 diabetes, the importance of meeting glycemic and weight goals early after a Type 2 diabetes diagnosis, as well as best practices for helping people stay motivated and engaged. This episode was made possible with support from Lilly, A Medicine Company. Learn more about this topic in this accompanying patient/client handout (support for the development of this handout was provided by Lilly, A Medicine Company): adces_tipsheet_early_control2.pdf References:American Diabetes Association. Obesity and weight management for the prevention and treatment of type 2 diabetes: standards of care in diabetes- 2024. Diabetes Care, 47(1): S145-S157.Center for Disease Control and Prevention. Adult overweight and obesity. https://www.cdc.gov/obesity/basics/adult-defining.htmlDCCT/EDIC study research group. Intensive Diabetes Treatment and Cardiovascular Outcomes in Type 1 Diabetes: The DCCT/EDIC Study 30-Year Follow-up. Diabetes Care. 2016;39(5):686-693. Gregg E, Jakicic J, Blackburn G, et al. Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post hoc analysis of the Look AHEAD randomized clinical trial. Lancet Diabetes Endocrinol. 2016; 4(11): 913-921.Gutiérrez-Cuevas J, Santos A, Armendariz-Borunda J. Pathophysiological Molecular Mechanisms of Obesity: A Link between MAFLD and NASH with Cardiovascular Diseases. Int J Mol Sci. 2021. 27;22(21):11629.Howard BV, Ruotolo G, Robbins DC. Obesity and dyslipidemia. Endocrinol Metab Clin North Am. 2003;32(4):855-867. Jin X, et al. Pathophysiology of obesity and its associated diseases. Acta Pharm Sin B. 2023;13(6):2403-2424.  Laiteerapong N, Ham SA, Gao Y, et al. The legacy effect in type 2 diabetes: impact of early glycemic control on future complications (The Diabetes & Aging Study). Diabetes Care. 2019;42(3):416-426.Lean MEJ, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial.Lancet Diabetes Endocrinol. 2019;7(5):344-355.Lingvay I, Sumithran P, Cohen RV, le Roux CW. Obesity management as a primary treatment goal for type 2 diabetes: time to reframe the conversation. Lancet. 2022 Jan 22;399(10322):394-405. doi: 10.1016/S0140-6736(21)01919-X. Epub 2021 Sep 30. Erratum in: Lancet. 2022 Jan 22;399(10322):358. PMID: 34600604Rachel G. Miller, Trevor J. Orchard; Understanding Metabolic Memory: A Tale of Two Studies. Diabetes 1 March 2020; 69 (3): 291–299. https://doi.org/10.2337/db19-0514Ross, R., Neeland, I.J., Yamashita, S. et al. Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nat Rev Endocrinol16, 177–189 (2020). https://doi.org/10.1038/s41574-019-0310-7Thom G, McIntosh A, Messow CM, et al. Weight loss-induced increase in fasting ghrelin concentration is a predictor of weight regain: Evidence from the Diabetes Remission Clinical Trial (DiRECT). Diabetes Obes Metab. 2021;(23):711-719.Tsai AG, Bessesen DH. Obesity. Ann Intern Med. 2019;170(5):ITC33-ITC48.Wing RR, Bolin P, Brancati FL, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145-154.World Health Organization. Obesity. https://www.who.int/health-topics/obesity#tab=tab_1 Listen to more episodes of The Huddle at adces.org/perspectives/the-huddle-podcast.Learn more about ADCES and the many benefits of membership at adces.org/join.

In this second episode in a three-part series of episodes focusing on artificial intelligence (AI) in cardiology, Dr. Effie Andrikopoulou hosts Dr. Nishath Quader and Mr. Demetri Giannikopoulos to discover how innovative AI solutions can tackle one of the biggest challenges facing today's cardiologists—burnout. Explore the transformative power of AI-driven automation in reducing administrative burdens and streamlining day-to-day tasks. Hear real-world success stories that discuss not only the potential but also challenges of integrating AI into everyday clinical practice.              Suggested Materials:   Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med 2016;165:753–60.  Topol EJ. High-performance medicine: the convergence of human and artificial intelligence. Nat Med 2019;25:44-56.   Subscribe to PracticeMadePerfect| Claim CME Credit 

A new year and a new beginning. Special guest co-host Pedro Mendes joins Dr. Chris Labos to answer a viewer question about menopause. Become a supporter of our show today either on Patreon or through PayPal! Thank you! http://www.patreon.com/thebodyofevidence/ https://www.paypal.com/donate?hosted_button_id=9QZET78JZWCZE Email us your questions at thebodyofevidence@gmail.com. Assistant researcher: Aigul Zaripova, MD Editor: Robyn Flynn Theme music: “Fall of the Ocean Queen“ by Joseph Hackl Rod of Asclepius designed by Kamil J. Przybos Chris' book, Does Coffee Cause Cancer?: https://ecwpress.com/products/does-coffee-cause- cancer Obviously, I'm not your doctor (probably). This podcast is not medical advice for you; it is what we call information. References: Geographic variability of menopausal symptoms 1) Nappi RE et al. Global cross-sectional survey of women with vasomotor symptoms associated with menopause: prevalence and quality of life burden. Menopause. 2021 May 24;28(8):875-882. doi: 10.1097/GME.0000000000001793. 2) Nappi RE, et al. Prevalence and quality-of-life burden of vasomotor symptoms associated with menopause: A European cross-sectional survey. Maturitas. 2023 Jan;167:66-74. doi: 10.1016/j.maturitas.2022.09.006. What's the normal duration of symptoms 3) Avis NE, et al. Study of Women's Health Across the Nation. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015 Apr;175(4):531-9. doi: 10.1001/jamainternmed.2014.8063. The Women's Health Initiative (WHI) studies Rossouw JE et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002 Jul 17;288(3):321-33. doi: 10.1001/jama.288.3.321. Anderson GL et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA. 2004 Apr 14;291(14):1701-12. doi: 10.1001/jama.291.14.1701. Decline in HRT after WHI studies Sprague BL, Trentham-Dietz A, Cronin KA. A sustained decline in postmenopausal hormone use: results from the National Health and Nutrition Examination Survey, 1999-2010. Obstet Gynecol. 2012 Sep;120(3):595-603. doi: 10.1097/AOG.0b013e318265df42. Danish Osteoporosis Prevention Study Schierbeck LL metal. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ. 2012 Oct 9;345:e6409. doi: 10.1136/bmj.e6409. Kronos Early Estrogen Prevention Study (KEEPS) Harman SM, et al. Arterial imaging outcomes and cardiovascular risk factors in recently menopausal women: a randomized trial. Ann Intern Med. 2014 Aug 19;161(4):249-60. doi: 10.7326/M14-0353. Kronos Early Estrogen Prevention Study (KEEPS) Hodis HN et al. Vascular Effects of Early versus Late Postmenopausal Treatment with Estradiol. N Engl J Med. 2016 Mar 31;374(13):1221-31. doi: 10.1056/NEJMoa1505241. Stopping hormonal therapy Berman RS et al. Risk factors associated with women's compliance with estrogen replacement therapy. J Womens Health. 1997 Apr;6(2):219-26. doi: 10.1089/jwh.1997.6.219. Grady D, Sawaya GF. Discontinuation of postmenopausal hormone therapy. Am J Med. 2005 Dec 19;118 Suppl 12B:163-5. doi: 10.1016/j.amjmed.2005.09.051. Tapering vs. abrupt stop or hormonal therapy Haimov-Kochman R et al. Gradual discontinuation of hormone therapy does not prevent the reappearance of climacteric symptoms: a randomized prospective study. Menopause. 2006 May-Jun;13(3):370-6. doi: 10.1097/01.gme.0000186663.36211.c0. PMID: 16735933.

Qui dit fin d'année dit Gala des grands crus et des piquettes du Pharmascope! Ne manquez pas cette 8e édition du Gala au velours des plus sérieux, le grand retour de Sébastien, des effets sonores entraînants, l'inclusion de nouvelles catégories exotiques… ** Veuillez noter que cet épisode ne rencontre pas les critères d'admissibilité pour l'octroi d'unités de formation continue ou de crédits Mainpro+** Ressources pertinentes en lien avec l'épisode La catégorie « L'éditorial de l'année »van Dijk SHB, Bui M, Eijkelboom AH. Living happily ever after? The hidden health risks of Disney princesses. BMJ. 2024;387:q2497. La catégorie « Nouvelles études de vieilles affaires pour de vieilles maladies »Kingsbury SR, Tharmanathan P, Keding A, et al. Pain Reduction With Oral Methotrexate in Knee Osteoarthritis : A Randomized, Placebo-Controlled Clinical Trial. Ann Intern Med. 2024;177(9):1145-1156. Wang Y, Jones G, Keen HI, et al. Methotrexate to treat hand osteoarthritis with synovitis (METHODS): an Australian, multisite, parallel-group, double-blind, randomised, placebo-controlled trial. Lancet. 2023;402(10414):1764-1772. La catégorie « Patente à gosse incroyable »Bartholdy C, Døssing A, Stisen ZR, et al. Effect of heated mittens on physical hand function in people with hand osteoarthritis: randomised controlled trial. BMJ. 2024;387:e078222. La catégorie « Je pleure tellement je ris »Li J, Liao Y, Zhang SY, et al. Effect of laughter exercise versus 0.1% sodium hyaluronic acid on ocular surface discomfort in dry eye disease: non-inferiority randomised controlled trial. BMJ. 2024;386:e080474. La catégorie « Alimentaire »Hakam N, Guzman Fuentes JL, Nabavizadeh B, et al. Outcomes in Randomized Clinical Trials Testing Changes in Daily Water Intake: A Systematic Review. JAMA Netw Open. 2024;7(11):e2447621. Hodder RK, O'Brien KM, Wyse RJ, et al. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev. 2024;9(9):CD008552. La catégorie « On n'est plus capable! »Duarte Romero B, Waterhouse M, Baxter C, et al. The effect of three years of vitamin D supplementation on erectile dysfunction: Results from the randomized placebo-controlled D-Health Trial. Clin Nutr ESPEN. 2024;60:109-115. La catégorie « L'étude ayant pris le plus de temps à être publiée »Hammond J, Fountaine RJ, Yunis C, et al. Nirmatrelvir for Vaccinated or Unvaccinated Adult Outpatients with Covid-19. N Engl J Med. 2024;390(13):1186-1195. La catégorie « Visuospatial »R Patel V, Liu M, Worsham CM, Jena AB. Alzheimer's disease mortality among taxi and ambulance drivers: population based cross sectional study. BMJ. 2024;387:e082194. Published 2024 Dec 17. La catégorie « Hommage »Yndigegn T, Lindahl B, Mars K, et al. Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction. N Engl J Med. 2024;390(15):1372-1381. Silvain J, Cayla G, Ferrari E, et al. Beta-Blocker Interruption or Continuation after Myocardial Infarction. N Engl J Med. 2024;391(14):1277-1286.

Siste nytt om en av verdens "eldste" sykdommer - pneumoni (eller lungebetennelse)! I dag har vi med oss fire forskere: Lars Heggelund, Magnus Gottfredson, Siri Knoop og Magrit Jarlsdatter Hovind tar oss gjennom viktige momenter og gir oss også et innblikk i fremtiden. Heng med!Referanser: Leannec: A treatise on the diseases of the chest and on mediate auscultation. 1834Heltborg A, et al. Can clinicians identify community-acquired pneumonia on ultralow-dose CT? A diagnostic accuracy study. Scand J Trauma Resusc Emerg Med. 2024 Aug 7;32(1):67.Lorentzen MJ, et al. Handheld Ultrasound Devices Used by Newly Certified Operators for Pneumonia in the Emergency Department-A Diagnostic Accuracy Study. Diagnostics (Basel). 2024 Aug 30;14(17):1921.Jones BE, et al. Diagnostic Discordance, Uncertainty, and Treatment Ambiguity in Community-Acquired Pneumonia : A National Cohort Study of 115 U.S. Veterans Affairs Hospitals. Ann Intern Med. 2024 Sep;177(9):1179-1189. Charalampous T et al. Routine Metagenomics Service for ICU Patients with Respiratory Infection. Am J Respir Crit Care Med. 2024 Jan 15;209(2):164-174. Lydon E, Langelier CR. Respiratory Metagenomics: Ready for Prime Time? Am J Respir Crit Care Med. 2024 Jan 15;209(2):124-126. Rögnvaldsson KG, Bjarnason A, Ólafsdóttir IS, Helgason KO, Guðmundsson A, Gottfreðsson M. Adults with symptoms of pneumonia: a prospective comparison of patients with and without infiltrates on chest radiography. Clin Microbiol Infect. 2023 Jan;29(1):108.e1-108.e6.https://indremedisineren.no/2017/04/samfunnservervet-lungebetennelse-mikrobiologisk-diagnostikk-arsaker-og-behandling/https://www.ahus.no/kliniske-studier/athenian-antibiotikabehandling-ved-virale-luftveisinfeksjoner/Serigstad S, et al; CAPNOR study group. Impact of rapid molecular testing on diagnosis, treatment and management of community-acquired pneumonia in Norway: a pragmatic randomised controlled trial (CAPNOR). Trials. 2022 Aug 1;23(1):622. Hosted on Acast. See acast.com/privacy for more information.

Send us a textDescription: An immersive reading of Hope by Joseph Zarconi with reflection on hope, goal concordant care, chemotherapy, and patients with young children. Website:https://anauscultation.wordpress.comReferences:Zarconi J. Hope. Ann Intern Med. 2024 Apr;177(4):541https://www.acpjournals.org/doi/10.7326/M23-2289 Feldman DB, Corn BW. Hope and cancer. Curr Opin Psychol. 2023 Feb;49:101506.

