POPULARITY
4 episodes with care excellence
2 episodes with care excellence
2 episodes with care excellence
2 episodes with care excellence
2 episodes with care excellence
2 episodes with care excellence
2 episodes with care excellence
2 episodes with care excellence
2 episodes with care excellence
An approach to dyspnea (shortness of breath), including the dyspnea pyramid to remember the differentials, as well as key investigations that help identify the cause, as well as common patterns in the history and physical examination. PDFs available here: https://rhesusmedicine.com/products/assessment-or-interpretationConsider subscribing on YouTube (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is Dyspnea?0:19 The Dyspnea Pyramid2:50 Dyspnea History & Physical Exam Patterns4:43 Dyspnea InvestigationsLINK TO MNEMONICS:https://www.youtube.com/watch?v=p-XE7PiwGgE&list=PLGNSE_HvIV4t7a33bbHN1fq-j_tge0GmpLINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/Please remember this podcast and all content from Rhesus Medicine is meant for educational purposes only and should not be used as a guide to diagnose or to treat. Please consult a healthcare professional for medical advice. ReferencesBMJ Best Practice (2025) Evaluation of dyspnoea in adults. BMJ Publishing Group.BMJ Best Practice (2025) Acute dyspnoea. BMJ Publishing Group.National Institute for Health and Care Excellence (2025) Breathlessness. Clinical Knowledge Summaries (CKS).MSD Manual Professional Edition (2025) Dyspnea. MSD Manual Professional Edition.StatPearls (2024) Dyspnea. In: StatPearls. Treasure Island (FL): StatPearls Publishing.Parshall, M.B., Schwartzstein, R.M., Adams, L., Banzett, R.B., Manning, H.L., Bourbeau, J., Calverley, P.M.A., Gift, A.G., Harver, A., Lareau, S.C., Mahler, D.A. and O'Donnell, D.E. (2012) An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea. American Journal of Respiratory and Critical Care Medicine, 185(4), pp.435–452.
What happens when language access moves from a compliance checkbox to a strategic priority? In part one of this two-part Elevate Care series, host Christin Stanford talks with Suzanne (Sue) Smith, System Director of Patient Experience at Main Line Health, about the evolving role of language services across a five-hospital system outside Philadelphia. Sue walks through how her team reframed language access from a cost center function into an essential clinical tool, one that belongs alongside staff, medicine, and equipment as a core part of care delivery. She shares how Main Line Health doubled its device deployment, the operational and financial ripple effects that followed, and why quality, safety, and patient experience function as a three-legged stool that only stands when every leg holds. The conversation also covers the human side of the equation: reduced staff burnout, stronger trust with patients who use American Sign Language, and fewer patients leaving without being seen. Sue makes the case that language access is not a cost center. It is a bridge for building relationships, supporting staff, and driving the kind of connected care that keeps patients coming back. Key Takeaways Language access works best when it is treated as an essential care tool, not a call-center service or a line-item expense. Doubling device availability at Main Line Health improved communication volume and clarity, while easing pressure on nursing and support staff. Quality, safety, and patient experience depend on each other. When one falls, the whole structure falls. Reliable interpretation reduces reliance on untrained family members or staff, protecting both accuracy and patient trust. Language access touches every part of the patient journey, from registration and wayfinding to discharge paperwork, not only clinical encounters. Strong language services can reduce patients leaving without being seen and support broader operational metrics tied to patient experience. Chapters 00:00 – Introduction to Language Access as a Strategic Priority 01:50 – Sue's Role Leading Patient Experience at Main Line Health 03:00 – From Compliance Checkbox to Shared Commitment 05:24 – Language Services as an Essential Care Tool 08:33 – Balancing Cost Conversations with Care Excellence 12:08 – How the Right Tools Reduce Staff Burnout 15:11 – Trust, Validation, and the Risk of Informal Interpreters 17:20 – Doubling Devices: A Main Line Health Deployment Story 21:07 – Connecting Language Access to Operational Metrics 24:58 – Language Access Beyond the Clinical Encounter 27:02 – A Final Word for Leaders Still on the Fence Meet Suzanne Smith Suzanne "Sue" Smith serves as System Director of Patient Experience at Main Line Health, where she oversees connected care across five hospitals and more than 150 physician practices outside Philadelphia. With over 25 years in healthcare, Sue leads a team spanning patient navigators, EDI ambassadors, spiritual care, and volunteers, all focused on making sure every patient feels seen and understood. Her work centers on building bridges between data and humanity, using language access as one of the clearest expressions of patient-centered care. Sponsors: We're proudly sponsored by AMN Healthcare, the leader in healthcare staffing and workforce solutions. Explore their services at AMN Healthcare. Learn how AMN Healthcare's workforce flexibility technology helps health systems cut costs and improve efficiency. Click here to explore the case study and discover smarter ways to manage your resources!Discover how WorkWise is redefining workforce management for healthcare. Visit workwise.amnhealthcare.com to learn more.About The Show: Elevate Care delves into the latest trends, thinking, and best practices shaping the landscape of healthcare. From total talent management to solutions and strategies to expand the reach of care, we discuss methods to enable high quality, flexible workforce and care delivery. We will discuss the latest advancements in technology, the impact of emerging models and settings, physical and virtual, and address strategies to identify and obtain an optimal workforce mix. Tune in to gain valuable insights from thought leaders focused on improving healthcare quality, workforce well-being, and patient outcomes. Learn more about the show here. Find Us On:WebsiteYouTubeSpotifyAppleInstagramLinkedInXFacebook Powered by AMN Healthcare Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
Gambling disorder is a behavioural addiction that affects a large number of individuals, yet often goes unrecognised. In this podcast, Dr Myooran Canagaratnam is joined by two of the UK's leading experts, Prof Henrietta Bowden-Jones and Prof Sam Chamberlain, to explore gambling and its profound clinical, social and psychiatric implications. Drawing on frontline experience, the discussion looks at how gambling disorder presents, those most at risk, and why comorbidity with depression, anxiety, attention-deficit hyperactivity disorder (ADHD) and other conditions makes it highly relevant to psychiatric practice. This podcast examines the impact of digital gambling, dopamine-modulating medications, and the wide-ranging spectrum of gambling-related harms. The podcast also offers an overview of evidence-based treatment and the rapidly expanding research which is now underpinned by NICE (National Institute for Health and Care Excellence] guidance and the gambling levy. Disclaimer: Thank you for listening to this Royal College of Psychiatrists CPD eLearning podcast. This podcast provides information, not advice. The content in this podcast is provided for general information only and is not intended to, and does not amount to, advice that you should rely on. It is not an alternative to specific, professional advice. Although we make reasonable efforts to present accurate information in our podcasts, we make no representations, warranties or guarantees, whether expressed or implied, that the content in this podcast is accurate, complete or up to date. If you have any questions about any medical matter, you should consult your doctor or other professional healthcare provider without delay. If you think you are experiencing any medical condition, you should seek immediate attention from a doctor or professional healthcare provider. Please note that the views of the interviewees are not necessarily those of the Royal College of Psychiatrists.
Welcome to Ozempic Weightloss Unlocked, where we dive into the latest on Ozempic, from medical breakthroughs to lifestyle impacts.Listeners, big news from the British Heart Foundation: over one million people with cardiovascular disease will soon get Wegovy, which contains semaglutide like Ozempic, on the National Health Service to prevent heart attacks and strokes. The National Institute for Health and Care Excellence recommends it for those with a body mass index of twenty-seven or higher who have had a heart attack, stroke, or severe artery issues. Clinical trials show it cuts cardiovascular risks, independent of weight loss, and it's given as a weekly injection with diet and exercise.The Obesity Medicine Association reports that in December twenty twenty-five, the Food and Drug Administration approved an oral Wegovy pill for obesity, starting at one point five milligrams and titrating up. It matches the injectable's side effects like stomach issues but offers a no-needle option, taken on an empty stomach.Tirzepatide, sold as Zepbound, leads in effectiveness per their data, with up to twenty-two point five percent average weight loss in trials, beating semaglutide's fourteen point nine percent. Expect one to two new GLP-one drugs yearly from twenty twenty-six, like Lilly's orforglipron oral pill showing eleven point two percent loss, and Novo Nordisk's amycretin with twenty-four point three percent in phase two.Beyond weight, Advisory Board notes semaglutide's approvals for chronic kidney disease in type two diabetes patients and cardiovascular benefits, reducing major events by twenty percent. Studies link it to lower cognitive decline risks and possible fertility boosts from weight loss improving hormones.Always pair these with healthy eating, exercise, and behavioral changes for best results and to preserve muscle.Thanks for tuning in, listeners. Subscribe for more updates. This has been a Quiet Please production, for more check out quietplease.ai. Some great Deals https://amzn.to/49SJ3QsFor more check out http://www.quietplease.aiThis content was created in partnership and with the help of Artificial Intelligence AI
Sheila Shepley (nurse practitioner, Walton Centre NHS Foundation Trust) speaks with Rita Som (editor, British Journal of Neuroscience Nursing) about caring for and managing women with epilepsy during pregnancy. The podcast episode aims to support healthcare professionals in delivering safe, coordinated and evidence-based care for women with epilepsy during pregnancy and postpartum, by exploring the clinical, pharmacological and psychosocial complexities involved in balancing seizure control with maternal and foetal safety. This educational episode was initiated and funded by Neuraxpharm UK Ltd. The date of recording was February 2026. Job code NXUK/E/0326/20. The views expressed are those of Sheila Shepley. Bibliography 1. Felker A, Patel R, Kotnis R, Kenyon S, Knight M. Saving lives, improving mothers' care compiled report: lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2021-23. Oxford: University of Oxford; 2025 2. Razaz N, Igland J, Bjørk MH et al. Risk of perinatal and maternal morbidity and mortality among pregnant women with epilepsy. JAMA Neurol. 2024;81(9):985–995. https://doi.org/10.1001/jamaneurol.2024.2375 3. UK Epilepsy and Pregnancy Register. Conducting research to make pregnancy for people with epilepsy safer. 2026. https://www.epilepsyandpregnancy.co.uk/ (accessed 16 February 2026) 4. Herzog AG, Mandle HB, Cahill KE, Fowler KM, Hauser WA. Predictors of unintended pregnancy in women with epilepsy. Neurology. 2017;88(8):728–733. https://doi.org/10.1212/WNL.0000000000003637 5. Samsonsen C, Karanauskaitė U, Stenbacka EJ, Hjelvik ES, Rektorli L, Brodtkorb E. Pregnancy planning in women with epilepsy: a single center observational study with focus on epilepsy type. Seizure. 2024;123:152–158. https://doi.org/10.1016/j.seizure.2024.11.010 6. Fu Y, Shi F, Sha L et al. Association of seizure control during pregnancy with adverse offspring outcomes in women with epilepsy. J Neurol Neurosurg Psychiatry. 2025;96(7):621–629. https://doi.org/10.1136/jnnp-2024-335751 7. Askarieh A, MacBride-Stewart S, Kirby J et al. Delivery of care, seizure control and medication adherence in women with epilepsy during pregnancy. Seizure. 2022;100:24–29. https://doi.org/10.1016/j.seizure.2022.06.002 8. Lupattelli A, Spigset O, Nordeng H. Adherence to medication for chronic disorders during pregnancy: results from a multinational study. Int J Clin Pharm. 2014;36(1):145–153. https://doi.org/10.1007/s11096-013-9864-y 9. SUDEP Action. Women left in dark over pregnancy and SUDEP risks. 2023. https://sudep.org/women-left-in-dark-over-pregnancy-and-sudep-risks/ (accessed 16 February 2026) 10. Harden CL, Meador KJ, Pennell PB et al. Management issues for women with epilepsy-Focus on pregnancy (an evidence-based review): II. Teratogenesis and perinatal outcomes: Report of the Quality Standards Subcommittee and Therapeutics and Technology Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia. 2009;50(5):1237–1246. https://doi.org/10.1111/j.1528-1167.2009.02129.x 11. Freund B, Chen B, Kaplan PW, Johnson EL. Managing antiseizure medications in pregnancy: is earlier and more frequent monitoring better?. Neurol Clin Pract. 2023;13(4):e200169. https://doi.org/10.1212/CPJ.0000000000200169 12. Hope OA, Harris KM. Management of epilepsy during pregnancy and lactation. BMJ. 2023;382:e074630. https://doi.org/10.1136/bmj-2022-074630 13. Yasguclukal M, Acar Z, Bastan B, Mutlu A, Cokar O. Self-discontinuation of antiseizure medication during pregnancy increases postpartum seizure frequency. Experimed. 2022;12(3):174–180. https://doi.org/10.26650/experimed.1183414 14. National Institute for Health and Care Excellence. Epilepsies in children, young people and adults. 2025. https://www.nice.org.uk/guidance/ng217 (accessed 16 February 2026) 15. Royal College of Obstetricians and Gynaecologists. Epilepsy in pregnancy (Green-top Guideline No. 68). 2016. https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/ (accessed 16 February 2026) 16. Scottish Intercollegiate Guidelines Network. Diagnosis and management of epilepsy in adults. 2018. https://www.sign.ac.uk/guidelines/diagnosis-and-management-of-epilepsy-in-adults/ (accessed 16 February 2026) 17. Weckesser A, Hughes A, Dyson J et al. Experiences of pregnancy and reproductive health for women living with epilepsy: a systematic review. Seizure. 2025;133:106–113. https://doi.org/10.1016/j.seizure.2025.10.011
In this week's Talking Health, Jessica is joined by consultant radiologist, Dr Alex King, to discuss new guidelines fromthe National Institute for Health and Care Excellence, or NICE, which have officially given the green light to thermal ablation to treat kidney cancer on the NHS.
