Podcasts about clinical guidelines

Learn how meta-analyses were manipulated and guidelines corrupted to promote statins for healthy people, especially women and the elderly. #StatinScandal #ConflictOfInterest #GuidelineBias #HealthTalks

Margo M. McKenna Benoit, MD, Director of Pediatric Otolaryngology at the University of Rochester Medical Center and Chair of the AAO-HNSF Guidelines Task Force, joins Maria Michaels, MBA, PMP, Immediate Past Chair of the Guidelines International Network (GIN) North America, to explore the transformation of clinical practice guidelines from static PDFs into dynamic, real-time clinical tools. Together, they tackle a sobering reality: it takes an average of 17 years for scientific evidence to reach clinical practice. Learn how the Guidelines Task Force evaluates and prioritizes new guideline topics, what makes a guideline truly "digitized" versus a traditional document, and how embedding guideline logic directly into EMR workflows can support clinicians without disrupting practice autonomy. Dr. McKenna Benoit and Michaels discuss strategies for reducing development cycle times, the concept of "living guidelines" that evolve with emerging evidence, and the role of health IT standards and AI in scaling evidence-based recommendations across healthcare systems while maintaining the scientific rigor that makes AAO-HNSF guidelines among the most cited publications in the specialty.

In this episode, Dr Brad Leech shares the exclusive results of his PhD research, which produced the first comprehensive clinical practice guidelines for intestinal permeability. Dispelling common myths about "leaky gut syndrome," Dr Leech explains why intestinal hyperpermeability is a legitimate physiological reaction—not a syndrome—and how his meticulously developed, evidence-based guidelines can transform clinical practice.This episode provides invaluable insights into the following:The rigorous methodology behind developing clinical practice guidelines, including stakeholder engagement, comprehensive literature review, and systematic evaluation of over 10,000 research articlesThe critical importance of risk-of-bias assessment when evaluating research—a cornerstone of methodology that helps practitioners look beyond cherry-picked studies and misleading claimsHow to systematically evaluate research quality by examining randomization procedures, analysis methods, conflict of interests and  clinical relevance rather than accepting published findings at face valueSurprising findings about commonly used interventions in intestinal permeability, including evidence that certain probiotics may not be effective for NSAID-induced permeability despite their widespread recommendationEvidence-based assessment of treatments for intestinal permeability using the NHMRC grading matrix to evaluate research qualityPractical recommendations and evidence-supported interventions that meet the threshold for clinical relevanceDr Leech's work represents a significant advancement in the field, bringing scientific rigour to an area often clouded by opinion and marketing claims. Learn how these new guidelines can help you make more informed clinical decisions and improve patient outcomes through evidence-based approaches to intestinal permeability.Connect with Dr Leech: Dr Brad LeechRead: The IP GuidelineShownotes and references are available on the Designs for Health websiteRegister as a Designs for Health Practitioner and discover quality practitioner- only supplements at www.designsforhealth.com.auFollow us on SocialsInstagram: DesignsforhealthausFacebook: DesignsforhealthausDISCLAIMER: The Information provided in the Wellness by Designs podcast is for educational purposes only; the information presented is not intenShownotes and references are available on the Designs for Health websiteRegister as a Designs for Health Practitioner and discover quality practitioner- only supplements at www.designsforhealth.com.au Follow us on Socials Instagram: Designsforhealthaus Facebook: Designsforhealthaus DISCLAIMER: The Information provided in the Wellness by Designs podcast is for educational purposes only; the information presented is not intended to be used as medical advice; please seek the advice of a qualified healthcare professional if what you have heard here today raises questions or concerns relating to your health