You're the new intern on your first night of night float. First page, right off the bat – AFib with rates into the 150s. What's your next move?! Dr. Nathan Anderson takes the anxiety out of approaching Atrial Fibrillation in the post-operative patient. Join him and Dr. Elizabeth Maginot as they discuss this very common post-operative you're guaranteed to see on the wards.  Hosts:  - Dr. Nathan Anderson, Internal Medicine Associate Professor and Hospitalist, University of Nebraska  - Dr. Elizabeth Maginot, General Surgery Resident and BTK Surgical Education Fellow, University of Nebraska Medical Center, Twitter: @e_magination95 Learning Objectives:  - Discuss the underlying pathophysiological mechanisms that contribute to the development of atrial fibrillation in the postoperative setting.  - Critically approach the different management options for atrial fibrillation in the post-cardiac and non-cardiac surgery settings, including rate versus rhythm control, indications for cardioversion, and the role of anticoagulation.  - Identify common risk factors for atrial fibrillation in the post-operative setting.  - Discuss long-term management and follow-up strategies for patients who develop atrial fibrillation after surgery. References:  1. Bhave PD, Goldman LE, Vittinghoff E, Maselli J, Auerbach A. Incidence, predictors, and outcomes associated with postoperative atrial fibrillation after major noncardiac surgery. AmericanHeart Journal. 2012;164(6):918-924. doi:10.1016/j.ahj.2012.09.004 https://pubmed.ncbi.nlm.nih.gov/23194493/ 2. Gialdini G, Nearing K, Bhave PD, et al.. Perioperative Atrial Fibrillation and the Long-term Risk ofIschemic Stroke. JAMA. 2014;312(6):616. doi:10.1001/jama.2014.9143 https://pubmed.ncbi.nlm.nih.gov/25117130/ 3. Snow V, Weiss KB, LeFevre M, McNamara R, Bass E, Green LA, Michl K, Owens DK, Susman J, Allen DI, Mottur-Pilson C; AAFP Panel on Atrial Fibrillation; ACP Panel on Atrial Fibrillation.Management of newly detected atrial fibrillation: a clinical practice guideline from the AmericanAcademy of Family Physicians and the American College of Physicians. Ann Intern Med. 2003 Dec16;139(12):1009-17. doi: 10.7326/0003-4819-139-12-200312160-00011. PMID: 14678921. https://pubmed.ncbi.nlm.nih.gov/14678921/ 4. A Comparison of Rate Control and Rhythm Control in Patients with Atrial Fibrillation. NewEngland Journal of Medicine. 2002;347(23):1825-1833. doi:10.1056/nejmoa021328 https://pubmed.ncbi.nlm.nih.gov/12466506/ Learn more about our Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship course and preview a full chapter here: https://app.behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  DOMINATE THE DAY 

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-392 Overview: Tune in as we explore a recent study that found no net all-cause benefit or harm from vitamin D and calcium supplementation. We review the study's findings in detail and reflect on whether these supplements should be recommended to our patients based on the latest evidence. Episode resource links: Ann Intern Med. doi:10.7326/M23-2598 Guest: Robert A. Baldor MD, FAAFP Music Credit: Richard Onorato Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com 

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-392 Overview: Tune in as we explore a recent study that found no net all-cause benefit or harm from vitamin D and calcium supplementation. We review the study's findings in detail and reflect on whether these supplements should be recommended to our patients based on the latest evidence. Episode resource links: Ann Intern Med. doi:10.7326/M23-2598 Guest: Robert A. Baldor MD, FAAFP Music Credit: Richard Onorato Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com 

Rapha, Ênio e Guilherme Kenzzo conversam sobre Transtorno de Ansiedade Generalizada (TAG): - Quais são os diagnósticos diferenciais? - Como diagnosticar e acompanhar TAG? - Como tratar TAG? Tudo isso nesse episódio! Referências: 1. Szuhany KL, Simon NM. Anxiety Disorders: A Review. JAMA. 2022 Dec 27;328(24):2431-2445. doi: 10.1001/jama.2022.22744. PMID: 36573969. 2. Penninx BW, Pine DS, Holmes EA, Reif A. Anxiety disorders. Lancet. 2021 Mar 6;397(10277):914-927. doi: 10.1016/S0140-6736(21)00359-7. Epub 2021 Feb 11. Erratum in: Lancet. 2021 Mar 6;397(10277):880. PMID: 33581801; PMCID: PMC9248771. 3. Stein MB, Sareen J. CLINICAL PRACTICE. Generalized Anxiety Disorder. N Engl J Med. 2015 Nov 19;373(21):2059-68. doi: 10.1056/NEJMcp1502514. PMID: 26580998. 4. Stahl, S. M. (2021). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press. - Jeremy DeMartini, Gayatri Patel, Tonya L Fancher. Generalized Anxiety Disorder. Ann Intern Med. 2019 Apr 2;170(7):ITC49-ITC64. doi: 10.7326/AITC201904020. 5. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.) 6. Slee, April et al. “Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysis.” Lancet (London, England) vol. 393,10173 (2019): 768-777. doi:10.1016/S0140-6736(18)31793-8 7. Brawman-Mintzer, Olga et al. “Sertraline treatment for generalized anxiety disorder: a randomized, double-blind, placebo-controlled study.” The Journal of clinical psychiatry vol. 67,6 (2006): 874-81. doi:10.4088/jcp.v67n0603 8. Guaiana, Giuseppe et al. “Hydroxyzine for generalised anxiety disorder.” The Cochrane database of systematic reviews ,12 CD006815. 8 Dec. 2010, doi:10.1002/14651858.CD006815.pub2

In this episode of Cardiology Digest, we delve into three pivotal papers to help us navigate modern cardiology and patient care strategies.  STUDY #1: First, we explore findings from a Swedish study that questions the blanket application of beta-blockers after an acute myocardial infarction in patients with normal left ventricular ejection fraction. Are we witnessing the end of an era in how we manage these patients? The complexities and nuances of this study are thought-provoking!  Yndigegn, T, Lindahl, B, Mars, K, et al. 2024. Beta-blockers after myocardial infarction and preserved ejection fraction. N Engl J Med. 15: 1372–1381. (https://doi.org/10.1056/NEJMoa2401479) Steg, PG. 2024. Routine beta-blockers in secondary prevention—On injured reserve. N Engl J Med. 15: 1434–1436. (https://doi.org/10.1056/NEJMe2402731) STUDY #2: Next, the integration of artificial intelligence in healthcare takes center stage, with a groundbreaking approach that uses AI in combination with routine chest x-rays. Could this offer a novel way to assess elevated risks for major adverse cardiovascular events, especially in settings where detailed clinical data might be lacking? The implications could transform patient screenings and prognostic assessments. Weiss, J, Raghu, VK, Paruchuri, K, et al. 2024. Deep learning to estimate cardiovascular risk from chest radiographs: A risk prediction study. Ann Intern Med. 4: 409–417. (https://doi.org/10.7326/M23-1898) STUDY #3: Lastly, we'll look into an exciting advancement in interventional cardiology with the introduction of drug-coated balloons. Fresh from their recent FDA approval in March of this year, these innovative devices represent a significant breakthrough for treating patients with in-stent restenosis, especially those who haven't responded well to multiple drug-eluting stents. Yeh, RW, Shlofmitz, R, Moses, J, et al. 2024. Paclitaxel-coated balloon vs uncoated balloon for coronary in-stent restenosis: The AGENT IDE randomized clinical trial. JAMA. 12: 1015–1024. (https://doi.org/10.1001/jama.2024.1361) Kundu, A and Moliterno, DJ. 2024. Drug-coated balloons for in-stent restenosis—Finally leaving nothing behind for US patients. JAMA. 12: 1011–1012. (https://doi.org/10.1001/jama.2024.0813) Join us to explore the potential impacts of these studies, the ongoing debates they spark within the cardiology community, and to see how these findings could influence your clinical decisions. Learn more with these courses: Chest X-Ray Essentials (7 CME) Chest X-Ray Essentials Workshop (1 CME) Get a Basic or Pro account, or, get a Trial account. Show notes: Visit us at  https://www.medmastery.com/podcasts/cardiology-podcast.

This week on Medmastery's Cardiology Digest, we're peeling back the layers of three enlightening studies that are pushing the boundaries of what we know about cardiac care. STUDY #1: First, we revisit the use of an everyday medication to check if it's doing more harm than good in the elderly. Aspirin, long touted for its preventative benefits, is under scrutiny for its role in anemia. Should we rethink the use of aspirin in primary prevention, especially among the older population? McQuilten, ZK, Thao, LTP, Pasricha, S-R, et al. 2023. Effect of low-dose aspirin versus placebo on incidence of anemia in the elderly: A secondary analysis of the Aspirin in Reducing Events in the Elderly trial. Ann Intern Med. 7: 913–921. (https://www.acpjournals.org/doi/10.7326/M23-0675) STUDY #2: Then, we shift focus to a comparison of approaches to mitral valve repair: the less-invasive minithoracotomy versus the conventional median sternotomy. Patient outcomes and success rates are put under the microscope, so we can tease apart what truly makes a difference in the final result. Is it the size of the incision or the skill of the hands making it?  Akowuah, EF, Maier, RH, Hancock, HC, et al. 2023. Minithoracotomy vs conventional sternotomy for mitral valve repair: A randomized clinical trial. JAMA. 22: 1957–1966. (https://jamanetwork.com/journals/jama/fullarticle/2805908) STUDY #3: Lastly, we wrap up with an insightful discussion on compression stockings after acute DVT, to see if they can prevent post-thrombotic syndrome. Do we have enough evidence to make confident recommendations on the real benefits and drawbacks of compression wearables? And how long should patients use them? We delve into the practical aspects of incorporating the findings of this paper into patient care. Meng, J, Liu, W, Wu, Y, et al. Is it necessary to wear compression stockings and how long should they be worn for preventing post thrombotic syndrome? A meta-analysis of randomized controlled trials. Thromb Res. 225: 79–86. (https://www.thrombosisresearch.com/article/S0049-3848(23)00090-7/fulltext) Join us as we dig into the actionable insights from these studies, so we can all better optimize our patients' outcomes!  Learn more with these courses: Cardiac MRI Essentials:  https://www.medmastery.com/courses/cardiac-mri-essentials Echo Masterclass—The Valves: https://www.medmastery.com/courses/echo-masterclass-valves Show notes: Visit us at  https://www.medmastery.com/podcasts/cardiology-podcast.

Today we dive into three cardiology papers with important insights for cardiac care. STUDY #1: We explore an analysis that compares Coronary CT Angiography (CCTA) with stress modalities like SPECT-MPI. We see if CCTA has the potential to reduce the need for invasive angiography, and how it stacks up against other testing strategies. Zito, A, Galli, M, Biondi-Zoccai, G, et al. 2023. Diagnostic strategies for the assessment of suspected stable coronary artery disease: A systematic review and meta-analysis. Ann Intern Med. 6: 817–826. (https://www.acpjournals.org/doi/10.7326/M23-0231) STUDY #2: We discuss the approval of a dual-chamber leadless pacemaker system by the FDA. Although this study supports the efficacy of this innovative approach in certain scenarios, it also raises important concerns.  Knops, RE, Reddy, VY, Ip, JE, et al. 2023. A dual-chamber leadless pacemaker. N Engl J Med. 25: 2360–2370. (https://www.nejm.org/doi/10.1056/NEJMoa2300080) STUDY #3: We look at a comprehensive retrospective study that evaluates aggressive management of hypertension in hospitalized adults. What are the ramifications of minimizing the use of BP-lowering agents, particularly intravenous ones, in certain inpatient scenarios? Anderson, TS, Herzig, SJ, Jing, B, et al. 2023. Clinical outcomes of intensive inpatient blood pressure management in hospitalized older adults. JAMA Intern Med. 7: 715–723. (https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2805021) Join us as we dissect these studies, unpacking their methodologies, outcomes, and the intriguing questions they raise.  For show notes, visit us at https://www.medmastery.com/podcasts/cardiology-podcast Learn more with these courses: Pacemaker Essentials: https://www.medmastery.com/courses/pacemaker-essentials Pacemaker Essentials Workshop: https://www.medmastery.com/workshops/pacemaker-essentials-workshop Coronary Angiography Essentials: https://www.medmastery.com/courses/coronary-angiography-essentials

Articles that Changed Our Practice-Part 1    In this episode we discuss 5 articles that changed our addiction medicine practice.    Mahdi Sheikh, et al. Postdiagnosis Smoking Cessation and Reduced Risk for Lung Cancer Progression and Mortality: A Prospective Cohort Study. Ann Intern Med.2021;174:1232-1239. [Epub 27 July 2021]. (Episode 4)    Santos GM, et al. Targeted Oral Naltrexone for Mild to Moderate Alcohol Use Disorder Among Sexual and Gender Minority Men: A Randomized Trial. Am J Psychiatry. 2022 Dec 1;179(12):915-926. Epub 2022 Oct 26. (Episode 20)    Perry, Briana N. MD; et al. Buprenorphine-naloxone Versus Buprenorphine for Treatment of Opioid Use Disorder in Pregnancy. Journal of Addiction Medicine 16(6):p e399-e404, 11/12 2022. (Episode 17)  Biddinger KJ, Emdin CA, Haas ME, et al. Association of Habitual Alcohol Intake With Risk of Cardiovascular Disease. JAMA Netw Open. 2022;5(3):e223849. (Episode 1)    Reed, M.K., et al. Sorting through life: evaluating patient-important measures of success in a medication for opioid use disorder (MOUD) treatment program. Subst Abuse Treat Prev Policy 18, 4 (2023). (Episode 19)  ----------  This podcast offers category 1 and MATE-ACT CME credits through MI CARES and Michigan State University. To get credit for this episode and others, go to this link to make your account, take a brief quiz, and claim your credit. To learn more about opportunities in addiction medicine, please visit MI CARES.  ----------  Episode Credits:  Original theme music: composed and performed by Benjamin Kennedy  Audio production: Erin McCue  Executive Producer: Dr. Patrick Beeman  A podcast from Ars Longa Media  ----------  This is Addiction Medicine Journal Club with Dr. Sonya Del Tredici and Dr. John Keenan. We practice addiction medicine and primary care, and we believe that addiction is a disease that can be treated. This podcast reviews current articles to help you stay up to date with research that you can use in your addiction medicine practice.     The best part of any journal club is the conversation. Send us your comments on social media or join our Facebook group.    Email: addictionmedicinejournalclub@gmail.com   Facebook: @AddictionMedJC  Facebook Group: Addiction Medicine Journal Club  Instagram: @AddictionMedJC   Threads: @AddictionMedJC  Twitter/X: @AddictionMedJC   YouTube: addictionmedicinejournalclub    Addiction Medicine Journal Club is intended for educational purposes only and should not be considered medical advice. The views expressed here are our own and do not necessarily reflect those of our employers or the authors of the articles we review. All patient information has been modified to protect their identities. 

TIME STAMPS: 03:11 Definition of a ZEALOT. 05:53 Two main types of people who track Calories. 10:32 What is a BOMB CALORIMETER, and how does this relate to the LAWS OF THERMODYNAMICS? 14:04 A simple way to BURN FAT by INCREASING YOUR “CALORIES.” 16:33 How to speak “mostly the same language” with Calorie-trackers (we actually agree on most aspects of fat loss). 17:08 RANDOMIZED TRIAL BREAKDOWN: Lean ME, Malkova D. Altered gut and adipose tissue hormones in overweight and obese individuals: cause or consequence? Int J Obes (Lond). 2016 Apr;40(4):622-32. doi: 10.1038/ijo.2015.220. Epub 2015 Oct 26. PMID: 26499438; PMCID: PMC4827002. 19:32 Review of Nate's contest prep consuming OVER 3000 CALORIES/DAY without ANY cardio through PEAK WEEK to place 2nd at the Granite State Open in New Hampshire in October 2023 over a split-judging decision; why this is the standard for my diet and the rest of our bodybuilding athletes. 23:19 What to do when you hit a FAT-BURNING PLATEAU on a KETOGENIC CONTEST PREP (hint: it involves increasing “Calories”). 26:51 MEAL TIMING / 2MAD / OMAD (one meal a day): yet another variable that CICO does not account for. 29:48 Your body will adjust to UNDEREATING by triggering specific HORMONES. STUDIES: Ludwig DS, Apovian CM, Aronne LJ, Astrup A, Cantley LC, Ebbeling CB, Heymsfield SB, Johnson JD, King JC, Krauss RM, Taubes G, Volek JS, Westman EC, Willett WC, Yancy WS Jr, Friedman MI. Competing paradigms of obesity pathogenesis: energy balance versus carbohydrate-insulin models. Eur J Clin Nutr. 2022 Sep;76(9):1209-1221. doi: 10.1038/s41430-022-01179-2. Epub 2022 Jul 28. PMID: 35896818; PMCID: PMC9436778. / Foltin RW, Fischman MW, Emurian CS, Rachlinski JJ. Compensation for caloric dilution in humans given unrestricted access to food in a residential laboratory. Appetite. 1988 Feb;10(1):13-24. doi: 10.1016/s0195-6663(88)80029-1. PMID: 3355123. / DiNicolantonio JJ, O'Keefe JH. Added Sugars Drive Insulin Resistance, Hyperinsulinemia, Hypertension, Type 2 Diabetes and Coronary Heart Disease. Mo Med. 2022 Nov-Dec;119(6):519-523. PMID: 36588634; PMCID: PMC9762218. 39:45 Colt's MACROS & CALORIE CALCULATIONS to prep to GUEST POSE. 200g pro / 250g fat = 3050 Calories / day. 45:00 Foster GD, Wyatt HR, Hill JO, Makris AP, Rosenbaum DL, Brill C, Stein RI, Mohammed BS, Miller B, Rader DJ, Zemel B, Wadden TA, Tenhave T, Newcomb CW, Klein S. Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Ann Intern Med. 2010 Aug 3;153(3):147-57. doi: 10.7326/0003-4819-153-3-201008030-00005. PMID: 20679559; PMCID: PMC2949959. 46:42 How GLUCOSE KILLS MITOCHONDRIA (the powerhouse of your cells!) Dr. Robert Kiltz (renowned author & fertility doctor) Kiltz's Keto is Carnivore: A Guide for a Fertile Life & Beyond, p.77 FAT = our PRIMARY FUEL SOURCE. 48:30 Watch MOST OF YOUR LIFE PROBLEMS GO AWAY when you EAT THE RIGHT FOOD and WORSHIP THE RIGHT DUDE!!! 49:01 Why YOUR BODY will tell you HOW MUCH FOOD TO EAT (you don't need to track Calories to find this out!!!) 50:02 The FIVE (5) TASTES: SWEET, SOUR, BITTER, SALTY & UMAMI/SAVORY. 52:01 Why PLANTS are the ULTIMATE PREDATORS! 55:18 Are you ON A BUDGET? That's why you should GO CARNIVORE and here's why! 57:41 SALE-SHOPPING. How to save on your meat shopping and make it work in your meal plan. 58:02 Detailed breakdown & cost analysis of Colt's current meal plan and GROCERY BILL (less than $6/day). 01:01:22 ORGAN MEATS: The CHEAPEST & MOST NUTRIENT DENSE animal-based foods to include in your meal plan. 01:04:10 How to make your weight loss journey SUSTAINABLE. 01:04:50 AUTISM & the Carnivore Diet. 01:11:38 Working out FASTED vs. FED: which is the most NATURAL for humans and which is best for you considering your lifestyle?  “CarnivoreJT” is an Equip-Foods sponsored bodybuilder, having just released a cook book (on his website) and hosts The Inner Carnivore Podcast. IG: @ carnivorejt / www.theinnercarnivore.com