NICE, the National Institute for Health and Care Excellence has recently approved new treatment in England for people living with the eye condition Leber hereditary optic neuropathy (LHON) helped by Researchers at the University of Cambridge. RNIB Connect Radio's Toby Davey was joined by Patrick Yu-Wai-Man, Professor of Ophthalmology at the University of Cambridge who was involved in the research into using idebenone to treat Leber hereditary optic neuropathy (LHON) who explains more about the eye condition and how the NICE approved treatment might be appropriate for some people who have LHON. To find out more about the University of Cambridge research into the new treatment for Leber hereditary optic neuropathy (LHON) do visit the following pages of the University website - https://www.clinical-neuroscience.cam.ac.uk/news/first-ever-mitochondrial-disease-treatment-approved-nhs-england (Image shows the RNIB Connect Radio logo. On a white background ‘RNIB' written in bold black capital letters and underline with a bold pink line. Underneath the line: ‘Connect Radio' is written in black in a smaller font)
Episode 198: Fatigue. Future doctors Redden and Ibrahim discuss with Dr. Arreaza the different causes of fatigue, including physical and mental illnesses. Dr. Arreaza describes the steps to evaluate fatigue. Some common misconceptions are explained, such as vitamin D deficiency and “chronic Lyme disease”. Written by Michael Ibrahim, MSIV, and Jordan Redden, MSIV, Ross University School of Medicine. Edits and comments by Hector Arreaza, MDYou are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Dr. Arreaza: Today is a great day to talk about fatigue. It is one of the most common and most complex complaints we see in primary care. It involves physical, mental, and emotional health. So today, we're walking through a case, breaking down causes, red flags, and how to work it up without ordering the entire lab catalog.Michael:Case: This is a 34-year-old female who comes in saying, "I've been feeling drained for the past 3 months." She says she's been sleeping 8 hours a night but still wakes up tired. No recent illnesses, no weight loss, fever, or night sweats. She denies depression or anxiety but does report a lot of work stress and taking care of her two little ones at home. She drinks 2 cups of coffee a day, doesn't drink alcohol, and doesn't use drugs. No medications, just a multivitamin. Regular menstrual cycles—but she's noticed they've been heavier recently.Jordan:Fatigue is a persistent sense of exhaustion that isn't relieved by rest. It's different from sleepiness or muscle weakness.Classification based on timeline: • Acute fatigue: less than 1 month • Subacute: 1 to 6 months • Chronic: more than 6 monthsThis patient's case is subacute—going on 3 months now.Dr. Arreaza:And we can think about fatigue in types: • Physical fatigue: like muscle tiredness after activity • Mental fatigue: trouble concentrating or thinking clearly (physical + mental when you are a medical student or resident) • Pathological fatigue: which isn't proportional to effort and doesn't get better with restAnd of course, there's chronic fatigue syndrome, also called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which is a diagnosis of exclusion after 6 months of disabling fatigue with other symptoms.Michael:The differential is massive. So, we can also group it by systems.Jordan:Let's run through the big ones.Endocrine / Metabolic Causes • Hypothyroidism: A classic cause of fatigue. Often associated with cold intolerance, weight gain, dry skin, and constipation. May be subtle and underdiagnosed, especially in women. • Diabetes Mellitus: Both hyperglycemia and hypoglycemia can cause fatigue. Look for polyuria, polydipsia, weight loss, or blurry vision in undiagnosed diabetes. • Adrenal Insufficiency: Think of this when fatigue is paired with hypotension, weight loss, salt craving, or hyperpigmentation. Can be primary (Addison's) or secondary (e.g., due to long-term steroid use).Michael: Hematologic Causes • Anemia (especially iron deficiency): Very common, especially in menstruating women. Look for fatigue with pallor, shortness of breath on exertion, and sometimes pica (craving non-food items). • Vitamin B12 or Folate Deficiency: B12 deficiency may present with fatigue plus neurologic symptoms like numbness, tingling, or gait issues. Folate deficiency tends to present with megaloblastic anemia and fatigue. • Anemia of Chronic Disease: Seen in patients with chronic inflammatory conditions like RA, infections, or CKD. Typically mild, normocytic, and improves when the underlying disease is treated.Michael: Psychiatric Causes • Depression: A major driver of fatigue, often underreported. May include anhedonia, sleep disturbance, appetite changes, or guilt. Sometimes presents with only somatic complaints. • Anxiety Disorders: Mental fatigue, poor sleep quality, and hypervigilance can leave patients feeling constantly drained. • Burnout Syndrome: Especially common in caregivers, healthcare workers, and educators. Emotional exhaustion, depersonalization, and reduced personal accomplishment are key features.Jordan: Infectious Causes • Epstein-Barr Virus (EBV):Mononucleosis is a well-known cause of fatigue, sometimes lasting weeks. May also have sore throat, lymphadenopathy, and splenomegaly. • HIV:Consider it in high-risk individuals. Fatigue can be an early sign, along with weight loss, recurrent infections, or night sweats. • Hepatitis (B or C):Can present with chronic fatigue, especially if liver enzymes are elevated. Screen at-risk individuals. • Post-viral Syndromes / Long COVID:Fatigue that lingers for weeks or months after viral infection. Often, it includes brain fog, muscle aches, and post-exertional malaise.Important: Chronic Lyme disease is a controversial term without a consistent clinical definition and is often used to describe patients with persistent, nonspecific symptoms not supported by objective evidence of Lyme infection. Leading medical organizations reject the term and instead recognize "post-treatment Lyme disease syndrome" (PTLDS) for persistent symptoms following confirmed, treated Lyme disease, emphasizing that prolonged antibiotic therapy is not effective. Research shows no benefit—and potential harm—from extended antibiotic use, and patients with unexplained chronic symptoms should be thoroughly evaluated for other possible diagnoses.Michael: Cardiopulmonary Causes • Congestive Heart Failure (CHF): Fatigue from poor perfusion and low cardiac output. Often comes with dyspnea on exertion, edema, and orthopnea. • Chronic Obstructive Pulmonary Disease (COPD): Look for a smoking history, chronic cough, and fatigue from hypoxia or the work of breathing. • Obstructive Sleep Apnea (OSA): Daytime fatigue despite adequate hours of sleep. Patients may snore, gasp, or report morning headaches. High suspicion in obese or hypertensive patients.Jordan:Autoimmune / Inflammatory Causes • Systemic Lupus Erythematosus (SLE): Fatigue is often an early symptom. May also see rash, arthritis, photosensitivity, or renal involvement. • Rheumatoid Arthritis (RA): Fatigue from systemic inflammation. Morning stiffness, joint pain, and elevated inflammatory markers point to RA. • Fibromyalgia: A chronic pain syndrome with widespread tenderness, fatigue, nonrestorative sleep, and sometimes cognitive complaints ("fibro fog").Cancer / Malignancy • Leukemia, lymphoma, or solid tumors: Fatigue can be the first symptom, often accompanied by weight loss, night sweats, or unexplained fevers. Consider when no other cause is evident.Michael:Medications:Common culprits include: ◦ Beta-blockers: Can slow heart rate too much. ◦ Antihistamines: Sedating H1 blockers like diphenhydramine. ◦ Sedatives or sleep aids: Can cause grogginess and daytime sedation. • Substance Withdrawal: Fatigue can be seen in withdrawal from alcohol, opioids, or stimulants. Caffeine withdrawal, though mild, can also contribute.Dr. Arreaza:Whenever we evaluate fatigue, we need to keep an eye out for red flags. These should raise suspicion for something more serious: • Unintentional weight loss • Night sweats • Persistent fever • Neurologic symptoms • Lymphadenopathy • Jaundice • Palpitations or chest painThis patient doesn't have these—but that doesn't mean we stop here.Dr. Arreaza:Those are a lot of causes, we can evaluate fatigue following 7 steps:Characterize the fatigue.Look for organic illness.Evaluate medications and substances.Perform psychiatric screening.Ask questions about quantity and quality of sleep.Physical examination.Undertake investigations.So, students, do we send the whole lab panel?Michael:Not necessarily. Labs should be guided by history and physical. But here's a good initial panel: • CBC: To check for anemia or infection • TSH: Screen for hypothyroidism • CMP: Look at electrolytes, kidney, and liver function • Ferritin and iron studies • B12, folate • ESR/CRP for inflammation (not specific) • HbA1c if diabetes is on the radarJordan:And if needed, consider: • HIV, EBV, hepatitis panel • ANA, RF • Cortisol or ACTH stimulation testImaging? Now that's rare—unless there are specific signs. Like chest X-ray for possible cancer or TB, or sleep study if you suspect OSA.Dr. Arreaza:Unaddressed fatigue isn't just inconvenient. It can impact on quality of life, affect job performance, lead to mood disorders, delay diagnosis of serious illness, increase risk of accidents—especially driving. So, don't ignore your patients with fatigue!Jordan:And some people—like women, caregivers, or shift workers—are especially at risk.Michael:The cornerstone of treatment is addressing the underlying cause.Jordan:If it's iron-deficiency anemia—treat it. If it's depression—get mental health involved. But there's also: Lifestyle Support: Better sleep hygiene, light physical activity, mindfulness or CBT for stress, balanced nutrition—especially iron and protein, limit caffeine and alcoholDr. Arreaza:Sometimes medications help—but rarely. And for chronic fatigue syndrome, the current best strategies are graded exercise therapy and CBT, along with managing specific symptoms. Beta-alanine has potential to modestly improve muscular endurance and reduce fatigue in older adults, but more high-quality research is needed.SSRI: fluoxetine and sertraline. Iron supplements: Even without anemia, but low ferritin [Anecdote about low ferritin patient]Jordan:This case reminds us to take fatigue seriously. In her case, it may be multifactorial—work stress, caregiving burden, and possibly iron-deficiency anemia. So, how would we wrap up this conversation, Michael?Michael:We don't need to order everything under the sun. A focused history and exam, targeted labs, and being alert to red flags can guide us.Jordan:And don't forget the basics—sleep, stress, and nutrition. These are just as powerful as any prescription.Dr. Arreaza:We hope today's episode on fatigue has given you a clear framework and some practical tips. If you enjoyed this episode, share it and subscribe for more evidence-based medicine!Jordan:Take care—and get some rest~___________________________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:DynaMed. (2023). Fatigue in adults. EBSCO Information Services. https://www.dynamed.com (Access requires subscription)Jason, L. A., Sunnquist, M., Brown, A., Newton, J. L., Strand, E. B., & Vernon, S. D. (2015). Chronic fatigue syndrome versus systemic exertion intolerance disease. Fatigue: Biomedicine, Health & Behavior, 3(3), 127–141. https://doi.org/10.1080/21641846.2015.1051291Kroenke, K., & Mangelsdorff, A. D. (1989). Common symptoms in ambulatory care: Incidence, evaluation, therapy, and outcome. The American Journal of Medicine, 86(3), 262–266. https://doi.org/10.1016/0002-9343(89)90293-3National Institute for Health and Care Excellence. (2021). Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: Diagnosis and management (NICE Guideline No. NG206). https://www.nice.org.uk/guidance/ng206UpToDate. (n.d.). Approach to the adult patient with fatigue. Wolters Kluwer. https://www.uptodate.com (Access requires subscription)Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.