Let's be honest – the occlusion after Aligner cases can be a little ‘off' (even after fixed appliances!) How do you know if your patient's occlusion after aligner treatment is acceptable or risky? What practical guidelines can general dentists follow to manage occlusion when orthodontic results aren't textbook-perfect? Jaz and Dr. Jesper Hatt explore the most common challenges dentists face, from ClinCheck errors and digital setup pitfalls to balancing aesthetics with functional occlusion. They also discuss key strategies to help you evaluate, guide, and optimize occlusion in your patients, because understanding what is acceptable and what needs intervention can make all the difference in long-term treatment stability and patient satisfaction. https://youtu.be/e74lUbyTCaA Watch PDP250 on YouTube Protrusive Dental Pearl: Harmony and Occlusal Compatibility Always ensure restorative anatomy suits the patient's natural occlusal scheme and age-related wear. If opposing teeth are flat and amalgam-filled, polished cuspal anatomy will be incompatible — flatten as needed to conform. Need to Read it? Check out the Full Episode Transcript below! Key Takeaways Common mistakes in ClinCheck planning often stem from occlusion issues. Effective communication and documentation are crucial in clinical support. Occlusion must be set correctly to ensure successful treatment outcomes. Understanding the patient’s profile is essential for effective orthodontics. Collaboration between GPs and orthodontists can enhance patient care. Retention of orthodontic results is a lifelong commitment. Aesthetic goals must align with functional occlusion in treatment planning. Informed consent is critical when discussing potential surgical interventions. The tongue plays a crucial role in orthodontic outcomes. Spacing cases should often be approached as restorative cases. Aligners can achieve precise spacing more effectively than fixed appliances. Enamel adjustments may be necessary for optimal occlusion post-treatment. Retention strategies must be tailored to individual patient needs. Case assessment is vital for determining treatment complexity. Highlights of this episode: 00:00 Teaser 00:59 Intro 02:53  Pearl – Harmony and Occlusal Compatibility 05:57 Dr. Jesper Hatt Introduction 07:34 Clinical Support Systems 10:18 Occlusion and Aligner Therapy 20:41 Bite Recording Considerations 25:32 Collaborative Approach in Orthodontics 30:31 Occlusal Goals vs. Aesthetic Goals 31:42 Midroll 35:03 Occlusal Goals vs. Aesthetic Goals 35:25 Challenges with Spacing Cases 42:19 Occlusion Checkpoints After Aligners 50:17 Considerations for Retention 54:55 Case Assessment and Treatment Planning 58:14 Key Lessons and Final Thoughts 01:00:19 Interconnectedness of Body and Teeth 01:02:48 Resources for Dentists and Case Support 01:04:40 Outro Free Aligner Case Support!Send your patient's case number and get a full assessment in 24 hours—easy, moderate, complex, or referral. Plus, access our 52-point planning protocol and 2-min photo course. No uploads, no cost. [Get Free Access Now] Learn more at alignerservice.com If you enjoyed this episode, don't miss: Do's and Don'ts of Aligners [STRAIGHTPRIL] – PDP071 #PDPMainEpisodes #OcclusionTMDandSplints #OrthoRestorative This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes A and C. AGD Subject Code: 370 ORTHODONTICS (Functional orthodontic therapy) Aim: To provide general dentists with practical guidance for managing occlusion in aligner therapy, from bite capture to retention, including common pitfalls, functional considerations, and case selection. Dentists will be able to – Identify common errors in digital bite capture and occlusion setup. Understand the impact of anterior inclination and mandibular movement patterns on occlusal stability. Plan retention strategies appropriate for aligner and restorative cases. Click below for full episode transcript: Teaser: The one thing that we always check initially is the occlusion set correct by the aligner company. Because if the occlusion is not set correctly, everything else just doesn't matter because the teeth will move, but into a wrong position because the occlusion is off from the beginning. I don't know about you, but if half the orthodontists are afraid of controlling the root movements in extraction cases, as a GP, I would be terrified. Teaser:I don’t care if you just move from premolar to premolar or all the teeth. Orthodontics is orthodontics, so you will affect all the teeth during the treatment. The question’s just how much. Imagine going to a football stadium. The orthodontist will be able to find the football stadium.  If it’s a reasonable orthodontist, he’ll be able to find the section you’re going to sit in, and if he’s really, really, really good, he will be able to find the row that you’re going to sit in, but the exact spot where you are going to sit… he will never, ever be able to find that with orthodontics. Jaz’s Introduction: Hello, Protruserati. I’m Jaz Gulati. Welcome back to your favorite dental podcast. I’m joined today by our guest, Dr. Jesper Hatt. All this dentist does is help other dentists with their treatment plans for aligners. From speaking to him, I gather that he’s no longer practicing clinically and is full-time clinical support for colleagues for their aligner cases. So there’s a lot we can learn from someone who day in day out has to do so much treatment planning and speaking to GDPs about their cases, how they’re tracking, how they’re not tracking, complications, and then years of seeing again, okay, how well did that first set of aligners actually perform? What is predictable and what isn’t? And as well as asking what are the most common errors we make on our ClinChecks or treatment plan softwares. I really wanted to probe in further. I really want to ask him about clinical guidelines for occlusion after ortho. Sometimes we treat a case and whilst the aesthetics of that aligner case is beautiful, the occlusion is sometimes not as good. So let’s talk about what that actually means. What is a not-good occlusion? What is a good occlusion? And just to offer some guidelines for practitioners to follow because guess what? No orthodontist in the world is gonna ever get the occlusion correct through ortho. Therefore, we as GPs are never gonna get a perfect textbook occlusion, but we need to understand what is acceptable and what is a good guideline to follow. That’s exactly what we’ll present to you in this episode today. Dental PearlNow, this is a CE slash CPD eligible episode and as our main PDP episode, I’ll give you a Protrusive Dental Pearl. Today’s pearl is very much relevant to the theme of orthodontics and occlusion we’re discussing today, and it’s probably a pearl I’ve given to you already in the past somewhere down the line, but it’s so important and so key. I really want to just emphasize on it again. In fact, a colleague messaged me recently and it reminded me of this concept I’m about to explain. She sent me an image of a resin bonded bridge she did, which had failed. It was a lower incisor, and just a few days after bonding, it failed. And so this dentist is feeling a bit embarrassed and wanted my advice. Now, by the way, guys, if you message me for advice on Instagram, on Facebook, or something like that, it’s very hit and miss. Like my priorities in life are family, health, and everything that happens on Protrusive Guidance. Our network. If you message me outside that network, I may not see it. The team might, but I may not see it. It’s the only way that I can really maintain control and calm in my life. The reason for saying this, I don’t want anyone to be offended. I’m not ignoring anyone. It’s just the volume of messages I get year on year, they’re astronomical. And I don’t mind if you nudge me. If you messaged me something weeks or months ago and I haven’t replied, I probably haven’t seen it. Please do nudge me. And the best place to catch me on is Protrusive Guidance. If you DM me on Protrusive Guidance, home of the nicest and geekiest dentists in the world, that’s the only platform I will log in daily. That’s our baby, our community. Anyway, so I caught this Facebook message and it was up to me to help this colleague. And one observation I made is that the lower teeth were all worn. The upper teeth were really worn, but this resin bonded bridge pontic, it just looked like a perfect tooth. The patient was something like 77 or 80. So it really made me think that, okay, why are we putting something that looks like a 25-year-old’s tooth in a 77-year-old? But even forgetting age and stuff, you have to look at the adjacent teeth in the arch. Is your restoration harmonious with the other teeth in the arch, and of course is the restoration harmonious with what’s opposing it? Because it’s just not compatible. So part one of this pearl is make sure any restoration you do, whether it’s direct or indirect, is harmonious with the patient’s arch and with the opposing teeth and with their occlusal scheme. Because otherwise, if you get rubber dam on and you give your 75-year-old patient beautiful composite resin, it’s got all that cuspal fissure pattern and anatomy, and you take that rubber dam off and you notice that all the other teeth are flat and the opposing teeth are flat amalgams, guess what? You’re gonna be making your composite flat, whether you like it or not. You created a restoration that’s proud, right? That’s why you did not conform to the patient’s own arch or existing anatomical scheme. So the part B of this is the thing that I get very excited to talk about, right? So sometimes you have a worn dentition, but then you have one tooth that’s not worn at all. It’s like that in-standing lateral incisor, right? Think of an upper lateral incisor that’s a bit in-standing, and you see some wear on all the incisors, but that lateral incisor does not have any wear in it because it was never in the firing line. It was never in function. It was never in parafunction. Now, if you give this patient aligners or fixed appliances, you’re doing ortho and you’re now going to align this lateral incisor. So it’s now gonna eventually get into occlusion and it will be in the functional and parafunctional pathways of this patient. Do you really think you can just leave that incisor be? No. It’s not gonna be compatible with the adjacent teeth. It’s not going to be compatible with the opposing tooth and the occlusal scheme. So guess what? You have to get your bur out or your Sof-Lex disc out, and you have to bake in some years into that tooth. Or you have to build up all the other teeth if appropriate for that patient. You’ve just gotta think about it. And I hope that makes sense so you can stay out of trouble. You’re not gonna get chipping and you can consent your patient appropriately for enamel adjustment, which is something that we do talk about in this episode. I think you’re in for an absolute cracker. I hope you enjoy. I’ll catch you in the outro. Main Episode: Doctor Jesper Hatt, thank you so much for coming to Protrusive Dental Podcast. We met in Scandinavia, in Copenhagen. You delivered this wonderful lecture and it was so nice to connect with you then and to finally have you on the show. Tell us, how are you, where in the world are you, and tell us about yourself. [Jesper] Well, thank you for the invitation, first of all. Well, I’m a dentist. I used to practice in Denmark since I originally come from Denmark. My mother’s from Germany, and now I live in Switzerland and have stopped practicing dentistry since 2018. Now I only do consulting work and I help doctors around the world with making their aligner business successful. [Jaz] And this is like probably clinical advice, but also like strategic advice and positioning and that kinda stuff. Probably the whole shebang, right? [Jesper] Yeah. I mean, I have a team around me, so my wife’s a dentist as well, and I would say she’s the expert in Europe on clear aligners. She’s been working for, first of all, our practice. She’s a dentist too. She worked with me in the practice. We practiced together for 10 years. Then she became a clinical advisor for Allion Tech with responsibility for clinical support of Scandinavia. She was headhunted to ClearCorrect, worked in Basel while I was doing more and more consulting stuff in Denmark. So she was traveling back and forth, and I considered this to be a little bit challenging for our family. So I asked her, well, why don’t we just relocate to Switzerland since ClearCorrect is located there? And sure we did. And after two years she told me, I think clinical support, it’s okay. And I like to train the teams, but I’d really like to do more than that because she found out that doctors, they were able to book a spot sometime in the future, let’s say two weeks out in the future at a time that suited the doctors… no, not the doctors, ClearCorrect. Or Invisalign or whatever clear aligner company you use. So as a doctor, you’re able to block the spot and at that time you can have your 30 minutes one-on-one online with a clinical expert. And she said it’s always between the patients or administrative stuff. So they’re not really focused on their ClearCorrect or clear aligner patient. And so they forget half of what I tell them. I can see it in the setups they do. They end up having to call me again. It doesn’t work like that. I would like to help them. [Jaz] It’s a clunky pathway of mentorship. [Jesper] Yes. And so she wanted to change the way clinical support was built up. So we do it differently. We do it only in writing so people can remember what we are telling them. They can always go back in the note and see what’s been going on, what was the advice we gave them, and we offer this co-creation support where we take over most of the treatment planning of the ClearCorrect or Clear Aligner or Spark or Invisalign or Angel Aligner treatment planning. So we do all the digital planning for the doctor, deliver what we think would be right for the patient based on the feedback we initially got from the doctor. And then the doctor can come back and say, well, I’d like a little more space for some crowns in the front, or I would like the canines to be in a better position in order to achieve immediate post disclusion. And so we can go into this discussion back and forth and adjust the digital setup in a way that is more realistic and predictable and do it all for the doctors. So they, on an average, they spend four to six hours less chair time when they use that kind of service compared to if they do everything themselves. And on top of that, you can put your planning time. She was responsible for that and it works quite well. I still remember when we initially got on all these online calls and we would see fireworks in the background and confetti coming down from the top and all of that. [Jaz] Exactly. So excuse that little bit, but okay. So essentially what you’re doing is, for an aligner user myself, for example, you’re doing the ClinChecks, you are helping, supporting with the ClinChecks, the planning. And I’ve got a lot of questions about that. The first question I’ll start with, which is off the script, but there’s probably a hundred different mistakes that could happen in a ClinCheck, right? But what is the most repeatable, predictable, common mistake that you’ll see when a new user sends a case to you to help them with their planning? What’s the most common mistake that you will see in a setup? [Jesper] Two things, actually. The one thing that we always check initially is the occlusion set correct by the aligner company. Because if the occlusion is not set correctly, everything else just doesn’t matter because the teeth will move but into a wrong position because the occlusion is off from the beginning. And so we always check that as the first part. How does this— [Jaz] So let’s talk about that ’cause that might be confusing for a younger colleague because they’re like, hey, hang on a minute. I scanned the bite left and right. What do you mean the occlusion is wrong? Because surely that gets carried through into what I see on the ClinCheck. So what do you think is the mechanism for this to happen? [Jesper] Two different reasons. I’m from a time when I graduated in 2003, so that was before digital dentistry. So when I went to the Pankey Institute and learned everything about functional occlusion and all of that stuff, I also found out that most of my patients, when I put silicone impression material between the teeth and asked the patients to bite together, they would always protrude a little bit unless I instructed them to bite hard on the posterior teeth. And when we got the scanners, when we put a scanner into the cheek and pull the cheek, most patients, when we asked them to bite together to do the intraoral scan of the bite, they also protruded a little bit, not much, but enough to set the bite wrong. So that is the one challenge when the technicians of the aligner companies put the models together. The other challenge is that some of the aligner companies, they let the technicians set the models. We always, as the first thing when we see a case, we always look at the photos, the clinical photos. And that’s why the clinical photos have to be of great quality. So we look at the clinical photos of the patient— [Jaz] And also in those clinical photos, Jesper, you have to coach them correctly to bite. You have to notice if they’re biting wrong even in the photos ’cause then it just duplicates the error. And that’s why good photography and actually being able to coach the patient is so imperative. [Jesper] Yes, that’s correct. But we compare the two and usually if we see a difference, we ask the doctor, is what we see in the photo correct, or is what we see on the digital models correct? And because we don’t like differences. So that would be the first step to look for. And what’s the second? The second thing is that when you look at the setup, the anterior teeth are usually—I’m trying to show you—the anterior teeth are very, very steep. Typically with aligners it’s a lot easier to tip the crowns. So when you have a class II patient, deviation one, where the anteriors are in a forward position, proclined, and you have a lot of space between the anteriors of the maxilla and the mandible, then the easiest thing on a digital setup is to just retrocline the anteriors of the upper to make them fit the lowers, which you could then procline a little bit, but usually you have very steep relationships between the two and this— [Jaz] So you’re more likely to restrict the envelope of function, functional interference anteriorly. You are obviously reducing the overjet, but you may end up reducing like a wall contact rather than an elegant, more open gate. [Jesper] Yes. And there’s another dimension to this because when we work with orthodontics, one of the most important things to look for is actually the profile of the patient. Because let’s say I’m trying to illustrate this now, so I hope you get a 90— [Jaz] So describe it for our audio listeners as well. So we’re looking at a profile view of Jesper. [Jesper] Yes. So I’m turning the side to the camera. I hope you can see my profile here. So let’s say I had flared anterior maxillary teeth and I wanted to retrocline them. It would have an effect on my upper lip, so the lip would fall backwards if I just retrocline everything. And every millimeter we move the anteriors in the maxilla in a posterior direction, we will have a potential lip drop of three millimeters. In addition, if we don’t get the nasolabial angulation correct, we risk the lower face will simply disappear in the face of the patient. So soft tissue plays a role here, so we cannot just retrocline the teeth. It looks great on the computer screen, but when it comes to reality, we’ll have a functional challenge. We’ll have a soft tissue support challenge, and in addition we’ll have long-term retention challenges as well. Because when you have a steep inclination, the anterior teeth in the mandible, they don’t have any kind of support. They will not be stopped by anything in the maxillary teeth, which you would if you had the right inclination between the teeth, which would be about 120 degrees. So why do aligner companies always set the teeth straight up and down in the anterior part? We wondered about this for years. We don’t have a strict answer. We don’t know exactly why it’s like this, but I have a hunch. I think there are two things to it. First of all, the easiest thing to do with aligners is to move the crown, so we can just tip the teeth. You take them back, you make a lot of IPR, and then you just tip them so they’re retroclined. Secondly, all aligner companies, they come from the United States. And in the United States there is a higher representation of class III patients. Now why is that important? All our patients can be put into two different categories in regards to how they move their mandible. They are the crocodiles that only open and close, like move up and down, and then we have the cows. And then we have the cows that move the mandible around, or the camels. I mean, every camel, if you’ve seen a camel chew, it’s just moving from side to side. [Jaz] Horses as well. Horses as well. [Jesper] They kind of do that. [Jaz] But I’m glad you didn’t say rats ’cause it’s more elegant to be a crocodile than a rat. [Jesper] Exactly. And I usually say we only tell the crocodiles. So why is this a challenge and why isn’t it a challenge with class III patients? Well, all real class III patients act like crocodiles, so they don’t move them side to side. From a functional perspective, it’s really not a problem having steep anterior inclination or steep relationships as long as you have a stable stop where the anteriors—so the anteriors will not elongate and create the red effect. So they just elongate until they hit the palate. If you can make a stop in the anterior part of the occlusion, then you’ll have some kind of stability with the class III patients. But with class II patients, we see a lot more cows. So they move the mandible from side to side and anterior and back and forth and all… they have the mandible going all kinds of places. And when they do that, we need some kind of anterior guidance to guide the mandible. I usually say the upper jaw creates the framework in which the mandible will move. So if the framework is too small, we fight the muscles. And whenever we fight the muscles, we lose because muscles always win. It doesn’t matter if it’s teeth, if it’s bone, if it’s joints, they all lose if they fight the muscles— [Jaz] As Peter Dawson would say, in the war between teeth and muscles or any system and muscles, the muscles always win. Absolutely. And the other analogy you remind me of is the maxilla being like a garage or “garage” from UK, like a garage. And the mandible being like the car, and if you’re really constrained, you’re gonna crash in and you’re gonna… everything will be in tatters. So that’s another great way to think about it. Okay. That’s very, very helpful. I’m gonna—’cause there’s so much I wanna cover. And I think you’ve really summed up nicely. But one thing just to finish on this aspect of that common mistake being that the upper anteriors are retroclined, really what you’re trying to say is we need to be looking at other modalities, other movements. So I’m thinking you’re saying extraction, if it’s suitable for the face, or distalisation. Are you thinking like that rather than the easier thing for the aligners, which is the retrocline. Am I going about it the right way? [Jesper] Depends on the patient. [Jaz] Of course. [Jesper] Rule of thumb: if you’re a GP, don’t ever touch extraction cases. Rule of thumb. Why? Because it is extremely challenging to move teeth parallel. So you will most—especially with aligners—I mean, I talk with a very respected orthodontist once and I asked him, well, what do you think about GPs treating extraction cases where they extract, you know, two premolars in the maxilla? And he said, well, I don’t know how to answer this. Let me just explain to you: half of my orthodontist colleagues, they are afraid of extraction cases. And I asked them why. Because it’s so hard to control the root movement. Now, I don’t know about you— [Jaz] With aligners. We’re specifically talking about aligners here, right? [Jesper] With all kinds of orthodontic appliances. [Jaz] Thank you. [Jesper] So now, I don’t know about you, but if half the orthodontists are afraid of controlling the root movements in extraction cases, as a GP, I would be terrified. And I am a GP. So I usually say, yeah, sometimes you will have so much crowding and so little space in the mandible, so there’s an incisor that is almost popped out by itself. In those cases, yes. Then you can do an extraction case. But when we’re talking about premolars that are going to be extracted, or if you want to close the space in the posterior part by translating a tooth into that open space, don’t. It’s just the easiest way to end up in a disaster because the only thing you’ll see is just teeth that tip into that space, and you’ll have a really hard time controlling the root movements, getting them corrected again. [Jaz] Well, thank you for offering that guideline. I think that’s very sage advice for those GPs doing aligners, to stay in your lane and just be… the best thing about being a GP, Jesper, is you get to cherry pick, right? There’s so many bad things about being a GP. Like you literally have to be kinda like a micro-specialist in everything in a way. And so sometimes it’s good to be like, you know what, I’ll keep this and I’ll send this out. And being selective and case selection is the crux of everything. So I’m really glad you mentioned that. I mean, we talked and touched already on so much occlusion. The next question I’m gonna ask you then is, like you said, a common error is the bite and how the bite appears on the ClinCheck or whichever software a dentist is using. Now, related to bite, vast majority of orthodontic cases are treated in the patient’s existing habitual occlusion, their maximum intercuspal position. Early on in my aligner journey, I had a patient who had an anterior crossbite. And because of that anterior crossbite, their jaw deviated. It was a displaced—the lower jaw displaced. And then I learned from that, that actually for that instance, perhaps I should not have used an MIP scan. I should have used more like centric relation or first point of contact scan before the displacement of the jaw happens. So that was like always in my mind. Sometimes we can and should be using an alternative TMJ position or a bite reference other than MIP. Firstly, what do you think about that kind of scenario and are there any other scenarios which you would suggest that we should not be using the patient’s habitual occlusion for their bite scan for planning orthodontics? [Jesper] Well, I mentioned that I was trained at the Pankey Institute, and when you start out right after—I mean, I spent 400 hours over there. Initially, I thought I was a little bit brainwashed by that because I thought every single patient should be in centric relation. Now, after having put more than 600 patients on the bite appliance first before I did anything, I started to see some patterns. And so today, I would say it’s not all patients that I would get into centric relation before I start treating the teeth. But when we talk about aligner therapy and orthodontic treatment, I think it’s beneficial if you can see the signs for those patients where you would say, hmm, something in the occlusion here could be a little bit risky. So let’s say there are wear facets on the molars. That will always trigger a red flag in my head. Let’s say there are crossbites or bite positions that kind of lock in the teeth. We talked about class III patients before, and I said if it’s a real skeletal-deviation class III patient, it’s a crocodile. But sometimes patients are not real class III skeletal deviation patients. They’re simply being forced into a class III due to the occlusion. That’s where the teeth fit together. So once you put aligners between the teeth and plastic covers the surfaces, suddenly the patients are able to move the jaws more freely and then they start to seat into centric. That may be okay. Usually it is okay. The challenge is consequences. So when you’re a GP and you suddenly see a patient moving to centric relation and you find out, whoa, on a horizontal level there’s a four- to six-millimeter difference between the initial starting point and where we are now, and maybe we create an eight-millimeter open bite in the anterior as well because they simply seat that much. And I mean, we have seen it. So is this a disaster? Well, it depends. If you have informed the patient well enough initially and said, well, you might have a lower jaw that moves into a different position when we start out, and if this new position is really, really off compared to where you are right now, you might end up needing maxillofacial surgery, then the patient’s prepared. But if they’re not prepared and you suddenly have to tell them, you know, I think we might need maxillofacial surgery… I can come up with a lot of patients in my head that would say, hey doctor, that was not part of my plan. And they will be really disappointed. And at that point there’s no turning back, so you can’t reverse. So I think if you are unsure, then you are sure. Then you should use some kind of deprogramming device or figure out where is centric relation on this patient. If there isn’t that much of a difference between maximum intercuspation and centric— [Jesper] Relation, I don’t care. Because once you start moving the teeth, I don’t care if you just move from premolar to premolar or all the teeth. Orthodontics is orthodontics, so you will affect all the teeth during the treatment. The question’s just how much. And sometimes it’s just by putting plastic between the teeth that you will see a change, not in the tooth position, but in the mandibular position. And I just think it’s nicer to know a little bit where this is going before you start. And the more you see of this—I mean, as I mentioned, after 600 bite appliances in the mouths of my patients, I started to see patterns. And sometimes in the end, after 20 years of practicing, I started to say, let’s just start, see where this ends. But I would always inform the patients: if it goes totally out of control, we might end up needing surgery, and there’s no way to avoid it if that happens. And if the patients were okay with that, we’d just start out. Because I mean, is it bad? No. I just start the orthodontic treatment and I set the teeth as they should be in the right framework. Sometimes the upper and the lower jaw don’t fit together. Well, send them to the surgeon and they will move either the upper or the lower jaw into the right position, and then we have it. No harm is done because we have done the initial work that the orthodontist would do. But I will say when I had these surgical patients—let’s say we just started out with aligners and we figured, I can’t control this enough. I need a surgeon to look at this—then I would send them off to an orthodontist, and the orthodontist and the surgeon would take over. Because then—I mean, surgical patients and kids—that’s the second group of patients besides the extraction cases that I would not treat as a GP. ‘Cause we simply don’t know enough about how to affect growth on kids. And when it comes to surgery, there’s so much that is… so much knowledge that we need to know and the collaboration with the surgeons that we’re not trained to handle. So I think that should be handled by the orthodontists as well. [Jaz] I think collaborative cases like that are definitely specialist in nature, and I think that’s a really good point. I think the point there was informed consent. The mistake is you don’t warn the patient or you do not do the correct screening. So again, I always encourage my guests—so Jesper, you included—that we may disagree, and that’s okay. That’s the beauty of dentistry. So something that I look for is: if the patient has a stable and repeatable maximum intercuspal position, things lock very well, and there’s a minimal slide—like I use my leaf gauge and the CR-CP is like a small number of leaves and the jaw hardly moves a little bit—then there’s no point of uncoupling them, removing that nice posterior coupling that they have just to chase this elusive joint position. Then you have to do so many more teeth. But when we have a breakdown in the system, which you kind of said, if there’s wear as one aspect, or we think that, okay, this patient’s occlusion is not really working for them, then we have an opportunity to do full-mouth rehabilitation in enamel. Because that’s what orthodontics is. And so that’s a point to consider. So I would encourage our GP colleagues to look at the case, look at the patient in front of you, and decide: is this a stable, repeatable occlusion that you would like to use as a baseline, or is there something wrong? Then consider referring out or considering—if you’re more advanced in occlusion studies—using an alternative position, not the patient’s own bite as a reference. So anything you wanna add to that or disagree with in that monologue I just said there? [Jesper] No, I think there’s one thing I’d like the listeners to consider. I see a lot of fighting between orthodontists and GPs, and I think it should be a collaboration instead. There’s a lot of orthodontists that are afraid of GPs taking over more and more aligner treatments, and they see a huge increase in the amount of cases that go wrong. Well, there’s a huge increase of patients being treated, so there will be more patients, just statistically, that will get into problems. Now, if the orthodontist is smart—in my opinion, that’s my opinion—they reach out to all their referring doctors and they tell them, look, come in. I will teach you which cases you can start with and which you should refer. Let’s start there. Start your aligner treatments. Start out, try stuff. I will be there to help you if you run into problems. So whenever you see a challenge, whenever there’s a problem, send the patient over to me and I’ll take over. But I will be there to help you if anything goes wrong. Now, the reason this is really, really a great business advice for the orthodontists is because once you teach the GPs around you to look for deviations from the normal, which would be the indication for orthodontics, the doctors start to diagnose and see a lot more patients needing orthodontics and prescribe it to the patients, or at least propose it to the patients. Which would initially not do much more than just increase the amount of aligner treatments. But over time, I tell you, all the orthodontists doing this, they are drowning in work. So I mean, they will literally be overflown by patients being referred by all the doctors, because suddenly all the other doctors around them start to diagnose orthodontically. They see the patients which they haven’t seen before. So I think this is—from a business perspective—a really, really great thing for the orthodontists to have a collaboration with this. And it’ll also help the GPs to feel more secure when they start treating their patients. And in the end, that will lead to more patients getting the right treatment they deserve. And I think that is the core. That is what’s so important for us to remember. That’s what we’re here for. I mean, yes, it’s nice to make money. We have to live. It’s nice with a great business, but what all dentists I know of are really striving for is to treat their patients to the best of their ability. And this helps them to do that. [Jaz] Ultimate benefactor of this collaborative approach is the patient. And I love that you said that. I think I want all orthodontists to listen to that soundbite and take it on board and be willing to help. Most of them I know are lovely orthodontists and they’re helping to teach their GPs and help them and in return they get lots of referrals. And I think that’s the best way to go. Let’s talk a little bit about occlusal goals we look for at the end of orthodontics. This is an interesting topic. I’m gonna start by saying that just two days ago I got a DM from one of the Protruserati, his name is Keith Curry—shout out to him on Instagram—and he just sent me a little message: “Jaz, do you sometimes find that when you’re doing alignment as a GP that it’s conflicting the orthodontic, the occlusal goal you’re trying to get?” And I knew what I was getting to. It’s that scenario whereby you have the kind of class II division 2, right? But they have anterior guidance. Now you align everything, okay, and now you completely lost anterior guidance. And so the way I told him is that, you know what, yes, this is happening all the time. Are we potentially at war between an aesthetic smile and a functional occlusion? And sometimes there’s a compromise. Sometimes you can have both. But that—to achieve both—needs either a specialist set of eyes or lots of auxiliary techniques or a lot more time than what GPs usually give for their cases. So first let’s touch on that. Do you also agree that sometimes there is a war between what will be aesthetic and what will be a nice functional occlusion? And then we’ll actually talk about, okay, what are some of the guidelines that we look for at the end of completing an aligner case? [Jesper] Great question and great observation. I would say I don’t think there’s a conflict because what I’ve learned is form follows function. So if you get the function right, aesthetics will always be great. Almost always. I mean, we have those crazy-shaped faces sometimes, but… so form follows function. The challenge here is that in adult patients, we cannot manipulate growth. So a skeletal deviation is a skeletal deviation, which means if we have a class II patient, it’s most likely that that patient has a skeletal deviation. I rarely see a dental deviation. It happens, but it’s really, really rare. So that means that in principle, all our class II and chronic class III patients are surgical patients. However, does that mean that we should treat all our class II and class III patients surgically? No, I don’t think so. But we have to consider that they are all compromise cases. So we need to figure a compromise. So initially, when I started out with my occlusal knowledge, I have to admit, I didn’t do the orthodontic treatment planning. I did it with Heller, and she would give me feedback and tell me, I think this is doable and this is probably a little bit challenging. If we do this instead, we can keep the teeth within the bony frame. We can keep them in a good occlusion. Then I would say, well, you have a flat curve of Spee. I’d like to have a little bit of curve. It’s called a curve of Spee and not the orthodontic flat curve of Spee. And then we would have a discussion back and forth about that. Then initially I would always want anterior coupling where the anterior teeth would touch each other. I have actually changed that concept in my mind and accepted the orthodontic way of thinking because most orthodontists will leave a little space in the anterior. So when you end the orthodontic treatment, you almost always have a little bit of space between the anterior teeth so they don’t touch each other. Why? Because no matter what, no matter how you retain the patient after treatment, there will still be some sort of relapse. And we don’t know where it’ll come or how, but it will come. Because the teeth will always be positioned in a balance between the push from the tongue and from the cheeks and the muscles surrounding the teeth. And that’s a dynamic that changes over the years. So I don’t see retention as a one- or two-year thing. It’s a lifelong thing. And the surrounding tissues will change the pressure and thereby the balance between the tongue and the cheeks and where the teeth would naturally settle into position. Now, that said, as I mentioned initially, if we fight the muscles, we’ll lose. So let’s say we have an anterior open bite. That will always create a tongue habit where the patient positions the tongue in the anterior teeth when they swallow because if they don’t, food and drink will just be splashed out between the teeth. They can’t swallow. It will just be pushed out of the mouth. [Jaz] So is that not like a secondary thing? Like that tongue habit is secondary to the AOB? So in those cases, if you correct the anterior open bite, theoretically should that tongue posture not self-correct? [Jesper] Well, we would like to think so, but it’s not always the case. And there’s several reasons to it. Because why are the teeth in the position? Is it because of the tongue or because of the tooth position? Now, spacing cases is one of those cases where you can really illustrate it really well. It looks really easy to treat these patients. If we take away all the soft tissue considerations on the profile photo, I mean, you can just retract the teeth and you close all the spaces—super easy. Tipping movements. It’s super easy orthodontically to move quickly. Very easy as well. However, you restrict the tongue and now we have a retention problem. So there are three things that can happen. You can bond a retainer on the lingual side or the palatal side of the teeth, upper, lower—just bond everything together—and after three months, you will have a diastema distal to the bonded retainer because the tongue simply pushes all the teeth in an anterior direction. [Jaz] I’ve also seen—and you’ve probably seen this as well—the patient’s tongue being so strong in these exact scenarios where the multiple spacing has been closed, which probably should have been a restorative plan rather than orthodontic plan, and the retainer wire snaps in half. [Jesper] Yes, from the tongue. [Jaz] That always fascinated me. [Jesper] Well, you’ll see debonding all the time, even though you sandblast and you follow all the bonding protocol. And debonding, breaking wires, diastemas in places where you think, how is that even possible? Or—and this is the worst part—or you induce sleep apnea on these patients because you simply restrict the space for the tongue. So they start snoring, and then they have a total different set of health issues afterwards. So spacing—I mean, this just illustrates the power of the tongue and why we should always be careful with spacing cases. I mean, spacing cases, in my opinion, are always to be considered ortho-restorative cases. Or you can consider, do you want to leave some space distal to the canines? Because there you can create an optical illusion with composites. Or do you want to distribute space equally between the teeth and place veneers or crowns or whatever. And this is one of those cases where I’d say aligners are just fabulous compared to fixed appliances. Because if you go to an orthodontist only using fixed appliances and you tell that orthodontist, please redistribute space in the anterior part of the maxilla and I want exactly 1.2 millimeters between every single tooth in the anterior segment, six years later he’s still not reached that goal because it just moves back and forth. Put aligners on: three months later, you have exactly—and I mean exactly—1.2 millimeters of space between each and every single tooth. When it comes to intrusion and extrusion, I would probably consider using fixed appliances rather than aligners if it’s more than three millimeters. So every orthodontic system—and aligners are just an orthodontic system—each system has its pros and cons, and we just have to consider which system is right for this patient that I have in my chair. But back to the tongue issue. What should we do? I mean, yes, there are two different schools. So if you have, let’s say, a tongue habit that needs to be treated, there are those that say we need to get rid of the tongue habit before we start to correct the teeth. And then there are those that say that doesn’t really work because there’s no room for the tongue. So we need to create room for the tongue first and then train the patient to stop the habit. Both schools and both philosophies are being followed out there. I have my preferred philosophy, but I will let the listener start to think about what they believe and follow their philosophy. Because there is nothing here that is right or wrong. And that is— [Jaz] I think the right answer, Jesper, is probably speak to that local orthodontist who’s gonna be helping you out and whatever they recommend—their religion—follow that one. Because then at least you have something to defend yourself. Like okay, I followed the way you said. Let’s fix it together now. [Jesper] That’s a great one. Yeah, exactly. [Jaz] Okay, well just touching up on the occlusion then, sometimes we do get left with like suboptimal occlusions. But to be able to define a suboptimal occlusion… let’s wrap this occlusion element up. When we are completing an orthodontic case—let’s talk aligners specifically—when the aligners come off and the fixed retainers come on, for example, and the patient’s now in retention, what are some of the occlusal checkpoints or guidelines that you advise checking for to make sure that, okay, now we have a reasonably okay occlusion and let things settle from here? For example, it would be, for me, a failure if the patient finishes their aligners and they’re only holding articulating paper on one side and not the other side. That’s for me a failure. Or if they’ve got a posterior open bite bilaterally. Okay, then we need to go refinement. We need to get things sorted. But then where do you draw the line? How extreme do you need to be? Do you need every single tooth in shim-stock foil contact? Because then we are getting really beyond that. We have to give the adaptation some wiggle room to happen. So I would love to know from your learning at Pankey, from your experience, what would you recommend is a good way for a GP to follow about, okay, it may not be perfect and you’ll probably never get perfect. And one of the orthodontists that taught me said he’s never, ever done a case that’s finished with a perfect occlusion ever. And he said that to me. [Jesper] So—and that’s exactly the point with orthodontics. I learned that imagine going to a football stadium. The orthodontist will be able to find the football stadium. If it’s a reasonable orthodontist, he’ll be able to find the section you’re going to sit in. And if he’s really, really, really good, he will be able to find the row that you’re going to sit in. But the exact spot where you are going to sit, he will never, ever be able to find that with orthodontics. And this is where settling comes in and a little bit of enamel adjustments. [Jaz] I’m so glad you said that. I’m so glad you mentioned enamel adjustment. That’s a very dirty word, but I agree with that. And here’s what I teach on my occlusion courses: what we do with aligners essentially is we’re tampering with the lock. Let’s say the upper jaw is the lock. It’s the still one. We’re tampering with the key, which is the lower jaw—the one that moves—we tamper with the key and the lock, and we expect them both to fit together at the end without having to shave the key and to modify the lock. So for years I was doing aligners without enamel adjustment ’cause my eyes were not open. My mind was not open to this. And as I learned, and now I use digital measuring of occlusion stuff and I seldom can finish a case to get a decent—for my criteria, which is higher than it used to be, and my own stat—is part of my own growth that’s happened over time is that I just think it’s an important skill that GPs are not taught and they should be. It’s all about finishing that case. And I think, I agree with you that some adjustment goes a long way. We’re not massacring enamel. It’s little tweaks to get that. [Jesper] Exactly. I like the sound there because sometimes you hear that “ahh,” it doesn’t really sound right, but “tsst,” that’s better. [Jaz] That’s the one. You know, it reminds me of that lecture you did in Copenhagen. You did this cool thing—which I’ve never seen anyone do before. You sat with one leg over the other and you said, okay guys, bite together. Everyone bit together. And then you swapped the legs so the other leg was over the other and bite together. And then you said, okay, whose occlusion felt different? And about a third of the audience put their hand up, I think. Tell us about that for a second. [Jesper] Well, just promise me we go back to the final part because there are some things we should consider. [Jaz] Let’s save this as a secret thing at the end for incentive for everyone to listen to the end—how the leg position changes your occlusion. Let’s talk about the more important thing. I digressed. [Jesper] Let’s talk about the occlusal goals because I think it’s important. I mean, if you do enamel adjustments in the end—so when we finish the treatment, when we come to the last aligner in the treatment plan—I think we should start by breaking things down to the simplest way possible. Start by asking the patient: are you satisfied with the way the teeth look? Yes or no? If she’s satisfied, great. How do you feel about the occlusion? “Well, it fits okay.” Great. Now the patient is happy. There’s nothing she wants to—or he wants to—change. Then you look at the occlusion. Now, it is important to remember that what we see on the computer screen, on the aligner planning tools, will never, ever correspond 100% to what we see in the mouth of the patient. And there are several reasons for that. But one of the things that we have found to be really interesting is that if you take that last step and you say, okay, the occlusion doesn’t fit exactly as on the screen, but it’s kind of there… if you use that last step and you don’t do a re-scan for a retainer, but you use the last step of the aligner treatment as your reference for your aligner retainer… We sometimes see that over six months, if the patient wears that aligner 22 hours a day for another three to six months, the teeth will settle more and more into the aligner and create an occlusion that looks more and more like what you see on the screen. Which to me just tells me that the biology doesn’t necessarily follow the plan everywhere in the tempo that we set throughout the aligner plan. But over time, at the last step, if it’s just minor adjustments, the teeth will actually move into that position if we use the last stage as a reference for the retainer. Now, if we do a scan at that point and use that as a reference for creating an aligner retainer, then we just keep the teeth in that position. Now, if the teeth are a little bit more off— [Jaz] I’m just gonna recap that, Jesper, ’cause I understood what you said there, but I want you to just make sure I fully understood it. When we request, for example, Align, the Vivera retainer, it gives you an option: “I will submit a new scan” or “use the last step.” And actually I seldom use that, but now I realize you’re right. It makes sense. But then on the one hand, if the occlusion is—if the aesthetics are good and the patient’s occlusion feels good, what is your own judgment to decide whether we’re still going to allow for some more settling and occlusal changes to happen over a year using the Vivera retainers based on the ClinCheck last-aligner profile, rather than, okay, let’s just retain to this position? What is making you do the extra work, extra monitoring? [Jesper] To me, it’s not extra monitoring. It’s just basic. I mean, it’s just part of my protocol. I follow the patients. And honestly, to me, it’s just time-saving to just use the last step in the aligner. Because I mean, if the plan is right and if the teeth have been tracking well, they should be in that position. Why do I then need to re-scan for Vivera retainers or for other kinds of retainers? Now, if the occlusion is a little bit more off—and in a minute you’ll probably ask me when do I see which is which, and I can’t really tell you; it’s about experience—but that’s the beauty of this. If I see there’s a little bit more deviation and I like some teeth, the occlusion isn’t really good on one side compared to the other side, I would rather have a bonded retainer from first premolar to first premolar in the mandible, combined with a Hawley or Begg or something like that retainer for the upper. And you can order them with an acrylic plate covering some of the anterior teeth so they keep that position, but that allows the teeth to settle. And over three months you should see some kind of improvement. If you don’t see enough improvement and let’s say you still have a tendency for a kind of an open bite on one side, you can always add some cross elastics, put some buttons on the upper, on the lower, instruct the patient to use these, and then in three months you will have the occlusion you want. Now, once that is established—you have that kind of occlusion—you need to keep the teeth there for at least six months before you do some kind of equilibration or enamel adjustment. Because if you do the enamel adjustment right after you have reached your final destination for the teeth, the teeth will still settle and move. So you do the equilibration, two weeks later everything looks off again. You do the equilibration, two weeks later things have changed again. So I prefer to wait six months before I do the final equilibration. Now, in this equation what we’ve been talking about here, it goes from very simple to more and more complex. And then we have to consider, well, did I expand the mandible posterior segment? If so, I can’t just use a bonded retainer on the lower and I need to add something to keep the teeth out there in combination with whatever I want in the upper. Do I want to keep the Begg retainer or the Hawley, or do I want to change to something differently? So these kinds of considerations have to be there from the beginning of the treatment because, I mean, it costs additional money to order a Begg retainer compared to just an aligner. [Jaz] A Begg retainer is the same as Hawley? [Jesper] Well, no. It has a little different design. [Jaz] Oh, a Begg as in B-E-G-G? [Jesper] Yes. [Jaz] Yeah, got it. Got it. Okay. [Jesper] And then in Denmark we use the Jensen retainer, which is a Danish invention, which goes from canine to canine or from first premolar to first premolar but with a different type of wire which keeps the teeth more in place compared to a round wire. So there are different variations. The most important part here is it allows the posterior teeth to settle so they can move, which they can’t in an aligner to the same degree at least. Now, this is all really nice in teeth that only need to be moved into the right position, but most of our patients are adult patients, or they should at least be adult patients. Most of my patients were more than 30 years old. So if you have a patient with anterior crowding and you move the teeth into the right position where the teeth should be, the teeth are in the right position, but they still look ugly because they have been worn anteriorly by the position they were in when they were crooked. So when we position them, we still need to do some restorative work. Then what? We still need to retain those teeth. The patient wants to be finished now as fast as possible, so we can’t wait the six months to make the final touches. So we have to figure out: what do we do? And then we have to think of some kind of retention strategy to keep the teeth in place during that restorative procedure. And I mean, at the end of an aligner treatment or any orthodontic treatment, two days is enough to have relapse in some patients. Some patients it’s not a problem. The teeth are just there to stay in the same position for three months, and then they start to move a little bit around. But other patients—I mean, you just have to look away and then go back to the teeth and they’re in a different position. You can’t know what kind of patient you have in your chair right now. So you have to consider the way you plan your restorative procedure in regards to how you retain the teeth during that phase. So if you want to do anterior composites or veneers, do it all at once. Put in a bonded retainer, scan, and get your aligner retainer as fast as possible. Or use a Begg or a Hawley or something like that that’s a little bit more flexible. If you want to do crowns, then we have a whole different challenge and then we have to consider how do we then retain the teeth. [Jaz] Okay. Well I think that was lovely. I think that gives us some thoughts and ideas of planning sequence of retention, which is the ultimate thing to consider when it comes to occlusion. Okay, yeah, you get the occlusion, but how do you retain it? But in many cases, as the patient’s wearing aligners, the occlusion is embedding in and is fine. And you take off the aligners, the patient’s happy with how it looks. They bite together. It feels good. You are happy that yes, both sides of the mouth are biting together. Now, it might not be that every single contact is shim-hold, but you got, let’s say, within 20 microns, 40 microns, okay? Then some bedding happens. In that kind of scenario, would you be happy to say, okay, I’m gonna scan your teeth as they are because I’m happy with the occlusion, the occlusal goals are good, and they’re near enough the ClinCheck, and go for the retainers to that position? Or is your default preference as a clinician to go for the Vivera or equivalent based on the last aligner, on the ClinCheck projection? [Jesper] I would still go for the last aligner because I think the planning I’ve done is probably a little bit more precise than what I see clinically. However, I still expect that I will have to do a little bit of enamel reshaping at the end after six months, but that’s okay. I mean, the changes are so small, so you can still use the last aligner or the Vivera retainer that you already have ordered. So it’s not that much of a problem. [Jaz] Which goes back to your previous point: if it’s a big deviation, then you’ve gotta look at the alternative ways, whether you’re gonna go for refinement or you’re gonna allow some occlusal settling with a Hawley and a lower fixed-retainer combination, or the elastics like you said. Okay. Just so we’re coming to the end of the podcast—and I really enjoyed our time—I would like to delve deep into just a final thing, which is a little checklist, a helpful checklist for case assessment that you have for GDPs. [Jesper] Yeah, thank you. First of all, one of the big challenges in a GP practice is being able to take a full series of clinical photos in two minutes without assistance. I think most dentists struggle with that, but that is a foundational prerequisite to any aligner treatment. Once you have the photos, I would sit down with the photos and I would consider six different steps. One: is this a patient that I could treat restoratively only? Because that would be the simplest for me to do. Next, moving up in complexity: would be, do I need periodontal crown lengthening? Or next step would be: do I need to change the vertical dimension, or is there something about centric relation that I should consider? Moving up a little bit on the complexity: are there missing teeth? Do I need to replace teeth with implants? Next step would be orthodontics. So this is step five. The next most complex case we can treat is actually an aligner case—orthodontics in general. And the last part would be: are the teeth actually in the right position in the face of the patient, or do I need surgery to correct the jaw position? So these six steps, I think they’re helpful to follow to just think, how can I break this case down into more easy, digestible bits and pieces to figure out what kind of patient I have in front of me? Now, if you consider it to be an orthodontic case or ortho-restorative case, here comes the challenge: case selection. How do you figure out is this an easy, moderate, complex, or referral case? And here’s the trick: do 500 to 1000 treatment plans or treatments with clear aligners. And then you know. But until then, you really don’t. This is where you should rely on someone you can trust who can help you do the initial case selection. Because you can have two identical patients—one is easy and one is super complex—but they look the same. So it’s really nice if you have done less than 500 cases to have someone who can help you with the case selection. And I don’t say this to sell anything, because we don’t charge for that. Because it’s so essential that we don’t do something that is wrong or gives us a lot of challenges and headaches in the practice. I mean, the practice runs really fast and lean-oriented, so we need to make things digestible, easy to work with. And I think that’s really important. [Jaz] It goes full circle to what we said before about having that referral network, staying in your lane, knowing when to refer out, cherry-picking—it all goes back full circle with that. And not even orthodontics, but restorative dentistry—case selection is just imperative in everything we do. [Jesper] Yes. And there is—we always get the question when we do courses and we do consulting—can’t you just show me a couple of cases that are easy to start with? And it works with implants, kind of. But with orthodontics where we move—I mean, we affect all the teeth—it’s just not possible. I know the aligner companies want to show you some where you say, you can only just do these kinds of cases and they are really easy. The fact is they’re not. But they want to sell their aligners. [Jaz] I get it. They are until they’re not. It’s like that famous thing, right? Everyone’s got a plan until they get punched in the face. So yeah, it can seemingly be easy, but then a complication happens and it’s really about understanding what complications to expect, screening for them, and how you handle that. But thanks so much. Tell us—yeah, go on, sorry. [Jesper] There are three things I’d like to end on here. So, first of all, we’ve been talking together for about an hour about a topic that, if you want to take postgraduate education, it takes three years to become an orthodontist. And there is a reason it takes three to four years. However, I want to encourage the listener to think about this: Mercedes has never, ever excused last year’s model. Meaning that they always strive for perfection. So if we go into the practice and we do the very best we can every single day, there is no way we can go back and excuse what we