Our latest episode dissects three groundbreaking studies that are reshaping our understanding of the heart and its intricate connections to the body and mind.   STUDY #1: First, we explore the potential of high-sensitivity cardiac troponin I (hs-cTnI) in risk-stratifying patients with known coronary artery disease. While current guidelines don't yet recommend these tests, could there be untapped value in using troponin concentration as a preventive treatment guide? Join us as we explore the intriguing possibilities and implications presented in this study from the Journal of the American College of Cardiology. Wereski, R, Adamson, P, Daud, NSS, et al. 2023. High-sensitivity cardiac troponin for risk assessment in patients with chronic coronary artery disease. J Am Coll Cardiol. 6: 473–485. (https://doi.org/10.1016/j.jacc.2023.05.046)   STUDY #2: Next, we shift our focus to the brain-heart connection. Ever wondered about the cognitive repercussions of a myocardial infarction (MI)? This study from JAMA Neurology sheds light on the potential cognitive consequences of an MI.  Johansen, MC, Ye, W, Gross, A, et al. 2023. Association between acute myocardial infarction and cognition. JAMA Neurol. 7: 723–731. (https://doi.org/10.1001/jamaneurol.2023.1331)   STUDY #3: Third, we dive deep (pun intended!) into decompression illness. Certain divers might want to reconsider their next dive because a recent Annals of Internal Medicine study suggests a primary mechanism behind decompression illness that could change the way we perceive diving risks. What are the implications for those passionate about the deep blue? Lee, H-J, Lim, DS, Lee, J, et al. 2023. Decompression illness in divers with or without patent foramen ovale: A cohort study. Ann Intern Med. 7: 934–939. (https://doi.org/10.7326/M23-0260)   Don't miss out on these captivating discussions. Listen in to stay at the forefront of cardiology insights and to satiate your curiosity about these studies' findings. We promise, it's a heartbeat away from being your favorite episode yet! For show notes, visit us at https://www.medmastery.com/podcasts/cardiology-podcast.

Our latest episode of Cardiology Digest delves into some of the most intriguing and thought-provoking recent studies in the realm of heart health. Here's a sneak peek into what awaits you:   STUDY #1: We have the Amiodarone Enigma: An observational study in the Annals of Internal Medicine has brought up some concerns regarding the use of amiodarone in patients with heart failure, coronary disease, and renal failure. But is everything as it seems? Dive into the nuances of this study with us, as we explore whether the observed excess bleeding is truly due to the drug, or the elevated bleeding risk in these patients. Is it time to change our practice or do we need more compelling evidence? Ray WA et al. Risk for bleeding-related hospitalizations during use of amiodarone with apixaban or rivaroxaban in patients with atrial fibrillation: A retrospective cohort study. Ann Intern Med 2023 Jun; 176:769. (https://doi.org/10.7326/M22-3238)   STUDY #2: We re-evaluate Aspirin for older patients, thanks to the ASPREE study that was recently published in JAMA Network Open. It looks like it's time to reassess our recommendations and consider whether we're truly informed about the pros and cons of aspirin as a risk-reduction strategy.  Cloud GC et al. Low-dose aspirin and the risk of stroke and intracerebral bleeding in healthy older people: Secondary analysis of a randomized clinical trial. JAMA Netw Open 2023 Jul 3; 6:e2325803. (https://doi.org/10.1001/jamanetworkopen.2023.25803)   STUDY #3: Lastly, we find out if there are health benefits to being a “weekend warrior”. Have you ever had patients question the health benefits of their active weekends? This study from JAMA sheds light on the potential importance of exceeding the 150-minute weekly threshold of moderate-to-vigorous physical activity. But just how beneficial is it? Tune in to find out! Khurshid S et al. Accelerometer-derived “weekend warrior” physical activity and incident cardiovascular disease. JAMA 2023 Jul 18; 330:247. (https://doi.org/10.1001/jama.2023.10875)   Join us in this episode as we dissect these studies, offering insights and sparking discussions that could reshape our understanding of cardiology. Don't miss out on this enlightening journey!  For show notes, visit us at https://www.medmastery.com/podcasts/cardiology-podcast.

Welcome to the latest episode of Cardiology Digest, where we dive into the pressing questions of today's medical research. Here's a glimpse of what's to come:   STUDY #1: Have you ever wondered about the optimal timing for introducing DOACs (direct-acting oral anticoagulants) after strokes due to atrial fibrillation? This New England Journal of Medicine study dives into the potential advantages of early DOAC introduction. You might be surprised at the rates of symptomatic intracranial hemorrhage. But remember, patient profiles vary—for example, what works for those with mild neurologic deficits might not hold true for everyone. Fischer, U, Koga, M, Strbian, D, et al. 2023. Early versus later anticoagulation for stroke with atrial fibrillation. N Engl J Med. 26: 2411–2421. (https://doi.org/10.1056/NEJMoa2303048)   STUDY #2: Next, we'll take a look at the curious case of rising hematocrit in certain chronic kidney disease patients who have anemia and were treated with SGLT-2 inhibitors. Did they have a genuine improvement in anemia or was it merely an illusion? SGLT-2 inhibitors are the focal point, and we'll dissect their multifaceted effects that may be at play here.  Koshino, A, Schechter, M, Chertow, GM, et al. 2023. Dapagliflozin and anemia in patients with chronic kidney disease. NEJM Evid.  6. (https://doi.org/10.1056/EVIDoa2300049)   STUDY #3: Hospitalization due to COVID-19 has presented a conundrum regarding post-discharge thromboprophylaxis. With the pandemic making such profound impacts on global health, it's crucial to address these concerns. See how new findings align with prior observational studies, and where rivaroxaban fits into all of this. Wang, TY,  Wahed, AS, Morris, A, et al. 2023. Effect of thromboprophylaxis on clinical outcomes after COVID-19 hospitalization. Ann Intern Med. 4: 515–523. (https://doi.org/10.7326/M22-3350)   STUDY #4: Cholesterol management remains pivotal in cardiac care. But the question our fourth study poses is this: do age differences impact the effectiveness of statins, particularly in lowering LDL cholesterol? A dive into this study could reshape perceptions on dosage recommendations for certain patient demographics. Corn, G, Melbye, M, Hlatky, MA, et al. 2023. Association between age and low-density lipoprotein cholesterol response to statins: A Danish nationwide cohort study. Ann Intern Med. 8: 1017–1026. (https://doi.org/10.7326/M22-2643)   So, arm yourself with your favorite beverage and comfy earphones, and join us in uncovering the gems these studies hold. The revelations might just change the way you see these medications and treatments!

Hyponatremia is a side effect of most diuretics but the incidence from thiazides is unknown. Join host, Geoff Wall, as he evaluates a new study from Denmark evaluating hyponatremia and thiazides. The GameChangerThiazide diuretics are considered first-line therapy but electrolyte side effects are underevaluated. A new study suggests hyponatremia is significantly more common than previously reported, especially in the elderly. HostGeoff Wall, PharmD, BCPS, FCCP, BCGPProfessor of Pharmacy Practice, Drake UniversityInternal Medicine/Critical Care, UnityPoint Health ReferenceAndersson NW, Wohlfahrt J, Feenstra B, et al. Cumulative Incidence of Thiazide-Induced Hyponatremia: A Population-Based Cohort Study. Ann Intern Med. 2023 Dec 19. doi: 10.7326/M23-1989. Epub ahead of print. PMID: 38109740.https://www.acpjournals.org/doi/abs/10.7326/M23-1989?journalCode=aim Pharmacist Members, REDEEM YOUR CPE HERE! Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)CPE Information Learning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Discuss the use of thiazides in hypertension and their adverse effects 2. Assess the strengths and weaknesses of the Andersson et al study0.05 CEU/0.5 HrUAN: 0107-0000-24-032-H01-PInitial release date: 1/15/2024Expiration date: 1/15/2025Additional CPE details can be found here.Follow CEimpact on Social Media:LinkedInInstagram

Dr. Mark Oldham, Associate Professor of Psychiatry at University of Rochester Medical Center, President-Elect of the American Delirium Society, and Deputy Editor of the Journal of the Academy of Consultation-Liaison Psychiatry, takes us through a deep dive on delirium. This episode covers an enormous amount of material. Contrast  encephalopathy and delirium before diving into the dangerousness of delirium and prevention strategies. Explore the neurobiology of delirium and tie it to validated assessment tools and treatment approaches. We also discuss areas for future research, and learn to appreciate the evolutionary function that delirium serves.This episode also deserves some references! (3:38) Lipowski ZJ. Delirium: Acute Brain Failure in Man. Springfield, IL: Charles C Thomas, 1980.  (7:55) Slooter AJC, Otte WM, Devlin JW, et al. Updated nomenclature of delirium and acute encephalopathy: statement of ten Societies. Intensive Care Med. 2020;46(5):1020-1022.  (21:46)  Marcantonio ER, Ngo LH, O'Connor M, et al. 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study [published correction appears in Ann Intern Med. 2014 Nov 18;161(10):764]. Ann Intern Med. 2014;161(8):554-561.   (29:50) Kunicki ZJ, Ngo LH, Marcantonio ER, et al. Six-Year Cognitive Trajectory in Older Adults Following Major Surgery and Delirium. JAMA Intern Med. 2023;183(5):442-450.   (41:40) Mews MR, Tauch D, Erdur H, Quante A. Comparing consultation-liaison psychiatrist's and neurologist's approaches to delirium - A retrospective analysis. Int J Psychiatry Med. 2016;51(3):284-301. = (1:08:08) Girard TD, Exline MC, Carson SS, et al. Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness. N Engl J Med. 2018;379(26):2506-2516.   (1:09:33) Hui D, Frisbee-Hume S, Wilson A, et al. Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care: A Randomized Clinical Trial. JAMA. 2017;318(11):1047-1056.   (1:31:36) By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081.  (1:33:54) Burton JK, Craig LE, Yong SQ, et al. Non-pharmacological interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev. 2021;7(7):CD013307. Published 2021 Jul 19.   (1:35:41) Skrobik Y, Duprey MS, Hill NS, Devlin JW. Low-Dose Nocturnal Dexmedetomidine Prevents ICU Delirium. A Randomized, Placebo-controlled Trial. Am J Respir Crit Care Med. 2018;197(9):1147-1156.   (1:36:00) Subramaniam B, Shankar P, Shaefi S, et al. Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial [published correction appears in JAMA. 2019 Jul 16;322(3):276]. JAMA. 2019;321(7):686-696. 

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.Originally released: December 5, 2019In 2016, when we first launched the BrainWaves podcast, cryptogenic stroke was a poorly understood concept. Three years later, it remains poorly understood. But we are making progress. In this week's update of episode 10, we review the progress that has been made in the pathogenesis, diagnosis, and management of these patients.Produced by James E Siegler. The original 2016 version of this show was also produced by Dr. Noah Levinson. Music courtesy of Josh Woodward, Julie Maxwell, Dan Lebowitz, and this group called E's Jammy Jams. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @BrainWavesaudio for the latest updates to the podcast.REFERENCESDi Tullio M, Sacco RL, Gopal A, Mohr JP, Homma S. Patent foramen ovale as a risk factor for cryptogenic stroke. Ann Intern Med 1992;117(6):461-5. PMID 1503349Diener HC, Sacco RL, Easton JD, et al. Dabigatran for prevention of stroke after embolic stroke of undetermined source. N Engl J Med 2019;380(20):1906-17. PMID 31091372Fonseca AC, Ferro JM. Drug abuse and stroke. Curr Neurol Neurosci Rep 2013;13(2):325. PMID 23299821Hart RG, Sharma M, Mundl H, et al. Rivaroxaban for stroke prevention after embolic stroke of undetermined source. N Engl J Med 2018;378(23):2191-201. PMID 29766772Jacobs BS, Boden-Albala B, Lin IF, Sacco RL. Stroke in the young in the northern Manhattan stroke study. Stroke 2002;33(12):2789-93. PMID 12468771Juul K, Tybjaerg-Hansen A, Steffensen R, Kofoed S, Jensen G, Nordestgaard BG. Factor V Leiden: The Copenhagen City Heart Study and 2 meta-analyses. Blood 2002;100(1):3-10. PMID 12070000Kaku DA, Lowenstein DH. Emergence of recreational drug abuse as a major risk factor for stroke in young adults. Ann Intern Med 1990;113(11):821-7. PMID 2240897Li J, Liu J, Liu M, et al. Closure versus medical therapy for preventing recurrent stroke in patients with patent foramen ovale and a history of cryptogenic stroke or transient ischemic attack. Cochrane Database Syst Rev 2015;2015(9):CD009938. PMID 26346232Mas JL, Derumeaux G, Guillon B, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med 2017;377(11):1011-21. PMID 28902593Overell JR, Bone I, Lees KR. Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies. Neurology 2000;55(8):1172-9. PMID 11071496Perera KS, Ng KK, Nayar S, et al. Association between low-dose rivaroxaban with or without aspirin and ischemic stroke subtypes: a secondary analysis of the COMPASS Trial. JAMA Neurol 2020;77(1):43-8. PMID 31524941Saver JL, Carroll JD, Thaler DE, et al. Long-term outcomes of patent foramen ovale closure or medical thera

