Podcasts about clinical center

Just a couple of weeks ago, 1,800 scientists, clinicians, postdoctoral fellows, and medical residents gathered in West Palm Beach, Florida, for the Americas Committee for Treatment and Research in Multiple Sclerosis annual meeting, better known as the ACTRIMS Forum. Dr. Darin Okuda is the Director of the Multiple Sclerosis and Neuroimmunology Imaging Program, the Director of  Neuroinnovation, and the Deputy Director of the Multiple Sclerosis Program and Clinical Center for Multiple Sclerosis at University of Texas Southwestern Medical Center. At the ACTRIMS Forum, we talked with Dr. Okuda about the impact of artificial intelligence on MS care, how to go about preventing MS, and a frightening case study of what went wrong with an MS patient's generic disease-modifying therapy.  We have a lot to talk about! Are you ready for RealTalk MS??! SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/actrims01 ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.com Phone: (310) 526-2283 And don't forget to join us in the RealTalk MS Facebook group! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes in the RealTalk MS app or at www.RealTalkMS.com RealTalk MS on YouTube https://www.youtube.com/@RealTalkMS Join the RealTalk MS Facebook Group https://facebook.com/groups/realtalkms Download the RealTalk MS App for iOS Devices https://itunes.apple.com/us/app/realtalk-ms/id1436917200 Download the RealTalk MS App for Android Deviceshttps://play.google.com/store/apps/details?id=tv.wizzard.android.realtalk Give RealTalk MS a rating and review http://www.realtalkms.com/review Follow RealTalk MS on Twitter, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Bonus Episode Guest: Dr. Darin Okuda Privacy Policy

Neurologists bring special skills to pain evaluation and management and are well equipped to appreciate both the focal and diffuse nature of pain. By using expert knowledge of the nervous system and implementing relevant therapies, neurologists can succeed at and find meaning in optimizing patient outcomes. In this episode, Allison Weathers, MD, FAAN, speaks with Beth B. Hogans, MD, PhD, author of the article “Principles of Pain Management,” in the Continuum October 2024 Pain Management in Neurology issue. Dr. Weathers is a Continuum® Audio interviewer associate chief medical information officer at the Cleveland Clinic in Cleveland, Ohio. Dr. Hogans is an associate professor in the department of neurology at Johns Hopkins School of Medicine and an associate director for education and evaluation at the Geriatric Research Education and Clinical Center at the VA Maryland Health Care System in Baltimore, Maryland. Additional Resources Read the article: Principles of Pain Management Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum Journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME.   Dr Weathers: This is Dr Allison Weathers. Today I'm interviewing Dr Beth Hogans, author of Principles of Pain Assessment, Diagnosis, and Management from the October 2024 Continuum issue on pain management and neurology. Welcome to the podcast, and please introduce yourself to our audience.   Dr Hogans: Good afternoon. My name is Beth Hogans. I'm a neurologist. My faculty appointment is at Johns Hopkins School of Medicine in the Department of Neurology, where I'm an assistant professor. I also serve at the Baltimore VA Medical Center, where I'm the Associate Director of Education and Evaluation for the Geriatric Research, Education and Clinical Center, as well as a neurologist.   Dr Weathers: Thank you so much for, again, being with us today and taking the time to speak with me. I was really struck by how broadly applicable this topic is, not only to all neurologists, but to all physicians and even to all of our listeners, given how prevalent these conditions are. Nearly all physicians involved in direct patient care treat some type of pain disorders, and we all experience pain at some point, though hopefully not chronic pain. Well, usually like to start with a question - again, it feels especially pertinent here in getting to speak with you - what is the most important clinical message of your article? Dr Hogans: So, I'm going to say there's two key messages. The first one is that all pain has a differential diagnosis, and the second one is that all meds work better with non-pharmacological and whole-health comprehensive management incorporated. So that's why I structured the article around the ideas of assessment, diagnosis and management. It's a pretty sort of traditional, basic approach to how we look at clinical problems, but we definitely want to start with proper assessment, go on to a thoughtful differential diagnosis, and then move towards a management plan that is not just, you know, one stop shop, but actually kind of brings several aspects together. Because pain is so multidimensional; you know, it's represented in multiple places in the brain as well as other levels of the nervous system. And so, I think we're still in an era, and we may stay in an era, of, you know, needing something to go along with medication in many cases.   Dr Weathers: I think those are two absolutely critical points for our listeners to keep in mind, both, again, keeping that broad differential, and - we'll get more into management in a bit, but again - that dual strategy of both the pharmacologic and the non-pharmacologic. And again, going down a little bit more there on that management track, a really recurring theme that I picked up in your article is the importance of interprofessional collaboration in the assessment and the management of patients with pain. In the abstract, you actually use the phrase “remarkable” for the diversity of health professions, which I really loved. What other clinicians do you work with in diagnosing and managing pain conditions, and what are their roles in the care of these patients? Dr Hogans: So, something you hear over and over again at pain meetings is, “there is no I in team.” They say that all the time. And it's one of the things I really love about pain, is that we get to work with great colleagues who have their own perspectives, approaches and therapies for pain. So, in my particular practice, which I do focus kind of more at the interface between neurological and musculoskeletal pain because of my passion and interest for spinal pain, you know, ranging from neck to tailbone, but most especially in the lower back. Physical therapy, clinical psychology, sleep sedicine, nursing, pharmacy, rehab… Podiatry is something that people don't often think of, but is really important for getting spine mechanics correct… Ergonomics. But I want to just say something about clinical psychology because there may not be enough clinical psychologists in the United States, but we as neurologists are also brain doctors. You know, we have to stay within our scope of practice. But there's a move now to talk about psychologically informed physical therapy. So why don't we talk about psychologically informed neurology? I think we could do an even better job of kind of leveraging our knowledge of the brain and how it works to kind of bring that into our practice. And so, people with pain often need a lot of empathetic support, for example, as well as knowledge about their condition. So, I would encourage people to build local networks of folks that they refer to and work with. Because when I was a younger doctor, physical therapists taught me a lot of what I know now - because I didn't get it at med school, although by the time I got to residency, I had some really great teachers. But clinical psychology, PT, sleep medicine, those are, like, almost all-the-time collaborators for me. And then like I said, nursing, pharmacy, rehab, podiatry, et cetera, et cetera, prosthetics… those things are all important for pain. Dr Weathers: I was struck by the quote, “one of the things I really love about pain.” That's a great line, and understand how it was meant, but I think - again, a really great quote, but I think you make such important points and, really, it is such a critical team approach. And I love all of those roles you called out. And I was struck in listening to your really thoughtful answer about how I've spoken with several other authors of actually very different topics, but about how we're thinking now about a trauma-informed care approach to many neurological conditions and the similarities with this patient population, how it likely informs very much the approach to this patient population as well and probably the significant potential.   Dr Hogans: A hundred percent! And so, for example, one of the things that probably does factor in for chronic pain - not in everyone, but in, let's say, many cases - is a prior exposure to trauma, whether it's PTSD or adverse childhood events. And so that's why, you know, clinical psychology is, like, very high up on my list of collaborators. And one of the things that I really like - you could say love - about working in the BA system is the ready availability of mental health co-management. So, I would say about a third of my patients in neurology are co-managed by mental health. And what it does is it sort of defuses a lot of what would otherwise come into the visit and be my job as a neurologist to manage, if not treat, right? I still have to manage, you know, someone who comes in with untreated mental trauma or mental health conditions if they're coming into that visit, and I'm trying to open the topic of whether mental health co-management could be helpful. That can sometimes, strangely enough, antagonize people. We're still in an era of substantial stigma. But I can just say the practice of neurology, together with appropriate mental health co-management, is far superior than going alone. Dr Weathers: Absolutely. And how fortunate that for a lot of your practice, your patients do have those resources available to them. And I think it speaks to the importance of those resources, that all of our patients should really have that availability, and the importance of access. Dr Hogans: Right. So, at Johns Hopkins, we also have exceptional access to, you know, some of the world 's best clinical psychologists. And I've been really privileged to work with my colleagues in clinical psychology. The challenges that - in some of my roles, I interact with trainees and learners who are in clinics that are not as well resourced. And therein lies just tremendous heartache and difficulty. We've been trying to build some resources. There are federal resources that can help to open those conversations and maybe take some of the initial steps towards things like cognitive behavioral therapy, acceptance commitment therapy, mindfulness-based stress reduction. There's many of these psychological therapies that are proven to be effective for pain and chronic pain, and yet we haven't really had that conversation as a society about, how do we get people connected with those therapies? Many of them can be delivered on a larger scale. And I think we just need to think a lot more thoughtfully about, how can we have more of a public health approach to chronic pain and wellness? Dr Weathers: Absolutely. Such really important points. So, we've talked about the really kind of important, obvious points for what we very much kind of know to be accurate. I want to talk now about, what are the most common misconceptions that you've encountered in treating patients with pain disorders?   Dr Hogans: Yeah. So, this is where, you know, physician as advocate for the patient really comes into play. So, I think the number one misconception that I and many of my colleagues encounter: that pain is the patient 's problem, or that that pain reflects an excessive sensitivity. I think one analogy that I use with students that helps to kind of piece this apart is the immune system, right? There are people who have immunodeficiencies that they're not sufficiently protected from the environment, and then there are - lots of people have allergies where their immune system is sort of hyper-alerted to things that are not a true threat. And the pain system is exquisitely regulated. The neurology of the pain system is fascinating and compelling, and once you learn a little bit about it, you can apply it at the bedside, time after time after time. So, number one: pain is real. And there is an association between strong pain and increased risk for chronic pain. And then sort of the flip side of that is that malingering or, you know, fictitious pain is probably a lot like other functional disorders in that it's part of a complex. So, I think we need to do a lot more work to discover, you know, quote, what is pain that people think is amplified or manufactured and how can we frame that in a clinical context rather than just casting blame or- we already mentioned stigma. You know, stigmatizing people does not help. And there are people who have real pain problems that are really severe and disabling, and neurologists can actually help support those people as they encounter their environment. Dr Weathers: I really love that response. And I think you're right in that we do so often, in the medical system, tend to stigmatize these patients, even as we say the right things and we, I think, talk about it and we recognize… and yet, still, it's almost these unconscious biases. I think, as good as we've gotten in some areas, it's still hard to separate them. It's almost kind of one of the last unspoken, still-acceptable ones in some ways that oh, they must be drug-seeking or, you know, to your point, you use the word, kind of malingering, that they're somehow, you know, either at fault or that there's some nefarious behavior going on there. And I think you made such really important points that we have to change our way of thinking that it is such a common and, frankly, wrong misconception that a lot of us really carry around and it's really hard to break. We have to kind of recognize these biases in ourself and really fight against them when we encounter these patients. Dr Hogans: I think part of how we got there is the opioid crisis. Dr Weathers: Yes. Dr Hogans: You know, unfortunately we still do not have a fantastic understanding of opioid durability. Like, how long does opioid analgesia last? Not from, like, hour to hour, but, like, from month to month. Roger Cho has done some awesome work looking at long-term efficacy of opioids, and it's surprisingly modest. And yet, opioids have this profound kind of behavioral impact, that they really are highly reinforcing. And so, once they're in the conversation, you find yourself in, like, almost this life-or-death struggle between, you know, am I going to get opioids at this visit? How many? You know, if not, why not; are you going to decrease? And so those of us who are working today, you know, and have been working for the last five years, have been through this terrible struggle. And that struggle is not yet resolved. But once opioids are kind of off the table or neutralized, then we actually have a conversation that is really, you know, A: how good of a clinician are we? Do we really understand what our patient is going through? And how can we bring, like Hippocrates said, you know, get the system to bear on the problem and not just, you know, try to throw drugs at it. So I think that, really, pain challenges us to be our best selves and to, you know, really be clever and kind and helpful. And it is a really great opportunity to help. And as I said, the mechanisms of pain are fascinating neurologically. So, it kind of satisfies some of what we come to work for, but I think it's not all done yet. One of my challenges has been, I wrote an article in 2011 with one of my trainees where we counted up the number of hours documented in the double AMC database for med schools, and we found that the modal value for US medical schools at that time was four. So out of four thousand curricular hours, there were four pain hours. And when you think about the prevalence of pain, that's just a drop in the bucket. So, you know, it's getting better, but we need to come up with some new strategies. So I wrote, I've written three books now. The latest one is really designed to give that intro-level knowledge of pain. But also, obviously, the Continuum article, I wanted to kind of set the table, lay the foundation, and give people some core knowledge to get started with. Dr Weathers: And again, a fantastic article. If our listeners haven't read it, I strongly encourage them to go back because I think you did just that. And as you were just talking, I was thinking about that, especially for those of us who, you know, depending on when in your training was, you know, mine started in the early 2000s. We've kind of lived through that era with the pendulum swinging. Where was, you know, the signs were posted in each clinic room. You know, don't forget to ask, you know, your provider about your pain meds, and it was the sixth vital sign, and all of that. And then the pendulum swung very quickly and very severely the other way, where it was, you have now created this problem, right? We have all caused this epidemic and we're supposed to immediately take these meds away, right? And now to your point, you know, we've all been in these situations with opioids where that was all that was talked about, right? So, you know, we've all been on call and now you're getting the call overnight from people trying to get their opioids filled when, you know, not their prescriber because they knew if they called - or family members, as soon as you got prescribing rights, were now calling and asking. And we've all been in these very hard situations. Dr Hogans: Just because you have a hammer doesn't mean that everything is a nail. Dr Weathers: I know. So, in trying to negotiate and navigate, you know, these very rough situations… And I think now we're reaching kind of this new era where, to your excellent point, realizing that there are a lot of other solutions. And I love how you framed it, that this is really where we can be our best selves as providers. And actually, to that point, so - as I've mentioned on this podcast many times, clinically, I'm a neuro-hospitalist and I actually wanted to get your opinion as one of the foremost experts. So, a challenging situation I'm also often faced with in my clinical role is when a patient with a chronic pain condition such as diabetic neuropathy or lumbar radiculopathy is admitted to the hospital, often with a totally unrelated condition that either results in a new acute pain, but often also exacerbates their underlying chronic pain, what's your approach to the assessment and management of similar cases? I know our listeners will return again and again to that fantastic approach you laid out in Figure 1.1 with the coordination of the pharmacologic and non-pharmacologic therapies, as we've talked about several times just throughout our conversation, how important both of those approaches are. But a lot of those options are unfortunately limited in the in-patient setting. So how do you balance those? Dr Hogans: So, there's a whole other toolkit that comes into play for acute pain or sort of pain palliation. And you actually have some important allies in the hospital. It turns out that nurses, generally speaking, have some more education than do most physicians about pain. And the nurses that I encounter really see themselves as genuine, sincere advocates for the patient 's interest. They're at the bedside, they're working very closely, and their training actually does, I think, give them a number of tools and a set of inspirational ideas that build towards patient comfort. So, if you communicate with nursing staff about your desire to provide more comfort for the patient, whether it's padding, positioning, activities such as, you know, having them participate in something, you know, whether it's just having a family member, you know, take them for a walk, whether it's in a wheelchair or having an older adult sit by the nurse's station just to give some form of distraction. Ice, you know, cool packs and hot packs, you know, supportive toweling or pillows, all of that can really help. Years ago, nurses used to actually be trained in giving massages, and that can provide some comfort. You know, supportive touch is kind of how we frame that nowadays. But the other piece that you have is, in many cases, PT is getting involved much earlier in the patient, you know, rehabilitation course. And remember that motion is lotion. So, our endogenous analgesia system, which actually involves both endogenous opioids and endogenous cannabinoids, can be activated through many forms of motion, as well as immobility is actually a cause of pain itself. So, you just, you break out your in-patient tool kit and, you know, there are other tools and there's other allies that you want to think about in that context. Dr Weathers: Those are all really great tips, many of which, I know, as you said, a lot of us tend in our thinking to go right to pharmacologic strategy, so wouldn't even be considered, but I think really thoughtful, and that we do have at our fingertips. So- Dr Hogans: I wish I had thought to put them in the article. Dr Weathers: No, they were fantas- but again, why we podcast, agree for complimenting the article… we encourage people to take advantage of both. Well, this has been wonderful, and I know I have learned so much, even more than was in the article. I always like to end on a hopeful note, so I would love to hear what developments in the field of pain that you're most excited about. What do you think is coming down the pipe? Dr Hogans: Well, I think, like a lot of people, I've been waiting for the opportunity that's happening right now, which is, there's a massive investment in pain science being made by the NIH. Finally. You know, we've moved from, you know, just like, little things here or there, commercial kind of entities, to, we now have large NIH dollars flowing into pain. I'd like to see not only a focus on small molecule development, which will ultimately lead to better pharmacological agents, but I'd also like to see a thoughtful approach to non-pharmacological therapies, whole health approaches. Things like healthy communities, safe exercise spaces for all ages, more nutritious food, yoga, Tai chi. We know from Skelly and Cho's article in 2020 that there are many, many non-pharmacological therapies that actually work for chronic pain. There're some things we still don't know. Like, do older adults respond as well as middle-aged adults? And how can we get NPTs - non-pharmacological therapies - more accessible to people who are subject to disparities? I think part of what happened during the opioid era is that you could get, you know, a bottle of pills for a four-to-ten dollar co-pay and physical therapy was twenty dollars a shot. And we know PT will get you to a better place, but that person that you're talking to may not have three hundred dollars to go to a course of PT. And we need to figure out, you know, how do we do this better, safer, more healthfully. Dr Weathers: And, I think, forgetting even the co-pay; it's the coordination, the time off work, all of it, right? So it's, I think, all of those challenges, but I think all of that are such important points about - and I think, that's really where I'm hopeful. Right? The emphasis, we talked a little bit about trauma-informed care earlier in our conversation, but the focus now on addressing the underlying social disparities of health and overall healthcare disparities, I think, is so promising. Dr Hogans: We need to think about the long-term consequences for human health; and pain has a terrible impact on human health for many reasons, and, I hope, will continue to be the focus of effort for years to come. Dr Weathers: Absolutely. Well, that is such an important statement to end on. Thank you again, Dr Hogans, for such a fantastic conversation and again, such an overall excellent article. Dr Hogans: Thank you, Dr Weathers, it was great to speak with you today again. Dr Weathers: Today I've been interviewing Dr Beth Hogans, whose article on principles of pain assessment, diagnosis, and management appears in the most recent issue of Continuum on pain management and neurology. To learn more about the topics of pain assessment and other topics of pain management, don't forget to listen to Continuum Audio episodes from this and other issues. Thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at Continpub.com/AudioCME. Thank you for listening to Continuum Audio.

