Podcasts about cme

Featuring perspectives from Dr David M O'Malley and Dr Brian M Slomovitz, including the following topics: Ovarian Cancer; HER2-Directed Therapy for Advanced Gynecologic Cancers — Dr O'Malley (0:00) Endometrial Cancer and Cervical Cancer — Dr Slomovitz (23:38) CME information and select publications

Some ambulance crews may not have the best understanding of how a fire crew is going to run a call, with everyone assigned specific roles – often the fire department will be allowing a new crew member to lead the callI always struggled with arriving first on scene on the ambulance because that role is more work and more pressure What does fire like from the ambulance crews when they arrive first?First on scene should be allowed to lead the call and ask for help where needed, second on scene should not be pushing their way in and trying to take over the callSometimes the providers that take over lack experience or are not yet comfortable enough with their own skills to allow someone else to leadIf you have another provider on scene constantly trying to interrupt, give them something to do - often this applies to a disruptive family memberDoes the ambulance paramedic have to attend in the back if the fire paramedic rides in?As a previous ambulance paramedic, I viewed the ambulance as my space, meaning I always appreciated it when the fire paramedic had the respect to treat it as such, asking to ride into the hospital as opposed to telling me they were riding in. As a general rule, if the fire paramedic believes they need to ride in due to acuity, the ambulance paramedic should also attendKash, as a medical director, gives his opinion on this situationI really appreciated it when the fire crews respected our ambulance because the front is truly our officeEMT's can ride in too on low acuity where more hands, not ALS treatment, is neededI've talked before that a paradigm shift is needed for the paramedics at times, where they are more likely to have to attend more calls then their EMT partners -  easy for me to say from outside the field now – but transporting the patient is almost always the safest, lowest liability option, we shouldn't be trying to get out of transports just because it's less workAlways treat the patient like they are a family memberWe are looking for proof that the patient is not sick, as opposed to assuming they are not sick from the outset, our approach is different in emergency medicineWe have, historically, reversed hypoglycemia or opiate OD, and the patient has refused when maybe transport to the hospital is warranted despite the fact that we have temporarily fixed a major problemSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

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Featuring an interview with Dr John P Leonard, including the following topics: First-line therapy for diffuse large B-cell lymphoma (DLBCL) with polatuzumab vedotin and R-CHP; impact of DLBCL cell of origin (0:00) Epcoritamab, glofitamab and other bispecific antibodies as initial therapy for large B-cell lymphoma (9:27) Sequencing chimeric antigen receptor T-cell therapy and bispecific antibodies for patients with relapsed/refractory (R/R) DLBCL (12:30) Approved and investigational bispecific antibodies for the treatment of DLBCL (15:24) Practical considerations for the administration of mosunetuzumab (22:03) Tafasitamab combined with lenalidomide/rituximab as second-line treatment for follicular lymphoma (FL); third- and later-line therapy options (24:33) Activity of Bruton tyrosine kinase inhibitors in FL and other non-Hodgkin lymphomas (31:27) Risk of infection for patients receiving bispecific antibodies (33:23) Chemotherapy-free regimens for the treatment of mantle cell lymphoma (MCL) (36:21) Current role of transplant in the treatment algorithm for MCL; potential integration of bispecific antibodies into therapy for R/R disease (41:23) Myths and misperceptions about the management of DLBCL, FL and MCL (47:29) CME information and select publications

Dr John P Leonard from Weill Cornell Medicine in New York, New York, reviews data presented at the 2024 ASH Annual Meeting and their implications for the treatment of non-Hodgkin lymphomas. CME information and select publications here.

On Thursday, Coinbase announced its acquisition of Deribit in a $2.9 billion deal, the largest merger in the crypto industry to date. In this episode, Owen Lau, executive director and senior analyst at Oppenheimer, delves into why Deribit was such a coveted prize, what this deal means for the global derivatives landscape, and how Coinbase is using its position as a public company to cement its dominance. Plus: The importance of Coinbase paying mostly in stock and barely touching its cash How the derivatives market dwarfs spot trading, and is only getting bigger What this means for CME and smaller crypto exchanges And how Base, Coinbase's L2, fits into the long game Visit our website for breaking news, analysis, op-eds, articles to learn about crypto, and much more: unchainedcrypto.com Thank you to our sponsors! FalconX Bitkey: Use code UNCHAINED for 20% off Mantle Guest Owen Lau, Executive Director and Senior Analyst at Oppenheimer Timestamps:

If international tensions break out into a wider war, it is likely to fought differently than previous wars. What will be the same is that the home front will become a target. Instead of Zeppelins, enemy bombers, V2 missiles, or Cuban paratroopers invading, the assault on the home front will likely be cyber warfare -- software viruses and backdoors to take down civilian infrastructure. How would prepping for CyberDoom be different than an EMP or CME?   If you are appreciating these topical episodes, consider becoming a Patron on Patreon, or a monthly member at Buy Me A Coffee, One-time coffee at Buy Me A Coffee are great too! All support appreciated.    

Featuring a slide presentation and related discussion from Dr John P Leonard, including the following topics: Five-year analysis of the POLARIX trial of polatuzumab vedotin with R-CHP for previously untreated diffuse large B-cell lymphoma (0:00) Epcoritamab, glofitamab and other bispecific antibodies for large B-cell lymphoma (5:33) Circulating tumor DNA as an early outcome predictor in patients with large B-cell lymphoma receiving second-line lisocabtagene maraleucel in the TRANSFORM study (16:44) The bispecific antibodies mosunetuzumab and odronextamab as initial therapy for follicular lymphoma (FL) (19:27) The Phase III inMIND trial of tafasitamab in combination with lenalidomide/rituximab for recurrent FL (22:58) Updated results from studies of bispecific antibodies and chimeric antigen receptor T-cell therapy for relapsed/refractory FL (24:58) Updates from the Phase III TRIANGLE and ECOG-ACRIN EA4151 trials on the role of autologous stem cell transplant in the treatment of previously untreated mantle cell lymphoma (MCL) (27:48) Novel treatment approaches with Bruton tyrosine kinase inhibitors for patients with newly diagnosed MCL (30:53) CME information and select publications

Beef remains tight — production ticks up slightly, but grilling season and shifting demand are pushing grinds higher. Some middle meats are cooling, others still heating up.Poultry prices still split — tenders climb, breasts stay high, wings dip again. Production's up and bird flu cases stayed low this week.Grains drift down — corn and wheat slide, soy holds firm. Ethanol chatter could shake things up.Pork cools off — bellies dip, loins still a solid value, and butts barely budge. Summer could bring the heat back.Dairy bounce back — after two weeks down, prices climb again. Not a rally yet, but some upside remains.Savalfoods.com | Find us on Social Media: Instagram, Facebook, YouTube, Twitter, LinkedIn

Gemma started her career studying Mechanical Engineering at Cardiff University. She quickly discovered the world of Continuous Improvement and spent 20 years working to improve processes and systems within various manufacturing industries including Automotive, Pharmaceutical, Dairy, Cosmetics & Toiletries, Food, and Medical Devices. She has been a CI Manager numerous times and an Operations Manager running a factory of over 500 people.Gemma is hugely passionate about Improvement and developing people and processes. She gets such a kick out of coaching and facilitating, especially when she sees the lightbulb switch on in someone's head – when they solve a problem; when they realize they have the power to change; or when they get excited about all the improvements they could make.In 2019, Gemma left the world of employment to establish her own business, SPARK Improvement, aiming to switch on as many lightbulbs as possible. Her mission is to help organizations and individuals be the BEST they can be, by helping people SEE, helping people THINK, and helping people CHANGE.Gemma is based in Cheshire in the UK, working globally.Link to claim CME credit: https://www.surveymonkey.com/r/3DXCFW3CME credit is available for up to 3 years after the stated release dateContact CEOD@bmhcc.org if you have any questions about claiming credit.

In this episode of the Oncology Brothers podcast, Drs. Rahul & Rohit Gosain wrap up their three-part CME series on HER2-positive biliary tract cancer. Joined by Dr. Rachna Shroff, they delved into the critical topic of managing adverse events associated with treatments like TDXD and Zanidatamab. The discussion covered: •⁠  ⁠Overview of the treatment landscape for biliary tract cancer •⁠  ⁠Common side effects of TDXD, including interstitial lung disease, nausea, and fatigue •⁠  ⁠Management strategies for adverse events, including dose reductions and supportive care •⁠  ⁠Insights on Zanidatamab, its side effects, and infusion-related reactions •⁠  ⁠The importance of biomarker testing and patient-centered care in treatment decisions Tune in to gain valuable insights on how to improve patient quality of life while navigating the complexities of HER2-positive biliary tract cancer treatments. Follow us on social media: •⁠  ⁠X/Twitter: https://twitter.com/oncbrothers •⁠  ⁠Instagram: https://www.instagram.com/oncbrothers •⁠  Website: https://oncbrothers.com/ Don't forget to like, subscribe, and hit the notification bell for more updates from the Oncology Brothers!

