Podcasts about cme

spain emory university salamanca cme university hospital multiple myeloma refractory relapsed winship cancer institute ash annual meeting

Play Episode Listen Later Jan 16, 2026 61:06

Dr Sagar Lonial from Winship Cancer Institute of Emory University in Atlanta, Georgia, and Dr María-Victoria Mateos from the University Hospital of Salamanca in Salamanca, Spain, discuss cases of relapsed/refractory multiple myeloma and recentresearch findings from the 2025 ASH Annual Meeting. CME information and select publications here.

The Market is Lying to Us

The Milk Check

Play Episode Listen Later Jan 16, 2026 27:01

Milk production is up 4.5% — but somehow, milk is clearing. Something doesn't add up. In this episode of The Milk Check, the team uncovers the shifts reshaping dairy economics in 2026. Ted Jacoby III leads a classic market roundtable with the Jacoby team to unpack what they're seeing as dairy transitions out of the holiday demand season and into early-year reality. Despite 4.5% year-over-year milk production growth, milk is clearing in many regions. Cheese and butter markets are under pressure, but inventories aren't yet burdensome. Protein markets remain tight. And nonfat dry milk is showing surprising strength. So what's going on? In this episode, we cover: Why added processing capacity may be masking where supply is really long How cheese and butter are absorbing milk that would normally back up at the farm Why protein demand is tightening skim solids and whey markets Whether nonfat's recent rally is real or a phantom And which dairy market narratives the team thinks are wrong right now If you're trying to make sense of conflicting signals across milk, fat, protein and powder, this episode delivers the context behind the numbers. Listen now to The Milk Check episode 90: The Market is Lying to Us. Got questions? We'd love to hear them. Submit below, and we might answer it on the show. Ask The Milk Check Ted Jacoby III: [00:00:00] Am I just being a conspiracy theorist? Diego Carvallo: I would probably bet a little bit on that conspiracy theory. It could be. It could be possible, Ted. Who knows. Ted Jacoby III: Welcome to the Milk Check from TC Jacob and Company, your complete guide to dairy markets, from the milking parlor to the supermarket shelf. I’m Ted Jacoby. Let’s dive in. We’re on the new side of the New Year. It is January 12th. we’re gonna have a classic market discussion today. Things have started to settle down from the holidays and I thought it would be a great idea just to share with everybody what we’re seeing in the markets as we’re transitioning from the high-demand season into the low-demand season. We have our usual suspects today. We have my brother Gus who manages our fluid group. We’ve got Josh White, head of our dairy ingredients group. We have Joe Maixner, head of all of our butter sales. Mike Brown, our Vice President of Market Intelligence, and myself. So, we’ll start with milk, Gus. What’s it look like right now? Gus Jacoby: It certainly isn’t tight, but it isn’t really long either. I think the November milk production was up [00:01:00] 4.5% and that typically would be fairly significant in areas where there isn’t a lot of additional processing capacity. One would think it would be very, very long with that kind of growth, but we’re not seeing that. Areas like the upper Midwest, Mideast, those areas are not as long as we thought they would be. I don’t want to act as if it’s tight. That’s not the case. Through the holidays, there was still plenty of milk that was around. But I think here as we climbed out of the New Year holiday and into mid-January, things have gotten fairly what we would say in balance. And that’s a little bit alarming considering that type of milk production growth. Ted Jacoby III: Why do you think that is? Is it just all the new capacity from all the new plants that have been built, or what else is going on? Gus Jacoby: Well, certainly in that western, upper Midwest and Southwest region, upstate New York as well, there’s been a lot of processing capacity that’s been added. So, those areas have been able to soak up that extra milk. I think milks travling a bit but I also think folks have found a little bit more efficient avenues to place the milk after dealing with some length over the past year [00:02:00] or so. But there’s a little bit of a question mark I have in the back of my mind as to how efficient we’ve been able to do so. Typically, when we have this kind of large growth, anything north of 4% is large, and large enough to be concerned about. But nonetheless, the processing capacity is significant. We don’t wanna discount that. But one can certainly wonder why in areas like the Mideast, where you haven’t really added a lot of production capacity here recently, why we aren’t seeing a bit more milk floating around. Ted Jacoby III: You think it’s just domino effect type things? Where, as milk is tighter in New York, so none of that milk is going into the southeast or into Appalachia, therefore it’s gotta be pulled from the Mideast? Gus Jacoby: Ted, that might be a part of it. I think domino effect is certainly going on here. There’s some areas of the country that don’t have enough milk because of that additional capacity we discussed. But having said all that, I think there’s some question marks out there right now as to why it isn’t a bit longer in certain parts of the country. Ted Jacoby III: What about some, I’ll call it non-traditional demand growth, and what I mean by that is things [00:03:00] like ESL or some of the protein drinks? It looks like there have been new brands showing up on the supermarket shelf lately. Gus Jacoby: If you’re alluding to areas like UF milk or high-protein fluid products there is certainly a lot of demand in that Class I, Class II segment of our industry. Add in the fact that you have a lot of demand for fortification solids for cheese plants, skim can seem a little bit tight right now, and there’s some logic behind that, but I don’t think there’s enough ultra filtration capacity right now to satisfy demand. So, if milk is going in that direction, there isn’t enough UF units out there, I think, to fill that void. And I wouldn’t say that’s the reason why we’re tightening up milk supplies by no means. In some parts of the world, yes, that might be the case, but that’s pretty small in the grand scheme of things. Ted Jacoby III: On the fluid side, is skim solids slash dairy protein tighter than the butterfat side? Gus Jacoby: Absolutely it is. Yes. I don’t think there’s any question about that. You’ve got two things driving [00:04:00] that. Too much butterfat requires cheese plants to gather more fortification solids, and the demand for protein right now is through the roof. You’re gonna have it hit from both sides and they’re hitting pretty strong. Ted Jacoby III: Could that extra skim solid slash dairy protein demand be what’s tightening up the milk market? Are we seeing it, for example, in lower cream multiples? Gus Jacoby: There still is plenty of cream around, to answer that question directly. I just don’t think there’s enough UF processing capacity at this moment in time to say that it’s tightening milk by any means. Ted Jacoby III: Could it be cheese plants taking the milk directly off the farm but spinning off a lot more cream? Gus Jacoby: I would say some of that is gonna go on. Yeah. ’cause there’s not enough fortification solids to be had, or at least not at the price the cheese plants are gonna be happy with. Cheese plants, even though they might prefer UF at times, they’ll take different types of skim solids and that certainly will tighten up that skim side of the market. That, combined with the fact that the protein sector is short, certainly you’re gonna have that element in our [00:05:00] market right now. I just think there’s enough milk out there, Ted, and not enough protein, isolation capacity of any sort to be the main reason as to why you’re not as long on milk as you think you should be. Ted Jacoby III: You know, I’ve had a theory going for a little while that all this extra capacity we’ve added, a lot of it is cheese capacity, and I feel like this time around, we’ve just transferred where we’re feeling the length. We’re not necessarily feeling the length in milk like we usually do. Instead, there’s enough processing capacity to get all that milk and to make cheese out of it. And therefore, we’re seeing the length in cheese, and we’re seeing the length in butter. And that’s why those two markets have been under so much pressure lately, whereas the milk market seems to be in balance. We’ve just moved down the supply chain a little bit where the length is manifesting. Does that make sense? Gus Jacoby: A little bit? Yeah. Mike Brown: It Does Make sense. Where you have new plants, they wanna be full. They’re cheese plants. They’re gonna try to fill those plants with milk to the extent they can market product, which is becoming a [00:06:00] concern as we see the CME cheese price continuing to drop. We’re also reaching a point when fat is very high, you can’t afford to fortify cheese vats because your skim solids price is high relative to fat. Right now everything’s kind of low, but powder relative to cheese, is as high as it’s been in quite a while. If you have revenue from waste stream, fortifying with nonfat or skim solids makes a whole lot of sense. But if you’re paying that full price for the casein portion of that skim, it gets closer again now too. It’s a little different situation than it’s been in a while. I don’t think Gus could be any more right about the need for more ultra filtered capacity. I’m just curious where it’s gonna show. Because the demand certainly seems to be there. Ted Jacoby III: If there’s one place where I think maybe we’re underestimating demand, it’s in that ESL protein space. And I agree with Gus, there’s probably not enough capacity to really manifest all of that resting demand or untapped demand, but I bet we’re maximizing that supply chain everywhere we can, especially given what we’re seeing in the whey protein [00:07:00] market right now. And it doesn’t show up in the data really clearly. You’re up four and a half percent in milk. Some of that is, we’re still measuring against weakness and we’re measuring against the bird flu outbreak that was happening a year ago. I just think there’s also some demand there possibly in that space that isn’t really showing up in the data in a way that makes it clear to everybody we’ve got some good demand in a couple of places. Having said that, I also think we’ve got more than enough cheese right now. We’ve got more than enough butter right now. But in both cases, and I’m gonna throw this at Joe I don’t think the inventories, at least what’s showing up in the cold storage data is telling us the inventories are burdensome yet. And that might just be when we are in the calendar, but it could just be we’re finding new places for demand. Joe, what are your thoughts? Joe Maixner: Yeah, inventories are definitely not burdensome right now. We’re coming off of pretty good draw down over the holiday season. Obviously, we’re really early into the inventory build period. But demand overall, coming back from [00:08:00] the holidays here, has been pretty strong out of the gate for the New Year. Everybody’s coming back to the office. They’re seeing these very depressed prices. And there’s been a lot of interest in both spot volume, building up some inventory on some spot buys, as well as some additional contract volume for the remainder of the year. So, going back to your comment on inventories, the one thing we always have to keep in mind with looking at cold storage is that number is all types of butter sitting in warehouse inventories. When it comes to pricing, the only thing that matters is 80% CME eligible bulk. We still have a fair amount of salted bulk, especially the older production, in people’s hands, and that has been showing up in the marketplace. A lot of that’s because there was not a lot of micro fixing for the holiday season. Cream was plentiful. People were making plenty of product outta fresh cream as opposed to reformulating that older butter into the retail pack. I think that there’s not a lot of fresh production being made right now [00:09:00] in the salted variety. We could see a nice little price pop here in the coming months once that older product becomes ineligible on the CME. Ted Jacoby III: It’ll be interesting to watch. It’s funny, I think there’s some interesting similarities, not with the old crop, new crop issue, but just some similarities on the cheese side. There’s an old saying about an anticipatory bull market where people start driving up the price ’cause they’re afraid of not having product tomorrow. This just feels like an anticipatory bear market where the inventory levels in cheese aren’t saying that we’ve got a massive amount of length and oversupply of cheese. But you can’t help but wonder if the reason the price is so low is because there is no one out there, both because they’re looking at their forecasted demand for their product and they’re looking at the forecasted milk supply, there’s just no one out there who has any worry about being able to get the cheese they need tomorrow. And so there’s no reason for them to go out there and buy the cheese today and tie up their capital when they’re pretty confident they’re gonna be able to get it tomorrow, maybe even at a lower price. And I get the feeling that there’s some similarities [00:10:00] in the butter market, too. But let’s switch over to the powder side. We’ve been talking about the strength in the protein market for a while, but lately we’ve been seeing some strength in the nonfat market. Diego, is that real strength is that long-term strength? Have we found a bottom in nonfat, what’s going on there? Diego Carvallo: Ted, it’s a very, very interesting question. It’s something everybody’s discussing and commenting about, right? The nonfat market feels like it’s way tighter, the spot market, than what most people were expecting. Right. And the funny thing is everybody has a different theory on what could be happening. We’re not sure what’s gonna happen in the coming months, but there’s definitely a few theories on why this market could be tight and why we’re seeing this kind of short covering rally that we saw in the past two weeks. There’s theories about more UF capacity in areas like the Midwest, which is creating a premium for that product in that region. There’s also theories of some plants in California [00:11:00] mainly being down during the months of November and October, which could have also created a shortage of product that needed to be delivered. Some point also to Mexico or the domestic market stepping in when prices reach the $1.10 or $1.15s and buying decent volumes. But the fact of the matter is, market is a little bit tighter, way tighter than what most anticipated at this period. At the same time, most people are expecting because of ample availability of milk in regions like California, that the market is gonna have to start building inventories because we are, I don’t know, 15 cents or 20 cents higher per pound than Europe. So we’re definitely not gonna be able to export a lot of product to Asia, to the Middle East, or to even Latin America at these prices. So, yeah, the market is tight, but the medium-term outlook is still that we’re gonna [00:12:00] see plenty of pressure. Ted Jacoby III: Any difference in price right now between skim milk powder and nonfat dry milk? Diego Carvallo: That differential between the two has shrank has been smaller because if you talk to most plants in California, everybody’s running nonfat at full capacity. Their plants are almost all of them at full capacity and nobody’s making skim this time of the year. It’s a throughput matter. They try to make as much nonfat as possible when they have plenty of milk. Ted Jacoby III: Interesting. You’d think if prices were going up in the U.S. but not going up in Europe, it would widen, but it’s actually shrinking. That’s wild. Diego Carvallo: Exactly. Yep. And with the U.S. making a lot of nonfat, all of that is gonna go into NDPSR, there should be pressure. At the same time, this week we have the ONIL tender, which most of the market is expecting a result and following it closely because if Europe doesn’t sell that tender, they’re gonna have more product and more pressure on their product. Ted Jacoby III: Makes sense. [00:13:00] Well, Europe’s had some surplus milk as well. Is it possible this market in the U.S. is popping because some of the European traders want it to pop so they can make sure that they clear the excess European product? Or am I just being a conspiracy theorist? Diego Carvallo: I would probably bet a little bit on that conspiracy theory. It could be. It could be possible, Ted. Who knows. Ted Jacoby III: Got it. All right. Sounds good. Josh, what’s going on in the whey market? We just keep talking about tight. Has anything changed? Josh White: No. It remains pretty tight. I think the whey protein demand seems strong. I will say coming into the year I’ve seen more product trade on the spot market, which is interesting. But the tale or the storyline is that that spot trade is still met with good demand and those prices are all still higher than the first quarter negotiated prices to many of the large users, meaning that there’s still good demand at these high prices, and the consumer hasn’t even seen these high prices yet. So it seems like it’s the same in Europe. First quarter is pretty much locked. Second quarter maybe there’s more vulnerability, but at the moment, I think that the [00:14:00] majority of the market would bet that we remain firm through the second quarter maybe even see some higher prices. I think what’s interesting if you look at the market is on the sweet whey powder side, you’ll have Europeans even comment that the whey market is a little bit firm, but they’re quite a bit lower than our price right now. And if you look at the forward futures prices, we have a classic short market. It’s inverted. It’s significantly inverted. And it’ll be curious to see if we really have that much additional sweet whey powder to either move the prices lower or we get enough demand pushback and reformulation to result in some extra product being available. But at the moment, across most of the whey complex it’s fairly firm, which I think tells the story. I mean, we went through the northern hemisphere’s lower milk production months, albeit we’re reporting really high year-over-year numbers, as you commented, compared to bird flu of a year ago in the West. People have had every incentive to place milk in any utilization other than butter and powder over the last few [00:15:00] months, and the market seems to be doing that. In addition to all of the other little comments, it feels like consumers knew that and really ran their supply chains pretty thin. And coming out of the holiday period, there is some short covering happening. Whether that’s just a derivative, speculative position short covering, physical short covering, it’s happening. In addition to that, when we look at the U.S., you can’t paint with a broad brush. The west seems to be running a lot of powder. The Midwest is not. And so that’s created a little bit of a tight situation here. So when you add the demand in Mexico for nonfat you add Midwestern pipeline filling, it’s enough that our spot market is carrying a really big premium to the rest of the world. We’ll see if that can continue as our daily milk production increases seasonally, both here and in Europe. I think that as that continues, as milk goes up, does that directly translate to butter and powder production going up? I would argue at least on some of these products, we know that the [00:16:00] WPI dryers are full. We know the WPC 80 dryers are full. I suspect that the MPC dryers are full and all of the fluid products going into those Class II products are probably full. So we’ll see if the market can handle the seasonal ramp up in production or not. And arguably, I think that’s what most of us are expecting. We’re expecting that we’ve still got plenty of milk. Then that’s gonna have some price pressure. But I also would comment that if we look back over the past few months, demand has been quite good. Global demand has been quite good. The question is, will it continue to be quite good or did we do a lot of buying in the late third quarter and early fourth quarter to refill the global pipeline? Things like Chinese New Year buying things like Ramadan buying and others, and are we gonna be met with an air pocket in demand as we start this year? Don’t know yet. The protein demand isn’t just in dry proteins or in UF for fortified milk. Mike Brown: It’s in yogurts. It’s in cottage cheese. At the same time, ice cream’s lackluster, sour cream is no better. And so that demand for [00:17:00] protein goes beyond just ingredients. On the whey side, boy, we’re gonna have to see a real shift in whey protein prices, wouldn’t we, Josh? We all know those dynamics can shift, but we’re a long ways from that. Other thing in California has got so much milk, they’re running everything full. If you look at anyone you talked the point made earlier, they can’t make SMP right now.They can’t, they are that full to the tilt. In fact, some of them are putting in production control programs again because they’ve got so much milk. Will milk move around, particularly if you can’t find a home for cheese no matter what the price is? Ted Jacoby III: The fact that California’s already running full and it’s the middle of January, which means we probably have at least a month and a half until they hit the peak of their flush. Mike Brown: Absolutely. Ted Jacoby III: That’s a Little bit concerning to me. Mike Brown: Yep. It, it should be to everyone and their spot prices show it. Cream’s been bad, and even the Midwest Class III spots are weak, but part of that’s because the cheese market’s weak. And that lag in Class III, which isn’t picked up in that weekly CME price until next month at the earliest. There’s signs that we’re seeing some shifts in the three four spread. We keep this up, [00:18:00] Ted, it’s gonna go away. Yeah. That may change where milk ends up. Ted Jacoby III: Yep. Diego Carvallo: I have a quick question, Ted. Where do you expect this extra milk in California to end up, because it seems it’s very early. I’m already hearing a lot of milk dumping in California. It seems like we’re at capacity in California. What’s the natural spill over for that milk? Ted Jacoby III: I’ve got two thoughts, but I wanna ask Gus a question first. Gus, if there’s one place where there might be extra UF capacity, would it be in California? Gus Jacoby: Perhaps, but probably not. Relative to demand. It’s limited pretty much all over the country. Ted Jacoby III: Okay. So what I’m gonna answer, in Diego’s question, first and foremost, we’ve lost a lot of milk in the Northwest. Yes. So I wouldn’t be surprised if it heads north on Interstate 10 and ends up in one of those plants in the state of Washington. That would be my first guess. My second guess would be the reason that I asked that question of Gus is they keep the butterfat in California and make butter out of it. Then they ship the UF milk to a cheese plant in the [00:19:00] southwest to extend the cheese yields there. If I were to guess it would happen in one of those two ways. Mike Brown: Diego, what you’re describing is exactly why they’ve put some production quotas back in California because they know it’s gonna get worse. And it makes perfect sense . To me, it’s gonna end up wherever the landed price is the best. On fat capacity, if California has the room to process fat, it’s gonna be in their best interest to process it. ’cause the people that buy surplus fat, outta California, that’s some of the lowest multiples in the country. Even when markets are tight. They’re not gonna wanna send that fat to Utah, Nebraska, or Washington State, or anywhere else if they can process it locally and store it. ’cause it’ll be just moving less water, it’s gonna be mm-hmm. To their benefit. And to Joe’s point. Butter markets are reasonably sound. I mean, they’re lower, but it doesn’t sound like we’re over big supply yet. But one thing we haven’t talked about much is that I think a lot of this price is gonna depend on if we keep exports strong. And that’s one of the big questions we all have. Are they gonna stay? I mean, certainly I think, Joe, listening to you talk, that’s helped a lot in [00:20:00] butter because we’re moving more than 82 overseas and we’re making more of it. On the cheese side. I’m hearing from some of the big cheddar guys that they’re still exporting cheese and relieved to do that. Prices are of course lower, but to me that’s really key. Particularly for products that aren’t as storable as powder. What are those trade markets gonna be? That may impact, where milk goes. Because even if cheese is a buck 30, if you sell it for 30 under, ’cause you have an oversupply, you’ve lost money. So that’s not something you’re gonna wanna do. Ted Jacoby III: All right. Well if I were to summarize really quickly what we’re seeing out there, I would say on the milk side, milk is clearing, which feels a little bit surprising given that we’re up 4.5%, but it’s probably due to all the extra capacity we have out there. However, on the butterfat side cream is long. Butter is long. And while we may get a new crop, old crop pop, the length probably will never fully go away. It just may be how the butterfat’s being processed and maybe we’ll have a temporary tightness in salted 80%. On the cheese side, we’re making a lot of cheese and we’re building inventories. [00:21:00] Mozzarella is feeling longer than cheddar because you can’t store mozzarella, whereas you can park cheddar in a warehouse if you want to, and that’s probably exactly what’s going on in the beginning of this year. Yes, we’ve got some exports but exports are not greater than they were at this time last year, though they may be at comparable levels, at least right now. But there seems to be a concern that that’s not sustainable like it was last year. On the nonfat side, that’s where we have some surprising tightness and we’re watching that market and we are watching it closely because there seems to be conflicting supply and demand indicators regarding where that tightness is coming from. And so our real big question is how sustainable this current tightness is. And on the whey market, whey market is strong. It’s been strong, it continues to be strong, and we haven’t really seen anything yet to change that narrative. And that in general probably sums up our dairy markets. I’m gonna ask everybody one lightning round question. What is one widely repeated dairy market narrative that you [00:22:00] think is wrong right now? Mike, I’m gonna start with you. Mike Brown: I think if there’s anything that is wrong or uncertain is how quick the response is gonna be to really, really low prices on milk supply. I still think we’re gonna take a while to back down and the folks that have really invested in and figured out the beef market are gonna be strong, but people that haven’t done that are gonna really get pummeled. So I think that’s it. How quick will we respond to the lower milk prices? How quick will market respond? It could be quicker than we think. Ted Jacoby III: You think it’ll be quicker. Mike Brown: I think it could be quicker. And I’m a good economist. I’m not gonna say it will, I’m gonna say it could, but yes, I think it could be a little quicker. Particularly with beef, with cull prices so high, there’s incentive to liquidate herds if you don’t wanna milk cows anymore right now. I’m not talking the 10,000 cow herds. I’m talking the smaller Midwest herds. Ted Jacoby III: You got it. Gus, what about you, one widely repeated dairy market narrative that you think is wrong? Gus Jacoby: I always have contrary perspectives on things. I don’t know what to tell you except, back to what I said originally. [00:23:00] Milk is just simply even with high growth production numbers, it’s not as long as some people might think in areas of the country where we haven’t added too much pricing capacity. All right. Sounds good. Diego, how about you? Diego Carvallo: I would say a lot of people are expecting farmers to be losing money at this level, and I think that’s wrong. Ted Jacoby III: They’re still making money. Diego Carvallo: Or maybe breaking even. Ted Jacoby III: All right. I like that one. Joe, how about you? Joe Maixner: I’m gonna buck Diego’s thoughts. I’m gonna go off a nonfat trend. I think that the nonfat market’s gonna continue to trend higher this year as opposed to fall back off. Ted Jacoby III: That’s a good one. That’s a good one. I will struggle with that one, but more power to you. Josh, how about you? Josh White: “This time’s different.” I don’t think this time’s any different than the prior times. I think it’s all perspective. Prices are gonna do what prices do to demand eventually. I realize that we have nuance to our markets, particularly with whey proteins, GLP-1 inspired demand, things like that. But I don’t know that I’m a subscriber to “this time’s different.” Ted Jacoby III: All right. Well, I’ll go ahead and venture mine out there, and I’m gonna have fun with it because I’m gonna [00:24:00] take the exact opposite side of the aisle from Mike and Gus, and I’m gonna say, I actually think this particular drop in prices is gonna last longer than the traditional six months. Usually you see it takes about six months for a market to bottom out and some of dairy farmer habits to change and see the market going back up. But I’m actually on the side of Diego. I think dairy farmers at this price are even still making money because they’re getting so much money from breeding to beef and in some cases from selling their manure. And as a result, their balance sheets will remain healthy. And they’re not gonna be under pressure to exit and sell their cows. I also believe that high beef prices have the inverse effect of what you would expect. And they don’t mean people will sell more cows. It actually means they’ll sell less because dairy farming’s a way of life. And so they’re gonna sell fewer cows to stay cash flow positive rather than more. And so I actually think that this one’s gonna take a lot longer than six months to adjust, but I think what’s really healthy is the fact that we have a diversity of opinions here, which means nobody really knows what’s gonna happen next. Alright guys, I thought [00:25:00] this was a great discussion. And, as it always is in the dairy industry, may we live in interesting times and this one’s not gonna be any different, is it? So thanks everybody for listening in. Great discussion today. Guys, thanks for joining us. Mike Brown: Thank you. Josh White: Thank you guys.