Host: Charles Turck, PharmD, BCPS, BCCCP Guest: Dr. Robert J. Shmookler Reis, PhD Guest: Dr. Srinivas Ayyadevara, PhD Numerous factors could predispose patients to the progression of mild cognitive impairment or dementia and Alzheimer's disease. Fortunately, a recent study found that a cholesterol-lowering medication called ezetimibe might help reduce the risk of Alzheimer's disease progression and related dementias. To learn about the methods and key findings of the study, join Dr. Charles Turck as he takes a deep dive with Dr. Robert Reis, Professor and Researcher at the University of Arkansas for Medical Sciences' Institute on Aging College of Medicine and Research Career Scientist at the Central Arkansas Veterans Healthcare System's Geriatric Research, Education and Clinical Center, and Dr. Srini Ayyadevara, Associate Professor at the UAMS Institute on Aging College of Medicine and is a Research Health Scientist at the Central Arkansas VA's GREC Center.

The August 2024 podcast features Registered Nurse, Dr. Sandra CItty who holds a joint position as a Clinical Associate Professor at the University of Florida College of Nursing in the Department of Family and Community Health Systems and faculty in the Geriatric Research, Education and Clinical Center at the North Florida South Georgia Veteran's Health System in Gainesville Florida. Dr. Citty shares her passion improving system-based medication and nutrition administration to reduce patient safety concerns. She reviews the results of her teams inquiry into the National Center for Patient Safety Joint Patient Safety Reporting System to understand sources of patient safety concern related to enteral nutrition prescription, administration, and monitoring. Her discussion clearly hihglights the need for clinician to act within their own institutions from an interdisciplinary perspective. Business Corporate by Alex Menco | alexmenco.net Music promoted by www.free-stock-music.com Creative Commons Attribution 3.0 Unported License creativecommons.org/licenses/by/3.0/deed.en_US August 2024

BRAVO ZULU Georgia American Legion Post enlists local resources to help homeless veteran THE INTERVIEW Dr. Jay Gorman, VA clinical psychologist and Education Director of the VISN 1 Mental Illness Research, Education, and Clinical Center at the VA Bedford Healthcare System, joins the podcast to discuss how VOICES Veteran Socials enhance communication and foster bonds among veterans and others in the community. Veteran socials are veteran-led weekly community-based social events with a purpose – getting veterans of all ages and service branches in one place to support and build connection with each other. Dr. Gorman stresses the importance of social connection to combat loneliness and isolation and improve overall health. SCUTTLEBUTT Bill would allow retroactive Purple Heart vets to transfer GI benefits How the Gaza humanitarian aid pier traces its origins to discarded cigar boxes before World War II What's to become of the keepsakes left at Arlington Cemetery? Special Guest: Dr. Jay Gorman.

What drives someone to work tirelessly, sacrificing leisure to stand by others during their most critical moments? What kind of dedication does it take to support people in their hour of need and perform complex, life-saving brain surgeries? And what pushes a person to take charge of developing an innovative neuronavigation surgical system, or to seek out groundbreaking treatments for one of the most formidable adversaries in cancer treatment—glioblastoma? These questions touch on the essence of what it means to be deeply committed to neurosurgery, neurotechnology, and neuroscience. Today on the "Neurocareers: Doing the Impossible!" podcast, we are privileged to introduce Dr. Anna Oleshkevich, MD, a luminary whose life and career embody the answers to these questions. With a distinguished background in neurosurgery and neurotechnology, Anna has dedicated a decade to clinical excellence and pioneering research. Her journey has taken her from notable achievements in neuro-oncology and reconstructive neurosurgery to groundbreaking work developing a pioneering treatment for glioblastoma. In this episode, Anna will share her insights into the motivations and character traits essential for pushing the boundaries of neuroscience and neurotechnology. She'll delve into her relentless pursuit of innovative treatments for glioblastoma, drawing on the viral theory of carcinogenesis as a promising avenue. Her story is one of unwavering dedication, a passion for helping others, and a ceaseless quest for innovation. You will gain a unique perspective on what it takes to make significant advancements in treating brain diseases and developing cutting-edge surgical technologies. Anna will share insights gained from years of experience, discussing the challenges encountered, the continual development of skills, and the immense pleasure derived from making a difference in patients' lives.  Join us as we explore Dr. Anna Oleshkevich's inspiring journey, her contributions to neurosurgery, neurotechnology, and neuroscience, and her vision for the future of neurocareers. Discover the beacon of hope and innovation in the relentless fight against brain cancer and a leader in neurosurgical advancement. About the Podcast Guest: Dr. Anna Oleshkevich, MD, stands out as a remarkable figure in the medical community. She has vast experience as a distinguished neurosurgeon from Belarus and an avid neurobiologist and longevity researcher. With a decade of rich expertise that cuts across both clinical practice and groundbreaking research, her work encompasses neuro-oncology, spine neurosurgery, facial paralysis surgery, and cranioplasty/reconstructive neurosurgery. At the Republican Research and Clinical Center of Neurology and Neurosurgery, Dr. Oleshkevich excelled in assessing and diagnosing patients, interpreting diagnostic tests and neuroimaging, and adeptly working with microscopes and neuronavigation systems to perform intricate neurosurgical procedures, including emergency surgeries. Her scientific research is equally impressive, focusing on antiviral therapy in patients with high-grade gliomas, intramedullary tumors of the spinal cord, and the reconstructive surgery of cranial defects using individual titanium implants. Dr. Oleshkevich's commitment to advancing the field of neurosurgery is evident in her active participation in presenting and discussing cases at scientific meetings and conferences, where she shares her knowledge and insights with the global medical and scientific community. Dr. Oleshkevich has esteemed memberships in the European Association of Neurosurgical Societies (EANS) and the Congress of Neurological Surgeons (CNS). You can connect with Dr. Oleshkevich via LinkedIn: https://www.linkedin.com/in/neurannette/ About the Podcast Host: The Neurocareers podcast is brought to you by The Institute of Neuroapproaches (https://www.neuroapproaches.org/) and its founder, Milena Korostenskaja, Ph.D. (Dr. K), a neuroscience educator, research consultant, and career coach for people in neuroscience and neurotechnologies. As a professional coach with a background in the field, Dr. K understands the unique challenges and opportunities job applicants face in this field and can provide personalized coaching and support to help you succeed. Here's what you'll get with one-on-one coaching sessions from Dr. K: Identification and pursuit of career goals Guidance on job search strategies, resume and cover letter development, and interview preparation Access to a network of professionals in the field of neuroscience and neurotechnologies Ongoing support and guidance to help you stay on track and achieve your goals You can always schedule a free neurocareer consultation/coaching session with Dr. K at https://neuroapproaches.as.me/free-neurocareer-consultation Subscribe to our Nerocareers Newsletter to stay on top of all our cool neurocareers news at updates https://www.neuroapproaches.org/neurocareers-news

In this episode of Causes or Cures, Dr. Eeks chats with Dr. Jeffrey Iliff about his research on changes in sleep patterns over time and how that is linked to cognitive function. He discusses the relationship between sleep and cognitive function in general, and then describes how some sleep patterns over time may be more prone to cognitive decline than others and explains the theories behind that. He talks about the optimal number of hours of sleep a person should get each night and how that was determined. Finally, he explains the larger health impact of his work, particulary in an age when cognitive decline and Alzheimer's disease are on the rise. Dr. Iliff is a researcher and professor at the University of Washington Department of Psychiatry and Behavioral Sciences and the Associate Director for Research at the Mental Illness Research, Education and Clinical Center at the Veterans Affairs Puget Sound Health Care System. His research focuses on traumatic brain injuries and neurodegeneration.You can contact Dr. Eeks at bloomingwellness.com.Follow Eeks on Instagram here.Or Facebook here.Or Twitter.On Youtube.Or Threads.SUBSCRIBE to her newsletter here.Support the showSupport the show

In this episode, we will discuss Central Line-Associated Bloodstream Infections (CLABSI). My guest is Dr. Naomi O'Grady, a critical care and infectious disease physician at the National Institutes of Health. She is Chief of the Internal Medicine Service and an attending physician in the Clinical Center's Critical Care Medicine Department (CCMD). Her research focuses on strategies to reduce the incidence of antimicrobial-resistant pathogens in the ICU and catheter-related bloodstream infections. Additional Resources: Prevention of Central Line-Associated Bloodstream Infections. N. O'Grady. New Engl J Med 2023: https://pubmed.ncbi.nlm.nih.gov/37733310/ Sustaining reductions in central line-associated bloodstream infections in Michigan intensive care units: a 10-year analysis. P Pronovost, et al. Am J Med Qual 2016: https://pubmed.ncbi.nlm.nih.gov/25609646/ Bloodstream infection event (central line-associated bloodstream infection and non central-line associated bloodstream infection.) National Healthcare Safety Network: https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf Books Mentioned in this Episode: Nancy Drew Book Series. By Carolyn Keene. Nancy Drew Books: https://tinyurl.com/4rjx6st8 The Checklist Manifesto. By Atul Gawande The Checklist Manifesto- Atul Gawande: https://tinyurl.com/5pccn98p

Os modelos de trabalho passaram por intensas transformações com o passar dos anos. O avanço da tecnologia permitiu que mais pessoas, nas mais variadas profissões, pudessem realizar o sonho de ter o próprio negócio e gerir o seu tempo. E foi nesse contexto que os espaços de coworking, com salas compartilhadas para trabalho, ganharam o coração – e o bolso – dos brasileiros. Um dos objetivos desse tipo de espaço é reduzir custos, principalmente para quem entra no mercado. Mas será que na área da saúde isso também é possível? Quem vai nos explicar é o Dr. Carlos Alceu Machado, diretor do Grupo Master Imóveis, que administra o Clinical Center.

COVID-19 survivors who experience severe critical illness are at risk even when they leave the ICU. Long COVID is becoming recognized as a widespread problem, resulting in lower quality of life and productivity. Ludwig H. Lin, MD, is joined by E. Wesley Ely, MD, MHP, MCCM, to discuss the range of symptoms encompassing long COVID, as well as the latest research and treatment. Dr. Ely is a subspecialist in pulmonary and critical care medicine who conducts patient-oriented health services research as a professor of medicine in the Division of Allergy, Pulmonary, and Critical Care Medicine at Vanderbilt University Medical Center in Nashville, Tennessee, USA. He is a practicing intensivist and the author of Every Deep-Drawn Breath: A Critical Care Doctor on Healing, Recovery, and Transforming Medicine in the ICU. As associate director for research for the VA Tennessee Valley Geriatric Research Education and Clinical Center, his focus is on geriatric ICU care.

