Podcasts about Clinical epidemiology

Welcome back to our series on AI for the clinician! Large language models, like ChatGPT, have been taking the world by storm, and healthcare is no exception to that rule – your institution may already be using them! In this episode we'll tackle the fundamentals of how they work and their applications and limitations to keep you up to date on this fast-moving, exciting technology. Hosts: Ayman Ali, MD Ayman Ali is a Behind the Knife fellow and general surgery PGY-3 at Duke Hospital in his academic development time where he focuses on data science, artificial intelligence, and surgery. Ruchi Thanawala, MD: @Ruchi_TJ Ruchi Thanawala is an Assistant Professor of Informatics and Thoracic Surgery at Oregon Health and Science University (OHSU) and founder of Firefly, an AI-driven platform that is built for competency-based medical education. In addition, she directs the Surgical Data and Decision Sciences Lab for the Department of Surgery at OHSU.  Phillip Jenkins, MD: @PhilJenkinsMD Phil Jenkins is a general surgery PGY-3 at Oregon Health and Science University and a National Library of Medicine Post-Doctoral fellow pursuing a master's in clinical informatics. Steven Bedrick, PhD: @stevenbedrick Steven Bedrick is a machine learning researcher and an Associate Professor in Oregon Health and Science University's Department of Medical Informatics and Clinical Epidemiology. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

In this episode of Joint Action, Professor David Hunter is joined by Dr. Bruno da Costa, Associate Professor of Clinical Epidemiology at the University of Toronto and Senior Scientist at the University of Oxford, to unpack the evidence behind injections for osteoarthritis.Dr. da Costa shares insights from his recent systematic review and network meta-analysis of clinical trials, revealing just how limited - and at times unreliable - the evidence is for many joint injection therapies.This episode explores:Which injections (if any) offer real benefit - and for how longThe surprising extent of bias in osteoarthritis trialsWhy some results may not be as credible as they seemThe role of placebo effects and commercial influenceWhat this means for people living with osteoarthritisIf you've ever considered injection therapy, this episode will help you sort fact from fiction.RESOURCESS04E10 - Care for an oil change? The role of viscosupplementation for osteoarthritis wit Dr Bruno da Costa: https://www.jointaction.info/podcast/episode/6cda642b/care-for-an-oil-change-the-role-of-viscosupplementation-for-osteoarthritis-with-dr-bruno-da-costaInfographic - How effective are intra-articular interventions for osteoarthritis?: https://www.osteoarthritisresearch.com.au/s/0225-Clinical-Editors-Choice.pngArticle - Effectiveness and safety of intra-articular interventions for knee and hip osteoarthritis based on large randomized trials: A systematic review and network meta-analysis: https://www.oarsijournal.com/article/S1063-4584(24)01389-X/fulltextCONNECT WITH USTwitter: @ProfDavidHunter @jointactionorgInstagram: @osteoarthritisresearchgroupEmail: osteoarthritis.research@sydney.edu.auWebsite: www.jointaction.info/podcast Hosted on Acast. See acast.com/privacy for more information.

In this podcast episode, Dr. Diego Delgado discusses how to manage patients with mixed phenotype hereditary transthyretin amyloidosis over the course of their disease from initial symptoms and clinical suspicion, to monitoring patients on treatment. For additional details, please see the related video publication by Dr. Delgado and colleagues: https://www.sciencedirect.com/science/article/pii/S2589790X25001180Our Guest: Dr. Diego Delgado is the Director of the Cardiac Amyloid Centre and Associate Professor in the Division of Cardiology and Cardiac Transplantation at the University Health Network in Toronto, Ontario. Dr. Diego Delgado graduated in Medicine from the Universidad del Salvador in Buenos Aires, Argentina. He completed his Internal Medicine and Cardiology training in Hospital Espanol in Buenos Aires. Subsequently he completed a research fellowship in cardiac transplantation at Rush Presbyterian St Luke's Medical Center in Chicago, US and a research/clinical fellowship in heart failure and transplantation at the Toronto General Hospital.Dr. Delgado completed his Maters of Science in Clinical Epidemiology at the University of Toronto and the Leadership Development Program at Rotman School of Management in Toronto. He is the author of more than 100 publications in the area of heart failure, transplantation and mechanical assist devices. His interests are immunologic aspects of heart failure and transplantation and cardio oncology.This podcast episode was sponsored by AstraZeneca Canada. For other medical education content, please subscribe to our podcast or visit our website at: https://www.impactmedicom.com (https://www.impactmedicom.com/).

Join us in this episode as we explore the groundbreaking Medication for Addiction Treatment (MAT) Order Set at UC San Diego Health. This innovative system helped them earn CHIME's top "Digital Health Most Wired" Level 10 status in 2024. What You'll Learn: The motivation behind the creation of UC San Diego's MAT Order Set. How interdisciplinary collaboration led to a comprehensive care model. Implementation details and integration of additional screenings. Data demonstrating reduced hospital readmissions and increased buprenorphine usage. Challenges and lessons learned during the implementation process. Educational impacts on medical resident training and future directions. MODERATOR: Gregory R. Polston, MD Clinical informaticist, Associate Medical Director, Center for Pain Medicine, UC San Diego Health Section Chief of the pain service, VA Medical Center La JollaBio: Dr. Polston is a board-certified anesthesiologist with expertise in pain medicine and clinical informatics at UC San Diego Health. He serves as Associate Medical Director at the Center for Pain Medicine and Section Chief of the pain service at the VA Medical Center La Jolla. Dr. Polston specializes in opioids and risk monitoring for acute and chronic pain, promoting a comprehensive approach to pain management that involves patient engagement and diverse therapeutic methods. His research focuses on chronic opioid therapy, placebos, and electronic medical records.GUEST: Laura Bamford, MD, MSCE Clinical Professor of Medicine Division of Infectious Diseases and Global Public Health Clinical Professor of Medicine Medical Director Owen Clinic Co-Director Clinical Investigations Core San Diego Center for AIDS Research Division of Infectious Diseases and Global Public Health University of California, San Diego Bio: Laura completed her Internal Medicine residency at Columbia University Medical Center and Infectious Diseases fellowship at the Hospital of the University of Pennsylvania where she also received a Master of Science in Clinical Epidemiology. She's a Clinical Professor of Medicine in the Division of Infectious Diseases and Global Public Health and Medical Director of the HIV Medicine Owen Clinic. Her clinical and research interests include HIV and HCV treatment and prevention in people who use drugs. She's passionate about delivering patient-centered care and research with a low barrier and harm reduction approach. With funding from the Ryan White HIV/AIDS Program Part F Special Projects of National Significance, she founded a HIV primary care clinic in 2013 within Philadelphia's syringe service program. She was selected as a member of the Mayor's Task Force to Combat the Opioid Epidemic in Philadelphia in 2017 and testified in federal court in 2019 as a fact witness on behalf of Safehouse, Philadelphia's proposed opioid overdose prevention site. She currently provides substance use disorder treatment integrated into HIV primary care at Owen Clinic and is a member of the UCSD Addiction Medicine/Pain Medicine Committee and the UCSD Opioid Use Disorder Task Force. She also serves as the coordinator of the newly mandated substance use disorder rotation at UCSD for all Internal Medicine residents and was recently appointed to the Board of Directors at Stepping Stone San Diego which specializes in substance use treatment in the LGBTQ+ community. GUEST: Carla Marienfeld, MD, DFAPA, FASAM Clinical Professor, University of California, San Diego Bio: Carla Marienfeld, MD, DFAPA, FASAM, Clinical Professor at UC San Diego, Medical Director Substance Treatment and Recovery (STAR) Program, Program Director UC San Diego Addiction Psychiatry Fellowship is board-certified in psychiatry, addiction psychiatry, and addiction medicine. She has authored over four dozen publications and edited four addiction treatment related books. 

About Dr. Richard Milani: Dr. Milani serves as the Chief Clinical Innovation Officer, at Sutter Health.  His background and research focus on population health with a special interest in chronic disease, medical informatics, preventive medicine, and healthcare technology. After receiving his Internal Medicine training at the University of Florida, Dr. Milani completed fellowships in Critical Care Medicine at the University of Florida, Preventive Medicine, and Clinical Epidemiology at Harvard University (Massachusetts General Hospital), and Cardiovascular Diseases at Ochsner Clinic Foundation. He has authored over 500 medical publications, is on the editorial board for several medical journals, and serves as a frequent lecturer for healthcare systems and Fortune 500 companies as well as an advisor to venture capital firms and emerging healthcare technology companies. Things You'll Learn:AI and scribe companies are being used to reduce clinician documentation time, and reduce 'pajama time'.AI models can predict patient deterioration, such as cardiac arrest, and allow for early intervention, reducing cardiac arrests by 44%.AI should act as an assistant, with a human clinician always in the loop for evaluation and decision-making.Technology should point clinicians toward patients most in need, optimizing care and resource allocation.Digital tools that can monitor the activities of daily living unobtrusively are the future of patient care, especially for elderly patients living alone.Resources:Connect with and follow Dr. Richard Milani on LinkedIn.Discover more about Sutter Health on LinkedIn and visit their website.

Listen in as rheumatology experts Alexis Ogdie, MD, MSCE, and Julia Swafford, PA-C, DFAAPA, discuss emerging therapies and strategies in managing patients with axial spondyloarthritis or psoriatic arthritis, including:The current treatment landscape (eg, small molecules, biologics)Risk factors to consider when prescribing JAK inhibitorsKey considerations regarding comorbidities, especially in addressing depression, anxiety, or social ideation Nonpharmacologic options to improve treatment outcomesShared decision-making strategies to enhance patients' investment in their carePresenter:Alexis Ogdie, MD, MSCEDirector, Penn Psoriatic Arthritis and Spondylarthritis ProgramDirector, Penn Center for Clinical Epidemiology and BiostatisticsUniversity of PennsylvaniaPhiladelphia, PennsylvaniaJulia Swafford, PA-C, DFAAPAPresident of SPARBronson Battle Creek Rheumatology SpecialistsBattle Creek, MichiganLink to full program:https://bit.ly/4gkTzSv

Listen in as rheumatology experts Alexis Ogdie, MD, MSCE, and Julia Swafford, PA-C, DFAAPA, discuss emerging therapies and strategies in managing patients with axial spondyloarthritis or psoriatic arthritis, including:The current treatment landscape (eg, small molecules, biologics)Risk factors to consider when prescribing JAK inhibitorsKey considerations regarding comorbidities, especially in addressing depression, anxiety, or social ideation Nonpharmacologic options to improve treatment outcomesShared decision-making strategies to enhance patients' investment in their carePresenter:Alexis Ogdie, MD, MSCEDirector, Penn Psoriatic Arthritis and Spondylarthritis ProgramDirector, Penn Center for Clinical Epidemiology and BiostatisticsUniversity of PennsylvaniaPhiladelphia, PennsylvaniaJulia Swafford, PA-C, DFAAPAPresident of SPARBronson Battle Creek Rheumatology SpecialistsBattle Creek, MichiganLink to full program: bit.ly/4gkTzSv

Chris Hoekstra, PT, DPT, PhD, OCS, FAAOMPT Chris received his PhD in biomedical informatics from Oregon Health & Science University, School of Medicine, his Masters of Science and Doctor of Physical Therapy degrees from Pacific University and undergraduate degree in biology from Willamette University.  He is board certified in orthopedics and Fellow of the American Academy of Orthopedic Manual Therapy.  Additionally, he completed a post-doctoral fellowship in clinical informatics through the National Library of Medicine.   He has worked as a physical therapist, clinic director, Health IT consultant, and more recently Chief Clinical Transformation Officer for Therapeutic Associates Inc.  In that role he has overseen the company's strategy related to the use of organizational data in business and clinical decision making, clinical and business information systems selection and optimization, quality improvement efforts, and value-based care initiatives. With Hychara Health, Chris oversees product development, program and project management, and sales and marketing strategy.  Additionally, he has worked with company subject matter experts to create an advisory services practice.   He is also an Assistant Professor in the Department of Medical Informatics and Clinical Epidemiology of the Oregon Health & Science University School of Medicine, where he teaches courses in organizational behavior and qualitative research.  He also continues his research focused on usability and end-user adoption of health information technology.  Additionally, he is a member of a multi-disciplinary AHRQ and NLM- funded research team with research focused on establishing safe training and effective use of medical scribes.   Chris has dedicated his career to improving clinicians' and business leaders' use of information in their daily decision making.  His work and research focus on refining a sociotechnical framework that integrates information systems with organizational strategy, team dynamics, workflow design, and information visualization to allow practices and providers to thrive in the changing value-based healthcare landscape.   Outside of his professional work, Chris has been active as a youth football coach for > 14 years, a Reserve Deputy Sheriff for nine years, and most recently an operations officer with a Military Police battalion of the Tennessee State Guard.  Additionally, he has served on numerous community and professional advisory boards. 

We explore the fitness of children in this episode of Run With Fitpage. Prof. Andrew Agbaje is a leading authority in Clinical Epidemiology and Child Health and works as the principal investigator of the Understanding Fitness and Cardiometabolic Health In Little Darlings research group at the University of Eastern Finland.We discuss how the state of sedentariness achieved and what can be done to improve the fitness of children. Give it a listen for a macro view on the topic and it may help build the fitness of our kids.About Vikas Singh:Vikas Singh, an MBA from Chicago Booth, worked at Goldman Sachs, Morgan Stanley, APGlobale, and Reliance before coming up with the idea of democratizing fitness knowledge and helping beginners get on a fitness journey. Vikas is an avid long-distance runner, building fitpage to help people learn, train, and move better.For more information on Vikas, or to leave any feedback and requests, you can reach out to him via the channels below:Instagram: @vikas_singhhLinkedIn: Vikas SinghTwitter: @vikashsingh101Subscribe To Our Newsletter For Weekly Nuggets of Knowledge!