Episode 146: RA vs OA    Future Dr. Magurany explains how to differentiate rheumatoid arthritis from osteoarthritis.  Written by Thomas Magurany, MSIV, Ross University School of Medicine. Comments by Hector Arreaza, MD. You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.1. Etiology: Rheumatoid Arthritis (RA): RA is an autoimmune disease wherein the immune system mistakenly attacks healthy tissues, particularly the synovial joints, usually between the ages of 30-50. Genetic predisposition, environmental factors such as smoking or infections, hormonal imbalances, and lower socioeconomic status have been associated with an increased risk of developing RA(1).Osteoarthritis (OA): OA primarily arises due to mechanical stress on the joints over time. Factors contributing to OA include age, obesity, joint injury or trauma, repetitive joint use or overuse, genetic abnormalities in collagen structure, and metabolic disorders affecting cartilage metabolism (2).The greatest risk factor for the development of OA is age with most patients presenting after 45 years of age. The greatest modifiable risk factor for OA is weight. People with a BMI >30 were found to have a 6.8 times greater risk of developing OA. (3) Primary OA is the most common and is diagnosed in the presence of associated risk factors such as: older age, female gender, obesity, anatomical factors, muscle weakness, and joint injury (occupation/sports activities) in the absence of trauma or disease. Secondary OA occurs alongside a pre-existing joint deformity including trauma or injury, congenital joint disorders, inflammatory arthritis, avascular necrosis, infectious arthritis, Paget disease, osteopetrosis, osteochondritis dissecans, metabolic disorders (hemochromatosis, Wilson's disease), Ehlers-Danlos syndrome, or Marfan syndrome.2. Pathogenesis:Rheumatoid Arthritis (RA):In some patients, RA is triggered by some sort of environmental factor in a genetically predisposed person. The best example is tobacco use in a patient with HLA-DRB1. The immune response in RA starts at sites distant from the synovial joints, such as the lung, gums, and GI tract. In these tissues, modified proteins are produced by biochemical reactions such as citrullination. (4)In RA, an abnormal immune response leads to chronic inflammation within the synovium lining the joints. The inflammatory cytokines released cause synovitis and lead to the destruction of articular cartilage and bone erosion through pannus formation. Immune cells infiltrate the synovium causing further damage. (4) In summary: formation of antibodies to citrullinated proteins, these antibodies begin attacking wrong tissues.Osteoarthritis (OA):The primary pathological feature of OA is the degeneration of articular cartilage that cushions the joints causing surface irregularity, and focal erosions. These changes progress down the bone and eventually involve the entire joint surface. Mechanical stress triggers chondrocyte dysfunction, leading to an imbalance between cartilage synthesis and degradation that cause cartilage outgrowths that ossify and form osteophytes. This results in the release of enzymes that degrade the extracellular matrix, leading to progressive cartilage loss. As more of the collagen matrix is damaged, chondrocytes undergo apoptosis. Improperly mineralized collagen causes subchondral bone thickening; in advanced disease, bone cysts infrequently occur (5). In summary: Osteophytes formation and cartilage loss.3. Clinical Presentation:Rheumatoid Arthritis (RA):The most common and predominant symptoms include joint pain and swelling, usually starting insidiously over a period of weeks to months. RA typically affects multiple joints symmetrically, commonly involving small joints of the hands, wrists, feet and progresses to involve proximal joints if left untreated. Morning stiffness lasting more than an hour is a characteristic feature. The affected joint will be painful if pressure is applied to the joint or on movement with or without joint swelling. Synovial thickening with a "boggy" feel on palpation will be noted. The classical physical findings of ulnar deviation, metacarpophalangeal joint subluxation, swan neck deformity, Boutonniere deformity, and the "bowstring" sign (prominent and tight tendons on the dorsum of the hand) are seen in advanced chronic disease. (4) Around ¼ of patients with RA may present with rheumatoid noduleswhich are well demarcated, flesh-colored subcutaneous lumps. They are usually described as being doughy or firm and are not typically tender unless they are inflamed. They are usually found on areas susceptible to repeated trauma or pressure and include the elbows, fingers and forearms. Osteoarthritis (OA):OA primarily affects weight-bearing joints such as knees, hips, spine, and hands. Symptoms include joint pain aggravated by activity and relieved with rest, morning stiffness lasting less than 30 minutes, joint swelling due to secondary inflammation, and occasionally the formation of bony outgrowths called osteophytes (6). Tenderness may be present at joint lines, and there may be pain upon passive motion. Classic physical exam findings in hand OA include Heberden's nodes (posterolateral swellings of DIP joints), Bouchard's nodes (posterolateral swellings of PIP joints), and “squaring” at the base of the thumb (first Carpal-Metarcapal or CMC joints), bony enlargement, crepitus, effusions (non-inflammatory), and a limited range of motion. Patients may also experience bony swelling, joint deformity, and instability (patients complain that the joint is “giving way” or “buckling,” a sign of muscle weakness). (5)4. Lab findings:Rheumatoid Arthritis: Laboratory testing often reveals anemia of chronic disease (increased ferritin, decreased iron and TIBC) and thrombocytosis. Neutropenia may be present if Felty syndrome is present. RF is present in 80-90% of patients with a sensitivity of 69%. In patients who are asymptomatic or those that have arthralgias, a positive RF and especially CCP predicts the onset of clinical RA. Patients with RA with RF, ACPA, or both are designated as having seropositive RA. About 10% of RA patients are seronegative. ESR and levels of CRP are usually elevated in patients with active disease and can be used to assess disease activity. The synovial fluid in RA will also reveal low C3 and C4 levels despite elevated serum levels.(4) Some non-specific inflammatory markers such as ESR, CRP can help you guide your diagnosis of RA.Osteoarthritis:Lab findings are not significant. Clinical diagnosis if the following are present: 1) pain worse with activity and better with rest, 2) age more than 45 years, 3) morning stiffness lasting less than 30 minutes, 4) bony joint enlargement, and 5) limitation in range of motion. Blood tests such as CBC, ESR, rheumatoid factor, ANA are usually normal but usually ordered to rule out an inflammatory process. Synovial fluid should show a white blood cell count less than 2,000/microL, predominantly mononuclear cells (non-inflammatory). X-rays of the affected joint can show findings consistent with OA, such as marginal osteophytes, joint space narrowing, subchondral sclerosis, and cysts; however, radiographic findings do not correlate to the severity of the disease and may not be present early in the disease. (5)5. Treatment Approaches:Rheumatoid Arthritis (RA):There is no cure for RA.The goal of treatment in RA is inducing remission and optimizing quality of life. This is initially done by beginning DMARDs, include methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide. Methotrexate is the initial DMARD of choice. Anti-TNF-alpha inhibitors include etanercept, infliximab, adalimumab, golimumab, and certolizumab may be used if DMARDs fail. NSAIDs are used to control joint pain and inflammation. Corticosteroids may be used as a bridge therapy to DMARDs in a newly diagnosed patient with a very active disease. (7) Coronary artery disease has a strong association with RA. RA is an independent risk factor for the development of coronary artery disease (CAD) and accelerates the development of CAD in these patients. Accelerated atherosclerosis is the primary cause of morbidity and mortality. There is increased insulin resistance and diabetes mellitus associated with RA and is thought to be due to chronic inflammation. When treated with specific DMARDs such as hydroxychloroquine, methotrexate, and TNF antagonists, there was a marked improvement in glucose control in these patients. (8) RA is not just a disease of the joints, it is able to affect multiple organ systems.Osteoarthritis (OA):OA treatment aims at reducing pain and improving joint function through a combination of non-pharmacological interventions like exercise programs tailored to strengthen muscles around affected joints, weight management strategies, and assistive devices like braces or walking aids if required (9). Medications including analgesics or nonsteroidal anti-inflammatory drugs may be prescribed for pain relief when necessary. Duloxetine has modest activity in relieving pain associated with OA. Intraarticular glucocorticoid joint injections have a variable response but are an option for those wanting to postpone surgical intervention. In severe cases where conservative measures fail, surgical options like joint replacement may be considered (9). Weight loss is a critical intervention in those who have overweight and obesity; each pound of weight loss can decrease the load across the knee 3 to 6-fold. (5) Summary: Medications (NSAIDs, topical, duloxetine), weight loss, PT, intraarticular injections of corticosteroids, and joint replacement.________________________________Conclusion: Now we conclude episode number 146, “RA vs. OA.” Future Dr. Magurany explained that rheumatoid arthritis is an autoimmune disease that presents with joint pain and inflammation, mostly on hands and small joints, accompanied by morning stiffness longer than 1 hour. The rheumatoid factor and ACPA may be positive in a percentage of patients but not always. The base of treatment is early treatment with disease-modifying antirheumatic drugs to induce remission of the disease. OA affects weight-bearing joints with little to no inflammation, treatment is mainly lifestyle modifications, analgesics, intraarticular injections, and joint replacement.This week we thank Hector Arreaza and Thomas Magurany. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Myasoedova E, Crowson CS & Gabriel SE et al. (2010). Is the incidence of rheumatoid arthritis rising?: Results from Olmsted County, Minnesota, 1955-2007. Arthritis and Rheumatism, 62(6), 1576-1582.Goldring MB & Goldring SR. (2007). Osteoarthritis. Journal of Cellular Physiology, 213(3), 626-634.King LK, March L, Anandacoomarasamy A. Obesity & osteoarthritis. Indian J Med Res. 2013;138(2):185-93. PMID: 24056594; PMCID: PMC3788203.Chauhan K, Jandu JS, Brent LH, et al. Rheumatoid Arthritis. [Updated 2023 May 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.Sen R, Hurley JA. Osteoarthritis. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.Hunter DJ, Bierma-Zeinstra S. & Eckstein F. (2014). OARSI Clinical Trials Recommendations: Design and conduct of clinical trials for primary hip and knee osteoarthritis: An expert consensus initiative of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) Task Force in collaboration with the Osteoarthritis Research Society International (OARSI). Osteoarthritis Cartilage, 22(7), 363-381.van Everdingen AA, Jacobs JW, Siewertsz Van Reesema DR, Bijlsma JW. Low-dose prednisone therapy for patients with early active rheumatoid arthritis: clinical efficacy, disease-modifying properties, and side effects: a randomized, double-blind, placebo-controlled clinical trial. Ann Intern Med. 2002 Jan 1;136(1):1-12. doi: 10.7326/0003-4819-136-1-200201010-00006. PMID: 11777359.Nicolau J, Lequerré T, Bacquet H, Vittecoq O. Rheumatoid arthritis, insulin resistance, and diabetes. Joint Bone Spine. 2017 Jul;84(4):411-416.Fernandes L, Hagen KB, Bijlsma JWJ et al. (2019). EULAR recommendations for non-pharmacological core management of hip and knee osteoarthritis. Annals of Rheumatic Diseases, 79(6), 715-722.Royalty-free music used for this episode: "Driving the Point." Downloaded on July 29, 2023, from https://www.videvo.net/ 

Contributor: Travis Barlock MD Educational Pearls: Clinical picture: A patient comes in with altered mental status, tachycardia, fever, elevated T4, and low TSH. What's the diagnosis?... Thyrotoxicosis secondary to Graves' Disease. How do you treat thyrotoxicosis? First, give a beta-blocker such as propranolol. This suppresses the elevated adrenergic activity. Second, give a thionamide such as propylthiouracil (PTU) or methimazole. This decreases the synthesis of new thyroid hormone. PTU is preferred because it also blocks the conversion of T4 to T3. Third, give an iodine solution such as potassium iodide. This blocks the release of thyroid hormone through a mechanism called the Wolff-Chaikoff effect. Note, this should be given about an hour after the PTU/methimazole to ensure iodine cannot be taken up and used to synthesize more thyroid hormone in individuals with toxic adenoma or toxic multinodular goiter. Fourth, give a glucocorticoid such as hydrocortisone. This will reduce thyroid hormone conversion from T4 to T3 and treat any concurrent adrenal insufficiency. References Abuid J, Larsen PR. Triiodothyronine and thyroxine in hyperthyroidism. Comparison of the acute changes during therapy with antithyroid agents. J Clin Invest. 1974 Jul;54(1):201-8. doi: 10.1172/JCI107744. PMID: 4134836; PMCID: PMC301541. Cooper DS, Saxe VC, Meskell M, Maloof F, Ridgway EC. Acute effects of propylthiouracil (PTU) on thyroidal iodide organification and peripheral iodothyronine deiodination: correlation with serum PTU levels measured by radioimmunoassay. J Clin Endocrinol Metab. 1982 Jan;54(1):101-7. doi: 10.1210/jcem-54-1-101. PMID: 6274892. Das G, Krieger M. Treatment of thyrotoxic storm with intravenous administration of propranolol. Ann Intern Med. 1969 May;70(5):985-8. doi: 10.7326/0003-4819-70-5-985. PMID: 5769631. Nayak B, Burman K. Thyrotoxicosis and thyroid storm. Endocrinol Metab Clin North Am. 2006 Dec;35(4):663-86, vii. doi: 10.1016/j.ecl.2006.09.008. PMID: 17127140. Tsatsoulis A, Johnson EO, Kalogera CH, Seferiadis K, Tsolas O. The effect of thyrotoxicosis on adrenocortical reserve. Eur J Endocrinol. 2000 Mar;142(3):231-5. doi: 10.1530/eje.0.1420231. PMID: 10700716. Summarized by Jeffrey Olson, MS2 | Edited by Jorge Chalit, OMSII

Episode Notes Drs. Zack Nelson (@zacroBID), Alison Dittmer, and Michael Pulia (@DrMichaelPulia) join Dr. Jillian Hayes (@thejillianhayes) to discuss the ins and outs of antimicrobial stewardship in one of the busiest parts of the hospital: the emergency department! Tune in for a discussion on communication considerations in the ED, the role of lipoglycopeptides for common gram-positive syndromes, and a rapid-fire round discussing common stewardship interventions. This podcast was supported by an educational grant from Melinta Therapeutics. References: Pulia M, et al. Antimicrobial Stewardship in the Emergency Department. Emerg Med Clin N Am 2018;36(4):853-872. doi: 10.1016/j.emc.2018.06.012. PMID: 30297009. Rech, Megan A et al. “PHarmacist Avoidance or Reductions in Medical Costs in Patients Presenting the EMergency Department: PHARM-EM Study.” Critical Care Explorations 2021;3(4):e0406. doi:10.1097/CCE.0000000000000406. PMID: 33912836. Sacdal JPA, Cheon E et al. Oritavancin versus oral antibiotics for treatment of skin and skin structure infections in the emergency department. Am J Emerg Med 2022;60:223-224. Jenkins TC, Jaukoos JS et al. Patterns of use and perceptions of an institution-specific antibiotic stewardship application among emergency department and urgent care clinicians. Infection Control and Hospital Epidemiology 2020;41:212-215. Dretske D, Schulz L, Werner E, Sharp B, Pulia M. Effectiveness of oritavancin for management of skin and soft tissue infections in the emergency department: A case series. The American Journal of Emergency Medicine 2021;43:77-80. doi: 10.1016/j.ajem.2021.01.050. PMID: 33545550. Paul M, Pulia M, Pulcini C. Antibiotic stewardship in the emergency department: not to be overlooked. Clin Microbiol Infect 2021;27(2):172-174. doi: 10.1016/j.cmi.2020.11.015. PMID: 33253938. Baxa J, McCreary E, Schulz L, Pulia M. Finding the niche: An interprofessional approach to defining oritavancin use criteria in the emergency department. Am J Emerg Med. 2020;38(2):321-324. doi:10.1016/j.ajem.2019.158442. Pulia MS, Hesse S, Schwei RJ, Schulz LT, Sethi A, Hamedani A. Inappropriate Antibiotic Prescribing for Respiratory Conditions Does Not Improve Press Ganey® Patient Satisfaction Scores in the Emergency Department. Open Forum Infect Dis 2020;7(6): ofaa214. doi:10.1093/ofid/ofaa214. Pulia MS, Lindenauer PK. Annals for Hospitalists Inpatient Notes - A Critical Look at Procalcitonin Testing in Pneumonia. Ann Intern Med. 2021;174(6):HO2-HO3. doi:10.7326/M21-1913. Redwood R, Knobloch MJ, Pellegrini DC, Ziegler MJ, Pulia M, Safdar N. Reducing unnecessary culturing: a systems approach to evaluating urine culture ordering and collection practices among nurses in two acute care settings. Antimicrob Resist Infect Control. 2018;7. doi:10.1186/s13756-017-0278-9. Pulia MS, Schwei RJ, Hesse SP, Werner NE. Characterizing barriers to antibiotic stewardship for skin and soft-tissue infections in the emergency department using a systems engineering framework. Antimicrob Steward Healthc Epidemiol. 2022;2(1):e180. doi:10.1017/ash.2022.316. May L, Gudger G, Armstrong P, et al. Multisite exploration of clinical decision making for antibiotic use by emergency medicine providers using quantitative and qualitative methods. Infect Control Hosp Epidemiol. 2014;35(9):1114-1125. doi:10.1086/677637. May L, Cosgrove S, L'archeveque M, et al. A Call to Action for Antimicrobial Stewardship in the Emergency Department: Approaches and Strategies. Ann Emerg Med 2013;62(1):69-77.e2. doi: 10.1016/j.annemergmed.2012.09.002. PMID: 23122955. Schoffelen T, Schouten JA, Hoogerwerf JJ, et al. Quality indicators for appropriate antimicrobial therapy in the emergency department: a pragmatic Delphi procedure. Clin Microbiol Infect 2021;27(2):210-214. doi: 10.1016/j.cmi.2020.10.027. PMID: 33144204. Yadav K, Stahmer A, Mistry RD, May L. An Implementation Science Approach to Antibiotic Stewardship in Emergency Departments and Urgent Care Centers. Academic Emergency Medicine 2020; 27(1):31-42. doi: 10.1111/acem.13873. PMID: 31625653. Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/   SIDP welcomes pharmacists and non-pharmacist members with an interest in infectious diseases, learn how to join here: https://sidp.org/Become-a-Member Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, Stitcher, Google Play, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/ Check out our podcast host, Pinecast. Start your own podcast for free with no credit card required. If you decide to upgrade, use coupon code r-7e7a98 for 40% off for 4 months, and support Breakpoints.