Christopher A. Lowry, Ph.D., is an Associate Professor at the University of Colorado Boulder in the Departments of Integrative Physiology, Psychology, and Neuroscience, the Center for Neuroscience, and the Center for Microbial Exploration. He has additional appointments in the Department of Physical Medicine and Rehabilitation and the Center for Neuroscience at the University of Colorado Anschutz Medical Campus, as a Principal Investigator in the Department of Veterans Affairs Eastern Colorado Health Care System, VA Rocky Mountain Mental Illness Research, Education, & Clinical Center, and as the director of the Behavioral Neuroendocrinology Laboratory at CU Boulder. He is also the Co-Founder and Co-Director of the Military and Veteran Microbiome Consortium for Research and Education.Dr. Lowry's research program at CU Boulder focuses on understanding stress-related physiology and behavior, emphasizing the microbiome-gut-brain axis. His research is designed to lead to novel, microbiome-based interventions for preventing anxiety, mood, and trauma- and stressor-related disorders, such as posttraumatic stress disorder (PTSD).In this episode, we talk with Dr. Lowry about his work involving the microbiome-gut-brain axis, a research term for how our digestive systems' health is intertwined with our brains' health. We'll cover broad theoretical topics like what the gut microbiome is and how it works, to the practical side of things like what you can eat to make it healthier.We'll also discuss some of Chris' work on how the gut biome can affect our resilience and susceptibility to traumatic brain injury and post-traumatic stress, as well as his research in these areas, specifically involving the veteran and first responder communities. Timestamps:00:00:22 Who is Dr. Chris Lowry00:03:08 Background, Education and the Microbiome00:10:28 Where is the Biome00:13:02 What Benefits Our Microbiome00:16:46 How Does Food Diversity Affect the Microbiome 00:20:15 Blood/Gut Barrier00:22:28 Fiber: Diversity is Best00:27:05 How do Antibiotics Affect the Microbiome00:29:13 Recovery From Antibiotics00:30:31 Guidelines in Probiotic Diversity00:35:00 Outro

Anger is something all humans experience. It can be uncomfortable for us as therapists when it shows up in therapy, whether it is the focus of intervention, or when expressed in session. Indeed, traditional clinical approaches have often focused on managing, preventing, or suppressing anger. But perhaps anger itself isn't always the problem, but rather aggression or other values-inconsistent behavioral choices. Join us as we discuss being curious about anger and its function from an ACT-informed perspective with our guest, John Donahue, Psy.D.John Donahue, Psy.D., is an associate professor of psychology in the College of Arts and Sciences at the University of Baltimore, where he directs their post-master's certificate program in professional counseling studies. He received a doctorate in clinical psychology from La Salle University and completed a postdoctoral fellowship with the NW Mental Illness Research, Education, and Clinical Center at the Portland VA Medical Center, where he specialized in posttraumatic stress disorder treatment and research. Dr. Donahue's clinical and research interests relate to the cross-cutting role of psychological flexibility processes in the development and maintenance of psychological disorders, and more broadly, the development of empirically based dimensional models of psychopathology. Calls-to-action: For example: Subscribe to the Practical for Your Practice PodcastSubscribe to The Center for Deployment Psychology Monthly Email

Dr. Diwakar Davar and Dr. Jason Luke, both of the University of Pittsburgh's Hillman Cancer Center, share the latest news on immunotherapy trials KEYNOTE-A10, LIBRETTO-001, and other key IO studies across tumor types featured at the 2022 ASCO Annual Meeting.  Transcript Dr. Diwakar Davar: Hello, and welcome to the ASCO Daily News Podcast. I am Dr. Diwakar Davar, and I'm an assistant professor of Medical Oncology in phase 1 therapeutics, at the University of Pittsburgh's Hillman Cancer Center, and the guest host of today's podcast. I'm delighted to welcome Dr. Jason Luke to this podcast. He's the director of the Cancer Immunotherapeutic Center at the Hillman Cancer Center, University of Pittsburgh, and a great colleague and friend.  Today we'll be discussing some key posters that highlight some advances in immunotherapy that will be featured and the 2022 ASCO Annual Meeting. You will find our collective disclosures in the show notes and the disclosures of all guests on the podcast are available on our transcripts at asco.org/podcasts.  So, Jason, thank you for coming on the podcast today.  Dr. Jason Luke: Well, thanks very much for the invitation. I always love doing these podcasts for ASCO, and never love anything more than hanging out with my friend Diwakar Davar.  Dr. Diwakar Davar: Well, thank you! Below are the abstracts we've selected. We will start with Abstract 2504. This is a phase 1 trial of the TIM-3 inhibitor cobolimab monotherapy, singly and in combination with the PD-1 inhibitors nivolumab or dostarlimab. Phase 1 data from the AMBER trial with the presenting author being Dr. Gerald Falchook. And this is a trial that initially started several years ago. And I know Jason, that you were involved with the inception of this agent, that TIM-3 inhibitor. So, walk us through, TIM-3. It's a third-generation checkpoint, we now have TIGIT LAG coming into the landscape. Definitely a first indication for LAG-3 melanoma with a positive trial, RELATIVITY 047. So, where are we with TIM-3? Why should we be excited about TIM in general, and this data in particular?  Dr. Jason Luke: It is quite exciting, especially building off the recent data that we saw for relatlimab or LAG-3 because it's becoming clearer that a number of these other immune checkpoints that we have been talking about for many years, actually really can be effective when used in the right setting.  So, this drug, this anti-TIM-3 antibody cobolimab monotherapy, as you mentioned, started out in a phase 1 clinical trial dating all the way back to I think about 2015. And that was at the time in immuno-oncology when everybody was so excited, [and] they thought everything was going to work immediately.  Subsequent to that, obviously, we've had some hurdles that we've had to come over. But we're coming back to some of these agents now, which are looking very exciting. So, just in the same way we think about blocking PD-1 or now blocking LAG-3 to reinvigorate T cells in the tumor microenvironment, there's a good chance and a high probability based on preclinical data that blocking TIM-3 could be just as effective as blocking LAG-3, so to say.  Now, one thing that I note in this abstract is really the safety finding and early PK analysis. And so, this is the important work we do early on to understand the drug. It's important to be aware that in a study like this, it's very hard to seek efficacy signals.  So, when you see this poster, really, you probably shouldn't be thinking, ‘Oh, this is a frontline phase 3 trial,' but rather that the efficacy is going to be a secondary consideration. Rather, what's quite important is looking at the properties of the drug and looking at the safety signals around that. And what we can see here is that TIM-3 appears to be quite safe when blocking it in conjunction with anti-PD-1 across several different tumor types. And that really sets the stage then to think about moving this into earlier lines of therapy across many different cancers.  And so, here we see advanced solid tumors but focused on lung cancer and melanoma and kind of the usual tumors we think about, and people can keep their eyes open because there are other posters of this molecule with PD-1 in some of the other sections outside of developmental therapeutics.  Now, one thing I would like to get your opinion on because your group has focused a lot on TIM-3, as I described it as this T cell centric mechanism to reinvigorate exhausted T cells. But it's possible that TIM-3 does other things as well. And I don't know if you want to comment on that or give any other feedback that you've had when thinking about this AMBER Trial.  Dr. Diwakar Davar: That was an excellent summary, Jason, of really what is a truncated 8-year track record of developing this agent all the way from 2015. But you bring up a very interesting point, which is: exactly what does this drug does in the non-T-cell compartment?  Some very interesting data from Brian Ruffell in a paper that was published about 3 years ago now suggested that TIM-3 was actually potentially a myeloid checkpoint, meaning that, in a tumor model in which Dr. Ruffell was studying this in the context of breast cancer, the drug primarily appeared to work on the effect of antigen-presenting cells and augment the presentation of antigen to T cells suggesting that it may be, in addition to being a chronicle T cell exhaustion marker, it may also be reinvigorating antigen-presenting cells. And the question of whether or not the role of TIM-3 on APCs as well as the role of TIM-3 on T cells, and which of these compartments are more important, and how these compartments segregate in any given cancer across many different lines of therapy will hopefully be something that we disengage, and understand a little bit better as we look at biomarkers of this drug across different settings.  And especially to that point, Jason, the biomarker question, you'll notice that very interestingly, that was a signal in which that drug had a certain response rate. Again, as you correctly point out, we cannot read too much into response rates in very small patient numbers. But very interestingly, there was a slightly higher response rate at the 300 milligrams, which is not the top dose level of the drug, and a slightly lower response rate at the ceiling dose of the drug that was tested, 900 milligrams, leading the investigators to conclude that the RP2D, was actually 300 milligrams every 3 weeks and not 900 milligrams.  What are your thoughts on dose in the context of immunotherapy (IO) drug development? And why might it be that 300 is the optimal dose as opposed to 900?  Dr. Jason Luke: That's a complicated question. I mean, when we think about checkpoint blockade, we classically think about it as only blocking on T cells. But to your point, if there are multiple mechanisms in play, sort of modulating other cell compartments actually may start to do different things at different doses that maybe weren't our primary intent as we went into the trial.  That's a little bit of hand waving, immunologic hand waving, but I think the data are the data and once we hit an effective dose level, there's really no need to really push the dose that much further. But that really emphasizes the importance of these kinds of early phase clinical trials.  So, I'm really looking forward to seeing this data. For disclosure, obviously, we have both been investigators on this trial. But we're very excited about the idea that there may be hope for a fourth checkpoint to come forward in the field beyond just PD-1 CTLA-4, and LAG-3, maybe now here with TIM-3.  Dr. Diwakar Davar: So, with that we'll go to the next abstract and that is Abstract 2516, “Phase I trial of adjuvant autogene cevumeran, an individualized mRNA neoantigen vaccine, for pancreatic ductal adenocarcinoma.”  So, this is an mRNA vaccine from our good friend, BioNTech. And that's been essentially evaluated in the context of highly lethal cancer, pancreatic ductal cancer, and specifically in the context of adjuvant vaccines, specifically in the setting of patients who had followed definitive pancreatic cancer surgery.  So, Jason, you know a lot of neoantigen vaccines, you've led some of these trials, really, the neoantigen vaccine is really the primary reason we are actually having an in-person meeting this year, because if not for this company and others like this, really this pandemic would not be behind us.  What are your thoughts on the role of neoantigen vaccines in cancer therapeutics, and also, particularly this particular trial in the data, the immunological data, and the clinical data regarding the development of neoantigen-specific T cells in this setting, and what this means for you?  Dr. Jason Luke: Right. So, the idea of targeting neoantigens as cancer immunotherapy was really all the rage a few years back, and it was thought based on preclinical animal models that this was just going to be the secret sauce, and this would be the new targeted therapy for immunotherapy. And it isn't to say that that's not true, but the first generation of neoantigen, peptide-based vaccines for the most part, unfortunately, just kind of didn't end up moving the needle the way we had hoped.  The question then was raised: is that because targeting neoantigens isn't reasonable, or is that because the setting where we were trying to do it in the refractory disease area was not the optimal way to leverage this?  And so, a couple of different companies and trials now are coming forward looking at targeting neoantigen in a minimal residual disease setting where the idea could be that immunologic responses that you could generate wouldn't be hampered by all the immunosuppression associated with the tumor microenvironment.  And so, here we have this molecule, which you eloquently pronounced, ‘autogene cevumeran.' It's an RNA-lipoplex neoantigen vaccine. So, it's not a peptide. It's more like the COVID-19 vaccines actually. And it's being given after surgery, followed by anti-PD-L1 followed by chemotherapy.  So, it's a complicated regimen, but it's very intriguing these early data, which do show that the patients who got the vaccine seemed to have better and longer-term outcomes. But then as you emphasize, really, I think probably what's at the heart of this that really makes it exciting is their ability to immune monitor the patients, meaning to look for antigen-specific immune cells from the peripheral blood in these patients to be able to identify those immune responses as being specific to cancer. Because this kind of a clinical trial, it's still signal seeking and proof of concept kind of trial.  In order to actually establish that a vaccine approach in a post-surgical setting would have efficacy, we need to do a large randomized trial. And so, this is not that yet. But I think these data really point in the direction that that could be a reasonable thing to try. And when you think about pancreatic cancer, where we've made no success with immunotherapy, really in a meaningful way in terms of checkpoint blockade, at least, that's pretty exciting actually to think about.  I would actually marry this dataset with another that we actually saw at the American Association for Cancer Research (AACR) meeting that also looked at neoantigen targeting and antigen-specific responses in colorectal cancer, again, and in a similar setting with the minimal residual disease setting.  And so, I think this highlights that we may need to start thinking about using immunotherapy in different ways than we had before. Obviously, everybody knows about using PD-1 blockade in lots of different cancer types that are really for metastatic disease, or maybe even for adjuvant now in melanoma a little bit. But maybe there's this space, which is the minimal residual disease setting where you might be able to detect by ctDNA after surgery, the patients are still positive. And maybe you could treat that before there's visible cancer, and maybe certain immunotherapies could be more valuable in that setting than others. And that's where I think maybe some of these mRNA technologies really might find their sweet spot.  So, coming back to this abstract, I think really, the emphasis point here is the novelty of generating patient-specific neoantigen vaccines, and then being able to track linearly over time the immune response against those vaccines.  I think with that kind of technology and being able to leverage that, I think we're really headed towards a real shift in the way we think about managing cancer in a post-surgical setting, again, thinking about MRD, or minimal residual disease, maybe in a way that our leukemia colleagues have been thinking it about for a long time.  Dr. Diwakar Davar: That's an excellent summary of a very, very complicated, both setting, and in this case, a therapeutic landscape. So, well said, well summarized, and we'll now pivot to Abstract 2514. So, this is ‘Efficacy and safety of NT-I7, long-acting interleukin-7, plus pembrolizumab in patients with advanced solid tumors: Results from the phase 2a study' [and] the presenting author is Dr. Aung Naing from [The University of Texas] MD Anderson [Cancer Center].  So, Jason, you know, with checkpoints, we've got so many thoughts about checkpoints, particularly given the rather unfortunate failure of BEMPEG in the context of melanoma.  So, we've got lots of interesting cytokines that we think of as important in the context of immuno-oncology 2, certainly 12, 15. You've been very involved with IO-15. We've got a lot of clinical trials studying IL-12. And now we've got one studying IL-7. So, tell us what do you think of this IL-7 targeting approach in the context of cytokine-based therapeutics?  Dr. Jason Luke: I think it's really important to emphasize on first principles, for those that are listening, who don't think about immunology all the time that not all cytokines are the same thing.  So, interleukin 2 that many people have heard of is very different actually than interferon. And that's very different from many of the other cytokines, the ILs, and everything, right?  So, IL-7 is a very potent cytokine that's associated with the expansion of immune responses, and that can drive interferon gamma-dependent effects. And you should hear whenever I say interferon-gamma is sort of a link through to PD-1 responsiveness. Because we think the mechanism that underpins anti-PD-1 effectiveness in patients really is interferon gamma biology.  So, IL-7 has been a molecule, it's been of a lot of interest but really was too toxic to try to deliver. But now we have novel drug delivery sorts of approaches that are being developed to try to bring the drug in, in a way that doesn't cause such systemic toxicity.  So, in this clinical trial, this NT-I7 molecule is given intramuscularly, every 6 weeks in conjunction with pembrolizumab, and very interestingly, in a small number of patients, but there were resist responses observed across a series of tumors that you really wouldn't expect should be responsive in any way to pembrolizumab alone. And so, we're talking about microsatellite stable colorectal cancer, pancreatic cancer, and some others as well.  And in conjunction with that, they were able to identify some of the biomarker effects we would think we would see with IL-7, such as expansion of peripheral immune compartments. And the toxicity profile was really consistent with what we've seen with fevers and chills, but manageable in a way that previous approaches really weren't.  So, I think this is really exciting because I think the idea here then is with this IL-7 approach, we might expand the kinds of cancers that we could go after, in conjunction with anti-PD-1 again, pancreas, colorectal cancer. I think that's really where the unmet need lies in oncology.  So, I really applaud these kinds of approaches and several of these cytokine approaches, and what we're going to talk about them, I think, have the potential to do that over the next couple of years.  Dr. Diwakar Davar: Excellent! Pivoting now to a different cytokine, but one that was alluded to before IL-12. So, Abstract 2518 is ‘Phase II evaluation of the combination of PDS0101, M9241, and bintrafusp alfa in patients with HPV 16+ malignancies,' and the presenting author here is Dr. Julius Strauss of the NCI Cancer Center and the Clinical Center of the National Cancer Institute at the National Institutes of Health.  So, what do you think, Jason, about the role of the HPV targeting vaccine, in this case, that was added to IL-12 immune-cytokine and bintrafusp alpha contextualizing the recent data that we have of bintra along with what is a very interesting result here?  Dr. Jason Luke: Yes, I think building on the last abstract where we talked about IL-7 as some novel biology now we move to IL-12, which again introduces other biology. So, interleukin-12 is a complicated cytokine, but one that's strongly associated with initial immune responses or immune priming, as well as enhancement of anti-tumor effects in the tumor microenvironment.  So, here we have sort of a 3-legged approach. So, the vaccination approach against HPV really can generate a strong immune response initially, and that can be supported with the IL-12. And then you come in with anti-PD-L1 and to whatever extent the TGF data is relevant here. And so, you have this cocktail where you're generating tumor-specific responses with a vaccine, you're supporting them with IL-12, and then blocking PD-L1.  And as we go back even a couple of abstracts we talked about, now we sort of have a cocktail right of approaches. And so, I think this is very exciting. It's unique in that, in these tumors, obviously, HPV is the driving force of cancer. So, developing a vaccine against that is fairly straightforward. But I really like this concept of bringing forward sort of a multi-dimensional immunotherapy approach. And we'll note they have previously presented data on this trial, I think last year at ASCO, actually. But what they see are pretty strong response rates, almost 30% range in PD-1 refractory tumors.  Again, that's our area of really high unmet need. It's hard to read through how useful a PD-1 naive treated patient here, although the response rates were high. But to me, it's really those patients who had progressed on PD-1 where they're getting these responses that tells me that this really could be something that's useful and potentially could be expanded beyond just say head neck cancer to any HPV relevant malignancy.  Dr. Diwakar Davar: Excellent! Now on to our last abstract. Abstract 2520, ‘Effect of intratumoral INT230-6 on tumor necrosis and promotion of a systemic immune response: Results from a multicenter phase 1/2 study of solid tumors with and without pembrolizumab (PEM) [Intensity IT-01; Merck KEYNOTE-A10].' The first author is Dr. Jacob Thomas.  Jason, we've seen a lot of interesting intratumoral therapies. You and I have both done a lot of studies in looking at intratumoral agents from toll-like receptor agonists, TLR-9, TLR 7-8, and more recently, oncolytic viruses.  So, contextualizing IT230-6 in the spectrum of intratumoral therapies, how do you feel about this drug, which is actually a very interesting novel drug. It's not just a TLR agonist, or for that matter, an OV, very interestingly, it's an intratumoral therapy that has actually got chemotherapy in it. So, how do you feel about this drug? How do you feel about the responses that we've seen? And particularly how do you feel about the setting in neoadjuvant breast cancer?  Dr. Jason Luke: Yeah. I would pick up where you said that this drug INT230-6 is just a really interesting concoction. So, it's cisplatin mixed with vinblastine, in a specific amphiphilic molecule that allows it to diffuse in through the cancer.  And so, if you had said that to me a few years ago, I would have looked at you and been like, ‘What are you talking about?' But I think the data that's been emerging for this is just really interesting because something about this chemotherapy cocktail actually drives immune responses. And really what the focus of this abstract is on is showing that you get an influx of CD foreign CDTa cells into the tumor microenvironment that's associated with a therapeutic benefit.  I think that's just really, really interesting to think about. It sort of makes one wonder when we're doing these intratumoral injections, how much of it is just the injection, and how much of it is the therapeutic agent, but I think it's a really novel therapy, and one that appears to be very well tolerated as well. And that's also the exciting part. When you hear cisplatin and vinblastine, you think, ‘Oh, well, that's not going to work.'  But apparently, it stays right in the tumor and generates these immune effects. I think it's very exciting. I think their approach here—going after what we usually call cold tumors, ones that don't respond to immunotherapy, you mentioned breast cancer—I think it's really interesting. I'm really looking forward to seeing the actual data from this abstract because, on first pass, it wouldn't have been what I thought about in terms of driving immune responses, but maybe it just goes to show that there's a lot more to understand there about immunogenic cell death and some of these other concepts that we bandy about. But I think this will be one of the most interesting abstracts actually to see the data for once it's available.  Dr. Diwakar Davar: Great! Taking a slight pivot from that. You've been involved in the development of novel response endpoints. One of the issues that we have with intratumoral therapies is that you're measuring a lesion that you inject, so now you inject something and it gets a little bigger. Is it getting bigger because it's growing? Is it getting bigger because the drug is working? We don't know. We have now itRECIST, which you have been working on.  What's very interesting is that whether you look at itRECIST, or RECIST, irRECIST, or imRECIST, when you have the monopoly of different response endpoints we have to deal with these days, these patients have monotherapy responses in non-injected tumors. How do you feel about that as a drug developer and somebody who's giving patients drugs like that? What is your impression of having shrinkage in the non-injected tumor?  Dr. Jason Luke: I think it's really exciting about this concept of the abscopal effect that we've bandied about for years. Despite being an investigator in this space, I'm really excited to actually see the data and to understand what these out of field responses are. If it's really true that this is robust, I mean, it could potentially be like a game-changer kind of thing. But I'll reserve judgment until I see the actual scans of the tumors that actually shrank that weren't injected.  Dr. Diwakar Davar: Fantastic insights, Jason. So, thank you for taking the time to join us on this podcast and to highlight these extraordinarily important advances in immunotherapy.  Dr. Jason Luke: I appreciate the opportunity to participate today.  Dr. Diwakar Davar: So, thank you, and thank you to our listeners for your time today, you will find the links to the abstracts that we discussed today in the transcript of the episode.  Finally, if you're enjoying the content on the ASCO Daily News podcast, please take a moment to rate review and subscribe wherever you get your podcasts.  So, thank you, Jason. And thank you to the team for putting this together.      Disclosures:   Dr. Diwakar Davar:   Honoraria: Merck, Tesaro, Array BioPharma, Immunocore, Instil Bio, Vedanta Biosciences  Consulting or Advisory Role: Instil Bio, Shionogi (Immediate Family Member), Vedanta Biosciences  Research Funding: Merck, Checkmate Pharmaceuticals, CellSight Technologies, Zucero Therapeutics (Inst), GSK, Merck, Arcus Biosciences  Patents, Royalties, Other Intellectual Property: Application No.: 63/124,231, and Enteric Microbiotype Signatures of Immune-related Adverse Events and Response in Relation to Anti-PD-1 Immunotherapy  Dr. Jason Luke:  Stock and Other Ownership Interests: Actym Therapeutics, Mavu Pharmaceutical, Pyxis, Alphamab Oncology, Tempest Therapeutics, Kanaph Therapeutics, Onc.AI, Arch Oncology, Stipe, NeoTX   Consulting or Advisory Role: Bristol-Myers Squibb, Merck, EMD Serono, Novartis, 7 Hills Pharma, Janssen, Reflexion Medical, Tempest Therapeutics, Alphamab Oncology, Spring Bank, Abbvie, Astellas Pharma, Bayer, Incyte, Mersana, Partner Therapeutics, Synlogic, Eisai, Werewolf, Ribon Therapeutics, Checkmate Pharmaceuticals, CStone Pharmaceuticals, Nektar, Regeneron, Rubius, Tesaro, Xilio, Xencor, Alnylam, Crown Bioscience, Flame Biosciences, Genentech, Kadmon, KSQ Therapeutics, Immunocore, Inzen, Pfizer, Silicon Therapeutics, TRex Bio, Bright Peak, Onc.AI, Stipe, Codiak Biosciences, Day One Therapeutics, Endeavor, Gilead Sciences , Hotspot Therapeutics, SERVIER , STINGthera, Synthekine  Research Funding (Inst): Merck, Bristol-Myers Squibb, Incyte, Corvus Pharmaceuticals, Abbvie, Macrogenics, Xencor, Array BioPharma, Agios, Astellas Pharma, EMD Serono, Immatics, Kadmon, Moderna Therapeutics, Nektar, Spring bank, Trishula, KAHR Medical, Fstar, Genmab, Ikena Oncology, Numab, Replimmune, Rubius Therapeutics, Synlogic, Takeda, Tizona Therapeutics, Inc., BioNTech AG, Scholar Rock, Next Cure  Patents, Royalties, Other Intellectual Property: Serial #15/612,657 (Cancer Immunotherapy), and Serial #PCT/US18/36052 (Microbiome Biomarkers for Anti-PD-1/PD-L1 Responsiveness: Diagnostic, Prognostic and Therapeutic Uses Thereof)  Travel, Accommodations, Expenses: Bristol-Myers Squibb, Array BioPharma, EMD Serono, Janssen, Merck, Novartis, Reflexion Medical, Mersana, Pyxis, Xilio  Disclaimer:   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.  Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. 