Three members of the Patient-Led Research Collaborative - Lisa McCorkell, Gina Assaf & Letícia Soares are interviewed by Dr Funmi Okunola about the organisation and the work it does.REFERENCES1 The Patient-Led Research Collaborative Website2 The Patient-Led Research Collaborative Donation Page3 Portela MC et al. 2024. Protocol for an ambidirectional cohort study on long COVID and the healthcare needs, use and barriers to access health services in a large city in Southeast Brazi. lBMJ Open 14:e086656.4 Caldas B et al. 2024. Promoting equity, diversity, and inclusion in surveys: insights from a patient-engaged study to assess long COVID health-care needs in Brazil. Journal of Clinical Epidemiology, 173: 111423

Alfredo Morabia and Prof. Vickie Mays (UCLA) from AJPH interview Profs Neil Pearce (London School of Hygiene and Tropical Medicine), Andrew C. Stokes (Boston University School of Public Health), and Jan P Vandenbroucke (Leiden University Medical Center, Dept. Clinical Epidemiology) in a compelling discussion about excess mortality and its significance during the COVID-19 pandemic. Why might excess mortality be a more accurate measure than COVID-19-specific mortality? What is the theoretical foundation for using excess mortality as an evaluative tool? How can excess mortality help determine whether countries or regions performed ‘equally well' during the pandemic? Can it provide insights into what strategies worked—or didn't—during the crisis? Despite delays in obtaining mortality data, how can excess mortality be used to track health emergencies in real time? Finally, what key recommendations should guide those using excess mortality as an outcome measure? Join us for this insightful conversation to better understand the critical role of excess mortality in shaping public health decisions and pandemic evaluations.

New Findings reveal that 4 cups of coffee a day increases chances of a stroke. Global research studies co-led by University of Galway, and an international network of stroke researchers also show consuming frequent fizzy drinks doubles the risk of a stroke. Lead researcher Andrew Smyth, Professor of Clinical Epidemiology at University of Galway.

Disclaimer:    The views and opinions expressed during this podcast are those of the individuals participating and do not necessarily represent the official stance or position of the SOGC.  Summary:  In this episode, we delve into the cutting-edge advancements in diagnosing and treating Endometriosis in Canada alongside esteemed experts Drs. Leyland, Singh, and Bougie. Together, we'll explore the accessibility of diagnosing and managing endometriosis while highlighting the importance of patient-centered care in addressing this condition. Gain invaluable insights into the evolving landscape of diagnosing and treating endometriosis and uncover the critical importance of prioritizing patient needs to enhance outcomes and foster patient well-being. Join us as we embark on a journey to empower both patients and health care professionals in the ongoing battle against endometriosis. Additional Resources:   Article in Press: Guideline No. 449: Diagnosis and Impact of Endometriosis – A Canadian Guideline - Journal of Obstetrics and Gynaecology Canada (jogc.com)    About Dr. Leyland  Dr. Leyland is known for his expertise in reproductive health and minimally invasive surgery and has focused on conditions like endometriosis and fibroids. He attained his medical degree from the University of Toronto and graduated Summa Cum Lauda from Harvard University with a Master of Health Care Management. Dr. Leyland holds academic positions at McMaster University, contributing to research and training future gynaecologists.     About Dr. Singh  Dr. Singh is the Chair of the Department of Obstetrics and Gynaecology at the University of Ottawa, the Head of the Department in Obstetrics, Gynaecology and Newborn Care at The Ottawa Hospital, and the E. Jolly Research Chair in Gynecologic Surgery at the Ottawa Hospital Institute. He has taken an active role in supporting gynaecology education and clinical care at the national level. Currently, he focuses his practice in the area of surgical excision of deep infiltrative endometriosis. At a local level, he has developed a specialty clinic for a multi-disciplinary approach to managing complex benign gynaecologic conditions.    About Dr. Bougie Dr. Bougie is an Assistant Professor at Queen's University in the Department of Obstetrics and Gynaecology. She attained her medical degree at Queen's University and completed her residency in Obstetrics and Gynaecology at the University of Ottawa. She subsequently completed an AAGL Fellowship in Minimally Invasive Gynaecology at the University of Ottawa, as well as a Master of Public Health, Clinical Epidemiology at Harvard University. Her clinical interests include endoscopic surgery and complex benign gynaecologic cases. Her research interests include endometriosis and patient-centered outcomes in gynaecology. 

Is banning smoking outdoors good for our health or state overreach?The Prime Minister has confirmed he's thinking about extending the indoor smoking ban to include outdoor areas restaurant terraces and pub gardens. This, in addition, to plans to progressively increase the age at which you can buy cigarettes so a whole generation never even starts smoking. It's sparked a social media discussion on personal freedom, the nanny state and the removal of civil liberties. But others argued that it would improve health, help the NHS and de-normalise smoking. Adam Fleming asks what does this reaction tell us about attitudes to public health, the collective wellness of a nation and the role of the individual within it?GUESTS Chris Snowdon, Head of Lifestyle Economics at the Institute of Economic Affairs Deborah Arnott Chief Executive of Action on Smoking and Health (ASH) Dr Tessa Langley, health economist specialising in the field of tobacco control, University of Nottingham Virginia Berridge , Professor of History and Health Policy, London School of Hygiene and Tropical Medicine Prof George Davey Smith, Professor of Clinical Epidemiology, Bristol Medical School

In this episode of the Owens Recovery Science podcast, Johnny and Kyle interview Annie Bane, PhD regarding her research into people with Parkinson's Disease and the use of Blood Flow Restriction Resistance Exercise as a maintenance strategy. Dr. Bane is a wealth of knowledge on how treatment strategies and the disease progression of PD affect the cardiovascular system. This was ultimately the target of her dissertation research while at Baylor and her findings are very exciting. We know you will enjoy this chat! If you know someone in the Abilene area that could benefit from the exercise program for people with Parkinson's please have them email Jill Jumper, PT, PhD at Jill.jumper@hsutx.edu If you would like to see Dr. Bane's TV show on she and her husband's gym in Abilene, TX the show is called "The Fieldhouse". It aired on the Magnolia Network and can now be found on Amazon Prime too. Dr. Bane's paper: Bane, A., Wilson, L., Jumper, J., Spindler, L., Wyatt, P., & Willoughby, D. (2024). Effects of blood flow restriction resistance training on autonomic and endothelial function in persons with Parkinson's disease. Journal of Parkinson's Disease, 1–15. The Hong paper referenced: Hong, C. T., Hu, H.-H., Chan, L., & Bai, C.-H. (2018). Prevalent cerebrovascular and cardiovascular disease in people with Parkinson's disease: a meta-analysis. Clinical Epidemiology, 10, 1147–1154.

Measuring the carbon impact of healthcare interventions is essential if we're going to make the sector sustainable, however tracing all of the emmission from even a simple treatment can be tricky. Romi Haas, a research fellow at Monash Department of Clinical Epidemiology joins us to explain how it works, and how research could be more efficient. New U.S. guideline on breast cancer screening  have been extended to women in their 40s -  Katy Bell, from the University of Sydney, and Stacy Carter, from the University of Wollongong explain why the good intention of that change wont be mirrored in outcomes - and may even induce harm.   Reading list: Clinician and health service interventions to reduce the greenhouse gas emissions generated by healthcare: a systematic review  Breast cancer screening from age 40 in the US  

A three-decade-long Harvard University study suggests that the quality of one's overall diet is more important to one's lifespan than the amount of ultra-processed foods one consumes. Guest: Dr. Mingyang Song, Associate Professor of Clinical Epidemiology and Nutrition at Harvard University Learn more about your ad choices. Visit megaphone.fm/adchoices

Seg 1: Are ultra-processed foods as dangerous as we think? A three-decade-long Harvard University study suggests that the quality of one's overall diet is more important to one's lifespan than the amount of ultra-processed foods one consumes. Guest: Dr. Mingyang Song, Associate Professor of Clinical Epidemiology and Nutrition at Harvard University Seg 2: Scott's Thoughts: Do you want to be an AI version of yourself? A company in Germany is taking all of a human's biological data and uploading it into a computer program. Guest: Scott Shantz, CKNW Contributor Seg 3: View From Victoria: Could BC United become United with the Conservatives? Another poll is showing the BC Conservatives closing the gap on the NDP which is prompting talks between BC United and the BC Conservatives about a possible merger. Guest: Vaughn Palmer, Vancouver Sun Columnist Seg 4: Could solar storms knock out our power grids and internet? Yesterday, the sun launched its largest solar flare in seven years and the largest of the ongoing 11-year solar cycle. Historically, stronger storms have caused severe disruptions, like the 1859 Carrington Event, which damaged telegraph systems and produced visible auroras at low latitudes. Guest: Dr. David Wallace, Assistant Clinical Professor of Electrical Engineering at Mississippi State University Seg 5: Managing your growing family in a small space! We all know how much of a struggle finding housing that works for your family can be and one of the compromises that many families are making is having kids share a room. Guest: Sarah Rosensweet, Peaceful Parenting Expert Seg 6: Should BC prepare for a future living with wildfires? The University of Victoria's Centre for Global Studies recently initiated the POLIS Wildfire Resilience Project to enhance the security of communities and ecosystems prone to wildfires. Guest: Doug Donaldson, Senior Wildfire Policy Analyst & Government Relations for the POLIS Wildfire Resilience Project Seg 7: CKNW Playoff Report: It's Playoff Hockey! We get the latest on the Vancouver Canucks as they make their way towards hopefully hoisting the Stanley Cup! Guest: Jay Janower, Sports Anchor for Global News Seg 8: Why is BC restricting who can legally change their name? The provincial government has introduced legislation to prevent individuals convicted of serious criminal offenses from legally changing their names. Guest: Adrian Dix, BC's Minister of Health Seg 9: Is BC United going to merge with the BC Conservatives? With the polls showing BC United behind the rest of BC's political parties, is there a way for the party to merge BC Conservatives without losing the identity of their party? Guest: Kevin Falcon, Leader of BC United Learn more about your ad choices. Visit megaphone.fm/adchoices

A 30-year-long population-based study, reported at the 14th European Breast Cancer conference held in Milan, Italy, showed that breast-conserving therapy for ductal carcinoma in situ (DCIS) had become increasingly effective in preventing the emergence of breast cancer over the long term, but that there were still unanswered questions. The population-based Netherlands Cancer Registry retrospective cohort study of 25,719 women with DCIS diagnosed from 1989 up to 2021 (all of whom were treated with standard conservative therapy) found there were successes and limitations with the current standard of care for DCIS. Surprisingly, long-term risk appeared to have been unrelated to tumor grade. Also, despite a continuing improvement in outcomes during this period, the investigators concluded that specific molecular predictors of outcome still needed to be identified to distinguish intrinsically low-risk tumors (that did not require even conservative therapy) from those that carry higher risk and are highly likely to benefit from breast-conserving surgery and radiotherapy. After reporting the study findings in Milan, study author Adri Voogd, PhD, Associate Professor of Clinical Epidemiology in the Faculty of Health, Medicine, and Life Sciences at Maastricht University, Maastricht, The Netherlands, discussed their clinical implications with Peter Goodwin.

 About Dr. Shanil EbrahimDr. Shanil Ebrahim, a distinguished leader in Canadian healthcare, is a Partner at Deloitte Canada, overseeing the National Life Sciences and Healthcare Consulting Business. With a PhD in Clinical Epidemiology, he has held roles at Stanford University and McMaster University, contributing extensively to disability research and preventative medicine.Shanil's expertise spans provincial authorities, hospitals, and the pharmaceutical industry, driving evidence-based strategies and innovation in healthcare delivery. He also serves on the boards of not-for-profit organisations, embodying his commitment to community welfare and inclusive healthcare access. About this EpisodeEmbark on an illuminating journey with Dr Shanil Ebrahim in this captivating Matrix Green Pill podcast episode. From his upbringing in Saudi Arabia to his pivotal role in reshaping Canadian healthcare, Dr. Ebrahim's story is one of passion, purpose, and profound impact. Delve into his early fascination with technology, pioneering work in bioethics and clinical epidemiology, and advocacy for evidence-based healthcare practices. Discover the groundbreaking potential of CAR-T therapy and explore the future of digital health technologies with a leader dedicated to making a difference in the lives of patients and vulnerable communities.Tune in for a thought-provoking discussion on healthcare innovation, compassionate leadership, and the transformative power of proactive healthcare solutions.Quotes8:08 - We focus on finding innovative, cost-effective solutions as a result that can deliver big impacts 11:38 - It's about making a real difference in people's lives and being involved in something that could change the game for cancer treatment. That is a privilege14:18 - In this future of healthcare, digital health technology will be at the forefront, making healthcare more proactive, more personalised, more accessible 21:18 - You have to build an unwavering belief in yourself21:33 - It's important to seize opportunities and immerse yourself fully in each learning moment21:55 - Embrace every challenge as a chance to growUseful LinksTwitter: https://twitter.com/shanilebrahimLinkedIn:https://www.linkedin.com/in/shanil-ebrahim-75914a7aThe Matrix Green Pill Podcast: https://thematrixgreenpill.com/Please review us: https://g.page/r/CS8IW35GvlraEAI/review