Description: An immersive reading of Alcestis by Rebekka DePew with reflection on resuscitation, life after death, and work-home balance.Website:https://anauscultation.wordpress.com/ Work:Alcestis by Rebekka DePewThose who die and then return areoften silentwhich has never once been attributed tohaving seen godsometimes when I come backI do not speaksometimes when I come backI smell on my children's breaththe tinge of flesh left too long unfedsinew without nervewe are lightning set to smolderI know that nowbefore I left I was toldthat the sun and the moon were too heavy forthe same skyI was not told that death would lingerI was not told that the river Styx was pettyand bureaucratic I was not toldthat I would always see theasphodel in its upperworld daffodil shadowsand never again fit like salt into water inthis living world with itsolive trees and vineyardsand chamomile tea in the eveningI belong to another worldone that does not know what to makeof such thingsReferencesAlcestis: https://www.acpjournals.org/doi/10.7326/M22-1169 DePew R. Alcestis. Ann Intern Med. 2023;176(3):422. doi:10.7326/M22-1169 Enjabment: https://www.poetryfoundation.org/learn/glossary-terms/enjambment  More poems by Rebekka DePewhttps://ars-medica.ca/index.php/journal/search/index?query=Rebekka+DePew&dateFromYear=&dateFromMonth=&dateFromDay=&dateToYear=&dateToMonth=&dateToDay=&authors= https://www.acpjournals.org/action/doSearch?AllField=Rebekka+DePew https://jamanetwork.com/searchresults?q=Rebekka%20DePew&allSites=1&SearchSourceType=1&exPrm_qqq={DEFAULT_BOOST_FUNCTION}%22Rebekka%20DePew%22&exPrm_hl.q=Rebekka%20DePew 

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-331 Overview: Current recommendations for when to start breast cancer screening do not consider race or ethnicity, which may be a source of racial disparity in breast cancer outcomes. In this installment, we take a closer look at these recommendations and how you can incorporate them into individualized patient care. Episode resource links: Chen T, Kharazmi E, Fallah M. Race and Ethnicity-Adjusted Age Recommendation for Initiating Breast Cancer Screening. JAMA Netw Open. 2023;6(4):e238893. Published 2023 Apr 3. Siu AL; U.S. Preventive Services Task Force. Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement [published correction appears in Ann Intern Med. 2016 Mar 15;164(6):448]. Ann Intern Med. 2016;164(4):279-296 Oeffinger KC, Fontham ET, Etzioni R, et al. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society [published correction appears in JAMA. 2016 Apr 5;315(13):1406]. JAMA. 2015;314(15):1599-1614.  Draft Update of USPSTF Screening for Breast Cancer: https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/breast-cancer-screening-adults Guest: Alan M. Ehrlich MD, FAAFP   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-331 Overview: Current recommendations for when to start breast cancer screening do not consider race or ethnicity, which may be a source of racial disparity in breast cancer outcomes. In this installment, we take a closer look at these recommendations and how you can incorporate them into individualized patient care. Episode resource links: Chen T, Kharazmi E, Fallah M. Race and Ethnicity-Adjusted Age Recommendation for Initiating Breast Cancer Screening. JAMA Netw Open. 2023;6(4):e238893. Published 2023 Apr 3. Siu AL; U.S. Preventive Services Task Force. Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement [published correction appears in Ann Intern Med. 2016 Mar 15;164(6):448]. Ann Intern Med. 2016;164(4):279-296 Oeffinger KC, Fontham ET, Etzioni R, et al. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society [published correction appears in JAMA. 2016 Apr 5;315(13):1406]. JAMA. 2015;314(15):1599-1614.  Draft Update of USPSTF Screening for Breast Cancer: https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/breast-cancer-screening-adults Guest: Alan M. Ehrlich MD, FAAFP   Music Credit: Richard Onorato

STUDIES REFERENCED   PATHOLOGY OF NON SCARRING AND SCARRING ALOPECIA   Amanda Araujo Dos Reis Botega et al. Scarring versus Non-Scarring Alopecia: An Interobserver Histopathological Reproducibility Study Skin Appendage Disord. 2023 Jan;9(1):34-41. doi: 10.1159/000526966. Epub 2022 Nov 25.     HYDROXYCHLOROQUINE AND RETINOPATHY RISK   Ronald B Melles RB et al. Hydroxychloroquine Dose and Risk for Incident Retinopathy : A Cohort Study. Ann Intern Med. 2023 Jan 17.   LOW DOSE NALTREXONE IN LICHEN PLANOPILARIS   Lajevardi et al. The efficacy and safety of oral low dose naltrexone versus placebo in the patients with lichen planopilaris: a randomized controlled trial. J Dermatol Treat. Jun 2020   Hamel RK et al. Oral Low-Dose Naltrexone in the Treatment of Frontal Fibrosing Alopecia and Lichen Planopilaris: An Uncontrolled Open-Label Prospective Study. Cureus Jan 2023.   Toledo-Pastrana et al. Perifollicular Erythema as a Trichoscopy Sign of Progression in Frontal Fibrosing Alopecia. Int J Trichology. 2013 Jul-Sep; 5(3): 151–153.     ACTINIC LICHEN PLANOPILARIS Lalagianni N et al. Actinic lichen planopilaris: a new variant of lichen planopilaris triggered by ultraviolet radiation. Clin Exp Dermatol. 2023 Feb 2;48(2):158-160.     FOLLICULITIS DECALVANS MICROBIOME STUDIES   Moreno-Arrones OM et al. Folliculitis decalvans has a heterogeneous microbiological signature and impaired immunological response. Dermatology. 2023 Jan 30.   Moreno-Arrones et al. Folliculitis decalvans microbiologic signature is specific for disease clinical phenotype. J Am Acad Dermatol. 2021 Nov;85(5):1355-1357.     TNF INHIBITORS IN DISSECTING CELLULITIS Alzahrani M et al. Treatment of dissecting cellulitis of the scalp with tumor necrosis factor inhibitors: a retrospective multicenter STUDY. Clin Exp Dermatol. 2023 Jan 26;llad036.

Amidst the battle of the mental health crisis, major depressive disorder stands out as an all-too-common reality for many children and adolescents, but the forces of science and medicine can stand against this foe. Dr. Christopher Drescher, a clinical child psychologist, joins pediatric resident Dr. Daniel Allen and medical student Vuk Lacmanovic to remove the cape from this increasingly common condition and discuss its symptoms, diagnosis, and treatment. Specifically, they will: Define major depressive disorder (MDD) and recognize the common symptoms in both children and adolescents. Formulate a differential diagnosis for patients presenting with depressive symptoms. Recognize validated screening tools for depression in both children and adolescents. Review cognitive behavioral therapy and pharmacotherapy as treatment options. Review appropriate referral to a mental health specialist. Free CME Credit (requires sign-in): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=12493  References: Bhatia SK, Bhatia SC. Childhood and adolescent depression. Am Fam Physician. 2007 Jan 1;75(1):73-80. PMID: 17225707. Brent DA, Maalouf F. Depressive Disorders (in Childhood and Adolescence). In: Ebert MH, Leckman JF, Petrakis IL. eds. Current Diagnosis & Treatment: Psychiatry, 3e. McGraw-Hill; Accessed November 17, 2020. https://accessmedicine.mhmedical.com/content.aspx?bookid=2509§ionid=200807606 Clark MS, Jansen KL, Cloy JA. Treatment of childhood and adolescent depression. Am Fam Physician. 2012 Sep 1;86(5):442-8. PMID: 22963063. Fendrich M, Weissman MM, Warner V. Screening for depressive disorder in children and adolescents: validating the Center for Epidemiologic Studies Depression Scale for Children. Am J Epidemiol. 1990 Mar;131(3):538-51. doi: 10.1093/oxfordjournals.aje.a115529. PMID: 2301363. (PDF of CES-DC here) Forman-Hoffman V, McClure E, McKeeman J, Wood CT, Middleton JC, Skinner AC, Perrin EM, Viswanathan M. Screening for Major Depressive Disorder in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2016 Mar 1;164(5):342-9. doi: 10.7326/M15-2259. Epub 2016 Feb 9. PMID: 26857836. Hathaway EE, Walkup JT, Strawn JR. Antidepressant Treatment Duration in Pediatric Depressive and Anxiety Disorders: How Long is Long Enough? Curr Probl Pediatr Adolesc Health Care. 2018 Feb;48(2):31-39. doi: 10.1016/j.cppeds.2017.12.002. Epub 2018 Jan 12. PMID: 29337001; PMCID: PMC5828899. March JS, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B, Domino M, McNulty S, Vitiello B, Severe J. The Treatment for Adolescents With Depression Study (TADS): long-term effectiveness and safety outcomes. Arch Gen Psychiatry. 2007 Oct;64(10):1132-43. doi: 10.1001/archpsyc.64.10.1132. Erratum in: Arch Gen Psychiatry. 2008 Jan;65(1):101. PMID: 17909125. Meister R, Abbas M, Antel J, Peters T, Pan Y, Bingel U, Nestoriuc Y, Hebebrand J. Placebo response rates and potential modifiers in double-blind randomized controlled trials of second and newer generation antidepressants for major depressive disorder in children and adolescents: a systematic review and meta-regression analysis. Eur Child Adolesc Psychiatry. 2020 Mar;29(3):253-273. doi: 10.1007/s00787-018-1244-7. Epub 2018 Dec 8. PMID: 30535589; PMCID: PMC7056684. Rachel A. Zuckerbrot, Amy Cheung, Peter S. Jensen, Ruth E.K. Stein, Danielle Laraque and GLAD-PC STEERING GROUP. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management. Pediatrics March 2018, 141 (3) e20174081; DOI: https://doi.org/10.1542/peds.2017-4081 Scott K, Lewis CC, Marti CN. Trajectories of Symptom Change in the Treatment for Adolescents With Depression Study. J Am Acad Child Adolesc Psychiatry. 2019 Mar;58(3):319-328. doi: 10.1016/j.jaac.2018.07.908. Epub 2019 Jan 8. PMID: 30768414; PMCID: PMC6557284. Sharma T, Guski LS, Freund N, Gøtzsche PC. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ. 2016 Jan 27;352:i65. doi: 10.1136/bmj.i65. PMID: 26819231; PMCID: PMC4729837. Siu AL; US Preventive Services Task Force. Screening for Depression in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. Pediatrics. 2016 Mar;137(3):e20154467. doi: 10.1542/peds.2015-4467. Epub 2016 Feb 8. PMID: 26908686. Weersing VR, Brent DA, Rozenman MS, Gonzalez A, Jeffreys M, Dickerson JF, Lynch FL, Porta G, Iyengar S. Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Randomized Clinical Trial. JAMA Psychiatry. 2017 Jun 1;74(6):571-578. doi: 10.1001/jamapsychiatry.2017.0429. PMID: 28423145; PMCID: PMC5539834. Weersing VR, Shamseddeen W, Garber J, Hollon SD, Clarke GN, Beardslee WR, Gladstone TR, Lynch FL, Porta G, Iyengar S, Brent DA. Prevention of Depression in At-Risk Adolescents: Predictors and Moderators of Acute Effects. J Am Acad Child Adolesc Psychiatry. 2016 Mar;55(3):219-26. doi: 10.1016/j.jaac.2015.12.015. Epub 2016 Jan 18. PMID: 26903255; PMCID: PMC4783159. Xu Y, Bai SJ, Lan XH, Qin B, Huang T, Xie P. Randomized controlled trials of serotonin-norepinephrine reuptake inhibitor in treating major depressive disorder in children and adolescents: a meta-analysis of efficacy and acceptability. Braz J Med Biol Res. 2016 May 24;49(6):e4806. doi: 10.1590/1414-431X20164806. PMID: 27240293; PMCID: PMC4897997. Zhou X, Cipriani A, Zhang Y, Cuijpers P, Hetrick SE, Weisz JR, Pu J, Giovane CD, Furukawa TA, Barth J, Coghill D, Leucht S, Yang L, Ravindran AV, Xie P. Comparative efficacy and acceptability of antidepressants, psychological interventions, and their combination for depressive disorder in children and adolescents: protocol for a network meta-analysis. BMJ Open. 2017 Aug 11;7(8):e016608. doi: 10.1136/bmjopen-2017-016608. PMID: 28801423; PMCID: PMC5629731. Zhou X, Teng T, Zhang Y, Del Giovane C, Furukawa TA, Weisz JR, Li X, Cuijpers P, Coghill D, Xiang Y, Hetrick SE, Leucht S, Qin M, Barth J, Ravindran AV, Yang L, Curry J, Fan L, Silva SG, Cipriani A, Xie P. Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: a systematic review and network meta-analysis. Lancet Psychiatry. 2020 Jul;7(7):581-601. doi: 10.1016/S2215-0366(20)30137-1. PMID: 32563306; PMCID: PMC7303954.

In episode 14 we discuss the connection between early life trauma, depression, anxiety, stress, and opioid use disorder.Effects of Early Life Trauma on Risks for Adult Opioid Use Disorder Are Mediated by Stress and Occur Independent of Depression and Anxiety. Dunn, Kelly E. PhD, MBA; Turner, Gavin M. BS; Oswald, Lynn M. PhD.  Journal of Addiction Medicine: 11/12 2022 - Volume 16 - Issue 6 - p 709-715 doi: 10.1097/ADM.0000000000001011We also discuss an opinion piece on AMA discharges and the new fentanyl vaccine.Retiring the “Against Medical Advice” Discharge Robert A. Kleinman, Thomas D. Brothers, Nathaniel P. Morris. Ann Intern Med.2022;175:1761-1762. [Epub 29 November 2022]. doi:10.7326/M22-2964An Immunconjugate Vaccine Alters Distribution and Reduces the Antinociceptive, Behavioral and Physiological Effects of Fentanyl in Male and Female Rats Haile CN, Baker MD, Sanchez SA, Lopez Arteaga CA, Duddupudi AL, Cuny GD, Norton EB, Kosten TR, Kosten TA. Pharmaceutics. 2022; 14(11):2290. ---------Episode 14 Credits:Original theme music: composed and performed by Benjamin KennedyAudio production: Angela OhlfestVideo production: Paul Kennedy----------This is Addiction Medicine Journal Club with Dr. Sonya Del Tredici and Dr. John Keenan. We practice addiction medicine and primary care, and we believe that addiction is a disease that can be treated. This podcast reviews current articles to help you stay up to date with research that you can use in your addiction medicine practice. The best part of any journal club is the conversation. Send us your comments on Twitter, Facebook, YouTube, email, or join our Facebook group. Email: addictionmedicinejournalclub@gmail.com Twitter: @AddictionMedJC Facebook: @AddictionMedJC Facebook Group: Addiction Medicine Journal Club YouTube: addictionmedicinejournalclub Addiction Medicine Journal Club is intended for educational purposes only and should not be considered medical advice. The views expressed here are our own and do not necessarily reflect those of our employers or the authors of the articles we review. All patient information has been modified to protect their identities.