Urgent Care Evaluation and Management of Motor Vehicle Collision Injuries: An Evidence-Based Approach

Urgentology by EB Medicine

Play Episode Listen Later Jan 16, 2026 16:34

In this episode, Tracey Davidoff, MD and Joe Toscano, MD discuss the January 2026 Evidence-Based Urgent Care article, Urgent Care Evaluation and Management of Motor Vehicle Collision Injuries: An Evidence-Based ApproachSpecial Guest IntroductionMotor Vehicle Collision EvaluationImaging and Diagnostic ToolsHead and Neck Injury ManagementChest and Extremity Injury ManagementDischarge Instructions and Patient EducationClosing Remarks and Upcoming Topics???? Subscribers, take the CME test here.✅️ Not a subscriber? Join here!

management md injuries evaluation collisions cme urgent care motor vehicles evidence based approach joe toscano

Uncertainty In Medicine: Jonathan Ilgen and Gurpreet Dhaliwal

GeriPal - A Geriatrics and Palliative Care Podcast

Play Episode Listen Later Jan 15, 2026 51:12

The only certainty in medicine is uncertainty. It touches every aspect of clinical practice, from diagnosis to treatment to prognosis. Despite this, many clinicians view uncertainty as something to tolerate at best or eliminate at worst. But what if we need to rethink and reframe our relationship with uncertainty in medicine? In this episode, we sit down with Jonathan Ilgen and Gurpreet Dhaliwal, co-authors of the New England Journal of Medicine article, "Educational Strategies to Prepare Trainees for Clinical Uncertainty." Together, we explore the nature of uncertainty in clinical practice, its effects on trainees and seasoned clinicians, and strategies to embrace it as a fundamental part of medical reasoning rather than a regrettable byproduct. Jonathan and Gurpreet share insights from research and clinical experience, offering practical methods to help trainees and clinicians recognize, manage, and even embrace uncertainty. Key topics we discuss include: The paradoxical nature of uncertainty: When perceived as a threat, it can provoke anxiety or fear; yet when framed as an opportunity, it can inspire hope and optimism. Why uncertainty is inevitable in medical practice and its impact on clinicians. Is uncertainty a state or a trait? The distinction between epistemic uncertainty (knowledge gaps) and aleatoric uncertainty (randomness in outcomes). How experienced clinicians utilize strategies such as forward planning and monitoring to navigate uncertainty. Communicating uncertainty with patients: how to do it effectively without eroding trust. How to integrate uncertainty into medical education. During the conversation, we explore the emotional responses to uncertainty and how these reactions can influence clinical practice and decision-making. Importantly, Jonathan and Gurpreet emphasize the importance of openly communicating uncertainty with colleagues, supervisors, and patients—a practice that, contrary to common belief, actually strengthens trust, fosters transparency, and encourages collaboration. By normalizing and embracing uncertainty, clinicians can better manage the complexities of medicine and build confidence in their ability to care for patients in the face of the unknown.

professor medicine uncertainty communicating nursing participation ucsf new england journal cme gurpreet gurpreet dhaliwal

Three Insights of Organizational Excellence with Chris Butterworth

Connecting the Dots

Play Episode Listen Later Jan 15, 2026 32:47

Chris is a certified Shingo Institute Faculty Fellow, Academy member, master trainer, and Shingo examiner. He is a co-author of four Shingo Publication award winning books - "4+1 Embedding a Culture of Continuous, " The Essence of Excellence", ”Why Bother?”, and “Why Care?”. He is also editor of the Shingo Institute book “Enterprise Alignment and Results”. His sixth co-authored book “Leading Excellence-the 5 Hats of the Adaptive Leader” has been an Amazon best seller in Australia and is currently being translated into several languages.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.

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Advancing Global Treatment of Cervical Cancer: Dr. Mary McCormack, University College London Hospitals

Raise the Line

Play Episode Listen Later Jan 15, 2026 28:51

New research is transforming the outlook for cervical and uterine cancers -- two of the most serious gynecologic malignancies worldwide – and we'll be hearing from one of the people shaping that progress, Dr. Mary McCormack, on this episode of Raise the Line. From her perch as the senior clinical oncologist for gynecological cancer at University College London Hospitals, Dr. McCormack has been a driving force in clinical research in the field, most notably as leader of the influential INTERLACE study, which changed global practice in the treatment of locally advanced cervical cancer, a key reason she was named to Time Magazine's 2025 list of the 100 most influential people in health. “In general, the protocol has been well received and it was adopted into the National Comprehensive Cancer Network guidelines which is a really big deal because lots of centers, particularly in South and Central America and Southeast Asia, follow the NCCN's lead.”In this conversation with host Michael Carrese, you'll learn about how Dr. McCormack overcame recruitment and funding challenges, the need for greater access to and affordability of treatments, and what lies ahead for women's cancer treatment worldwide. Mentioned in this episode:INTERLACE Cervical Cancer Trial If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast

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Encore Episode - Selco Begovic - Survivor of the Balkan War - SHTF Expert!

Prepping Academy

Play Episode Listen Later Jan 15, 2026 83:10

Send us a textSelco Begovic, a survivor of the tumultuous Balkan war in the 1990s, endured the daunting challenges of living in a besieged city without access to basic necessities like electricity, running water, and food distribution. Today, he shares his firsthand experiences through physical courses, offering invaluable insights for those eager to learn from his real-life ordeal.Through his online writings, Selco offers an unfiltered view into the brutal realities of survival in extreme conditions. With candid assessments of effective strategies and lessons learned from his trials, he also discusses contemporary preparations for uncertain times.Continuing his relentless pursuit of survival knowledge since the war, Selco provides a unique opportunity for others to glean from his experiences, even if they may never face such extreme circumstances themselves.Explore Selco's articles, purchase his PDF books, including the highly acclaimed "The Dark Secrets of Survival," or dive deep into his expertise through his online course, the SHTF Survival Boot Camp. Gain an insider perspective on life during a crisis by enrolling in his course, "One Year in Hell."Selco's message is clear: Real survival lacks romance or idealism; it's a brutal, arduous, and often unfair journey. Let Selco guide you through this uncompromising world and prepare you for the realities that may lie ahead.https://www.shtfschool.com/Selco's Books on Amazon: https://amzn.to/4abVRRB 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 Daily deals for preppers, survivalists, off-gridders, homesteaders https://prepperfinds.com Contact us: https://preppingacademy.com/contact/ www.preppernet.net Amazon Store: https://amzn.to/3lheTRTwww.forrestgarvin.com

Hormone Therapy After 60” with Mimi Ison and Dr. Jessica Shepherd

Perimenopause WTF?

Play Episode Listen Later Jan 15, 2026 58:19

Welcome to Perimenopause WTF!, brought to you by ⁠Perry⁠—the #1 perimenopause app and safe space for connection, support, and new friendships during the menopause transition. You're not crazy, and you're not alone! Download the free Perry App on ⁠Apple⁠ or ⁠Android⁠ and join our live expert talks, receive evidence-based education, connect with other women, and simplify your perimenopause journey.Today's episode is titled “Hormone Therapy After 60” with Mimi Ison and Dr. Jessica Shepherd. In this episode we dive deep into the nuances of Hormone Replacement Therapy (HRT) for women over 60, debunking common myths regarding age limits, discuss the long-term benefits for bone and brain health all while receiving actionable advice as we answer Perry community's most asked questions.

HER2-Positive Breast Cancer — Proceedings from a San Antonio 2025 Symposium Series

Play Episode Listen Later Jan 14, 2026 118:19

Featuring perspectives from Prof Giuseppe Curigliano, Prof Nadia Harbeck, Dr Ian E Krop, Dr Nancy U Lin and Dr Joyce O'Shaughnessy, including the following topics: Introduction (0:00) Considerations in the Care of Patients with Localized HER2-Positive Breast Cancer — Prof Harbeck (1:39) Case: A woman in her mid 50s presents with locally advanced ER-positive, HER2-positive breast cancer — Alan B Astrow, MD (12:52) Case: A woman in her mid 40s with ER-positive, HER2-positive Stage II breast cancer s/p neoadjuvant TCHP with residual disease receives adjuvant T-DM1 but discontinues due to neuropathy — Laila Agrawal, MD (20:02) Previously Untreated HER2-Positive Metastatic Breast Cancer (mBC) — Prof Curigliano (25:10) Case: A woman in her early 80s presents with de novo metastatic (bone-only) ER-positive, HER2-positive breast cancer — Zanetta S Lamar, MD (35:03) Optimal Management of Brain Metastases in Patients with HER2-Positive Breast Cancer — Dr Lin (46:20) Case: A woman in her early 60s with ER-positive, HER2-positive breast cancer develops a cerebellar metastasis while receiving adjuvant anastrozole after prior anti-HER2 therapy — Justin Favaro, MD, PhD (59:41) Case: A woman in her early 40s with ER-negative, HER2-positive mBC develops a headache shortly after neoadjuvant TCHP, surgery and postneoadjuvant T-DM1 and is found to have an isolated 4-cm brain metastasis — Dr Agrawal (1:05:36) Selection and Sequencing of Therapy for Relapsed/Refractory HER2-Positive mBC in the Absence of CNS Involvement — Dr Krop (1:12:00) Case: A woman in her early 40s with ER-positive, HER2-positive mBC receives THP (docetaxel/trastuzumab/pertuzumab) and maintenance tucatinib with trastuzumab/pertuzumab on a clinical trial and now has disease progression — Yanjun Ma, MD, PhD (1:23:04) Tolerability Considerations with HER2-Targeted Therapies — Dr O'Shaughnessy (1:29:32) Case: A woman in her mid 60s presents with localized ER-negative, HER2-positive infiltrating ductal carcinoma — Erik Rupard, MD (1:46:06) Case: A woman in her early 70s with recurrent ER-positive, HER2-positive mBC receives trastuzumab deruxtecan (T-DXd) and has concerning pulmonary symptoms but without findings on diagnostic imaging — Kimberly Ku, MD Case: A woman in her mid 40s with ER-positive, HER2-positive breast cancer metastatic to the brain and lung who received multiple prior treatments responds to T-DXd but develops Grade 1 interstitial lung disease — Richard Zelkowitz, MD (1:49:49) CME information and select publications

Follicular Lymphoma and Diffuse Large B-Cell Lymphoma | Expert Second Opinion: Investigators Discuss the Role of Novel Treatment Approaches in the Care of Patients with Follicular Lymphoma and Diffuse Large B-Cell Lymphoma

university germany italy positive san antonio munich breast cancer symposium proceedings cme dana farber cancer institute her2 baylor university medical center yale cancer center

Play Episode Listen Later Jan 14, 2026 116:55

Featuring perspectives from Dr Nancy L Bartlett, Dr John P Leonard, Dr Matthew Matasar, Dr Loretta J Nastoupil and Prof Pier Luigi Zinzani, including the following topics: Introduction (0:00) Rational Incorporation of Antibody-Drug Conjugates (ADCs) into the Management of Newly Diagnosed Diffuse Large B-Cell Lymphoma (DLBCL) — Dr Matasar (1:34) Case: A man in his late 50s who presents with left testicular swelling and abdominal discomfort is diagnosed with ABC-subtype Stage IV DLBCL — Laurie H Sehn, MD, MPH (11:27) Clinical Utility of CD19-Directed Monoclonal Antibodies for DLBCL and Follicular Lymphoma (FL) — Dr Leonard (19:00) Case: A woman in her early 80s with refractory DLBCL receives tafasitamab/lenalidomide — Carla Casulo, MD (32:50) Case: A man in his late 70s with chronic renal disease and relapsed cutaneous DLBCL receives tafasitamab and dose-reduced lenalidomide — Matthew Lunning, DO (35:51) Optimal Use of ADCs in the Treatment of Relapsed/Refractory DLBCL — Prof Zinzani (42:09) Case: A woman in her late 60s with relapsed DLBCL after polatuzumab vedotin with bendamustine/rituximab receives loncastuximab tesirine with partial response and develops a rash — Dr Casulo (57:45) Case: A woman in her early 40s with multiregimen-relapsed GCB-type DLBCL experiences disease progression on loncastuximab tesirine and receives brentuximab vedotin with lenalidomide/rituximab (1:03:07) Bispecific Antibody Therapy for DLBCL — Dr Bartlett (1:08:31) Case: A man in his mid 60s with DLBCL and early relapse on axicabtagene ciloleucel receives glofitamab — Dr Sehn (1:22:33) Case: A man in his late 60s with Type 2 diabetes, congestive heart failure and COPD receives glofitamab monotherapy after glofitamab with gemcitabine/oxaliplatin for relapsed GCB-type double-hit DLBCL — Dr Lunning (1:29:06) Bispecific Antibody Therapy for FL and Other Lymphoma Subtypes — Dr Nastoupil (1:35:34) Case: A woman in her mid 50s with multiregimen-recurrent FL receives mosunetuzumab — Dr Casulo (1:47:01) Case: A man in his late 70s with multiregimen-refractory FL receives mosunetuzumab and achieves an ongoing complete response — Dr Sehn (1:52:23) CME information and select publications

care management abc patients md treatments large approaches mph investigators copd cme second opinion diffuse adcs follicular lymphoma dlbcl gcb sehn john p leonard