Cracked teeth — the diagnosis we all hate as Dentists! How do you decide when to monitor and when to intervene? What is the recommended intervention at different scenarios of cracks? Should we be chasing cracks and reinforcing with fibers; is there actually enough long-term data to support that approach? Over the years, we've had some epic episodes on this topic — from Kreena Patel's “I Hate Cracked Teeth” (PDP028) to Dr. Lane Ochi's Masterclass on Diagnosis and Management (PDP175). But in this brand-new episode, Jaz is joined by Dr. Masoud Hassanzadeh to bring it all together — not just the diagnosis of cracks, but their management. They explore when to intervene, the role of fibers in preventing propagation, and even the fascinating possibility that cracks in teeth may have some ability to heal, just like bone! This one's a deep dive that will change how you talk to patients — and how you approach cracked teeth in your own practice. https://youtu.be/VHYRBnfJS3I Watch PDP246 on YouTube  Protrusive Dental Pearl Your patient's history predicts the future! Ask if past extractions were difficult → clues you into anatomical challenges. Ask how they lost other teeth → if cracks, be proactive with today's cracks. History isn't just background—it's a clinical tool. Key Takeaways Cracks in teeth can be diagnosed using magnification and high-quality imaging. Patient factors such as age and muscle strength play a significant role in crack prognosis. Symptomatic cracks should be treated to prevent further propagation. Understanding the anatomy of the tooth is crucial for effective treatment. The healing mechanism of cracks in teeth is possible but varies between enamel and dentin. Fibers can be used to strengthen restorations and manage cracks effectively. Long-term studies are needed to assess the effectiveness of current crack management protocols. The use of fluorescence filters can help identify bacteria in cracks. Chasing cracks should be done cautiously to avoid pulp exposure. A comprehensive understanding of crack mechanics can improve treatment outcomes. Highlights of this episode: 00:00 Teaser 00:47 Intro 03:08 Protrusive Dental Pearl - The Importance of Dental History 07:18 Interview with Masoud Hassanzadeh 08:22 Diagnosing and Managing Cracks 21:13 When to Intervene on Cracks 25:50 Restoration Techniques and Materials 28:30 Chasing Cracks: Guidelines and Techniques 36:50 Mechanisms of Crack Healing in Teeth 45:11 Exploring the Use of Fibers in Dentistry 52:43 Introducing the Book on Cracked Teeth 54:57 Percussion-Based Diagnostics (QPD) 56:44 Key Takeaways 57:21 Conclusion and Final Thoughts 01:00:07 Outro As promised, here are the studies mentioned during the discussion: Why cracks do not propagate as quickly in root dentin: Study 1a & 1b Root dentin has significantly higher fracture toughness compared to coronal dentin—nearly twice as tough, as demonstrated in multiple studies. The key difference lies in their structure and toughness. Root dentin's unique collagen orientation adds strength, while its fewer lumens and thinner peritubular cuffs make it less brittle. In contrast, coronal dentin has thicker cuffs, which increase brittleness. Unlike coronal dentin, which fractures uniformly, radicular dentin is anisotropic—its fracture behavior varies depending on direction. These structural features give root dentin greater resistance to cracking, making it more durable under stress. Studies on decreasing crack length due to crack repair in enamel. Study 2 The importance of the modulus of elasticity of the final restoration in arresting crack propagation. Study 3 The role of fiber in restoring cracked teeth and how it can increase fracture strength—even surpassing that of natural teeth. Study 4 Decision Making for Retention of Endodontically Treated Posterior Cracked Te...