CUPOM: BLACKFRIDAYGUIA www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis Um serviço de revisão e atualização continuados em clínica médica. A informação que você precisa, do jeito que você prefere. Junte-se aos mais de 800 assinantes. Assine o Guia, ganhe tempo e atualize-se sem esforço. Joanne, Kaue e Lucca conversam sobre armadilhas no tromboembolismo pulmonar (TEP): Quando pedir d-dímero e ajuste, em que momento iniciar a anticoagulação, como fazer a estratificação, quando trombolisar, qual anticoagulante iniciar, anticoagular ou não o TEP subsegmentar/assintomático e um pouco de TEP na gestante. Referências: 1. Kahn SR, de Wit K. Pulmonary Embolism. N Engl J Med. 2022 Jul 7;387(1):45-57. doi: 10.1056/NEJMcp2116489. PMID: 35793208. 2. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J 2019; 54. 3. Raja AS, Greenberg JO, Qaseem A, et al. Evaluation of Patients With Suspected Acute Pulmonary Embolism: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med 2015; 163:701. 4. Stevens SM, Woller SC, Kreuziger LB, et al. Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report. Chest 2021; 160:e545. 5. Kucher N, Goldhaber SZ. Management of massive pulmonary embolism. Circulation 2005; 112:e28. 6. Aujesky D, Obrosky DS, Stone RA, et al. A prediction rule to identify low-risk patients with pulmonary embolism. Arch Intern Med 2006; 166:169. 7. Becattini C, Casazza F, Forgione C, et al. Acute pulmonary embolism: external validation of an integrated risk stratification model. Chest 2013; 144:1539. 8. Righini M, Van Es J, Den Exter PL, Roy PM, Verschuren F, Ghuysen A, Rutschmann OT, Sanchez O, Jaffrelot M, Trinh-Duc A, Le Gall C, Moustafa F, Principe A, Van Houten AA, Ten Wolde M, Douma RA, Hazelaar G, Erkens PM, Van Kralingen KW, Grootenboers MJ, Durian MF, Cheung YW, Meyer G, Bounameaux H, Huisman MV, Kamphuisen PW, Le Gal G. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA. 2014 Mar 19;311(11):1117-24. doi: 10.1001/jama.2014.2135. Erratum in: JAMA. 2014 Apr 23-30;311(16):1694. PMID: 24643601. 9. Ortel TL, Neumann I, Ageno W, Beyth R, Clark NP, Cuker A, Hutten BA, Jaff MR, Manja V, Schulman S, Thurston C, Vedantham S, Verhamme P, Witt DM, D Florez I, Izcovich A, Nieuwlaat R, Ross S, J Schünemann H, Wiercioch W, Zhang Y, Zhang Y. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv. 2020 Oct 13;4(19):4693-4738. doi: 10.1182/bloodadvances.2020001830. PMID: 33007077; PMCID: PMC7556153. 10. Duffett L, Castellucci LA, Forgie MA. Pulmonary embolism: update on management and controversies. BMJ. 2020 Aug 5;370:m2177. doi: 10.1136/bmj.m2177. PMID: 32759284. 11. van der Hulle T, Cheung WY, Kooij S, Beenen LFM, van Bemmel T, van Es J, Faber LM, Hazelaar GM, Heringhaus C, Hofstee H, Hovens MMC, Kaasjager KAH, van Klink RCJ, Kruip MJHA, Loeffen RF, Mairuhu ATA, Middeldorp S, Nijkeuter M, van der Pol LM, Schol-Gelok S, Ten Wolde M, Klok FA, Huisman MV; YEARS study group. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet. 2017 Jul 15;390(10091):289-297. doi: 10.1016/S0140-6736(17)30885-1. Epub 2017 May 23. Erratum in: Lancet. 2017 Jul 15;390(10091):230. PMID: 28549662.

Listen in as Dr. Nally discussed the history of gout, why Hippocrates only thought it happened to royalty and how you can treat and prevent it with a ketogenic or carnivorous lifestyle. Show Note Sources: Kanbara A., Seyama I. Effect of urine pH on uric acid excretion by manipulating food materials. Nucleosides, Nucleotides Nucleic Acids. 2011;30(12):1066–1071. Towiwat P., Li Z.G. The association of vitamin C, alcohol, coffee, tea, milk and yogurt with uric acid and gout. Int J Rheum Dis. 2015;18(5):495–501. Bedir A., Topbas M., Tanyeri F., Alvur M., Arik N. Leptin might be a regulator of serum uric acid concentrations in humans. Jpn Heart J. 2003;44(4):527–536. Garrod AB. The Nature and Treatment of Gout and Rheumatic Gout, 2nd ed, Walton and Maberly, London 1863. Dalbeth N, Phipps-Green A, Frampton C, et al. Relationship between serum urate concentration and clinically evident incident gout: an individual participant data analysis. Ann Rheum Dis 2018; 77:1048. Hall AP, Barry PE, Dawber TR, McNamara PM. Epidemiology of gout and hyperuricemia. A long-term population study. Am J Med 1967; 42:27. Campion EW, Glynn RJ, DeLabry LO. Asymptomatic hyperuricemia. Risks and consequences in the Normative Aging Study. Am J Med 1987; 82:421. Zalokar J, Lellouch J, Claude JR, Kuntz D. Epidemiology of serum uric acid and gout in Frenchmen. J Chronic Dis 1974; 27:59. BRILL JM, MCCARTY DJ. "STUDIES ON THE NATURE OF GOUTY TOPHI" BY MAX FREUDWEILER, 1899. (AN INFLAMMATORY RESPONSE TO INJECTED SODIUM URATE, 1899). AN ABRIDGED TRANSLATION, WITH COMMENTS. Ann Intern Med 1964; 60:486. McCarty DJ, Hollander JL. Identification of urate crystals in gouty synovial fluid. Ann Intern Med 1961; 54:452. Seegmiller JE, Howell RR, Malawista SE. The inflammatory reaction to sodium urate: its possible relationship to the genesis of acute gouty arthritis. JAMA 1962; 180:469. Hutton J, Fatima T, Major TJ, et al. Mediation analysis to understand genetic relationships between habitual coffee intake and gout. Arthritis Res Ther 2018; 20:135. Fanning N, Merriman TR, Dalbeth N, Stamp LK. An association of smoking with serum urate and gout: A health paradox. Semin Arthritis Rheum 2018; 47:825. Lin KC, Lin HY, Chou P. Community based epidemiological study on hyperuricemia and gout in Kin-Hu, Kinmen. J Rheumatol 2000; 27:1045. Zhang Y, Woods R, Chaisson CE, et al. Alcohol consumption as a trigger of recurrent gout attacks. Am J Med 2006; 119:800.e13. Hunter DJ, York M, Chaisson CE, et al. Recent diuretic use and the risk of recurrent gout attacks: the online case-crossover gout study. J Rheumatol 2006; 33:1341. Chhana A, Lee G, Dalbeth N. Factors influencing the crystallization of monosodium urate: a systematic literature review. BMC Musculoskelet Disord 2015; 16:296. Loeb JN. The influence of temperature on the solubility of monosodium urate. Arthritis Rheum 1972; 15:189. Horvath SM, Hollander JL. INTRA-ARTICULAR TEMPERATURE AS A MEASURE OF JOINT REACTION. J Clin Invest 1949; 28:469. Martinon F, Pétrilli V, Mayor A, et al. Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature 2006; 440:237. Guerne PA, Terkeltaub R, Zuraw B, Lotz M. Inflammatory microcrystals stimulate interleukin-6 production and secretion by human monocytes and synoviocytes. Arthritis Rheum 1989; 32:1443. Terkeltaub R, Zachariae C, Santoro D, et al. Monocyte-derived neutrophil chemotactic factor/interleukin-8 is a potential mediator of crystal-induced inflammation. Arthritis Rheum 1991; 34:894. di Giovine FS, Malawista SE, Thornton E, Duff GW. Urate crystals stimulate production of tumor necrosis factor alpha from human blood monocytes and synovial cells. Cytokine mRNA and protein kinetics, and cellular distribution. J Clin Invest 1991; 87:1375. Guerne PA, Terkeltaub R, Zuraw B, Lotz M. Inflammatory microcrystals stimulate interleukin-6 production and secretion by human monocytes and synoviocytes. Arthritis Rheum 1989; 32:1443.

Credits: 0.25 AMA PRA Category 1 Credit™     CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-301   Overview: In this episode, we will discuss a simple and inexpensive yet effective strategy for slowing the loss of knee joint cartilage in a patient with osteoarthritis: walking. Hear how recent evidence suggests that including a walking regimen into treatment plans may confer numerous benefits in this patient population.   Episode resource links: Busse, JW, Sadeghirad, B., Oparin, Y. et al; Management of Acute Pain From Non–Low Back, Musculoskeletal Injuries: A Systematic Review and Network Meta-analysis of Randomized Trials. Ann Intern Med.2020;173:730-738. [Epub 18 August 2020]. doi:10.7326/M19-3601 Kolasinski, S.L., Neogi, T., Hochberg, M.C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., Gellar, K., Harvey, W.F., Hawker, G., Herzig, E., Kwoh, C.K., Nelson, A.E., Samuels, J., Scanzello, C., White, D., Wise, B., Altman, R.D., DiRenzo, D., Fontanarosa, J., Giradi, G., Ishimori, M., Misra, D., Shah, A.A., Shmagel, A.K., Thoma, L.M., Turgunbaev, M., Turner, A.S. and Reston, J. (2020), 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res, 72: 149-162. https://doi.org/10.1002/acr.24131 Lo GH, Vinod S, Richard MJ, et al. Association Between Walking for Exercise and Symptomatic and Structural Progression in Individuals with Knee Osteoarthritis: Data from the Osteoarthritis Initiative Cohort [published online ahead of print, 2022 Jun 8]. Arthritis Rheumatol. 2022;10.1002/art.42241. doi:10.1002/art.42241 Thudium C. Markers of synovial inflammation matrix turnover and symptoms. Presented at: OARSI 2022 World Congress on Osteoarthritis; April 7-10; Berlin, Germany (virtual meeting). Ooman JMH. Babs on a mission: An experimental study on the effects of message framing and exemplification on treatment intentions of osteoarthritis patients. Presented at: OARSI 2022 World Congress on Osteoarthritis; April 7-10; Berlin, Germany (virtual meeting). Zeng C, Doherty M, Persson MSM, et al. Comparative efficacy and safety of acetaminophen, topical and oral non-steroidal anti-inflammatory drugs for knee osteoarthritis: evidence from a network meta-analysis of randomized controlled trials and real-world data. Osteoarthritis Cartilage. 2021;29(9):1242-1251. doi:10.1016/j.joca.2021.06.004   Guest: Susan Feeney, DNP, FNP-BC, NP-C   Music Credit: Richard Onorato  

Credits: 0.25 AMA PRA Category 1 Credit™     CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-301   Overview: In this episode, we will discuss a simple and inexpensive yet effective strategy for slowing the loss of knee joint cartilage in a patient with osteoarthritis: walking. Hear how recent evidence suggests that including a walking regimen into treatment plans may confer numerous benefits in this patient population.   Episode resource links: Busse, JW, Sadeghirad, B., Oparin, Y. et al; Management of Acute Pain From Non–Low Back, Musculoskeletal Injuries: A Systematic Review and Network Meta-analysis of Randomized Trials. Ann Intern Med.2020;173:730-738. [Epub 18 August 2020]. doi:10.7326/M19-3601 Kolasinski, S.L., Neogi, T., Hochberg, M.C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., Gellar, K., Harvey, W.F., Hawker, G., Herzig, E., Kwoh, C.K., Nelson, A.E., Samuels, J., Scanzello, C., White, D., Wise, B., Altman, R.D., DiRenzo, D., Fontanarosa, J., Giradi, G., Ishimori, M., Misra, D., Shah, A.A., Shmagel, A.K., Thoma, L.M., Turgunbaev, M., Turner, A.S. and Reston, J. (2020), 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res, 72: 149-162. https://doi.org/10.1002/acr.24131 Lo GH, Vinod S, Richard MJ, et al. Association Between Walking for Exercise and Symptomatic and Structural Progression in Individuals with Knee Osteoarthritis: Data from the Osteoarthritis Initiative Cohort [published online ahead of print, 2022 Jun 8]. Arthritis Rheumatol. 2022;10.1002/art.42241. doi:10.1002/art.42241 Thudium C. Markers of synovial inflammation matrix turnover and symptoms. Presented at: OARSI 2022 World Congress on Osteoarthritis; April 7-10; Berlin, Germany (virtual meeting). Ooman JMH. Babs on a mission: An experimental study on the effects of message framing and exemplification on treatment intentions of osteoarthritis patients. Presented at: OARSI 2022 World Congress on Osteoarthritis; April 7-10; Berlin, Germany (virtual meeting). Zeng C, Doherty M, Persson MSM, et al. Comparative efficacy and safety of acetaminophen, topical and oral non-steroidal anti-inflammatory drugs for knee osteoarthritis: evidence from a network meta-analysis of randomized controlled trials and real-world data. Osteoarthritis Cartilage. 2021;29(9):1242-1251. doi:10.1016/j.joca.2021.06.004   Guest: Susan Feeney, DNP, FNP-BC, NP-C   Music Credit: Richard Onorato  