Dr. Andrea Schwartz talks about her passion and methods for training clinicians to provide age-friendly care to Veterans. Dr. Andrea Schwartz is a geriatrician at VA Boston Healthcare System, Associate Director for Clinical Innovation in the VA New England Geriatrics Research Education and Clinical Center, Associate Program Director for the Harvard Multicampus Geriatrics Fellowship, and Assistant Professor at Harvard Medical School.

Charleston describes his background and what attracted him to MSU. He talks about how a person knows whether they have a headache or facial pain they can treat themselves or whether they need to schedule a headache specialty visit. He talks about stigmas surrounding headaches and discusses current research underway and treatments on the horizon that may aid in treating headaches and facial pain.Conversation highlights:(:43) – “I'm from Detroit Michigan, and I decided I wanted to be a neurosurgeon when I wrote my fifth-grade career research paper.”(2:12) – “Michigan State University is a great institution. We can add tremendous value to our community and the region with exceptional headache care and research. We're working toward becoming the premier headache destination in the Midwest.”(4:07) “If headaches are not responding to treatment and are incapacitating or debilitating or you're taking a lot of different medications to treat your pain, that may be the time to seek medical attention.”(5:31) – “Migraines are the most common headaches that people seek medical attention for. Tension headaches are the most prevalent, but a lot of people don't seek medical attention for these.”(5:50) – Dr. Charleston describes the stigmas surrounding headaches.  (9:07) – Dr. Charleston describes the difference between headaches and facial pain. “Your face is part of your head.”(10:35) – What is a headache specialty visit? “History is king when it comes to headache medicine as there are more than 300 headache diagnoses, and the treatment will vary from headache to headache.”(13:37) – Is there exciting research on the horizon that has you excited about treating headaches and facial pain? “Migraines are the second most disabling neurological disorder in the world.”(15:22) – What are challenges and opportunities ahead for treating headaches and facial pain? “There needs to be more awareness and greater funding of research. When we look at federally funded research dollars and the impact headaches have on so many people and their quality of life, headache research should be funded 10 times more than it is now.”(18:30) – “We're always learning. We always want people to have hope. A lot of people who come to see me have lost hope. If we don't have hope, we don't have anything. Headache disorders don't define a person. We don't have a cure, but we strive to make things manageable.”Dr. Charleston's practice is in MSU's Clinical Center on Service Road. For more information, call 517-353-8122 or visit healthcare.msu.edu.MSU Today airs Saturdays at 5 p.m. and Sundays at 5 a.m. on WKAR News/Talk and Sundays at 8 p.m. on 760 WJR. Find “MSU Today with Russ White” on Spotify, Apple Podcasts, and wherever you get your shows.

Veterans experiencing homelessness face unique challenges that increase their risk for suicide. In this episode, Dr. Edgar Villarreal talks to our guest Dr. Ryan Holliday about the need for research focused on this population. They discuss an article that explores research priorities identified by experts and Veterans with lived experience in suicide prevention and homelessness who came together in a recent VA meeting. Today's conversation covers reaching Veterans with the services they have access to, upstream interventions and the need for tailored approaches for subgroups such as women and men or rural and urban. Targeted research will help broaden suicide prevention efforts beyond mental health interventions to support those experiencing or at risk for homelessness. Transcript Episode 133 Short Takes Article Discussed: Establishing a Research Agenda for Suicide Prevention Among Veterans Experiencing Homelessness Host: Edgar Villarreal, PhD, is a Psychologist and the Director of Education and Training at the VA Rocky Mountain Mental Illness Research Education and Clinical Center for Veteran Suicide Prevention. Guest: Ryan Holliday, PhD, is a Clinical Research Psychologist at the Rocky Mountain Mental Illness Research Education and Clinical Center for Veteran Suicide Prevention and Assistant Professor at the University of Colorado Anschutz Medical Campus.

Acquired neurologic conditions can lead to functional challenges and changes that might increase risk for suicide. In this episode, Dr. Jordan Wyrwa and Dr. Lisa Brenner discuss three recent research papers on suicide rates among Veterans with Traumatic Brain Injury (TBI), Amyotrophic Lateral Sclerosis (ALS) and Stroke. They talk about the similarities and differences of how these conditions impact mental health and offer guidance to providers on suicide risk screening and lethal means safety. Learn more from the resources below. Articles Discussed: Suicide and Traumatic Brain Injury Among Individuals Seeking Veterans Health Administration Services Between Fiscal Years 2006 and 2015 Suicide Among Veterans with Amyotrophic Lateral Sclerosis  Suicide After Stroke in the US Veteran Health Administrative Population Lethal Means Safety for Providers: Information on lethal means safety  Free training on lethal means safety   Guest Bios:   Lisa A. Brenner, Ph.D., is a Board-Certified Rehabilitation Psychologist, a Professor of Physical Medicine and Rehabilitation (PM&R), Psychiatry, and Neurology at the University of Colorado, Anschutz Medical Campus, and the Director of the Department of Veterans Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center. She is also Vice Chair of Research for the Department of PM&R. Jordan Wyrwa, DO, is a Board-Eligible Fellow Physician in Pediatric Rehabilitation Medicine at Children's Hospital Colorado. He is a recent graduate of the University of Colorado, PM&R Residency Program.

In Connecticut, like many states, minors cannot be vaccinated without parental consent. According to a Kaiser Family Foundation Poll, 3 out of 10 parents surveyed say they would not get their child vaccinated against COVID. Today, Dr. Holly Taylor, a researcher at the National Institutes of Health, joins us to talk about her recent paper “Adolescents, Parents, and Covid-19 Vaccination — Who Should Decide?” We want to hear from you. Should adolescents be able to get the COVID-19 vaccine without their parents permission? GUESTS: Dr. Holly Taylor - member of faculty at the Department of Bioethics at the Clinical Center at the National Institutes of Health Susanna McGrew - Fellow at the Department of Bioethics at the Clinical Center at the National Institutes of Health Dr. Sharon Ostfeld-Johns - Assistant Professor of Clinical Pediatrics and Assistant Professor of Internal Medicine at Yale Dr. Asha Shah - Director of Infectious Diseases Stamford Health Support the show: http://wnpr.org/donate See omnystudio.com/listener for privacy information.