Special Public Service Announcement – Free Crypto WebinarIn this brief Public Service Announcement, I'm sharing an exciting opportunity for you to join my upcoming free live webinar, “The Case for Cryptocurrency.” This isn't a full podcast episode, but I wanted to let you know about this important event and why it's a must-attend for anyone curious about cryptocurrency or looking to secure their financial future. During the webinar, I'll explain why now is the time to embrace crypto and how it can empower you to stay ahead in a rapidly changing world.Registration is free—just head to preppingacademy.com/crypto to sign up today.Thank you for being part of our community, and I look forward to seeing you at the webinar.Stay safe, and we'll catch up in the next full episode!Join PrepperNet.Net - https://www.preppernet.netPrepperNet is an organization of like-minded individuals who believe in personal responsibility, individual freedoms and preparing for disasters of all origins.Join PrepperNet.Net - https://www.preppernet.netPrepperNet is an organization of like-minded individuals who believe in personal responsibility, individual freedoms and preparing for disasters of all origins.PrepperNet Support the showPlease give us 5 Stars! www.preppingacademy.com Contact us: https://preppingacademy.com/contact/ www.preppernet.net Amazon Store: https://amzn.to/3lheTRTwww.forrestgarvin.com

Featuring perspectives from Prof Rebecca A Dent and Dr Nancy U Lin, including the following topics: Introduction: A New Paradigm for Triple-Positive Breast Cancer? (0:00) CDK4/6 Inhibitors for HR-Positive, HER2-Negative Breast Cancer (10:06) Oral Selective Estrogen Receptor Degraders for HR-Positive, HER2-Negative Breast Cancer (21:17) Treatment of PIK3CA/PTEN/AKT-Mutated Breast Cancer (31:34) Antibody-Drug Conjugates (ADCs) for HR-Positive, HER2-Negative Breast Cancer (38:41) ADCs for HER2-Positive Breast Cancer (46:30) HER2-Targeting Tyrosine Kinase Inhibitors for HER2-Positive Breast Cancer (53:26) ADCs for Advanced Triple-Negative Breast Cancer (58:29) CME information and select publications