What happens when you bring together three previous heads of biomedical informatics departments? A lot of reflection, storytelling, and joking around! In this episode, we bring together guests who have previously run informatics departments and are still involved in various ways, whether through research, teaching, or creating content to educate the public. We get the inside scoop into all the administrative responsibilities of these department chairs, their favorite parts of the job, and how they hope to see the field respond to modern technological developments like AI. We had some fantastic guests on this episode. Dr. Bill Hersh is the Associate Professor of Medicine, Medical Informatics, and Public Health at Oregon Health & Science University in Portland, Oregon. He was also the inaugural chair of the Department of Medical Informatics and Clinical Epidemiology at OHSU when the department began in 2003. He is a researcher of electronic health record data, has authored more than 200 scientific papers, and conceptualized the first offering of the American Medical Informatics Association's ten-by-ten virtual informatics training. Having just recently stepped down from his chair position, Bill now runs the Informatics Professor blog which teaches about prominent topics in biomedical informatics. Dr. George Hripcsak is the Vivian Beaumont Allen Professor at Columbia University's Department of Biomedical Informatics. He led Columbia University's informatics department for 15 years. He currently leads the Observational Health Data Sciences and Informatics coordinating center, which organizes the health records of almost one billion patients. He has authored over 350 scientific papers, serves as the PI for Columbia's recruitment center for the All of Us precision medicine program, and focuses his research on developing the next generation of health record systems. Finally, our host turned guest for this episode! Dr. Kevin Johnson is the David L. Cohen University Professor of Pediatrics, Biomedical Informatics, and Science Communication at the University of Pennsylvania. Before Penn, he was the Chair of the Department of Biomedical Informatics at Vanderbilt University from 2012-2022. He currently researches how to integrate advanced technology and artificial intelligence with health documentation systems. And, of course, he loves sharing informatics with a wider audience whether through his children's books, his documentary projects, or this podcast! Thanks to our host Harris Bland and our production assistant Ellie Shuert for leading us through this discussion. We loved reminiscing together, and we hope you enjoy getting an inside look into informatics departments! Make sure to follow our Instagram, Twitter, Threads, and TikTok accounts so you can stay up to date on all our new content. Also don't forget to follow us on Twitter @kbjohnsonmd and @htbland21. You can also find us wherever you typically get your podcasts. Thanks for listening! Instagram: @infointhernd Twitter: @infointhernd Threads: @infointhernd TikTok: @infointhernd Website: https://www.kevinbjohnsonmd.net/projects

In this month's episode, we talk heart health with Dr. Gbenga Ogedegbe, renowned cardiologist and founding director of the Institute for Excellence in Health Equity at NYU Langone Health. Dr. Ogedegbe provides an overview of how exactly the heart works and shares the good news and the not-so-good news about heart disease. He reviews the target numbers we should all aim for and offers simple steps we can take to keep our hearts in good working order. And because stress is a major risk factor for heart disease, Dr. Ogedegbe shares some of his own stress-busting strategies he practices daily.     The Takeaway  Find out where you stand heart-wise by making an appointment with your primary care physician. Don't have one? Find one at our Provider Directory: www.1199SEIUBenefits.org/find-a-provider.    Visit the Healthy Living Resource Center for wellness tips, information and resources; www.1199SEIUBenefits.org/healthyliving.  Get to know your numbers at www.1199SEIUBenefits.org/healthyhearts.    Join WeightWatchers at a discounted rate of just $8 a month; $0 if you are living with diabetes or prediabetes: www.1199SEIUBenefits.org/ww.  If you are living with type 2 diabetes, find out more about our partner Virta's diabetes reversal program: www.1199SEIUBenefits.org/news/virta.   Get inspired by fellow members through our new Members' Voices series: www.1199SEIUBenefits.org/healthyliving/membervoices.   Stop by our Benefits Channel to join webinars on managing stress, building healthy meals and more: www.1199SEIUBenefits.org/videos.  Visit our  YouTube channel to view a wide collection of healthy living videos: www.youtube.com/@1199SEIUBenefitFunds/playlists.  Sample our wellness classes to exercise body and mind: www.1199SEIUBenefits.org/wellnessevents.     Guest Bio  Gbenga Ogedegbe, MD, MPH is the inaugural and founding director of the Institute for Excellence in Health Equity (IEHE) at NYU Langone Health. He is the Dr. Adolph & Margaret Berger Professor of Medicine and Population Health at NYU Grossman School of Medicine. He is a leading NIH-funded scientist in health equity research. He has led numerous NIH-funded studies for cardiovascular disease risk reduction with a focus on developing and evaluating clinic-community linkage models of care to address inequities in health outcomes.   Dr. Ogedegbe is a member of the National Academy of Medicine and the United States Prevention Services Task Force (USPSTF). He is a Fellow of many scientific organizations including the American Heart Association, American College of Physicians and the Academy of Behavioral Medicine.   After obtaining his MD degree in Ukraine, Dr. Ogedegbe completed his residency in internal medicine at Montefiore Medical Center, followed by a fellowship training in Health Services Research and Clinical Epidemiology at Cornell University, during which received his MPH from Columbia University Mailman School of Public Health. Prior to his current position, he was a faculty member at both Cornell Weill Medical College and Columbia University College of Physicians and Surgeons. 

This installment of The Axis Effect features Shanil Ebrahim, Partner and the National Life Sciences and Healthcare Consulting Leader at Deloitte Canada. As the world's emphasis on healthcare continues to grow, so does the importance of practical innovation, ensuring the best medical care available for all patients. To best deliver the future of medical care requires individuals with a multitude of experiences and education, which is what makes Ebrhaim, who currently holds a position as a joint professor at McMaster University in addition to his job at Deloitte Canada, experience as a researcher at Stanford, and received an MSc in Medical Science and Bioethics as well as a Ph.D. in Clinical Epidemiology, perfect for the job. While the world may often expect individuals with a background like this to become physicians, Ebrahim felt that while working directly with patients was meaningful, he could make a significantly broader impact as a researcher on a “population level.” Ebrahim discusses potential solutions for bringing high-quality healthcare to underserved countries, how different countries undertake innovation policies to advance the world of healthcare, and the role of Artificial Intelligence in healthcare going forward. To learn more, tune in to “Global Health Equity.”

About the Lecture: In 2022 the government introduced the out-of-home calorie labelling policy in England to help people make informed nutritional decisions as part of a broader strategy to reduce rates of obesity. However, little is known about how this policy impacts people's mental health, especially those with lived experience of eating disorders. This lecture will explore why the policy might be harmful for people with lived experience of eating disorders, what the current evidence says, and potential impacts for public policy. In particular, we will discuss whether public health policies can be inclusive of both obesity prevention and eating disorder prevention. About the speaker: Nora Trompeter is a Research Fellow at the Institute of Child Health. Nora has a background in developmental psychology and completed her PhD in 2022 at Macquarie University, Sydney, Australia. Her research is focused on identifying social and emotional risk factors for the development of eating disorder symptoms in adolescents. Ivonne Derks is Research Fellow at the Research Department of Behavioural Sciences and Health. She has a background in Health Sciences, Psychology and Clinical Epidemiology, and completed her PhD (2019) at Erasmus Medical Centre Rotterdam, The Netherlands. Ivonne's research is focussed on the development of eating disorder symptoms in adolescence and identifying shared risk factors between obesity and eating disorders.

About the Lecture: In 2022 the government introduced the out-of-home calorie labelling policy in England to help people make informed nutritional decisions as part of a broader strategy to reduce rates of obesity. However, little is known about how this policy impacts people's mental health, especially those with lived experience of eating disorders. This lecture will explore why the policy might be harmful for people with lived experience of eating disorders, what the current evidence says, and potential impacts for public policy. In particular, we will discuss whether public health policies can be inclusive of both obesity prevention and eating disorder prevention. About the speaker: Nora Trompeter is a Research Fellow at the Institute of Child Health. Nora has a background in developmental psychology and completed her PhD in 2022 at Macquarie University, Sydney, Australia. Her research is focused on identifying social and emotional risk factors for the development of eating disorder symptoms in adolescents. Ivonne Derks is Research Fellow at the Research Department of Behavioural Sciences and Health. She has a background in Health Sciences, Psychology and Clinical Epidemiology, and completed her PhD (2019) at Erasmus Medical Centre Rotterdam, The Netherlands. Ivonne's research is focussed on the development of eating disorder symptoms in adolescence and identifying shared risk factors between obesity and eating disorders.

Dr. Jia Ng, MD MSCE is a Board-certified Nephrologist and Assistant Professor at the Zucker School of Medicine at Hofstra/ Northwell, New York. She is also the founder of PublishedMD, where she coaches clinicians on how to publish research papers, build authority, and achieve their academic goals without the overwhelm. Since 2020, she has been giving Academic Writing Workshops and Seminars to Medical Departments that want to increase the scholarly productivity of their students and faculty members. She has been invited to speak at institutions around the US and internationally at King's College London, UK and Sheikh Shakhbout Medical City - Mayo Clinic, Abu Dhabi. She received her Nephrology Fellowship training and Masters of Science in Clinical Epidemiology from University of Pennsylvania, US. Currently, she is an active clinical researcher, and has received more than $1 Million Dollars of grant funding from the National Institutes of Health and Foundational Grants. Dr. Jia joins Jo on this podcast to discuss about her journey from clinical research student to helping researchers to avoid overwhelm. Find more podcast episodes here: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://access2perspectives.pubpub.org/podcast⁠⁠⁠⁠⁠⁠ Host:⁠⁠⁠⁠⁠⁠⁠⁠⁠ Dr Jo Havemann⁠⁠⁠⁠⁠⁠⁠⁠⁠, ORCID iD ⁠⁠⁠⁠⁠⁠⁠⁠⁠0000-0002-6157-1494 ⁠⁠⁠⁠⁠⁠⁠⁠⁠ Editing: ⁠⁠⁠⁠⁠⁠⁠⁠⁠Ebuka Ezeike⁠⁠⁠⁠⁠⁠⁠⁠⁠ Music:⁠⁠⁠⁠⁠⁠⁠⁠⁠ Alex Lustig⁠⁠⁠⁠⁠⁠⁠⁠⁠, produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠ Kitty Kat ⁠⁠⁠⁠⁠⁠⁠⁠⁠ License:⁠⁠⁠⁠⁠⁠⁠⁠⁠ Attribution 4.0 International (CC BY 4.0)   ⁠⁠⁠⁠⁠⁠⁠⁠⁠ At Access 2 Perspectives, we guide you in your complete research workflow toward state-of-the-art research practices and in full compliance with funding and publishing requirements. Leverage your research projects to higher efficiency and increased collaboration opportunities while fostering your explorative spirit and joy. Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://access2perspectives.pubpub.org⁠⁠⁠⁠⁠⁠⁠ --- Send in a voice message: https://podcasters.spotify.com/pod/show/access2perspectives/message

Join us in an insightful conversation with Shanil Ebrahim, a Partner and the National Life Sciences and Healthcare Consulting Leader at Deloitte Canada. In this episode, we delve into Shanil's remarkable journey and the transformative impact he's making in the world of healthcare and diversity and inclusion. Shanil has a wealth of international experience, working closely with both public and private health sector organizations. His impressive track record includes spearheading evidence-based strategies, driving innovation and analytics initiatives, and leading the development of patient-centric platforms. He's a true expert when it comes to provincial authorities, hospitals, retail pharmacies, and the pharmaceutical industry. What sets Shanil apart is his commitment to outcomes-oriented models and complex implementations, such as patient support program initiatives and his perpetual ability to optimize team inclusion solutions. He's also at the forefront of shaping multiple health system solutions, his role is just a sliver of genius you will connect with in this episode. Because Shanil's journey doesn't stop there. He holds a joint appointment as an Assistant Professor at McMaster University and has previously conducted research at Stanford University. With a Ph.D. in Clinical Epidemiology, an MSc in Medical Science and Bioethics, and a BSc in Psychology, Shanil Ebrahim is not just a leader; he's a visionary leader shaping the future of healthcare with passion, depth, and commitment to family alongside his passions in diversity and inclusion.

Who here lives to eat good food? According to Nature Medicine and the American Society for Nutrition, food is undeniably essential to both our physical and mental health. Beyond the nutrients we acquire from food alongside their ability to prevent and fight disease, certain foods can improve mood and result in the reduction of depressive symptoms. As for me, I know that I get super excited and happy about eating good food! This is even made better when I share a great meal with loved ones. Truly, food and eating are healing for yourself and others. In this episode, we meet an incredible guest who provides healing to others with his skillful hands, both in the kitchen and the hospital.We are joined today by Chef AND Doctor Yoon Sung, family medicine physician and owner of Oksusu Restaurant. He received his BA in Public Health and Spanish from Johns Hopkins University, MHS in Clinical Epidemiology from the Johns Hopkins Bloomberg School of Public Health, MD from Drexel University College of Medicine, and Family Medicine Residency at Stanford Health Care. Dr. Yoon was also a Clinical Research Coordinator and Predoctoral Fellow at the Johns Hopkins Hospital Department of Otolaryngology and Center on Aging and Health. From serving and healing others' illnesses in clinic halls as an Urgent Care Supervising Physician at Carbon Health and UCLA Health, he now also serves and heals others through food and cooking in the kitchen. Chef Yoon is the owner-to-be and chef of Oksusu, a contemporary Korean-inspired restaurant that seeks to showcase the beauty of traditional Korean ingredients and the communal, family-style dining of Korean culture. He has also been the pastry chef at Hanchic and Red Room wine bar in Koreatown, Los Angeles. In 2013, he began his blog called 'Cooking With Yoon,' where he shares his journey from medicine to the culinary arts alongside gastronomic photographs and printable, budget-friendly recipes (some of which he created for his patients). Chef Dr. Yoon's work has been featured in the annual H Mart calendar, with his recipe video displayed in H Marts across the nation.Livestream Air Date: April 19, 2023Follow Chef Yoon Sung, MD, MHS: Instagram, FacebookFollow Friends of Franz Podcast: Website, Instagram, FacebookFollow Christian Franz Bulacan (Host): Instagram, YouTubeThankful to the season's brand partners: Covry, House of M Beauty, Nguyen Coffee Supply, V Coterie, Skin By Anthos, Halmi, By Dr Mom, LOUPN, Baisun Candle Co., RĒJINS, Twrl Milk Tea, 1587 Sneakers

“Big data” and “data science” are terms we hear more and more these days. The idea that we can use these vast amounts of information to understand and analyse phenomena, and find solutions to problems, is gaining prominence, both in business and academia. Cathie Sudlow, Professor of Neurology and Clinical Epidemiology at the University of Edinburgh, has been at the forefront of enabling health-related research using ever-increasing datasets. She tells presenter Jim Al-Khalili why this type of research matters and how the COVID-19 pandemic changed attitudes towards data in healthcare. Over the course of her career, Cathie has held a variety of roles at different organisations, and she is currently Chief Scientist and Deputy Director at Health Data Research UK. She believes that there is no room for prima donnas in science, and wants her field to be open and collaborative, to have the most impact on patients' lives.Presenter: Jim Al-Khalili Producer: Florian Bohr Production Co-ordinator: Jonathan Harris

William Hersh, MD, a Professor in the Department of Medical Informatics & Clinical Epidemiology in the School of Medicine at Oregon Health & Science University in Portland, Oregon, speaks with Pitt HexAI podcast host Jordan Gass-Poore' about his background and work, the field of biomedical informatics, his books and writing on health informatics, explainable AI and on being an educator in the AI age.