Join NETEC and host Lauren Sauer as they welcome Dr. Sameer Kadri, author of the article "Association Between Caseload Surge and COVID-19 Survival in 558 U.S. Hospitals, March to August 2020," recently published in the Annals of Internal Medicine.Dr. Kadri is an ICU physician and associate research physician at NIH. He serves as the head of the Clinical Epidemiology Section in the NIH Clinical Center's Critical Care Medicine Department.In this episode of Transmission Interrupted, Dr. Kadri discusses his findings from a study that sought to understand the relationship between the COVID-19 surge and its impact on the mortality risk of patients admitted to these hospitals. Additional topics discussed in this episode include surge index, a metric designed to help measure the strain of hospital overcrowding.Questions or comments for NETEC? Contact us: info@netec.orgFind us on the web: netec.orgGuestSameer S. Kadri, MD, MSDr. Sameer S. Kadri is currently an associate research physician and head of the Clinical Epidemiology Section in the Clinical Center's Critical Care Medicine Department.Dr. Kadri earned his degree in Medicine from the Seth G. S. Medical College and King Edward Memorial Hospital in Mumbai, India. He went on to complete internship and residency training in Internal Medicine at the New York-Presbyterian Hospital and Weill Cornell Medical Center and obtained a Masters degree in Clinical Epidemiology at the Harvard T.H. Chan School of Public Health.Following his fellowship training in Critical Care Medicine at the NIH and in Infectious Diseases at Massachusetts General Hospital and Harvard Medical School, Dr. Kadri was appointed to Staff Clinician in the Critical Care Medicine Department at the NIH in 2014. In this role, he splits his time between attending in the Intensive Care Unit at the NIH Clinical Center, conducting clinical research and training clinical and research fellows in the Critical Care Medicine Department.His primary research interest lies in infections in the critically ill. He leverages large datasets for epidemiologic investigations on antimicrobial resistance, sepsis, procalcitonin use, smoke inhalation acute lung injury and the role of IVIG in necrotizing fasciitis and granulocyte transfusions in invasive mycoses. His ongoing work includes use of large electronic health record-based repositories to understand the market size for new antibiotics (in collaboration with the US FDA), the impact of early discontinuation of antibiotics in culture negative sepsis and identify more objective candidate ICU performance measures.He founded and leads the NIH Antimicrobial Resistance Outcomes Research Initiative (NIH–ARORI), a collaborative between the NIH Clinical Center, Intramural NIAID, the CDC and Harvard Medical School. Through this initiative he developed and tested a simple but clinically relevant bedside classification scheme for antimicrobial resistance called “Difficult-to-treat Resistance” or DTR that focuses on non-susceptibility to all first-line antibiotics. He is a peer reviewer for several subspecialty journals and has served as an editor for the Infectious Diseases Clinics of North America issue titled Complex Infectious Disease Issues in the Intensive Care Unit. He has spearheaded investigations that underscore the benefits of dually training in critical care medicine and infectious diseases and is promoting the unique role of critical care providers in combating antimicrobial resistance.HostLauren Sauer, MScLauren is an Associate Professor in the College of Public Health, Department of Environmental, Agricultural, and Occupational Health, at the University of Nebraska Medical Center and Core Faculty of the UNMC Global...

HSR&D investigator and director of the North Florida/South Georgia Geriatrics Research, Education, and Clinical Center Ron Shorr, MD, MS, and healthcare architect Gary Fischer with VA’s Construction and Facilities Unit, discuss the value of partnered research within the context of Dr. Shorr’s HSR&D-funded project, Nursing Unit Design and Hospital Falls.

Town Square with Ernie Manouse airs at 3 p.m. CT. Tune in on 88.7FM, listen online or subscribe to the podcast. Join the discussion at 888-486-9677, questions@townsquaretalk.org or @townsquaretalk. Last night, 60 minutes had a profile of the acclaimed musical artist, Tony Bennett as he prepared for his last concert. It was, at times, both heart-breaking & heartwarming.  Bennett is dealing with the effects of Alzheimer's disease. We talked about Alzheimer's on this show just a week ago and noticed the overwhelming response to the topic, In light of that and Bennett's story, we return to our conversation on the disease that steals so much from its patients as well as those who love them. Plus, the latest on the new experimental COVID pill called Merk could cut the risk of death and hospitalization by half. Guests: Dr. Mark Kunik Professor of in the Menninger Department Psychiatry and Behavioral Sciences at Baylor College of Medicine Director of the VA South Central Mental Illness Research, Education and Clinical Center at Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center Dr. Jill Weatherhead Assistant Professor in Tropical Medicine and in Infectious Disease at Baylor College of Medicine Resources: communityresourcefinder.org alz.org/texas/helping_you CarePartnersTexas.org https://www.caregiver.va.gov/ Alzheimer's Association 24/4 Helpline: 800-272-3900 Town Square with Ernie Manouse airs at 3 p.m. CT. Tune in on 88.7FM, listen online or subscribe to the podcast. Join the discussion at 888-486-9677, questions@townsquaretalk.org or @townsquaretalk.

Town Square with Ernie Manouse airs at 3 p.m. CT. Tune in on 88.7FM, listen online or subscribe to the podcast. Join the discussion at 888-486-9677, questions@townsquaretalk.org or @townsquaretalk. Alzheimer's – the neurodegenerative disease, most common in people over the age of 65 – can majorly impact quality of life. It's also the most common cause of dementia all over the world, and it's important to pay attention to the early symptoms of Alzheimer's. What are those symptoms? And where are we with research and treatment? Today, in honor of World Alzheimer's Day, experts discuss their latest understanding of memory loss, Alzheimer's, dementia and other challenges of aging. Plus, Texas Radio Hall of Famer, Dayna Steele, is here to share her personal journey of her mother's battle with Alzheimer's. Guests: Dayna Steele Speaker, author and Texas Radio Hall of Famer Host of the podcast “Rock Star Principals” Author of “Surviving Alzheimer's With Friends, Facebook and a Really Big Glass of Wine,” which she has adapted into a new play, "The Woman in the Mirror: A Caregiver's Story of Love, Laughter and Wine" (Nov. 4 – 14 at The Match) Katie Scott President of CarePartners  Dr. Mark Kunik Professor of in the Menninger Department Psychiatry and Behavioral Sciences at Baylor College of Medicine Director of the VA South Central Mental Illness Research, Education and Clinical Center at Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center Resources: communityresourcefinder.org   alz.org/texas/helping_you CarePartnersTexas.org https://www.caregiver.va.gov/ Alzheimer's Association 24/4 Helpline: 800-272-3900 Town Square with Ernie Manouse airs at 3 p.m. CT. Tune in on 88.7FM, listen online or subscribe to the podcast. Join the discussion at 888-486-9677, questions@townsquaretalk.org or @townsquaretalk.

Social isolation can have harmful effects on health and often increases with age because of loss of friends, acquaintances, or a spouse, hearing or vision deficits, or loss of mobility. In addition to being a risk factor for poor health, social isolation has been associated with an increased risk of death. Loneliness may lead to poor sleep and depression, two problems that already affect a proportion of people with Parkinson's disease (PD). On top of all this, for more than a year social distancing to limit the spread of COVID-19 has added to problems of mental and physical health for many people.   In the face of a lack of research on social isolation in PD, Dr. Indu Subramanian, Director of the Parkinson's Disease Research, Education and Clinical Center at the West Los Angeles Veterans Affairs Medical Center, conducted a survey of people with Parkinson's to see if social isolation is associated with the severity of their symptoms and with their quality of life.   The survey was done before the pandemic. It showed that people reporting loneliness had 55% higher symptom severity, but individuals with a lot of friends had 21% fewer symptoms as compared with people reporting having few or no friends. (These are associations, and one should not assume a cause-and-effect relationship.) These results support the need for people with Parkinson's to be socially engaged to prevent loneliness. In this podcast, Dr. Subramanian discusses loneliness and social isolation and offers suggestions for keeping them at bay.

Two important issues regarding Parkinson's medications are when to initiate them in the early phases of the disease and how to ensure that people use their medications on time, every time. Myths and misconceptions have surrounded the controversial question of when to start taking medication. Fortunately, research has provided some answers, indicating that early initiation of levodopa or other medications does not diminish their usefulness later on. In this episode, Dr. Indu Subramanian, Director of the Parkinson's Disease Research, Education and Clinical Center at the West Los Angeles Veterans Affairs Medical Center, discusses what has been learned about the timing of the initiation of therapy.   She also provides strategies for getting the most benefit from medications, from taking them at the right time every time, to establishing other regular schedules, to working with your doctor at every visit to optimize benefits and minimize side effects. And as a neurologist who is also board certified in integrative medicine, Dr. Subramanian advocates for incorporating mind-body, movement, and breathing techniques, as well as connecting with nature when using medication and other traditional Western medical practices.

The prevention of veteran suicides has been a ongoing and high priority for the Veterans Affairs Department. Efforts go far beyond hotlines and other operational measures, and extend into research. Both research and operational support have a locus at VA's Rocky Mountain Mental Illness Research Education and Clinical Center in Aurora, Colorado. For an update, we turn to the center's director, Dr. Lisa Brenner.

Nutrition is a vital component of maintaining and preserving good health. It may be an especially important consideration when one has a disease or other health condition that may impose certain dietary requirements or restrictions. At the same time, the standard recommendations for good health still stand – heart healthy eating, weight control, adequate fluid intake, limiting alcohol consumption, and more. With Parkinson’s disease, dietary choices and habits can help alleviate some symptoms. For example, fluid and fiber intake may help with constipation, increasing fluid intake may alleviate orthostatic hypotension, the feeling of dizziness when standing up, and a high protein meal can interfere with levodopa absorption, leading to fluctuations in medication effectiveness. In this second of two episodes with Dr. John Duda, Director of the Parkinson’s Disease Research, Education and Clinical Center at the Philadelphia Veterans Affairs Medical Center and Professor of Neurology at the University of Pennsylvania, a Parkinson’s Foundation Center of Excellence, he tells what he recommends about diet and nutrition for his Parkinson’s patients, including when to look for organically grown produce.

Executive Editor Michael Roy speaks with Ayana Jordan, M.D., Ph.D., and Christina Mangurian, M.D., M.A.S., about their article on psychiatry diversity leadership in academic medicine. Dr. Ayana Jordan is an associate program director of the adult psychiatry training program and an assistant professor of psychiatry at the Yale University School of Medicine. She is a member of the APA Board of Trustees, and she serves on the Early-Career Psychiatrist Advisory Committee for the journal Psychiatric Services. Her research is concentrated on increasing access to care for minoritized populations with substance use problems. Dr. Christina Mangurian is a professor of psychiatry, epidemiology, and biostatistics in the School of Medicine at the University of California, San Francisco (UCSF). She is also vice chair for diversity and health equity at the UCSF Department of Psychiatry and Behavioral Sciences and a former chair of the APA Council on Minority Mental Health and Health Disparities. Her primary research program focuses on promoting mental health equity for patients and the workforce. The authors’ background and how they became involved in their work [2:50] How the authors’ roles in the workplace and in the community changed over the course of the past few years [7:51] Description of the case vignette presented in the article [14:23] The overall landscape for diversity leaders at psychiatry departments [18:40] Comparisons with other fields of medicine and academia [22:20] Three unique challenges faced by individuals who hold diversity, equity, and inclusion (DEI) roles [24:44] Initial steps that can help leaders in DEI positions [28:42] What people with institutional power can do to make sure that the experiences of BIPOC individuals are not ignored [34:40] Best practices to effectively support DEI leadership efforts in psychiatry [37:18] How scholarly research can adapt to help advance these efforts [42:39] Are the authors optimistic that we can overcome barriers and make real progress in efforts to expand diversity, equity, and inclusion throughout our community and workplaces? [46:11] Photo (from top): Helena Hansen, M.D., Ph.D., Christina Mangurian, M.D., M.A.S., Carolyn I. Rodriguez, M.D., Ph.D., Ayana Jordan, M.D., Ph.D., Ruth S. Shim, M.D., M.P.H., Altha J. Stewart, M.D. (Image courtesy of Dr. Mary Kay Smith.) Full author list of the article: Ayana Jordan, M.D., Ph.D. (Department of Psychiatry, Yale University School of Medicine, New Haven, Conn.) Ruth S. Shim, M.D., M.P.H. (Department of Psychiatry, University of California, Davis) Carolyn I. Rodriguez, M.D., Ph.D. (Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., and Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif.) Eraka Bath, M.D. (Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California, Los Angeles) Jean-Marie Alves-Bradford, M.D. (Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York) Lisa Eyler, Ph.D. (Department of Psychiatry, University of California, San Diego, and Desert-Pacific Mental Illness Research, Education, and Clinical Center, VA San Diego Healthcare Center, San Diego) Nhi-Ha Trinh, M.D. (Department of Psychiatry, Massachusetts General Hospital and Harvard University School of Medicine, Boston) Helena Hansen, M.D., Ph.D. (Departments of Psychiatry and Anthropology, New York University, New York) Christina Mangurian, M.D., M.A.S. (Department of Psychiatry and Behavioral Sciences and Department of Biostatistics and Epidemiology, University of California, San Francisco (UCSF), UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General, and UCSF Philip R. Lee Institute for Health Policy Studies, San Francisco) Be sure to let your colleagues know about the podcast, and please rate and review it on Apple Podcasts, Google Podcasts, Stitcher, Spotify, or wherever you listen to it. Subscribe to the podcast here. Listen to other podcasts produced by the American Psychiatric Association. Browse articles online. Watch Deputy Editor Daniel S. Pine, M.D., present highlights from the March 2021 issue. Follow the journals of APA Publishing on Twitter. E-mail us at ajp@psych.org

A major thrust of Parkinson’s research today is exploring potential ways to slow the progression of the disease. Exercise may be one way and is recommended. Another possible approach is nutrition, although the evidence is not as solid as for exercise. Nonetheless, there is evidence that good nutrition and dietary practices can have beneficial effects for people with Parkinson’s, including lessening digestive symptoms, as well as preserving quality of life by lowering the risk of heart disease, stroke, diabetes, high blood pressure, and dementia. Improving digestive function may even improve the absorption and actions of medications. Dr. John Duda, Director of the Parkinson’s Disease Research, Education and Clinical Center at the Philadelphia Veterans Affairs Medical Center and Professor of Neurology at the University of Pennsylvania, a Parkinson’s Foundation Center of Excellence, recommends a plant-based, whole foods diet. In this podcast, the first of two with Dr. Duda, he explains what a whole foods diet is, how it differs from a standard American diet, and how people can reliably and comfortably change the way they eat.