Double vision is a symptom often experienced by patients with neurologic disease. An organized systematic approach to evaluating patients with diplopia needs a foundational understanding of the neuroanatomy and examination of eye movements and ocular alignment. In this episode, Teshamae Monteith, MD, FAAN, speaks with Devin Mackay, MD, FAAN, author of the article “Approach to Diplopia” in the Continuum® April 2025 Neuro-ophthalmology issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Mackay is an associate professor of neurology, ophthalmology, and clinical neurosurgery at Indiana University School of Medicine in Indianapolis, Indiana. Additional Resources Read the article: Approach to Diplopia Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Monteith: This is Dr Teshamae Monteith. Today I'm interviewing Dr Devin Mackay about his article on approach to diplopia, which appears in the April 2025 Continuum issue on neuro-ophthalmology. Welcome to the podcast. How are you? Dr Mackay: Thank you. It's great to be here. Dr Monteith: Congratulations on your article. Dr Mackay: Thank you. I appreciate that. Dr Monteith: Why don't you start off with introducing yourself to our audience? Dr Mackay: So, yeah, my name is Devin Mackay. I'm a neuro-ophthalmologist at Indiana University. I did my residency at what was used to be known as the Partners Healthcare Program in Boston, and I did a fellowship in neuro-ophthalmology in Atlanta. And I've been in practice now for about ten years. Dr Monteith: Oh, wow. Okay. Tell us a little bit about your goals when you were writing the chapter. Dr Mackay: So, my goal with the approach to double vision was really to demystify double vision. I think double vision is something that as trainees, and even as faculty members and practicing neurologists, we really get intimidated by, I think. And it really helps to have a way to approach it that demystifies it and allows us to localize, just like we do with so many other problems in neurology. Dr Monteith: I love that, demystification. So why don't you tell us what got you interested in neuro-ophthalmology? Dr Mackay: Yeah, so neuro-ophthalmology I stumbled on during a rotation during residency. We rotated in different subspecialties of neurology and I did neuro-ophthalmology, and I was just amazed by the exam and how intricate it was, the value of neuroanatomy and localization, the ability to take a complicated problem and kind of approach it as a diagnostic specialist and really unravel the layers of it to make it better. To, you know, figure out what the problem is and make it better. Dr Monteith: Okay, so you had a calling, clearly. Dr Mackay: I sure did. Dr Monteith: You talked about latest developments in neuro-ophthalmology as it relates to diplopia. Why don't you share that with our listeners? Dr Mackay: Yeah. So, you know, double vision is something that's really been around since the beginning of time, essentially. So that part hasn't really changed a lot, but there are some changes that have happened in how we approach double vision. Probably one of the bigger ones has been, we used to teach that with a, you know, patient over the age of fifty with vascular risk factors who had a cranial nerve palsy of cranial nerves 3, 4, or 6, we used to automatically assume that was a microvascular palsy and we just wouldn't do any more testing and we'd just, you know, wait to see how they did. And it turns out we're missing some patients who have significant pathologies, sometimes, with that approach. And so, we've really shifted our teaching with that to emphasize that it's a lot easier to get an MRI, for example, than it ever has been. And it can be important to make sure we're not missing important pathology in patients, even if they have vascular risk factors over the age of fifty and they just have a cranial nerve 3, 4, or 6 palsy. So that's been one change. Dr Monteith: Interesting. And why don't you tell us a little bit about the essential points that you want to get across in the article? Dr Mackay: Yeah. So, I think one is to have a systematic approach to double vision. And a lot of that really revolves around localization. And it even begins with the history that we take from the patients. There's lots of interesting things we can ask about double vision from the patient. For example, the most important thing you can ever ask someone with double vision is, does it go away when you cover either eye? And that really helps us figure out the first question for us as neurologists, which is, is it neurologic or non-neurologic? If it's still there when covering one eye, then it is not neurologic and that's usually a problem for an ophthalmologist to sort out. So that's really number one. And then if it is binocular double vision, then we get into details about, is it horizontal or vertical misalignment? Is it- what makes it better and worse? Is there an associated ptosis or other symptoms? And based on all of that, we can really localize the abnormality with the double vision and get into details about further testing if needed, and so forth. I also love that that approach really reduces our need to rely on things like neuroimaging sometimes when we may not need it, or on other tests. So, I think it really helps us be more efficient and really take better care of patients. Dr Monteith: So definitely that cover/uncover test, top thing there. Your approach- and you mentioned, are you really getting that history, and are there any other kind of key factors when you're approaching diplopia before getting into some of the details? Dr Mackay: Yeah, that's a good question. I think also having some basics of how to examine the patient, because double vision is such a challenging thing. A lot of us aren't as familiar with the exam toolkit, so to speak, of what you would do with a patient with double vision. And so, I go over in the article a bit about a Maddox rod, which is a handy little tool that I always keep in my pocket of my lab coat. It allows you to assign a red line to one eye and a light to the other eye, and you can see if the eyes line up or not. And you don't need any other special equipment, you just need the light in that Maddox rod. That really helps us understand a lot about the pattern of misalignment, which is really important for evaluating double vision. So, for example, if someone has a right 6th nerve palsy, I'll expect a horizontal misalignment of the eyes that worsens when the patient looks to the right and improves when they look to the left. And especially if it's a partial palsy, it's not always easy to see that just by looking at their eye movements. And having a way to really measure the eye alignment and figure out, is it worse or better in certain directions, is really essential to localization, I think, in a lot of cases. Dr Monteith: You caught me. I skipped over that Maddox rod part, even though you spent a lot of time talking about Maddox rods. Kind of skipped over it. So, you're saying that I need one. Dr Mackay: Everyone needs one. I've converted some of our residents here to carry one with them. And yeah, I realize it's a daunting tool at first, but when you have a patient with double vision and their eye movements look normal, I feel like a lot of neurologists are- kind of, their hands seem like they're tied and they're like, oh, I don't know, I don't know what to do at this point. And if you can get some more details with a simple object like that, it can really change things. Dr Monteith: So, we've got to talk to the AAN store and make sure that they have enough of these, because now there's going to be lots of… Dr Mackay: We're going to sell out on Amazon today now because of this podcast. Dr Monteith: Cyber Monday. So, let's talk about the H pattern. And I didn't know it had the- well, yeah, I guess the official name is “H pattern.” In medical school, I mean, that's what I learned. But as a resident and, you know, certainly as an attendee, I see people doing all sorts of things. You're pro-H pattern, but are there other patterns that you also respect? Dr Mackay: It depends on what you're looking for, I think. The reason I like the H pattern is because you get to look at upgaze and downgaze in two different directions. So, you get to look at upgaze and downgaze when looking to the left, and up- and downgaze when looking to the right. And the reason that matters is because vertical movements of the eyes are actually controlled by different eye muscles depending on whether the eye is adducted toward the nose or abducted away from the nose. And so that's why I love the H pattern, is because it allows you to see that. If you just have them look up and down with just a cross pattern, for example, then you really lose that specificity of looking at both the adduction and abduction aspects. So, it's not wrong to do it another way with, like, the cross, for example, but I just think there are some cases where we'll be missing some information, and sometimes that can actually make a difference. Dr Monteith: Well, there you have it. Let's talk a little bit about eliciting diplopia during the neurologic exam. What other things should we be looking out for? Dr Mackay: So, in terms of eliciting diplopia, it really starts with the exam and again, figuring out, are we covering one eye? And figuring out, is this patient still having double vision? It's tricky because sometimes the patients won't even know the answer to that question or they've never done it, they've never covered one eye. And so, if that's the case, I really make them do it in the office with me and it's like, okay, well, are we having double vision right now? Well, great, okay, we are, then we're going to figure this out right now. And we cover one eye and say, is it still double? And that way we can really figure out, are we monocular or binocular? That's always step one. And then if we've established that it's binocular diplopia, then that's when we get into the other details that I mentioned before. And then as far as other things to look for, we're always in tune to other things that are going on in terms of symptoms, like ptosis, or if there's bulbar weakness, or some sensory change or motor problem that seems to be associated with it. Obviously, those will give us clues in the localization as well. Dr Monteith: And what about ocular malalignment? Dr Mackay: Yeah. So ocular malalignment, really, the cardinal symptom of that is going to be double vision. And so, if a patient has a misalignment of the eyes and they don't have double vision, then usually that means either we're wrong and they don't have double vision, or they do have double vision and they, you know, haven't said it correctly. Or it could be that the vision is poor in one eye. Sometimes that can happen. Or, some patients were actually born with an eye misalignment and their brain has learned in a way to kind of tune out or not allow the proper development of vision in one eye. And so that's also known as amblyopia, also known as the lazy eye, some people call it. But that finding can also make someone not experience double vision. But otherwise, if someone's had normal vision kind of throughout their life, they'll usually be pretty aware of when they first notice double vision. It'll be an obvious event for them in in most cases. Dr Monteith: And then the Cogan lid twitch? Dr Mackay: Oh yes, the Cogan lid twitch. So, the Cogan lid twitch is a feature of myasthenia gravis. The way you elicit it is, you have the patient look down. I'm not sure there's a standardization for how long; you want to have it long enough that you're resting the levator muscle, which is the muscle that pulls the upper lid open. And so, you rest that by having them look down for… I usually do about ten or fifteen seconds. And then I have them look up to looking straight forward. And you want to pay careful attention to their lid position as their eye settles in that straight-forward position. What will happen with a Cogan's lid twitch is, the lid will overshoot, and then it'll come back down and settle into its, kind of, proper position. And what we think is happening there is, it's almost like a little mini “rest test” in a way, where you're resting that muscle just long enough to allow some of the neurotransmission to recover. You get a normal contraction of the muscle, but it fades very quickly and comes back down. And that's experienced as a twitch. Dr Monteith: So, the patient can feel it. And it's something you can see? Dr Mackay: Yeah, the patient may not feel it as much. It's usually it's going to be something that the clinician can see if they're looking for it. And I would say that's one of the physical exam findings that can be a hallmark of myasthenia gravis, but certainly not the only one. Some others that we often look for are fatigable ptosis with sustained upgaze. You have the patient look up for a prolonged time and you'll see the lid droop down. So that can be one. Ice pack test is very popular nowadays, and it has pretty good sensitivity and specificity for myasthenia. So, you keep an ice pack over the closed eyes for two minutes and you compare the lid position before and after the ice pack test. And in the vast majority of myasthenia patients, if they have ptosis, the ptosis will have resolved, or at least significantly improved, in those patients. And yet one more sign is, if you find the patient's eye with ptosis and you lift open the eye manually, you'll often see that the other eyelid and the other eye will lower down. So, I'm not sure there's a name for that, but that can be a helpful sign as well. Dr Monteith: Since you're going through some of these, kind of, key features of different neurologic disease, why don't you tell us about a few others? Dr Mackay: Yeah, so another I mentioned in the in the article is measurement of levator function, which is really a test of eyelid strength. And so, that can be helpful if we have- someone has ptosis, or we're not sure if they have ptosis and we're trying to evaluate that to see if it's linked to the double vision, because that really changes the differential if ptosis is part of the clinical situation. So, the way that's measured is you have a patient look down as far as they can. And you get out a little ruler---I usually use a millimeter ruler---and I set the zero of the ruler at the upper lid margin when they're looking down. So, I hold the ruler there, and then I ask the patient to look up as far as they can without moving their head. Where the lid position stops of the upper lid is the new point on the ruler. And so, you measure that and see how much that is. And so, a normal patient may have a value somewhere between, I don't know, twelve or thirteen millimeters up to seventeen or eighteen millimeters, probably, in most cases. Especially if there is an asymmetric lid position, if you find that the levator function is symmetric, then it tells you that the muscle is working fine and that the ptosis is not from the muscle. So then the ptosis may be from dehiscence of the lid margin from the muscle. And so, that's a really common cause of ptosis, and that's often age-related or trauma-related. And we can dismiss that as being part of the symptom constellation of double vision. So, it can be really helpful to clarify, is this a muscle problem, which you'd expect with myasthenia or a third nerve palsy, or is this a mechanical problem with the lid, which is non-neurologic and really should be dismissed? So that can be a really helpful exam tool. Dr Monteith: So, you're just now getting into a little localization. So why don't we kind of start from the most proximal pistol with localization. Give us a little bit of tips. I know they just got to read your article, but give us a few tips. Dr Mackay: So, in terms of most proximal causes, there are supranuclear causes of ocular misalignment. For example, a skew deviation would qualify as that. Anything that's happening from some deficient input before you get to the cranial nerve nuclei, that we would consider supranuclear. So, we also see that with things like progressive supranuclear policy and certain other conditions. And then there can be lesions of the cranial nerve nuclei themselves. So, cranial nerves 3, 4, and 6 all have nuclei, and if they're lesioned they will cause double vision in specific patterns. And then there's also another subgroup, which is known as intranuclear problems with eye alignment. And so, the most common of that is going to be intranuclear ophthalmoplegia. And so that's very common in patients with demyelinating disorders, or it can also happen with strokes and tumors and other causes. And then there's infranuclear problems, which are from the cranial nerve nuclei out, and so those would be the cranial nerves themselves. So that's where your microvascular palsies, any tumor pressing on the nerve in those locations can cause palsies like that, any inflammatory disorder along that course. Then as we get more distal, we get into the orbit, we have the neuromuscular junction---so, the connection between the nerve and the muscle. And of course, that's our myasthenia gravis. And there are rare causes, things like botulinum and tick borne illnesses and certain other things that are more rare. And then, of course, we get to the muscle itself, and there can be different muscular dystrophies, different things like myositis or inflammatory disorders of the orbit or even physical trauma. So, if a patient, you know, had a trauma in trapping an extraocular muscle, that can be a localization. So really, anywhere along that pathway you can have double vision. So, I love to approach it from that perspective to help narrow down the diagnostic possibilities. Dr Monteith: Okay, just like everything? Dr Mackay: Just like all of the rest of the neurology. See, it's not that scary. Dr Monteith: You know, and so, yeah. And then you do a lot more than, you know, a few cranial nerves, right? Dr Mackay: Right. That's right. There's a lot more to double vision than that. I think as neurologists, we get lost if it's not a cranial nerve palsy, we're like, oh, I don't know what this is. And if it's not myasthenia, not a cranial nerve palsy. But it's worth also considering that there are ophthalmologic causes of someone having double vision that we often don't consider. So maybe someone who was born with strabismus, or maybe they have a little bit of a tendency toward an eye misalignment that their brain compensates, for and then it decompensates someday and that now they have a little bit of double vision intermittently, so that those can be causes to consider as well. Dr Monteith: Yeah, well, we'll just have to, you know, request those records from forty years ago. No problem. Dr Mackay: That's right. Dr Monteith: Why don't you also give us a little bit of tip when we're on the wards and we want to teach either a medical student or a resident, or if it's a resident listening, may want to teach a junior resident and seem like a star when approaching a patient with diplopia. Give us some teaching pearls. Dr Mackay: Yeah. So, I would love people teaching more about this at the bedside. I'd say probably the first thing to do would be to equip yourself by recognizing what some of the pertinent questions are to ask someone with double vision. Those things would include, is the double vision worse when looking in a certain direction? Does the double vision go away or not when you cover one eye? What happens when you tilt your head one direction or the other? Is it intermittent or constant? What makes it better? What makes it worse? Those kinds of things can really help us narrow down the possibilities. And then the other thing would be to equip yourself with some tools for examining. And it doesn't have to be physical tools. These can actually be things like, you mentioned the cross-cover test or cover/uncover test. That's described in the article. And I think knowing how to do that properly, knowing how to examine the eye movements properly and how to check for subtle things like a subtle intranuclear ophthalmoplegia, which is also mentioned in the article, being familiar with those things can be a really useful exercise in allowing you to teach others later on. Dr Monteith: Cool. Why don't you tell us about some of the things you're most excited about in the field? Dr Mackay: One of the things about our subspecialty for so long is we really haven't had big data with, you know, big trials and all these things that all the stroke people have. And that's starting to change slowly. There's been, for example, the idiopathic intracranial hypertension treatment trial that was published back in, I think it was 2014. You know, of course we had the optic neuritis treatment trial, back a few decades ago now. Some of the exciting ones coming up, there's going to be a randomized controlled trial looking at different treatments for idiopathic intracranial hypertension that are surgically based. So, for example, comparing venous sinus stenting with optic nerve sheath fenestration. And so, figuring out, is there a best practice for surgical intervention for patients with IIH? So, we're starting to have more trials like that now than I think we've had in the past. And so, it's exciting to get to have an evidence base for some of the things that we recommend and do. Dr Monteith: And what about some of the treatment for diplopia? Like prisms, and where are we with some of that? Dr Mackay: Yeah, great. So, it's a pretty simple concept, but still kind of difficult in practice. I kind of say there are four different ways to treat double vision: you can ignore it, you can patch or cover one eye, you can treat with prisms, and you can treat with eye muscle surgery. And so, those are the main ways other than, of course, treating the underlying disorder if there's a disorder causing double vision. So those are the main ways to treat. In terms of knowing if someone's going to be a candidate for prism therapy, we also have to remember that prisms are really going to be most helpful for when someone's looking straight forward. So, we need to make sure that their double vision is happening when they look straight forward. So, for example, if they're only having double vision looking to the left or to the right, that patient may not benefit from prisms as much as someone who is having double vision when they look straight forward. So that's one thing I look for. And then strabismus surgery is something to be considered if someone is not tolerating prisms and they're not helping and their eye alignment is stable. So, if you think about it, if someone's eye alignment is changing a lot, you're probably not going to want to do surgery for that patient because it's going to keep changing after surgery. And so, if someone's eye alignment is stable for six months or more and they're not getting the benefit they'd like from prisms, then maybe referral to a strabismus surgeon might be something to consider. Dr Monteith: Great. And then, I guess another question is just popping up in my head selfishly. What are your thoughts about patients that get referrals for exercises? Say they have, like, a convergence efficiency or something causing diplopia, maybe after a concussion. Maybe there's not a lot of evidence, but what is your take on exercising? Dr Mackay: Yeah, excellent question. So, there actually is evidence for exercises for convergence insufficiency. So, we know that those do work. Now where exercises are probably not as helpful, or at least not- there isn't an evidence base for them, is really with just about every other kind of eye misalignment in adults. We hear a lot about eye movement therapies for concussion and barely any other acquired misalignment of the eyes as well. And really, the evidence really hasn't shown us that that's helpful; again, with the exception being convergence insufficiency. So, we know that an office-based vision therapy type program for convergence insufficiency does work, but of course it's kind of inconvenient. It can cost money that may or may not be covered by insurance. And so, there are difficulties even with doing that. And so, I often recommend that patients with convergence insufficiency at least try something called pencil push-ups, where they take a pencil at arm's length and they bring it in and exercise that convergence ability. You know, that's a cheap, easy way to try to treat that initially. So yeah, there can be some limited utility for eye muscle exercises in certain conditions. Dr Monteith: My one example. I was- it was fuzzy, but in a different way. So, what do you do for fun? I mean, it sounds like you like to see a lot of eyeballs? Dr Mackay: I do. I like to see a lot of eyeballs. Dr Monteith: When you're not doing these things, what do you do for fun? Dr Mackay: So, people ask me what my hobbies are, and I laugh because my hobby is actually raising children. Dr Monteith: Oh, okay! Dr Mackay: So, my wife and I have eight kids- Dr Monteith: Oh, wow! Dr Mackay: Ages three to thirteen. So, kind of doesn't allow me to have other things right now. I'm sure I'll have more hobbies later on, but no, I really love my kids. And I- they give me plenty to do. There's no shortage of- in fact, they were really, they were really excited about this podcast today. They're so excited that Dad gets to be on a podcast, and so I'm going to have to show this to them later. They're going to be thrilled about it. Dr Monteith: Excellent. Well, thank you so much for being on the podcast. Dr Mackay: Thank you. It's been my pleasure. Dr Monteith: Again, today I've been interviewing Dr Devin Mackay about his article on approach to diplopia, which appears in the most recent issue of Continuum on neuro-ophthalmology. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Get inspired by this high-energy recap of AIMW25, where Drs. Vidya Gopinath, Chavon Onumah, Jen Spicer, and Sarah Vick share the most practice-changing pearls from Academic Internal Medicine Week. From rethinking feedback to boosting board pass rates and advancing ambulatory education, this episode is packed with insights every health professions educator can use. Recorded live in New Orleans, it brings the highlights—and the heart—of the conference straight to your ears. Sorry no CME for this one! Website | Instagram | Twitter | Subscribe | Patreon | Youtube  thecurbsidersteach@gmail.com Credits Producers, Hosts:  Era Kryzhanovskaya MD, Molly Heublein MD Show notes, Infographic, Cover Art: Molly Heublein, MD, Era Kryzhanovskaya, MD Guests: Drs. Vidya Gopinath, Sarah Vick, Jen Spicer, and Chavon Onumah Technical support: Podpaste Theme Music: MorsyMusic 