In this episode, CANCER BUZZ speaks with Anna Liza Rodriguez, MSN, MHA, RN, OCN, NEA-BC, chief nursing officer and vice president of Nursing and Patient Care Services at Fox Chase Cancer Center about her program's receipt of a 2025 ACCC Innovator Award. Fox Chase Cancer Center's innovation, Ambulatory Care Excellence (ACE): Charting a New Path in Ambulatory Care Model and Coordination, is a structured approach designed to improve efficiency, coordination, and patient outcomes in ambulatory cancer care while ensuring top of license scope of work for clinicians. Rodriguez will discuss key features of the ACE Model, its impact on patients with cancer, and notable results of the initiative. Anna Liza Rodriguez, MSN, MHA, RN, OCN, NEA-BC Chief Nursing Officer, Vice President, Nursing and Patient Care Services Fox Chase Cancer Center Philadelphia, PA “All of our team members are really connected to our purpose...from frontline staff to executives to different support services. [They] truly have the patient front and center, [and] that really drives a lot of our passion towards improvement [and] making sure that the care we deliver is exceptional.” - Anna Rodriguez This podcast is part of a special series featuring the 2025 ACCC Innovator Award winners. For a deeper dive into this topic and other content that will help your team reimagine how care is delivered at your cancer program or practice, register today for the ACCC 42nd National Oncology Conference, October 15-17 in Denver, Colorado. Resources: Geriatric Oncology Ambulatory Care Clinics Implementing Telephone Triage Guidelines into Nursing Workflow The Oncology Nursing Fellowship Program Transitioning Select Chemotherapeutics to the Outpatient Setting Improves Care and Reduces Costs
Episode 194: Acute low back pain. Future Dr. Ibrahim presents a clinical case to explain the essential points in the evaluation of back pain. Future Dr. Redden adds information about differentiating between a back strain and more serious diseases such as cancer, and Dr. Arreaza shares information about returning to work after back strain.Written by Michael Ibrahim, MSIV. Editing and comments by Jordan Redden, MSIV, and 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.Dr. Arreaza:Welcome back, everyone. Today's topic is one that every primary care provider, emergency doctor, and even specialist sees routinely: low back pain. It's so common that studies estimate up to 80% of adults will experience it at some point in their lives. But despite how frequent it is, the challenge is to identify which cases are benign and which demand urgent attention.Jordan:Exactly. Low back pain is usually self-limiting and mechanical in nature, but we always need to keep an eye out for the rare but serious causes: things like infection, malignancy, or neurological compromise. That's why a good history and physical exam are our best tools right out of the gate.Michael:And to ground this in a real example, let me introduce a patient we saw recently. John is a 45-year-old warehouse worker who came in with two weeks of lower back pain that started after lifting a 50-lb box. He describes it as a dull, aching pain that radiates from his lower back down the posterior left thigh into the calf. He says it gets worse with bending or coughing, but he feels better when lying flat. He also mentioned some numbness in his left foot, but he denies any bowel or bladder issues. His vitals are completely normal. On exam, he had lumbar paraspinal tenderness, a positive straight leg-raise at 40 degrees on the left and decreased sensation in the L5 dermatome, though reflexes were still intact.Dr. Arreaza:That's a great case. Let's take a minute and talk about the straight leg raise test. This is a bedside tool we use to assess for lumbar nerve root irritation often caused by a herniated disc. ***Here's how it works: the patient lies supine, and you slowly raise their straight leg. If pain radiates below the knee between 30° and 70°, that suggests radiculopathy, especially involving the L5 or S1 nerve roots. Pain at higher angles is more likely due to hamstring tightness or mechanical strain.Michael:Right. So, stepping back: what do we mean by "low back pain"? Broadly, it's any pain localized to the lumbar spine, but it's often classified by type or cause:Mechanical (like muscle strain or degenerative disc disease), Radicular (nerve root involvement), Referred pain (like from pelvic or abdominal organs), Inflammatory (AS), and Systemic or serious causes like infection or malignancy. Jordan:In John's case, we're thinking radicular pain, most likely from a herniated disc compressing the L5 nerve root. That's supported by the dermatomal numbness, the leg pain, and that positive straight leg test.Dr. Arreaza:Good reasoning. Now, anytime we see back pain, our brains should run a checklist for red flags. These help us pick up more serious causes that require urgent attention. Let's run through the red flags.Michael:Sure. For fracture, we think about major trauma or even minor trauma in the elderly, especially those with osteoporosis or on chronic steroids. Also, anyone over 70 years old.Jordan:Then we have infections, which could include things like discitis, vertebral osteomyelitis, or epidural abscess. Red flags include fever, IV drug use, recent surgery, or immunosuppression.Michael:Malignancy is another critical one, especially if there's a history of breast, prostate, lung, kidney, or thyroid cancer. Clues include unexplained weight loss, night pain, or constant pain not relieved by rest.Jordan:And don't forget about inflammatory back pain, like ankylosing spondylitis, which is often seen in younger patients with morning stiffness that lasts more than 30 minutes and improves with activity.Dr. Arreaza:And of course, we always rule out cauda equina syndrome: a surgical emergency. That's urinary retention or incontinence, saddle anesthesia, bilateral leg weakness, or fecal incontinence. Missing this diagnosis can be catastrophic.Michael:Thankfully, in John's case, we don't see any red flags. His presentation is classic for uncomplicated lumbar radiculopathy. But we must stay vigilant, because sometimes patients don't offer up key symptoms unless we ask directly.Jordan:And that's where associated symptoms help guide us. For example:Radicular symptoms like numbness or weakness follow dermatomal patterns. Constitutional symptoms like fever or weight loss raise red flags. Bladder/bowel changes or saddle anesthesia raise alarms for cauda equina. Pain that wakes patients up at night might point to malignancy. Dr. Arreaza:So when do we order labs or imaging?Michael:Not right away. For most patients with acute low back pain, imaging is not needed unless they have red flags. If infection is suspected, we'd get CBC, ESR, and CRP. For cancer, maybe PSA or serum protein electrophoresis. And if inflammatory back disease is suspected, HLA-B27 can be helpful.Jordan:Yes, imaging should be delayed for at least six weeks unless red flags or significant neurologic deficits are present. When we do image, MRI is our go-to especially for suspected radiculopathy or cauda equina. X-rays can help if we're thinking about fractures, but they won't show soft tissue or nerve root issues.Michael:In the example from our case, since the patient doesn't have red flags, we'd go with conservative management: start NSAIDs and recommend activity modification. As this is the acute setting, physical therapy would not be recommended.Jordan:For the acute phase, research shows no serious difference between those with PT and those without in the long term. However, physical therapy is really the cornerstone of management for chronic back pain. It's not just movement: it's education, body mechanics, and teaching patients how to move safely. And PT can actually reduce opioid use, imaging, and injections down the line for patient struggling with long term back pain.Dr. Arreaza:Yes, and PT is not one-size-fits-all. PT might include McKenzie exercises, manual therapy, postural retraining, or even neuromuscular re-education. The goal is always to build core stability, promote healthy movement patterns, and reduce fear of motion.Jordan:Let's take a minute to talk about the McKenzie Method, a physical therapy approach used to treat lumbar disc herniation by identifying a specific movement, (often spinal extension) that reduces or centralizes pain. A common exercise is the prone press-up, (cobra pose for yoga fans) where the patient lies face down and pushes the upper body upward while keeping the hips on the floor to relieve pressure on the disc. These exercises should be done carefully, ideally under professional guidance, and discontinued if symptoms worsen.Michael:For our case patient, our working diagnosis is mechanical low back pain with L5 radiculopathy. No imaging needed now, no red flags. We'll treat conservatively and educate him about proper lifting, staying active, and recovery expectations.Jordan:We also emphasized to him that bed rest isn't helpful. In fact, bed rest can make things worse. Keeping active while avoiding heavy lifting for now is key.Dr. Arreaza:Return-to-work recommendations should be individualized. For example, an office worker, positioning while working, or work hours may be able to return to work promptly. However, those with physically demanding jobs may need light duty or be off work.Ice: no evidence of benefit. Heat: may reduce pain and disability in pain of less than 3 months, although the benefit was small and short.And we should always teach safe lifting techniques: bend at the knees, keep the load close, avoid twisting. It's basic knowledge, but it is very effective in preventing recurrence.Jordan:Now, if a patient fails to improve after 6 weeks of conservative therapy, or if they develop new neurologic deficits, that's when we think about referral to spine specialists or surgical consultation.Michael:And as previously mentioned: in cases where back pain becomes chronic (lasting more than 12 weeks) a multidisciplinary approach works best. That can include:Physical therapy, Cognitive behavioral therapy (CBT) And sometimes pain management interventions. Jordan:We can't forget the psychological toll either. Chronic back pain is associated with depression, anxiety, and opioid dependence. Increased risk factors include obesity, smoking, sedentary lifestyle, and previous back injuries.Dr. Arreaza:Well said. So, let's summarize. Michael?Michael:Sure! Low back pain is common, and most cases are benign. But we have to know the red flags that point to serious pathology. A focused history and physical exam are more powerful than many people realize. And the first step in treatment is almost always conservative, with a strong emphasis on maintaining physical activity.Jordan:And don't underestimate the value of patient education. Helping patients understand their pain, set realistic expectations, and stay active is often just as important as the medications or therapies we offer.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:Chou, R., Qaseem, A., Snow, V., Casey, D., Cross, J. T., Shekelle, P., & Owens, D. K. (2007). Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, 147(7), 478–491. https://doi.org/10.7326/0003-4819-147-7-200710020-00006Deyo, R. A., Mirza, S. K., Turner, J. A., & Martin, B. I. (2009). Overtreating chronic back pain: Time to back off? Journal of the American Board of Family Medicine, 22(1), 62–68. https://doi.org/10.3122/jabfm.2009.01.080102National Institute for Health and Care Excellence. (2020). Low back pain and sciatica in over 16s: Assessment and management (NICE Guideline No. NG59). https://www.nice.org.uk/guidance/ng59Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166(7), 514–530. https://doi.org/10.7326/M16-2367UpToDate. (n.d.). Evaluation and treatment of low back pain in adults. Wolters Kluwer. https://www.uptodate.com (Access requires subscription)Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.
London Tech Week has wrapped for 2025.For a look at this year's highlights, we're joined by The Standard's technology editor, Alex Pell, who not only attended the event but also joined multiple panels across the week.Alex told us about why he thinks we need to use AI to become more than human ("bionic if you will”), plus, he explains the rise of the artificial intelligence super agents.UK officials are being deployed to India to support the investigation into the Air India Crash, the Air Accidents Investigation Branch has said.The Boeing 787 Dreamliner struck a medical college moments after takeoff on Thursday in the Indian city of Ahmedabad, killing 241 people on board.Blood cancer patients in England and Wales will be among the first in the world to have access to a new “Trojan horse” treatment.Blenrep has been approved by the National Institute for Health and Care Excellence for NHS use.Also in this episode:-Tesla sues former Optimus humanoid robotics engineer over alleged trade secret theft-A 'Google Maps for the sea' that's aiming to help cut the shipping industry's CO2 emissions-Flo Health respond to claims that women face “real and frightening privacy and safety risks” when using period tracker apps-US caregivers are dressing up as bears to care for a bear cub Hosted on Acast. See acast.com/privacy for more information.
Dr Eisert, from Humboldt University in Germany, told us how pulse rates in super-realistic deepfakes are hard to detect and could escape traditional detector technology.A new AI tool to spot suspected skin cancer has been approved for NHS use.The National Institute for Health and Care Excellence said that the technology has the potential to reduce waiting times.Plus, a soviet rocket entry capsule, which was headed for Venus, is expected to come crashing back to Earth in the coming days.Also in this episode:One in three report the ability ‘to sing better than speak' after a strokeThe UK could experience the warmest start to May ever recordedArchaeologists discover ancient penis shaped pendant near Hadrian's Wall - and it's believed to have been a good luck charm Hosted on Acast. See acast.com/privacy for more information.
Chelsea McGivney, DVM earned her Doctor of Veterinary Medicine degree from Colorado State University.Her diverse veterinary career includes completing a small animal internship, working as an emergency and general practitioner, serving as an in-home end-of-life care veterinarian, and working in the pet food industry as a veterinary consultant for a leading company. This unique blend of experiences prepared McGivney for her role as General Manager at Caring Pathways, where she leads a dedicated team of at-home, end-of-life specialists. Her deep passion for the human-animal bond allows her to combine her professional expertise with her love of veterinary care to support families during some of life's most tender moments. Tyler Carmack, DVM, CVA, CVFT, CHPV, CTPEP, is the Director of Hospice and Palliative Care for Caring Pathways. She founded Hampton Roads Veterinary Hospice, an AAHA Accredited End of Life practice, and has practiced exclusively hospice and palliative care since 2011. She has served on the Board of Directors of the International Association for Animal Hospice and Palliative Care (IAAHPC) since 2016 in various roles, including President in 2020 and 2025. Carmack holds certifications in animal hospice and palliative care, veterinary pain management, peaceful euthanasia, veterinary acupuncture, TCVM food therapy, and TCVM End-of-Life care.