Xanax and other benzodiazepines (“benzos”) are often prescribed to treat symptoms like agitation, anxiety, and depression in people living with dementia. Yet, these drugs come with significant side effects and safety concerns, especially for older adults living with dementia. The Women's Age Lab's Dr. Paula Rochon and Dr. Christina Reppas-Rindlisbacher join Being Patient Live Talks to discuss why these medications are prescribed and what treatment alternatives they recommend. Rochon is the founding director of Women's Age Lab, a geriatrician, and a senior scientist at Women's College Hospital and ICES. She chairs the Canadian Institutes for Health Research Institute of Aging Advisory Board to support research and promote healthy aging across Canada. Rochon is committed to the development of trainees and new investigators in aging research and making valuable contributions to our future understanding of aging. Her team has won prestigious research awards, and published in peer-reviewed academic journals, disseminating key learnings and important findings from their research projects. Reppas-Rindlisbacher is a trainee with the Women's Age Lab at the Women's College Research Institute. She currently works as a geriatrician whilst completing her PhD in Clinical Epidemiology & Health Care Research at the Institute of Health Policy, Management and Evaluation (IHPME) at the University of Toronto. Her research aims to better understand how delirium care differs depending on sociodemographic factors such as gender, income, language, and recent immigrant status. Watch this live talk to learn more about benzodiazepines, why they are prescribed, and alternative treatments for people living with dementia. Read the Article: https://www.beingpatient.com/benzodiazepines-and-dementia/ ___ If you loved watching this Live Talk, visit our website to find more of our Alzheimer's coverage and subscribe to our newsletter: https://www.beingpatient.com/

Host: John Buse, MD, PhD Guest: Michael Fang, PhD According to a recent study published in the Annals of Internal Medicine, the median age of patients with type 1 diabetes is 24. However, type 1 diabetes that develops in adulthood is often mistakenly identified as type 2 diabetes, resulting in improper treatment. Joining Dr. John Buse to review this study's key findings and how we can determine if an adult with new-onset diabetes might have type 1 diabetes is Dr. Michael Fang, Assistant Professor in the Division of Cardiovascular and Clinical Epidemiology at Johns Hopkins University.

“Big data” and “data science” are terms we hear more and more these days. The idea that we can use these vast amounts of information to understand and analyse phenomena, and find solutions to problems, is gaining prominence, both in business and academia. Cathie Sudlow, Professor of Neurology and Clinical Epidemiology at the University of Edinburgh, has been at the forefront of enabling health-related research using ever-increasing datasets. She tells presenter Jim Al-Khalili why this type of research matters, how the COVID-19 pandemic changed attitudes towards data in healthcare, and why the NHS gives the UK a big advantage when it comes to population-wide studies. Over the course of her career, Cathie has held a variety of roles at different organisations, and she is currently Chief Scientist and Deputy Director at Health Data Research UK. She believes that there is no room for prima donnas in science, and wants her field to be open and collaborative, to have the most impact on patients' lives. Produced by Florian Bohr.

In this episode, we talk with Dr. Sasha Bernatsky, about lupus and cancer, if there's a link between lupus and cancer, and a new abstract about cancer incidence and risk factors in a large SLE cohort.  Dr. Bernatsky is a rheumatologist, a James McGill professor and a senior scientist in the Centre for Health Outcomes Research and Division of Clinical Epidemiology at the Research Institute of the McGill University Health Centre. Her expertise lies in using ‘big data' from health services, linked to additional clinical sources of information. Read more about lupus facts and statistics Learn how doctors diagnose lupus FAQs about participating in clinical trials Help expand lupus research through RAY (Research Accelerated by You) Read the mentioned abstract: Updated analyses  of cancer incidence and risk factors in a large international SLE cohort SUBSCRIBE to receive an email update when new episodes of The Expert Series are released.