AUA2025: Integration of Biomarkers, MRI and PSMA PET Imaging Into the Management of Prostate Cancer CME Available: https://auau.auanet.org/node/43069 At the conclusion of this CME activity, participants will be able to: 1. Evaluate recent advances in biomarkers and molecular imaging technologies and their role in improving the accuracy of prostate cancer staging, and treatment monitoring. 2. Identify the clinical scenario in which PSMA PET/CT is most helpful to identify the localization and extent of locoregional or systemic metastatic disease. 3. Identify the pitfalls of false-positive and false-negative PSMA PET/CT findings. 4. Apply the findings of PSMA PET/CT for the best individual therapeutic approach. 5. Identify patients with radiorecurrent organ-confined prostate cancer. ACKNOWLEDGEMENTS Support provided by independent educational grants from: Blue Earth Diagnostics, Inc. Lantheus Medical Imaging Novartis Pharmaceuticals Corporation

The CME's 13th birthday is coming up, and you know what that means: It's pledge month! Now through June 1, GET 50% OFF A NEW MONTHLY OR ANNUAL PATREON SUBSCRIPTION when you use the code CME13 at checkout! Get on it! Join the team! Support the community! Stick it to the man! Belal Muhammad said he doesn't care what you think anymore. He knows he's good, even if you don't. Well, I mean, yeah, he is the UFC welterweight champion, so there is some evidence to suggest he's pretty good. Somehow, though, it still feels like there are constantly a lot of doubts. You doubt he'll win his next fight. You doubt it'll be exciting, if he does. You doubt he'll sell many PPVs, you doubt he'll get in the UFC's good graces, you doubt he'll hang onto that belt for long … and on and on and on … So far, for the most part, he's proved you wrong. Still, that makes this weekend's title defense at UFC 315 against Jack Della Maddalena all the more important. It's the first time in a long while that Belal isn't the underdog. So … gotta win this one, right? Plus, what now for Bo Nickal? That's up to him. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr Rebecca Dent from National Cancer Centre Singapore and Dr Nancy Lin from Dana-Farber Cancer Institute in Boston, Massachusetts, discuss important efficacy and safety data from 2024 related to the management of localized and advanced breast cancers. CME information and select publications here.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/MJX865. CME credit will be available until 8 May 2026.Seeing Beyond the Numbers in Type 2 Diabetes: Empowering Patients for Optimal Weight and Glycaemic Management In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/MJX865. CME credit will be available until 8 May 2026.Seeing Beyond the Numbers in Type 2 Diabetes: Empowering Patients for Optimal Weight and Glycaemic Management In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/MJX865. CME credit will be available until 8 May 2026.Seeing Beyond the Numbers in Type 2 Diabetes: Empowering Patients for Optimal Weight and Glycaemic Management In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/MJX865. CME credit will be available until 8 May 2026.Seeing Beyond the Numbers in Type 2 Diabetes: Empowering Patients for Optimal Weight and Glycaemic Management In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This week, we're joined by special guest Tarun Gupta, CEO and co-founder of Coinshift, to discuss stablecoin adoption globally and his long-term vision for decentralized finance.In the market update, we highlight large inflows into BTC, CME flows up over 100% month-over-month, and a strong front-month basis at 11%. We also break down what's next for BTC and key support levels.On the macro front, we recap last week's Non-Farm Payrolls, discuss equity market valuations, preview this week's FOMC decision, and consider what to expect from the Milken Conference and key crypto earnings. In the news section, we cover Arizona's rejection of a proposal to create a Strategic Bitcoin Reserve—and Schwab and Morgan Stanley's plans to launch crypto trading. We also cover the revival of virtual asset platforms with the launch of Genesis, and continued explosive growth in real-world assets (RWAs), including Telegram's $500M tokenized bond fund and BlackRock's BUIDL reaching $2.8B in TVL, up from $665M in March. BlackRock has also filed to tokenize a $150B Treasury trust fund on Ethereum.Onchain, we discuss Apple's relaxation of crypto app rules—allowing Bitcoin and crypto payments, NFTs, and reduced App Store fees—and Solana's patch of a zero-day vulnerability in its ElGamal Proof program. We close with key upcoming catalysts: the FOMC decision on May 7, and Ethereum's Pectra upgrade also expected on May 7.Topics Covered:Special Guests:Tarun Gupta on stablecoin adoptionMarket Update: BTC inflows, CME flows +100% MoM, front-month basis at 11%, key support levelsMacro Overview: Non-Farm Payrolls, equity market valuations, FOMC expectations, Milken Conference, crypto earningsNews & Policy: Bitcoin reserve proposal rejections, Schwab & Morgan Stanley crypto plans, virtuals revival, Telegram & BlackRock RWA expansionOnchain Insights: Apple relaxes app rules, Solana patches zero-day vulnerabilityCatalysts Ahead: FOMC Meeting (May 7), Ethereum Pectra Upgrade (May 7), multiple crypto company earnings (May 8)Host:Ben Floyd, Head of Execution ServicesSpeakers:David Duong, Head of Institutional ResearchBrock Miller, Senior Staff Software EngineerJoshua Pak, Senior CES Sales TraderCoinbase News:MANTLE-USD, WLD-USD available on Coinbase Exchange and Advanced Trade

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/MJX865. CME credit will be available until 8 May 2026.Seeing Beyond the Numbers in Type 2 Diabetes: Empowering Patients for Optimal Weight and Glycaemic Management In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/MJX865. CME credit will be available until 8 May 2026.Seeing Beyond the Numbers in Type 2 Diabetes: Empowering Patients for Optimal Weight and Glycaemic Management In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/MJX865. CME credit will be available until 8 May 2026.Seeing Beyond the Numbers in Type 2 Diabetes: Empowering Patients for Optimal Weight and Glycaemic Management In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/MJX865. CME credit will be available until 8 May 2026.Seeing Beyond the Numbers in Type 2 Diabetes: Empowering Patients for Optimal Weight and Glycaemic Management In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

Highlights and Pearls from SHM's Annual Meeting We recap the top pearls for the hospitalist from #SHM #Converge25 hitting updates in GI, stroke, anticoagulation, perioperative medicine, artificial intelligence, and more.  Note: There is no CME for this episode, but visit curbsiders.vcuhealth.org to claim credit for past episodes. Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Care of the Patient Experiencing Homelessness Updates in GI Delirium Adaptive Leadership Transgender Health Capacity Assessment Heart Failure Care of the Transplanted Kidney Precipitated Withdrawal IV contrast Alcohol Withdrawal MRSA Nares Swabs Bugs, Bite, and Fever Perioperative Medicine  Parkinson's Disease Stroke  Outro Credits Producer, Writer, Show Notes: Meredith Trubitt MD, Monee Amin MD, Caroline Coleman MD  Cover Art: Caroline Coleman, MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Rahul Ganatra, MD MPH Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Michelle Brooks MD, Avital O'Glasser MD, Rahul Ganatra MD MPH Disclosures The Curbsiders report no relevant financial disclosures.  Sponsor: Freed Visit www.getfreed.ai and sse code: CURB50 to get $50 off your first month when you subscribe! Sponsor: Locumstory Learn about locums and get insights from real-life physicians, PAs and NPs at Locumstory.com. Sponsor: Grammarly  Download Grammarly for free at Grammarly.com/PODCAST. Sponsor: Continuing Education Company Special offer for Curbsiders listeners: Save 30% on all online courses and live webcasts with promo code CURB30. Visit www.CMEmeeting.org/curbsiders to explore all offerings and claim your discount.