Neuropalliative Care in Movement Disorders With Dr. Benzi M. Kluger

Continuum Audio

Play Episode Listen Later Jan 14, 2026 20:51

Patients with Parkinson disease and other movement disorders have significant palliative care needs that are poorly met under traditional models of care. Clinical trials demonstrate that specialist palliative care can improve many patient and family outcomes. In this episode, Aaron Berkowitz, MD, PhD, FAAN, speaks with Benzi M. Kluger, MD, MS, FAAN, author of the article "Neuropalliative Care in Movement Disorders" in the Continuum® December 2025 Neuropalliative Care issue. Dr. Berkowitz is a Continuum® Audio interviewer and a professor of neurology at the University of California San Francisco in the Department of Neurology in San Francisco, California. Dr. Kluger is the Julius, Helen, and Robert Fine Distinguished Professor of Neurology in the Departments of Neurology and Medicine (Palliative Care) at the University of Rochester in Rochester, New York. Additional Resources Read the article: Neuropalliative Care in Movement Disorders 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: @AaronLBerkowitz Guest: @BenziKluger 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 Berkowitz: This is Dr Aaron Berkowitz, and today I'm interviewing Dr Benzi Kluger about his article on neuropalliative care in Parkinson disease and related movement disorders, which is found in the December 2025 Continuum issue on neuropalliative care. Welcome to the podcast, Dr Kluger, and could you please introduce yourself to our audience? Dr Kluger: I'm Benzi Kluger. I'm a professor of neurology and palliative medicine at the University of Rochester. I'm the chief of our neuropalliative care service, I'm the director of our Palliative Care Research Center, and I'm also the founding president of the International Neuropalliative Care Society. Dr Berkowitz: Wow, that is a large number of hats that you wear in a very important area of palliative care. So, your article is a fantastic article that covers a lot of concepts in palliative care that I myself was not familiar with and really applies them in a very nuanced way to patients with Parkinson's disease and related disorders. So, I'm looking forward to learning from you today to discuss some of the concepts you talk about in the article and how you apply them in your daily practice of palliative care in this particular patient population. So, one of the key points in your article is that we're often so focused on treating the motor symptoms of Parkinson's disease and other degenerative movement disorders that we are often at risk of underdiagnosing and undertreating the nonmotor symptoms, which in some cases, as you mentioned in the article, are more disabling to the patient than the motor symptoms that we tend to focus on. So, from a palliative care perspective, what are some of the nonmotor symptoms that you find tend to be underdiagnosed and undertreated in this patient population? Dr Kluger: The literature suggests---and we've replicated it, actually, Lisa Schulman published a paper twenty-five years ago and the data is almost exactly the same when it comes to things like depression, pain, fatigue, constipation, sleep---that you miss it about 50% of the time. And there's a number of reasons for that. One is that these are subjects that people don't always like to talk about. People don't like talking about depression. People don't like talking about poop and constipation. And I think there are things that neither the patient or the caregiver nor the physician are necessarily comfortable with. And they're also sometimes confusing of, which doctor should I talk to this about? Should I talk to my primary care doctor, should I talk to my neurologist? And so I think the key here is really having a checklist and being proactive about it. In the article, I suggest a template or previsit questionnaire that you can use, but I think it's just about being automatic about it. And it just takes the burden off of the patient and the family to bring them up and letting them know that this is a safe space and this is the right space to talk about these symptoms. Dr Berkowitz: That's very helpful to know. So, having some type of checklist or template just so we go all through them and, as you said, it sort of destigmatizes, just, this is the list of things, and I'm going to just ask about all of them. So we check in on those particular symptoms, whether they're present or not. Are there any particular symptoms that jump out to you as ones that tend to be missed---either because we don't ask about them or patients are less comfortable mentioning them---that in your practice, when you've elicited them, have allowed for particular intervention that's really improved the quality of life for patients in this group? Dr Kluger: Yeah, I'll mention a few that I think come up and are very pertinent. One is mood. And, to use depression---but we could also use anxiety as an example---again, these are topics that people don't always want to talk about. And I think it's important---we may get to this a little bit more later---is being careful to distinguish between depression and grief, sadness, normal worry, frustration. A lot of times the way I'll ask that when I'm talking to a patient is, you know, I hear you're using the word depressed. I want to make sure. does this feel to you like normal sadness given that you have an illness that sucks, or does this really feel like it's above and beyond that and you feel like you'd need a little extra help to get your emotions under control? The second one, which is kind of related, is other behavioral symptoms, including PD psychosis and hallucinations. And there, I think, the thing is that people are quite frankly afraid that they're losing their mind or going insane. So, I think that's another critical one. And then one that, you know, it's kind of a low-hanging fruit but people don't want to talk about, is constipation. And when we did our large randomized control trial of palliative care, our single biggest effect size was actually that we did a better job of treating constipation than usual care. And I think the only trick there is that we asked about it. Dr Berkowitz: I see. So, do you then as part of your routine practice and seeing these patients with Parkinson's disease in particular, you have a particular checklist you go through during the appointment or, as you mentioned, you- one could do it before the appointment. But you tend to go through this in the visit, and is there any palliative care wisdom you have for us, those who are not trained in palliative care, to making sure we really elicit these symptoms in an effective way and how much they're bothering the patient? Dr Kluger: Two things that I've seen work---and we've done a lot of implementation studies. One is that, if it works for your practice, having patients fill out a questionnaire or survey in advance. And I think one of the highest-yield things there too is for blank lines to allow patients to write in what their top three problems are. And I've found when we've used it, and I think other people have found, that it's a huge time saver. People hand them the form, they look to see what's at checked a yes or what's checked as high, and then that becomes the agenda for the visit. The other thing that I think works equally well is just having a template, and at this point its just kind of, like, hard-wired into my neurons that, you know, no matter what we talked about in the HPI, I'll always ask about sleep and mood and bowel and bladder and pain to make sure that I don't miss those things. Dr Berkowitz: You mentioned in your article that palliative care needs in patients with Parkinson's disease really differ over the course of the illness and may be different at the time the initial diagnosis is given versus as the disease progresses versus the latest, most advanced stages of the disease. Can you talk a little bit more about how your approach to these patients changes over time from a palliative care perspective? Dr Kluger: Yes. And I'll also add, I think some of this is going to be more relevant to our listeners than to me. I'm now almost entirely in a neuropalliative care clinic, but for early-stage illness, it's really primary palliative care. And just to reinforce, this is palliative care that's provided by neurologists and primary care doctors, not specialist palliative care. I think that mindset's particularly important around the time of diagnosis. One of the things that, for me, was most eye-opening when we were doing qualitative interviews and studies was how devastating the diagnosis of Parkinson's disease was for patients and their families. And that was not something that I really anticipated. I think, like a lot of people and a lot of movement disorder doctors, I kind of thought of Parkinson's disease as a relatively good-news diagnosis. And that was often the way I pitched it, and we talked about Sinemet and DBS and exercise and all these things, but I have a relativity bias. And that bias is, I know that Parkinson's is better than PSP or MSA or brain cancer. But for the individual getting that diagnosis, that's it's not good news because their relativity bias is, I didn't have Parkinson's before and now I do. And for the rest of my life I'm going to have Parkinson's. And for the rest of my life, there may be things that I can do today that I won't be able to do tomorrow or next week. And so that was… yeah. And I think it really changed my practice and was pretty eye-opening for me. In the article, I mentioned the SPIKES (S-P-I-K-E-S) protocol for talking about serious conversations or talking about bad news. But I think one of the keys there for the time of diagnosis is asking people about their perceptions of Parkinson's. And part of that's also asking them what they know and what they're worried about. And you may be surprised that when you ask somebody about Parkinson's, you know, sometimes they may say it was good news. It's been three years, I've been trying to find an answer, and I feel like I've been being blown off. And sometimes you might say, this is the thing I feared the most. My uncle died of Parkinson's in a nursing home. And I also find that more often than not, even in end-of-life, that a lot of times the serious illness conversations I have, the facts that I have to present people, are better than their fears. And that's true at the time of diagnosis. But I think if we don't go into it and we don't ask people what they're feeling and what their perceptions are, then we miss this opportunity to support them. So that's the early stage. And in midstage, I think the, you know, the real keys there are to catch nonmotor symptoms early, to catch things like pain and depression and constipation before they become really bad or even lead to a hospital stay. And also starting to plant the seed and maybe doing some advanced care planning so that we are- people feel more prepared for the end stages of Parkinson's. And I think there, too, people ask about the future; when we tell them everyone's different or you don't have to worry about that now, that doesn't help an individual very much. So, oftentimes in the middle stages of the illness, people do want to know, am I going to go to a nursing home? How much longer is this going to be? You don't need a crystal ball, but if you can give people the best case, the worst case, the most likely case, that can be very helpful for life planning. And then as we're getting to more advanced and endstage, the lens that I'm looking at people with really is, should we begin talking about hospice? And we know again, from data that as a system---not just neurologists, but as a system---we're missing this all the time. And that if you have Parkinson's disease, you're about 50% chance of dying in a hospital, which is not where people want to die. And so, when I see people with more advanced disease, I'm asking questions about weight loss, and are they sleeping more during the day, and is there an acceleration in their decline of function? So, not just asking about where they are, but what's the rate of decline so that I can give people months of hospice as opposed to either them dying in a hospital or just scrambling for hospice in the last few days of their life. Dr Berkowitz: Another important palliative care concept you discussed in this article that was new to me is the concept of total pain, where you talk about aspects of pain beyond the physical and emotional pain we often think of when we hear the word pain. Can you talk a little bit about this concept of total pain, and then in particular how you apply it specifically when caring for patients with Parkinson's disease and related disorders? Dr Kluger: Yeah, absolutely. In the article there's a figure, and this is a- one of the foundational concepts of palliative care is this idea of total pain. Which is that the pain of a serious illness, whether that be cancer or Parkinson's, is not simply physical. There's also emotional components. And that also goes beyond the psychiatric. So, that includes grief and worry and frustration, and it also includes loneliness. And I think with Parkinson's disease, actually, one of one of the quotes that really sticks with me from some of our qualitative interviews was a woman who talked about her Parkinson's as a "flamboyant illness" because her tremor and her dyskinesias were always coming out at inopportune times. And it wasn't something I thought about, but there's this cosmetic aspect of having a movement disorder. There's also a cosmetic aspect of drooling or of using a walker. And so, there is a social stigma associated with Parkinson's, and people also lose a lot of social capital. Part of that is that often times neighbors and friends and family don't feel comfortable being around that person anymore. They don't know what to say. And so, sometimes coaching or connecting them with a chaplain or a counselor can be helpful in maintaining those social networks. There's a social pain. There's a spiritual and existential pain. And when I ask people a question, I ask almost everybody, is, what's the toughest part of this for you? A lot of times things fall into that bucket. And it's my loss of independence. I'm no longer able to do the things that bring me joy. I feel guilty that I'm going to be a burden to my family. My relationships are changing. So those are things that are essentially spiritual and existential. And then the last bucket, there are logistical things. And this can be lost driving and how do I get around, the cost of doctor visits, spending time with doctors, co-pays for medications; in the case of Parkinson's disease, the logistics of taking medication every two to three hours. So those all contribute to the total pain or the multiple dimensions of suffering. And that is something that I think about---in fact, in our assessment and plan, one of the things I like to mark out is sources of suffering. And that could be from any of those parts of the pie chart. Dr Berkowitz: And how do you approach this at the bedside? So, there are different concepts here. Obviously, physical pain, everyone is familiar with probably the concept of emotional pain. But as you get out in these concentric circles into sort of spiritual, existential pain, how do you sort of start these discussions with patients to elicit some of these aspects of their suffering? Dr Kluger: You know, the most common question I ask is, what's the toughest part of this for you? And very often that's going to lead into these existential and spiritual issues. I'll also ask people at the start of visits is, just tell me overall, big picture, how's your quality of life? Sometimes the answer is pretty good. Sometimes it sucks. Sometimes it's I have none. I know we're going to talk a little bit about joy later. But I'll also often times follow that up with, what do you enjoy or look forward to? And sometimes I get a response to that, and sometimes I get there's nothing in my life right now. But foundationally, I feel like those are all, you know, definitely spiritual and existential issues. And I'll ask people, too, where do you find meaning? What are your sources of support? I know for different physicians, people have different comfort with this, but I do find it helpful also to ask people, are you spiritual or religious? Because that can sometimes open up a window to other means of coping. An example of that---I mean, not everybody is going to have access to a chaplain. Some people will. But oftentimes one of the things that I do is encourage people to reconnect with their spiritual community. And so, I've had some very heartwarming winds where somebody would say, you know what, I haven't been to church for a while. And people at churches or synagogues or mosques are often looking for opportunities to help. And so that I think is another, I think, really important message. But I think one of the- my favorite parts of my job is kind of opening up these bridges and opening up these connections. And helping people to recognize, I would kind of put it under a larger practice of grace, is that asking for help can be a gift to another person. And if you're strong enough to ask for help, you're giving, you know, sometimes a really tremendous gift to another individual. If somebody has a strong community that they're connected with, doesn't have to be religious. it could be that they were a high school sports coach, it could be that they were involved in a book club, it could be that they were DJ or ran a restaurant or who knows what. Those all can provide opportunities for bringing people together and bringing together community. And again, thinking about the total pain of having a neurologic illness like Parkinson's, that loss of community, that loss of connection, is one of the things that's most painful. Dr Berkowitz: So, when people think about palliative care, they tend to think about pain and suffering and a lot of the topics we've been talking about. But you also talk about joy in your article, and you alluded to it a moment ago, working with your patients to find what brings them joy, opportunities for joy. As I was reading this, I was trying to imagine sitting across from a patient who has maybe just received the diagnosis of Parkinson's or is in a stage of the disease where, as you mentioned, they might be quite depressed, whether that's capital-D depression or sadness related to their loss of independence and other aspect. Sitting across from a patient who is suffering so much and has come maybe to a palliative care doctor such as yourself to alleviate suffering and have pain and other symptoms addressed, how do you begin a conversation about joy in that context and have the patient feel comfortable to open up? And how do you then use that conversation to help them improve their quality of life? Dr Kluger: Yeah, that's a great question. And it's one that actually comes up every time I talk about joy because it can be daunting. And there certainly are situations where I don't bring it up. You know, if we are deep into a session about grief or we're talking about kind of an unexpected bad turn of events, there's times where it would be insensitive to try to push, you know, an agenda of joy or something like that. And yet I would say that particularly residents and students who work with me, you know, may be surprised at how often I do bring it up. And I would say it's probably 95% of the time or more where I am able to talk about joy. And as an example, you know, we might be talking about grief and loss and changes in independence. And then I would say, you know, I want to make sure that we have time to talk about this, and we'll connect you to our chaplain or counselors so that you can talk about and process your grief. And at the same time, I want to make sure that we don't lose sight that there are still opportunities for joy and love and meaning in your life. And I want to make sure that we make space and time to talk about those things too. So, it's creating that balance. That's a transition that, even when you're on a very heavy subject---in fact, I would say maybe even particularly when you're getting into a heavy subject---that you can talk about joy and love and meaning. I gave a talk at the American Academy of Neurology a few years ago where I referred to them as weapons that you can use against some curable illnesses. One example is, my approach to chronic pain often centers around joy. So, I'll have somebody who comes in with back pain. My goal with that person is not for them to take Percocet four times a day to eliminate their back pain. When I talk to that person, I may find out that their grandson's soccer games and boxing class are the two most important things in their life. So maybe we take Percocet three or four times a week a half-hour before those activities so that you can get that joy back in your life. And so, we kind of use joy as a way and as a goal to reclaim those parts of your life that are most important to you. So, that's a pretty concrete example. Even for people nearing end of life, it could be giving people permission to eat more of their favorite food, often times ice creams, milkshakes---which is great, because we want people to gain weight at that point. Getting out into nature, even if they can't hike or do things the way they used to, that they might be able to go out with their family. Having simple touch, spending time together, really trying to prioritize what's most important. In the article, we talk about the total joy of life or the total enjoyment of living. But I like to be systematic about thinking about opportunities for living and make sure that we're just as systematic about thinking about what are the opportunities for joy as we are about thinking about the sources of suffering. Dr Berkowitz: I'm sure I only sort of scratched the surface of palliative care in general, let alone specifically related to Parkinson's disease and other related disorders. For our listeners who may be interested in learning more about neuropalliative care specifically or getting a little more training in this, any recommendations? Dr Kluger: Yeah, absolutely. Thanks for asking me that. There is a growing community of people interested in neuropalliative care, and so I would really encourage people who are passionate about this and want to get connected to this community to consider joining the International Neuropalliative Care Society. We're a young and growing community. I think you'll find a lot of like-minded individuals. And whether you're thinking about going into neuropalliative care as a specialty or doing a fellowship or just making it more a part of your practice, you'll find a lot of like-minded individuals. And then at the end of the article, there are some websites, but there are opportunities: for example, Vital Talk, the education palliative and end-of-life care neurology curriculum out of Northwestern, where people can dig deeper and kind of do their own mini-fellowship to try to bolster these skills. Dr Berkowitz: Gives, certainly, me a lot to think about. I'm sure it gives our listeners a lot to think about as well in implementing some of the palliative care concepts you tell us about today and discuss in much more detail in your article as we see these patients and, hopefully, can refer them to talented expert colleagues like yourself in palliative care, but don't always have that opportunity. And as you said, there's always opportunities to be practicing palliative care, even though we're not palliative care specialists. So, I encourage all the listeners to read your article, which goes through these concepts and many more as well some sort of key points and strategies for implementing them as you gave us many examples today. So again, today I've been interviewing Dr Benzi Kluger about his article on neuropalliative care in Parkinson disease and related movement disorders, which is found in the December 2025 Continuum issue on neuropalliative care. Be sure to check out Continuum Audio episodes from this and other issues, and thank you again to our listeners for joining us 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.