On Friday, Oct. 17, the Physician Enterprise hosted a Grand Rounds session discussing evidence-based updates for respiratory immunization clinical guidelines. We also have this additional resource available related to fall viruses and immunizations:5-Minute Check In: Fall Viruses and Vaccinationshttps://youtu.be/PowPADYqzGA?si=x_G3XJY_335rcdW2

In this episode of Better Edge, Jennifer Miles-Thomas, MD, moderates a thoughtful conversation with Anthony Schaeffer, MD, discussing complicated urinary tract infections (cUTIs) and their management. Dr. Schaeffer, who contributed to the recent IDSA guidelines on cUTIs, emphasizes the need to understand underlying causes of recurrent infections rather than treating them as isolated events. The conversation explores critical topics such as antibiotic resistance, effective treatment strategies and the importance of early intervention in febrile cases.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This short episode covers the basics of electroconvulsive therapy.Hosts: Ravi Bhindi (CC3), Dr. Angad Singh (PGY2)Audio Editing: Dr. Angad Singh (PGY2)Show Notes: Dr. Angad Singh (PGY2)Time Stamps:(0:36) - What is ECT?(2:18) - Indications and efficacy(4:35) - Treatment course(4:32) - Combination treatment(6:33) - Medications to discontinue(8:16) - Contraindications(9:40) - Side effects(11:52) - Procedure(16:03) - SummaryResources:https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/electroconvulsive-therapyhttps://sunnybrook.ca/content/?page=psychiatry-electroconvulsive-therapy-ect-faqReferences:Andrade, C., Arumugham, S. S., & Thirthalli, J. (2016). Adverse Effects of Electroconvulsive Therapy. The Psychiatric clinics of North America, 39(3), 513–530.Brakemeier, E. L., Merkl, A., Wilbertz, G., Quante, A., Regen, F., Bührsch, N., van Hall, F., Kischkel, E., Danker-Hopfe, H., Anghelescu, I., Heuser, I., Kathmann, N., & Bajbouj, M. (2014). Cognitive-behavioral therapy as continuation treatment to sustain response after electroconvulsive therapy in depression: a randomized controlled trial. Biological psychiatry, 76(3), 194–202.Espinoza, R. T., & Kellner, C. H. (2022). Electroconvulsive therapy. New England Journal of Medicine, 386(7), 667-672.Gill, S., Hussain, S., Purushothaman, S., Sarma, S., Weiss, A., Chamoli, S., ... & Loo, C. K. (2023). Prescribing electroconvulsive therapy for depression: Not as simple as it used to be. Australian & New Zealand Journal of Psychiatry, 57(9), 1202-1207.Janjua, A. U., Dhingra, A. L., Greenberg, R., & McDonald, W. M. (2020). The efficacy and safety of concomitant psychotropic medication and electroconvulsive therapy (ECT). CNS Drugs, 34(5), 509-520.Jelovac, A., Kolshus, E., & McLoughlin, D. M. (2013). Relapse following successful electroconvulsive therapy for major depression: a meta-analysis. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 38(12), 2467–2474.Kolshus, E., Jelovac, A., & McLoughlin, D. M. (2017). Bitemporal v. high-dose right unilateral electroconvulsive therapy for depression: a systematic review and meta-analysis of randomized controlled trials. Psychological Medicine, 47(3), 518-530.Lam, R. W., Kennedy, S. H., Adams, C., Bahji, A., Beaulieu, S., Bhat, V., ... & Milev, R. V. (2024). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023: Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes. The Canadian Journal of Psychiatry, 69(9), 641-687.Luchini, F., Medda, P., Mariani, M. G., Mauri, M., Toni, C., & Perugi, G. (2015). Electroconvulsive therapy in catatonic patients: Efficacy and predictors of response. World journal of psychiatry, 5(2), 182–192.Tess, A. V., & Smetana, G. W. (2009). Medical evaluation of patients undergoing electroconvulsive therapy. New England Journal of Medicine, 360(14), 1437-1444.Zolezzi M. (2016). Medication management during electroconvulsant therapy. Neuropsychiatric disease and treatment, 12, 931–939.For more PsychEd, follow us on Instagram (@psyched.podcast),  Facebook (PsychEd Podcast), X (@psychedpodcast), and Bluesky (@psychedpodcast.bsky.social‬). You can email us at psychedpodcast@gmail.com and visit our website at psychedpodcast.org.

In this episode, we speak to Dr Diarmuid Quinlan, a GP and MD candidate based at the Department of General Practice at University College Cork.Title of paper: Competencies and clinical guidelines for managing acne with isotretinoin in general practice: a scoping reviewAvailable at: https://doi.org/10.3399/BJGP.2025.0135There is evidence of inequitable access to the most effective treatment for severe acne, isotretinoin. This scoping review identified the clinical competencies to safely manage acne using isotretinoin. No global consensus exists among clinical practice guidelines (CGPs) on whether GPs are appropriate prescribers of isotretinoin. Appropriately resourced and CPG-guided patient access to isotretinoin in primary care may promote safe, timely, and equitable acne management for patients and improve antimicrobial stewardship.Transcript:This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.440 - 00:01:07.850Hello and welcome to BJGP Interviews. My name is Nada Khan and I'm one of the associate editors of the bjgp. And welcome to our autumn edition of the BJGP podcast.We're kicking off with a new set of interviews for the next few months. So thanks again for joining us.Today we're speaking to Dr. Dermod Quinlan, who is a practicing GP in Cork and is also an MD candidate at University College Cork in Ireland.We're here today to discuss his paper, recently published in the BJGP titled Competency and Clinical Guidelines for Managing Acne with Isotretinoin in General Practice. A Scoping Review. So thanks very much, Dermid, for joining me here today to talk about this paper.But yeah, I guess I just wanted to start by saying that this is a really interesting paper and I think it covers a very common condition that we see in general practice and covers treatment, which can be quite difficult as well for acne.But I wonder if you could just start by telling us a little bit about why you wanted to do this research and just a bit about the treatment of it and why you focused down on this topic, really.Speaker B00:01:09.610 - 00:02:59.510So lovely to meet you, Nada. I'm first and foremost a GP and I see patients three days a week, 20 hours a week.And I did a diploma in dermatology over a decade ago and I still do some online tutoring. So I have a long standing interest in dermatology and have an extended role in dermatology.I work in an urban practice with lots of young teenagers and young people in it.Acne is a common chronic disorder and I would see a lot of young people with acne of all grades of severity, mild, moderate and severe, and very severe. And as a clinician, very clearly recognize that behind acne is a patient very commonly suffering profound distress.And we know that the morbidity associated with acne and particularly severe acne, is very extensive.There's the emotional morbidity, there's psychological morbidity, it impacts people's employment opportunities, their education achievements, and then more widely, because treating acne is resource intensive, it has an impact on the healthcare workforce. And then there are concerns about the very prolonged use of antibiotics in acne, raising real antimicrobial stewardship concerns.So I have an interest in this. And then we decided that we would do research into it because we don't know the clinical competencies for safe use of isotretinoin.So I was particularly interested in severe acne and the management of severe acne, and also it didn't clearly...

In this episode of the PFC Podcast, Dennis and Alex delve into the topic of forced vital capacity in the context of chest trauma. They discuss a research paper that explores the assessment of forced vital capacity for risk stratification of blunt chest trauma patients in emergency settings. The conversation covers the importance of understanding chest wall injuries, clinical guidelines for treatment, challenges in diagnosing rib fractures, and the implications of the study's findings on patient outcomes and resource allocation in military medicine.TakeawaysForced vital capacity is crucial for assessing chest trauma.Chest wall injuries can significantly impact patient outcomes.Pain management is a key component of treatment strategies.Clinical guidelines help in managing chest injuries effectively.Risk stratification is essential for resource allocation in trauma care.The study highlights the importance of forced vital capacity measurements.Understanding patient dispositions is vital in emergency settings.Challenges exist in diagnosing rib fractures in the field.The study's methodology raises questions about its applicability.Future research is needed to refine treatment approaches for chest trauma.Chapters00:00 Introduction to the Podcast00:30 Exploring Forced Vital Capacity02:02 Understanding Chest Trauma04:56 The Importance of Chest Wall Injuries08:37 Clinical Guidelines and Treatment Algorithms10:21 Challenges in Diagnosing Rib Fractures12:33 Pain Management and Treatment Strategies16:25 Dispositions and Resource Allocation19:02 Risk Stratification in Chest Injuries22:39 Forced Vital Capacity and Its Relevance27:16 Study Overview and Methodology32:29 Outcomes and Implications of the Study36:41 Critical Analysis of the Research46:38 Reflections on the Study's Impact52:12 Conclusion and Future DirectionsFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠

In this episode, host Jonathan Sackier is joined by Emanuele Angelucci, Director of Hematology and Cellular Therapies and Director of the Stem Cell Transplant and Cellular Therapies Program at the Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino Hospital in Genoa, Italy.   Timestamps   00:00 – Introduction 02:14 – The future of stem cell transplantation 03:15 – What continues to drive Emanuele in his work 05:40 – Donation of haematopoietic stem cells 10:00 – Gene therapy for haemoglobinopathies 11:40 – Will stem cell transplantation remain central in treating thalassaemia and sickle cell disease? 14:14 – Emanuele's work on iron overload and toxicity 16:53 – Current landscape for haemoglobinopathies 22:11 – Key recommendations in the most recent clinical guidelines for haemoglobinopathies  25:00 – Promising developments on the horizon for patients with haemoglobinopathies  28:00 – Emanuele's key takeaways 

Justin Aunger, PhD, and Kay Por Yip MBChB, PhD, join CHEST® Journal Podcast Moderator, Gretchen Winter, MD, to discuss their research into interventions for improving adherence to clinical guidelines for the management and follow-up of pulmonary nodules.  DOI: 10.1016/j.chest.2025.02.031  Disclaimer: The purpose of this activity is to expand the reach of CHEST content through awareness, critique, and discussion. All articles have undergone peer review for methodologic rigor and audience relevance. Any views asserted are those of the speakers and are not endorsed by CHEST. Listeners should be aware that speakers' opinions may vary and are advised to read the full corresponding journal article(s) for complete context. This content should not be used as a basis for medical advice or treatment, nor should it substitute the judgment used by clinicians in the practice of evidence-based medicine.     