Local Pet Care Excellence: Boulder City Critter Sitter.In today's episode of The Best Dam Podcast, Jill has the pleasure of chatting with Michelle Carroll, the owner of Boulder City Critter Sitter. Michelle shares her journey of turning a lifelong love for animals into a thriving business. From pet sitting to professional training, Michelle offers invaluable insights into the world of animal care and how her dedicated critter crew is enhancing the lives of both pets and their owners in Boulder City.DISCUSSION TOPICSMichelle Carroll's BackgroundPassion for animalsOwnership of Boulder City Critter SitterPet Sitting Business in Boulder CityNeed for pet sitting services in Boulder CityImportance of providing assurance for pet owners when awayProfessionalism and CertificationsVarious certifications and training Michelle has acquiredImportance of being insured and bondedHiring and training of independent contractorsFormation of the "critter crew"Training and EducationContinuing education and additional certificationsApprenticeship with Sabrina SmilerFuture training workshops in Boulder CityPet Behavior and Owner EducationFocus on positive reinforcement training methodsExplanation of animal behavior understandingImportance of educating the pet ownersPersonal Stories and ExperiencesPersonal anecdotes, such as a cat stealing personal itemsConnection and trust-building with animalsCommunity Involvement and Future PlansDesire to work with local animal sheltersPlans for a ribbon-cutting and community event to promote animal adoptionPartnerships with local businessesPassion for Animals and the CommunityMichelle's personal journey and satisfaction working with animalsIntegration of technology skills into the businessEnthusiasm for community collaboration and eventsMEDIAhttps://www.bouldercity.com/new-business-critter-sitter-and-dog-walking/LEARN MOREClick here to learn more about Michelle and Boulder City Critter Sitter, visit their website at https://bouldercitycrittersitter.com or on Facebook at https://www.facebook.com/bouldercitycrittersitterKEYWORDSMichelle Carroll, Boulder City Critter Sitter, Jill Lagan, Boulder City Chamber of Commerce, The Best Dam Podcast, Podcast Interview#MichelleCarroll #BoulderCityCritterSitter #BoulderCity #JillLagan #BCNVChamber2025 #TheBestDamPodcast #PodcastInterviewCREDITSThe Best Dam Podcast is a Boulder City Chamber of Commerce podcast production.This episode is sponsored by the i & i Podcast & Music Studio. Be Heard.
In this podcast recorded in early February, David Phizackerley and Julian Treadwell (DTB Associate Editor) provide an overview of the March 2025 issue of DTB. Julian talks about his work as an academic GP based at Bristol University. He explains why and how he developed the GP Evidence website (https://gpevidence.org/) as a resource for health professionals to use as part of a shared decision making process, and talks about the importance of providing patients with information on the absolute benefits and harms of different treatment options for long-term conditions. The editorial discusses a paper published in The Lancet on the population-health impact of new drugs recommended by NICE and highlights the tension between NICE's role in ensuring that treatments are a cost-effective use of taxpayers' money and its role in championing the for-profit life-sciences - https://dtb.bmj.com/content/63/3/34. A DTB Select item summarises safety alerts issued by the US Food and Drug Administration and the European Medicines Agency on liver problems associated with fezolinetant (▼Veoza), a drug licensed for the treatment of moderate-to-severe vasomotor symptoms associated with the menopause - https://dtb.bmj.com/content/63/3/36. The main article provides an overview of systemic anticancer treatments and conventional cytotoxic drugs - https://dtb.bmj.com/content/63/3/37. Links GP Evidence (https://gpevidence.org/) Naci H, Murphy P, Woods B, et al. Population-health impact of new drugs recommended by the National Institute for Health and Care Excellence in England during 2000–20: a retrospective analysis. The Lancet 2025;405:50–60. (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02352-3/fulltext) Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email dtb@bmj.com. Thank you for listening.
Imagine living with an illness that can sap your energy levels so completely that even day-to-day tasks, such as doing laundry, walking the dog, or even getting out of bed can be insurmountable challenges. To make matters worse, this illness is not well understood either by the public or by medical staff, and is often dismissed and stigmatised, making it difficult to find understanding or treatment. This is the unfortunate lived experience of many people with myalgic encephalomyelitis/chronic fatigue syndrome (or ME/CFS for short). In a recent Communication article, researcher Caroline Kingdon of the London School of Hygiene and Tropical Medicine, and colleagues, discuss this misunderstood condition through the prism of the 2021 guideline for the treatment of those with ME/CFS, which have been published by the UK's National Institute for Health and Care Excellence (or NICE for short). Their article aims to inform primary caregivers about the NICE guideline, and, happily, reveals that the new guideline prioritises an overdue shift toward compassionate and patient-focused care for ME/CFS.
The latest episode of Digital Health Unplugged features Holly Coole, senior manager for digital mental health at the Medicines and Healthcare products Regulatory Agency (MHRA), talking about the regulation of digital mental health technologies (DMHTs). Tammy Lovell, news editor at Digital Health News, chats to Coole about the three-year Digital Mental Health Project, which aims to improve outcomes for people with mental health conditions by ensuring that both medical professionals and the public have safe and effective access to DMHTs. In the podcast they discuss how the project, led by the MHRA in partnership with the National Institute for Health and Care Excellence, aims to provide clarity around the key considerations for the regulation and valuation of DMHTs. They also talk about the challenges of regulating this area and why it is so important to protect patient safety, and ensure access to effective products for mental health. Coole, who is a registered mental health nurse, co-authored a paper on the project, published in The Lancet Digital Health in January 2025. Listen to this episode to discover what this project means for the future of mental health technology in the UK. Guest: Holly Coole, senior manager for digital mental health at the MHRA
The National Institute for Health and Care Excellence in the UK looks set to reduce the number of people to be offered what's known as the ‘King Kong' of weight loss, Mounjaro. They are now going to offer the drug only to those with the highest clinical needs. Dr. Michael Crotty, the Irish College of GP's Clinical Lead on Obesity tells us more.
Today, we're speaking to Dr Charlotte Archer, Research fellow in primary care mental health based at the University of Bristol.Title of paper: GPs' views of prescribing beta- blockers for people with anxiety disorders: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2024.0091Beta-blockers are licensed for managing the symptoms of anxiety, and new prescriptions for patients with anxiety have increased substantially in recent years. However, National Institute for Health and Care Excellence guidance for anxiety does not recommend beta-blockers as a treatment for anxiety, and recent reports have highlighted risks associated with the beta-blocker propranolol. Our research found that GPs prescribe beta-blockers for anxiety because they consider them to be low risk, a quicker solution than other treatments, and useful for managing associated physical symptoms.
The average full term baby weighs just over 7lbs. One pound of that is the baby's brain. Nature, via the mother's body, devotes enormous amounts of energy into building the baby's brain during and just after pregnancy. And as you've heard me say many, many times, the brain is the hungriest organ in the body and requires specific nutrients from the diet for proper structure and function.So why, dear listeners, is brain development completely absent from the National Institute for Health and Care Excellence guideline update on pregnancy and child nutrition?In this week's episode I am a starting a teeny tiny beef with NICE.Think Through NutritionThe Food ProgrammeNICE Maternal & Child Nutrition Stakeholder List___Newsletter sign up How to Build a Healthy Brain* Unprocessed: What Your Diet is Doing to Your Brain* Patreon Original music by Juan Iglesias *Affiliate links Support this show http://supporter.acast.com/strongerminds. Hosted on Acast. See acast.com/privacy for more information.
The National Institute for Health and Care Excellence has, for the first time, published a guideline on the identification and management of adrenal insufficiency, a rare condition which occurs when the adrenal glands do not produce enough essential hormones – particularly cortisol and aldosterone. We're joined by Dr Helen Simpson, a consultant endocrinologist at UCLH NHS Foundation Trust and Sally Tollerfield an endocrine clinical nurse specialist at Great Ormond Street Hospital, to discuss the guideline and the benefits it will provide to patients and healthcare professionals.
On this episode of the podcast, host Amanda Head talks with Dr. Richard Bosshardt, a seasoned, board-certified plastic surgeon with 35 years of experience, to discuss the growing influence of ideology and politics in medicine.Dr. Bosshardt dives into how critical race theory and Marxist ideology have infiltrated universities, steering the focus towards DEI (Diversity, Equity, and Inclusion) and anti-racism at the expense of patient care. He shares his professional concerns about the American College of Surgeons' embrace of these ideologies and recounts his own experience of being banned for speaking out against them.Dr. Bosshardt also addresses the controversial topic of gender-affirming surgeries for minors, highlighting the lack of evidence supporting such procedures and citing studies that show the majority of children with gender confusion eventually reconcile with their biological sex. Lastly, he commends the American Society of Plastic Surgeons for departing from medical establishment and taking a more cautious approach to gender-affirming care.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
What is mindfulness? What's the difference between mindfulness and doing things 'mindfully'? What does evidence about the positive impact of mindfulness tell us about the origins of our mental health struggles?We'll be discussing these topics with Dr Afrosa Ahmed, who has just written a book: "Mindful Healing, 5 Simple Steps to Transform your Life" published by Michael O'Mara Books.A practising GP in the NHS for over 20 years, as well as a Harley Street-based mindfulness coach, Afrosa launched life-coaching programme MindfulDoc in 2020.In her book, Afrosa shares her knowledge of how we can incorporate the ancient practice of mindfulness into our everyday lives. Mindfulness is now endorsed by the National Institute for Health and Care Excellence and the NHS. "Mindful Healing, 5 Simple Steps to Transform your Life" is published by Michael O'Mara Books.Follow @livelymindspod on X, Facebook, Instagram, LinkedIn and more at https://www.bio.link/livelymindsPlease note that this show does not constitute medical advice and is not a replacement for seeking professional help. You can find our more about the show and get signposting to support on our website anyamedia.net/livelyminds
Our Dragons' Den mentor Sara Davies MBE had gestational diabetes in both of her pregnancies and talks to us today about the guilt she felt when first diagnosed and what she has since learned about this condition that affects around 5% of pregnant women in the UK.We are also joined by Cathy Tabner of My Expert Midwife whose knowledge of gestational diabetes, and more widely about pregnancy and your body when you are pregnant, is unsurpassed!This conversation covers mum guilt, pregnancy hormones, how the placenta works, what happens in your body when pregnant, how your diet can help control gestational diabetes and much more.Any pregnant woman can develop gestational diabetes so if you are expecting a baby or may do in the future, you need to hear this conversation.*Please note, this episode references Dr Michael Mosley's work, in particular his blood sugar diet. This episode was recorded prior to his tragic death.If you love this episode, please share and leave us a podcast review, and don't forget to subscribe on your favourite podcast platform so that you never miss these important family health conversations.Follow Sara Davies here on Instagram or connect here on LinkedIn.Learn more about Dragons' Den here and watch Mini First Aid on Dragons' Den here.Connect with Cathy Tabner here and find out all about the brilliant work of My Expert Midwife here.Check out all the guidance and resources from Diabetes UK here on their website, in particular this page on gestational diabetes and learn more from Diabetes UK about the HBA1C test here and read the NHS information page for gestational diabetes here and learn about the drug Metformin hereVisit Dr Michael Mosley's website here and check out his recipe books hereNational Institute for Health & Care Excellence guidance for diabetes in pregnancyMini First Aid is an award-winning, Dragons' Den winning business bringing vital first aid training to parents, carers and workers across the UK. You can find out more about our wide range of first aid classes and courses here Mini First Aid first aid kits are designed to meet all your family's first aid needs. With a range of sizes available, you can keep our kits at home and take them out and about with you on day trips with your little ones. Browse our full range of kits hereSeries 3 of the Family Health Podcast by Mini First Aid is sponsored by Savlon Scar Prevention Gel. Savlon has been trusted by the nation for generations and can help the whole family with the range of products available.