Dr. Dan Ackerman talks with Dr. Trey Bateman about the significance of blood-based biomarkers in Alzheimer disease. Purchase Annual Meeting On Demand to get access to the recordings and the ability to claim CME through March 1, 2026.  Disclosures can be found at Neurology.org.   

In this episode, hosts Drs. Peter Lu and Jason Silverman talk to Dr. Cary Sauer about Competency-Based Medical Education (CBME) to break down this concept and all the related terminology that is part of this approach to medical training. If you're confused about CBME, EPAs, milestones and competencies, this episode is for you! Dr. Sauer is a Pediatric Gastroenterologist specializing in the care of children with IBD and Division Chief at Children's Healthcare of Atlanta and Emory University.Learning Objectives:Understand what Competency-Based Medical Education (CBME) means and how it differs from traditional time-based models of medical trainingUnderstand how milestones, competencies and EPAs relate to one another within the CBME frameworkRecognize the central role of entrustment and how that can is incorporated into workplace-based assessments of traineesLinks:Pediatric GI Milestones (v2.0)NASPGHAN EPA resourcesABP EPAs for subspecialtiesNorth American Society for Pediatric Gastroenterology,  Hepatology, and Nutrition Position Paper on Entrustable  Professional Activities: Development of Pediatric  Gastroenterology, Hepatology, and Nutrition Entrustable  Professional ActivitiesEducating pediatric gastroenterology fellows: milestones, EPAs, & their application within a new educational curriculumImplementing entrustable professional activities in pediatric fellowships: facilitating the processSupport the showThis episode may be eligible for CME credit! Once you have listened to the episode, click this link to claim your credit. Credit is available to NASPGHAN members (if you are not a member, you should probably sign up). And thank you to the NASPGHAN Professional Education Committee for their review!As always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Check out our merch website!Follow us on Bluesky, Twitter, Facebook and Instagram for all the latest news and upcoming episodes.Click here to support the show.

In episode 59 we discuss outpatient low-dose initiation of buprenorphine. Suen LW, Chiang AY, Jones BLH, Soran CS, Geier M, Snyder HR, Neuhaus J, Myers JJ, Knight KR, Bazazi AR, Coffin PO.Outpatient Low-Dose Initiation of Buprenorphine for People Using Fentanyl. JAMA Netw Open. 2025 Jan 2;8(1):e2456253. We also discuss impulse control dysregulation from ropinerole, and the new non-opioid painkiller, suzetrigine. BBC:Prescription medication made me a gambling addict Grall-Bronnec M, et al.Dopamine agonists and impulse control disorders: a complex association. Drug Saf. 2018;41(1):19-75. FDA:FDA Approves Novel Non-Opioid Treatment for Moderate to Severe Acute Pain Vertex Pharmaceuticals: Randomized, Placebo-Controlled, Phase 3 Trials of Suzetrigine, a Non-Opioid, Pain Signal Inhibitor for Treatment of Acute Pain After Abdominoplasty or Bunionectomy --- This podcast offers category 1 and MATE-ACT CME credits through MI CARES and Michigan State University. To get credit for this episode and others, go tothis link to make your account, take a brief quiz, and claim your credit. To learn more about opportunities in addiction medicine, visitMI CARES. CME:https://micaresed.org/courses/podcast-addiction-medicine-journal-club/ --- Original theme music:composed and performed by Benjamin Kennedy Audio editing: Michael Bonanno Executive producer:Dr. Patrick Beeman A podcast fromArs Longa Media --- Learn more about your ad choices. Visit megaphone.fm/adchoices

Featuring perspectives from Dr Jennifer R Brown and Prof Paolo Ghia, including the following topics: Introduction: The Chronic Lymphocytic Leukemia (CLL) Experience — 2000 to 2025 (0:00) Current Therapy Options with Covalent Bruton Tyrosine Kinase (BTK) Inhibitors (9:42) Role of Venetoclax in the Treatment of CLL (26:52) AMPLIFY Trial and Other Novel BTK Inhibitor and Bcl-2 Inhibitor Combination Strategies (32:29) Noncovalent BTK Inhibitor Pirtobrutinib (46:47) CAR T-Cell Therapy; Novel Agents (56:12) CME information and select publications

How do we have successful, long careers in EMS?John recommends living away from where you work, doing unrelated activities outside of work so your life doesn't revolve around work thingsTaking care of someone you know is an odd position to be in, it can mess with your ability to be objectiveJason says we need to have an awareness of how we are feeling and how those around us are feeling, therapy is always a great option, get outsideThose of us in EMS/fire do deal with a level of PTSDTerry talks about this in his own life, when he broke down and started crying without an obvious reasonPTSD is not a lack of desire to cope nor is it a sign of weaknessKash talks about burnout vs moral injuryBurnout tends to blame the individual vs moral injury blames the system we work inI don't disagree that the systems we work in are imperfect and moral injury exists, but I still like the term burnout because, no one is coming to save us, the responsibility is on the individual to overcomeBurnout can slowly occur to the degree that you don't even realize right away what is happeningIs burnout inevitable?Kash says that moral injury is inevitable in some form or another - the important thing is to recognize it and deciding what to do about it, take actionAcute vs chronic burnout requires different solutions as wellKash recounts the Covid effects on EMSTerry talks about the ability to acknowledge your struggles and continue to move on and live your life, in spite of themI asked Jason about his decision to stay a fire paramedic instead of promoting up the chain, he didn't want to promote just for the money, he would rather have passion for it. He is still very passionate about practicing medicine as a paramedic and enjoys his career as it isHow do we get along on scene when responding with multiple agencies, fire vs private ambulanceJason talks about how beneficial it has been to see both sides, you can have more compassion for the other side when you see their strugglesHave the right attitude approaching a scene, work to get along with others as best you can despite the strong personalities we all tend to haveSometimes a short conversation goes a long way. Having ambulance crews stop by the fire station for some food or short hang-out can also dramatically improve your relationshipWe tend to assign ill-intent when we don't know someone, vs good intent when we do know themIt is difficult to fully understand each other's roles, when you aren't doing that job on a daily basis, trauma bonding calls can be helpful when you get into thSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Dr Jennifer R Brown from Dana-Farber Cancer Institute in Boston and Prof Paolo Ghia from IRCCS Ospedale San Raffaele in Milano, Italy, summarize clinically relevant research findings and datasets over the past year regarding the treatment of chronic lymphocytic leukemia. CME information and select publications here.

Love to travel but hate overspending? In this episode, I'm diving into practical, low-effort ways to stretch your travel budget without sacrificing fun or comfort. Whether you're planning a weekend road trip, a CME conference, or an international adventure, these tips will help you save on flights, lodging, food, and activities—so you can travel on budget while reaching your financial goals. I'll cover smart booking strategies and money-saving hacks for accommodations and meals. You'll also learn how travel hacking works and why using the right credit card can unlock serious perks. (Check out my favorite travel hacking card, the Chase Sapphire Preferred, to get it's highest offer of 100,000 points now!) Want a printable version of everything covered? Download your free copy of The Ultimate Guide to Saving Money on Travel with 30+ tips to help you plan smarter and spend less on your next trip. Resources mentioned: Chase Sapphire Preferred credit card The Ultimate Guide to Saving Money on Travel Are you just beginning your journey to financial independence and want to learn more? Download your free copy of the PA the FI Way Beginner's Workbook here! Website / Blog: pathefiway.com Follow along on Instagram: @pathefiway https://www.instagram.com/pathefiway/ Connect on LinkedIn: https://www.linkedin.com/in/katarina-kat-astrup-mspas-pa-c-175848255/ Join the private Facebook group created for current and future PAs on their journey to financial independence: https://www.facebook.com/groups/pathefiway Like the Facebook page to follow along for updates: https://www.facebook.com/pathefiway Questions or thoughts about the show? Email pathefiway@gmail.com Enjoy the show? You can now support the PA the FI Way podcast through Buy Me a Coffee! Thank you for all of your support! https://www.buymeacoffee.com/pathefiway

Advocacy and policy leaders Dr. Michael Repka and Rebecca Hyder join host Dr. Andrew Pouw to share their experiences and perspectives about the Academy's work engaging with policy stakeholders. The conversation reviews recent government healthcare funding debates that may affect Medicaid and the Children's Health Insurance Program (CHIP). For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