HER2-Positive Breast Cancer — Proceedings from a San Antonio 2025 Symposium Series

Breast Cancer Update

Play Episode Listen Later Jan 14, 2026 118:18

Prof Giuseppe Curigliano from the University of Milan in Italy, Prof Nadia Harbeck from LMU University Hospital in Munich, Germany, Dr Ian E Krop from Yale Cancer Center, Dr Nancy U Lin from Dana-Farber Cancer Institute and Dr Joyce O'Shaughnessy from Baylor University Medical Center discuss real-world cases and recent clinical data pertinent to the management of HER2-positive breast cancer. CME information and select publications here.

How Physicians Survive Medical Mistakes without Losing Themselves, with Danielle Ofri, MD, PhD | Ep500

Physician's Guide to Doctoring

Play Episode Listen Later Jan 13, 2026 40:30

This episode is sponsored by Lightstone DIRECT. Lightstone DIRECT invites you to partner with a $12B AUM real estate institution as you grow your portfolio. Access the same single-asset multifamily and industrial deals Lightstone pursues with its own capital – Lightstone co-invests a minimum of 20% in each deal alongside individual investors like you. You're an institution. Time to invest like one.—---------------------------Join us for Doctor PodFest in Florida! Go here to secure your ticket: Here—---------------------------What if owning your medical mistakes could rebuild trust and prevent future harm?In this profound episode, Dr. Bradley Block sits down with Dr. Danielle Ofri, to explore the raw realities of errors in medicine. Sharing a vivid story from her residency, Dr. Ofri discusses why mistakes happen, the difference between guilt which drives improvement, and shame which paralyzes, and the power of genuine apologies. Ideal for physicians grappling with perfectionism, this conversation offers strategies for self-compassion, seeking mentors, and creating systems that support clinicians, helping you continue caring without being crushed by uncertainty.Three Actionable Takeaways:Distinguish Guilt from Shame: Guilt focuses on the error and motivates change e.g., "I forgot the long-acting insulin, next time I'll double-check protocols". Shame attacks your identity "I'm a bad doctor". Dr. Ofri advises recognizing this to avoid paralysis; practice by journaling an error's facts versus your emotional narrative, then discuss with a trusted colleague to reframe it productively.Bear Witness to Suffering: For patients and peers, simply listening and acknowledging pain builds trust, whether it's a patient's chronic illness story or a colleague's post-error distress. Try this: Next time a teammate struggles, offer a quick check-in like "Need a coffee break?" to foster community and remind them they're valued beyond one mistake.Deliver Genuine Apologies: Avoid passive language; own your role actively e.g., "I'm sorry my oversight contributed to this outcome, I've been reflecting deeply and changing my process". Patients value transparency and prevention steps; role-play with a mentor before tough talks to ensure honesty while consulting risk management for legal guidance.About the Show:Succeed In Medicine covers patient interactions, burnout, career growth, personal finance, and more. If you're tired of dull medical lectures, tune in for real-world lessons we should have learned in med school!About the Guest:Dr. Danielle Ofri is a primary care internist at Bellevue Hospital and clinical professor at NYU. She's a renowned writer on medical emotions for outlets like The New York Times and The New Yorker. Founder of Bellevue Literary Review, she's authored books like "What Doctors Feel" and "When We Do Harm," focusing on errors and humanity in medicine. Website: danielleofri.comAbout the Host:Dr. Bradley Block – Dr. Bradley Block is a board-certified otolaryngologist at ENT and Allergy Associates in Garden City, NY. He specializes in adult and pediatric ENT, with interests in sinusitis and obstructive sleep apnea. Dr. Block also hosts Succeed In Medicine podcast, focusing on personal and professional development for physiciansWant to be a guest?Email Brad at brad@physiciansguidetodoctoring.com or visit www.physiciansguidetodoctoring.com to learn more!Socials:@physiciansguidetodoctoring on Facebook@physicianguidetodoctoring on YouTube@physiciansguide on Instagram and Twitter This medical podcast is your physician mentor to fill the gaps in your medical education. We cover physician soft skills, charting, interpersonal skills, doctor finance, doctor mental health, medical decisions, physician parenting, physician executive skills, navigating your doctor career, and medical professional development. This is critical CME for physicians, but without the credits (yet). A proud founding member of the Doctor Podcast Network!Visit www.physiciansguidetodoctoring.com to connect, dive deeper, and keep the conversation going. Let's grow! Disclaimer:This podcast is for informational purposes only and is not a substitute for professional medical, financial, or legal advice. Always consult a qualified professional for personalized guidance. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Episode 165: From Hidden Rates to Contract Intelligence: The Data Transparency Era

Medical Money Matters with Jill Arena

Play Episode Listen Later Jan 13, 2026 18:30

Send us a textNegotiated payer rates are public… sort of.For decades, some of the most important numbers in healthcare lived behind locked doors. The actual negotiated rates between payers and providers—the numbers that determine whether a practice thrives, survives, or quietly bleeds margin—were treated like trade secrets. You were expected to negotiate them, manage against them, and forecast your future with only partial visibility. (Which may also be referred to as guessing.) And now, suddenly, those rates are posted online. Publicly available. Downloadable by anyone. Often buried inside massive machine-readable files that can be tens or even hundreds of gigabytes in size, split across dozens of links, and structured in ways that make them nearly impossible to interpret without specialized tools.So yes, the data is “public.” But that doesn't mean it's usable. And that gap—between availability and usability—is where the real story begins.This episode isn't about patient shopping tools or consumer price estimates. This is a conversation for physicians, administrators, and revenue leaders who live in the real world of payer contracts, underpayments, denials, and annual budget pressure. It's about what the price transparency laws actually unlocked on the payer side, what data is now available because of them, why payers released it so reluctantly, and why a whole new category of software has emerged almost overnight to turn that raw data into something you can actually use. And most importantly, it's about why renewing insurance contracts—every single year—is no longer optional best practice, but essential financial governance.Please Follow or Subscribe to get new episodes delivered to you as soon as they drop! Visit Jill's company, Health e Practices' website: https://healtheps.com/ Subscribe to our newsletter, Health e Connections: http://21978609.hs-sites.com/newletter-subscriber Want more formal learning? Check out Jill's newly released course: Physician's Edge: Mastering Business & Finance in Your Medical Practice. 32.5 hours of online, on-demand CME-accredited training tailored just for busy physicians. Find it here: Purchase your copy of Jill's book here: Physician Heal Thy Financial Self Join our Medical Money Matters Facebook Group here: https://www.facebook.com/groups/3834886643404507/ Original Musical Score by: Craig Addy at https://www.underthepiano.ca/ Visit Craig's website to book your Once in a Lifetime music experience Podcast coaching and development by: Jennifer Furlong, CEO, Communication Twenty-Four Seven https://www.communicationtwentyfourseven.com/

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Follicular Lymphoma and Diffuse Large B-Cell Lymphoma — Proceedings from a Symposium Series Preceding the 67th ASH Annual Meeting and Exposition

PeerView Clinical Pharmacology CME/CNE/CPE Audio Podcast

Play Episode Listen Later Jan 13, 2026 116:55

Dr Nancy L Bartlett from the Washington University School of Medicine, Dr John P Leonard from the Perlmutter Cancer Center, Dr Matthew Matasar from Rutgers Cancer Institute, Dr Loretta J Nastoupil from Southwest Oncology and Prof Pier Luigi Zinzani from the University of Bologna in Italy discuss recent updates on available and novel treatment strategies for follicular lymphoma and diffuse large B-cell lymphoma. CME information and select publications here.

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Prof. Solange Peters, MD, PhD / Prof. David Planchard, MD, PhD - The Challenges of Choice in First-Line EGFRm NSCLC: Practical Guidance on Optimising Treatment Approaches

Play Episode Listen Later Jan 13, 2026 40:14

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/YJT865. CME credit will be available until 30 December 2026.The Challenges of Choice in First-Line EGFRm NSCLC: Practical Guidance on Optimising Treatment Approaches 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 independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.

William Balistreri- Hepatitis B

Bowel Sounds: The Pediatric GI Podcast

Play Episode Listen Later Jan 12, 2026 46:40

In this episode of Bowel Sounds, hosts Dr. Temara Hajjat and Dr. Amber Hildreth and talk to Dr. William Balistreri, Dorothy M. M. Kersten Professor of Pediatrics at the University of Cincinnati, Director Emeritus of the Pediatric Liver Center at Cincinnati Children's Hospital, Medical Director Emeritus of Liver Transplantation, and Program Director Emeritus of Transplant Hepatology Fellowship. We talk about the history of the Hepatitis B virus and vaccine, and the new ACIP vaccination recommendations.Learning objectivesUnderstand the history of Hepatitis B infection and vaccination in the United StatesExamine the impact of the ACIP vote to overturn the recommendation for universal Hepatitis B vaccination for newbornsApply knowledge gained to clinical practice Support 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.Support 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.

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Is It Too Late to Buy Silver and Is TELUS Dividend at Risk?

The Canadian Investor

Play Episode Listen Later Jan 12, 2026 49:50

After BCE cut its dividend in mid-2025, investor capital rotated into TELUS as the next high-yield alternative. In this episode, we examine whether TELUS is now facing the same fate or whether the comparison is flawed. We break down the key differences between TELUS and BCE at the point of stress, focusing on free cash flow coverage, leverage, capital intensity, growth outlook, and management execution. While TELUS’s dividend remains uncovered today, improving free cash flow and contributions from capital-light segments such as TELUS Health and TELUS Digital differentiate it from BCE’s deteriorating position prior to its cut. We also discuss the specific scenarios that could force a dividend reduction, including stalled tech-segment growth, regulatory pressure, and prolonged share-price weakness, as well as one recent management move that raises concerns around signaling. In the second half, we shift to silver and explain what is driving the recent price surge. We cover CME margin hikes, record physical delivery requests, backwardation, U.S.–Shanghai price divergence, China’s new export restrictions, and silver’s addition to the U.S. critical minerals list. The conclusion: this is primarily an industrial and geopolitical supply story, not a monetary hedge narrative. Tickers discussed: T.TO, BCE.TO, PSLV, PAAS, AG, HL, CDE, WPM, SIL, SILJ New to investing? Check out these episodes: Investment Accounts Simplified and 5 Stocks on Our Radar Apple Podcast Spotify Web player 3 Things to Do Before You Invest a Single Dollar Apple Podcast Spotify Web player 8 simple ways to Save and Have More Money to Invest Apple Podcast Spotify Web player Investment Accounts Simplified and 5 Stocks on Our Radar Apple Podcast Spotify Web player Check out our portfolio by going to Jointci.com Our Website Our New Youtube Channel! Canadian Investor Podcast Network Twitter: @cdn_investing Simon’s twitter: @Fiat_Iceberg Braden’s twitter: @BradoCapital Dan’s Twitter: @stocktrades_ca Want to learn more about Real Estate Investing? Check out the Canadian Real Estate Investor Podcast! Apple Podcast - The Canadian Real Estate Investor Spotify - The Canadian Real Estate Investor Web player - The Canadian Real Estate Investor Asset Allocation ETFs | BMO Global Asset Management Sign up for Fiscal.ai for free to get easy access to global stock coverage and powerful AI investing tools. Register for EQ Bank, the seamless digital banking experience with better rates and no nonsense.See omnystudio.com/listener for privacy information.