This detailed episode with Dr. Mark Harper, author of breaks down the benefits of cold water swimming for trauma, chronic pain, depression, bipolar disorder, and other illnesses plaguing so many of us these days. Dr. Mark Harper shares the findings of his cold swimming studies and the direction his research is going. We discuss the various reasons you might consider cold water swimming as a priority in your wellness habits and how to start, if, like me, you are terrified of being cold and unable to breathe. Mark explains how cold the water should be to be effective, how long one should stay immersed, and how often to engage in cold water swimming to receive its benefits. He shares the many stories of those whose health has been drastically improved by cold water swimming and many other recommendations for blue therapy, and why this therapy works to reduce stress in all areas of our lives. Dr. Mark Harper is a consultant anesthetist. His first field of research was investigating the best way to keep patients warm during surgery and thereby reduce the incidence of postoperative complications. The results of these studies have been incorporated into national and international guidelines and Mark was invited to be an expert clinical adviser to NICE, the National Institute of Health and Care Excellence. Shortly after taking up his consultant post in Brighton in 2003, he started swimming in the sea throughout the year. Around the same time, whilst working on his PhD, he brought together his clinical research and the physiology of cold-water adaptation to show how outdoor swimming could be employed to reduce surgical complications. Further insights – both from his personal experience and the experimental literature - led him to propose that cold water swimming might be an effective intervention for mental health problems. In collaboration Dr Chris van Tulleken and the Extreme Environments Lab in Portsmouth, he had the opportunity to test this in practice on the BAFTA award-nominated BBC television program “The Doctor Who Gave Up Drugs.” Following this success, he set up and ran the first-ever clinical trial using sea swimming as a clinical treatment - for anxiety and depression – the outcomes of which were incredibly positive. In the process, he helped set up Chill UK which now provides outdoor swimming courses for hundreds of people around the UK. His book, ‘Chill – the cold water swim cure' was published in 2022 and is being translated into three other languages. Website | Instagram | Book ------------------------------------------------------------------------------------------------------------ Your support is deeply appreciated! Find me, Lara, on my Website / Instagram You can support this podcast with any level of donation here. Order The Essential Guide to Trauma Sensitive Yoga: How to Create Safer Spaces for All
This week we will continue our coverage of Bile acid malabsorption (BAM), a gastrointestinal disease. It's a common cause of chronic diarrhea. When bile acids aren't properly absorbed in your intestines, they build up, upsetting the chemical balance inside. Excess bile acids trigger your colon to secrete extra water, leading to watery stools. This week we will continue our coverage of Bile acid malabsorption (BAM), a gastrointestinal disease. It's a common cause of chronic diarrhea. When bile acids aren't properly absorbed in your intestines, they build up, upsetting the chemical balance inside. Excess bile acids trigger your colon to secrete extra water, leading to watery stools. Bile acid malabsorption (BAM) is often misdiagnosed as Irritable Bowel Syndrome or is overlooked in individuals with Crohn's disease. Bile Acid Malabsorption happens when the small intestine is unable to direct bile acid back to the liver. This means that the body doesn't absorb water properly and affects digestion. The condition results in what is known as Bile Acid Diarrhoea. How will a new test for Bile Acid Malabsorption be developed? Currently, the only test for bile acid malabsorption is the SeHCAT test which is expensive, time consuming and uses radiation. The team have developed a test which they believe will diagnose the condition more rapidly and cost effectively than the current test. For its initial testing phase, it will be used on stool (poo) samples, and in its second phase the research team will assess whether it can also guide treatment decisions on what dose should be given to individual patients. The aim of the study is to establish a better test for BAM, do the groundwork for a future study of the role of faecal bile acid measurements within the NHS, and use the data collected from this trial to prepare other studies to assist with the diagnosis and treatment of individuals with BAM. Why diagnose bile acid malabsorption? Chronic diarrhea is one of the most common reasons why people get referred to specialist gastroenterology clinics, and can account for as many as 1 in 20 referrals. Bile acid malabsorption is a major cause of chronic diarrhoea and is thought to affect up to 1 million people in the UK. As well as individuals with Crohn's disease, as many as one in three people diagnosed with IBS with diarrhoea (IBS-D) may actually be experiencing BAM but the current gold standard SeCHAT test is only available in certain UK centres. It is also time consuming and costly. In 2012 the National Institute for Health and Care Excellence's Diagnostic Advisory Group concluded that a new test for the diagnosis of BAM was needed. (credits: Diagnosing bile acid malabsorption - Bowel Research UK :Bowel Research UK )
Listen in to learn how to challenge and encourage the next generation of leaders using real-life experiences as an accomplished professional. You will also learn the importance of always remembering your why because it will get you through any challenges you face in your career or business. Dr. Sabrina Dean is the CEO of Dr. Sabrina's Healthcare Consulting, LLC for healthcare organizations, the Founder of Sabrina's Consulting, where she helps individuals fulfill their holistic and health desires, and the Co-Founder of the African American Women Giving Circle, Dayton, OH. She is the former Director of Quality, Infection Control, Regulatory and Accreditation, Employee Health, Risk Management at several healthcare organizations, and she is an Adjunct Professor at Franklin University, Columbus, OH for their doctoral program. Dr. Sabrina is an experienced Registered Nurse with a demonstrated history of working in the healthcare industry. In this episode, Sabrina talks about her journey in the healthcare industry and the lessons she'd like to pass down to upcoming leaders in the industry.
As a member of the Parkinson's Disease guideline committee of the National Institute for Health and Care Excellence, Clare Johnson explains the vast number of ways Occupational Therapists help patients and their families cope with the everyday motor and non-motor challenges of living with Parkinsons. We hear about the benefits of multi-disciplinary clinics and why standard measurement scales can fall short compared to individualised evaluation.
Around 1 billion people around the world suffer from a mysterious neurological condition called migraine. Far more than just a headache, migraine is abnormal processing of the world around us that can have symptoms like loss of sight and speech, dizziness, nausea and extreme fatigue.There are drugs which can help those struggling with the condition like anti-depressants and anti-convulsants. However, they weren't developed specifically for migraine and can come with quite a lot of side effects or simply not work.For a long time migraine medication has been a process of trial and error. But a new class of drugs called anti-CGRPs are being hailed as a breakthrough migraine medication. Anti-CGRPs have a small side effect profile and were designed specifically to target migraine. They work by blocking CGRP (Calcitonin Gene-Related Peptide) from building up in the body and triggering a receptor in the brain which turns on a head pain pathway causing the migraine attack.Earlier this year the National Institute of Health and Care Excellence - or NICE – in England cleared the use of an anti-CGRP called Rimegepant to use as both a preventive and acute treatment. Clinicians are hoping this will massively improve the lives of those living with the condition.So this week on The Inquiry were asking ‘Have we reached a turning point with migraine medication?'Contributors: Dr. Amaal Starling, neurologist and headache specialist at Mayo Clinic in Scottsdale, in the US state of Arizona. Dr Faraidoon, researcher at the Georgian Institute for Global Health at the University of New South Wales, Sydney, Australia. Peter Goadsby , Director of the NIHR King's Clinical Research Facility and a professor of neurology at King's College London, England. Dr Lise Rystad Oie, researcher at the government funded Norwegian Centre for Headache Research - also known as NorHead.Presenter: Charmaine Cozier Producer: Anoushka Mutanda-Dougherty Editor: Tara McDermott Researcher: Matt Toulson Technical Producer: Craig Boardman Broadcast Co-ordinator: Jordan KingImage: eternalcreative - Getty Images: 1372323487
Dengue CDC. Clinical assessment. Centers for Disease Control and Prevention. Cdc.gov. https://www.cdc.gov/dengue/training/cme/ccm/page73112.html CDC. Dengue. Centers for Disease Control and Prevention. Published August 15, 2023. https://www.cdc.gov/dengue/index.html Rigby J. First Pill for Dengue Shows Promise in Human Challenge Trial. Medscape: Emergency Medicine. Published October 23, 2023. https://www.medscape.com/s/viewarticle/997558?ecd=wnlscitech231101MSCPEDIT_etid6007373&uac=255848DR&impID=6007373 Schnirring L. California confirms 2nd local dengue case. Center for infectious disease research and policy. University of Minnesota. Umn.edu. Published November 2, 2023. https://www.cidrap.umn.edu/dengue/california-confirms-2nd-local-dengue-case Penis Pain Lizza E. Peyronie Disease. Medscape.com. Published August 17, 2023. https://emedicine.medscape.com/article/456574-overview Malloy M, Sinert R. Dysuria and Discharge After a New Sexual Partner. Medscape. Published November 20, 2023. https://reference.medscape.com/viewarticle/847159 Promethazine 2018-2019 Targeted Medication Safety Best Practices for Hospitals. Ismp.org. https://www.ismp.org/sites/default/files/attachments/2019-01/TMSBP-for-Hospitalsv2.pdf Drug Shortage Detail: Promethazine Injection. Ashp.org. Updated November 21, 2023. https://www.ashp.org/drug-shortages/current-shortages/drug-shortage-detail.aspx?id=872 Fass O. Antiemetics and QT prolongation. Clinicalcorrelations.org. Published January 15, 2021. https://www.clinicalcorrelations.org/2021/01/15/antiemetics-and-qt-prolongation/ Ozempic Korte C. Ozempic side effects could lead to hospitalization — and doctors warn that long-term impacts remain unknown. CBS News. Published June 10, 2023. https://www.cbsnews.com/news/ozempic-side-effects-weight-loss-drugs-wegovy-mounjaro-doctors-warn/ Krishnan L, Dhatariya K, Gerontitis D. No clinical harm from a massive exenatide overdose – a short report. Clin Toxicol (Phila). Clinical Toxicology. Published December 11, 2012. https://www.tandfonline.com/doi/pdf/10.3109/15563650.2012.752495 MedWatch: The FDA Safety Information and Adverse Event Reporting Program. FDA: U.S. Food and Drug Administration. Published September 15, 2022. https://www.fda.gov/medwatch Nakanishi R, Hirose T, Tamura Y, et.al. Attempted suicide with liraglutide overdose did not induce hypoglycemia. Diabetes Research and Clinical Practice. Diabetesresearchclinicalpractice.com. Published November 12, 2012. https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(12)00384-1/fulltext Ozempic® (semaglutide) injection for Type 2 Diabetes. Ozempic.com. https://www.ozempic.com/ Hearing Loss Ahmed OH, Gallant SC, Ruiz R, Wang B, Shapiro WH, Voigt EP. Validity of the Hum Test, a Simple and Reliable Alternative to the Weber Test. Ann Otol Rhinol Laryngol. NIH: National Library of Medicine: National Center for Biotechnology Information. Published June 2018. https://pubmed.ncbi.nlm.nih.gov/29776326/#:~:text=Results%3A%20When%20examining%20the%20ability,respectively%2C%20with%20low%20pitched%20humming. Clinical Practice Guideline: Sudden Hearing Loss (Update). American Academy of Otolaryngology – Head and Neck Surgery. Entnet.org. https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ Hearing loss in adults: assessment and management. National Guideline Centre (UK). Immediate, Urgent and Routine Referral. National Institute for Health and Care Excellence; 2018. NIH: National Library of Medicine: National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK536553/#:~:text=If%20the%20hearing%20loss%20developed,service%20or%20an%20emergency%20department. Mroz M. Do you know the three main types of hearing loss? Healthy Hearing. Published April 17, 2014. https://www.healthyhearing.com/help/hearing-loss/types 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 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!
In this podcast episode titled "Building Trust and Reputation: The Consistency Factor in Child Care Excellence," we delve into the crucial role of consistency in child care centers. As a director, you're guided through the challenges and solutions for maintaining consistent policies and procedures. The episode emphasizes the positive impact of consistency on building trust with parents, enhancing word-of-mouth marketing, and ensuring employee retention and satisfaction. It offers actionable strategies like establishing clear policies, providing ongoing training, fostering a collaborative culture, leading by example, and regularly monitoring and evaluating practices. Additionally, it stresses the importance of explaining the "why" behind policies to empower and engage employees. The episode is a comprehensive guide for child care center directors to foster a stable, nurturing environment that benefits children, parents, and staff alike.Let's connect:www.thedirectorsclub.netCommunity:Join my FREE Facebook group and connect with other directors and me as we navigate leading a child care center together! FB Group Child Care Center Owners and DirectorsSocials:Facebook page, The Director's ClubInstagram, The Director's ClubWORKING WITH NOELLE AND THE DIRECTOR'S CLUB:The ClubDiscover more about The Director's Club, a mastermind group designed for child care center directors who seek support and expert guidance to maintain high-quality early education centers. LEARN MORE ABOUT THE CLUB HEREThe Teacher's LoungeDo you want to enhance your teachers' confidence in the classroom through a mentoring program tailored to their needs? Look no further than The Teacher's Lounge, a dedicated mentoring department that you've always wanted for your child care center. Don't hesitate, visit us now to learn more HERE
In this podcast, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the November 2023 issue of DTB. They discuss the history of the BNF and the announcement that the 86th edition of the BNF and the 2023–2024 edition of the BNF for Children will be the last print issues to be purchased by the National Institute for Health and Care Excellence for the NHS in England (https://dtb.bmj.com/content/61/11/162 and https://dtb.bmj.com/content/61/11/166). They talk about a retrospective review of a case series of UK coroners' Reports to Prevent Future Deaths that found that around one in five reports involved a medicine (https://dtb.bmj.com/content/61/11/165). The main article provides an introduction to pharmacogenetics (https://dtb.bmj.com/content/61/11/168). They begin by responding to a listener's email. Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page (https://podcasts.apple.com/gb/podcast/dtb-podcast/id307773309). If you want to contact us please email dtb@bmj.com. Thank you for listening.