The beef market is catching its breath, but ground beef continues to climb as shoppers trade down from pricier cuts. Could this pause be the calm before another round of increases?Chicken takes a breather this week, but there's chatter about a possible summer sandwich surge. Plus, a surprisingly quiet week on the avian flu front during peak migration season.Grain markets are stuck in a holding pattern, but talk of drought and rising oil prices could stir things up. Planting's on track – for now.Dairy prices continue to slide, with barrels, blocks, and butter all moving lower. A major change is coming in June with the USDA removing the 500# barrel from pricing formulas – something to keep an eye on.Savalfoods.com | Find us on Social Media: Instagram, Facebook, YouTube, Twitter, LinkedIn

Julie Simmons, now retired, worked with her husband Scott as part of the Scott Wade Simmons & Associates, LLC providing leadership coaching and training in Strategy Development and Deployment, Leadership Development, and the Improvement Kata & Coaching Kata. Julie always had a passion for helping others develop their skills, capabilities, and confidence to solve complex challenges in their organizations using scientific thinking. Julie had the honor to be a frequent speaker and presenter at KataCon. Julie retired as the Executive Director for the Northwest High Performance Enterprise Consortium (NWHPEC) in January 2018 after leading the organization for fifteen years. As the Executive Director, Julie was responsible for promoting the vision, mission, and purpose of the consortium within the Portland and Vancouver business area. Prior to joining NWHPEC in 2004, Julie worked at the The Boeing Company for 14 years as Flight Line Expeditor, Shortage Controller, Supply Chain Analyst, and Manufacturing Process Analyst. She developed her skills as a Continuous Improvement practitioner while working as a Manufacturing Process Analyst where she became a Certified Accelerated Improvement Workshop leader and supported several Shingijutsu led Kaizen events. In retirement, Julie spends her time planning future travel, cooking for family and friends, and spending time with her husband Scott in all of their shared hobbies.Link to claim CME credit: https://www.surveymonkey.com/r/3DXCFW3CME credit is available for up to 3 years after the stated release dateContact CEOD@bmhcc.org if you have any questions about claiming credit.

Welcome to another episode of the Oncology Brothers podcast! In this episode, Drs. Rohit and Rahul Gosain, both practicing community medical oncologists, continue their discussion on HER2-positive biliary tract cancer. They are joined by Dr. Shubham Pant from MD Anderson, who shares his expertise on this rapidly evolving field. In this episode, we cover: •⁠  ⁠The importance of HER2 testing in biliary tract cancers, including intrahepatic and extrahepatic cholangiocarcinomas and gallbladder cancers. •⁠  ⁠Who should be tested for HER2 positivity and how to classify HER2-positive disease. •⁠  ⁠The role of next-generation sequencing (NGS) and immunohistochemistry (IHC) in determining HER2 status. •⁠  ⁠Current treatment options for HER2-positive biliary tract cancer, including the latest clinical trials and approved therapies like trastuzumab deruxtecan and zanidatamab. •⁠  ⁠The significance of patient-centered decision-making and managing side effects associated with these treatments. •⁠  ⁠Insights into the potential for brain metastases in biliary tract cancer and the importance of ongoing surveillance. Join us as we delve into the latest data and strategies for managing HER2-positive biliary tract cancer, and stay tuned for our next episode where we will discuss side effects and management of these therapies. Accreditation/Credit Designation Physicians' Education Resource®, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Physicians' Education Resource®, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Acknowledgment of Commercial Support This activity is supported by an educational grant from Jazz Pharmaceuticals, Inc. Link to gain CME credits from this activity: https://www.gotoper.com/courses/from-bench-to-bedside-paradigm-shifts-in-her2-metastatic-btc-treatment Follow us on social media: •⁠  ⁠X/Twitter: https://twitter.com/oncbrothers •⁠  ⁠Instagram: https://www.instagram.com/oncbrothers •⁠  Website: https://oncbrothers.com/ Don't forget to like, subscribe, and hit the notification bell for more updates from the Oncology Brothers!

Listen in as our expert panel discusses medications for management of opioid use disorder. They'll review strategies to optimize buprenorphine use and clarify the role of methadone and naltrexone.Special guest:Tyler J. Varisco, PharmD, PhDUniversity of Houston College of Pharmacy Assistant Professor, Department of Pharmaceutical Health Outcomes and PolicyAssistant Director, The PREMIER CenterYou'll also hear practical advice from panelists on TRC's Editorial Advisory Board:Stephen Carek, MD, CAQSM, DipABLM, Clinical Associate Professor of Family Medicine for the Prisma Health/USC School of Medicine Greenville Family Medicine Residency Program at the University of South Carolina School of Medicine, GreenvilleCraig D. Williams, PharmD, FNLA, BCPS, Clinical Professor of Pharmacy Practice at the Oregon Health and Science UniversityFor the purposes of disclosure, Dr. Varisco reports a financial relationship [cardiology, inflammatory bowel disease] with HEALIX Infusion Therapy (research consultant).The other speakers have nothing to disclose.  All relevant financial relationships have been mitigated.This podcast is an excerpt from one of TRC's monthly live CE webinars, the full webinar originally aired in March 2025.TRC Healthcare offers CE credit for this podcast. Log in to your Pharmacist's Letter, Pharmacy Technician's Letter,or Prescriber Insights account and look for the title of this podcast in the list of available CE courses.Claim CreditThe clinical resources mentioned during the podcast are part of a subscription to Pharmacist's Letter, Pharmacy Technician's Letter, and Prescriber Insights: FAQ: Management of Opioid Use DisorderChart: Treatment of Opioid WithdrawalFAQ: Treatment of Acute Pain in Opioid Use DisorderFAQ: Meds for Opioid OverdoseSend us a textIf you're not yet a subscriber, find out more about our product offerings at trchealthcare.com. Follow, rate, and review this show in your favorite podcast app. Find the show on YouTube by searching for ‘TRC Healthcare' or clicking here. You can also reach out to provide feedback or make suggestions by emailing us at ContactUs@trchealthcare.com.

Get The Same Nutrient Protocols Ashley Used To Reverse her Type 2 Diabetes, Chronic Adrenal fatigue, Infertility, and PCOS 14 years ago! Visit https://TakeYourSupplements.com TakeYourSupplements.com   Get on the new Learn True Health newsletter by scrolling to the bottom of Ashley's site, LearnTrueHealth.com https://learntruehealth.com   Check Out Ashley's Latest Book, Addicted To Wellness: https://www.learntruehealth.com/addictedtowellness   Dr. Kyle Gillett's Websites: GillettHealth.com SageBio.com CME talks/courses at the metabolic health initiative

The Missing Manual for Medical Writing: Behind the Scenes of WriteCME AcceleratorEver wondered who creates the CME credits you earn? Or how to get started as a freelance medical writer in this niche but high-paying field?In this special behind-the-scenes episode, Tracy shares the exact kind of opportunity she wishes existed when she was first building her coaching business: a clear, strategic, step-by-step guide to becoming a profitable medical writer — without wasting time, money, or energy.Enter: WriteCME Accelerator, a yearlong, high-touch mentorship program led by CME expert Dr. Alexandra Howson (check out her story in Episode 317!). Whether you're curious about freelance writing, pivoting your clinical role, or expanding your skillset — this program delivers.Join WriteCME Accelerator: https://write-medicine.circle.so/checkout/writecme-accelerator?affiliate_code=314420Inside this episode:Why CME writing is a sustainable, flexible career path for cliniciansThe most common barriers to getting started in freelance writing — and how to overcome themAn overview of what's inside WriteCME Accelerator (hint: it's everything you need to succeed)Real stories from graduates who made the leap with confidence and clarityIf you're ready to explore this niche and get paid well for your clinical expertise, check out WriteCME Accelerator. https://write-medicine.circle.so/checkout/writecme-accelerator?affiliate_code=314420

CME professionals, medical writers, educators, and researchers - what would you do if PubMed suddenly became less accessible? You depend on this critical resource daily to find evidence-based information that powers your work. But recent funding uncertainties at the NIH have raised questions about its future. You need consistent, reliable access to quality biomedical research to meet deadlines and maintain credibility, but navigating alternatives can feel overwhelming. Where would you even begin if your go-to resource is compromised? Today's episode is your insurance policy. My conversation with medical librarian Rachel Wedeward MLIS, AHIP reveals not only why PubMed matters, but also provides you with practical alternatives, including a downloadable resource sheet, and evaluation strategies to ensure you'll never be left without the research you need - no matter what happens. In this episode, you'll discover: The remarkable infrastructure behind PubMed's indexing system that makes it an indispensable tool for organizing and accessing biomedical research A comprehensive overview of complementary resources, including European PubMed Central and specialized databases that can enhance your research approach Practical wisdom for evaluating evidence quality Listen now to expand your research toolkit with expert knowledge that will help you confidently navigate the evolving landscape of medical information resources. Connect with Rachel Website LinkedIn