Drs. Diwakar Davar and Ben Boursi discuss the role of the gut microbiome in the outcome of cancer immunotherapy and the prevention of immunotherapy-related adverse events, as well as compelling research on nutritional interventions to improve response to immune checkpoint inhibitors. TRANSCRIPT   Dr. Diwakar Davar: Hello, and welcome to the ASCO Daily News Podcast. I'm your guest host, Dr. Diwakar Davar. I'm an associate professor of medicine and the clinical director of the Melanoma and Skin Cancer Program at the University of Pittsburgh's Hillman Cancer Center.   Researchers have shown that microorganisms in the gut can impact the effectiveness of immunogenic chemotherapy for patients with cancer. Although microbial therapies for cancer are still at a very early stage of clinical development, compelling research in recent years has shown that changing the gut microbiome can help improve outcomes in patients receiving treatments for cancer enduring immune checkpoint inhibition.  My guest today is Dr. Ben Boursi, a GI medical oncologist at the Sheba Medical Center at Tel Aviv University in Israel. Dr. Boursi is also an adjunct professor at the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania. He joins me today to discuss his pivotal research on the role of the gut microbiome in mediating its effects on immunotherapy. And again, I want to highlight that we're recording this on October 9th, and as you may well know, many recent events over the last couple of days have happened in Israel, and so Dr. Boursi has joined us at a very difficult time. So, we're very grateful for him taking time out of his suddenly very busy schedule to join us at a time that is fraught for all. You'll find our disclosures in the transcript of this episode. You'll also find the disclosures of all guests on the podcast at asco.org/DNpod. Ben, it's great to have you on the podcast today. Thank you for being here at such a difficult time, sharing what will, I think, be a great episode.  Dr. Ben Boursi: Thanks for having me, Diwakar. Dr. Diwakar Davar: Ben, the gut microbiome and its role in terms of mediating effects and side effects of cancer immunotherapy has gotten a lot of interest recently. You've done some fundamental work in this space. Why don't you briefly summarize for the audience, firstly, what is the gut microbiome and what are the major themes in relation to cancer immunotherapy?  Dr. Ben Boursi: Well, the microbiome is the ecosystem of microorganisms, bacteria, phages, fungi, that are crucial for immunologic, metabolic and hormonal homeostasis of the host. In the last decade, we began to understand the central role of the gut and tumor microbiome in tumorigenesis, metastasis, treatment efficacy and toxicities, and in 2022, polymorphic microbiomes became one of the hallmarks of cancer, in addition to previous hallmarks that focused mainly at the cellular/genetic levels. The initial studies in mice models showed that therapeutic efficacy of immunotherapy depends on both the presence and composition of the microbiota (In germ-free or antibiotic treated mice, immunotherapy is ineffective), and following these studies, three observational studies in human patients showed that the gut microbiome can predict response to immunotherapy and that response to immunotherapy could be transferred to germ-free mice by fecal microbiota transplantation (FMT) from responding patients.  These studies helped us to define three main research questions regarding the possible role of microbial modulation in cancer treatment. First, can microbial modulation overcome resistance to immunotherapy, both primary and secondary resistance? And this question was the focus of the initial proof of concept studies. Second, can microbial modulation improve response to immunotherapy in treatment-naive patients? And third, can microbial modulation prevent or treat immune related adverse events? The initial positive results of clinical trials also led to additional questions. For example, can microbial modulation induce anti-tumor immune response even in non-immunogenic tumors? And it is important to note that there are many ways to modulate the microbiota, but so far, the only reliable way that showed positive results is fecal microbiota transplantation that allows the transfer of the entire microbiota both in terms of composition and relative abundance. Dr. Diwakar Davar: That's great. Essentially with the trials that I think the data sets that you're referencing of course, are papers by Jennifer Wargo, Thomas Gajewski, and Lawrence Zitvogel, looking at the role of gut microbiota in several different cancers, primarily immune checkpoint sensitive tumors such as melanoma, non-small cell lung cancer and kidney cancer. And then the work from several different groups showing that essentially proof of concept experiments can be done to try to change this, certainly preclinically, and now we know that that can be done clinically.   So, I guess the failure rates of immunotherapy in some patients are quite high. And we know that the microbial composition can change the likelihood to respond to immunotherapy based on all these trials. And actually, even going back to 2015, we had two seminal papers that looked at the role of CTLA-4 blockade as well. But subsequently, many years after that, 7 years after 2015, and certainly 3 years after 2018, when the three observational PD-1 papers were published, there were 2 pivotal trials in PD-1 advanced or refractory melanoma. They demonstrated that changing the gut microbiome can reprogram the immune system to attack tumors. So, there were 2 separate trials, both published the same issue of Science. One trial was led by your group at Sheba, and another one's led by us, the University of Pittsburgh. Why don't you summarize both studies for our audience. Dr. Ben Boursi: So, both studies were Phase I clinical trials of FMT in metastatic melanoma patients who failed immunotherapy. Recipients were metastatic melanoma patients that progressed on at least one line of anti PD-1 and in BRAF mutated patients, BRAF inhibitors as well. Donors in the Sheba study were metastatic melanoma patients with durable complete responses to immunotherapy for at least one year, and in the Pittsburgh study, you also included patients with durable partial responses of more than two years as donors. It is important to note that each fecal transplant in both studies was composed of a single donor. Prior to transplantation, we performed a microbiome depletion phase using a combination of two antibiotics, vancomycin and neomycin. The goal of this phase was to assist in engraftment (by avoiding colonization-resistance by recipient bacteria) and to “reset” the immune system, which may remind some people of the logic behind bone marrow transplantation. In the Pittsburgh study, there was no bacterial eradication with antibiotics, mainly because of studies showing that response to immunotherapy is lower following antibiotic treatment.  Both studies performed FMT through colonoscopy. At Sheba, we also performed maintenance FMT using capsules in order to keep the donor's microbial composition. After the initial FMT, both studies reintroduced the same immunotherapy in which the patient progressed in the past. Clinically, we have seen a 30% response rate with durable, complete and partial responses, and in the Pittsburgh study, there was a 20% response rate and 40% disease control rate. Both studies showed following FMT, immune response in the gut and in the tumor, and tumors that were immune deserts prior to FMT became infiltrated with lymphocytes. Interestingly, in our study, there were no moderate to severe immune related adverse events following FMT and reintroduction of immunotherapy. And this is despite the fact that five of the patients had significant side effects during previous rounds of the same immunotherapy.  Dr. Diwakar Davar: So essentially, in these very early proof of concept studies, what I think is pretty remarkable is that obviously the sample sizes were very small, but remarkably, patients that appeared to respond, responded in a setting in which they were not expected to respond. So, the probability of a patient responding to attempt at giving PD-1 in patients who were PD-1 relapse refractory is on the order of about 7%, based on an FDA analysis by Viva et al. And here, two separate studies, two independent studies, investigators had not known that each paper was being published, remarkably similar results clearly demonstrating that this is perhaps one of the best pieces of evidence to suggest that microbiome modulation may actually truly be effective in reversing PD-1 refractoriness.  More recently, our colleague Dr. Bertrand Routy at University of Montreal has done a proof of concept trial in evaluating the use of healthy donor fecal microbiota transplant in addition to anti PD-1 monotherapy in PD-1 naive metastatic melanoma. In this study, published in Nature Medicine a few weeks ago, his group reported an objective response rate of 65%. What are your thoughts about this study? And specifically, what are your thoughts about some of the pharmacodynamic and translational results that were demonstrated?  Dr. Ben Boursi: This is a very interesting question, because in both the Sheba and the University of Pittsburgh studies we chose responding patients as donors. We thought that by using these patients, we provide beneficial bacteria that enhance responses to immunotherapy through several mechanisms (molecular mimicry, immunomodulatory bacterial metabolites, modulation of immune checkpoint expression, and much more), and here in the Routy paper, the researchers used FMT from healthy donors without any selection for specific beneficial bacteria, and they demonstrated a similar effect on overall response rate. So maybe FMT works actually through reducing colonization by deleterious bacteria? Another question that we should ask is whether we need to choose donors differently when we use microbial modulation in treatment resistant patients compared to treatment-naive patients? Moreover, a previous meta-analysis of FMT studies across indications that was conducted by the group of Dr. Nicola Segata, demonstrated that recipients with better engraftment were more likely to experience clinical benefit, and that increased engraftment was mainly observed in individuals receiving FMTs through multiple routes, colonoscopy and capsules, as well as recipients that received antibiotics prior to FMT. But in Routy's trial, they not only used healthy donors, they performed bacterial cleansing only prior to FMT instead of bacterial eradication with antibiotics, and used FMTs through colonoscopy only, and they didn't give maintenance FMT. Of course, such an approach is much more feasible in the clinical setting and is relevant for designing future clinical trials.  Dr. Diwakar Davar: So, many differences, relatively few similarities, but I guess one interesting point is that of engraftment, which is that in your paper, our paper, and certainly in Bertrand's paper, it is very interesting that engraftment appears to be a key pharmacodynamic biomarker of microbiome modulation. And certainly, the analogy that you used earlier, which is that it's very similar to what happens in a stem cell transplant, which is that if there's no take, there's probably not going to be any effect. So that's very interesting that engraftment is emerging as a key PD biomarker of essentially the success of any kind of microbiome modulation across multiple different settings.  Now, we've heard of certainly defined microbial consortia, of cultivated species, as an alternative gut microbiome modulation strategy that balances the benefits of the ecological complexity of FMT with the scalability and practicality of probiotics. Do you think we are ready to design consortia?  Dr. Ben Boursi: So to date there are several probiotics that use a single bacteria and several microbial consortia that were evaluated in clinical trials, and as you mentioned, they may offer more tractable solutions for widespread clinical use. If we begin with the single bacteria probiotics, two phase 2 clinical trials found that administration of the butyrate producing probiotic clostridium butyricum 588 (CBM588) to immunotherapy naive patients with metastatic renal cell carcinoma led to markedly better immunotherapy responses, although the probiotic had a minimal effect on the composition of the microbiota, and the control arm of the trial responded worse than expected. In addition, in preclinical studies, probiotic strains of lactobacillus and bifidobacterium have been shown to enhance immune control of transplanted tumors and to augment anti PD-1 activity. However, a clinical trial in patients with metastatic melanoma found that the use of lactobacillus or bifidobacterium probiotics was associated with reduced microbiota diversity and worse responses to anti PD-1.  So here the conclusion is that when we try to design probiotics, we should not focus only on the composition since other factors, such as the relative abundance also matter. Too much of a beneficial bacterial species may potentially be worse than having a balanced and diverse microbiota. For example, a recent study of patients with non-small cell lung cancer receiving immunotherapy found that patients with a detectable Akkermansia muciniphila in their gut microbiota (this is a beneficial bacteria) responded well to treatment, but those with relative abundance of Akkermansia muciniphila greater than 5% responded worse than patients lacking Akkermansia, and this is due to the mucolytic effect of the bacteria. So, the use of rationally designed consortia may be better than a single probiotic strain.  And there are currently 3 main microbial consortia that are being evaluated: the SER-401, a bacterial consortium enriched with clostridium, led in a randomized controlled trial to reduced response to immunotherapy compared to placebo control in first line metastatic melanoma patients, potentially due to a confounding effect of a vancomycin pretreatment; MET4 is a 30 bacteria consortium that was shown to be safe and to alter the gut microbiota and serum metabolome of immunotherapy naive patients. Here, the initial study was underpowered to determine the effect on treatment efficacy; And finally, VE800 is an immunotherapy enhancing 11-bacterial consortium that is currently being evaluated in phase 1 and 2 clinical trials, and we are looking forward to see the results with this agent. Dr. Diwakar Davar: So I guess where we are right now is that social design is clearly difficult because of all the reasons you've mentioned. The SER-401 data and the MET4-IO trials certainly give us pause for thought. Certainly, no pharmacodynamic changes that were seen with SER-401, MET4-IO did result in pharmacodynamic shifts metagenomically, but neither trial was positive. And certainly, the VE800 trial, which has been ongoing now for several years, and the lack of publicly reported data certainly doesn't suggest that there's a huge efficacy signal. So consortias, at least at this point, certainly do not appear to be having a significant effect, though we don't know what might happen in the future. Data from multiple groups has shown that gut microbial composition influences the development of immune related adverse events (irAEs) in both PD-1 and combination PD-1 and CTLA-4 treated patients. Unsurprisingly, as a result, there have been attempts made at evaluating the role of fecal microbiota transplants to treat refractory immune related adverse events and very specifically immune checkpoint associated colitis or IMC. So, Dr. Yinghong Wang, who is the chair of the Immunotherapy Toxicity Working Group at the University of Texas MD Anderson Cancer Center has been very prominent in this space, and in a recent paper published in Science Translational Medicine, which is a follow up paper to her early work in Nature Medicine, she reported that HDFMT, healthy donor fecal transplantation, was very efficacious in feeding early refractory immune checkpoint colitis. So, what are your thoughts on this approach and how important is this space and where else might it be efficacious?  Dr. Ben Boursi: When I talked about the Sheba clinical study, I mentioned the possible role for microbiota modulation in the prevention of immunotherapy related adverse events in general, not only colitis. But the study by Dr. Yinghong showed that FMT can actually treat immune-related colitis refractory to steroids and anti-TNF. Now, this approach is probably relevant not only for immune related colitis, but also to other immune related adverse events. We can define certain bacterial species that may be associated with different immune related events. For example, streptococci can be associated with immune related arthritis. And maybe in the future we won't need to use FMT, but we will rather be able to target these specific immunogenic strains by narrow spectrum antibiotics or phages. The main challenge would be to develop microbiotic targeting interventions that reduce immune related adverse events without compromising therapeutic efficacy.   Now, is microbial modulation relevant only for toxicity from immune checkpoint inhibitors? So, the answer is ‘no'. We know mainly from animal models of hematopoietic cell transplantation, CAR T, and immune agonist antibodies that antibiotic-treated or germ-free mice have markedly reduced immunotoxicity, such as graft versus host disease, cytokine release syndromes, and more. It is also worth mentioning that microbial modulation is relevant not only for reducing toxicity from immunotherapy, but also from chemotherapy and other anticancer modalities. And the best example is the gastrointestinal toxicity of irinotecan that is mediated by the bacterial beta-glucuronidase. And here the targeting may even be a bit less complex. Dr. Diwakar Davar: So, what we take away from that is that starting with actually your paper originally, and papers to be produced, immune-related adverse events can be prevented using microbiome modulation with FMT, and Dr. Wang's data suggesting that eventually FMT can be used to eradicate highly refractive colitis, again, this is important to keep in mind that this approach is not yet FDA-approved. It's being done under IND. It's not currently something that is a certain standard of care. One interesting area of drug development is that there's a French microbiome company named MaaT Pharma where they have an agent that is a very interestingly a pooled microbiome product from multiple different donors. Again, the trials in both Israel and Pittsburgh used individual donors. This is a pooled donor construct. The lead candidate is actually graft versus host disease. The trial is the ARES trial, A-R-E-S, as in the Roman god of war. This trial is actually ongoing in Europe, and I believe there's some effort to try to see whether or not it's going to be a trial that can be done in the United States as well. So, at this point in time, again, we don't know whether or not there are any developmental approaches from a pharmaceutical company in the United States, but certainly this is definitely an area of interest.  So microbial therapies are still relatively early. It's going to be interesting to see how the advanced field of nutritional interventions provide an appealing method for modulating the gut microbiome due to the excellent safety profile, cost effectiveness and noninvasiveness. And certainly, if you are what you eat and your bacteria are what they eat, which goes down to our diet, there's enough rationale to believe that certain nutritional interventions can have an effect via the intermedial gut microbiota modulation. Holistic dietary changes and or supplementation specific nutrients such as prebiotics could therefore be utilized to specifically shape the population of beneficial microbes and shift the immune microbiota landscape. Now, we have seen in data published by several of our colleagues that in patients with cancer, high fiber intake is associated with greater microbial diversity, greater abundance in fiber fermenting microbes such as members of the Ruminococcaceae family, and these are all associated with the response to checkpoint inhibitor therapy. So, what do you think about nutritional interventions? Do you want us to briefly summarize data regarding nutritional data and where it stands in cancer at his time? And can you speculate as to how effective this might be in the context of patients with cancer? Dr. Ben Boursi: So, let's begin with diet. A growing number of clinical and preclinical studies suggest that specific dietary interventions such as a high fiber diet can not only improve response to immune checkpoint blockers, but also reduce immunotoxicity such as graft versus host disease. And there are many other diets that are being tested such as ketogenic diets and intermittent fasting. And the effects of diet may be mediated by both microbiota-dependent and microbiota-independent mechanisms. The limitation of this approach is that changes to the microbiota induced by diet are generally quite variable between patients and can depend on an individual's microbiota prior to intervention. And patient compliance is also a concern, particularly in the very strict diets.  Now, regarding high fiber diets, several large cohorts of melanoma patients from the US, Australia, and the Netherlands demonstrated how a high fiber diet modulates the microbiome and results in a better response to immunotherapy, better progression-free survival. Additional studies that were presented at AACR in 2023 showed that high fiber dietary interventions, in which patients received a fiber-enriched diet for six weeks, was feasible and that the high fiber diet resulted in a rapid shift in the gut microbiota toward fiber-responsive short chain fatty acid-producing taxa and a shift of the metabolome, with increase in the short chain fatty acid acetate, Omega-3, Omega-6, polyunsaturated fatty acid, and tryptophan metabolites. Prebiotics can also promote the growth of beneficial microbial species in the gut by providing targeted nutrition. And one example of a prebiotic that was shown to enhance immunotherapy efficacy in mouse models is castalagin, which is isolated from the camu-camu berry. Castalagin directly binds the outer membrane of ruminococci and promotes their growth, which has been shown to increase the CD8-positive T-cell activity and anti-PD-1 efficacy. Now, since prebiotics rely on the presence of beneficial taxa already in the host microbiota, symbiotics, which refers to the administration of the appropriate prebiotic and probiotic together, may prove in the future to be more effective than using either separately. Dr. Diwakar Davar: Certainly, these dietary interventions can be very exciting and certainly we do know of several colleagues who are doing these diet interventions, though compliance with any kind of dietary intervention may be a challenge that decides how effective such an approach is going to be. So microbial therapies in general are still at a relatively early stage of development. And it'll be exciting to see how they advance. What approaches are you excited about? What is on your radar?  Dr. Ben Boursi: There are many exciting works that are currently ongoing, and to emphasize just a few: there are many clinical trials in immunogenic tumors, in addition to melanoma, for example, renal cell carcinoma, and non-small cell lung cancer, that also evaluate different modulation protocols. We should remember that one size does not fit all, and different tumors have different microbiomes. We have a project in collaboration with MD Anderson in MSI-high patients with exciting initial results. Another study that was initiated at Sheba is using microbial modulation in order to improve TIL therapy (to overcome resistance to TIL and T-cell exhaustion). There are also studies that try to change the pharmaco-microbiome, for example, to eradicate bacteria that inactivates the chemotherapy agent, gemcitabine, in pancreatic cancer patients. And there are groups that try to identify recipients that will respond to microbial modulation and to generate better donor-recipient matching algorithms. There are already signatures like TOPOSCORE that was presented at ASCO 2023 that try to predict response to immunotherapies through the ratio between harmful and beneficial bacteria. Now, there's also more basic science work, for example, bacterial engineering. There was a wonderful study from the Fischbach group in Stanford that demonstrated how Staphylococcus epidermidis engineered to express melanoma tumor antigens was able to generate a systemic tumor-specific response in mice models when applied topically; functional imaging of the microbiome, for example, FDG uptake in the colon can reflect microbial diversity and response to immunotherapy; works that characterizes other microbiomes such as the urinary and skin microbiomes, and their interaction with the gut microbiome; and studies of the nonbacterial component of the microbiome, mainly phages and fungi. But for me, the most important word should probably be collaboration, because without joining forces internationally, we won't be able to understand the human metaorganism, the variations according to geography, ethnicity, lifestyle, diets, and much more in the microbiome. And this is crucial in order to really understand the complex tumor ecological niche within the human host. Dr. Diwakar Davar: I think one of the key points that you just mentioned is collaboration. That's going to be very, very critical as we move this forward for many reasons, including the unexpected impact of geography upon the composition of the gut microbiome in work that has been published by many groups, but also including ours in a paper that we published about a year ago now.  So, Dr. Boursi, thank you for your great work in this area. Thank you for sharing your insights with us today on the ASCO Daily News Podcast. This is a very difficult time for all of you and your colleagues in Israel, and we thank you so much for taking such a great deal of time out of your busy workday to spend some time with us.  Dr. Ben Boursi: Thank you very much. Dr. Diwakar Davar: Thank you to all our listeners today. This is a very exciting area. This is an area where we are discovering more every day than we knew just up until the day prior. You will find the links to the studies that were discussed today in the transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take the time to rate, review, and subscribe wherever you get your podcast.  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. Guests' 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.   Follow today's speakers:   Dr. Diwakar Davar  Dr. Ben Boursi   Follow ASCO on social media:   @ASCO on Twitter    ASCO on Facebook    ASCO on LinkedIn      Disclosures:   Dr. Diwakar Davar:     Honoraria: Merck, Tesaro, Array BioPharma, Immunocore, Instil Bio, Vedanta Biosciences    Consulting or Advisory Role: Instil Bio, Vedanta Biosciences    Consulting or Advisory Role (Immediate family member): Shionogi    Research Funding: Merck, Checkmate Pharmaceuticals, CellSight Technologies, GSK, Merck, Arvus Biosciences, Arcus Biosciences    Research Funding (Inst.): Zucero Therapeutics    Patents, Royalties, Other Intellectual Property: Application No.: 63/124,231 Title: COMPOSITIONS AND METHODS FOR TREATING CANCER Applicant: University of Pittsburgh–Of the Commonwealth System of Higher Education Inventors: Diwakar Davar Filing Date: December 11, 2020 Country: United States MCC Reference: 10504-059PV1 Your Reference: 05545; and Application No.: 63/208,719 Enteric Microbiotype Signatures of Immune-related Adverse Events and Response in Relation to Anti-PD-1 Immunotherapy       Dr. Ben Boursi: No relationships to disclose.        