Dustin Atwood and Sarah Myers talk about a variety of topics in the automotive industry, including: Dustin brings on special guest, Annie! Annie is the store manager for the Sunset store. Annie talks about what it's like running a busy shop and highlights some of her amazing team. Annie and Sarah compare their experiences when it comes to votech education. --- Send in a voice message: https://podcasters.spotify.com/pod/show/a1custom/message
Dustin Atwood and Sarah Myers talk about a variety of topics in the automotive industry, including: Dustin brings on special guest, Annie! Annie is the store manager for the Sunset store. Annie talks about what it's like running a busy shop and highlights some of her amazing team. Annie and Sarah compare their experiences when it comes to votech education. --- Send in a voice message: https://podcasters.spotify.com/pod/show/a1custom/message
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers depression in children and adolescents with Dr. Darren Courtney, a scientist with the Cundill Centre for Child and Youth Depression and the Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health and a staff psychiatrist in the Youth Addictions and Concurrent Disorders Service at the Centre for Addiction and Mental Health (CAMH) in Toronto. He is also an associate professor in the Department of Psychiatry at the University of Toronto. Dr. Courtney earned his MD in 2004 at Queen's University and completed psychiatry residency in 2009 at the University of Ottawa. He was the clinical director of the Youth Inpatient Unit at the Royal Ottawa Mental Health Centre from 2009 to 2014 and moved to Toronto in 2014, where he worked on the Concurrent Youth Inpatient Unit at the Centre for Addiction and Mental Health until 2017 and where his clinical work with concurrent disorders continues now with outpatient youth. Dr. Courtney's research focus is on the treatment of adolescent depression through the use of an integrated care pathway — a collaboratively developed treatment algorithm based on high-quality clinical practice guidelines. Through his research, he works on identifying quality practice guidelines and corresponding multi-disciplinary care pathways to facilitate evidence-based and measurement-based care for adolescents with depression. He has also participated in a systematic review and quality appraisal of clinical practice guidelines for psychiatric disorders in children and adolescents. Additionally, he has an interest in the management of concurrent disorders, where young people are affected by both primary psychiatric disorders and substance use disorders. The learning objectives for this episode are as follows: By the end of this episode, you should be able to… Outline the prevalence and risk factors for depression in children and adolescents Explain how children and adolescents with depression present in clinical practice Discuss the use of screening tools for depression in this population Describe an approach to the management of depression in children and adolescents Outline the management of an adolescent with suicidal thoughts or behaviours Guest: Dr. Darren Courtney Hosts: Kate Braithwaite (MD) and Nikhita Singhal (PGY5) Audio editing by: Nikhita Singhal Show notes by: Kate Braithwaite and Nikhita Singhal Interview Content: Introduction - 0:00 Learning objectives - 02:11 Prevalence of depression in youth - 03:11 Risk factors for depression in youth - 06:25 Diagnosing depression in youth - 08:30 Screening tools - 14:24 Approach to taking a history from youth - 19:45 Management of depression in youth - 30:12 Psychotherapies - 33:20 Medications - 37:37 Assessing and managing suicidality in youth - 44:00 Measurement based care - 51:00 Final thoughts - 55:10 Resources: Previous PsychEd episodes: PsychEd Episode 1: Diagnosis of Depression with Dr. Ilana Shawn PsychEd Episode 2: Treatment of Depression with Dr. Sidney Kennedy PsychEd Episode 18: Assessing Suicide Risk with Dr. Juveria Zaheer ICHOM Set of Patient-Centered Outcome Measures for Children & Young People with Depression & Anxiety Screening tools/rating scales: Revised Children's Anxiety and Depression Scale (RCADS) Mood and Feelings Questionnaire (MFQ) NICE guideline: Depression in children and young people: identification and management NICE guideline: Self-harm: assessment, management and preventing recurrence The CARIBOU Pathway by CAMH: A youth-centered program for the treatment of depression Includes links to download free clinician-specific and youth-specific resources co-developed with youth and mental health clinicians Clinical Innovations and Tools | Cundill Centre for Child and Youth Depression | CAMH Includes links to various tools for health care providers, researchers, youth, and other stakeholders (such as teachers and family members) informed by research evidence References: Bennett K, Courtney D, Duda S, Henderson J, Szatmari P. An appraisal of the trustworthiness of practice guidelines for depression and anxiety in children and youth. Depress Anxiety. 2018 Jun;35(6):530-540. https://doi.org/10.1002/da.22752 Courtney D, Bennett K, Henderson J, Darnay K, Battaglia M, Strauss J, Watson P, Szatmari P. A Way through the woods: Development of an integrated care pathway for adolescents with depression. Early Interv Psychiatry. 2020 Aug;14(4):486-494. https://doi.org/10.1111/eip.12918 Georgiades K, Duncan L, Wang L, Comeau J, Boyle MH; 2014 Ontario Child Health Study Team. Six-Month Prevalence of Mental Disorders and Service Contacts among Children and Youth in Ontario: Evidence from the 2014 Ontario Child Health Study. Can J Psychiatry. 2019 Apr;64(4):246-255. https://doi.org/10.1177%2F0706743719830024 Goodyer IM, Reynolds S, Barrett B, Byford S, Dubicka B, Hill J, Holland F, Kelvin R, Midgley N, Roberts C, Senior R, Target M, Widmer B, Wilkinson P, Fonagy P. Cognitive-behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial. Health Technol Assess. 2017 Mar;21(12):1-94. https://doi.org/10.3310/hta21120 Hetrick SE, McKenzie JE, Bailey AP, Sharma V, Moller CI, Badcock PB, Cox GR, Merry SN, Meader N. New generation antidepressants for depression in children and adolescents: a network meta-analysis. Cochrane Database Syst Rev. 2021 May 24;5(5):CD013674. https://doi.org/10.1002/14651858.CD013674.pub2 MacQueen GM, Frey BN, Ismail Z, Jaworska N, Steiner M, Lieshout RJ, Kennedy SH, Lam RW, Milev RV, Parikh SV, Ravindran AV; CANMAT Depression Work Group. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 6. Special Populations: Youth, Women, and the Elderly. Can J Psychiatry. 2016 Sep;61(9):588-603. https://doi.org/10.1177%2F0706743716659276 National Institute for Health and Care Excellence. Depression in children and young people: Identification and management NG134 [Internet]. London: NICE; 2019 Jun 25 [cited 2023 Sep 22]. Available from: https://www.nice.org.uk/guidance/ng134. Parikh A, Fristad MA, Axelson D, Krishna R. Evidence Base for Measurement-Based Care in Child and Adolescent Psychiatry. Child Adolesc Psychiatr Clin N Am. 2020 Oct;29(4):587-599. https://doi.org/10.1016/j.chc.2020.06.001 Walter HJ, Abright AR, Bukstein OG, Diamond J, Keable H, Ripperger-Suhler J, Rockhill C. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders. J Am Acad Child Adolesc Psychiatry. 2023 May;62(5):479-502. https://doi.org/10.1016/j.jaac.2022.10.001 Wiens K, Bhattarai A, Pedram P, Dores A, Williams J, Bulloch A, Patten S. A growing need for youth mental health services in Canada: examining trends in youth mental health from 2011 to 2018. Epidemiol Psychiatr Sci. 2020 Apr 17;29:e115. https://doi.org/10.1017%2FS2045796020000281 World Health Organization. Mental health of adolescents [Internet]. 2021 [cited 2023 Sep 22]. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.
Contributor: Aaron Lessen MD Educational Pearls: What is Carbamazepine (Tegretol)? Carbamazepine is an anti-epileptic drug with mood-stabilizing properties that is used to treat bipolar disorder, epilepsy, and neuropathic pain. It functions primarily by blocking sodium channels which can prevent repetitive action potential firing. What are the symptoms of an overdose? Common initial signs include diminished conscious state, nystagmus, ataxia, hyperreflexia, CNS depression, dystonia, and tachycardia Severe toxicity can cause seizures, respiratory depression, decreased myocardial contractility, pulmonary edema, hypotension, and dysrhythmias. How is an overdose treated? An overdose is treated with large doses of activated charcoal and correction of electrolyte disturbances. Be ready to intubate given the potential for respiratory depression. Carbamazepine is moderately dialyzable and dialysis is recommended in severe overdoses. Additional educational pearl: Individuals in correctional facilities can occasionally self-administer medications which means that medication overdose should still be on the differential for any of these individuals. References Epilepsies in children, Young People and adults: NICE guideline [NG217]. National Institute for Health and Care Excellence. (2022, April 27). https://www.nice.org.uk/guidance/ng217 Ghannoum M, Yates C, Galvao TF, Sowinski KM, Vo TH, Coogan A, Gosselin S, Lavergne V, Nolin TD, Hoffman RS; EXTRIP workgroup. Extracorporeal treatment for carbamazepine poisoning: systematic review and recommendations from the EXTRIP workgroup. Clin Toxicol (Phila). 2014 Dec;52(10):993-1004. doi: 10.3109/15563650.2014.973572. Epub 2014 Oct 30. PMID: 25355482; PMCID: PMC4782683. Seymour JF. Carbamazepine overdose. Features of 33 cases. Drug Saf. 1993 Jan;8(1):81-8. doi: 10.2165/00002018-199308010-00010. PMID: 8471190. Spiller HA. Management of carbamazepine overdose. Pediatr Emerg Care. 2001 Dec;17(6):452-6. doi: 10.1097/00006565-200112000-00015. PMID: 11753195. Tran NT, Pralong D, Secrétan AD, Renaud A, Mary G, Nicholas A, Mouton E, Rubio C, Dubost C, Meach F, Bréchet-Bachmann AC, Wolff H. Access to treatment in prison: an inventory of medication preparation and distribution approaches. F1000Res. 2020 May 13;9:357. doi: 10.12688/f1000research.23640.3. PMID: 33123347; PMCID: PMC7570324. Summarized by Jeffrey Olson, MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII
On today's Summer Special, I am joined by Dr Louise Newson, a GP and renowned Menopause Specialist, author, podcast host and the founder of the Balance app. Louise is passionate about improving education about the perimenopause and menopause and improving awareness of safe prescribing of HRT to healthcare professionals. Women are increasingly discussing the forgetfulness, anxiety and suicidal thoughts they have experience as their hormones change in midlife. It's true that the link between menopause and depression is now sufficiently recognised and the National Institute for Health and Care Excellence now recommends HRT as the first line of treatment for low mood or anxiety in menopausal women. Today, I speak to Louise all about mental health and emotional wellbeing in the perimenopause and menopause, particularly the psychological symptoms and ask her about how we can support our mental health during these changes.Find Louise:Website: https://www.newsonhealth.co.uk/Podcast: https://podcasts.apple.com/gb/podcast/the-dr-louise-newson-podcast/id1459614845Instagram: https://www.instagram.com/menopause_doctor/?hl=enFollow Hurt to Healing on Instagram:@hurttohealingpodA big thank you our wonderful charity partner Shout. Shout is the UK's first 24/7 mental health text support service so if you're struggling or in need of someone to talk to, please remember to text Shout to 85258. And a massive thank you to The&Partnership for supporting my mission and showing what we can achieve when we come together. To find out more about the work The&Partnership creates, visit theandpartnership.com. Hosted on Acast. See acast.com/privacy for more information.
Faricimab, or as it is commercially known Vabysmo, is a drug that has recently been approved for use by the NHS to treat two eye diseases: diabetic macular oedema (DMO) and age-related macular degeneration (AMD), with fewer injections. Both conditions result in vision loss caused by swelling behind the eye, which can now be slowed or halted by injections. Robin Hamilton is an Ophthalmic Surgeon at Moorfield's Eye Hospital and he provides details of how this drug works and Bernie Warren tells us about its prospects from a DMO patient perspective. Bernie was also on a National Institute for Health and Care Excellence panel, that helped approve the drug for NHS use. Discovering Hands is a project in Germany that trains visually impaired women to perform breast examinations. The project involves using touch to locate early indications of breast cancer. Elvira Häußler is one of the women who is employed to perform them and she, along with gynaecologist Dr. Frank Hoffmann who came up with the idea, tell us more about it and whether it may one day come to the UK. Presenter: Peter White Producer: Beth Hemmings Production Coordinator: Liz Poole Website image description: Peter White sits smiling in the centre of the image, wearing a dark green jumper. Above Peter's head is the BBC logo (three individual white squares house each of the three letters). Bottom centre and overlaying the image are the words "In Touch" and the Radio 4 logo (the word Radio in a bold white font, with the number 4 inside a white circle). The background is a bright mid-blue with two rectangles angled diagonally to the right. Both are behind Peter, one of a darker blue and the other is a lighter blue.
Today's storyteller is Kitty Dry, telling the story of entirely losing her hair, learning she has the autoimmune condition alopecia, and navigating her twenties as a bald woman. In our conversation we talk about being stared at on the tube, techniques for coping with anxiety, hiding and being seen, social media and self-worth, and finding support online and off.More information about Alopecia UK can be found here: https://www.alopecia.org.uk.Updated information on The National Institute for Health and Care Excellence's decision not to recommend JAK inhibitor drugs to treat alopecia areata on the NHS, and what Alopecia UK are doing to oppose this, can be found here: https://www.alopecia.org.uk/news/baricitinib-nice-consultation-updateFollow True Story London online: https://linktr.ee/TrueStoryLDNFind out about our live shows, workshops and past podcast episodes on our website: https://www.truestorylondon.com Hosted on Acast. See acast.com/privacy for more information.
Discover the key to unlocking success in your lawn care business with special guest Dr. Frank Holleman. In this episode, we dive into the power of professionalism and explore practical tips to elevate your business by becoming more professional. Don't miss this insightful conversation that can transform your lawn care journey. Get Your Copy of The Lawn Care Advantage Here! Secure Your Spot: Register for Lawn Care Life Conference 2024 Equip Expo: Register Now! The Resource Center at GreenIndustryPodcast.com Get Jobber Apply for Jobber Grants Start Your Website Journey w/ Footbridge Media The Landscaping Bookkeeper - Megan and Joey Coberly GPS Trackit Kubotausa.com The Hardscape Academy Paul Jamison's Books Try Audible Ferris Mowers
How do you recognise the signs of sepsis? And how should you respond when you suspect the patient in front of you is at risk?The latest episode of the podcast examines what nursing staff need to know about this life-threatening condition.Our guest, Sian Annakin, is deteriorating patient lead at the Dudley Group NHS Foundation Trust, and a sepsis practitioner.She tells Emergency Nurse editor Sophie Blakemore what to watch out for in adults and what the guidelines say about how and when to treat a patient with suspected sepsis.The National Institute for Health and Care Excellence sepsis guidance is currently under review with an update expected in late June.Ms Annakin, who is also communications officer for the UK Sepsis Practitioner Forum, discusses why the review is taking place and what it means for nurses and hospital trusts in the interim, as well as when the update is published, whatever the outcome. Listeners will also hear what tools are available to help them screen for sepsis and how to supplement these using their own clinical experience. For more episodes of the Nursing Standard podcast, visit rcni.com/podcast Hosted on Acast. See acast.com/privacy for more information.