Papilledema describes optic disc swelling (usually bilateral) arising from raised intracranial pressure. Due to its serious nature, there is a fear of underdiagnosis; hence, one major stumbling points is correct identification, which typically requires a thorough ocular examination including visual field testing. In this episode, Kait Nevel, MD speaks with Susan P. Mollan, MBChB, PhD, FRCOphth, author of the article “Papilledema” in the Continuum® April 2025 Neuro-ophthalmology issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Mollan is a professor and neuro-ophthalmology consultant at University Hospitals Birmingham in Birmingham, United Kingdom. Additional Resources Read the article: Papilledema Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @IUneurodocmom Guest: @DrMollan Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Nevel: Hello, this is Dr Kait Nevel. Today I'm interviewing Dr Susan Mollan about her article Papilledema Diagnosis and Management, which appears in the April 2025 Continuum issue on neuro-ophthalmology. Susie, welcome to the podcast, and please introduce yourself to our audience. Dr Mollan: Thank you so much, Kait. It's a pleasure to be here today. I'm Susie Mollan, I'm a consultant neuro-ophthalmologist, and I work at University Hospitals Birmingham- and that's in England. Dr Nevel: Wonderful. So glad to be talking to you today about your article. To start us off, can you please share with us what you think is the most important takeaway from your article for the practicing neurologist? Dr Mollan: I think really the most important thing is about examining the fundus and actually trying to visualize the optic nerves. Because as neurologists, you're really acutely trained in examining the cranial nerves, and often people shy away from looking at the eyes. And it can give people such confidence when they're able to really work out straightaway whether there's going to be a problem or there's not going to be a problem with papilledema. And I guess maybe a little bit later on we can talk about the article and tips and tricks for looking at the fundus. But I think that would be my most important thing to take away. Dr Nevel: I'm so glad that you started with that because, you know, that's something that I find with trainees in general, that they often find one of the more daunting or challenging aspects of learning, really, how to do an excellent neurological exam is examining the fundus and feeling confident in diagnosing papilledema. What kind of advice do you give to trainees learning this skill? Dr Mollan: So, it really is practice and always carrying your ophthalmoscope with you. There's lots of different devices that people can choose to buy. But really, if you have a direct ophthalmoscope, get it out in the ward, get it out in clinic. Look at those patients that you'd know have alternative diagnosis, but it gives you that practice. I also invite everybody to come to the eye clinic because we have dilated patients there all the time. We have diabetic retinopathy clinics, and it makes it really easy to start to acquire those skills because I think it's very tricky, because you're getting a highly magnified view of the optic nerve and you've got to sort out in your head what you're actually looking at. I think it's practice. and then use every opportunity to really look at the fundus, and then ask your ophthalmology colleagues whether you can go to clinic. Dr Nevel: Wonderful advice. What do you think is most challenging about the evaluation of papilledema and why? Dr Mollan: I think there are many different aspects that are challenging, and these patients come from lots of different areas. They can come from the family doctor, they can come from an optician or another specialist. A lot of them can have headache. And, as you know, headache is almost ubiquitous in the population. So, trying to pull out the sort of salient symptoms that can go across so many different conditions. There's nothing that's pathognomonic for papilledema other than looking at the optic nerves. So, I think it's difficult because the presentation can be difficult. The actual history can be challenging. There are those rare patients that don't have headache, don't have pulsatile tinnitus, but can still have papilledema. So, I think it- the most challenging thing is actually confirming papilledema. And if you're not able to confirm it, getting that person to somebody who's able to help and confirm or refute papilledema is the most important thing. Dr Nevel: Yeah, right. Because you talk in your article the importance of distinguishing between papilledema and some other diagnoses that can look like papilledema but aren't papilledema. Can you talk about that a little bit? Dr Mollan: Absolutely. I think in the article it's quite nice because we were able to spend a bit of time on a big table going through all the pseudopapilledema diagnoses. So that includes people with shortsightedness, longsightedness, people with optic nerve head drusen. And we've been very fortunate in ophthalmology that we now have 3D imaging of the optic nerve. So, it makes it quite clear to us, when it's pseudopapilledema, it's almost unfair when you're using the direct ophthalmoscope that you don't get a cross sectional image through that optic nerve. So, I'd really sort of recommend people to delve into the article and look at that table because it nicely picks out how you could pick up pseudopapilledema versus papilledema. Dr Nevel: Perfect. In your article, you also talk about what's important to think about in terms of causes of papilledema and what to evaluate for. Can you tell us, you know, when you see someone who you diagnose with papilledema, what do you kind of run through in terms of diagnostic tests and things that you want to make sure you're evaluating for or not missing? Dr Mollan: Yeah. So, I think the first thing is, is once it's confirmed, is making sure it's isolated or whether there's any additional cranial nerve palsies. So that might be particularly important in terms of double vision and a sixth nerve palsy, but also not forgetting things like corneal sensation in the rest of the cranial nerves. I then make sure that we have a blood pressure. And that sounds a bit ridiculous in this day and age because everybody should have a blood pressure coming to clinic or into the emergency room. But sometimes it's overlooked in the panic of thinking, gosh, I need to investigate this person. And if you find that somebody does have malignant hypertension, often what we do is we kind of stop the investigational pathway and go down the route of getting the medics involved to help with lowering the blood pressure to a safe level. I would then always think about my next thing in terms of taking some bloods. I like to rule out anemia because anemia can coexist in a lot of different conditions of raised endocranial pressure. And so, taking some simple blood such as a complete blood count, checking the kidney function, I think is important in that investigational pathway. But you're not really going to stop there. You're going to move on to neuroimaging. It doesn't really matter what you do, whether you do a CT or an MRI, it's just getting that imaging pretty much on the same day as you see the patient. And the key point to that imaging is to do venography. And you want to rule out a venous sinus thrombosis cause that's the one thing that is really going to cause the patient a lot of morbidity. Once your neuroimaging is secure and you're happy, there's no structural lesion or a thrombosis, it's then reviewing that imaging to make sure it's safe to proceed with lumbar puncture. And so, we would recommend the lumbar puncture in the left lateral decubitus position and allowing the patient to be as calm and relaxed as possible to be able to get that accurate opening pressure. Once we get that, we can send the CSF for contents, looking for- making sure they don't have any signs of meningitis or raised protein. And then, really, we're at that point of saying, you know, we should have a secure diagnosis, whether it would be a structural lesion, venous sinus thrombosis, or idiopathic intracranial hypertension. Dr Nevel: Wonderful. Thank you for that really nice overview and, kind of, diagnostic pathway and stepwise thought process in the evaluations that we do. There are several different treatments for papilledema that you go through in your article, ranging from surgical to medication options. When we're taking care of an individual patient, what factors do you use to help guide you in this decision-making process of what treatment is best for the patient and how urgent treatment is? Dr Mollan: I think that's a really important question because there's two things to consider here. One is, what is the underlying diagnosis? Which, hopefully, through the investigational save, you'll have been able to achieve a secure diagnosis. But going along that investigational pathway, which determines the urgency of treatment, is, what's happening with the vision? If we have somebody where we're noting that the vision is affected- and normally it's actually through a formal visual field. And that's really challenging for lots of people to get in the emergency situation because syndromes of raised endocranial pressure often don't cause problems with the visual acuity or the color vision until it's very late. And also, you won't necessarily get a relative afferent papillary defect because often it's bilateral. So I really worry if any of those signs are there in somebody that may have papilledema. And so, a lot rests on that visual field. Now, we're quite good at doing confrontational visual fields, but I would say that most neurologists should be carrying pins to be able to look at the visual fields rather than just pointing fingers and quadrants if you're not able to get a formal visual field early. It's from that I would then determine if the vision is affected, I need to step up what I'm going to do. So, I think the sort of next thing to think about is that sort of vision. So, if we have somebody who, you know, you define as have severe sight loss at the point that you're going through this investigational pathway, you need to get an ophthalmologist or a neuro-ophthalmologist on board to help discuss either the surgery teams as to whether you need to be heading towards an intervention. And there are a number of different types of intervention. And the reason why we discuss it in the article---and we'll also be discussing it in a future issue of Continuum---is there's not high-class evidence to suggest one surgery over another surgery. We may touch on this later. So, we've got our patients with severe visual loss who we need to do something immediately. We may have people where the papilledema is moderate, but the vision isn't particularly affected. They may just have an enlarged blind spot. For those patients, I think we definitely need to be thinking about medical therapy and talking to them about what the underlying cause is. And the commonest medicine to use for raised endocranial pressure in this setting is acetazolamide, a carbonic anhydrous inhibitor. And I think that should be started at the point that you believe somebody has moderate papilledema, with a lot of discussion around the side effects of the medicine that we go into the article and also the fact that a lot of our patients find acetazolamide in an escalating dose challenging. There are some patients with very mild papilledema and no visual change where I might say, hey, I don't think we need to start treatment immediately, but you need to see somebody who understands your disease to talk to you about what's going on. And generally, I would try and get somebody out of the emergency investigational pathway and into a formal clinic as soon as possible. Dr Nevel: Thank you so much for that. One thing that I was wondering that we see clinically is you get a consult for a patient, maybe, who had an isolated episode of vertigo, back to their normal self, completely resolved… but incidentally, somebody ordered an MRI. And that MRI, in the report, it says partially empty sella, slight flattening of the posterior globe, concerns for increased intracranial pressure. What should we be doing with these patients who, you know, normal neurological exam, maybe we can't detect any definite papilledema on our endoscopic exam. What do you think the appropriate pathway is for those patients? Dr Mollan: I think it's really important. The more neuroimaging that we're doing, we're sort of seeing more people with signs that are we don't believe are normal. So, you've mentioned a few, the sort of partially empty sella, empty sella, tortuosity of the optic nerves, flattening of the globes, changes in transverse sinus. And we have quite a nice, again, table in the article that talks about these signs. But they have really low sensitivity for a diagnosis of raised endocranial pressure and isolation. And so, I think it's about understanding the context of which the neuroimaging has been taken, taking a history and going back and visiting that to make sure that they don't have escalating headache. And also, as you said, rechecking the eye nerves to make sure there's no papilledema. I think if you have a good examination with the direct ophthalmoscope and you determine that there's no papilledema, I would be confident to say there's no papilledema. So, I don't think they need to necessarily cry doubt. The ophthalmology offices, we certainly are having quite a few additional referrals, particularly for this, which we kind of called IIH-RAD, where patients are coming to us for this exclusion. And I think, in the intervening time, patients can get very anxious about having a sort of MRI artifact picked up that may necessarily mean a different diagnosis. So, I guess it's a little bit about reassurance, making sure we've taken the appropriate history and performed the examination. And then knowing that actually it's really a number of different signs that you need to be able to confidently diagnose raised ICP, and also the understanding that sometimes when people have these signs, if the ICP reduces, those signs remain. You know, we're learning an awful lot more about MRI imaging and what's normal, what's within normal limits. So, I think reassurance and sensible medical approach. Dr Nevel: Absolutely. In the section in your article on idiopathic intracranial hypertension, you spend a little bit of time talking about how important it is that we sensitively approach the topic of potential weight loss for those patients who are overweight. How do you approach that discussion in your clinic? Because I think it's an important part of the holistic patient care with that condition. Dr Mollan: I think this is one of the things that we've really listened to the patients about over the last number of years where we recognize that in an emergency situation, sometimes we can be quite quick to sort of say, hey, you have idiopathic endocranial hypertension and weight loss is, you know, the best treatment for the condition. And I think in those circumstances, it can be quite distressing to the patient because they feel that there's a lot of stigma attached around weight management. So, we worked with the patient group here at IIH UK to really come up with a way of a signposting to our patients that we have to be honest that there is a link, you know, a strong evidence that weight gain and body shape change can cause someone to fall into a diagnosis of IIH. And we know that weight loss is really effective with this condition. So, I think where I've learned from the patients is trying to use language that's less stigmatizing. I definitely signpost that I'm going to talk about something sensitive. So, I say I'm going to talk about something sensitive and I'm going to say, do you know that this condition is related to body shape change? And I know that if I listen to this podcast in a couple of years, I'm sure my words will have changed. And I think that's part of the process, is learning how to speak to people in an ever-changing language. And they think that sort of signpost that you're going to talk about something sensitive and you're going to talk about body shape change. And then follow up with, are you OK with me talking about this now? Is it something you want to talk about? And the vast majority of people say, yes, let's talk about it. There'll be a few people that don't want to talk about it. And I usually come in quite quickly, say, is it OK if I mention it at the next consultation? Because we have a duty of care to sort of inform our patients, but at the same time we need to take them on that journey to get them back to health, and they need to be really enlisted in that process. Dr Nevel: Yeah, I really appreciate that. These can be really difficult conversations and uncomfortable conversations to have that are really important. And you're right, we have a duty as medical providers to have these conversations or inform our patients, but the way that we approach it can really impact the way patients perceive not only their diagnosis, but the relationship that we have with our patients. And we always want that to be a positive relationship moving forward so that we can best serve our patients. Dr Mollan: I think the other thing as well is making sure that you've got good signposts to the professionals. And that's what I say, because people then say to me, well, you know, kind of what diet should I be on? What should I be doing? And I say, well, actually, I don't have professional experience with that. I'm, I'm very fortunate in my hospital, I'm able to send patients to the endocrine weight management service. I'm also able to send patients to the dietetic service. So, it's finding, really, what suits the patient. Also what's within licensing in your healthcare system to be able to provide. But not being too prescriptive, because when you spend time with weight management professionals, they'll tell you lots of different things about diets that people have championed and actually, in randomized controlled trials, they haven't been effective. I think it's that signpost really. Dr Nevel: Yeah, absolutely. So, could you talk a little bit about what's going on in research in papilledema or in this area, and what do you think is up-and-coming? Dr Mollan: I think there's so much going on. Mainly there's two parts of it. One is image analysis, and we've had some really fantastic work out of the Singapore group Bonsai looking at a machine learning decision support tool. When people take fundal pictures from a normal fundus camera, they're able to say with good certainty, is this papilledema, is this not papilledema? But more importantly, if you talk to the investigators, something that we can't tell when we look in is they're able to, with quite a high level of certainty, say, well, this is base occupying lesion, this is a venous sinus thrombosis, and this is IIH. And you know, I've looked at thousands and thousands of people's eyes and that I can't tell why that is. So, I think the area of research that is most exciting, that will help us all, is this idea about decision support tools. Where, in your emergency pathway, you're putting a fundal camera in that helps you be able to run the image, the retina, and also to try and work out possibly what's going on. I think that's where the future will go. I think we've got many sort of regulatory steps and validation and appropriate location of a learning to go on in that area. So, that's one side of the imaging. I think the other side that I'm really excited about, particularly with some of the work that we've been doing in Birmingham, is about treatment. The surgical treatments, as I talked about earlier… really, there's no high-class evidence. There's a number of different groups that have been trying to do randomized trials, looking at stenting versus shunting. They're so difficult to recruit to in terms of trials. And so, looking at other treatments that can reduce intracranial pressure. We published a small phase two study looking at exenatide, which is a glucagon-like peptide receptor agonist, and it showed in a small group of patients living with IIH that it could reduce the intracranial pressure two and a half hours, twenty-four hours, and also out to three months. And the reason why this is exciting is we would have a really good acute therapy---if it's proven in Phase III trials---for other diseases, so, traumatic brain injury where you have problems controlling ICP. And to be able to do that medically would be a huge breakthrough, I think, for patient care. Dr Nevel: Yeah, really exciting. Looking forward to seeing what comes in the future then. Wonderful. Well, thank you so much for chatting with me today about your article. I really enjoyed learning more from you during our conversation today and from your article, which I encourage all of our listeners to please read. Lots of good information in that article. So again, today I've been interviewing Dr Susie Mollan about her article Papilledema Diagnosis and Management, which appears in the most recent issue of Continuum on neuro-ophthalmology.Please be sure to check out Continuum episodes from this and other issues. And thank you to our listeners for joining us today. Thank you, Susie. Dr Mollan: Thank you so much. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