If you've ever been prescribed medication for overactive bladder, you might wonder what it's actually doing and what the risks are. In this episode, I break down the two main types of medications used to treat OAB: anticholinergics and beta-3 agonists. We'll talk about how they work, the side effects (including memory concerns), and how to weigh the benefits and risks. I also explore alternative options like Botox and nerve stimulation, and why shared decision-making with your provider matters more than ever. If bladder urgency or leaking has been part of your life, this episode will help you make informed, confident choices about your treatment path.For more information on this topic: https://journals.lww.com/fpmrs/abstract/2017/05000/augs_consensus_statement__association_of.4.aspx#:~:text=Given%20the%20available%20evidence%2C%20which,medications%20in%20patients%20at%20risk.https://pubmed.ncbi.nlm.nih.gov/34213600/Timeline00:30 Introduction to Overactive Bladder 00:48 Behavioral Treatments for Overactive Bladder 00:57 Medications for Overactive Bladder 01:18 Anticholinergic Medications and Memory Concerns 01:37 Types of Medications for Overactive Bladder 03:55 Studies on Anticholinergics and Cognitive Impairment 03:23 Clinical Guidelines and Recommendations 04:26 Prevalence and Types of Overactive Bladder 05:00 Side Effects and Risk Factors 05:38 Research Findings on Anticholinergics 08:32 Considerations for Prescribing Medications 10:38 Alternative Treatments and Final Thoughts

n this episode of Psychedelics Today, kicking of Psychedelic Science 2025 week in Denver, we sit down with Jonathan Dicksinson, Chief Executive Officer, and Trevor Millar, Chief Operations Officer of Ambio Life Sciences – one of the world's leading ibogaine clinics – to explore the potential of ibogaine for addiction, neuroregeneration, and how ethics, honoring experience, and sustainability will be key to delivering ibogaine at scale.  Trevor shares his early work supporting marginalized populations in Vancouver's Downtown Eastside, which led to the founding of Liberty Root, one of Canada's first ibogaine clinics. Jonathan reflects on his apprenticeship in Mexican clinics, years of international advocacy with the Global Ibogaine Therapy Alliance, and drafting the first set of clinical guidelines for ibogaine detoxification. Together with paramedic and ibogaine safety protocols expert Jose Inzunza, they co-founded Ambio in Tijuana in 2021. They discuss: The unique safety standards Ambio has pioneered – including industry-wide clinical protocols and magnesium therapy to mitigate cardiac risk. Their scale: over 3,000 patients treated, with 100+ clients per month across five dedicated houses in Baja California. Ambio's groundbreaking neuroregenerative program for Parkinson's, MS, and traumatic brain injury – which has already drawn patients like Brett Favre and Clay Walker. How ibogaine appears to drive profound physiological change – including evidence of TBI reversal as shown in Stanford's 2024 study on Special Forces veterans. Why ibogaine isn't just a molecule – it opens a long-lasting “critical period” of neuroplasticity that must be supported with preparation, integration, and holistic care. The deeper story of sourcing: through his company Terragnosis, Jonathan is the only person with a legal export license for Tabernanthe iboga from Gabon, and Ambio is setting a precedent for reciprocal and ethical global supply chains. Their cautionary perspective on Texas' $50M push toward ibogaine clinical trials – and why the traditional “one drug, one indication” model misses the complexity and promise of psychedelic healing. They also make a compelling case that Ambio is already modeling what the future of psychedelic care should look like – not a single drug in a sterile clinical setting, but a comprehensive, integrated protocol combining preparation, medical oversight, and deep integration. “Start with the end in mind,” Trevor urges – Ambio isn't just part of the movement; it's the blueprint for how ibogaine could be delivered worldwide. Links: Ambio Website: https://ambio.life/ Significant lesion reduction and neural structural changes following ibogaine treatments for multiple sclerosis (Frontiers in Immunology, Feb 2025) Magnesium–ibogaine therapy in veterans with traumatic brain injuries (Nature Medicine, Jan 2024) Ibogaine reduced severe neuropathic pain associated with a case of brachial plexus nerve root avulsion (Frontiers in Pain Research, Aug 2023) Novel treatment of opioid use disorder using ibogaine and iboga in two adults (Journal of Psychedelic Studies, Jan 2020) Clinical Guidelines for Ibogaine-Assisted Detoxification Ambio Life Sciences Launches World's First Clinical Ibogaine Program for Patients With Neurodegenerative Conditions Bios:  Jonathan Dickinson is the Chief Executive Officer and Co-Founder of Ambio Life Sciences. One of the world's leading experts on ibogaine, Jonathan brings over 15 years of experience in clinical care, traditional practice, and psychedelic research to his leadership at Ambio. A Mexico-licensed psychologist and former Executive Director of the Global Ibogaine Therapy Alliance, he authored the field's foundational safety guidelines and has published widely on ibogaine's therapeutic, cultural, and ecological significance. He holds the only active export license for Tabernanthe iboga root, led the first Nagoya-compliant export from Gabon, and was initiated into the Dissoumba/Fang tradition of Bwiti in 2014 and the Missoko tradition in 2022. He has co-authored peer-reviewed research on ibogaine's potential for trauma, TBI, pain, MS, and Parkinson's. At Ambio, he leads strategy, research, and innovation – advancing a globally scalable model of care that bridges tradition, science, and integrity. Trevor Millar is the Chief Operating Officer and Co-Founder of Ambio Life Sciences. A social entrepreneur and pioneer in ibogaine advocacy and treatment, Trevor brings over a decade of experience supporting individuals through addiction recovery, trauma healing, and post-treatment integration. His background includes co-founding the Canadian Psychedelic Association and serving as Chair of the Board for MAPS Canada. He has co-authored peer-reviewed research on ibogaine's applications for trauma, TBI, and opioid use disorder, and has been featured in award-winning documentaries including DOSED and In Waves and War. Grounded in personal experience and guided by a philosophical approach to healing, Trevor is helping shape a new model for ethical, integrative psychedelic care on a global scale. At Ambio, Trevor leads operations, strategic partnerships, and client experience – bridging clinical care with systems design, education, and public advocacy.

In this episode, Dr. Jaclyn Smeaton and Dr. Kelly Ruef discuss the importance of education on perimenopause, a significant yet often overlooked phase in women's health. They explore the physiological changes that occur during this transition, the common symptoms women experience, and the need for effective hormone therapy.  This conversation also highlights:  The development of our new educational course, Perimenopause Management, aimed at helping practitioners better support women during perimenopause  Clinical gray areas surrounding perimenopause treatment options  The importance of understanding physiological changes during this stage How practitioners can support perimenopausal women through education and tailored treatment approaches  The need for comprehensive education in women's health, particularly regarding perimenopause Show Notes:Perimenopause Management is exclusive for registered DUTCH Providers. Get access by becoming a DUTCH Provider today or by logging in to the Provider Portal! 

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This short episode is about counselling patients on antidepressant medications.Hosts: Matthew Cho and Angad SinghAudio editing: Angad SinghTime Stamps:2:03 - Steps to antidepressant counselling7:31 - Frequently asked questions about antidepressantsRelated Episodes:PsychEd Episode 1: Diagnosis of Depression with Dr. Ilana ShawnPsychEd Episode 2: Treatment of Depression with Dr. Sidney KennedyPsychEd Episode 58: Depression in Children and Adolescents with Dr. Darren CourtneyPatient Education:UpToDate resource on ‘Medicines for Depression': https://www.uptodate.com/contents/medicines-for-depression-the-basicsCAMH resource on ‘Antidepressant Medications':https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/antidepressant-medicationsKelty Mental Health resource on ‘Selective Serotonin Reuptake Inhibitors': https://keltymentalhealth.ca/sites/default/files/resources/SSRI_MedicationSheet2022.pdf, References:PsychDB. (2024, January 11). Introduction to Antidepressants. https://www.psychdb.com/meds/antidepressants/homeLam RW, Kennedy SH, Adams C, Bahji A, Beaulieu S, Bhat V, Blier P, Blumberger DM, Brietzke E, Chakrabarty T, Do A. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023: Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes. The Canadian Journal of Psychiatry. 2024 Sep;69(9):641-87.Contact:For more about PsychEd follow us on Instagram (@psyched.podcast),  Facebook (PsychEd Podcast), and X (@psychedpodcast). You can email us at psychedpodcast@gmail.com and visit our website at psychedpodcast.org.

In this episode, Dr. Zanotti discussed the Society of Critical Care Medicine “Focused Update on the Clinical Guidelines for the Prevention and Management of Pain, Anxiety. Agitation/Sedation. Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU." This is also known as the PADIS Guidelines. He is joined by Joanna L. Stollings, PharmD, a Board-Certified Pharmacotherapy Specialist and a Board-Certified Critical Care Pharmacotherapy Specialist. Joanna is the Medical Intensive Care Unit (MICU) Clinical Pharmacy Specialist at the Vanderbilt University Medical Center. She also served as vice chair for the PADIS Guideline Focused Update and co-authored the guidelines. Additional resources: Society of Critical Care Medicine Focused Update on the Clinical Guidelines for the Prevention and Management of Pain, Anxiety. Agitation/Sedation. Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. PADIS 2025 Update: https://pubmed.ncbi.nlm.nih.gov/39982143/ Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. PADIS 2018 Guidelines: https://pubmed.ncbi.nlm.nih.gov/30113379/ Link to a previous episode of Critical Matters discussing the PADIS 2018 Guidelines: https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=635606964 Landing page for the Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center: https://www.icudelirium.org/ Books mentioned in this episode: The Prophet. By Kahlil Gibran: https://bit.ly/4lA2Jhx

◆Voicy新チャンネル開設！【獣医Sara先生のペットの暮らしと健康】https://bit.ly/3sLljup【お知らせ

In this episode, Dr Brad Leech shares the exclusive results of his PhD research, which produced the first comprehensive clinical practice guidelines for intestinal permeability. Dispelling common myths about "leaky gut syndrome," Dr Leech explains why intestinal hyperpermeability is a legitimate physiological reaction—not a syndrome—and how his meticulously developed, evidence-based guidelines can transform clinical practice.This episode provides invaluable insights into the following:The rigorous methodology behind developing clinical practice guidelines, including stakeholder engagement, comprehensive literature review, and systematic evaluation of over 10,000 research articlesThe critical importance of risk-of-bias assessment when evaluating research—a cornerstone of methodology that helps practitioners look beyond cherry-picked studies and misleading claimsHow to systematically evaluate research quality by examining randomization procedures, analysis methods, conflict of interests and  clinical relevance rather than accepting published findings at face valueSurprising findings about commonly used interventions in intestinal permeability, including evidence that certain probiotics may not be effective for NSAID-induced permeability despite their widespread recommendationEvidence-based assessment of treatments for intestinal permeability using the NHMRC grading matrix to evaluate research qualityPractical recommendations and evidence-supported interventions that meet the threshold for clinical relevanceDr Leech's work represents a significant advancement in the field, bringing scientific rigour to an area often clouded by opinion and marketing claims. Learn how these new guidelines can help you make more informed clinical decisions and improve patient outcomes through evidence-based approaches to intestinal permeability.Connect with Dr Leech: Dr Brad LeechRead: The IP GuidelineGet in touch! Shownotes and references are available on the Designs for Health websiteRegister as a Designs for Health Practitioner and discover quality practitioner- only supplements at www.designsforhealth.com.au Follow us on Socials Instagram: Designsforhealthaus Facebook: Designsforhealthaus DISCLAIMER: The Information provided in the Wellness by Designs podcast is for educational purposes only; the information presented is not intended to be used as medical advice; please seek the advice of a qualified healthcare professional if what you have heard here today raises questions or concerns relating to your health

Doug Reynolds  Doug Reynolds is the author of The Road to Metabolic Health, the Founder and CEO of LowCarbUSA® and President of the Society of Metabolic Health Practitioners.    LowCarbUSA (now called Symposium of Metabolic Health) provides a platform for internationally renowned scientists and medical practitioners to present the ever-increasing body of evidence on the benefits of reducing carbohydrates in the diet and adding in healthy fats. It has now evolved into one of the primary resources for the low carb community.  This includes a huge library of educational videos, a growing database of practitioners and dietitians and sports trainers who are open to the carb reduction conversation as well as a searchable database for papers and articles covering the research into the evidence supporting this lifestyle.   The SMHP is a non-profit for practitioners focused on metabolic health and they have a panel of advisors to oversee the creation and maintenance of a set of ‘Clinical Guidelines for Therapeutic Carbohydrate reduction’ which was first published in May, 2019.  The SMHP also defines numerous pathways for accreditation and the forums encourage open discussion which helps to establish Standard of Care around carbohydrate reduction. Link to Show Notes on Website https://fabulouslyketo.com/podcast/228. Doug’s Book The Road to Metabolic Health: Why the Answer Lies in Food, Not Pharmaceuticals Resources Mentioned For a discount for Symposium of Metabolic Health Conferences use coupon code FABULOUSLYKETO for a 20% discount   The Journal of Metabolic Health Nutrition Network The SMHP scientific papers Connect with Doug Reynolds on social media X: https://twitter.com/lowcarbusa https://twitter.com/TheSMHP https://twitter.com/DougieReynolds https://twitter.com/LCPamDevine Facebook: https://www.facebook.com/pam.devine.961/ Facebook Page: https://www.facebook.com/LowCarbUSA https://www.facebook.com/TheSMHP Facebook Group:  https://www.facebook.com/groups/LowCarbUSACommunity Instagram: https://www.instagram.com/lowcarbusa/ https://www.instagram.com/thesmhp/ LinkedIn: https://www.linkedin.com/company/low-carb-usa/ https://www.linkedin.com/company/society-of-metabolic-health-practitioners/ https://www.linkedin.com/in/pam-devine-bab66721/ Website Details: https://www.lowcarbusa.org/ https://thesmhp.org/ The Fabulously Keto Diet & Lifestyle Journal: A 12-week journal to support new habits – Jackie Fletcher If you have enjoyed listening to this episode – Leave us a review By leaving us a review on your favourite podcast platform, you help us to be found by others. Support Jackie Help Jackie make more episodes by supporting her. If you wish to support her we have various options from one off donations to becoming a Super Fabulously Keto Podcast Supporter with coaching and support. Check out this page for lots of different ways to support the podcast. https://fabulouslyketo.com/support Or You can find us on Patreon: https://www.patreon. com/FabulouslyKeto Connect with us on social media https://www.facebook.com/FabulouslyKeto https://www.instagram.com/FabulouslyKeto1 https://twitter.com/FabulouslyKeto Facebook Group: https://www.facebook.com/groups/FabulouslyKeto Music by Bob Collum Recommend a guest We would love to know if you have a favourite guest you would like us to interview. Let us know who you would like to hear of if you have a particular topic you would like us to cover. https://fabulouslyketo.com/recommend-a-guest We sometimes get a small commission on some of the links, this goes towards the costs of producing the podcast.

On this episode of IPA's What, Why & How podcast, Kate Gainer welcomes Kyle Robb, PharmD, BCPS, Director of State Policy & Advocacy at ASHP, and Anna Legreid​​​​ Dopp, PharmD, CPHQ, Senior Director of Government Relations at ASHP, to discuss ASHP's top priorities and what's happening at the federal level. Kyle Robb, PharmD, BCPS, currently serves as Director of State Policy & Advocacy at the American Society of Health-System Pharmacists (ASHP). Kyle supports ASHP members and State Affiliates as they seek to advance the practice of pharmacy through engagement with state government. He is an alumnus of the Virginia Commonwealth University/American College of Clinical Pharmacy/American Society of Health-System Pharmacists Congressional Health Care Policy Fellow Program and served as a Health Policy Fellow on the staff of the U.S. Senate Committee on Health, Education, Labor & Pensions. Prior to working in policy, Kyle was a pharmacist at the University of Virginia Health System. Anna Legreid Dopp, PharmD, CPHQ, currently serves as Senior Director, Government Relations at the American Society of Health-System Pharmacists (ASHP). Previously, Anna served as Director of Clinical Guidelines and Quality Improvement at ASHP. Prior to this role, she served as Vice President of Public Affairs for the Pharmacy Society of Wisconsin (PSW) while practicing as a clinical pharmacist at the University of Wisconsin Hospital and Clinics. She also served as a Pharmacy Benefit Consultant with WEA Trust in Madison, WI and a Clinical Assistant Professor at the University of Wisconsin-Madison School of Pharmacy. Anna received her Doctor of Pharmacy from the University of Minnesota College of Pharmacy and served as a Congressional Health Policy Fellow with the United States Senate. Resources from today's episode: Action Alert: Residency Funding and the Rebuild America's Health Care Schools Act of 2024 ASHP Medication Shortages Webpage Action Alert: Oppose Site Neutral Proposals ASHP 340B Resources ASHP/ACCP/VCU Congressional Fellow Program ASHP on PBMs Podcast Series: Federal Trade Commission's Report on PBMs Specialty Steering White Bagging and Site of Care Restrictions Connect with us on LinkedIn: Kyle Robb Anna Legreid Dopp Kate Gainer Iowa Pharmacy Association

 We're combining education and relaxation in our final episode of Season 13! We're wrapping up our season with Zach Swartz, Perioperative Practice Specialist and Yoga Teacher. Tune in to learn more about how clinical guidelines are researched and developed, learn about the AORN Guideline for Tourniquet Safety, AND, learn more about incorporating yoga techniques into your day! Zach will even provide a short guided relaxation exercise for us, so don't miss it! #operatingroom #ornurse #scrubtech #surgicaltechnologist #perioperative #perioperativenurse #yoga #yogainnursing

DISCLAMER >>>>>>    The Ditch Lab Coat podcast serves solely for general informational purposes and does not serve as a substitute for professional medical services such as medicine or nursing. It does not establish a doctor/patient relationship, and the use of information from the podcast or linked materials is at the user's own risk. The content does not aim to replace professional medical advice, diagnosis, or treatment, and users should promptly seek guidance from healthcare professionals for any medical conditions.   >>>>>> The expressed opinions belong solely to the hosts and guests, and they do not necessarily reflect the views or opinions of the Hospitals, Clinics, Universities, or any other organization associated with the host or guests.       Disclosures: Ditch The Lab Coat podcast is produced by (Podkind.co) and is independent of Dr. Bonta's teaching and research roles at McMaster University, Temerty Faculty of Medicine and Queens University. Welcome to another episode of "Ditch the Lab Coat," the podcast where we critically explore the latest in medical science and healthcare with engaging discussions and a dose of skepticism. I'm your host, Dr. Mark Bonta, and today we have an insightful conversation lined up with our distinguished guest, Dr. Allan Detsky. Dr. Detsky, a professor at the University of Toronto and former Chief Physician at Sinai Health Systems, brings his extensive knowledge in evidence-based medicine, health policy, and clinical experience into our discussion.In this episode, we'll delve into the complex landscape of pain management and the opioid crisis, explore the future health challenges posed by climate change and societal shifts in civility, and critique the growing influence of unregulated health advice on social media. Dr. Detsky shares his candid views on the pharmaceutical industry's role in drug development, conflicts of interest, and the intricate relationship between lifestyle changes and medical advancements.We'll also discuss the limitations of evidence-based medicine, especially when it comes to treating patients with multiple conditions, and the challenges of applying clinical guidelines to real-world settings. Plus, stay tuned for an announcement about a website overhaul, launching in December, featuring expanded blog content for our curious listeners.Join us as we unravel these pressing issues and more, always questioning, always learning. "Ditch the Lab Coat" continues right now.00:00 - Podcast begins with healthcare insights from Dr. Alan Detsky.05:31 - Highlighting the role of randomized trials in improving evidence-based medicine.08:52 - Questioning the efficacy of zinc supplements for healthy young adults.10:27 - Clinical study results often fail to align with real patient demographics.16:57 - Lack of shared decision-making opportunities for hospitalized patients.19:22 - Discussing right-wing skepticism toward pharmaceutical companies, balanced with acknowledgment of their contributions.21:21 - Exploration of how pharmaceutical companies prioritize profits over public-interest-driven drug development.25:00 - Reflecting on personal and professional relationships with drug industry figures.30:43 - Increasing dependency on lifelong medications in healthcare.35:14 - Potential for AI to address systemic issues despite its resource demands.36:35 - Emphasizing the importance of verifying credentials to avoid unqualified healthcare professionals.