Dr. David S. Hong is deputy chair of Investigational Cancer Therapeutics at The University of Texas MD Anderson Cancer Center. He also serves as associate vice president for Clinical Research and clinical medical director of the Clinical Center for Targeted Therapy. Dr. Hong received a bachelor’s degree in biology from Yale University and a medical degree from Albert Einstein College of Medicine. He then completed an internship and residency at Thomas Jefferson University Hospital and a medical oncology fellowship at MD Anderson, during which time he was appointed chief medical oncology fellow. In 2005, he joined MD Anderson’s faculty. Dr. Hong is the recipient of the 2004 Young Investigator Award from the American Society of Clinical Oncology, the Jesse H. Jones Fellowship in Cancer Education, MD Anderson’s Best Boss Award, the Irwin H. Krakoff Award for Excellence in Clinical Research, the Gerald P. Bodey Award for Excellence in Education and a research training fellowship from Howard Hughes Medical Institute. He has published more than 270 articles in prestigious journals. John Marchica is a veteran health care strategist and COO of Darwin Research Group, a health care market intelligence firm specializing in health care delivery systems. He’s a two-time health care entrepreneur, and his first company, FaxWatch, was listed twice on the Inc. 500 list of fastest-growing American companies. John is the author of The Accountable Organization and has advised senior management on strategy and organizational change for more than a decade. John did his undergraduate work in economics at Knox College, has an MBA and M.A. in public policy from the University of Chicago, and completed his Ph.D. coursework at The Dartmouth Institute. He is a faculty associate in the W.P. Carey School of Business and the College of Health Solutions at Arizona State University and is an active member of the American College of Healthcare Executives. About Darwin Research Group   Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin’s client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 2010 as Darwin Advisory Partners, LLC and is headquartered in Scottsdale, Ariz. with a satellite office in Princeton, N.J.

Ezekiel J. Emanuel is Vice Provost for Global Initiatives and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. From January 2009 to January 2011, he served as special advisor for health policy to the director of the White House Office of Management and Budget. Since 1997 he was chair of the Department of Bioethics at The Clinical Center of the National Institutes of Health and a breast oncologist. Dr. Emanuel received his M.D. from Harvard Medical School and his Ph.D. in political philosophy from Harvard University. After completing his internship and residency in internal medicine at Boston’s Beth Israel Hospital and his oncology fellowship at the Dana-Farber Cancer Institute, he joined the faculty at the Dana-Farber Cancer Institute. He has since been a visiting professor at the University of Pittsburgh School of Medicine, UCLA, the Brin Professor at Johns Hopkins Medical School, and the Kovitz Professor at Stanford Medical School and visiting professor at New York University Law School. Dr. Emanuel has written and edited 9 books and over 200 scientific articles. He is currently a columnist for the New York Times. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Naomi Gerber serves as the Director of Research for the Department of Medicine at Inova Fairfax Hospital in Virginia and the Outcomes Program at the Beatty Center for Integrated Research. After graduating from Tufts University School of Medicine, Dr. Gerber completed two residencies in internal medicine and rehabilitation medicine and a fellowship in rheumatology. She served as the Chief of the Rehabilitation Medicine Department at the Clinical Center, National Institutes of Health in Bethesda, Maryland and was instrumental in helping to develop the sub-specialty of rehabilitative rheumatology. In 2006, Dr. Gerber joined the faculty of George Mason University in the Health Administration and Policy Department and is co-director of the Laboratory for the Study and Simulation of Human Movement.  Listeners to Part 1 of Dr. Gerber’s presentation will recall that she talked about fatigue in the context of proteomics, performance, and perception. In Part 2, she began by asking how do we separate central fatigue from depression? It is a difficult question and may be why the biosignatures are so important. From a clinical perspective, sad and despairing feelings, anhedonia, really is the hallmark of depression. It’s not the hallmark of central fatigue, which is a different pathway. Many important factors here originate in the liver. We need to be attentive to the way we measure the specifics of both peripheral and central fatigue. We have objective measures that are quantitative and we have self-reports. Both are needed, along with observer-recorded reports to obtain a full picture of what we mean by fatigue. A perfect fatigue instrument has not been found yet. She described the fatigue severity scale and indicated some of its deficiencies. She also described the kinds of procedures undertaken in her laboratory to obtain a fuller understanding of fatigue. She indicated who can be considered fatigued. It’s usually women, individuals who are less active, who are obese or overweight, who are smokers with more than moderate alcohol intake, often complaining of depressed symptomology, and they are anxious. In her view, metabolic issues are under appreciated by our specialty. 

Dr. Naomi Gerber serves as the Director of Research for the Department of Medicine at Inova Fairfax Hospital in Virginia and the Outcomes Program at the Beatty Center for Integrated Research. After graduating from Tufts University School of Medicine, Dr. Gerber completed two residencies in internal medicine and rehabilitation medicine and a fellowship in rheumatology. She served as the Chief of the Rehabilitation Medicine Department at the Clinical Center, National Institutes of Health in Bethesda, Maryland and was instrumental in helping to develop the sub-specialty of rehabilitative rheumatology. In 2006, Dr. Gerber joined the faculty of George Mason University in the Health Administration and Policy Department and is co-director of the Laboratory for the Study and Simulation of Human Movement.  In Part 1 of her presentation, Dr. Gerber’s aim is to decipher fatigue in the context of proteomics, performance, and perception. She wants to describe the construct that is beginning to be shaped to enable us to understand fatigue better and indicate how it is effectively measured both objectively and subjectively. She mentioned that the term biosignature is a more robust term than biomarker because it represents multiple domain measures to help us understand complex ideas, such as fatigue. When talking about fatigue, it is necessary for individuals to report what they are experiencing. Expectation plays a role in what a person is trying to accomplish. In order to treat fatigue effectively, it is necessary to know the parameters. Her presentation included the topics of cancer fatigue and liver fatigue, noting that if we do not study the liver better, an important concept in the rehabilitation world, we are not going to conquer this problem. She made a distinction between pathological and non-pathological (normal) fatigue and how to treat these conditions. She also discussed peripheral and central fatigue. There is confusion in the domain culture about these kinds of fatigue and an effort is underway to identify a biosignature that gives a mix of objective measures linked to perception. A portion of the tryptophan pathway is critical for understanding fatigue, both peripheral and central.