This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In part 1 we talked about a request that has been submitted for the World Health Organization (WHO) to add diet drugs to their list of “essential medicines.” We discussed who was making this request and the justification that they were using. Today we're going to take a deeper dive into the research that they used to try to support this request, and in part three will look at the research around harm and “efficacy,” as well as “cost effectiveness.” (I was originally going to write this in two parts, but I realized that it was just ridiculously long, and there is time before the WHO meets about this, so I've decided to break it into three parts.)Just a reminder that I don't hyperlink to studies or articles that come from a place of weight stigma, though I do provide enough information that someone could google them.In their ”Summary statement of the proposal for inclusion” they say“The use of GLP-1 RAs in the treatment of ob*sity has been well studied and meta-analyses of various GLP-1 RAs have demonstrated that this class of medications can lead to clinically significant weight loss. Compared to control groups, GLP-1 RAs were found to lead to more significant weight loss with a mean difference of approximately 7.1 kg as well as an improvement in glycemic control, with low concern for hypoglycemia[3].”The single paper they cite to back this up (Iqbal et al. Effect of glucagon-like peptide-1 receptor agonists on body weight in adults with ob*sity without diabetes mellitus-a systematic review and meta-analysis of randomized control trials, 2022) looked at weight loss on these drugs among “ob*se” adults without type 2 diabetes (so hypoglycemia would have been unlikely anyway.) It included 12 trials with a total of 11,459 participants. 80% of the participants were white, 10% were Black or African Americans and 5% were Asians. It is concerning that they are making a global recommendation based on a study population that is overwhelmingly white. There is also the issue of follow-up. Some of the trials were as short as 14 weeks and the longest trial included was only 3 years. The average weight loss was 15.6 lbs more in the group taking the drugs than in control, but some subjects on the drugs lost as little as 5.5 lbs. Those on the drugs also experienced vomiting, nausea, dyspepsia (indigestion,) diarrhea, constipation and abdominal pain as common side effects. There is no way to know how much of this (short-term) weight loss is due to experiencing these common side effects. These drugs also have significant (possibly life-threatening) side effects and the short-term follow-up included here is not likely long enough to capture those. Also, remember that the recommendation is for people to take these drugs for the rest of their lives (since, if they don't, their weight shoots right back up and they lose cardiometabolic benefits,) and they are making that recommendation (globally) on just 14 weeks to 3 years of data.The authors of this study cite no conflicts of interest. Per LinkedIn, someone with the same name as the lead author is a product specialist at Novo Nordisk but I imagine that must be a coincidence or surely it would have been listed as a COI. The article was published in “Ob*sity Reviews” which is an official journal of the “World Ob*sity Federation” (WOF). The WOF took over $5.3 Million dollars from Novo Nordisk (whose weight loss drugs are covered by this recommendation) over three years. Their “members” include the Ob*sity Action Coalition (whose chief funder is Novo Nordisk.) Their current President has taken money to speak on behalf of Novo Nordisk and their past president is John Wilding who was implicated in the recent Novo Nordisk scandal for not disclosing his financial ties to Novo Nordisk while praising their weight loss drugs in the media.There are more issues with this meta-analysis but I'll just stop there and say that I don't think there is any way that 14 weeks to 3 years of data on 11,459 people who are mostly white justifies a global recommendation of these drugs as “essential.”Under “Treatment details (requirements for diagnosis, treatment and monitoring)”Here again they say “Ob*sity, a preventable disease” but offer no citation or support for this narrative that has been largely architected and marketed by the weight loss industry. They continue:“When used in supplement to life style modifications, including a decrease in caloric intake and an increase in exercise, liraglutide is indicated for adults with ob*sity (BMI >30.00) or overweight (BMI >27.00) with a weight-related comorbidity”I just want to note here that this indication (which wasn't created by those who wrote the recommendation to the WHO) predicates risk on body size and simple correlation. These drugs have very unpleasant common side effects and other, possibly life-threatening, side effects. So the fact that those who are “overw*ight” have to have at least one condition that is correlated with being higher weight (with no proof of causation, by the way) but those who are “ob*se” are recommended to risk these side effects based on size alone, with no required symptomology, is pure weight stigma.Next is a table “Excerpts from national and international guidelines on the pharmacological treatment of ob*sity”It is a list of organizations with quotes pulled from various publications that are intended to show support for the drugs. Almost every one of the organizations has financial ties to Novo Nordisk and/or Eli Lilly which doesn't prove that there is anything shady going on, but would be worth disclosing given their use to back up the request that these companies' drugs be considered “essential.” Let's take a deeper look:The American College of Cardiology (ACC)The recommendation that is cited is for the use of these drugs for Type 2 diabetes (T2D), and they mention weight loss as an ancillary effect. This will be a pattern in these recommendations and it matters because the risk/benefit analysis is different for people who have an actual health condition (Type 2 diabetes) rather than those who are simply living in a higher-weight body. Also, one might be misled by the title of the section to believe that these recommendations are specifically for the use of the drugs in the treatment of “ob*sity” which is not the case.The ACC has a partnership with Novo NordiskThey have also partnered with Eli LillySouth Asian Task ForceAgain, this is a recommendation for these medications for the treatment of T2D, not for weight loss.The paper's lead author, Sanjay Kalra has received honoraria for lectures and advisory boards from Eli Lilly and Novo Nordisk.International Diabetes FederationThis, again, is a recommendation of these drugs for the treatment of T2D.Novo Nordisk is a “platinum partner” and Eli Lilly is a “gold partner” (the website isn't clear about how much money they donate, and an email I sent has gone unanswered so far.)National Institute for Health and Care Excellence (NICE)This one actually is a recommendation for these drugs for weight loss, however, NICE was implicated in the recent scandal which found that “Novo Nordisk had paid millions to prominent ob*sity “charities,” NHS trusts, universities and other bodies as well healthcare professionals who publicly praised the drug (typically without disclosure of their funding) and who advised NICE (The National Institute for Health and Care Excellence) on their reviewing of Novo's weight loss drug to decide whether or not it should be made available.”Position statement from the Brazilian Diabetes Society (SBD), the Brazilian Cardiology Society (SBC) and the Brazilian Endocrinology and Metabolism Society (SBEM)This is a statement of recommendations for prevention of cardiovascular disease in patients with diabetes.Here is a selection of the authors “competing interests” (I've only included Novo Nordisk and Eli Lilly, the two main companies trying to sell this class of drugs for weight loss.) ROM has received speaker honorarium from: Novo Nordisk and Eli Lilly.CMV has received honoraria as speaker from Novo Nordisk.SV over the last 5 years, has received honoraria for clinical research from Novo Nordisk; Advisory Board to Novo Nordisk; has received honoraria as speaker from Novo NordiskFT has received honoraria for medical lectures from: Lilly, Novo NordiskRDS over the last 3 years has received honoraria for consulting, research and speaker activities from Eli LillyThe Brazilian Diabetes Society (SBD) has collaborated with Novo NordiskThe Brazilian Cardiology Society (SBC) holds an annual congress that is sponsored by Novo Nordisk and Eli Lilly. The Brazilian Endocrinology and Metabolism Society (SBEM) has partnered with Novo Nordisk on multiple occasions.Korean Society for the Study of Ob*sity Guidelines for the Management of Ob*sity in KoreaThis is not a study but guidelines put out by an organization that appears to represent those with a profit interest in “ob*sity treatment” (similar to the Ob*sity Action Coalition.) Their “recommendation” includes every drug that is approved for long-term use, fails to cite any evidence of efficacy (short or long-term) and they mention that “Not all ob*se people respond to ob*sity drugs, and there are a significant number of non-responders.”Novo Nordisk is a platinum sponsor for their conference. They are also a member of the World Ob*sity Federation which took over $5M from Novo Nordisk.European Medical Association[sic]Here they are citing a press release stating that the European Medicines Association (EMA) (the recommendation authors appear to have been mistaken on the name) has “recommended granting a marketing authorisation for Saxenda (liraglutide) for weight management in overweight or ob*se adults.” Per the EMA's website they are “a scientific body with the expertise required to assess the benefits and risks of medicines. However, under EU law it has no authority to actually permit marketing in the different EU countries. The role of EMA is to make a recommendation to the European Commission which then takes a final legally binding decision on whether the medicine can be marketed in the EU.”I could not find information about the panel that made the decision, or any conflicts of interest they may have had.Australia: NPS Medicine WiseThe citation they offer here is not to Australia: NPS Medicine Wise, but to a paper by a single author - Joseph Proietto who “has been on the medical advisory boards for liraglutide, semaglutide 2.4 mg and bupropion/naltrexone. He has been involved in educational sessions for ob*sity management for both Novo Nordisk (liraglutide, semaglutide) and iNova (phentermine and bupropion/ naltrexone) for which he has received honoraria.” In other disclosures it mentions that he was, in fact, chair of the medical advisory board for Saxenda (Novo Nordisk's brand name for liraglutide, the drug being recommended here.)In the paper he recommends all of the above weight loss drugs in general, but does not recommend the GLP-1 class of drugs over any of the others. The study he uses to recommend these drugs only follows participants for 68 weeks.Singapore HPB-MOH Clinical Practice GuidelinesIn the section on liraglutide they offer information for 56 weeks of follow up and conclude “The long-term safety of high dose liraglutide therapy is, however, unclear.”Canadian Medical Association Journal- Ob*sity in adults: a clinical practice guidelineFunding for these guidelines was provided by Ob*sity Canada, an organization that lobbies for the priorities of those who profit from “ob*sity treatment.” Specifically, the funds came from “Ob*sity Canada's Fund for Ob*sity Collaboration and Unified Strategies (FOCUS) initiative” Novo Nordisk is a supporter of this fund, as well as a sponsor for their annual summit.Here are excerpts from the 1,293 word competing interests statement for the authors (I've only included Novo Nordisk and Eli Lilly, the two main companies trying to sell this class of drugs for weight loss.) Sean Wharton reports receiving honoraria and travel expenses and has participated in academic advisory boards for Novo Nordisk, Eli Lilly. Sean Wharton is also the medical director of a medical clinic specializing in weight management and diabetes. David Lau reports receiving grants and research support from Novo Nordisk, speaker bureau fees from Eli Lilly and Novo Nordisk; and consulting fees from Eli Lilly and Novo Nordisk. Michael Vallis is a member of advisory boards for Novo Nordisk. Michael Vallis has also received consulting fees from Novo Nordisk and speaking fees from Novo Nordisk. Arya Sharma reports receiving speaker's bureau and consulting fees from Novo Nordisk. Laurent Biertho is a member of advisory boards for Novo Nordisk. Denise Campbell-Scherer reports receiving research funding from Novo Nordisk. She also reports receiving an unrestricted education grant from Ob*sity Canada, funded by Novo Nordisk Global. Jennifer Brown reports receiving nonfinancial support from Novo Nordisk, and personal fees Yoni Freedhoff is the co-owner of the Bariatric Medical Institute and Constant Health, which provide weight management services; Constant Health has received a grant from Novo Nordisk. Yoni Freedhoff also regularly speaks on topics related to ob*sity and receives honoraria and travel costs and expenses for same. Michel Gagner reports receiving consulting fees from Novo Nordisk. Marie-France Langlois reports receiving personal fees from Novo Nordisk, Eli Lilly. David Macklin reports receiving personal fees from Novo Nordisk. Priya Manjoo reports receiving personal fees from Novo Nordisk. Marie-Philippe Morin reports receiving speaker honoraria from Novo Nordisk, Eli Lilly and research subvention from Novo Nordisk, and consultation honoraria from Novo Nordisk, Eli Lilly. Sue Pedersen reports receiving personal fees from Novo Nordisk, Eli Lilly and grants from Eli Lilly, and nonfinancial support from Novo Nordisk and Eli Lilly.Megha Poddar reports receiving honoraria for continuing medical education (CME) from Novo Nordisk, Eli Lilly, education grants from Novo Nordisk, fees for mentorship from Novo Nordisk; fees for membership of advisory boards from Novo Nordisk. Paul Poirier reports receiving fees for consulting and continuing medical education from Eli Lilly, Novo Nordisk. Judy Shiau reports receiving personal fees from Novo Nordisk. Diana Sherifali reports receiving a grant from Ob*sity Canada to support the literature review process, during the conduct of the study. Shahebina Walji reports receiving consulting or advisory board fees from Novo Nordisk and speaker's bureau fees from Novo Nordisk.All of their recommendations around liraglutide are level 2a (Evidence from at least 1 controlled study without randomization) and Grade B ( Directly based on level 2 evidence or extrapolated recommendation from category 1 evidence) they suggest that these recommendations should use the terms “may” or “can” (as opposed to “should.”) The studies that they cite offer, at most, only 56 weeks of follow-up.Information supporting the public health relevanceIn this section they claim that “not only is the prevalence of ob*sity increasing, but the number of global deaths attributed to BMI has substantially increased from 1990 to 2017 (Figure 1) [23]. The global burden of disease of ob*sity study also found that though the age-standardized rate of high BMI related disability adjusted life years (DALY) increased by 12.7% for females and 26.8% for males, the actual global number of high BMI DALYs has doubled, despite