Dr. Mahdi Sheikh and Dr. David Zaridze join Dr. Shannon Westin to discuss how quitting smoking after diagnosis may impact survival in kidney cancer. TRANSCRIPT  The guest on this podcast episode has no disclosures to declare. Dr. Shannon Westin: Hello everyone, and welcome to another episode of JCO After Hours. This is the podcast where we get in-depth on manuscripts that have been published in the Journal of Clinical Oncology. As always, I'm your host, Shannon Westin, Gynecologic Oncologist and Social Media Editor for the JCO. And I am so excited to be here today. We are going to be discussing the paper, “Smoking Cessation After Diagnosis of Kidney Cancer Is Associated With Reduced Risk of Mortality and Cancer Progression: A Prospective Cohort Study,” which was published in the JCO on March 29, 2023. And this very intriguing paper, I have two of the major authors from this paper. First is Mahdi Sheikh, who is a scientist and epidemiologist at the International Agency for Research on Cancer, the World Health Organization in Lyon, France. Welcome, Dr. Sheikh. Dr. Mahdi Sheikh: Thank you very much, Dr. Westin, and thanks for having us. Dr. Shannon Westin: And then with Dr. Sheikh is Dr. David Zaridze. He is the Director of the Department of Clinical Epidemiology at the N.N. Blokhin Russian Cancer Research Center in Moscow and also the President of the Russian Cancer Society. We are with greatness today. Dr. David Zaridze: Thank you. Thank you very much. Nice to be with you. Dr. Shannon Westin: Very nice to be with the two of you. So, let's get started. I first wanted to just level set. Could one of you review just the overall incidence of kidney cancer and what proportion of patients with kidney cancer are known to be smokers at diagnosis? Dr. David Zaridze: The figures I'm going to present are rates. They are adjusted to standard world population. Why am I saying that? Because in America you sometimes use adjustment to the US population. These figures will be different from what you are accustomed to see. Okay, incidence of kidney cancer in Russia, in men, 14.1 per 100,000. I compare this with the United States of America, men, 16.5. Very small difference. Women in Russia, 8 per 100,000. In the United States of America, 8.8 per 100,000 of population. Exactly the same. Very close. These rates are sort of high-ish, but there are very high rates, for example, in the Czech Republic, where rates are more than 20 and other Central European countries. In Russia, kidney cancer mortality in men is 6 per 100,000. In USA, 3 per 100,000. In women in Russia, 1.9. In the United States, 1.3. I would say that there is a difference in mortality in men, not much in women. The incidence of kidney cancer is increasing in Russia sharply, sharply. Since 1990 it has increased - it's tripled. It increased from 5 per 100,000 in 1990 to 14 per 100,000 in 2019. Mortality is stable or declining. This is suggesting that kidney cancer is overdiagnosed in Russia and probably elsewhere. But this is not a problem of our discussion now. The frequency of the prevalence of smoking in kidney cancer patients. It is estimated that 15% to 20% of patients with kidney cancer smoke. In Russia, we have results only from our study. 18% of patients smoked at admission to our cancer center. Dr. Shannon Westin: Got it. Okay, good. Well, that's really helpful, especially to those of us that don't take care of patients with kidney cancer every day. It helps us just understand. And I guess the next question is what do we know about the impact of tobacco cessation on the risk of kidney cancer? So you were talking about that increasing incidence. How does tobacco cessation impact that? Dr. Mahdi Sheikh: Tobacco smoking is a known risk factor for kidney cancer and an estimated 17% of the kidney cancer burden worldwide can be attributed to tobacco smoking. There is a recent meta-analysis of 56 studies that was published a few years ago that clearly showed a dose-response relationship between smoking and kidney cancer, meaning that the more cigarettes a day you smoke, the risk of kidney cancer will go up. For example, the risk that was shown for five cigarettes per day was 20%. It goes up until 70% for 30 cigarettes per day. And also with a duration, the more years you smoke, the risk for kidney cancer will go higher. However, the good news is that when you quit smoking, there is strong evidence that the risk for developing kidney cancer will be lower compared to if you continue smoking. And there is some evidence that shows again dose-response relationship, meaning that the more years you spend in quitting smoking, the lower your risk would be for developing kidney cancer compared to if you continue smoking. So this is not only about renal cancer or kidney cancer but also true about many other cancer sites as well. Dr. Shannon Westin: Okay, that's super helpful. And then I guess prior to your study that we're about to talk about, did we have any information on what happens when patients quit smoking after their diagnosis? Any limitations to those data that were available? Dr. David Zaridze: You mean the data which was prior our study? You know, the negative effect of smoking after diagnosis has been shown nearly three decades ago. The information exists already for thirty years, but it was largely ignored not only in clinical practice but also in clinical trials. And I have to stress that in clinical trials this information is still ignored. I came across these studies and decided to review them some time ago. All they were case-control studies and to my knowledge, none of them assessed the effect of quitting smoking. I decided to review these studies and included this review in my book, Smoking: A Major Cause of Cancer, which was published in 2012 and was dedicated to Professor Richard Doll's anniversary. In fact, this was a stimulus for the study we are discussing. And in fact, the component of this study we are discussing today was built in and baked into the existing cohort study to which we added the active follow-up component for assessing the changes in smoking habit and disease status. Dr. Mahdi Sheikh: If you review the evidence, before publishing this study just like a few years ago, we find that there are many studies published talking about the effects of smoking cessation on cancer survival. However, as David mentioned when you go deep into these studies, you'll find a lot of limitations. First of all, most of these studies are retrospective studies, which means that either case-control or retrospective course that patients developed the outcome, and then some investigators came to see their records to assess or ask family members before they developed the outcomes. There are a lot of biases with these types of studies. And with the epidemiologic study, perspective study that we did, has less limitations compared to retrospective ones. Another one is that when we go into the study you see, they only assess a small number of patients, small sample size. Some studies just assess 10 smokers, some assess like 30. By this study we try to assess a large number of smokers who quit smoking after diagnosis. Another limitation is that– First, let's see what exposure and what setting we are talking about. We're talking about smoking which is a very dynamic behavior. People quit smoking and they relapse smoking and they quit smoking and so on. So if you access this exposure for only a limited time, for example, for one year, then you may miss what happens after that which results in misclassification of some of the participants. So repeated assessment was not done in other studies that we did here in this study. Another one, you are talking about special setting patients who are diagnosed with cancer. These patients have special circumstances, they have treatments, they have family support, they might go under the stress of cancer, and all these different stages at diagnosis. And most studies that are available, they didn't account for this. They didn't adjust or they didn't try to understand the role of these compounding factors, as we call it in epidemiology, on that, the thing that we're trying to address. And a prospective study, as I said, long follow-up time. Even the very few prospective studies that were available for other cancer sites that have only one year or maximum two years of follow-up with this type of exposure, so it is important to follow them for a long time. Another thing I would say was exposure assessment. Not only did we repeatedly try to assess exposure among participants, but try to call the people– David and his team who did the study in the field, called the participants and tried to ask the family members and sometimes their physicians about their smoking behaviors. When you go to current evidence you see, mostly smoking behavior was assessed using the record that is available like treatment records or patient records, which again has some limitations if you do not assess exposure among qualified participants. Finally, we're talking about a dynamic behavior in the follow-ups. Some people might change smoking. But there is a very important thing, in this study, we also collect at the time of quitting smoking. There's a very important thing in statistics we call Survivorship Bias, meaning that, if you were assessing an exposure doing the follow-up and if you do not pay attention to this, you will assess an exposure that is a proxy of people who lived longer. Meaning that people have enough time, they have a long time, and those who have longer time, will have more time to quit smoking. And then you will be assessing this, actually, not the exposure, but you're only assessing people who quit smoking, and then whatever you assess, you would end up with a beneficial effect. But if you have the time of quitting smoking and follow up and all these statistical things and lower sample size, you are able to account for this very very important bias in epidemiology. Dr. Shannon Westin: Before we go further, I'd love for just a bit of a description of exactly how you laid out your study to really add to where this data are so limited around survival and tobacco cessation. So maybe review the primary/secondary objectives, basic design, just to make sure our listeners are all on the same page. Dr. David Zaridze: The study has classical prospective cohort design that the study, which was basically a basic study, in which the new component was built in. This study used a user's questionnaire-based exposure assessment and molecular epidemiologic approach. I mean that, in addition to the questionnaire approach, we collected blood and tumor tissues for molecular studies. All patients with kidney cancer admitted to the cancer center were interviewed at admission before receiving any treatment. A structured lifestyle questionnaire was used. Participants were asked about their lifetime smoking history which included questions about the duration and frequency of smoking cigarettes, the average number of cigarettes smoked every day. They were also asked about their lifetime history of alcohol drinking. The questions included questions about exposures to carcinogens other than smoking, and health conditions, including chronic kidney diseases, hypertension, diabetes and so on. Height and weight were measured. Today, this study generated and continues to generate plenty of results and papers published in most prestigious journals such as Nature Genetics, for example. So, as you know, we started from 2012, we started the follow up of the cohort members, we were focusing on Moscow residents and the follow-up includes regular annual contacts with the patients personally or via telephone or with patients' household members, etc. Again, we collected information about changes in smoking behavior and disease status. We also used information from the regional cancer registry to confirm the information obtained from patients. The average period of follow up was eight years. And this is quite a long follow-up. Repeated assessment of smoking status reduces the likelihood that exposure to smoking was misclassified. However, regrettably, the self-reported information on smoking was not supported by biochemical tests, for example, by blood cotinine testing. To my knowledge, this is the only prospective cohort study in patients with cancer, not only with kidney cancer that have collected data on participants' smoking status prospectively for quite a long time. The average follow-up time was eight years. Dr. Shannon Westin: That was incredible. That definitely caught my eye. And I was looking, I was like, “Oh, how many did they lose?” And you guys kept 80-100% of the patients. I just was so impressed by that. And now hearing the mechanisms in which you did that, it makes sense. You were very diligent, multiple ways to contact patients and confirm the data. So you really are to be congratulated for the work that you're able to achieve. Dr. Sheikh, I'd love to hear, you talked a little bit about how some of the studies didn't really think about confounding variables. Can you kind of highlight some of the confounding variables that you all controlled for in order to really assess the impact of the cessation on survival? Dr. Mahdi Sheikh: Thanks to the high-quality data and also the large sample size and the way the study was designed, we were able to adjust for a lot of confounding. So we tried to adjust for all these things. So we used three approaches. The first approach was adjustment. When you ran this in the analysis, we tried a statistical model, we tried to adjust for these confounders like age, sex, treatment, socioeconomic status, smoking intensity, alcohol, and other factors. This is one effect, one approach. The second approach was stratification, meaning that we come and see the effect within people who have been diagnosed with only earlier stage tumors to see if the effect among people with earlier stage tumors differs with the effect that we see among people with higher stage tumors. But again, if you read the paper, you see that we saw the protective effects of smoking cessation on both groups of people, those who were diagnosed at earlier stages and those who were diagnosed at later stages. And also heavy smokers or mild to moderate smokers, again, we tried stratified analysis excluding those heavy smokers and saw the effect, again, among those who were light smokers or moderate smokers and also with the heavy smokers. I want to say that we tried all these types of analytical approaches and we really saw the protective effects across all patient subgroups. Finally, I talked again about the survivorship bias. So we used really strict statistical approaches to address this confounding, and because we had the time of quitting, we had the follow up time and all these things. And, again, whatever we did in the study we still could see the effects of smoking and all this is due to the good design, the large sample size, and the good questionnaire data that we have. Dr. Shannon Westin: That's awesome. I think, of course, now let's get to the bottom line. 40% reported that they quit smoking after diagnosis with none relapsing during the time period. And what did you see was the impact on overall survival as well as cancer-specific survival? Dr. Mahdi Sheikh: So we tried several outcomes - overall survival, cancer-specific survival, but also progression-free survival. And then because we had the large sample size we could assess all this. Interestingly, we saw the effect on all the three outcomes that we assessed. So the overall survival was better among those during the quitting time and also the cancer-specific survival was also better and also progression-free survival was better among all these participants. Dr. Shannon Westin: I think most people that have read this paper - and if you haven't read this paper you should run to read it right now - I really was impressed with that kind of clear benefit across cancer-specific mentality across all subgroups regardless of how much they smoked. So I don't know why you get a sense of like, “Oh, if you smoke a little bit you wouldn't see as big of an impact,” but a very clear impact. And I would love to hear why you think smoking negatively impacts these outcomes. How does the cessation help? This is a perfect time for that. Dr. Mahdi Sheikh: When we review the evidence about how smoking cessation may be beneficial for patients, for the survivorship of patients with cancer, we come to five mechanisms that are suggested in the literature. So the first one can be, is suggested, that is altered cancer biology. Smoke and tobacco smoke contain numerous carcinogens and mutagens. So it has been shown that cancer cells that are exposed to tobacco smoke, they may become more aggressive and the risk of metastasis might go higher and also, angiogenesis and all other effects on the biology of cancer cells. So it may affect the cancer cell biology. Another suggested mechanism might be altered immune response. So tobacco smoking affects the immune system and then the immune response among those who are exposed to tobacco might be affected by tobacco smoking. So their response to the cancer cells but also other bacteria, viruses, and other things might be affected as well. The third possible mechanism suggested altered drug metabolism. It has been shown that tobacco smoke and smoking can affect some of the enzymes that have metabolic responsibilities and metabolism of the drugs. So that can affect the washout period for the drug. It might not stay enough in the blood or vice versa as well. It might affect the toxicity. There is some evidence about this. The fourth mechanism suggested is about increasing treating-related complications or treatment-related complications. People who smoke have delayed wound healing, they have more complications, the surgery, the time they spend at the hospital might be longer. And this is also part of which smoking may affect the outcomes that we saw here. And finally, that is we are talking about tobacco smoking and patients with cancer are human beings with all these systems. So we know that smoking causes damage to the cardiovascular system, to the pulmonary system and also to the lungs and other things. So this is why we see different outcomes are affected by cancer. Dr. David Zaridze: I was impressed by the data that exposure to tobacco smoke condensate induces changes in tumor microenvironment. For example, it inhibits formation of interferons, interferon alpha and gamma, inhibits the migration to tumor microenvironment of the immune cells. The number of CD8+ T lymphocytes, T killers, are significantly lower in the tumor microenvironment of current smokers compared to former smokers and never smokers. And even more interestingly, the number of PD-L1+ cells are also lower in the tumor microenvironment of current smokers than former or never smokers. This is probably very important in terms of effectiveness of impairment by smoking of the immunotherapeutic approaches in cancer treatment. Dr. Shannon Westin: That's very important and we know the microenvironment has a huge impact on just the way the cells respond to treatment and develop resistance and so that makes a lot of sense. Okay, well, this has been amazing and I think one thing that you just said just struck me, Dr. Sheikh, that you've obviously shown this in lung cancer and you're looking at this in other cancers. I guess the question is: What should we be doing? How should we be implementing tobacco cessation efforts across all cancer diagnoses to help all patients that have really any diagnosis of cancer? Dr. David Zaridze: Let me first underline the clinical importance of these results. The benefits from quitting smoking are comparable or even superior to those recorded in the clinical trials of modern kidney cancer treatments such as immune checkpoint inhibitors. I refer to the results of pivotal trials in advanced renal cell cancer in the frontline setting and these results were reported at ASCO Meeting 2023 recently in May. If you compare the results of our study with results of these pivotal trials, it is very impressive. It is clear that our findings strengthen the case for making tobacco cessation treatment a standard part of the routine health care for all people with cancer, however, smoking is still quite high in cancer patients. And I would like to quote Peter Shields who is saying that, in the United States,10% to 50% of cancer patients smoke. As far as Russia is concerned, in our study, 80% of kidney cancer patients smoke, and in our lung cancer study, 58% of cancer patients smoke.  The barrier is that the oncologists do not believe or are accepting with a great deal of skepticism the results of our study. They don't believe the idea that anything else besides surgical, radiological, or medical treatment could improve the outlook of cancer patients. It's difficult for them to apprehend. Many of them think that smoking cessation after diagnosis is simply a waste of time. Many patients simply don't know that smoking cessation after diagnosis may be beneficial for them. In addition, they are pessimistic and they feel discouraged to quit smoking, as they might think it is too late. I would like to quote my favorite quote: “Smoking cessation treatment has to become the fourth pillar of cancer treatment, one that could affect cancer treatment outcomes as powerfully as surgery, chemotherapy, or radiation therapy.” This is Dr. Fiore, 2019. Dr. Shannon Westin: Thank you so much. And Dr. Sheikh, anything to add there around cessation efforts? Dr. Mahdi Sheikh: As we saw the results of these studies that smoking cessation is feasible and it is accessible at a minimum cost for many patients, it should really be integrated in the  management of patients with cancer. It is feasible, it is cheap, it is accessible. But unfortunately, when we review the evidence we see that only less than half of the physicians, like around 40% of physicians, send the patients to tobacco smoking cessation services. And even some do not discuss this issue. And as David mentioned, they do not know the effect of smoking cessation. So when you go through these studies to find the major barriers, in addition to what David had mentioned, we find two important points. First one is lack of education or experience in providing tobacco cessation interventions among those who deal with patients with cancer. So they do not have the education. And second is lack of available resources for referrals. Now we're not only talking about the United States but also many other countries even high-income countries, we do not see the resources for referrals on smoking cessation services in cancer care settings. The take home message probably from this study and also from these barriers, would be for three groups. First, for the policymakers, we would recommend sustainable funding should be dedicated to tobacco cessation services. As we saw, the effect is huge and seems to be a very big effect and it is cheap so why not implement this smoking cessation service within cancer care settings.  And the second one, tobacco treatment training programs for healthcare providers. This is also very, very important that we try to implement this training program in the curriculum of healthcare providers, especially those who deal with cancers and tobacco-related outcomes. And also for physicians, we recommend that physicians should assess and address tobacco use in all patients with cancer. They should talk about this topic and also show the benefits of quitting smoking. And patients with cancer who smoke should be supported to stop smoking at any time and each visit after diagnosis is not like some time pass, as we saw, all patient subgroups could benefit from smoking cessation. This is important.  But something also very, very important that we shouldn't forget that cancer itself causes a lot of fear and anxiety and stress. And smoking cessation sometimes may be associated with stress and more anxiety. So it is very, very important to think about this point and provide the psychosocial support to patients who quit smoking. Sometimes they may relapse just because of the fear and anxiety they have. So it's not only showing the evidence, but also supporting these patients, telling them how to do that and also supporting them emotionally and also psychosocially. And finally for the patients, I would like to give this message that we see and we know that it is never too late to quit smoking. As David said, patients may feel like, “It is too late now I've developed cancers,” but no, it's really not too late. And if you quit smoking at any time after diagnosis, you would benefit a lot from smoking cessation. Dr. David Zaridze: In the United States there are guidelines, several guidelines for smoking cessation, specifically for cancer patients because smoking cessation in cancer patients is very different from smoking cessation in general population. In the general population, we more or less succeeded, I would say, and we have to look now at this direction to the smoking cessation in cancer patients. And this is a message to WHO, that countries, members of WHO, based on the recommendation guidelines of WHO, develop their own specific guidelines for smoking cessation in cancer patients. And that should be used in all cancer clinics and that should be a must, absolutely important part of anti-cancer treatment. And as I already told, it should be the fourth pillar in cancer treatment, as treatment, as surgery, chemotherapy and radiation. Dr. Shannon Westin: Thank you both. That was such a great discussion, and I hope that we've convinced everyone that this is a critical effort that they need to be addressing every day.  I just want to thank everyone who listened. This has been "Smoking Cessation after Diagnosis of Kidney Cancers Associated with Reduced Risk of Mortality and Cancer Progression: A Prospective Cohort Study", again published in the JCO on March 29, 2023. Thank you guys again for listening to JCO After Hours. Please check out our other podcast offerings. You can check them out on the website or wherever you get your podcasts and let us know what you think about the podcast on Twitter. Dr. David Zaridze: Thank you. Dr. Mahdi Sheikh: Thank you very much.  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.  