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Get Healthy in the New Year with BestHealth

Right Care at Baptist

Play Episode Listen Later Jan 12, 2026 13:25

Hosts: Jake Lancaster MD, Chief Medical Information Officer and Amanda Comer DNP, System Director, Advanced Practice ProvidersGuests: Lia Lansky and Shannon WilloughbyCME Credit Info:Link to complete brief survey and claim CME credit: https://www.surveymonkey.com/r/C55LKSYCME credit is available for up to 3 years after the stated release dateContact CEOD@bmhcc.org if you have any questions about claiming credit.

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Colorectal Cancer — 5-Minute Journal Club Issue 2 with Dr Scott Kopetz: Current and Future Role of Tumor-Informed Circulating Tumor DNA Assays

current informed findings tumors cme colorectal cancer crc circulating journal club future role prognostic minute journal stage iii assays ctdna

Play Episode Listen Later Jan 12, 2026 23:31

Featuring an interview with Dr Scott Kopetz, including the following topics: Circulating tumor DNA (ctDNA)-guided adjuvant chemotherapy de-escalation in the treatment of Stage III colon cancer from the ctDNA-negative cohort of the DYNAMIC-III trial (0:00) Prognostic and predictive role of ctDNA in the management of Stage III colon cancer treated with celecoxib: Findings from the CALGB (Alliance)/SWOG 80702 trial (8:01) Phase III ALTAIR study comparing trifluridine/tipiracil to placebo for patients with molecular residual disease after curative resection of colorectal cancer (CRC); a methylation-based, tissue-free ctDNA test (12:51) ctDNA with locally advanced mismatch repair-deficient/microsatellite instability-high solid tumors; real-world evidence regarding ctDNA with resected CRC (17:31) CME information and select publications

Colorectal Cancer — 5-Minute Journal Club Issue 2 with Dr Scott Kopetz: Current and Future Role of Tumor-Informed Circulating Tumor DNA Assays

university dna current informed tumors cme colorectal cancer circulating journal club texas md anderson cancer center future role minute journal assays

Play Episode Listen Later Jan 12, 2026 25:18

Dr Scott Kopetz from The University of Texas MD Anderson Cancer Center in Houston discusses recent developments with circulating tumor DNA assays in the management of colorectal cancer. CME information and select publications here.

Colorectal Cancer — 5-Minute Journal Club Issue 2 with Dr Scott Kopetz: Current and Future Role of Tumor-Informed Circulating Tumor DNA Assays

university dna current informed tumors cme colorectal cancer circulating journal club texas md anderson cancer center future role minute journal assays

Play Episode Listen Later Jan 12, 2026 25:18

HUGE INSTITUTIONAL CRYPTO NEWS! CANTON NETWORK JPMORGAN RIPPLE BNY!

Thinking Crypto Interviews & News

Play Episode Listen Later Jan 10, 2026 16:40 Transcription Available

Crypto News: BNY launches tokenized deposits amid TradFi rush into blockchain and crypto. JPMorgan to issue its JPM deposit token directly on privacy-focused Canton Network. Nasdaq, CME Group join forces to launch Nasdaq-CME Crypto Index.Brought to you by

Myelofibrosis and Systemic Mastocytosis — Proceedings from a Symposium Series Preceding the 67th ASH Annual Meeting and Exposition

THE SOVEREIGN SOUL Show: Cutting Edge Topics, Guests & Awakened Truth Bombs with lotsa Love, Levity ’n Liberty.

Play Episode Listen Later Jan 10, 2026 117:30

Featuring perspectives from Prof Claire Harrison, Dr Andrew T Kuykendall, Dr Stephen T Oh, Dr Jeanne Palmer and Dr Raajit K Rampal, including the following topics: Introduction (0:00) Current Clinical Decision-Making for Myelofibrosis (MF) in the Absence of Severe Cytopenias — Dr Palmer (1:46) Case: A woman in her mid 70s presents with symptomatic JAK2 V61F-mutant primary MF with mild anemia and normal platelet count — John Mascarenhas, MD (16:09) Discussion: Asymptomatic MF; re-reads of pathology reports; "triple-negative" MF; secondary causes — Laura C Michaelis, MD (22:47) Discussion: Ruxolitinib-associated dermatologic cancers and weight gain — Prithviraj Bose, MD (27:34) Managing MF in Patients with Anemia — Dr Oh (30:21) Case: A man in his early 70s with splenomegaly and mild fatigue is diagnosed with JAK2 V617F-mutant primary MF and receives momelotinib — Dr Michaelis (42:34) Discussion: Post-hoc analysis from the SIMPLIFY-1 trial — Dr Bose (46:20) Managing MF in Patients with Thrombocytopenia — Dr Rampal (49:57) Discussion: MF with moderate thrombocytopenia — Dr Michaelis Case: A man in his mid 60s with primary MF and anemia, thrombocytopenia and splenomegaly has a low JAK2 V617F allele frequency — Dr Mascarenhas (1:05:46) Promising Novel Agents Under Investigation for MF — Prof Harrison (1:11:21) Case: A woman in her late 70s with primary MF with CALR1 and SF3B1 mutations and anemia receives luspatercept — Dr Michaelis Discussion: Luspatercept for MF-associated anemia — Dr Bose (1:24:52) Discussion: Promising novel therapies — Dr Mascarenhas (1:28:24) Current and Future Management of Systemic Mastocytosis — Dr Kuykendall (1:32:40) Discussion: Initial assessment of patients diagnosed with systemic mastocytosis; avapritinib dosing — Dr Bose (1:49:12) Discussion: Systemic mastocytosis with associated hematologic neoplasm — Dr Bose (1:52:24) Discussion: Bezuclastinib for systemic mastocytosis — Dr Bose (1:55:23) CME information and select publications

$309 Silver Call… Is QFS Live? COMEX Vaults Under Pressure (What We Know)

Play Episode Listen Later Jan 9, 2026 45:55

TWIFO 479: A Year of Treacherous and Improbable Events

The Options Insider Radio Network

Play Episode Listen Later Jan 9, 2026 54:11

The first "January Lion" of 2026 has arrived. Join Mark Longo and Carley Garner of DeCarley Trading as they kick off the new year with a high-octane look at the futures options landscape. From the aftermath of a historic 2025 to the geopolitical shocks of the first week of January, this episode breaks down why the "old rules" of the commodity markets are being rewritten. In This Episode: The 2025 Retrospective: A look back at a "once-in-50-year" event in the metals complex. Carley provides a candid "humbling" on the massive surge in gold and silver, and why 2025 was the year of the devoted trend follower. The Silver Beast: Silver dominated last year with a 140%+ gain. Carley and Mark discuss the "Reverse 2020" effect, the impact of triple-leveraged ETFs, and why trading Silver options right now requires nerves of steel and a massive margin account. Movers & Shakers: * The Light Side: A continuation of the metals rally (Silver, Platinum, Palladium) and a surprising 5% YTD surge in the Russell 2000 ($RUT). The Dark Side: Energy struggles as WTI and Brent lead the losers, while Natural Gas faces a "trap door" at the $3.60 pivot. Equity Index Analysis: Why the "Mag 7" dominance is yielding to a Small-Cap catch-up play in the Russell. Plus, a strategy for "tail-risk nibbling" using deep out-of-the-money March and June puts. Energy & Geopolitics: The team breaks down the "Maduro effect" and why Venezuela's supply won't be a quick fix for the crude markets. Carley explores the possibility of a capitulation move in oil toward the low $40s. Viewer Q&A: The blurring lines between "trading" and "betting" as CME and FanDuel move closer together. Market Volatility Snapshot (CVOL) Treasury Yield Vol: Pinning the needle at 78.9 (High for the week). Energy CVOL: Popping to 60.6 as geopolitical tensions rise. Metals CVOL: Easing slightly to 31.0 despite massive moves in the underlying.

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Myelofibrosis and Systemic Mastocytosis — Proceedings from a Symposium Series Preceding the 67th ASH Annual Meeting and Exposition

medicine symposium systemic exposition annual meetings proceedings cme st thomas memorial sloan kettering cancer center washington university school preceding moffitt cancer center myelofibrosis nhs foundation trust ash annual meeting mastocytosis mayo clinic school

Play Episode Listen Later Jan 9, 2026 117:30

Prof Claire Harrison from Guy's and St Thomas' NHS Foundation Trust in London, Dr Andrew T Kuykendall from Moffitt Cancer Center, Dr Stephen T Oh from the Washington University School of Medicine, Dr Jeanne Palmer from the Mayo Clinic School of Medicine and Dr Raajit K Rampal from Memorial Sloan Kettering Cancer Center discuss recent updates on available and novel treatment strategies for myelofibrosis and systemic mastocytosis.CME information and select publications here.

Behind the Scenes: Generational Divides, Physician Unions, and What Practice Owners Really Want - A Special Snack Episode, EP 230

Entrepreneur Mindset-Reset with Tracy Cherpeski

Play Episode Listen Later Jan 9, 2026 13:09 Transcription Available

In this candid SNACK episode, Miranda turns the microphone around and interviews Tracy about her recent speaking tour across California. Tracy spoke at multiple events with the Santa Clara County Medical Association and Fresno Madera Medical Society, teaching burnout prevention at the CME level—and what she learned surprised even her. You'll hear about the practice owners who started their own practices after burning out in large integrated systems, the generational divide that's causing friction in healthcare workplaces, and a surprising discovery: residents in California can unionize, but attending physicians cannot. Tracy also shares her perspective on why burnout prevention programs often miss the mark by putting the onus on individual physicians when burnout is, by definition, a workplace problem. Plus, she poses a provocative question she asked a room full of employed physicians: What would happen if 50% of you walked out? This episode offers fresh insights on systemic healthcare challenges, the commodification of healthcare, and what Tracy is learning as she builds the Thriving Practice Community. Is your practice growth-ready? See Where Your Practice Stands: Take our Practice Growth Readiness Assessment Read the full show notes, memorable quotes, and key takeaways. Connect With Us: Be a Guest on the Show Thriving Practice Community Schedule Strategy Session with Tracy Tracy's LinkedIn Business LinkedIn Page

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TWIFO 479: A Year of Treacherous and Improbable Events

This Week in Futures Options

Play Episode Listen Later Jan 9, 2026 54:11

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The New Year Split

Market Trends with Tracy

Play Episode Listen Later Jan 9, 2026 3:12

The calendar flipped, and the markets followed. Beef is splitting seasonally, chicken is finally waking up, pork remains a value with signs of strength, grains won't budge, and dairy keeps testing new lows. This is the quiet part of the year where small shifts now can mean big moves later.BEEF: The New Year reset is in full swing — middle meats are sliding fast while roasts and grinds quietly push higher. This seasonal split is right on schedule. The question is which side of the market you want to be on before January wraps up.POULTRY: After weeks of waiting, chicken prices are finally turning higher, led by breasts and now wings as the playoff season kicks in. With avian flu still very much in play, this market may not give buyers much time to react.GRAINS: Grain prices remain stuck in neutral, offering continued relief for protein markets. Until something breaks the pattern, this quiet stretch looks firmly in place.PORK: Pork remains one of the best values on the board, but signs of strength are starting to show. Bellies are holding steady for now — the next move feels closer than it looks.DAIRY: Butter has hit a five-year low while cheese shows hints of stabilizing. It's a rare pricing moment that may not stick around long.Savalfoods.com | Find us on Social Media: Instagram, Facebook, YouTube, Twitter, LinkedIn

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Today Was Fun with Bree Groff

Connecting the Dots

Play Episode Listen Later Jan 8, 2026 35:39

Bree Groff is a workplace culture expert and author of Today Was Fun: A Book About Work (Seriously). She has spent her career guiding executives at companies such as Microsoft, Google, Pfizer, Calvin Klein, Point32Health, and Memorial Sloan Kettering Cancer Center through periods of complex change. She is a Senior Advisor to the global consultancy SYPartners, previously served as the CEO of NOBL Collective, and she holds an MS in Learning and Organizational Change from Northwestern University. Bree lives in New York City with her husband and daughter.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.