sex”The study that they cite to support this (The global burden of disease attributable to high body mass index in 195 countries and territories, 1990-2017: An analysis of the Global Burden of Disease Study, Dai et al., 2020) calculates these numbers based on the assumption that the health problems higher-weight people have are due to their weight (even though people of all sizes experience them). They also fail to control for the health impacts of weight stigma, weight cycling, or healthcare inequalities, despite the research that shows that they are confounding variables. The assumption that higher-weight people's health issues are caused by their weight coupled with the failure to account for (or even discuss) confounding variables suggests to me either near-complete incompetence of the study authors around basic research methods, or a desire for specific conclusions.The study is at least honest that they don't know if weight loss would change this, stating “Successful population-wide initiatives targeting high BMI may mitigate the burden of a wide range of diseases” [emphasis mine].Thus, this doesn't actually support the recommendation to the WHO. Without proof that these medications would reduce disease or increase life years long-term, there is no reason to consider them “essential,” and no such evidence exists.Next they claim that “Ob*sity also plays a role in health care related costs; for patients and families, total healthcare costs for patients with ob*sity were higher than that of patients who are overweight.”First of all, this begins to wade into the idea that higher-weight people should be eradicated because they are “too expensive,” which is heading down a bad road when it comes to ethics. Further, the study they use to support this is based on 97 Dutch people who filled out a survey. The study included costs such as “expenditures related to the respondent's weight, such as adapted clothing, gym subscription, diet books, parking permit, food, etc.” First of all, thin people also have gym subscriptions and parking permits, but, moreover, telling fat people that they should buy diet books and pay for various weight loss foods and methods (despite the near-total failure rate,) then blaming them for the cost of following those dubious recommendations (as well as the additional costs of living in a world where structural weight stigma creates a lack of accommodation in clothing etc.) as a justification for more expensive, more dangerous “interventions” is a long way from being ethical science and is a particularly craven marketing tactic. I'm just going to stop there, but to say that I've seen elementary school science fair projects with more rigorous methodology and I would be beyond embarrassed to cite this for any reason ever, other than as an example of the piss-poor state of weight science.They finish up the section with “Given the global burden of ob*sity and the goal of reducing preventable disease related deaths, it is evident that affordable and available pharmacotherapy for ob*sity is needed on a global level.”Let's rephrase this to reflect the evidence they provided: “Based on a survey taken by 97 people, a study that failed to control for any confounding variables and made wild assumptions about causality based on simple correlation, and their own research's acknowledgment that changing body size may not change health outcomes, it is evident that affordable and available pharmacotherapy for ob*sity is needed on a global level.”Which is to say, what they provided here does not come close to justifying their request.In part three we'll wrap this up with a look at the evidence they use to discuss harm, effectiveness, and cost-effectiveness.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In Part 1 we talked about how Novo Nordisk got suspended from The Association of the British Pharmaceutical Industry for their shady marketing practices. Today, we're going to talk about an investigation by The Observer that found what so many of us have been saying for a looooong time - that Novo Nordisk had paid millions to prominent ob*sity “charities,” NHS trusts, universities and other bodies as well healthcare professionals who publicly praised the drug (typically without disclosure of their funding) and who advised NICE (The National Institute for Health and Care Excellence) on their reviewing of Novo's weight loss drug to decide whether or not it should be made available.The Observer article by Shanti Das and Jon Ungoes-Thomas “‘Orchestrated PR campaign': how skinny jab drug firm sought to shape ob*sity debate” (Note: per my policy I'm not linking to it because it still comes from a place of weight stigma) found that in three years, Novo Nordisk had shelled out £21,700,000 (about $26,415,301.50 USD) over 3,500 transactions which were separate from their research and development spending.The Observer found:“The payments include donations, event sponsorship, grants and other fees to prominent ob*sity charities, NHS trusts, royal colleges, GP surgeries, healthcare education providers and universities - on top of £28m spent by the company on research and development. A further £4m in payments such as consulting and lecture fees went to health professionals, including experts on ob*sity. The business has also provided financial support for the running of the all-party parliamentary group on ob*sity - a cross party group of MPs and members of the Lords that lobbies the government on health policy.”I've written before about how major papers like the New York Times are writing articles that are, essentially, lobbying for Novo Nordisk's priorities where every expert quoted is on Novo's payroll with no disclosure. One question I get asked a lot is “how is that legal?” First I'll point out that legal and ethical are two different things. Beyond that, there is a tendency to believe that doctors and academics are somehow immune to industry influence (or to the ways that their promotion of the weight loss paradigm will support their careers) such that reporters and others (including those on the pharma industry's payroll) claim that disclosing these conflicts of interest isn't important.An excellent example of the ways in which those who are seen as “impartial” experts in academia are, in fact, on the payroll of these companies and actively shilling for them is Professor John Wilding. Professor Wilding is at Liverpool University, where he leads clinical research on “ob*sity.” He also serves as president of the “World Ob*sity Federation” (an astroturf organization similar to the Ob*sity Action Coalition) which took more than £4.3M over three years, per The Observer. Somehow, this did not make its way onto his conflicts of interest statement. Meanwhile, he was quoted extensively in the media recommending Novo's drug Wegovy. Jason Halford, who is the Head of the School of Psychology at the University of Leeds, told an audience of millions on BBC that Wegovy is “one of the most powerful pharmaceutical tools” for treating “ob*sity.” He did not disclose that he is also the president of the European Association for the Study of Ob*sity (EASO), another astroturf organization (which is to say, an organization that claims to advocate for marginalized people but, in reality, is predominantly funded by and acting as a lobbying arm of, the pharmaceutical/weight loss surgery industry.) The Observer found that the EASO received more than three-quarters of its income (more than £3.65m) from Novo Nordisk. He was also a previous member of Novo Nordisk's UK advisory board.I'm glad Novo Nordisk's lack of ethics are getting wider coverage (though, as I pointed out in part 1, people in fat liberation and weight-neutral health advocates like Mikey Mercedes, Louise Adams, Asher Larmie, myself and others have been talking about this for some time,) but I don't expect it to stop them until we can put enough pressure on them to force them to stop. This is a company that orchestrated aggressive price gouging on insulin, proving beyond a doubt that they will kill people for money. And as pressure in the US is forcing Novo to lower the price of insulin, they seem to have a lot of eggs in the Wegovy basket. Prior to launch, they promised their shareholders the “fastest ever” post FDA-approval launch and that they would double their “ob*sity” sales by 2025. In fact, The Observer found that Novo Nordisk's sales on their new “ob*sity treatments” rose 84% in 2022 to $2.4B – a figure Novo projects will “grow significantly” in 2023.And what will they do to grow this figure significantly this year? I think their behavior makes it clear – absolutely anything they can get away with.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
In this episode, we explore the importance of customer service in optometry with Dr.Jennifer Stewart. She is the Editor of Independent Strong, Founder of OD Perspective, Co-Founder and Chief Vision Officer of Performance 2020, and an optometrist with almost 20 years of experience. Dr. Jennifer shares her insights on how to create a welcoming and comfortable environment for patients, the role of technology in enhancing customer service, and the benefits of investing in staff training and development. If you're a healthcare professional looking to improve your customer service skills, this episode is for you.
In this podcast, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the March 2023 issue of DTB. They discuss incorrect penicillin allergy labels and ways that these can be corrected (https://dtb.bmj.com/content/61/3/34). They review clinical trial results for lecanameb in early Alzheimer's disease (https://dtb.bmj.com/content/61/3/37) and also talk about a new combined oral contraceptive that contains estetrol and drospirenone (https://dtb.bmj.com/content/61/3/39). They begin by discussing a proposal from the National Institute for Health and Care Excellence to lower the threshold for offering statins for primary prevention. The contact address for the DTB team is dtb@bmj.com. Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page (https://podcasts.apple.com/gb/podcast/dtb-podcast/id307773309). Thank you for listening.
In 2020 a black 15 year old schoolgirl, known as Child Q, was strip-searched by police while on her period after being wrongly suspected of carrying cannabis. A safeguarding report on the incident concluded it was unjustified and racism was "likely" to have been a factor. New data published by the Children's Commissioner has found what she calls a “concerning” number of children have been strip-searched by the Metropolitan Police without an appropriate adult present. BBC reporter Celestina Olulode joins Jessica to talk us through this data and we also hear from Jacqueline Courtenay, a mother from North London who organised a rally about this issue. Following the launch of the Women's Health Strategy we speak to the new chief executive of NICE - the National Institute for Health and Care Excellence. The agency makes recommendations to the NHS in England and Wales on medicines treatments and procedures. Dr Sam Roberts took up the post in February 2022. Before joining Nice, she was Managing Director of Health and Care at Legal and General but began her career in clinical practise and spent some time working as a junior doctor in a London hospital.
In episode #103 of Productivity Mastery, we talked about a topic that more and more companies are aware of - neurodiversity! Did you know that 1 in 7 people has a neurodivergent condition, and this is crucial to be considered in order to help them do their best at work? Our guest was the incredible Theo Smith, who, being neurodivergent himself, is a leading advocate for neurodiversity and its opportunities that come along. In this episode, hear about:
In this episode with Theo Smith - Neurodiversity Evangelist, Author, and Podcast Host: ✔️ What is neurodiversity and why it matters to recognize it, ✔️ How to best support neurodiverse people and create a win-win, ✔️ The challenges for parents, managers, and workers who face neurodiverse needs, ✔️ The far-reaching impact that addressing neurodiversity will bring, and much more! Theo Smith is a leading advocate for neurodiversity. Passionate to raise awareness of neurodiversity, Theo has founded Neurodiversity At Work LTD to advocate the importance of neurodiversity in the workplace. Recently, Theo joined forces with Dynamis Group to help take neurodiversity to the top of organisations agendas via the CEOs and their leadership teams. Formerly, Theo has been the Recruitment Manager for the National Institute for Health and Care Excellence, enjoying a successful career in HR and recruitment, ensuring organisations had a diverse workforce and thrived. He has also been an advisor for TapIn and host of the Talent Hacks for Scaleups podcast. Sharing his expertise on neurodiversity, Theo helps businesses to have a better understanding of neurodiversity, why it is important and what the benefits of having a neurodiverse workforce can have in business. Spreading the message that an organisation's employees are their biggest competitive advantage, Theo shares the importance of different skills, strengths, approaches and problem-solving techniques that are evident in a diverse workforce. Known for his love of speaking, Theo is now a popular choice as a speaker for diversity and inclusion-themed events. Sharing his experience of being neurodiverse as a passionate neurodiversity evangelist, Theo has formerly spoken for the likes of Wayfair and is commended for his concepts on neurodiversity in the workplace. Covering topics such as DE&I, neurodiversity at work, neurodiversity recruitment and being ADHD, Dyslexic and Dyscalculia, Theo Smith is the perfect speaker when looking for an expert on neurodiversity. Tune in!
Dr. Ardeshir Z. Hashmi MD, FACP, Section Chief of Geriatrics at Cleveland Clinic and is the Endowed Chair of Geriatric Innovation and Section Chief/ He is Assistant Professor of Medicine at the Case Western Reserve University and the Cleveland Clinic Lerner College of Medicine. He has conducted lectures and workshops in geriatrics nationally and internationally. Under Dr. Hashmi's leadership Cleveland Clinic Geriatrics has garnered the following milestones; Age Friendly Health Systems Committed to Care Excellence designation via the Institute for Healthcare Improvement; highest Geriatrics US News and World report national rankings in Cleveland Clinic history; national accreditation as a top tier Level 1 Geriatrics Emergency Department by the American College of Emergency Physicians. Dr. Hashmi's niche area of interest is the intersection of affordable technology solutions and geriatric population health in the service of our most vulnerable populations. Sponsor: www.BeyondDrivingwithDignity.com
Craig Williams is a returning guest on the podcast. A Traditional Chinese Medicine & Ayurvedic practitioner, Craig resides in Austin, Texas. In this episode, we delve into Craig's recent writings, why Dry Needling and the National Institute for Health and Care Excellence are creeping up on our profession, and a rhetorical question as to whether Chinese medicine colleges should offer business courses. Join us as we unearth a few rocks to see what's under them. For more information or to contact Craig, please visit ayurvedaaustin.com The Strength of TCM Workbook, along with digital downloads, study charts and practice support are all available at kentonsefcik.com Track is Samurai Code by Levox: levox.bandcamp.com
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