Dr. Jerry Brown, TIME Person of the Year, joins Mike Shanley to discuss Dr. Brown's work during the Ebola crisis, COVID-19 response and lessons learned for global pandemic preparedness, becoming TIME Person of the Year, and the role of international aid donors and implementing partners. Co-host: Care Africa Medical Foundation (CAMF) focuses on building clinics in rural Liberia, starting with their hometown of Buchanan in Grand Bassa County, where they have organized free health fairs to provide essential health resources. In addition to their nonprofit efforts, Henry and Gormah run successful businesses that cater to the aging population and assist the homeless in Colorado, creating over 60 local jobs. CAMF plans to open its first medical center in Grand Bassa County in the spring of 2025, addressing urgent healthcare needs. However, the lack of reliable electricity poses a significant challenge to operating medical equipment. As a registered 501(C)(3) organization, CAMF aims to make a lasting impact on healthcare in Africa and inspire others with its dedication to health and community service. https://www.linkedin.com/in/care-africa-medical-foundation-536206336/ https://www.camedfoundation.org/about/ Biography Jerry Fahnloe Brown was born on October 18, 1968. Dr. Brown has worked in several capacities as physician. He worked as Escort Doctor for MERCI on boats repatriating Sierra Leonean Refugees back to Sierra Leone. He then worked as the County Health Officer for Grand Bassa County and Medical Director for the Buchanan Government Hospital from 2006 to 2008 after working as a Volunteer Physician at the ELWA Hospital and General Practitioner from 2004 to 2006. In March 2014 he was employed as Medical Director and General Surgeon at the ELWA Hospital a position he held until February 2018 when he was appointed by the President of Liberia to serve as the Chief Medical Officer of the John F. Kennedy Medical Center, the premier teaching and referral hospital. During those years at ELWA, he worked tirelessly performing varieties of surgeries in this low resource setting. He became Clinical Supervisor and Clinician at the ELWA II Ebola Treatment Unit from July 2014 to June 2015. Under his leadership and guidance this unit produced the highest number of Ebola survivors changing the survival rate from ten percent to seventy percent of Ebola Patients at his Center. From October 2014 to December 2016, he served as Principal Investigator on two research projects with the Clinical Research Management on convalescent plasma and the sequelae of Ebola in survivors. In 2018, he was appointed by the President of Liberia as the Chief Executive Officer of the John F. Kennedy Medical Center, the premier referral hospital in Liberia, a position held until January 30, 2024, due to the political transition of power. While at JFKMC, he established the only active functional Intensive Care Unit in country with support from partners such as Project Cure International and NOCAL. Under his leadership JFKMC, obtained accreditation for training specialists in the areas of pediatrics, internal medicine, general surgery, ophthalmology and psychiatric. He also established the only histopathology unit; a state of the art executive private ward; a dialysis center among others. On May 23, 2019, he was elected Civilian Representative and Advisor to APORA. He also serves as Acting Faculty Head, Department of Surgery, A. M. Dogliotti College of Medicine for two years, and is currently a Part-Time Faculty member, in the Department of Surgery, Liberia College of Physician and Surgeon. In March 2020, he was appointed by the president of Liberia to serve as the Head of the National Case Management Pillar of COVID-19. He coordinated the management of COVID-19 patients across the country and the care of patients with COVID-19 vaccine related complications. He supervised the drafting of Liberia COVID-19 Clinical Guidelines. Dr. Brown has received many honors to include, Time Person of the Year in 2014; among Time 100 Most Influential Persons, 2014; Civil Servant of the Year, 2014, Republic of Liberia; President of Liberia Highest Honor, Star of Africa in 2015; Golden Key Awards, 2018; He has spoken as several places to include Keynote Speaker, PICC 2016, 8th World Congress on Pediatric Intensive and Critical Care, Toronto Canada, June 2016; keynote Speaker, Case Western University, Ohio, October 2015; Keynote Speaker, Risky Business Conference, London, UK, May 2017; Speaker, American Society of Tropical Medicine and Hygiene, (ASTMH) 64TH Annual Meeting, ASTMH Ebola 360 symposium, October 2015; Pepperdine University, Dean Honorary Speaker—Leadership June 2017.    Thank you for tuning into this episode of the Aid Market Podcast. Learn more about working with USAID by visiting our homepage: Konektid International and AidKonekt. To connect with our team, message the host Mike Shanley on LinkedIn  

A troubling disconnect between medical expertise and insurance mandates is putting patients' health at risk. Policies like step therapy and prior authorization are forcing individuals into treatments not recommended by their doctors—often with devastating consequences. In this episode, we hear from a patient who endured months of suffering due to her insurer's 'fail-first' requirements. We also talk with a doctor navigating this impossible system and a biotech leader fighting to ensure innovative treatments reach the patients who need them most. Follow us on LinkedIn, X, Facebook and Instagram. Visit us at https://www.bio.org/

Evaluation and Credit:  https://www.surveymonkey.com/r/Medchat72 Target Audience This activity is targeted toward primary care physicians and advanced providers. Statement of NeedAdolescents with Type 1 diabetes mellitus (T1DM) face a significantly higher risk of developing cardiovascular disease (CVD) compared to their peers without diabetes. Regular physical activity is crucial for these young individuals, as it helps mitigate CVD risk and improves cardiorespiratory fitness (CRF). Therefore, promoting lifelong physical activity, with appropriate insulin and dietary adjustments, is essential for managing T1DM and preventing CVD. This podcast will highlight the benefits of exercise in preventing cardiovascular disease, describe the advantages of sports activities, and outline clinical guidelines for safe exercise practices in adolescents with T1DM. Objectives At the conclusion of this offering, the participant will be able to:  Discuss the benefits of exercise in the management of adolescent patients with Type 1 diabetes.  Describe potential glycemic management strategies during times of sport/activity in adolescents with Type 1 diabetes. Review the role of technology and future advancements in the management of diabetes.  Moderator Mark McDonald, M.D., MHA, CPE System Vice President Pediatric Medical Affairs Medical Director, Norton Children's Louisville, Kentucky  Professor Department of Pediatrics Division of Critical Care UofL School of Medicine Louisville, Kentucky Speaker Brad Thrasher, D.O., MBAPediatric Endocrinologist Medical Director, Pediatric Diabetes Medical Director, Sport & Activity Wendy Novak Diabetes Institute Norton Children's Endocrinology Louisville, Kentucky Associate Professor UofL School of Medicine Louisville, Kentucky    Moderator, Speaker and Planner Disclosures  The planners, moderator and speaker of this activity do not have any relevant financial relationships with ineligible companies to disclose.   Commercial Support  There was no commercial support for this activity.  Physician Credits Accreditation Norton Healthcare is accredited by the Kentucky Medical Association to provide continuing medical education for physicians. Designation Norton Healthcare designates this enduring material for a maximum of .50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.   For more information about continuing medical education, please send an email to cme@nortonhealthcare.org.  Nursing CreditaNorton Healthcare Institute for Education and Development is approved with distinction as a provider of nursing continuing professional development by the South Carolina Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. This continuing professional development activity has been approved for .50 contact hours. In order for nursing participants to obtain credits, they must claim attendance by attesting to the number of hours in attendance.   For more information related to nursing credits, contact Sally Sturgeon, DNP, RN, SANE-A, AFN-BC at (502) 446-5889 or sally.sturgeon@nortonhealthcare.org. Resources for Additional Study/References Chang, Xinyi, et. Al.  “Effect of Physician Activity/Exercise on Cardiorespiratory Fitness in Children and Adolescents with Type I Diabetes: A Scoping Review”; International Journal of Environmental Research and Public Health, Jan. 12, 2023; https://doi.org/10.3390/ijerph20021407 Cockcroft et al. “Factors affecting the support for physical activity in children and adolescents with type 1 diabetes mellitus: a national survey of health care professionals' perceptions”; BMC Pediatrics (2023) 23:131. https://doi.org/10.1186/s12887-023-03940-3   Date of Original Release | Nov. 2024; Information is current as of the time of recording. Course Termination Date | Nov. 2026 Contact Information | Center for Continuing Medical Education; (502) 446-5955 or cme@nortonhealthcare.org Also listen to Norton Healthcare's podcast Stronger After Stroke. This podcast, produced by the Norton Neuroscience Institute, discusses difficult topics, answers frequently asked questions and provides survivor stories that provide hope. Norton Healthcare, a not for profit health care system, is a leader in serving adult and pediatric patients throughout Greater Louisville, Southern Indiana, the commonwealth of Kentucky and beyond. More information about Norton Healthcare is available at NortonHealthcare.com.

Send us a Text Message.Doug Reynolds is a returning guest on our show! Be sure to check out his first appearance on episode 532 of Boundless Body Radio! Doug Reynolds is the Founder and CEO of LowCarbUSA®. The original organization was founded in the beginning of 2016 with the initial intention of providing  a platform, through an annual conference, for internationally renowned scientists and medical practitioners to present the ever-increasing body of evidence on the benefits of reducing carbohydrates in the diet. Doug has also coordinated the establishment of a panel of advisors to oversee the creation and maintenance of a set of 'Clinical Guidelines for Therapeutic Carbohydrate Reduction' which was first published in 2019. Currently, Doug is the president of the Society of Metabolic Health Practitioners (SMHP™), and this organization now provides education and training of Metabolic Health Practitioners, and serves those who are interested in making a difference in worldwide metabolic health.  The aim is to stall and reverse the increasing prevalence of chronic diseases, influenced by metabolic dysfunction and insulin resistance.Find Doug at-https://www.lowcarbusa.org/https://thesmhp.org/IG- @lowcarbusaTW- @lowcarbusaFind Boundless Body at- myboundlessbody.com Book a session with us here!

The Surgical Management of BPH and Updates from the AUA Clinical Guidelines Podcast (2024) CME Available: https://auau.auanet.org/node/41595 ACKNOWLEDGEMENT: This educational series is supported by an independent educational grant from Olympus Corporation of the Americas. At the conclusion of this activity, participants will be able to:   1. Describe the role of the AUA Clinical Guideline on the Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia. 2. Discuss the evidence base for current technologies, including pivotal studies, and be able to define the role and clinical expectation for each of them. 3. Interpret the current clinical results and compare the patient experiences of these treatments in relation to more established and even abandoned treatments for patient groups with similar characteristics. 4. Differentiate between each of the new technologies for treating BPH/LUTS based on both their mode-of-action and the quality of their supporting evidence.

Listen to Diana Rubledo Ruiz talk about applying genetics to conservation and comedy - part 1. News of new Clinical Guidelines for ME/CFS. Hosted and produced by Ian Woolf Support Diffusion by making a contribution Support Diffusion by buying Merchandise

This podcast summarises the BEVA primary care clinical guidelines on equine parasite control by David Rendle et al.   

Doug Reynolds and Pam Devine  When Pam Devine turned 47 she was super excited that she had found something that helped her to lose the weight that she had put on since turning 40. Up until that point no matter what she did she couldn't lose it.  Pam felt she worked out more than many of the people she encountered during her workday and was getting super frustrated with her failure to keep her weight under control.   Once she and her partner Doug Reynolds found keto and changed their way of eating the weight dropped away and she found peace of mind, feeling totally satiated and more focused than she has ever been. Best yet, the ups and downs of blood sugar roller coaster have calmed and she feels like she found food freedom, lowering her growing anxiety of not knowing what to eat for health. Now with Doug, Pam hosts the Low Carb USA events that bring together medical professionals and experts in the low carb / keto / carnivore world to share their knowledge and the latest research with other health professionals and non-healthcare people. They are working towards halting the catastrophic rise in obesity, type 2 diabetes, and other chronic diseases that we’ve seen since 1977. Pam is also one of the key Founding Members and Volunteers of The Society of Metabolic Health Practitioners. Doug Reynolds is the Founder and CEO of LowCarbUSA® and President of the Society of Metabolic Health Practitioners.   LowCarbUSA (now called Symposium of Metabolic Health) provides a platform for internationally renowned scientists and medical practitioners to present the ever-increasing body of evidence on the benefits of reducing carbohydrates in the diet and adding in healthy fats. It has now evolved into one of the primary resources for the low carb community.  This includes a huge library of educational videos, a growing database of practitioners and dietitians and sports trainers who are open to the carb restriction conversation as well as a searchable database for papers and articles covering the research into the evidence supporting this lifestyle.   The SMHP is a non-profit for practitioners focused on metabolic health and they have a panel of advisors to oversee the creation and maintenance of a set of ‘Clinical Guidelines for Therapeutic Carbohydrate Restriction’ which was first published in May, 2019.  The SMHP also defines numerous pathways for accreditation and the forums encourage open discussion which helps to establish Standard of Care around carbohydrate restriction. Link to Show Notes on Website https://fabulouslyketo.com/podcast/190. Doug Reynold’s and Pam Devine Top Tips Pam Top Tips Keep your cooking simple. If you are struggling to start or stick to it – look at food addiction and get some help. If you can tolerate them – make substitutions Doug Top Tips Be open minded and don't be dogmatic. Help people who are interested in keto to be successful. Be supportive – don't be judgmental of people who say it is too hard or can't get started. Resources Mentioned For a discount for Symposium of Metabolic Health use coupon code FABULOUSLYKETO for a 20% discount The Journal of Metabolic Health Nutrition Network Ketogenic: The Science of Therapeutic Carbohydrate Restriction in Human Health – Tim Noakes, Tamzyn Murphy, Neville Wellington and more  The SMHP scientific papers Dave Feldman – Citizen Science 164: Dr Laura Buchannan – Ageing Successfully 181: Dr Matt Calkins – Prevention Better Than Cure PHC UK Conference 086: Carrie Brown – Chow, Cooking, Cats and Cameras 162: Dr Bret Scher – Metabolic Mind for Improving Mental Health 185: Kent Bray – Messages of Hope From A Cocaine Addict 166: Anna Frueling – Addiction Is A Disease Fat Fiction Connect with Doug Reynolds and Pam Devine on social media Twitter: https://twitter.com/lowcarbusa Facebook: https://www.facebook.com/pam.devine.961/ Facebook Page: https://www.facebook.com/LowCarbUSA https://www.facebook.com/TheSMHP Facebook Group: https://www.facebook.com/groups/LowCarbUSACommunity Instagram: https://www.instagram.com/lowcarbusa/ https://www.instagram.com/thesmhp/ LinkedIn: https://www.linkedin.com/company/low-carb-usa/ https://www.linkedin.com/company/society-of-metabolic-health-practitioners/ https://www.linkedin.com/in/pam-devine-bab66721/ Website Details: https://www.lowcarbusa.org/ https://thesmhp.org/ The Fabulously Keto Diet & Lifestyle Journal: A 12-week journal to support new habits – Jackie Fletcher If you have enjoyed listening to this episode – Leave us a review By leaving us a review on your favourite podcast platform, you help us to be found by others. Support Jackie Help Jackie make more episodes by supporting her If you wish to support her by just pledging £1 or £2 a month go to: https://fabulouslyketo.thrivecart.com/support-the-podcast/ Or You can get some extra benefits by supporting her on Patreon: https://www.patreon.com/FabulouslyKeto Connect with us on social media https://www.facebook.com/FabulouslyKeto https://www.instagram.com/FabulouslyKeto1 https://twitter.com/FabulouslyKeto Facebook Group: https://www.facebook.com/groups/FabulouslyKeto Music by Bob Collum Recommend a guest We would love to know if you have a favourite guest you would like us to interview. Let us know who you would like to hear of if you have a particular topic you would like us to cover. https://fabulouslyketo.com/recommend-a-guest We sometimes get a small commission on some of the links, this goes towards the costs of producing the podcast.