AUA2025: PARP-Inhibitor Combination Treatments for the Urologic Care Team CME Available: https://auau.auanet.org/node/42822 At the conclusion of this CME activity, participants will be able to: 1. Apply the mechanism of action of PARP inhibitors and the rationale for using them in patients with advanced prostate cancer. 2. Recognize the role and importance of genetic testing in patients with mCRPC and the implications of germline mutations on response to therapy. 3. Identify best practices and utilize available guidelines for patients with mCRPC to optimize treatment success and oncologic outcomes. 4. Recognize when to use PARP inhibitors as monotherapy, the rationale and indications for combination therapy, and appropriate treatment sequencing. 5. Successfully counsel patients on the possible adverse events associated with PARP inhibitor therapies alone or in combination. ACKOWLEDGEMENTS Support provided by independent educational grants from: AstraZeneca Merck & Co., Inc.

The CME's 13th birthday is coming up, and you know what that means: It's pledge month! Now through June 1, GET 50% OFF A NEW MONTHLY OR ANNUAL PATREON SUBSCRIPTION when you use the code CME13 at checkout! Get on it! Join the team! Support the community! Stick it to the man! Ya boi Ian (Machado) Garry commands a lot of attention in MMA. If the most difficult thing a UFC fighter can do in the year of our lord 2025 is make people care about your fights, well, Garry's got that part down. Take Saturday's scrap with Carlos Prates, for example. What otherwise might have been a fairly run-of-the-mill Fight Night main event felt like appointment viewing with Garry and Prates involved. As it turned out, it was pretty much a cakewalk for Garry … except those last five minutes. Plus, Anthony Smith had the classiest retirement possible when you're bathed in your own blood and flipping off some rando in the crowd. Learn more about your ad choices. Visit megaphone.fm/adchoices

Patrick takes the Prepping Academy helm once again with a new episode of Grid Down Comms Up. In breaking world news massive power outages in in Spain impact communications infrastructure sending some residents looking for portable radios to receive information. This episode looks at commercially available information sources that have been hardened by FEMA to survive disasters, EMP's and national blackouts too. Do you know where to turn to if internet and cell service stops? What information should you have available before the grid goes down?73PatrickLink the list of FEMA Public Alert Warning System stations. https://www.fema.gov/emergency-managers/practitioners/integrated-public-alert-warning-system/broadcasters-wirelessJoin PrepperNet.Net - https://www.preppernet.netPrepperNet is an organization of like-minded individuals who believe in personal responsibility, individual freedoms and preparing for disasters of all origins.PrepperNet Support the showPlease give us 5 Stars! www.preppingacademy.com Contact us: https://preppingacademy.com/contact/ www.preppernet.net Amazon Store: https://amzn.to/3lheTRTwww.forrestgarvin.com

Featuring perspectives from Dr Rahul Aggarwal and Dr William K Oh, including the following topics: Hormonal Therapy for Patients with Prostate Cancer — Dr Oh (0:00) Other Available and Emerging Therapeutic Approaches — Dr Aggarwal (27:14) CME information and select publications

Featuring slide presentations and related discussion from Dr Hanny Al-Samkari, Dr James B Bussel and Prof Nichola Cooper, including the following topics: Introduction (0:00) Clinical Manifestations and Initial Management of Immune Thrombocytopenia (ITP) — Dr Al-Samkari (10:24) Second- and Later-Line Therapies for ITP — Dr Bussel (1:00:51) Tolerability and Other Practical Considerations with Available Treatment Strategies for Persistent/Chronic ITP — Prof Cooper (1:28:08) CME information and select publications

Measles - with Dr. Alok Patel! -Mogamulizumab > vorinostat for CTCL -Acquired congenital malalignment of the great toenails -Learn more about Dr. Patel at https://www.alokpatelmd.com/ or on social media @alokpatelMD -Join Luke's CME experience on Jak inhibitors! rushu.gathered.com/invite/ELe31Enb69Register for the U of U Practical Derm course!medicine.utah.edu/dermatology/educ…nities/practicalLearn more about the U of U Dermatology ECHO model!physicians.utah.edu/echo/dermatology-primarycareWant to donate to the cause? Do so here!
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