کتاب سلامتی در هر سایز https://www.amazon.com/Health-At-Every-Size-Surprising/dp/1935618253 اسامی مقالات ذکر شده Akram, D. S., et al. Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation on Obesity. Geneva, Switzerland: World Health Organization, 1997 Ernsberger, Paul and Richard]. Koletsky, "Biomedical Rationale for a Wellness Approach to Obesity: An Alternative to a Focus on Weight Loss," journal of Social Issues 55, no. 2 (1999) Ernsberger, Paul and D. 0. Nelson, "Effects of Fasting and Refeeding on Blood Pressure Are Determined by Nutritional State, Not by Body Weight Change," Americanjoumal of Hypertension (1988) Guagnano, M. T., et al., "Weight Fluctuations Could Increase Blood Pressure in Android Obese Women," Oinical Sciences (London) 96, no. 6 (1999) Ernsberger, Paul, et al., "Consequences of Weight Cycling in Obese Spontaneously Hypertensive Rats," American journal of Physiology: Regulatory, Integrative and Comparative Physiology 2 70 ( 1996): Ernsberger, Paul, et al., "Refeeding Hypertension in Obese Spontaneously Hypertensive Rats," Hypertension 24 (1994) Chernin, K., The Obsession: Reflections on the ryranny of Slenderness. New York: Harper&. Row, 1981. Barrett-Connor, Elizabeth and K. T. Khaw, "Is Hypertension More Benign When Associated with Obesity?" Circulation 72 (1985) Cambien, Francois, et al., "Is the Relationship between Blood Pressure and Cardiovascular Risk Dependent on Body Mass Index?" American journal of Epidemiology 122 (1985): 434-42. Weinsier, Roland L., et al., "Body Fat: Its Relationship to Coronary Heart Disease, Blood Pressure, Lipids, and Other Risk Factors Measured in a Large Male Population," American journal of Medicine 61 (1976): 815-24. Uretsky, Seth, et al., "Obesity Paradox in Patients with Hypertension and Coronary Artery Disease," American journal of Medicine 120, no. 10 : 863-70. Kang, Xingping, et al., "Impact of Body Mass Index on Cardiac Mortality in Patients with Known or Suspected Coronary Artery Disease Undergoing Myocardial Perfusion Single-Photon Emission Computed Tomography," journal of the American College of Cardiology 47, no. 7 (2006): 1418--26. Nowson, Caryl A., et al., "Blood Pressure Change with Weight Loss Is Affected by Diet Type in Men," American journal of Ginical Nutrition 81, no. 5 : 983--89. McDonald, K. Colleen, Jean C. Blackwell, and Linda N. Meurer, "dinical Inquiries. What Lifestyle Changes Should We Recommend for the Patient with Newly Diagnosed Hypertension?" journal of Family Practice 55, no. ll (2006): 991-93. Delichatsios, Helen K. and Francine K. Welty, "Influence of the Dash Diet and Other Low-Fat, High-Carbohydrate Diets on Blood Pressure," no. 6 (2005): 446-54. Gregg, Edward W, et al., "Secular Trends in Cardiovascular Disease Risk Factors According to Body Mass Index in Us Adults," journal of the American Medical Association 293, no. 15 (2005): 1868--74. McGill, Henry C.,Jr., The Geographic Pathology of Atherosclerosis. Baltimore: Williams and Wilkins, 1986. Montenegro, M. R. and L. A Solberg, "Obesity, Body Weight, Body Length, and Atherosclerosis," Laboratory Investigations 18 (1968): 134-43. A Study of Interassociations," Atherosclerosis 36, no. 4 (1980): 481-90. Warnes, C. A. and W C. Roberts, "The Heart in Massive (More Than Pounds or 136 Kilograms) Obesity: Analysis of 12 Patients Studied at Necropsy," Ameri.canjourncll of Cardiology 54, no. 8 (1984): 1087-91. Chambless, Lloyd E., et al., "Risk Factors for Progression of Common Carotid Atherosclerosis: The Atherosclerosis Risk in Communities Study, 1987-1998," American journcll of Epidemiology 155, no. l (2002): 38-47 Salonen, Riitta andJukka T. Salonen, "Progression of Carotid Atherosclerosis and Its Determinants: A Population-Based Ultrasonography Study," Atherosclerosis 81, no. l (1990) Applegate, William B.,]. P. Hughes, and R. Vander Zwaag, "CaseControl Study of Coronary Heart Disease Risk Factors in the Elderly," journal of Clinical Epidemiology 44

Before anyone sends me a grumpy email about the title of this episode, it's actually the title of the book written by today's two guests. According to Profs lan and Rachelle, "we've ended up with a healthcare system that's one of the greatest threats to human health". This episode presents some mind-blowing info and stats from two of the most-qualified, well-researched and well-respected people I've chatted with on the show. *Professor Rachelle Buchbinder is an Australian NHMRC Senior Principal Research Fellow. She has been the Director of the Monash Department of Clinical Epidemiology since its inception in 2001 and a Professor in the Monash University Department of Epidemiology and Preventive Medicine since 2007. She is a rheumatologist and clinical epidemiologist. *Professor lan Harris is a clinician and researcher based in Sydney. He is an orthopedic surgeon with a clinical interest in trauma care where his practice is based at Liverpool Hospital in southwest Sydney. He is Professor of Orthopedic Surgery at the South Western Sydney Clinical School of UNSW Sydney and Honorary Professor at the School of Public Health, University of Sydney. amazon.comSee omnystudio.com/listener for privacy information.

AI-assisted healthcare is reaching maturity in many applications and could alleviate some of the capacity gap increasingly faced by health systems . Over the next three podcasts we focus on artificial intelligence tools designed to assist directly with clinical practice. Most commonly reported on are the algorithms capable of pattern recognition on medical images, that in some settings perform as well or better than expert diagnosticians at classifying disease. AI models have also been developed to perform regression analyses more complex than classical risk stratification aids.The standard statistical algorithms used to solve these problems struggle when many variables are introduced, in which case deep learning models that mimic brain networks are sometimes a powerful alternative. In this episode we explain how machine learning algorithms are trained on particular tasks and where there are risks of error and bias being introduced. In part 2, we identify the ergonomic issues that affect practical implementation of AI tools in the clinic and in the decision cascade. And in the final episode of the series we discuss the questions that regulators and lawyers should be asking of this new technology and what role natural language processors might have in medicine. GuestDr Ian Scott FRACP MHA MEd (Director of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital; Professor of Medicine, University of Queensland)ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Thyone' by Ben Elson, ‘Broke No More' by Cushy, ‘Desert Hideout' by Christopher Moe Ditlevesen and ‘Alienated' by ELFL. Music courtesy of Free Music Archive includes ‘Capgras' by Ben Carey. Image by Olemedia licenced from Getty Images.Editorial feedback kindly provided by physicians; Rhiannon Mellor, David Arroyo, Aidan Tan, Joseph Lee, Rachel Murdoch, Michelle Chong, Phillipa Wormald and digital health academics; Paul Cooper and Natasa Lazarevic.Key ReferencesDemystifying machine learning: a primer for physicians [Scott, IMJ. 2021]Clinician checklist for assessing suitability of machine learning applications in healthcare [Scott, BMJ Health Care Inform. 2021]Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox, or any podcasting app.  