Subscribe through iTunes and Google Play. Lisa Lacasse, president of the American Cancer Society Cancer Advocacy Network, speaks passionately about the critical importance of advocacy and ACS CAN’s partnership with ASCO in reducing the cancer burden, in latest AiA podcast with host ASCO CEO Dr. Clifford Hudis. Find all of ASCO's podcasts at podcast.asco.org TRANSCRIPT Ad: Hi. My name is Shannon McKernin. And I am the host of the ASCO Guidelines Podcast Series. When a new ASCO guideline publishes, we release a podcast episode featuring an interview with one or more expert panel members. Each episode highlights the key recommendations and the implications for patients and providers. You can find the ASCO Guidelines Podcast Series on Apple Podcasts or wherever you're listening to this show. And you can find all nine of ASCO's podcasts, which cover a wide range of educational and scientific content, and offer enriching insight into the world of cancer care at podcast.asco.org. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Clifford Hudis: Welcome to this ASCO in Action Podcast, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insights into the world of cancer care. You can find all of the shows, including this one, at podcast.asco.org. This ASCO in Action Podcast is ASCO's podcast series where we explore policy and practice issues that impact oncologists, the entire cancer care delivery team, and the individuals we care for-- people with cancer. My name is Clifford Hudis. And I'm the CEO of ASCO, as well as the host of the ASCO in Action Podcast series. For today's podcast, I am really pleased to have Lisa Lacasse, president of the American Cancer Society Cancer Action Network, or ACS CAN, as my guest. Welcome, Lisa. Lisa Lacasse: Thanks so much, Cliff. It's really great to be with you today. I appreciate the invitation. CH: Well, I'm really delighted that you could join me today for this discussion. And I think there are probably hundreds of topics that you and I could discuss. But I want to start with the big picture first. The American Cancer Society, of course, is a very well-known, nationwide organization with a mission of saving lives and leading the fight for a world without cancer. Can you tell our guests about the American Cancer Society Cancer Action Network, ACS CAN? What's the relationship with ACS itself? And what exactly does ACS CAN do? LL: So thanks. That's a great question, Cliff. So many are very familiar with the American Cancer Society, which is a large, old organization that attacks cancer from every angle. The Society works to advance breakthroughs in research, treatment for patients, providing direction and information to help people manage their cancer care, and also mobilizes volunteers at the community level to really support patients in their fight against cancer. But we know that the fight to end cancer doesn't just happen in a doctor's office or a scientific lab. It really requires the government and all elected officials to join us to impact the disease. And so that effort to engage government requires advocacy. And that's where the American Cancer Society Cancer Action Network, ACS CAN, steps in. And we are the advocacy affiliate of the American Cancer Society. So ACS CAN simply urges lawmakers and rallies all of our community partners to lead in the fight against cancer. And together-- the American Cancer Society and the American Cancer Society Cancer Action Network-- although we're two independent organizations, we're working towards the same mission. However, ACS CAN uses different but complementary set of tools. So we obviously resemble ACS in a lot of important ways. We're both nonprofits. We are both absolutely, obviously evidence-based. And we're both supported by a vast army of volunteers. And we all focus on the ultimate goal of eliminating cancer as a major health problem. But ACS CAN advances this mission using tools that aren't fully available to ACS. One, an electoral program called Cancer Votes, which is really an effort to educate voters on important issues to cancer. And we also do a significant amount of lobbying. And that's not just in Washington DC, but in all 50 state capitals and many, many localities. And because of the breadth of that direct lobbying, that's often beyond what's allowable for a charity. So back in 2001, which is-- we're coming up on our 20th anniversary, which is very exciting-- the American Cancer Society Board really recognized that if we were going to achieve our goal to reduce the cancer mission, we had to do that by improving public policy. And so they decided to create ACS CAN. And my job as president is really to empower this huge network of grassroots advocates across the country. And with their staff partners-- we have about 200 people that work for ACS CAN-- every single day, they're imploring their elected officials, working with administrative officials to impact the cancer burden. CH: Well, I mean, that's a remarkable portfolio. And I would say, obviously that ACS CAN has been a key ally and a natural partner for us here at ASCO in our own mission to conquer cancer through research, education, and the promotion of the highest quality patient care. I know that ASCO shares many advocacy priorities with your organization, including our strong support for robust federal funding for cancer research, improving patient access to clinical trials, and addressing, among other things, the alarming rise in youth tobacco use-- something listeners will recall, we discussed in detail with Scott Gottlieb last year. So it's really a privilege to be able to talk to you about all of this. One of the efforts I think that many of our listeners would want to hear more about would be the Medicare Part D, six protected classes issue. I think earlier this year, ACS CAN mounted a very public outcry and a very visible advertising campaign against a proposal that would have potentially impeded or limited access to lifesaving drugs within the Medicare Part D program, specifically in the six protected classes. And we were proud to join your campaign. We at ASCO couldn't have been more pleased than we were with the impact. Can you explain why this effort was so necessary and talk to our listeners a little bit about how it turned out? LL: Absolutely. And I do want to say thank you to ASCO's partnership on this issue. It was really important. So this is a regulatory issue. As you mentioned, it's colloquially referenced as the "six protected classes." But that's policy that was established more than a decade ago to make sure that Medicare beneficiaries had access to innovative therapies. So really, the concept's fairly simple. If you're a health insurer and you provide a Medicare Part D plan to a Medicare beneficiary-- so you sell a Part D plan, which is a prescription drug plan-- you are, by definition, required to cover virtually all drug therapies that treat cancer, epilepsy, HIV/AIDS, mental illness, and organ transplant. And unfortunately, late last year, the Department of Health and Human Services proposed to alter that rule. And if the rule that they had put forth had been finalized, we believe it would have dramatically impacted access and affordability to critical medications for cancer patients who are part of the Medicare Part D program. So the proposal, although it was put forth as an effort to save Medicare money-- programmatically to save Medicare money-- we were really concerned that that approach would potentially have the exact opposite effect. We were worried that it would result in raising costs in other parts of the Medicare program and absolutely shifting costs to patients. So that certainly would have happened, because the proposed changes included, for example, excluding drugs from formularies or increasing the use of utilization management tools, such as step therapy. And we know that for a disease like cancer, specific drugs are very important for specific cancers. So if beneficiaries were unable to access their prescription drug that was most medically appropriate for them, they certainly would incur higher costs because it wouldn't be a covered medication. But we also were worried that they wouldn't get physician services, or they would need additional physician services because they weren't getting the right medication, and/or they would end up in the emergency room, which is all things that we know happen if you're not on the right drug regime for your cancer diagnosis. So had these proposed changes gone into effect, it really could have been devastating for cancer patients and survivors. And because of that, once we analyzed the proposed rule, we launched a multi-pronged campaign. It's one of the things that we take a lot of pride in, and we're able to address these issues in many different ways. But one of the most powerful is working in coalition. So ACS CAN and ASCO were joined by nearly 60 other patient and provider organizations. And we ran an advertising campaign-- a very visible advertising campaign. We did a Twitter Day of Action, where all of our volunteer advocates from all of our organizations directed their concern to HHS Secretary Alex Azar. We know that he heard from us. We got confirmation of that. And additionally, ACS CAN and ASCO were among more than 23 patient provider organizations actually went to the Hill for a day, did a lobby day on the hill-- again, making sure that our legislators, congressional members really understood the patient perspective of this proposed policy change. And then finally, ACS CAN did something that we actually don't do that often, which is we shot and ran some television spots. We really wanted to make sure that we were coming at this issue from many different directions because we felt it was so critical to our cancer patients and their need to have access to innovative drugs. So once we went through all of that, we were really proud and, more importantly, thrilled for our cancer patients. The final rule did not include all the proposed changes to the six protected classes that were put forth. These plans are not allowed to impose additional utilization management techniques such as prior authorization and step therapy if a cancer patient already has an established Medicaid regimen. And we really think-- we know, actually-- that HHS and the White House, hearing from doctors and patients and survivors in such an incredible coalition made the agency realize that this could be a very problematic rule. And so I want to, again, Cliff, say thank you to ASCO providing such a critical perspective from your physicians, your oncologists. They know firsthand what these barriers and delays can mean. And the partnership really, really worked. And we're proud of the outcome of that campaign. CH: Well, again, we want to applaud ACS CAN for your bold leadership on the issue and the wonderful success. It does show the tremendous impact that we can have with a unified, collective voice on behalf of people with cancer. So another issue that I guess, in a way, relates at least tangentially to this-- and I know is near and dear to your heart-- is federal funding, in this case for cancer research and for clinical trials. But before you started ACS CAN, which I think is more than a decade ago, as I understand correctly, you were the CFO of the NIH's Cancer Research Center. So how did that experience shape your understanding of the federal research infrastructure and the need for increased funding for cancer research at the federal level? LL: So it's a great question. And it is true. I was at NIH for nearly a decade, a decade ago. I have been at ACS CAN for just a little over 10 years now. And NIH is really a fascinating place to work. And I learned so much when I was on the NIH campus just up the road in Bethesda. And I would say most importantly and what has been most impactful is really through that time understanding that the pathways to discovery, particularly in cancer, are very long, and they're very complex, and they are extremely resource-intensive. And all parts of that journey-- every single step has to work well together from the very early scientific discoveries at the bench to ultimately bringing those discoveries to the bedside of patients. And the government has a critical role to play in that journey. Because a lot of that initial science, as you know, is risky, you really have to take a long view. And the very, very early clinical trials, which is what the clinical center focused on-- really phase 0 and phase 1, a few phase 2 trials, natural history trials-- those can only be done in certain types of facilities that have a lot of resources like the NIH Clinical Research Center. And then the other thing that I think about often as I'm doing my work is the many, many patients that I met while I was there at the Clinical Center. We had a 200-bed hospital, a huge outpatient center. And they really are the true heroes. I really think a lot about the many patients who knew that they were enrolling on trials that may or may not benefit them, but would potentially move us forward in the fight against cancer. And so I'm very passionate about the resources that are needed for NIH and NCI. And a lot of that is driven because of this, what I consider, a really transformative experience for me while I was at NIH. CH: Well, many listeners will remember that I occasionally talk about when I was president of ASCO back in 2013 and '14. And that was the end of an era-- about a decade-long era-- where we had flat funding in dollars. And that, of course, with inflation meant a relative loss of purchasing power and missed opportunities. And this really rallied our broad community. And this is a bit of a little detour, but one of the things that ultimately helped, I think, increase the enthusiasm of many of our members for political engagement and reduce some of our cynicism is that the last few years, we've seen, instead, a steady rise and consistent support for federal funding. And it's crossed party lines. It's clearly been bipartisan. I wonder-- I mean, we like to take some credit for it-- but, of course, I was one of thousands of people knocking on doors and one of many thousands of people repeating the message. But why do you think that we currently are enjoying a period of such steady and reliable bipartisan support? And as you answer that, I would ask you to think about the future. Do you think that support can continue? LL: Yeah. Look, I think it's a really important question. And I do think that one of the important things that we collectively lend to this discussion is a bipartisan lens. I mean, cancer does not discriminate. It is not political. We ran a big campaign, as you might remember, a few years ago that we dubbed the "One Degree Campaign," because if you are not your own cancer story, you are certainly not more than one degree away from a cancer story. I think there are a couple reasons why we've been able to rally support from a bipartisan standpoint. One is, I do think that people can clearly understand the important role government has in the fight against cancer. But also, just that our patients are very compelling storytellers. They are there, talking to their lawmakers on both sides of the aisle in Washington DC when they're in district about their experiences-- their own, personal experiences about their fight or their engagement with someone else in the fight against cancer, and how critically important federal investment is in what their experience has been. And I do think that when members hear those stories from people who've been directly impacted, or maybe they've experienced it themselves or seen it themselves, it's compelling. I think collectively, as a community, we're getting better at continuing to show the incredible impact that NIH has. And the statistics sort of bear this out, right. There has been incredible progress in diagnosing cancer, treating cancer, caring for people who have cancer. And in the last 50 years, every major medical breakthrough in cancer can be traced back to NIH and the NCI. So I think when we tell those stories, we remind so many people that people that they love are alive today because they have helped fuel that discovery. And they do that by appropriating money for NCI. And so to that end, we would like to call it an evergreen issue. Getting appropriations every year from Congress is something that we can never let up on. It is a sustained effort. And we must continue to really coordinate well among partners-- so between ACS CAN and ASCO and many, many of our cancer partners-- so that we're sure to be bringing a concerted, collective voice to this issue. And we certainly know, because we see it every day in our political lives, that Congress definitely has a habit of reacting to the latest crisis. And so we want to make sure that we don't want cancer to continue to be such a huge crisis. We want continued forward movement. And that's why it's so critical that we bring the patient voice to this issue. We are good partners, again, united with ASCO, ACS CAN, and others in One Voice Against Cancer, which we fondly call "OVAC," which is our coalition that continues to make the case on a regular basis to lawmakers and their staff. But I'm really seeing-- and, Cliff, I know you probably have through your career, as well-- but if we get the patient voice to an elected official, it's not hard for them to support our cause and to understand why these funds to NIH are so critically important to changing the face of this disease. CH: Well, one of the ways-- I mean, one of the most tangible, obvious ways that we do that and the patients see it, of course, is through clinical trials. Those advances you describe at the NIH have to lead to clinical trials before they can actually change a standard of care. And this is another policy area where we've been working together, in particular advocating for the passage of the Clinical Trial Act. This is legislation that would federally require Medicaid to cover those routine care costs that come with participating in clinical trials, which would bring Medicaid into line with every other major payer, including Medicare, for example. Can you talk a little bit about what impact this bill would have on patients with cancer? And I ask that, reminding everybody that we will shortly post another podcast where we discuss this in detail with Melissa Dillmon, who is the current chair of our Government Relations Committee and on the front lines. LL: And a shout-out to Dr. Dillmon, because she actually worked with us on a congressional briefing around the six protected classes. And she is a fabulous leader. So congratulations for getting her to work with you. Because her voice needs to be heard in these fights, as well. And I want to do a shout-out to ASCO for your leadership in this particular piece of legislation. So specifically with Medicaid-- I mean, Medicaid by definition obviously serves people facing financial challenges. So right now, it is, as you mentioned, the only major category of insurance where routine costs in cancer clinical trials aren't covered. And so just to be clear, there's the experimental part of a cancer trial, but there are also maybe just regular standard of care that a patient would be getting even if they weren't enrolled in the trial. And those are the costs that you're talking about in this piece of legislation, and that when we talk about the financial challenges of enrolling on a clinical trial, it's not the experimental part of the trial itself. It's really the care around that. So currently, only 12 states and the District of Columbia have state requirements that Medicaid cover these routine trial costs. So that means 38 other states, if a patient wants to enroll in a trial, they're responsible for 100% of that routine costs out of pocket, which we know very few Americans could afford, much less those on a limited incomes. So to us, we see this as essentially a ban on participation by Medicaid patients, which really doesn't make any sense since, by definition, those routine costs would certainly be covered if they were seeing a doctor just on a regular visit. And we also don't want to exclude this whole cohort of millions of patients that we want to have participate in these clinical trials, since that is a critical success factor, as you noted, getting discovery out there that can impact a cancer diagnosis. CH: Well, while we're on the topic of Medicaid-- and here we were focusing on coverage of its beneficiaries' participation in clinical research-- but can you talk a little bit about your Medicaid Covers Us campaign? How does that relate to this, if it does at all? Or what direction does that take us in? LL: So Medicaid Covers Us-- I really hope that people that are listening to the podcast can take a minute and go to our URL, which is medicaidcoversus.org. And this is a campaign that we launched last year. And although ACS CAN has a very long history of advocating for Medicaid, Medicaid is just an insurance coverage, right. It just happens to cover a lower level of income for patients. But really, the focus of that program is to improve access to screening, diagnosis, treatment, which happens if you have insurance coverage. So when the Affordable Care Act was passed, there was an opportunity to expand Medicaid, although it is optional for a state. ACS CAN has worked hard with many partners to actively advocate for expanding and really educating the public on how important Medicaid is in the insurance landscape. And so part of that-- what we realized is that we really wanted to make sure that people understood what Medicaid truly is. And one of the ways we are doing that is through this campaign. And this is a public education campaign that's really trying to create a dialogue for everyone who touches health care, which is really an entire community, to understand the importance. If you want to achieve a healthy community, healthy economy, health care is a really important part of that. And Medicaid plays an important role in health care. So we decided to pursue kind of this larger educational effort, and it's really been an exciting project. We have gotten a lot of opportunity to have many members of a community have this conversation. And we're excited about the role that we're able to play in continuing to make sure that people understand that quality cancer care needs access to insurance. And access to insurance for many, many people means access to Medicaid. CH: So really, in the last few moments we've talked about Medicaid from two perspectives. One is coverage for a substantial bloc of Americans at about 42 million, if memory serves me correctly. And the second is specific coverage of a vulnerable subset that is those beneficiaries who need access to clinical research for advanced cancer or cancer at all. Is that a fair summary of the two prongs of this effort? LL: 100%, 100%. And I think that we want comprehensive coverage. And Medicaid provides, again, a lifeline for so many patients. And we really want to work to address a couple of big challenges right now in Medicaid. One is that there still 15 states that have not fully expanded their Medicaid program. So that means that there are low-income parents, adults that are not able to access affordable health insurance. And we've seen through a significant amount of research that we've done on our end that there are a lot of cancer patients in the Medicaid program. So that program itself is very, very important to our mission. And then another issue that we're paying a lot of attention to and trying to make sure through ACS CAN that we're having influence on, our policy changes that are creating some barriers if you actually are in Medicaid-- things like what are known as 1115 waivers that are introducing things like work requirements, or maybe some other types of barriers like a lockout period that really create a significant barrier in a pathway for patients to make sure they continue to be able to seek care. So we want to make sure that for all Medicaid enrollees with serious conditions like cancer, that they're able, one, to continue to work-- if they are unable to work, though, that they don't lose their coverage. So we are continuing to work on many, many components of Medicaid, so both the public education and awareness, but also a lot of these very direct lobbying issues. CH: You know what's interesting, I was thinking as you described all that, the ability to understand the system and then help to constructively shape it is, in fact, the reason-- personally, I can tell you-- that I was so interested in making the career change to go from breast cancer doctor to ASCO CEO. You've been at ACS CAN in total, as we heard already, for just about a dozen years. But recently you stepped into the role of president for the organization. So thinking about all of this, I wonder, has your view of the organization and its role and potential changed over these years? And what are the things that you want to focus on, going forward with this tool that you now have at your disposal? LL: Yeah. So that's a great question. I'm almost at my six-month mark, so that's very exciting. And it's certainly interesting and always very, very different to work in an organization from a different vantage point. But as president, the first thing I'll say as I continue to be unbelievably impressed with our partnerships and our staff and our incredible volunteers nationwide and their ability to impact policy through very deliberate approaches that we have trained people on-- and when we're clear about the impact that we can have and we talk to our legislators about that impact, we've found a lot of champions. I continue to be very proud, but also convinced that the role of advocacy is critically important to the future of cancer and changing that future for more and more people to have more opportunities to successfully fight their diagnosis. And for organizational goals, I think we obviously want to continue to grow ACS CAN. The bigger our organization is, both from a network of volunteers to resources, the more influence I know that we can have. And then finally, a personal passion of mine is to make sure that our organization is relevant to the entire cancer ecosystem, but particularly everyone who is going to face a cancer burden. And we know that cancer burden is unequal in many, many segments of our population. So I feel a great responsibility and drive to work with my many colleagues, including you, Cliff, and ASCO, to do everything we can to very deliberately reduce the disparity of cancer. CH: Well, that's an inspiring way, I think, to wrap up this conversation. I can't thank you enough for joining me today for this ASCO in Action Podcast. ASCO and ACS CAN share so many common goals, as I'm sure everybody will hear through this conversation. And we are both dedicated to helping people whose lives have been affected by cancer. And when patients, survivors, families, cancer care providers work together the way we do, and so many others, it's clear that the results can be tremendous in terms of impact and change. So thanks again for leading this charge with us. LL: Well, Cliff, it really was my pleasure to do this today with you. And I look forward to many years of productive partnership between ASCO and ACS CAN. Thanks for having me today. CH: Sure. And for all of you listening, if you want to keep up with ASCO's advocacy efforts, I encourage you to visit our website. This is ascoaction, written as one word, .asco.org. And there's more information about ACS CAN and Medicaid Covers Us available at fightcancer-- that's written as one word-- .org. And, Lisa, I think you previously told us that there's a special website for Medicaid Covers Us. What's that URL again? LL: Medicaidcoversus.org. CH: I don't know how I forgot it. So until next time, thank you for listening to this ASCO in Action Podcast. If you enjoyed what you heard here today, don't forget to give us a rating or review on Apple Podcasts or wherever you listen. And while you're there, be sure to subscribe so you never miss an upcoming episode. The ASCO in Action Podcast is just one of ASCO's many podcasts. And you can find all of them at podcast.asco.org.

In today’s episode, John returns to his conversation with renowned cancer researcher Dr. David S. Hong. Dr. Hong is deputy chair of Investigational Cancer Therapeutics at The University of Texas MD Anderson Cancer Center. He also serves as associate vice president for Clinical Research and clinical medical director of the Clinical Center for Targeted Therapy. Dr. Hong has published more than 270 papers in leading academic journals. Topics include: Go/No-go decisions in clinical trials. Interchangeability of oncology drugs and biosimilars. Rising drug prices and declining trust in pharmaceutical companies. Health care delivery in the United States. Speaker Bios Dr. David S. Hong is deputy chair of Investigational Cancer Therapeutics at The University of Texas MD Anderson Cancer Center. He also serves as associate vice president for Clinical Research and clinical medical director of the Clinical Center for Targeted Therapy. Dr. Hong received a bachelor’s degree in biology from Yale University and a medical degree from Albert Einstein College of Medicine. He then completed an internship and residency at Thomas Jefferson University Hospital and a medical oncology fellowship at MD Anderson, during which time he was appointed chief medical oncology fellow. In 2005, he joined MD Anderson’s faculty. Dr. Hong is the recipient of the 2004 Young Investigator Award from the American Society of Clinical Oncology, the Jesse H. Jones Fellowship in Cancer Education, MD Anderson’s Best Boss Award, the Irwin H. Krakoff Award for Excellence in Clinical Research, the Gerald P. Bodey Award for Excellence in Education and a research training fellowship from Howard Hughes Medical Institute. He has published more than 270 articles in prestigious journals. John Marchica is a veteran health care strategist and CEO of Darwin Research Group, a health care market intelligence firm specializing in health care delivery systems. He’s a two-time health care entrepreneur, and his first company, FaxWatch, was listed twice on the Inc. 500 list of fastest growing American companies. John is the author of The Accountable Organization and has advised senior management on strategy and organizational change for more than a decade. John did his undergraduate work in economics at Knox College, has an MBA and M.A. in public policy from the University of Chicago, and completed his Ph.D. coursework at The Dartmouth Institute. He is a faculty associate in the W.P. Carey School of Business and the College of Health Solutions at Arizona State University, and is an active member of the American College of Healthcare Executives. About Darwin Research Group Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin’s client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 2010 as Darwin Advisory Partners, LLC and is headquartered in Scottsdale, Ariz. with a satellite office in Princeton, N.J.

In today’s episode, John has a fascinating conversation with renowned cancer researcher Dr. David S. Hong. Dr. Hong is deputy chair of Investigational Cancer Therapeutics at The University of Texas MD Anderson Cancer Center. He also serves as associate vice president for Clinical Research and clinical medical director of the Clinical Center for Targeted Therapy. Dr. Hong has published more than 270 papers in leading academic journals. Topics include: The rise of immunotherapy and the Golden Age of cancer treatment. The role of clinical pathways and personalized medicine in improving patient care. Industry-researcher collaborations and investments in clinical trials. How physicians balance research with providing clinical care. Speaker Bios Dr. David S. Hong is deputy chair of Investigational Cancer Therapeutics at The University of Texas MD Anderson Cancer Center. He also serves as associate vice president for Clinical Research and clinical medical director of the Clinical Center for Targeted Therapy. Dr. Hong received a bachelor’s degree in biology from Yale University and a medical degree from Albert Einstein College of Medicine. He then completed an internship and residency at Thomas Jefferson University Hospital and a medical oncology fellowship at MD Anderson, during which time he was appointed chief medical oncology fellow. In 2005, he joined MD Anderson’s faculty. Dr. Hong is the recipient of the 2004 Young Investigator Award from the American Society of Clinical Oncology, the Jesse H. Jones Fellowship in Cancer Education, MD Anderson’s Best Boss Award, the Irwin H. Krakoff Award for Excellence in Clinical Research, the Gerald P. Bodey Award for Excellence in Education and a research training fellowship from Howard Hughes Medical Institute. He has published more than 270 articles in prestigious journals. John Marchica is a veteran health care strategist and CEO of Darwin Research Group, a health care market intelligence firm specializing in health care delivery systems. He’s a two-time health care entrepreneur, and his first company, FaxWatch, was listed twice on the Inc. 500 list of fastest growing American companies. John is the author of The Accountable Organization and has advised senior management on strategy and organizational change for more than a decade. John did his undergraduate work in economics at Knox College, has an MBA and M.A. in public policy from the University of Chicago, and completed his Ph.D. coursework at The Dartmouth Institute. He is a faculty associate in the W.P. Carey School of Business and the College of Health Solutions at Arizona State University, and is an active member of the American College of Healthcare Executives. About Darwin Research Group Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin’s client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 2010 as Darwin Advisory Partners, LLC and is headquartered in Scottsdale, Ariz. with a satellite office in Princeton, N.J.