Join Gaining Health host, Karli Burridge, PA, FOMA, as she discusses the newest Clinical Practice Statement (CPS) for Adolescents with Obesity published by the Obesity Medicine Association (OMA).  The rates are alarming, and clinician education on best care practices is vital.   While treatment can be complex with various influences, treatment starting at the onset leads to the best outcomes.  Link to Article HereLink to "AAP's Clinical Guidelines for Pediatric Obesity" on Spotify or Apple PodcastsSupport the showThe Gaining Health Podcast will release a new episode monthly, every second Wednesday of the month. Episodes including interviews with obesity experts as well as scientific updates and new guidelines for the management of obesity.If you're a clinician or organization looking to start or optimize an obesity management program, and you want additional support and resources, check out the Gaining Health website! We offer monthly and annual Memberships, which include live group coaching, a community forum to ask questions and post resources, pre-recorded Master Classes, digital resources inlcuding patient education materials and office forms, and much more! We also sell our popular Gaining Health products, including a book on developing an obesity management program, editable forms and templates, and patient education materials in our Gaining Health Shop! If you are loving this podcast, please consider supporting us on Patreon

❌❌❌در قسمت صد و بیست و‌چهار دنتکست، مقاله ی قبلی رو ادامه میدیم و به اتمام میرسونیماین مقاله گایدلاینهای کلینیکی ای برای بازسازی دندانهای خلفی ارائه میده.این گایدلاینها در مورد اینه که با توجه به میزان تخریب، دندونها به چه شکل و با چه نوع رستوریشنی بازسازی بشنمقاله ی جدید و جالبیه ،حتما گوش‌کنید.

❌❌❌در قسمت صد و بیست و‌سوم دنتکست، مقاله ی قبلی رو ادامه میدیم.این مقاله گایدلاینهای کلینیکی ای برای بازسازی دندانهای خلفی ارائه میده.این گایدلاینها در مورد اینه که با توجه به میزان تخریب، دندونها به چه شکل و با چه نوع رستوریشنی بازسازی بشنمقاله ی جدید و جالبیه ،حتما گوش‌کنید.

❌❌❌در قسمت صد و بیست و‌دوم دنتکست، مقاله ی قبلی رو ادامه میدیم.این مقاله گایدلاینهای کلینیکی ای برای بازسازی دندانهای خلفی ارائه میده.این گایدلاینها در مورد اینه که با توجه به میزان تخریب، دندونها به چه شکل و با چه نوع رستوریشنی بازسازی بشنمقاله ی جدید و جالبیه ،حتما گوش‌کنید.

In this episode, Ryan dives into cutting-edge research on the treatment of acetaminophen (APAP) overdose, featuring interviews with authors of several key abstracts from the North American Congress of Clinical Toxicology (NACCT) in Montreal Canada (Abstracts and posters available in the show notes). We get first looks insights into research evaluating the impact of fomepizole high risk acetaminophen overdose, as well as who gets fomepizole for acetaminophen overdose and dies. Then we evaluate the effectiveness of standard N-acetylcysteine (NAC) treatment in high risk patients and high dose NAC in high risk patients. Join us for an insightful discussion on these advancements that are reshaping the management of APAP toxicity. Guests include Dr. Masha Yemets PharmD, Dr. Molly Stott PharmD, Dr. Alexandru Ulici PharmD, and Dr. Michael Moss MD.   Link to published abstracts(First guest) Abstract #126 Characterizing fomepizole use in acetaminophen deaths reported to US poison centers- Dr. Yemets(Second guest) Abstract #125 Clinical impact of fomepizole as an adjunct therapy in massive acetaminophen overdose- Dr. Stott(Third guest) Abstract #131 Comparison of low-risk and high risk acetaminophen ingestions using the standard prescott protocol of intravenous N-acetylcysteine- Dr. Ulici(Fourth guest) Abstract #130 High-risk acetaminophen overdose outcomes after treatment with standard dose vs. increased dose N-acetylcysteine- Dr. MossOther studies discussed regarding NAC dosingATOM 2 Angela ChiewOutcomes of massive APAP treated with regular NAC (Virginia group, lead author Dr. Downes)

در قسمت صد و بیست و‌یکم‌دنتکست، مقاله ی جدید ی رو شروع میکنیم.این مقاله گایدلاینهای کلینیکی ای برای بازسازی دندانهای خلفی ارائه میدهاین گایدلاینها در مورد اینه که با توجه به میزان تخریب، دندونها به چه شکل و با چه نوع رستوریشنی بازسازی بشنمقاله ی جدید و جالبیه ،حتما گوش‌کنید.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers depression in children and adolescents with Dr. Darren Courtney, a scientist with the Cundill Centre for Child and Youth Depression and the Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health and a staff psychiatrist in the Youth Addictions and Concurrent Disorders Service at the Centre for Addiction and Mental Health (CAMH) in Toronto. He is also an associate professor in the Department of Psychiatry at the University of Toronto.   Dr. Courtney earned his MD in 2004 at Queen's University and completed psychiatry residency in 2009 at the University of Ottawa. He was the clinical director of the Youth Inpatient Unit at the Royal Ottawa Mental Health Centre from 2009 to 2014 and moved to Toronto in 2014, where he worked on the Concurrent Youth Inpatient Unit at the Centre for Addiction and Mental Health until 2017 and where his clinical work with concurrent disorders continues now with outpatient youth.   Dr. Courtney's research focus is on the treatment of adolescent depression through the use of an integrated care pathway — a collaboratively developed treatment algorithm based on high-quality clinical practice guidelines. Through his research, he works on identifying quality practice guidelines and corresponding multi-disciplinary care pathways to facilitate evidence-based and measurement-based care for adolescents with depression. He has also participated in a systematic review and quality appraisal of clinical practice guidelines for psychiatric disorders in children and adolescents. Additionally, he has an interest in the management of concurrent disorders, where young people are affected by both primary psychiatric disorders and substance use disorders.   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Outline the prevalence and risk factors for depression in children and adolescents Explain how children and adolescents with depression present in clinical practice Discuss the use of screening tools for depression in this population Describe an approach to the management of depression in children and adolescents Outline the management of an adolescent with suicidal thoughts or behaviours   Guest: Dr. Darren Courtney Hosts: Kate Braithwaite (MD) and Nikhita Singhal (PGY5) Audio editing by: Nikhita Singhal Show notes by: Kate Braithwaite and Nikhita Singhal   Interview Content: Introduction - 0:00 Learning objectives - 02:11 Prevalence of depression in youth - 03:11 Risk factors for depression in youth - 06:25 Diagnosing depression in youth - 08:30 Screening tools - 14:24 Approach to taking a history from youth - 19:45 Management of depression in youth - 30:12 Psychotherapies - 33:20 Medications - 37:37 Assessing and managing suicidality in youth - 44:00 Measurement based care - 51:00 Final thoughts - 55:10   Resources: Previous PsychEd episodes: PsychEd Episode 1: Diagnosis of Depression with Dr. Ilana Shawn PsychEd Episode 2: Treatment of Depression with Dr. Sidney Kennedy PsychEd Episode 18: Assessing Suicide Risk with Dr. Juveria Zaheer ICHOM Set of Patient-Centered Outcome Measures for Children & Young People with Depression & Anxiety Screening tools/rating scales: Revised Children's Anxiety and Depression Scale (RCADS) Mood and Feelings Questionnaire (MFQ) NICE guideline: Depression in children and young people: identification and management NICE guideline: Self-harm: assessment, management and preventing recurrence The CARIBOU Pathway by CAMH: A youth-centered program for the treatment of depression Includes links to download free clinician-specific and youth-specific resources co-developed with youth and mental health clinicians Clinical Innovations and Tools | Cundill Centre for Child and Youth Depression | CAMH Includes links to various tools for health care providers, researchers, youth, and other stakeholders (such as teachers and family members) informed by research evidence   References: Bennett K, Courtney D, Duda S, Henderson J, Szatmari P. An appraisal of the trustworthiness of practice guidelines for depression and anxiety in children and youth. Depress Anxiety. 2018 Jun;35(6):530-540. https://doi.org/10.1002/da.22752 Courtney D, Bennett K, Henderson J, Darnay K, Battaglia M, Strauss J, Watson P, Szatmari P. A Way through the woods: Development of an integrated care pathway for adolescents with depression. Early Interv Psychiatry. 2020 Aug;14(4):486-494. https://doi.org/10.1111/eip.12918 Georgiades K, Duncan L, Wang L, Comeau J, Boyle MH; 2014 Ontario Child Health Study Team. Six-Month Prevalence of Mental Disorders and Service Contacts among Children and Youth in Ontario: Evidence from the 2014 Ontario Child Health Study. Can J Psychiatry. 2019 Apr;64(4):246-255. https://doi.org/10.1177%2F0706743719830024 Goodyer IM, Reynolds S, Barrett B, Byford S, Dubicka B, Hill J, Holland F, Kelvin R, Midgley N, Roberts C, Senior R, Target M, Widmer B, Wilkinson P, Fonagy P. Cognitive-behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial. Health Technol Assess. 2017 Mar;21(12):1-94. https://doi.org/10.3310/hta21120 Hetrick SE, McKenzie JE, Bailey AP, Sharma V, Moller CI, Badcock PB, Cox GR, Merry SN, Meader N. New generation antidepressants for depression in children and adolescents: a network meta-analysis. Cochrane Database Syst Rev. 2021 May 24;5(5):CD013674. https://doi.org/10.1002/14651858.CD013674.pub2 MacQueen GM, Frey BN, Ismail Z, Jaworska N, Steiner M, Lieshout RJ, Kennedy SH, Lam RW, Milev RV, Parikh SV, Ravindran AV; CANMAT Depression Work Group. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 6. Special Populations: Youth, Women, and the Elderly. Can J Psychiatry. 2016 Sep;61(9):588-603. https://doi.org/10.1177%2F0706743716659276 National Institute for Health and Care Excellence. Depression in children and young people: Identification and management NG134 [Internet]. London: NICE; 2019 Jun 25 [cited 2023 Sep 22]. Available from: https://www.nice.org.uk/guidance/ng134. Parikh A, Fristad MA, Axelson D, Krishna R. Evidence Base for Measurement-Based Care in Child and Adolescent Psychiatry. Child Adolesc Psychiatr Clin N Am. 2020 Oct;29(4):587-599. https://doi.org/10.1016/j.chc.2020.06.001 Walter HJ, Abright AR, Bukstein OG, Diamond J, Keable H, Ripperger-Suhler J, Rockhill C. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders. J Am Acad Child Adolesc Psychiatry. 2023 May;62(5):479-502. https://doi.org/10.1016/j.jaac.2022.10.001 Wiens K, Bhattarai A, Pedram P, Dores A, Williams J, Bulloch A, Patten S. A growing need for youth mental health services in Canada: examining trends in youth mental health from 2011 to 2018. Epidemiol Psychiatr Sci. 2020 Apr 17;29:e115. https://doi.org/10.1017%2FS2045796020000281 World Health Organization. Mental health of adolescents [Internet]. 2021 [cited 2023 Sep 22]. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Episode 145: Family Planning for the LGBTQIA+Future Dr. Hoque explains how to assist with family planning for the LGBTQIA+ community. Some principles such as avoiding unintended pregnancies and reducing and early treatment of STIs are discussed.  Written by Ashfi Hoque, MBA, MS4, Ross University School of Medicine. You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Arreaza: Welcome to episode 145 of the Rio Bravo qWeek podcast. My name is Hector Arreaza, a faculty member of the Rio Bravo Family Medicine Residency Program.Ashfi: Hello everyone, I am Ashfi Hoque a 4th-year medical student at Ross University School of Medicine. I am from Long Beach, California. Patient advocacy and patient-centered care have always been a priority of mine. I've volunteered for years at the LGBT+ center in Weho and Long Beach. Today we will be discussing Family Planning for everyone while learning ways to become LGBTQIA+ inclusive. Arreaza: Yes, family planning is important, and I'm glad you included all types of families. I believe medical care must be offered to everyone, and I also believe in freedom of conscience, that's why I can freely express that I support traditional family for me. Why did you choose this topic?Ashfi: I chose this topic because my partner recently went to get her physical. Her provider had an extensive conversation about family planning and even discussed the anticipated cost of freezing her oocytes. I really loved the way this provider went about the conversation so I started researching ways I can support my community and also teach others to provide Queer inclusive medical care. What is LGBTQIA+?LGBTQIA+ stands for Lesbian, Gay, Bisexual, Trans, Queer, Intersex, Asexual, etc. The community will be referenced as the Queer community, an umbrella term for people who are not heterosexual or not cisgender. There are many inequalities that the community faces and we can do our due diligence to educate ourselves continuously and be aware that terminology and health needs may change. We have another Rio Bravo episode, Caring for LGBTQ+ Patients on Episode 103, that discusses healthcare disparities, but during this episode, we will be diving into an introduction to bridging health gaps, creating health equity, and building trust with the community. A 2023 Global Survey found that the self-identified Queer community represents 9% of the population, while the true estimate may be higher due to safety concerns. While diabetics are 10-13% of the population. These statistics show that as a medical provider, you'll encounter Queer patients more often than you think. One of the healthcare issues that Queer folks face is a lack of family planning.What is Family Planning?The World Health Organization (WHO) defines family planning as “the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through the use of contraceptive methods and the treatment of involuntary infertility.”Family planning serves three critical needs: Avoiding unintended pregnanciesReducing sexually transmitted diseases (STDs)Early treatment of STDs to reduce rates of infertilityWhen discussing family planning for patients, here are some examples of questions you can ask. What name may I use to address you?What are your pronouns?What is your gender? (Only if necessary for care, what is your assigned sex at birth?)Are you sexually active?What is the gender(s) of your partner(s)?Are you concerned about unintended pregnancy?Are you currently using any contraceptive measures?Are you taking any precautions to reduce STI/STD such as physical barriers like condoms, dental dams, or any harm reduction such as PrEP?What kind of STI/STD screening are you requesting?Do you need me to request additional labs such as oral or anal swabs?Those questions must be asked in a natural, non-judgmental way. While STD/STI screening and treatment is part of family planning, the part that we tend to neglect is the desire for Queer folks to build a family. Why is Family Planning Important for the LGBTQIA+ community?The Queer community gained the legal right to marry eight years ago, in 2015. They did not have the nationwide right to adopt until the last state, Mississippi, overturned the unconstitutional restrictions for the Queer community to adopt in 2016. A UCLA study in 2018 titled, “How many same-sex couples in the US are raising children?” reported cis-heterosexual couples: 3% are raising at least one adopted child and 95% are raising biological children while same-sex couples: 21.4% are raising at least one adopted child and 68% have a biological child. When it comes to family planning, there is more than adoption for Queer people. Queer folks are not offered the same pregnancy planning options, such as cis hetero-couples who are experiencing infertility or cis-women planning for advanced maternal age pregnancy. However, the options are quite similar. These options require specific types of planning, and that information can be provided to patients by their primary care doctor. A couple needs to know their options and consider the long-term financial planning necessary for surrogacy, in vitro fertilization (IVF), or donor insemination. The main difference for many Queer couples is the method of conception needed. Depending on sexual orientation and gender identity, patients may have varying reproductive needs as part of their family planning. We cannot make assumptions about how family planning should look and need to remember this journey looks different from person to person and couple to couple.How to approach family planning with the LGBTQIA+ community? Basic tenants of providing medical care for queer patients: Clinics specializing in Queer family planning found patient-centered care leads to better outcomes. The best approach is to be mindful, conscious, and to communicate without assumptions. We have to start with providers building trust, being honest, showing sensitivity assisting with reproductive services, and working towards being more knowledgeable about Queer parenthood. A provider could ask questions such as: Would you like information about family planning?What do you imagine your future family to look like?Would you like to see options and potential costs?Would you need a referral for a specialist?Or it can be as simple as being honest about your scope of knowledge by stating, “I am not well versed in LGBTQIA+ community issues but what ways can I support you?” It is ethically appropriate to transition care to a physician with better knowledge if you feel unable to assist a person from the LGBTQ+ community. Make sure to do it in a polite and respectful way.Gender inclusive: With more people openly identifying as non-binary and trans, there is a need for a gender-neutral approach to discussing a patient's biological and reproductive needs. First, we will avoid assuming gender identity based on the biological sex of a patient. Episode 14 of Rio Bravo does a great job of breaking down gender diversity and the difference between gender identity and biological sex. For transgender and nonbinary patients, providing care for medical transitioning often includes conversations about family planning before starting HRT. It is common to ask patients about to begin HRT if they would like to freeze their sperm or eggs. Second, we want to avoid assuming anything based on what reproductive organs a patient has. We can ask a patient about their intention to start a family. Avoid asking if a trans patient has received transitional surgery (bottom surgery) unless it is completely necessary for the care we are providing. Instead, it is appropriate to ask the patient if birthing is an option? Have you given birth before? Were there any complications? Is there any current hormonal treatment? This mindful strategy is also useful for patients who may have limitations in: producing oocytes or sperm, the ability to house a fetus in utero, or implantation and fertility. Third, we are going to address our underlying beliefs and assumptions about gendered parenthood. Parenthood is almost always thought of as motherhood and fatherhood, but this can be alienating for transgender patients. There are many possible ways of being a parent, and to be inclusive let's consider the possibility of a masculine woman or transmasculine man being a birthing parent or of a transgender woman being the mother of a child without giving birth to the child. There are many more scenarios we can discuss at another point. In the interest of time, we are going to shift into discussing family planning for lesbian and gay people and couples. Sexuality inclusive:For homosexual cis-gendered people who are single or in relationships, family planning can look similar to couples facing infertility issues. When having family planning conversations with these patients, a provider should ask broad, unassuming questions. If you have established that a queer person or couple wants a child, then you can ask if they have a family plan. If the patient or couple has a plan, follow the couple's lead. If the patient(s) do not have a plan, then you can begin to ask questions like: Do you have someone in mind to be a birth giver? Do you have a sperm donor? Do you have an egg donor? These questions are a great transition into discussing the following options for family planning.What are the options for having a newborn and the financial and ethical cost?Having a child can cost up to $100k, and this does not even include the cost of childcare. Infertility treatment is not covered by regular insurance, so patients need either infertility insurance or private financing to cover the cost of treatment. However, fertility insurance does not cover same-sex couples. There is a large emotional, physical, and ethical cost to deciding which route to choose. Let's discuss options and obstacles.1. Donor Insemination: The most affordable route is having a birth-giving parent who is fertile with a known sperm donor. This method can be as simple as using a syringe to inseminate the uterus-carrying person, but we need to consider necessary attorney fees to terminate the parental rights of the sperm donor. Sperm from a sperm bank requires an extensive workup including STD panel, HIV, and genetic disorder screening. The sperm donor gives up all parental rights during the process. The price of these procedures is constantly changing and depends on location.California Cryobank costs start at $1200 for anonymous donors and $1900 for identification disclosure donor which the child will receive information about the donor at age 18. Selecting a donor can include specifics such as race, talents, education, hobbies, physical attributes, and showing donor baby photos. There are two common insemination processes:Intracervical insemination: semen inside the cervical opening and covers the cervixIntrauterine insemination: semen is inserted through the cervix and placed directly into the cavityThe next option jumps up in cost significantly.2. Freezing Eggs (Oocyte Cryopreservation):Pacific Fertility Center Los Angeles, reports a single cycle of egg freezing can cost $6-10k per freezing cycle and may need multiple cycles without medication. The medications are typically around $3-6k depending on how much your body needs. Storage is an additional cost of $700-$1,000 a year. This is an option for parents planning pregnancy during advanced ages.3. In Vitro Fertilization (IVF): It is a process where an oocyte is collected similarly to freezing eggs but fertilized with a partner's or donor's sperm.Pacific Fertility Center Los Angeles reports it costs $8-13k per cycle of fertilization. It is an option for those who have issues with infertility, previous pelvic inflammatory diseases, surgeries, and issues with implantations.4. Surrogacy: This is the process of hiring a professional birthing surrogate to carry an embryo. This is an alternative option for couples who decline or cannot carry a pregnancy. The surrogate has no legal rights or biological relation to the fetus. Family Tree Surrogacy reports it costs about $45-65k.5. Adoption: Foster care adoption in California can be $1-5k. American Cost of Adoption, reports the cost of adoption for infants in California $40-70k including the medical expenses for the birth-giving person and legal expenses for the process. Versus adopting an infant from another country due lack of resources and poverty may better their lives or cause a higher demand for infants which may be an ethical issue. Also, transcultural adoption where the race of the parents and the children are different, and navigating culture and race with the children. Adoptees have reported having racial identity crises.With all these studies, it is well documented that providers will not be perfect at giving care to the Queer community. These studies do not represent every queer person and do not take the intersectionality of race, class, or gender identity into consideration. It is our job as providers to be supportive of all types of patients in order to increase their access to proper medical care. _______________Conclusion: Now we conclude episode number 145, “Family Planning for the LGBTQIA+.” Future Dr. Hoque explained how queer people can be included in family planning conversations, even before heterosexual couples. She described some options such as donor insemination, freezing eggs, IVF, and adoption. Dr. Arreaza explained that it is important to ask reproductive questions in a natural, non-judgmental way to all your patients, and refer to another professional when needed. This week we thank Hector Arreaza and Ashfi Hoque. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:American Adoptions—How Much Does a Private Adoption Cost in California? [And Why?]. (n.d.). Retrieved July 14, 2023, fromhttps://www.americanadoptionsofcalifornia.com/adopt/cost-of-adoption-in-californiaAmerican Adoptions—LGBTQ Adoption: Can Same-Sex Couples Adopt? (n.d.). Retrieved July 14, 2023, fromhttps://www.americanadoptions.com/adopt/LGBT_adoptionCarpenter, E. (2021). “The Health System Just Wasn't Built for Us”: Queer Cisgender Women and Gender Expansive Individuals' Strategies for Navigating Reproductive Health Care. Women's Health Issues, 31(5), 478–484.https://doi.org/10.1016/j.whi.2021.06.004Choosing the Right Sperm Donor | California Cryobank. (n.d.-a). Retrieved July 14, 2023, from HTTPS://www.cryobank.com/how-it-works/choosing-your-donor/Choosing the Right Sperm Donor | California Cryobank. (n.d.-b). Retrieved July 14, 2023, from HTTPS://www.cryobank.com/how-it-works/choosing-your-donor/Cost of Egg & Embryo Freezing in the U.S. | PFCLA. (n.d.). Retrieved July 14, 2023, fromhttps://www.pfcla.com/blog/egg-freezing-costs. (2012, April 25).Donor Insemination. American Pregnancy Association.https://americanpregnancy.org/getting-pregnant/donor-insemination/Hollingsworth, L. D. (2003). International adoption among families in the United States: Considerations of social justice. Social Work, 48(2), 209–217.https://doi.org/10.1093/sw/48.2.209In vitro fertilization (IVF): MedlinePlus Medical Encyclopedia. (n.d.). Retrieved July 14, 2023, fromhttps://medlineplus.gov/ency/article/007279.htmIngraham, N., Fox, L., Gonzalez, A. L., & Riegelsberger, A. (2022a). “I just felt supported”: Transgender and non-binary patient perspectives on receiving transition-related healthcare in family planning clinics. PLOS ONE, 17(7), e0271691.https://doi.org/10.1371/journal.pone.0271691Ingraham, N., Fox, L., Gonzalez, A. L., & Riegelsberger, A. (2022b). “I just felt supported”: Transgender and non-binary patient perspectives on receiving transition-related healthcare in family planning clinics. PLOS ONE, 17(7), e0271691.https://doi.org/10.1371/journal.pone.0271691Ingraham, N., & Rodriguez, I. (2022a). Clinic Staff Perspectives on Barriers and Facilitators to Integrating Transgender Healthcare into Family Planning Clinics. Transgender Health, 7(1), 36–42.https://doi.org/10.1089/trgh.2020.0110Ingraham, N., & Rodriguez, I. (2022b). Clinic Staff Perspectives on Barriers and Facilitators to Integrating Transgender Healthcare into Family Planning Clinics. Transgender Health, 7(1), 36–42.https://doi.org/10.1089/trgh.2020.0110Klein, D. A., Malcolm, N. M., Berry-Bibee, E. N., Paradise, S. L., Coulter, J. S., Keglovitz Baker, K., Schvey, N. A., Rollison, J. M., & Frederiksen, B. N. (2018). Quality Primary Care and Family Planning Services for LGBT Clients: A Comprehensive Review of Clinical Guidelines. LGBT Health, 5(3), 153–170.https://doi.org/10.1089/lgbt.2017.0213PFCLA. (n.d.). The Cost of IVF in California. Retrieved July 14, 2023, fromhttps://www.pfcla.com/blog/ivf-costs-californiaPODCAST. (n.d.). Rio Bravo Residency. Retrieved July 14, 2023, fromhttps://www.riobravofmrp.org/qweek/episode/fcb76527/episode-103-caring-for-lgbtq-patientsRotabi, K. S. (n.d.). From Guatemala to Ethiopia: Shifts in Intercountry Adoption Leaves Ethiopia Vulnerable for Child Sales and Other Unethical Practices.Smoley, B. A., & Robinson, C. M. (2012). Natural Family Planning. American Family Physician, 86(10), 924–928.Surrogate Compensation | How Much Do Surrogater Paid in CA? (n.d.). Https://Familytreesurrogacy.Com/. Retrieved July 14, 2023, fromhttps://familytreesurrogacy.com/blog/surrogate-pay-california/The National Academies Press. (n.d.). Retrieved July 14, 2023, fromhttps://nap.nationalacademies.org/thisisloyal.com, L. |. (n.d.). How Many Same-Sex Couples in the US are Raising Children? Williams Institute. Retrieved July 14, 2023, fromhttps://williamsinstitute.law.ucla.edu/publications/same-sex-parents-us/Royalty-free music used for this episode: "Rain in Spain." Downloaded on October 13, 2022, from https://www.videvo.net/ 