In this World Shared Practice Forum podcast, Dr. Ebor Jacob James discusses the current state of pediatric critical care in India. Dr. Jacob James describes clinical staffing models, fellowship and accreditation programs, as well as the impact of simulation training in these areas. He also provides background on PediSTARS, the Pediatric Simulation Training And Research Society in India, and describes the impact of the Stop the Bleed Project which provides life-saving training to first responders and non-healthcare professionals. Finally, Dr. Jacob James gives advice for learners interested in a career in medical education. Upon listening to this presentation, learners will be able to: - Identify the current state of pediatric critical care training in India - Describe the impact of pediatric simulation training in India on clinical practice - Discuss several educational innovations in India including the PediSTARS program and the Stop the Bleed Project Chapters 01:10 Current state of pediatric critical care training in India 07:21 Growth of simulation-based education and training 16:59 Virtual and distance simulation during the COVID-19 pandemic 22:06 The Stop the Bleed project 24:09 Advice for students interested in a career in medical education Publication date: May 23, 2023 Citation: James EJG, O'Hara JE, Wolbrink TA. Innovations in Education and Training in India. 05/2023. OPENPediatrics. Online Video: https://youtu.be/0nSnxcnWDmY. Podcast: https://on.soundcloud.com/jASqa. Articles Referenced: •Bhalala U, Khilnani P. Pediatric Critical Care Medicine Training in India: Past, Present, and Future. Front Pediatr. 2018;6:34. Published 2018 Feb 26. doi:10.3389/fped.2018.00034 •Ramachandra G, Deutsch ES, Nadkarni VM. A Road Map for Simulation Based Medical Students Training in Pediatrics: Preparing the Next Generation of Doctors. Indian Pediatr. 2020;57(10):950-956. •James EJG, Vyasam S, Venkatachalam S, et al. Low-Cost "Telesimulation" Training Improves Real Patient Pediatric Shock Outcomes in India. Front Pediatr. 2022;10:904846. Published 2022 Jul 26. doi:10.3389/fped.2022.904846 •Geethanjali Ramachandra, G.V. Ramana Rao, Shailaja Tetali, Devendar Karabu, Manideep Kanagala, Srinivas Puppala, Rani Janumpally, H.V. Rajanarsing Rao, Brendan Carr, Steven C. Brooks, Vinay Nadkarni, Active bleeding control pilot program in India: Simulation training of the community to stop the bleed and save lives from Road Traffic Injuries, Clinical Epidemiology and Global Health, Volume 11, 2021, 100729, ISSN 2213-3984, https://doi.org/10.1016/j.cegh.2021.100729. Additional References: Citation: James EJG, O'Hara JE, Wolbrink TA. Innovations in Education and Training in India. 05/2023. OPENPediatrics. Online Video: https://youtu.be/0nSnxcnWDmY. Podcast: https://soundcloud.com/openpediatrics/innovations-in-education-and-training-in-india-by-dr-ebor-jacob-james-for-openpediatrics. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.

Viscosupplementation is a procedure that involves injections of hyaluronic acid, most commonly into the knee joint. In the United States, one in every seven people receive a hyaluronic acid injection as first line treatment for their knee osteoarthritis. However, the effectiveness and safety of viscosupplementation has remained controversial. On this week's episode of Joint Action, we are joined by Bruno da Costa to discuss viscosupplementation, their effectiveness and safety.Dr. Bruno R. da Costa is Deputy Director of Trial Methodology Program at Nuffield Department of Population Health, University of Oxford, and Associate Professor of Clinical Epidemiology at the Institute of Health Policy, Management and Evaluation, University of Toronto. He has a Ph.D. in Clinical Epidemiology and Biostatistics from the University of Bern in Switzerland, a M.Sc. in Medical Statistics from the University of Leicester in the UK, and a M.Sc. in Physical Therapy from the University of Alberta in Canada. Dr. da Costa is considered to be an influential scientist in the field of musculoskeletal and cardiovascular disease and methodological research on comparative effectiveness. He has co-authored over 100 scholarly peer-reviewed publications, which have been published in prominent peer-reviewed scientific journals such as The New England Journal of Medicine, The Lancet, Journal of the American Medical Association (JAMA), and The BMJ.RESOURCESViscosupplementation for knee osteoarthritis: systematic review and meta-analysisCONNECT WITH USTwitter: @ProfDavidHunter @jointactionorgEmail: hello@jointaction.infoWebsite: www.jointaction.info/podcastIf you enjoyed this episode, don't forget to subscribe to learn more about osteoarthritis from the world's leading experts! And please let us know what you thought by leaving us a review! Hosted on Acast. See acast.com/privacy for more information.

Dr. Cykert is a Professor of Medicine at UNC-CH in the Division of General Internal Medicine and Clinical Epidemiology. He was the founding director of the UNC School of Medicine Program on Health and Clinical Informatics. See more at https://sph.unc.edu/adv_profile/samuel-cykert-md/

Do you want to join the fight for more equitable health and healthcare? The lads talked to Prof Celia Gregson about her life's mission to make healthcare not just fairer but better. It's a truly fascinating and inspiring insight into how one of our generational leaders is reaching out around the world to make everyone healthier. Sit back and enjoy this episode it's a cracker.Celia Gregson is a Professor of Clinical Epidemiology at Bristol Medical School, Consultant Orthogeriatrician, and Chair of the NOGG - National Osteoporosis Guideline Group.

The boys sit down with Julie, the reigning queen of pain science and mindfulness. She's got the degrees to back it up - Clinical Psychology, Clinical Epidemiology, and a PhD in behavioural medicine. Smart. We delve into the world of pain care, where waiting times are longer than a traffic jam on the way to a job you hate. But the good news? Chronic pain is finally being recognized as a public health emergency, and Julie thinks it's about time! She shares her thoughts on the nervous system, and how mindfulness is the gold standard for fixing the mess. We explore the reality of pain, which is real, no matter what anyone says. Pain impacts everything - your mental health, finances, relationships and more. Julie believes it's time for society to take back control and regulate their own nervous systems.

The boys sit down with Julie, the reigning queen of pain science and mindfulness. She's got the degrees to back it up - Clinical Psychology, Clinical Epidemiology, and a PhD in behavioural medicine. Smart. We delve into the world of pain care, where waiting times are longer than a traffic jam on the way to a job you hate. But the good news? Chronic pain is finally being recognized as a public health emergency, and Julie thinks it's about time! She shares her thoughts on the nervous system, and how mindfulness is the gold standard for fixing the mess. We explore the reality of pain, which is real, no matter what anyone says. Pain impacts everything - your mental health, finances, relationships and more. Julie believes it's time for society to take back control and regulate their own nervous systems.

Richard Gearhart and Elizabeth Gearhart, hosts of The Passage to Profit Show along with Kenya Gipson interview Brian Strom from Rutgers University Biomedical and Health Sciences, Erik Korem from AIM7 and John Nicholas from East Hampton Shucker Company. Brian Strom is chancellor of Rutgers Biomedical and Health Sciences (RBHS) and the executive vice president for health affairs at Rutgers University. Chancellor Strom was formerly the executive vice dean of institutional affairs, founding chair of the Department of Biostatistics and Epidemiology, founding director of the Center for Clinical Epidemiology and Biostatistics, and founding director of the Graduate Program in Epidemiology and Biostatistics, all at the Perelman School of Medicine of the University of Pennsylvania (Penn). Read more at: https://academichealth.rutgers.edu/chancellor/about-brian-strom Erik Korem is the founder of AIM7 Inc., an app that is bringing world-class wellness to anyone with a wearable device through its data intelligence platform, which unlocks the power of wearable and mobile health data to provide customized and predictive wellness solutions. AIM7 tells you exactly what you need to do each day to look, feel, and perform your best. They do this by providing you with daily personalized recommendations to enhance your body, mind, and recovery. Read more at: https://www.aim7.com/ John Nicholas is the founder of East Hampton Shucker Company and the inventor of his patented oyster shuckers. His shucker line includes the Teak Shucker, the Essential Shucker, the Metropolis Shucker and the Commercial Shucker. The East Hampton Shucker Company was founded on the belief that if more people could open oysters easily, safely without the risk of injury to enjoy these delectable and healthy Bivalves, then more people would consume them. Read more at: https://easthamptonshucker.com/ Visit https://passagetoprofitshow.com/ for the latest updates and episodes.

Dr. Criselle Peñamante is a physician-scientist interested in the field of behavioral epidemiology. She is a faculty member of the Department of Clinical Epidemiology, Department of Psychology, and Department of Medical Biology at the University of Sto. Tomas. An active global clinical researcher conducting studies and collaborating with fellow clinical researchers across the globe, she is also a Research Fellow on Climate Change and Mental Health at the Planetary and Global Health Program of St. Luke's Medical Center College of Medicine - William H. Quasha Memorial. We talked about being a physician-scientist as an alternative career path for medical doctors, her experiences regarding teaching college students online, the opportunities and challenges that come with being a global clinical research scholar, the field of behavioral epidemiology, the link between climate change and mental health, and more. How to contact Dr. Criselle: LinkedIn: linkedin.com/in/criselle-angeline-peñamante-500371154 Facebook: fb.com/Criselllllllle Twitter: @criselllllllle Email: ccpenamante@ust.edu.ph

In this episode Johnny and the fellas discuss 4 papers where BFR did not work! What?!? How can that be??? Well...gotta listen to find out! We begin by discussing briefly how hard research in medicine is... Here's a reference: Howick, J., Koletsi, D., Ioannidis, J. P. A., Madigan, C., Pandis, N., Loef, M., Walach, H., Sauer, S., Kleijnen, J., Seehra, J., Johnson, T., & Schmidt, S. (2022). Most healthcare interventions tested in Cochrane Reviews are not effective according to high quality evidence: a systematic review and meta-analysis. Journal of Clinical Epidemiology, 148, 160–169. And here's a podcast discussing the paper: https://ptinquest.com/episode-250-most-healthcare-interventions-lack-high-quality-evidence/ Here's the paper Zac describes: Tramer, J. S., Khalil, L. S., Jildeh, T. R., Abbas, M. J., McGee, A., Lau, M. J., Moutzouros, V., & Okoroha, K. R. (2022). Blood Flow Restriction Therapy For Two Weeks Prior to Anterior Cruciate Ligament Reconstruction Did Not Impact Quadriceps Strength Compared to Standard Therapy. Arthroscopy: The Journal of Arthroscopic & Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association. https://doi.org/10.1016/j.arthro.2022.06.027 Here's the paper Kyle describes: Iversen, E., Røstad, V., & Larmo, A. (2016). Intermittent blood flow restriction does not reduce atrophy following anterior cruciate ligament reconstruction. Journal of Sport and Health Science, 5(1), 115–118. Here's the paper Johnny describes: Curran, M. T., Bedi, A., Mendias, C. L., Wojtys, E. M., Kujawa, M. V., & Palmieri-Smith, R. M. (2020). Blood Flow Restriction Training Applied With High-Intensity Exercise Does Not Improve Quadriceps Muscle Function After Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial. The American Journal of Sports Medicine, 48(4), 825–837. And here's the paper Ben describes: Brumitt, J., Hutchison, M. K., Kang, D., Klemmer, Z., Stroud, M., Cheng, E., Cayanan, N. P., & Shishido, S. (2020). Blood Flow Restriction Training for the Rotator Cuff: A Randomized Controlled Trial. International Journal of Sports Physiology and Performance, 1–6. Intro soundbite: Trick or Treat (instrumental) by RYYZN https://soundcloud.com/ryyzn Creative Commons — Attribution 3.0 Unported — CC BY 3.0 Free Download / Stream: https://bit.ly/l_trick-or-treat Music promoted by Audio Library https://youtu.be/uNPXJ9CDzbc

Studies have shown that the rates of joint replacement surgeries has increased steadily over the past decade. In Australia alone, there are about 110,000 joint replacements performed every year. This number is expected to rise with the aging population and increasing rates of obesity. Furthermore, COVID-related cancellations and hospital restrictions will likely impact the provision of joint replacements for years to come. Although joint replacement surgery is an effective treatment for end-stage osteoarthritis, the volume of joint replacement surgeries being places a huge burden on the surgical workforce and the healthcare system. Ilana Ackerman is a Professor (Research) in the School of Public Health and Preventive Medicine at Monash University and a Deputy Director of the Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology. Ilana is a musculoskeletal epidemiologist and an experienced orthopaedic physiotherapist. She completed her PhD at The University of Melbourne in 2006. Over the past 15 years, Ilana has led a program of clinical and population-based research designed to quantify osteoarthritis impacts and joint replacement trends to inform optimal patient care. RESOURCESJournal articlesThe projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030Actual versus Forecast Burden of Primary Hip and Knee Replacement Surgery in Australia: Analysis of Data from the Australian Orthopaedic Association National Joint Replacement Registry Lifetime Risk of Primary Shoulder Arthroplasty From 2008 to 2017: A Population-Level Analysis Using National Registry Data WebsitesOrthoanswerAAOS CONNECT WITH ILANATwitter @IlanaAckermanCONNECT WITH USTwitter: @ProfDavidHunter @jointactionorgEmail: hello@jointaction.infoWebsite: www.jointaction.info/podcastIf you enjoyed this episode, don't forget to subscribe to learn more about osteoarthritis from the world's leading experts! See acast.com/privacy for privacy and opt-out information.

Professor Rachelle Buchbinder is an Australian NHMRC Senior Principal Research Fellow. She has been the Director of the Monash Department of Clinical Epidemiology since its inception in 2001 and a Professor in the Monash University Department of Epidemiology and Preventive Medicine since 2007. She is a rheumatologist and clinical epidemiologist who combines clinical practice with research in a wide range of multidisciplinary projects relating to arthritis and musculoskeletal conditions.Rachelle and her colleague Ian Harris have written a brilliant book called Hippocrasy, which reveals the true state of modern medicine and how doctors are letting their patients down.This powerful exposé reveals the tests, drugs and treatments that provide little or no benefit for patients and the inherent problem of a medical system based on treating rather than preventing illness. The book also provides tips to empower patients – do I really need this treatment? What are the risks? Are there simpler, safer options? What happens if I do nothing? Plus solutions to help restructure how medicine is delivered to help doctors live up to their Hippocratic Oath.Make sure you buy this brilliant book.