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Training Healthcare Workers to Be “The Only One” In Crisis Settings: Dr. James Gough, CEO of The David Nott Foundation

Raise the Line

Play Episode Listen Later Jan 8, 2026 25:48

“The world is a very volatile place, with currently 110 conflicts globally, and yet healthcare staff in the hospitals, even here in London, are not prepared to be the only clinician who can help in a crisis or hostile setting,” says Dr. David Gough, CEO of the David Nott Foundation, which equips providers with the skills and confidence needed to function in war and other extraordinary situations. A former British Army doctor injured in Afghanistan, Gough brings lived experience as well as a background in tech to his current role at the Foundation, which itself is anchored in decades of field work amassed by its namesake, a renowned war surgeon. As Dr. Gough points out to host Lindsey Smith, the cause could be helped by augmenting medical school curricula, but in the meantime, the Foundation is filling the knowledge gap by using prosthetics, virtual reality simulations and cadavers to train a broad swath of health workers including surgeons, anesthetists, and obstetricians. Tune in to this important Raise the Line conversation as Dr. Gough reflects on the strengths and weaknesses of NGOs in doing this work, his plans to expand the Foundation's footprint in the US, and the gratifying feedback he's received from trainees now operating on the frontlines in Ukraine and elsewhere. Mentioned in this episode:David Nott Foundation If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast

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Challenges in Managing Retinal Vein Occlusion

Experts InSight

Play Episode Listen Later Jan 8, 2026 30:44

Host Dr. Jay Sridhar welcomes Drs. Michael Ip and Sophie Bakri to discuss the challenges in caring for patients with macular edema secondary to retinal vein occlusion (RVO). The panel reviews the current approach to treatment using anti-VEGF agents and factors that may suggest a need for more intensive, long-term treatment. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

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Antibody-Drug Conjugates for Breast Cancer — Proceedings from a San Antonio 2025 Symposium Series

Play Episode Listen Later Jan 8, 2026 90:22

Featuring perspectives from Dr Javier Cortés, Dr Rita Nanda, Prof Peter Schmid and Dr Priyanka Sharma, including the following topics: Introduction (0:00) Case: A woman in her early 80s with multiple comorbidities and triple-negative breast cancer (TNBC) develops bone-only metastases 4 months after declining capecitabine for post-neoadjuvant residual disease — Justin Favaro, MD, PhD (1:50) Case: A woman in her mid 70s with ER-negative, HER2-low (IHC 1+), PIK3CA-mutated, PD-L1-positive metastatic breast cancer (mBC) after receiving 3 cycles of neoadjuvant paclitaxel/carboplatin/pembrolizumab, which was discontinued — Alan Astrow, MD (6:47) Previously Untreated Metastatic TNBC (mTNBC) — Prof Schmid (10:47) Case: A woman in her early 80s with multiregimen-recurrent ER-positive, HER2-low (IHC 1+) ESR1-mutant mBC receives sacituzumab govitecan — Jennifer Yannucci, MD (27:19) Case: The role of datopotamab deruxtecan (Dato-DXd) for patients with ER-positive, HER2-low mBC who experienced disease progression on prior trastuzumab deruxtecan (T-DXd) — Ranju Gupta, MD; Case: A woman in her late 70s with bilateral recurrence in the lungs of ER-negative, HER2-low (IHC 1+) breast cancer (PD-L1 TPS 20%) receives Dato-DXd with durvalumab on protocol — Yanjun Ma, MD, PhD (31:35) Integrating Antibody-Drug Conjugates (ADCs) into the Management of Endocrine-Resistant Hormone Receptor-Positive mBC — Dr Sharma (36:31) Case: A woman in her early 70s with recurrent ER-negative, HER2-low (IHC 2+) mBC receives sacituzumab govitecan and achieves complete remission — Dr Gupta; Case: Management of neutropenia associated with sacituzumab govitecan — Gigi Chen, MD (50:30) Case: A woman in her late 60s with recurrent ER-negative, HER2-low (IHC 1+) mBC (HER2 V69L mutation) receives T-DXd and achieves a complete response but develops Grade 1 interstitial lung disease — Dr Gupta; Case: Management of T-DXd-related side effects — Laila Agrawal, MD (54:10) Selection and Sequencing of Therapy for Relapsed/Refractory mTNBC — Dr Nanda (58:59) Case: A woman in her early 40s with multiregimen-recurrent ER-positive, HER2-low mBC who has experienced severe nausea with past treatments is about to initiate T-DXd — Atif M Hussein, MD, MMM (1:12:40) Tolerability and Other Practical Considerations with ADCs and Other Cytotoxic Agents for mBC — Dr Cortés (1:18:10) CME information and select publications

Antibody-Drug Conjugates for Breast Cancer — Proceedings from a San Antonio 2025 Symposium Series

Breast Cancer Update

Play Episode Listen Later Jan 8, 2026 90:21

Dr Javier Cortés from the International Breast Cancer Center in Barcelona, Spain, Dr Rita Nanda from the University of Chicago, Prof Peter Schmid from Barts Cancer Institute in London, United Kingdom, and Dr Priyanka Sharma from the University of Kansas Cancer Center in Westwood discuss key clinical data with antibody-drug conjugates for metastatic breast cancer and their expert perspectives surrounding its clinical applications.CME information and select publications here.

university chicago spain united kingdom barcelona san antonio breast cancer symposium antibodies proceedings cme westwood antibody drug conjugates javier cort priyanka sharma kansas cancer center barts cancer institute

Chronic Lymphocytic Leukemia — Proceedings from a Symposium Series Preceding the 67th ASH Annual Meeting and Exposition

Play Episode Listen Later Jan 7, 2026 115:47

Featuring perspectives from Dr Matthew S Davids, Dr Bita Fakhri, Prof Constantine Tam and Dr Jennifer Woyach, including the following topics: Introduction (0:00) Current and Emerging Approaches to First-Line Therapy for Chronic Lymphocytic Leukemia (CLL) — Dr Davids (1:42) Case: A man in his mid 70s with a plethora of comorbidities but good performance status requires treatment for CLL — Bhavana (Tina) Bhatnagar, DO (14:58) Case: A man in his early 50s, a Jehovah's Witness, under observation for IGHV-mutated CLL develops pulmonary emboli and worsening lymphadenopathy, undergoes anticoagulation and begins therapy with zanubrutinib — Jennifer Yannucci, MD Case: A man in his mid 70s with a history of atrial fibrillation on apixaban receives zanubrutinib — Zanetta S Lamar, MD (22:30) Optimal Management of Adverse Events with Bruton Tyrosine Kinase and Bcl-2 Inhibitors; Considerations for Special Patient Populations — Prof Tam (32:50) Case: A man in his mid 90s with CLL has concurrent locally advanced Merkel cell carcinoma of the scalp — Erik Rupard, MD (50:51) Case: A woman in her early 50s under observation for IGHV-unmutated CLL develops progressive splenomegaly and receives obinutuzumab/venetoclax — Sean Warsch, MD (54:28) Selection and Sequencing of Therapy for Relapsed/Refractory CLL — Dr Woyach (1:05:51) Case: A man in his mid 70s with high-risk (del[TP53]) CLL experiences disease progression on ibrutinib and then venetoclax/obinutuzumab — Dr Bhatnagar (1:27:23) Case: A man in his early 80s with IGHV-unmutated CLL who previously received FCR now experiences disease relapse after 5 years of acalabrutinib, and a BTK C481S resistance mutation is detected — Priya Rudolph, MD, PhD (1:29:34) Chimeric Antigen Receptor T-Cell Therapy and Other Novel Strategies for CLL — Dr Fakhri (1:34:08) Case: A man in his early 70s with multiregimen-relapsed CLL experiences an 18-month response to pirtobrutinib — Brian P Mulherin, MD (1:50:46) CME information and select publications

Chronic Lymphocytic Leukemia — Proceedings from a Symposium Series Preceding the 67th ASH Annual Meeting and Exposition

Physician's Guide to Doctoring

Play Episode Listen Later Jan 7, 2026 115:47

Dr Matthew S Davids from Dana-Farber Cancer Institute, Dr Bita Fakhri from Stanford University School of Medicine, Prof Constantine Tam from Alfred Health in Melbourne, Australia, and Dr Jennifer Woyach from The Ohio State University Comprehensive Cancer Center review the treatment landscape for patients with chronic lymphocytic leukemia and discuss current research immediately before the 67th ASH Annual Meeting.CME information and select publications here.

australia medicine melbourne symposium exposition annual meetings proceedings cme stanford university school dana farber cancer institute preceding chronic lymphocytic leukemia ash annual meeting matthew s davids