Hemophilia B is a rare inherited X-linked disorder characterized by a congenital anomaly in the factor IX gene leading to a variable deficiency in clotting factor IX. In this episode, we explore the known differences between Hemophilia B and Hemophilia A and discuss priority areas for further research into Hemophilia B. The episode also guides listeners on an entertaining journey through 19th and 20th century European monarchy and the unlikely role that hemophilia played in forever shaping Europe's governance!    Contributors: Bethany Samuelson Bannow, MD Brian O'Mahony Kathaleen M. Schnur, MSW, LCSW   Senior Advisor: Donna DiMichele, MD   Episode Advisors (also contributors): Dr. Amy Shapiro Professor Jan Astermark   Hosted by: Laurence Woollard   Links to learn more:   Brown A. "The Royal Disease and The Royal Collapse: Political Effects of Hemophilia in the Royal Houses of Europe." Honor Scholar Theses. 2017;63. [Online]. Available at: https://scholarship.depauw.edu/cgi/viewcontent.cgi?article=1063&context=studentresearch [Accessed 10 October 2022]   Hoffman TA. "Bad Blood: Hemophilia and Its Detriment to the Russian Imperial Family." Young Historians Conference. 2022;8. [Online]. Available at: https://pdxscholar.library.pdx.edu/cgi/viewcontent.cgi?article=1244&context=younghistorians [Accessed 10 October 2022]   Lannoy N, Hermans C. The ‘royal disease' – haemophilia A or B? A haematological mystery is finally solved. Haemophilia 2010;16:843-47. Doi: 10.1111/j.1365-2516.2010.02327.x   Potts WTW. Royal haemophilia. J Biol Educ 1996;30(3):207-17. DOI: 10.1080/00219266.1996.9655504   Price KD. "Diary of Nicholas II, 1917-1918, an annotated translation." Graduate Student Theses, Dissertations, & Professional Papers. 1966;2065. [Online]. Available at: https://scholarworks.umt.edu/cgi/viewcontent.cgi?article=3084&context=etd [Accessed 10 October 2022]   Radcliffe J. “Rasputin and the Fragmentation of Imperial Russia.” Young Historians Conference. 2017;14. [Online]. Available at: https://pdxscholar.library.pdx.edu/younghistorians/2017/oralpres/14/ [Accessed 10 October 2022]   Funnell APW, Crossley M. Hemophilia B Leyden and once mysterious cis-regulatory mutations. Trends Genet 2014;30(1):18-23. Doi: 10.1016/j.tig.2013.09.007   Simioni P, et al. X-linked thrombophilia with a mutant factor IX (factor IX Padua). N Engl J Med 2009;361(17):1671-5. Doi: 10.1056/NEJMoa0904377   Nogami K, et al. Clinical conditions and risk factors for inhibitor-development in patients with haemophilia: A decade-long prospective cohort study in Japan, J-HIS2 (Japan Hemophilia Inhibitor Study 2). Haemophilia 2022;28(5):745-59. Doi: 10.1111/hae.14602   Thorland EC, et al. Anaphylactic response to FIX replacement therapy in haemophilia B patients: complete gene deletions confer the highest risk. Haemophilia 1999;5(2):101-5.    Chitlur M, et al. Inhibitors in factor IX deficiency a report of the ISTH-SSC international FIX inhibitor registry (1997-2006). Haemophilia 2009;15(5):1027-31. Doi: 10.1111/j.1365-2516.2009.02039.x   DiMichele D. The North American Immune Tolerance Registry: contributions to the thirty-year experience with immune tolerance therapy. Haemophilia 2009;15(1):320-8. Doi: 10.1111/j.1365-2516.2008.01880.x   Astermark J, et al. The B-Natural Study – The outcome of immune tolerance induction therapy in patients with severe haemophilia B. Haemophilia 2021;27(5):802-13. Doi: 10.1111/hae.14357   Iorio A, et al. Establishing the prevalence and prevalence at birth of hemophilia in males: a meta-analytic approach using national registries. Ann Intern Med 2009;171(8):540-46. Doi: 10.7326/M19-1208   Soucie JM, et al. Occurance rates of haemophilia among males in the United States based on surveillance conducted in specialized haemophilia treatment centres. Haemophilia 2020;26(3):487-93. Doi: 10.1111/hae.13998   Berntorp E, et al. Quality of life in a large multinational haemophilia B cohort (The B-Natural Study – Unmet needs remain. Haemophilia 2022;28(3):453-61. Doi: 10.1111/hae.14525   Kihlberg K, et al. Treatment outcomes in persons with severe haemophilia B in the Nordic region: The B-NORD study. Haemophilia 2021;27(3):366-74. Doi: 10.1111/hae.14299   Feng D, et al. Evidence of clinically significant extravascular stores of factor IX. Thromb Haemost 2013;11(12):2176-2178. Doi: 10.1111/jth.12421   DiMichele DM, et al. Severe and moderate haemophilia A and B in US females. Haemophilia 2014;20(2):e136-43. Doi: 10.1111/hae.12364   Buckner TW, et al. Management of US men, women, and children with hemophilia and methods and demographics of the Bridging Hemophilia B Experiences, Results and Opportunities into Solutions (B-HERO-S) study. Eur J Haematol 2017;98:5-17. Doi: 10.1111/ejh.12854     Show Notes: Presenting Sponsor: Sanofi Subscribe to the Global Hemophilia Report   Connect with the Global Hemophilia Report Global Hemophilia Report on LinkedIn Global Hemophilia Report on Twitter Global Hemophilia Report on Facebook   Connect with BloodStream Media: BloodStreamMedia.com BloodStream on Facebook  BloodStream on Twitter 

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-295   Overview: Chronic obstructive pulmonary disease (COPD) is typically diagnosed based on spirometry findings, but what if that finding isn't what you expect? Spirometry measurements are compared to standard values for age, sex, and race. The use of race-based equations has been questioned in several clinical situations, and researchers are now raising similar concerns about the use of race-based equations in spirometry, which may lead to health inequities. Join us for an important discussion on how to overcome these potential disparities in diagnosing COPD.   Episode resource links: Liu GY, Khan SS, Colangelo LA, et al. Comparing Racial Differences in Emphysema Prevalence Among Adults With Normal Spirometry: A Secondary Data Analysis of the CARDIA Lung Study [published online ahead of print, 2022 Jul 19]. Ann Intern Med. 2022;10.7326/M22-0205.   Guest: Alan Ehrlich MD, FAAFP   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-295   Overview: Chronic obstructive pulmonary disease (COPD) is typically diagnosed based on spirometry findings, but what if that finding isn't what you expect? Spirometry measurements are compared to standard values for age, sex, and race. The use of race-based equations has been questioned in several clinical situations, and researchers are now raising similar concerns about the use of race-based equations in spirometry, which may lead to health inequities. Join us for an important discussion on how to overcome these potential disparities in diagnosing COPD.   Episode resource links: Liu GY, Khan SS, Colangelo LA, et al. Comparing Racial Differences in Emphysema Prevalence Among Adults With Normal Spirometry: A Secondary Data Analysis of the CARDIA Lung Study [published online ahead of print, 2022 Jul 19]. Ann Intern Med. 2022;10.7326/M22-0205.   Guest: Alan Ehrlich MD, FAAFP   Music Credit: Richard Onorato

Episode 4 discusses the benefits of smoking cessation after a diagnosis of lung cancer.Mahdi Sheikh, Anush Mukeriya, Oxana Shangina, et al. Postdiagnosis Smoking Cessation and Reduced Risk for Lung Cancer Progression and Mortality: A Prospective Cohort Study. Ann Intern Med.2021;174:1232-1239. [Epub 27 July 2021].We also talk about whether or not increased buprenorphine prescribing will lead patients to be placed on it inappropriately, and some of the hurdles faced when trying to prescribe medications for opioid use disorder in the hospital.To make sure you're prescribing buprenorphine correctly, read SAMHSA's Practical Tools for Prescribing and Promoting Buprenorphine in Primary Care Settings.Take a look at the article A Call to Action: Hospitalists' Role in Addressing Substance Use Disorder.This is Addiction Medicine Journal Club with Dr. Sonya Del Tredici and Dr. John Keenan. We practice addiction medicine and primary care, and we believe that addiction is a disease that can be treated. This podcast reviews current articles to help you stay up to date with research that you can use in your addiction medicine practice. The best part of any journal club is the conversation, and we want to hear what you have to say. To have your opinions about the articles included in a future episode, you can email us at addictionmedicinejournalclub@gmail.com or talk to us on Twitter @AddictionMedJC. If you want to hear your comment in your own voice on the air, you can record a voice memo on your phone and email it to us.Credits:Original theme music: composed and performed by Benjamin KennedyAudio production: Angela OhlfestAddiction Medicine Journal Club is intended for educational purposes only, and should not be considered medical advice. The views expressed here are our own, and do not necessarily reflect those of our employers or the authors of the articles we review. All patient information has been modified to protect their identities.

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-288 Overview: Coffee is one of the most consumed beverages worldwide. An estimated 500 million cups are consumed per day in the United States. As testimony to this, count the number of coffee shops available—most with drive-through access—the next time you are out for a drive. A growing body of evidence indicates that moderate coffee consumption (2-3 cups per day) is associated with reduction in all-cause mortality. What hasn't been looked at closely is the effect of coffee with sugar and artificial sweeteners on these measures. Join us while we discuss recent evidence regarding consumption of coffee—with or without sweeteners—and its association with all-cause mortality. Episode resource links: Liu D, Li ZH, Shen D, Zhang PD, Song WQ, Zhang WT, Huang QM, Chen PL, Zhang XR, Mao C. Association of Sugar-Sweetened, Artificially Sweetened, and Unsweetened Coffee Consumption With All-Cause and Cause-Specific Mortality : A Large Prospective Cohort Study. Ann Intern Med. 2022 May 31. doi: 10.7326/M21-2977. Epub ahead of print. PMID: 35635846. Wee CC. The Potential Health Benefit of Coffee: Does a Spoonful of Sugar Make It All Go Away? Ann Intern Med. 2022 May 31. doi: 10.7326/M22-1465. Epub ahead of print. PMID: 35635845. Guest: Susan Feeney, DNP, FNP Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-288 Overview: Coffee is one of the most consumed beverages worldwide. An estimated 500 million cups are consumed per day in the United States. As testimony to this, count the number of coffee shops available—most with drive-through access—the next time you are out for a drive. A growing body of evidence indicates that moderate coffee consumption (2-3 cups per day) is associated with reduction in all-cause mortality. What hasn't been looked at closely is the effect of coffee with sugar and artificial sweeteners on these measures. Join us while we discuss recent evidence regarding consumption of coffee—with or without sweeteners—and its association with all-cause mortality. Episode resource links: Liu D, Li ZH, Shen D, Zhang PD, Song WQ, Zhang WT, Huang QM, Chen PL, Zhang XR, Mao C. Association of Sugar-Sweetened, Artificially Sweetened, and Unsweetened Coffee Consumption With All-Cause and Cause-Specific Mortality : A Large Prospective Cohort Study. Ann Intern Med. 2022 May 31. doi: 10.7326/M21-2977. Epub ahead of print. PMID: 35635846. Wee CC. The Potential Health Benefit of Coffee: Does a Spoonful of Sugar Make It All Go Away? Ann Intern Med. 2022 May 31. doi: 10.7326/M22-1465. Epub ahead of print. PMID: 35635845. Guest: Susan Feeney, DNP, FNP   Music Credit: Richard Onorato

Contributor: Aaron Lessen, MD  Educational Pearls: Direct Oral Anticoagulants (DOACs) have surpassed Warfarin and Lovenox® for anticoagulation as they do not require injection and allow for easier discharge. In the ED, they are commonly prescribed after PE or DVT diagnosis.  Common DOACs are Apixaban (Eliquis®) and Rivaroxaban (Xarelto®). There has not been a direct head to head study comparing outcomes.  2 large observational studies evaluated the recurrence of clots and bleeding risk in patients with newly prescribed Eliquis® or Xarelto® for DVT or PE. Both studies found that Eliquis® had superior outcomes.  Further data is required to determine the preferred DOAC. A randomized trial comparing the two DOACs is upcoming with enrollment ending in 2023.  References Dawwas GK, Leonard CE, Lewis JD, Cuker A. Risk for Recurrent Venous Thromboembolism and Bleeding With Apixaban Compared With Rivaroxaban: An Analysis of Real-World Data. Ann Intern Med. 2022;175(1):20-28. doi:10.7326/M21-0717 Aryal MR, Gosain R, Donato A, et al. Systematic review and meta-analysis of the efficacy and safety of apixaban compared to rivaroxaban in acute VTE in the real world. Blood Adv. 2019;3(15):2381-2387. doi:10.1182/bloodadvances.2019000572 Image from: Bristol-Myers Squibb Company. Eliquis 10 Million Patients and Counting. Sec.gov. https://www.sec.gov/Archives/edgar/data/14272/000114036119003478/s002621x16_425.htm. Accessed June 12, 2022.   Summarized by Kirsten Hughes, MS4 | Edited by John Spartz MS4 & Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

Welcome to Episode 17 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 17 of “The 2 View” – Monkeypox, A Typical NP/PA Day in the ER: Tips from the Heart, Timesavers, and Anaphylaxis. Monkeypox Lewis D. How PAs Can Avoid Malpractice: Go Back to Practice Basics. Medscape. Published May 23, 2022. Accessed May 30, 2022. https://www.medscape.com/viewarticle/974472 Monkeypox in Multiple Countries - Alert - Level 2, Practice Enhanced Precautions - Travel Health Notices. Centers for Disease Control and Prevention. Travelers' Health. Cdc.gov. Accessed May 30, 2022. https://wwwnc.cdc.gov/travel/notices/alert/monkeypox Monkeypox: public health advice for gay, bisexual and other men who have sex with men. World Health Organization. Who.int. Published May 25, 2022. Accessed May 30, 2022. https://www.who.int/news/item/25-05-2022-monkeypox--public-health-advice-for-gay--bisexual-and-other-men-who-have-sex-with-men Monkeypox Virus Infection in the United States and Other Non-endemic Countries – 2022. Centers for Disease Control and Prevention. HAN archive - 00466. Cdc.gov. Published May 20, 2022. Accessed May 30, 2022. https://emergency.cdc.gov/han/2022/han00466.asp Morgenstern J. Monkeypox. First10EM. Published May 19, 2022. Accessed May 30, 2022. https://first10em.com/monkeypox/ Rezaie S. Monkeypox…the basics. REBEL EM - Emergency Medicine Blog. Published May 26, 2022. Accessed May 30, 2022. https://rebelem.com/monkeypoxthe-basics/ Top Three Timesavers Heckerling PS, Tape TG, Wigton RS, et al. Clinical prediction rule for pulmonary infiltrates. Ann Intern Med. NIH National Library of Medicine: National Center for Biotechnology Information. PubMed.gov. Published November 1, 1990. Accessed May 30, 2022. https://pubmed.ncbi.nlm.nih.gov/2221647/ Mellick L. Ten Ways to Reduce a Dislocated Shoulder. Published August 13, 2015. Accessed May 30, 2022. https://www.youtube.com/watch?v=HtOnreM7heg Mellick L. The Davos Method of Shoulder Dislocation Reduction. Published May 2, 2016. Accessed May 30, 2022. https://www.youtube.com/watch?v=u2MsnjVNoPM UofSC Athletic Training. Spaso Technique for Glenohumeral Joint Reduction. Published October 11, 2020. Accessed May 30, 2022. https://www.youtube.com/watch?v=ei5Z62Whs1I Anaphylaxis? Roberts M, Sharma M. The 2 View. The Center for Medical Education. 14 - Urticaria, Foreign Bodies, and a Special Interview. 2 View: Emergency Medicine PAs & NPs. Published February 27, 2022. Accessed May 30, 2022. https://2view.fireside.fm/14 Tang AW. A Practical Guide to Anaphylaxis. Am Fam Physician. Published October 1, 2003. Accessed May 30, 2022. https://www.aafp.org/pubs/afp/issues/2003/1001/p1325.html Something Sweet Shoutouts to: Dr. Brendon Carmondy, who is the Assistant Director of the Emergency Department at Suburban Hospital in Maryland, and his entire team. Sierra Campus of the Hospitals of Providence in El Paso, TX, especially Dr. Madhu Achalla. Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