Dr. Michael Kauth is a clinical psychologist and has two major roles in the VA. He is Director of the VHA LGBT Health Program – a position shared with Dr. Jillian Shipherd – and he is also Co-Director of the South Central Mental Illness Research, Education and Clinical Center. In addition, Dr. Kauth is a professor in the Department of Psychiatry at Baylor College of Medicine in Houston, TX. Recently he received The American Psychological Association, Division 18, James Besyner Award for Lifetime Achievement and later this week he and Dr. Shipherd will be receive the 2018 Achievement Award from the Gay/Lesbian Medical Association in Las Vegas. I have known Michael for almost 15 years beginning when he was the National Educational Director for MIRECC/CoE and I maintained the website. I caught up with Michael to reflect on his work and get his view of the future.

On this episode of the Healthy Wealthy and Smart Podcast, Jennifer Stevens-Lapsley joins me on Facebook Live to discuss the pathway to a PhD. Dr. Stevens-Lapsley received her Physical Therapy degree at the University of Delaware, where she went on to complete a PhD in Biomechanics and Movement Science with a focus in Applied Physiology. She then completed post-doctoral training at the University of Florida. Her research uses a multifaceted approach to evaluate intervention strategies designed to enhance the effectiveness of rehabilitation in older adult patient populations. As such, her research ranges from understanding the mechanisms of skeletal muscle dysfunction to studies of implementation of best rehabilitation practices in post-acute care settings. In this episode, we discuss: -Deciding whether a residency, fellowship or PhD program is right for you -How to identify the qualities in a PhD program that best match your career goals -Why the perfect mentorship match is essential for growth and success -The key elements Dr. Stevens-Lapsley looks for in a stand out PhD application -And so much more!   With many lifestyle options for students, they can pursue higher education at their own pace and explore different approaches to learning as Dr. Stevens-Lapsley stresses, “There are such a myriad of ways that PhD training can unfold.” With multiple PhD programs in the country, “The options continue to grow… It is nice to have a variety of options to figure out what is going to fit your individual needs.”   While the learning style, academic environment and available resources are important deciding factors, Dr. Stevens-Lapsley suggests you appraise, “The track record of the mentors in the program as one of the most important considerations.” Dr. Stevens-Lapsley has found that, “Finding the right mentor for a PhD is like a mini marriage.”   Asking about a PhD program’s success rate with securing loan repayment plans for their students is an important consideration as Dr. Stevens-Lapsley stresses, “While people see the finances as the ultimate barrier, our math suggests that it shouldn’t be.”   For more information on Dr. Stevens-Lapsley: I received my Physical Therapy degree at the University of Delaware, where I went on to complete a PhD in Biomechanics and Movement Science with a focus in Applied Physiology. I then completed post-doctoral training at the University of Florida. Research Interests My research uses a multifaceted approach to evaluate intervention strategies designed to enhance the effectiveness of rehabilitation in older adult patient populations. As such, my research ranges from understanding the mechanisms of skeletal muscle dysfunction to studies of implementation of best rehabilitation practices in post-acute care settings. More specifically, my research includes the evaluation of mechanisms of quadriceps dysfunction, interventions to maximize savings with bundled care with joint arthroplasty, pragmatic trials in medically complex patient populations, and health services research to understanding how rehabilitation services impact hospitalization rates and functional performance. One additional area of research emphasis is the development and refinement of more intensive and progressive strategies for the rehabilitation of older adult populations. Responsibilities: Director: Rehabilitation Sciences PhD Program, MOVE Lab Co-Director: RESTORE group Investigator, ACCORDS Investigator, VA Geriatric Research, Education, and Clinical Center   Resources discussed on this show: University of Colorado: Jennifer Stevens-Lapsley Email: Jennifer.Stevens-Lapsley@ucdenver.edutw APTA: PhD Programs Research Gate Profile: Jennifer Stevens-Lapsley NIH Loan Repayment Plan   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!   Have a great week and stay Healthy Wealthy and Smart!   Xo Karen    

This is a sermon I preached in the chapel at the Clinical Center of the National Institutes of Health in Bethesda, MD, on December 24, 2017. The texts are Isaiah 9:2-7; Hebrews 1:1-4; and Luke 1:26-38. The service ended with the lighting of the Christ candle and the reading of the Nativity story from Luke's gospel. The image is by Palestinian artist Zaki Baboun. Please pray for all those at the Clinical Center during this season, who are courageously volunteering their very bodies in the search for new cures for some of the world's most difficult-to-treat medical conditions.

Erica Sprey of VA Research Communications speaks with Dr. Melissa Garrido, who is a health services researcher with the Geriatric Research Education and Clinical Center at the James J. Peters VA Medical Center in the Bronx, New York. Her research is focused on examining the quality of mental health care provided to Veterans with serious physical illnesses, such as advanced cancer. She hopes to better understand the need for mental health care in a palliative care setting, and if provided, the effects on health care utilization and cost. Read more: The impact of mental illness on palliative care outcomes for seriously ill Veterans

In continuing with the series of the North American Sasquatch Researcher, Nite Callers Bigfoot Radio will be interviewing Kenny Joholske from the state of Maryland.Kenneth Joholske is a native of Collage Park, Md and raised in Montgomery County Maryland. At a young age Kenny became fascinated with Bigfoot after reading Ivan Sanderson book: Abominable Snowman, Legend Comes to Life.  After graduating from University of Maryland in 1994 with a degree in Anthropology, he began working in the field of Native American Health Care creating culturally appropriate models of HIV/ AIDS prevention for Urban Native Two -Spirit ( GLBT)populations. In 1996 Kenny joined the staff of the Biomedical Research Clinical Center Library at the National Institutes of Health in Bethesda, Maryland where he provided research data for clinical trials and other health related research on going at the Clinical Center. His academic work in Native American studies deepened his interest in Sasquatch related research. Kenny has researched extensively the relationship of Sasquatch as it relates to the religious and social ritual of tribes in North America.He also has an ongoing interest and research into the possible social organization of the Sasquatch and the cultural attributes that may be displayed. Kenny enjoys music and studied classical piano for over 20 years and loves the study of world music. He is currently studying the Turkish language and culture. Join us for a very educational and interesting show with Kenny Jolhoske.

Guest Ronni Chernoff, Ph.D., R.D., Associate Director Education and Evaluation, Little Rock Geriatric Research, Education and Clinical Center. Chernoff is one of the nations leading experts on nutrition and aging. Shell tell how to age well and determine nutritional riskNutritional Checklist

Laura Stark‘s lucid and engaging new book explores the making and enacting of the rules that govern human subjects research in the US. Using a thoughtfully conceived combination of ethnographic and archival work, Behind Closed Doors: IRBs and the Making of Ethical Research (University of Chicago Press, 2012) locates the emergence of a system of “governing with experts” by Institutional Review Boards (IRBs) in the middle of the twentieth century. Stark shows how the features that now characterize the IRB deliberations that consider whether research on people can proceed in institutional contexts emerged in the particular context of the NIH Clinical Research Committee in 1950s and 1960s, and she explains how they managed to spread thereafter across the US and the globe. Behind Closed Doors draws from a wide and transdisciplinary set of methodological resources in articulating the power of performative language in shaping negotiations around human subjects research, suggesting innovative ways to read documentary evidence as a narrative of voices in time. True to its title, Stark’s story takes us behind the closed doors of occasionally heated IRB deliberations. It also introduces us to some of the spirited and disruptive “healthy patients” of the Clinical Center at the National Institutes of Health (NIH), prisoners and conscientious objectors among them, as they were dosed with LSD or infected with malaria and influenza, making a kind of home in the Center or cleverly escaping from it. It’s a wonderfully stimulating book that should be widely read and included on the syllabi of many graduate seminars to come. Learn more about your ad choices. Visit megaphone.fm/adchoices

Laura Stark‘s lucid and engaging new book explores the making and enacting of the rules that govern human subjects research in the US. Using a thoughtfully conceived combination of ethnographic and archival work, Behind Closed Doors: IRBs and the Making of Ethical Research (University of Chicago Press, 2012) locates the emergence of a system of “governing with experts” by Institutional Review Boards (IRBs) in the middle of the twentieth century. Stark shows how the features that now characterize the IRB deliberations that consider whether research on people can proceed in institutional contexts emerged in the particular context of the NIH Clinical Research Committee in 1950s and 1960s, and she explains how they managed to spread thereafter across the US and the globe. Behind Closed Doors draws from a wide and transdisciplinary set of methodological resources in articulating the power of performative language in shaping negotiations around human subjects research, suggesting innovative ways to read documentary evidence as a narrative of voices in time. True to its title, Stark’s story takes us behind the closed doors of occasionally heated IRB deliberations. It also introduces us to some of the spirited and disruptive “healthy patients” of the Clinical Center at the National Institutes of Health (NIH), prisoners and conscientious objectors among them, as they were dosed with LSD or infected with malaria and influenza, making a kind of home in the Center or cleverly escaping from it. It’s a wonderfully stimulating book that should be widely read and included on the syllabi of many graduate seminars to come. Learn more about your ad choices. Visit megaphone.fm/adchoices

Laura Stark‘s lucid and engaging new book explores the making and enacting of the rules that govern human subjects research in the US. Using a thoughtfully conceived combination of ethnographic and archival work, Behind Closed Doors: IRBs and the Making of Ethical Research (University of Chicago Press, 2012) locates the emergence of a system of “governing with experts” by Institutional Review Boards (IRBs) in the middle of the twentieth century. Stark shows how the features that now characterize the IRB deliberations that consider whether research on people can proceed in institutional contexts emerged in the particular context of the NIH Clinical Research Committee in 1950s and 1960s, and she explains how they managed to spread thereafter across the US and the globe. Behind Closed Doors draws from a wide and transdisciplinary set of methodological resources in articulating the power of performative language in shaping negotiations around human subjects research, suggesting innovative ways to read documentary evidence as a narrative of voices in time. True to its title, Stark’s story takes us behind the closed doors of occasionally heated IRB deliberations. It also introduces us to some of the spirited and disruptive “healthy patients” of the Clinical Center at the National Institutes of Health (NIH), prisoners and conscientious objectors among them, as they were dosed with LSD or infected with malaria and influenza, making a kind of home in the Center or cleverly escaping from it. It’s a wonderfully stimulating book that should be widely read and included on the syllabi of many graduate seminars to come. Learn more about your ad choices. Visit megaphone.fm/adchoices

Laura Stark‘s lucid and engaging new book explores the making and enacting of the rules that govern human subjects research in the US. Using a thoughtfully conceived combination of ethnographic and archival work, Behind Closed Doors: IRBs and the Making of Ethical Research (University of Chicago Press, 2012) locates the emergence of a system of “governing with experts” by Institutional Review Boards (IRBs) in the middle of the twentieth century. Stark shows how the features that now characterize the IRB deliberations that consider whether research on people can proceed in institutional contexts emerged in the particular context of the NIH Clinical Research Committee in 1950s and 1960s, and she explains how they managed to spread thereafter across the US and the globe. Behind Closed Doors draws from a wide and transdisciplinary set of methodological resources in articulating the power of performative language in shaping negotiations around human subjects research, suggesting innovative ways to read documentary evidence as a narrative of voices in time. True to its title, Stark’s story takes us behind the closed doors of occasionally heated IRB deliberations. It also introduces us to some of the spirited and disruptive “healthy patients” of the Clinical Center at the National Institutes of Health (NIH), prisoners and conscientious objectors among them, as they were dosed with LSD or infected with malaria and influenza, making a kind of home in the Center or cleverly escaping from it. It’s a wonderfully stimulating book that should be widely read and included on the syllabi of many graduate seminars to come. Learn more about your ad choices. Visit megaphone.fm/adchoices

1) AAN quality measures on Parkinson disease and 2) Topic of the month: Neuro-muscular disease. This podcast for the Neurology Journal begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the print issue of Neurology. In the second segment Dr. Ted Burns interviews Dr. Eric Cheng about the AAN quality measures on Parkinson disease. In the next segment, Dr. Ryan Overman is reading our e-Pearl of the week about Guillain-Barre mimics: Amiodarone neurotoxicity. In the next part of the podcast Dr. Beau Bruce interviews Dr. James Howard for the last part of our discussion on neuro-muscular disease with this week being about acetylcholine esterase inhibitors for our Lesson of the Week. In concluding, there is a brief statement where to find other up-to date patient information and current Patient Page. The participants had nothing to disclose except Drs. Burns, Cheng and, Overman. Dr. Burns receives a stipend as Podcast Editor for Neurology®, and performs EMG studies in his neuromuscular practice (30% effort).Dr. Cheng serves as a consultant for the National Parkinson Foundation; and receives research support from the NIH/NINDS (K23NS058571 [PI]), the VA Parkinson's Disease Research, Education, and Clinical Center, the Department of Veterans Affairs, the California Office of Statewide Planning and Development, the National Multiple Sclerosis Society, and the American Heart Association. Dr. Overman serves as Deputy Editor on the Neurology® Resident and Fellow Section editorial team and the Neurology® Podcast Committee.

Guest: Bruce Troen, MD Host: Eric Tangalos, MD Vitamin D deficiency has been receiving a deluge of media coverage lately, and physicians are likely to hear many related questions from patients, especially long-term care residents and their families. What are the latest developments in vitamin D research, and how can adequate vitamin D levels help prevent falls among our older patients? Even more fundamentally, how do we define vitamin D insufficiency and deficiency? Dr. Bruce Troen, professor of medicine, research scientist at the Geriatric Research, Education, and Clinical Center, and director of the molecular gerontology program at the University of Miami Miller School of Medicine in Miami, Florida, describes the crucial role that vitamin D plays throughout the body, beyond its well-known role in the musculoskeletal system. How common is vitamin D insufficiency among geriatric and nursing home residents? What is the best regimen and dosage to overcome vitamin D insufficiency or deficiency? When should calcium be supplemented to help prevent fractures? Tune in to hear host Dr. Eric Tangalos and this week's guest sift through the latest information on vitamin D.