Dr. Faisel and Dr. Dan are discussing Empowered Choices Bridging the Gap between Clinical Guidelines and Informed Decisions on this episode of Faisel & Friends! Our conversation revolves around the structures that allow us to spend more time with patients, the need for more in-depth drug trials, and the difference between evidence-based medicine and evidence-informed care.Being a doctor is your calling because you couldn't imagine doing anything else. Let's talk about your career goals in medicine. Connect with us and tell us how you dream of practicing medicine. Want to learn more about how we do healthcare? Visit our resource center and check out how we are transforming healthcare. Don't forget to subscribe to ChenMed Rx to receive the latest news and articles from ChenMed.

Evidence Behind Oncology Accelerated Approvals in Clinical Guidelines with guests Drs. Maryam Mooghali and Reshma Ramachandran July 2, 2023 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Evidence Behind Oncology Accelerated Approvals in Clinical Guidelines with guests Drs. Maryam Mooghali and Reshma Ramachandran July 2, 2023 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

“Evidence-based practice is asking the right clinical question, searching the evidence and then really appraising and determining what is the quality of the evidence, and synthesizing it to move forward with a recommendation or a possible implementation plan,” Caroline Clark, MSN, APRN, OCN®, AG-CNS, director of evidence-based practice and inquiry at ONS, told Jaime Weimer, MSN, RN, AGNCS-BC, AOCNS®, oncology clinical specialist at ONS, during a discussion about the nurse's role in evidence-based oncology care. You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.5 contact hour of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by February 24, 2025. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: The learner will report an increase in knowledge related to evidence-based practice. Episode Notes Complete this evaluation for free NCPD. ONS Evidence-Based Practice Learning Library ONS Voice articles: Real-World Usage Reports Show That ONS Guidelines™ Empower Nurses to Provide Best Patient Care Evidence-Based Practice Gives Oncology Nurses Knowledge and Standards for Clinical Care From Evidence to Standard: The Role of Clinical Guidelines in Oncology Care Overcome Barriers to Applying an Evidence-Based Process for Practice Change Adopt an Evidence-Based Practice Model to Facilitate Practice Change Strengthen a Commitment to Practice Change Through EBP Immersions The Difference Between Quality Improvement, Evidence-Based Practice, and Research Nursing evidence-based practice topic tag Clinical Journal of Oncology Nursing articles: Evidence-Based Practice in Oncology Nursing: Oncology Nursing Society Survey Results Success Is Not Final: Onward to the Future of Evidence-Based Practice Oncology Nursing Forum article: Measuring Clinical Decision Support Influence on Evidence-Based Nursing Practice ONS Biomarker Database The Ohio State University College of Nursing course: EBP Basics National Institutes of Health: Evidence-based practices, programs, and resources National Cancer Institute: Evidence-based cancer control programs Healthy People 2030 National Comprehensive Cancer Network American Society of Clinical Oncology To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From Today's Episode “Evidence-based practice (EBP) is asking the right clinical question, searching the evidence and then really appraising and determining what is the quality of the evidence, and synthesizing it to move forward with a recommendation or a possible implementation plan.” Timestamp (TS) 01:56 “Having a culture and environment that supports EBP is really foundational. An environment that encourages questions is going to cultivate the mentors in that environment and has leadership support. And often, that means tying EBP into your whole organizations mission and vision just to sustain evidence-based changes.” TS 06:15 “Developing your skills in critical appraisal does take time. It's not something that happens overnight, so you have to look for the opportunities to practice. Mentorship is certainly important. . . . Many organizations have adopted an EBP methodology, so while there's a lot of methodologies out there to choose from, there's so much overlap in them and the tools they use. I would really just explore if there's something already preferred in your organization.” TS 13:18 “Some key players to ask around about EBP are your nursing professional development specialists, your clinical nurse specialists, your DNP-prepared nurses, and your nurse scientists. And a great, low-risk way to practice critical appraisal is through journal clubs.” TS 13:57 “I think there's a lot of great work going on with the overarching theme of closing that gap from research to translation into practice. Some general things that I think are happening are really incorporating evidence into daily practice. That could be clinical decision support tools that are embedded in our electronic health record and then physicians, nurses, and clinicians have that at their fingertips at the point of care. And then standardized policies and templates to guide care for specific populations. And I think the use of religiously developed practice guidelines that are current at the point of care, as well.” TS 22:20 “If you're embarking on EBP change early on—I cannot stress this enough—you really need to determine what your outcome measures will be. How are things measured and recorded in the literature? How would you apply them in your practice? . . . From the start, consider specifically what the patient outcomes will be that you're monitoring that you're hoping to make a positive change in.” TS 31:12

Drs. Ravi Kalhan and Sidney S. Braman discuss COPD and some of its overlap syndromes including asthma-COPD overlap (ACO) and COPD-bronchiectasis, as well as controversies regarding their definitions, diagnosis, prognosis, monitoring and treatment despite lack of clinical guidelines.

In this episode of What's Up Wednesday, obesity specialist and host, Karli Burridge, reviews the brand-new, first-ever Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity released by the American Academy of Pediatrics (AAP).FROM THE AMERICAN ACADEMY OF PEDIATRICS| CLINICAL PRACTICE GUIDELINE| JANUARY 09 2023Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity  by Sarah E. Hampl, MD, FAAP et alExecutive Summary: Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With ObesityObesity-focused Organizations Issue Statement in Support of New AAP Clinical Guideline on Childhood ObesitySupport the showThe Gaining Health Podcast will release a new episode monthly, every second Wednesday of the month. Episodes including interviews with obesity experts as well as scientific updates and new guidelines for the management of obesity.If you're a clinician or organization looking to start or optimize an obesity management program, and you want additional support and resources, check out the Gaining Health website! We offer monthly and annual Memberships, which include live group coaching, a community forum to ask questions and post resources, pre-recorded Master Classes, digital resources inlcuding patient education materials and office forms, and much more! We also sell our popular Gaining Health products, including a book on developing an obesity management program, editable forms and templates, and patient education materials in our Gaining Health Shop! If you are loving this podcast, please consider supporting us on Patreon

As they were gearing up for the Symposium for Metabolic Health in Boca Raton (https://www.lowcarbusa.org/smhp-symposiums/) - their 18th conference over the past eight incredible years - they decided to celebrate their 100th episode of the LowCarbUSA® Podcast with a look back at how they got here. In Episode 100, they talk about how they first learned about the low-carb/ketogenic lifestyle, and how they got the idea to organize the first Symposium for Metabolic Health in 2016. They also discuss the creation of the Clinical Guidelines (https://thesmhp.org/clinical-guidelines/), the formation of the Society of Metabolic Health Practitioners (The SMHP), the free resources available from both LowCarbUSA and The SMHP, the Metabolic Health Practitioner (MHP) accreditation process (https://thesmhp.org/membership-account/membership-levels/), and much more, including many of their hopes and dreams for the future! After the very first conference in San Diego, in 2016, we really started to realize how much this meant for the healthcare professional. And we really knew that's where we wanted to focus and make sure that healthcare professionals were aware of this information, first of all, and second of all, that there were conferences and training where they could come to learn all about it.

The European Respiratory Society has provided 8 conditional recommendations for the use of nasal high flow/high flow nasal cannula/high flow oxygen/whatever you want to call it. Here, I review the 8 recommendations and add some commentary on them. Show Notes: https://eddyjoemd.com/high-flow/ Citation: Oczkowski S, Ergan B, Bos L, Chatwin M, Ferrer M, Gregoretti C, Heunks L, Frat JP, Longhini F, Nava S, Navalesi P, Ozsancak Uğurlu A, Pisani L, Renda T, Thille AW, Winck JC, Windisch W, Tonia T, Boyd J, Sotgiu G, Scala R. ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure. Eur Respir J. 2022 Apr 14;59(4):2101574. doi: 10.1183/13993003.01574-2021. PMID: 34649974. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/eddyjoemd/support

"We need to address the underlying preventable factors that cause more Black Americans to die of heart attacks and strokes and suffer from high blood pressure and diabetes complications than white Americans instead of focusing on non-existent biological differences. I would like to see the scientific disciplines unite to call out the mislabeling of race as a biological category and stop using race in place of structural racism, toxic stress caused by discrimination, and systemic inequities in social determinants of health. Instead of emphasizing our biological differences, the research community needs to focus on the real problems Black Americans continue to face that increase their risk of illness and death." Carmen Presti is a nurse practitioner. She shares her story and discusses her KevinMD article, "Remove race from clinical guidelines." Did you enjoy today's episode? Rate and review the show so more audiences can find The Podcast by KevinMD. Subscribe on your favorite podcast app to get notified when a new episode comes out. Reflect and earn 1.0 AMA PRA Category 1 CME for this episode. Also available in Category 1 CME bundles. Powered by CMEfy - a seamless way for busy clinician learners to discover Internet Point-of-Care Learning opportunities that reward AMA PRA Category 1 Credit(s)™. Learn more at about.cmefy.com/cme-info