European Heart JournalBariatric surgery and cardiovascular disease: a systematic review and meta-analysisEur Heart J 2022 Mar 04;[EPub Ahead of Print], SL van Veldhuisen, TM Gorter, G van Woerden, RA de Boer, M Rienstra, EJ Hazebroek, DJ van Veldhuisen  39 studies, all prospective or retrospective cohort studies, showed Bariatric surgery is associated with a reduced hazard ratio (HR) of CV morality (0.59), all-cause mortality (0.55), incident HF (0.50), myocardial infarction (0.58) and stroke (0.64) Authors state “”The present systematic review and meta-analysis suggests that bariatric surgery is associated with reduced all-cause and CV mortality, and lowered incidence of several CV diseases in patients with obesity. Bariatric surgery should therefore be considered in these patients.””” Here is the problem and I have said it before—“no randomized control trials examining the effect of bariatric surgery on CV outcomes,”Among frail patients with AF, OAC treatment was associated with a positive net clinical outcome. Direct OACs provided lower incidences of stroke, bleeding, and mortality, compared with warfarin. Just talked recently about continue doac in hospice and everyone agrees that is bad but ultimately there are very few conditions in which you should not resume anticoag—even in those with GI bleed, falls, or subachrnoid hemerage—the data suggest the pts are better off back on anticoag. Well this study looked at the frail. In this retrospective cohort study analyzed 83 635 patients  with mean age 78.5 those individuals who were on ORAL anticoag(doac or warfarin) had overall lower risks of ischemic stroke (HR, 0.91) and cardiovascular death (HR, 0.52), with no significant difference in major bleeding (HR, 1.02),   Bottom line- restart the OAC – even in the frail to prevent the outcomes we really care about like stroke and death    Dave CV et al. Risks for anaphylaxis with intravenous iron formulations: A retrospective cohort study. Ann Intern Med 2022 Mar 29; [e-pub]. (https://doi.org/10.7326/M21-4009. opens in new tab) Anaphylaxis occurs rarely with intravenous (IV) iron does happen but how often does it happen??  It is a mystery—till now Using a retrospective cohort design, investigators assessed 167,000 U.S. Medicare patients who received IV iron products between 2013 and 2018. Patients who had received IV iron within the previous year and those with end-stage renal disease, HIV infection, history of anaphylactic reaction, or recent transfusions were excluded. This is the perfect study for observational data. We know it happens so we look at a large data set and try to see how often it happens. In this population of older adults, the rate of anaphylaxis for iron dextran was ≈0.1%, but it was closer to 0.01% for iron sucrose, ferric gluconate, and ferric carboxymaltose (can give once== carboxy and dextran). As indications have broadened for use of IV iron in managing various clinical conditions (e.g., heart failure, chronic kidney disease) when iron deficiency is present, clinicians might use these data to inform selection of a preparation.  A lot depends on cost and availability but these are good numbers to have in your head for the anaphylaxis event rate... Sure it might take 5 years or even 10 years but some of the outcomes like MI and HF will easily hit in the first 5-10 years!! This RCT could be done tomorrow! Instead we continue to do this observational studies and say look how great this procedure is!! Well maybe it is ‘healthy' patient bias—you have two pts with BMI of 40 but one seems motivated is working out eating better- trying to take all the right steps and the other hasn't left the couch in 6 years. The one that is active then gets referred for bariatric surgery and when we match them up we say LOOK AT THIS THE BARIATRIC SURGERY person did so much better. WEEELLLLLL that pt was likely going to do better anyways!!! AT this point everyone know that bariatric surgery seems to have great CV outcomes in retrospective and prospective observational trials we have done enough of them.. THIS analysis had 39 STUDIES—39!!!! We don't need 30 more we need and RCT!!!     Katz PO et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2022 Jan; 117:27. (https://doi.org/10.14309/ajg.0000000000001538. opens in new tab) Much of this guideline is worthwhile for nongastroenterologists.  An empirical 8-week trial of a proton-pump inhibitor (PPI), given once daily, is recommended for a patient who has classic heartburn and regurgitation but no alarm symptoms.  PPIs should be taken 30 to 60 minutes before a meal, because they bind to proton pumps that have been stimulated by meals. Bedtime dosing is discouraged because this is less effective than a predinner dose in acid control GERD is thought to contribute to various extraesophageal symptoms, including chronic cough, hoarseness, and laryngitis; however, a causal relation often is unclear in any given patient. For patients with extraesophageal symptoms — but no heartburn or regurgitation — the authors argue against empirical PPI therapy  After 8 weeks you STOP the PPI--PPI nonresponders, and PPI responders whose symptoms return after an 8-week PPI course, should be evaluated with Endoscopy about 2 to 4 weeks off PPIs.  If endoscopy is normal, ambulatory pH monitoring (off treatment) is the next step. authors encourage intermittent or “on-demand” (rather than indefinite) PPI therapy in patients with no history of high-grade esophagitis or Barrett esophagus. IF requires ongoing PPI therapy for symptom control should use the lowest effective dose.I do like these guidelines cause they seem to be great at making sure PPI are stopped (ideally). I do hate these guidelines cause getting a scope after 8 weeks of a PPI with reoccurring symptoms seems like a lot of scopes will be done. Especially because some people get rebound gerd when going off of a PPI. As the authors state “One area of controversy relates to abrupt PPI discontinuation and potential rebound acid hypersecretion, resulting in increased reflux symptoms. Although rebound acid hypersecretion has been demonstrated to occur in healthy controls, strong evidence for an increase in symptoms after abrupt PPI withdrawal is lacking.”  -- none of this is super strong evidence!!! This seems like a lot of scopes.The fear of progression to adenocarcinoma with Barrett's Esophagus would make for an easy decision for prolonged PPI use, however, a systematic review and meta-analysis published in PLoS One - Hu Q, Sun TT, Hong J, et al. Proton Pump Inhibitors Do Not Reduce the Risk of Esophageal Adenocarcinoma in Patients with Barrett's Esophagus: A Systematic Review and Meta-Analysis. PLoS One 2017;12(1):e0169691. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0169691 found no protective effect.1And even though long term use of PPI is associated with many bad outcomes even the authors state -  “””“PPIs are the most effective medical treatment for GERD. Some medical studies have identified an association between the long-term use of PPIs and the development of numerous adverse conditions including intestinal infections, pneumonia, stomach cancer, osteoporosis-related bone fractures, chronic kidney disease, deficiencies of certain vitamins and minerals, heart attacks, strokes, dementia, and early death. “” the authors go on to say “””Those studies have flaws, are not considered definitive, and do not establish a cause-and-effect relationship between PPIs and the adverse conditions. High-quality studies have found that PPIs do not significantly increase the risk of any of these conditions except intestinal infections. .”””  THIS IS ALSO GARBAGE!!! The reason the high quality studies don't show this is because most studies are only 8-12 weeks long PPI you need long term trials which most people are on and you have to power your study so large to find a super rare outcome that observational data is the best we are ever going to have for this particular finding. I know the authors knew this but it didn't fit their agenda…Which is my last point—although we will never know—all but one of the authors has or is taking big pharma money. Take home if you are following the guideslines-- start PPI only for Gerd like symptoms. Make sure taking the PPI correctly. Stop after 8 weeks. If it reoccurs then 2-4 weeks later off the PPI they need a scope and if the scope is normal then they need PH monitoring. Then the rec is for PRN PPI.  

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-272 Overview: Clinicians need to accurately assess the degree of heart failure at the bedside to make appropriate management decisions. However, the common bedside practice of estimating right atrial pressure by measuring jugular venous pressure (JVP) has several accuracy limitations. This session focuses on the use of point-of-care ultrasound (POC-US) to improve the accuracy of JVP measurements. Join us to hear the salient findings from a recent study comparing POC-US measurements to right heart catheterization measurements, and walk away with a clear understanding of how POC-US can quickly and easily improve accuracy. Episode resource links: Wang L, Harrison J, Dranow E, Aliyev N, Khor L. Accuracy of Ultrasound Jugular Venous Pressure Height in Predicting Central Venous Congestion. Ann Intern Med. 2021 Dec 28. doi: 10.7326/M21-2781. Epub ahead of print. Guest: Alan Ehrlich MD, FAAFP Music Credit: Richard Onorato

Isabel Chen and Jamar Slocum join us to discuss the history of American medical education and how its evolution has maintained injustice. They speak about prestige, research dollars, medical school rankings, race, admissions, wealth and power, health disparities, and the long shadow of the 1910 Flexner Report that laid the foundation of the current system. They also share how justice-informed movements like the Beyond Flexner Alliance are attempting to rattle the paradigm and recenter care, love, and justice as the ‘social mission' of medicine. Beyond Flexner Alliance (BFA) is a national movement, focused on health equity and training health professionals as agents of more equitable health care. This movement takes us beyond centuries-old conventions in health professions education to train providers prepared to build a system that is not only better, but fairer. The Beyond Flexner Alliance aims to promote social mission in health professions education by networking learners, teachers, community leaders, health policy makers and their organizations to advance equity in education, research, service, policy, and practice. Beyond Flexner Conference 2022 (March 28-30, 2022), Phoenix AZ: https://flexnerconference.org/ Isabel Chen MD MPH is a family medicine resident and Chief of Social Mission & Advocacy at the Kaiser Permanente Los Angeles Medical Center. She is a staunch advocate for social justice through the lens of health and medicine. She performs medical evaluations for asylum seekers in Southern California and is implementing a social determinants of health curriculum and patien screening tool for Kaiser Permanente. She founded the Keep Safe Initiative, a grassroots organization that develops panic alarms for sex-trade workers in Vancouver's Downtown Eastside, and co-founded The Reading Bear Society, a citywide early education that promotes inner-city health and literacy. She has servedon multiple boards including at Yale, UNESCO, UBC, APHA, CAFP, and STFM. Jamar Slocum MD MBA MPH is a clinical assistant professor of medicine at the George Washington University (GW), where he practices hospital medicine and serves as faculty for the Atlantic Fellows for Health Equity and Beyond Flexner Alliance. During the course of his career, he has combined his skills and experience in clinical medicine and public health to build a healthcare system that is based on equity and prevention. He is a former board member of the Tennessee Health Campaign, one of the leading non-profit advocacy organizations working to ensure affordable and high quality health care for all Tennesseans. Jamar completed his residency training in internal medicine at Brown University in Providence, RI and fellowship training in general preventive medicine at the Bloomberg School of Public Health at Johns Hopkins. Recommended Resources: Beyond Flexner Alliance website Mullan F, Chen C, Petterson S, et al. The Social Mission of Medical Education: Ranking the Schools. Ann Intern Med.2010;152:804-811. doi:10.7326/0003-4819-152-12-201006150-00009 Mullan F. White Coat, Clenched Fist: The Political Education of an American Physician (Ann Arbor: University of Mich. Press, 2006) Wright-Mendoza, J., 2019. The 1910 Report That Disadvantaged Minority Doctors. JSTOR Daily. bit.ly/3u2kMTI

Contributor: Chris Holmes, MD Educational Pearls: Many are taught that patients with cocaine chest pain should not receive beta-blockers due to unopposed alpha agonism, but is this true? 363 consecutive admissions for chest pain with positive cocaine on urine toxicology were reviewed in a retrospective cohort study 60 patients in this cohort received a beta-blocker and multivariate analysis demonstrated a reduction in myocardial infarction risk Another retrospective cohort study demonstrated no association of negative outcomes with beta-blocker administration in those with a recent positive result on cocaine urine toxicology Two more recent meta-analyses were performed finding no association between adverse clinical outcomes and beta-blocker administration for cocaine chest pain No prospective randomized-controlled trials have been performed to evaluate the use of beta-blockers for treatment of cocaine chest pain in the ED setting References Dattilo PB, Hailpern SM, Fearon K, Sohal D, Nordin C. Beta-blockers are associated with reduced risk of myocardial infarction after cocaine use [published correction appears in Ann Emerg Med. 2008 Jul;52(1):90]. Ann Emerg Med. 2008;51(2):117-125. doi:10.1016/j.annemergmed.2007.04.015 Rangel C, Shu RG, Lazar LD, Vittinghoff E, Hsue PY, Marcus GM. Beta-blockers for chest pain associated with recent cocaine use. Arch Intern Med. 2010;170(10):874-879. doi:10.1001/archinternmed.2010.115 Pham D, Addison D, Kayani W, et al. Outcomes of beta blocker use in cocaine-associated chest pain: a meta-analysis. Emerg Med J. 2018;35(9):559-563. doi:10.1136/emermed-2017-207065 Lo KB, Virk HUH, Lakhter V, et al. Clinical Outcomes After Treatment of Cocaine-Induced Chest Pain with Beta-Blockers: A Systematic Review and Meta-Analysis. Am J Med. 2019;132(4):505-509. doi:10.1016/j.amjmed.2018.11.041 Richards JR, Hollander JE, Ramoska EA, et al. β-Blockers, Cocaine, and the Unopposed α-Stimulation Phenomenon. J Cardiovasc Pharmacol Ther. 2017;22(3):239-249. doi:10.1177/1074248416681644 Lange RA, Cigarroa RG, Flores ED, et al. Potentiation of cocaine-induced coronary vasoconstriction by beta-adrenergic blockade. Ann Intern Med. 1990;112(12):897-903. doi:10.7326/0003-4819-112-12-897 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

In this episode from the Endocrine Surgery team at BTK we go through three controversial topics in endocrine surgery and cite pertinent articles during a lively debate format. We debate the role of four-gland exploration versus focused exploration for parathyroid disease. Indications for parathyroidectomy are hotly contested. And finally, we discuss the role and relevance of using a nerve monitor. Tune in to see if Dr. Yeh and Dr. Wu remain collegiate after recording this episode…               Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established.  Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department  Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department  Dr. Vivek Sant is an Endocrine Surgery Fellow at UCLA in his first year of fellowship Dr. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research  Dr. Max Schumm is a PGY-5 General Surgery Resident at UCLA who has completed two years of research. He is a future endocrine surgeon.  Important Papers  Norlén O, Wang KC, Tay YK, Johnson WR, Grodski S, Yeung M, Serpell J, Sidhu S, Sywak M, Delbridge L. No need to abandon focused parathyroidectomy: a multicenter study of long-term outcome after surgery for primary hyperparathyroidism. Ann Surg. 2015 May;261(5):991-6. doi: 10.1097/SLA.0000000000000715. PMID: 25565223. Schneider DF, Mazeh H, Sippel RS, Chen H. Is minimally invasive parathyroidectomy associated with greater recurrence compared to bilateral exploration? Analysis of more than 1,000 cases. Surgery. 2012 Dec;152(6):1008-15. doi: 10.1016/j.surg.2012.08.022. Epub 2012 Oct 12. PMID: 23063313; PMCID: PMC3501613. Jinih M, O'Connell E, O'Leary DP, Liew A, Redmond HP. Focused Versus Bilateral Parathyroid Exploration for Primary Hyperparathyroidism: A Systematic Review and Meta-analysis. Ann Surg Oncol. 2017 Jul;24(7):1924-1934. doi: 10.1245/s10434-016-5694-1. Epub 2016 Nov 28. PMID: 27896505. Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med. 1999 Oct 21;341(17):1249-55. doi: 10.1056/NEJM199910213411701. Erratum in: N Engl J Med 2000 Jan 13;342(2):144. PMID: 10528034. Seib CD, Meng T, Suh I, Harris AHS, Covinsky KE, Shoback DM, Trickey AW, Kebebew E, Tamura MK. Risk of Fracture Among Older Adults With Primary Hyperparathyroidism Receiving Parathyroidectomy vs Nonoperative Management. JAMA Intern Med. 2022 Jan 1;182(1):10-18. doi: 10.1001/jamainternmed.2021.6437. PMID: 34842909; PMCID: PMC8630642. Yeh MW, Zhou H, Adams AL, Ituarte PH, Li N, Liu IL, Haigh PI. The Relationship of Parathyroidectomy and Bisphosphonates With Fracture Risk in Primary Hyperparathyroidism: An Observational Study. Ann Intern Med. 2016 Jun 7;164(11):715-23. doi: 10.7326/M15-1232. Epub 2016 Apr 5. PMID: 27043778. Zanocco K, Butt Z, Kaltman D, Elaraj D, Cella D, Holl JL, Sturgeon C. Improvement in patient-reported physical and mental health after parathyroidectomy for primary hyperparathyroidism. Surgery. 2015 Sep;158(3):837-45. doi: 10.1016/j.surg.2015.03.054. Epub 2015 May 29. PMID: 26032828. Barczyński M, Konturek A, Cichoń S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg. 2009 Mar;96(3):240-6. doi: 10.1002/bjs.6417. PMID: 19177420. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.