Neuropalliative Care in Dementia With Dr. Neal Weisbrod

Continuum Audio

Play Episode Listen Later Jan 7, 2026 26:01

Dementia is often a highly burdensome disease process for patients, their caregivers and families, and the community at large. Palliating symptoms and providing guidance surrounding advance care planning and prognostication are integral components of the management plan. In this episode, Katie Grouse, MD, FAAN, speaks with Neal Weisbrod, MD, an author of the article "Neuropalliative Care in Dementia" in the Continuum® December 2025 Neuropalliative Care issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California San Francisco in San Francisco, California. Dr. Weisbrod is a neurologist at Hartford Healthcare with the Ayer Neuroscience Institute in Mystic, Conneticut. Additional Resources Read the article: Neuropalliative Care in Dementia Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. 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 Grouse: This is Dr Katie Grouse. Today I'm interviewing Dr Neal Weisbrod about his article on neuropalliative care in dementia, which appears in the December 2025 Continuum issue on neuropalliative care. Welcome to the podcast, and please introduce yourself to our audience. Dr Weisbrod: Thank you. I'm really excited to be here. I'm Neal Weisbrod. I'm a neurologist and palliative care physician currently working at Hartford Healthcare in Mystic, Connecticut. Dr Grouse: To start, I'd like to ask why you think it's important that neurologists read your article? Dr Weisbrod: The primary reason I think it's really important to read the article is because these are just really common problems that neurologists run into in clinical practice. So, Alzheimer disease and many other dementias are extremely common, and managing the burdensome symptoms and the complex discussions that we have to have with the patients and their families as they go through the course of dementia is something that is very common in clinical practice. And so my hope is that by reading this article, clinicians will pick up a few tools, a few new ideas for how to make these conversations easier and for how to help these patients get through the disease with a little bit less suffering. Dr Grouse: I learned a lot from reading your article, and I really encourage our listeners to check it out. But I was curious what you feel that you discussing your article would come as the biggest surprise to our listeners? Dr Weisbrod: So, I think that the most surprising thing a lot of people will see reading this article is the section on prognosis. A lot of times it seems families are counseled, when they're talking about the prognosis of Alzheimer disease, that it could be ten years or longer. But really, the data show that for many patients, the median prognosis is closer to three to eight years. And that is a little bit longer for Alzheimer disease than many other types of dementia, but also gets significantly shorter as patients get older. So, we're looking at a closer to three-year median prognosis for patients who are over eighty-five, whereas patients in their sixties are probably closer to the eight or nine-year median prognosis. And so I think that piece will hopefully help people give a little bit more accurate counseling about prognosis. Dr Grouse: I'm glad you brought that up because I was wondering, why is it so important that we are careful to make sure that we're giving prognostic information for our patients and maybe even updating it as their clinical status changes? Dr Weisbrod: I think first of all, it's a really common thing that patients and families are thinking about and worried about. They don't necessarily always seem to ask as much as they want to know. I think there's a lot of fear around that conversation, even though it's really important. And then there's also often tension between the family and caregivers tend to want to know more than patients do. I think that it really helps people plan for the future as well as possible to know what their future might be. And we have a lot of limitations in predicting the future, but using the best information we can, laying out what we think the likely range is, allows people to make a lot more clear plans for their future. Dr Grouse: I'd imagine it's also pretty helpful for hospice referrals, too, having that data. Dr Weisbrod: Yeah, definitely. And there's a lot of angst about when to refer patients who have dementia to hospice. The most important thing I think about when I'm making a hospice referral is that I don't have to be right. And I think it takes a lot of that concern off to just say, all I'm doing is making a connection, getting someone who's potentially interested in the hospice, who has a really advanced serious illness connected to a hospice agency. And then they can go through the full evaluation with the hospice and the hospice medical director and determine whether they're eligible. So, I think there are really helpful thresholds to think about that would be a good trigger. Like a patient who we think has advanced dementia, who has a hospitalization for pneumonia or a fracture of the hip or some other really serious acute medical condition, I think is a really good trigger to start to think about hospice. But most importantly, it's just the connection, and I tell the patients that upfront. I tell them that you're going to have a conversation and we'll decide whether you're a good fit, and if not, the hospice will usually just check in with you over time and decide when is the right time in the future. Dr Grouse: That's really helpful. And I think just a really great reminder to our listeners about thinking about hospice sooner or at certain critical points in their patient care rather than waiting, maybe, before it's gone on too long and may be of less use later on. I was wondering, in your own clinical practice, what do you think is the most challenging aspect of providing care to patients with dementia? Dr Weisbrod: I think this one's easy. I would say managing the time has to be the most difficult part. I think that taking care of patients who have dementia is time-consuming. There's a lot of different priorities that we have to manage the time around. How much time are we going to spend doing cognitive testing? How much time are we going to spend doing counseling? How much time are we going to spend making up a treatment plan and discussing medications? How much time are we going to spend on advanced care planning? And the way I try to combat that is really just trying to think about what I'm going to prioritize in a certain visit and not try to accomplish everything. I'll tell patients and their families, the next time you come in, we're going to have a conversation focusing on advanced care planning. Or, the next time you come in, we're going to sit down and try to talk through all the questions you have about what the future might hold. That way I in that visit, I don't feel like, oh, I have to do updated cognitive testing and I have to review all the next steps in medication, and that allows me to take it in more bite-sized chunks. Dr Grouse: You made some of the great points, and specifically you mentioned advanced care planning. Your article makes a really strong case for the importance of advanced care planning, yet you definitely acknowledge the many barriers to initiating discussions that clinicians face. In your patients with dementia, can you walk us through how you integrate discussions about advanced care planning with your patients and their families? Dr Weisbrod: Yeah, I think this is still something that is evolving in my practice, and I don't think there's any perfect way of doing it. I think there's a lot of right ways of doing it, and as long as we're thinking about it a lot and bringing it up periodically, that's probably the best. What I try to do, though, is after I discuss what I think is the most likely diagnosis with patients and their families, I try to have a fairly close follow-up visit after that. Allow them to digest that information, to often do a little bit of their own research, to talk about it as a family. And then when they come in for that next appointment, I try to at least lay some groundwork about advanced care planning, asking them what they've completed already, and then based on what they've already done to that point, talking to them about what I think the next step would be. If they have done nothing, usually it's just, hey, I really think you should start to think about who would be making decisions for you if you lose the ability to make your own decisions and counsel them about power of attorney paperwork and establishing a healthcare surrogate. When it's patients who have already done some of that initial prep, I think that it's really important to keep in mind it's a longitudinal discussion and you can take it in small pieces over time. Often that helps because you can really establish that rapport and that trust. And then I like to just keep checking in whenever there's major changes in the patient's health or condition, like admission to the hospital or transfer to an assisted living facility or memory care clinic. Those are good times to remember, hey, I really need to revisit this conversation. Dr Grouse: It's probably good to also mention another really important point from your article, which was that impairment of decision-making in patients with dementia can actually start significantly even in the phase of mild cognitive impairment. Yet these patients will need to make many medical decisions with their neurologist as they go through this journey. How can we make sure our patients have capacity and make decisions appropriately regarding their care? Dr Weisbrod: Yeah, I think that's a definite challenge of taking care of patients with cognitive disorders of any type, including those with stroke and multiple sclerosis, that have some cognitive impairment. In my opinion, the most important way to help manage that is to make sure when we are making important decisions about the future that we're having a deep exploration of the values and the reasoning behind that. And definitely teach back is the most helpful way that I use to explore those values and the logic behind patients' decisions. So, I think we have to have a really low threshold to move on to a formal evaluation of capacity; if there's any inconsistency between what the patient's saying now and what their families say they've said in the past, or if they're having struggled to come up with a really clear logic behind their decision, then I think we have to have a low threshold to move on to a formal evaluation of capacity. So, I think having the family involved, having other people who know the patient really well, usually helps identify some of those periods where it seems like the patient's not making the decision that really reflects their true wishes. Dr Grouse: Now I wanted to switch gears a little bit and get into the management of neuropsychiatric symptoms, which you spend a lot of time on and I think a lot of neurologists find very challenging. What are some nonpharmacologic approaches that can help patients with significant neuropsychiatric symptoms? Dr Weisbrod: I really like the DICE paradigm for coming up with nonpharmacologic approaches. The DICE paradigm is an acronym. The D is Describe, I is Investigate, C is Create, and E is Evaluate. The idea is that we're exploring what's happening behind the symptoms, we're creating a plan to intervene, and then we're evaluating the outcome of that plan and creating a sort of feedback loop there. But ultimately, I think, when we're creating a solution, thinking about how we can change the environment is the most important thing. We have very limited ability to change the way that someone who has severe cognitive dysfunction reacts to their environment, but we can often change the environment to not produce that reaction in the first place. One example is with wandering behaviors. Trying to change the environment where you put locks that don't have deadbolts that you can use on the inside of the house, you have to have a key on the inside of the house, and then the family can put that key somewhere safe where the patient is not likely to find it and be able to unlock the door and wander out unsafely. I also think it's really important to acknowledge that as doctors, we are maybe not the best people to always have the answer when it comes to changing a patient's environment. And so, I think we really need to rely on the wisdom of support groups and other people who are going through the challenge of dementia. Our interdisciplinary care teams like social workers and nurses who have experience in managing dementia, and really try to plug the caregivers into as many of these avenues as possible so that they can learn from all of that community of wealth and not always rely on the doctor to have the answer. Dr Grouse: Switching gears to pharmacologic management, which is a lot of what we do for patients as neurologists. Thinking about agitation, pharmacologic management of agitation can be very challenging. And reading your article, it reminds me how disheartening it is to reflect and how modest the effect of the available options are, along with the many potential risks of their use, When nonpharmacologic interventions fail, what should neurologists recommend for their patients with agitation? Dr Weisbrod: Yeah, I definitely agree. It's every time I go back and look at this literature and look at what's new, it is a bit disheartening. But even in the face of all that, I really feel like SSRIs are my first-line therapy for most of these patients. I always try to ask myself what might be causing the patient discomfort that they are then manifesting as agitation because they don't have a better way of expressing themselves. Often, I feel like that's anxiety or depression or some other psychological symptom that we might be able to address with an SSRI. So, I tend to use sertraline and escitalopram, start those early and as long as patients are tolerating it, give it a really good trial. Outside of that, escalating to other pharmacologic approaches, even though there's such controversy in the data about antipsychotics and even though there are very real risks, sometimes I think we essentially do need a chemical sedative. And I think that it's important to have a very frank conversation upfront with the caregivers and the medical decision maker for that patient. Make sure we are counseling them on the risk, the increased risk of mortality, and also to make it a time-limited trial. So, I think that saying we're going to try this medication (if the patient's decision maker agrees, obviously) for a month or two months or three months. But I definitely wouldn't want them to just have an open-ended plan where they're going to stay on it indefinitely. It should have some end point where we say, hey, is this working or not? And if it's working, then we'd make a decision, is the improvement in quality of life worth the risks? And if we're not seeing that improvement, then we definitely need to stop it. Dr Grouse: That seems very reasonable. And then thinking more towards some of the other types of symptoms that can be really challenging, I was really surprised to see how often uncontrolled pain is a significant contributor in patients with dementia. And certainly, both uncontrolled pain and poor sleep can worsen cognitive function and neuropsychiatric symptoms in general. But of course, there's ongoing concerns about side effects of these therapies and how they can also potentially worsen things. How should we be approaching management of pain and insomnia or poor sleep in these patients? Dr Weisbrod: I think the key is just to start with really low burden treatments and escalate carefully and start with low doses of higher risk medications. So, when I think the low burden treatments for pain, scheduling acetaminophen, 1000 milligrams every eight hours, seems like a trivial thing to do, maybe? But it's actually surprising how much scheduled acetaminophen can take the edge off of pain and might be able to avoid some of these flare-ups of neuropsychiatric symptoms, may be able to really improve that pain a little bit. I do think it really has to be scheduled, though. Trying to rely on patients who have significant cognitive dysfunction to use a PRN medication is going to lead to a lot of problems and undertreatment. And then on the sleep disorder side, I think starting with low-dose Trazodone and gradually increasing the dose of Trazodone as a really safe way of initially approaching the insomnia. And then only when it's a more refractory case do I reach for the high-risk medications. Like for pain, we're talking about opiates. I think there's a lot of very reasonable concern about using opioids in patients who have cognitive dysfunction. But if there is a really good reason to think that they have severe pain, like they have a past pain disorder, I think that just like with antipsychotics, there are definitely real risks to these medications. But at the end of the day, if we are improving someone's quality of life dramatically and the patient's medical decision maker is willing to take on those risks, then we're really doing the patients a favor. Dr Grouse: Now, another issue that you mentioned in your article, which I see a lot and often struggle with myself, is how and when to deprescribe certain types of medications such as cholinesterase inhibitors and memantine. Any tips or tricks to how to approach this? Dr Weisbrod: My approach to this has also evolved a bit over the years. The new data that cholinesterase inhibitors may have a mortality benefit in patients with Alzheimer disease has changed my thinking a little bit. But there are still lots of situations where it's just too burdensome or patients seem to be having side effects. And so, I think about deprescribing. The most important thing in my mind is really thorough counseling before deprescribing with the patient's family and medical decision maker. I think that letting them know that we might actually be holding things more stable with the medication than we realize, there could be a flare-up, that we can resume the medication if that flare-up happens but we don't always guarantee getting back to the same point. I think having that conversation ahead of time will ward off some of the worst issues that you have afterwards. And then I think doing a taper of cholinesterase inhibitors over two weeks to a month is probably the most prudent because of some of the data about withdrawal and exacerbation of neuropsychiatric symptoms or cognitive worsening. Memantine, I think the data is a lot more shaky on withdrawal. And so, I think it's less important to gradually taper memantine. But I think that once again, just having the conversation upfront and letting the family know these are the things we have to look out for and these are the risks is going to be the most important. Dr Grouse: That's really helpful and a great strategy to take advantage of. Another, I think, really difficult topic that I wanted to ask you about was the discussion around nutrition and whether or not to consider putting in some type of a permanent tube for tube feeds. How do you approach that conversation? Certainly a difficult one. Dr Weisbrod: Yeah, I think it's easily one of the most difficult conversations to have in the care of patients who have dementia. And there's so much emotion in the families when they're having this discussion. And I think really acknowledging there's a huge emotional piece of the conversation is one key piece. For families and caregivers, they're thinking, I don't want my loved one to starve to death. That's usually the most important thing in their mind. We have to address that concern in the conversation, or they're never going to get to a point of satisfaction with the decision that's being made. So, I think while there is still some controversy in the literature about artificial nutrition for patients who have dementia, the bulk of data indicates that it is not helpful for patients. It may exacerbate dementia, it leads to more restraint. And so, I think unless there's some reversible medical condition that we're just trying to do artificial nutrition to get them through, like, they have a stroke and we're expecting that their dysphasia is going to improve because of the stroke is going to heal. Those situations might be a good reason, but if we really think that the driving factor behind their dysphasia is their dementia, I think we should be guiding the families away from that. And I think that explaining that as dementia gets really advanced, the body is slowly shutting down. The body is not needing as much nutrition, and forcing more nutrition in has not been shown to help people who have dementia. Really putting it in that sort of language is going to help the families understand and be comfortable with that decision. I also think that it's really helpful to consider talking to families about what they can do and not have the entire conversation be about what we're not doing or not putting in a feeding tube for artificial nutrition. So, I think really good counseling about, we can do comfort feeding, we can expand what food we're giving the person who has dementia and really focus on foods that they really enjoy and not worry so much about the health and nutrition anymore. I think that focus on what they can take control of can also help make the decision easier for families. Dr Grouse: I really like that approach. And I agree, it does seem that it being such an emotional decision with just so much a concern about this underlying feeling of not caring for their family member. I think that is a really great way to look at it and to kind of start off that conversation. Now, I'd love to hear more about what drew you to this field when you first got into your career as a neurologist. Dr Weisbrod: I had an interesting journey to doing neuropalliative care. Definitely didn't know that's what I was going to do when I started neurology residency. At University of Rochester, we had amazing palliative care physicians that were involved in medical school, and so I got a little bit of exposure to it early on. Then when I was in neurology residency, I first of all realized that I really enjoyed making sure that what we were doing respected a patient's wishes. And so, as other people seemed to run away from those conversations, I was really drawn to them. And so that definitely made me realize that that might be more of the right field for me. But also, as I went through neurology residency, I really discovered that I love so many different things in neurology, and that made me not want to subspecialize and focus on a narrower set of conditions in neurology. So, doing palliative care fellowship was a really good way of getting a specialist tool set and expanding my knowledge in one area, but staying a neurologist, generalist. And I think it also really enhances a lot of the other things I do in neurology. It gives me a lot of additional skills on how to counsel patients and how to prepare for the future in general. I think there's a lot about just good bedside manner in palliative care education. I feel like it helped me become a better neurologist, and I decided that I really loved the palliative care piece as well. Dr Grouse: Well, we're certainly all grateful that you found this aspect of your career and have been able to share the skills you've honed with us as well. And we really appreciate you taking the time to talk with us about your excellent article today, which I encourage everybody to read. Dr Weisbrod: Yeah, thank you. It's been wonderful to be on, and I hope that people can take away a few small points from the article. Dr Grouse: Again, today I've been interviewing Dr Neal Weisbrod about his article on neuropalliative care in dementia, which appears in the December 2025 Continuum issue on neuropalliative care. 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.

The Quickest Way to De-escalate a Hostile Patient with Luke Weisner | Ep499

Play Episode Listen Later Jan 6, 2026 30:50

This episode is sponsored by Lightstone DIRECT. Lightstone DIRECT invites you to partner with a $12B AUM real estate institution as you grow your portfolio. Access the same single-asset multifamily and industrial deals Lightstone pursues with its own capital – Lightstone co-invests a minimum of 20% in each deal alongside individual investors like you. You're an institution. Time to invest like one.—-----------------------------Join us for Doctor PodFest in Florida! Go here to secure your ticket: Here------------------------------What if an angry patient's "eruption" isn't an attack on you, but a desperate attempt to protect something vital, like their health, time, or family?In this essential episode, Dr. Bradley Block sits down with Luke Wiesner, a seasoned conflict specialist who's trained hundreds of healthcare teams, to unpack de-escalation strategies for volatile patient interactions. Drawing from his decade of experience in mediation and coaching, Luke introduces the "volcano" model: eruptions stem from underlying pressures, not malice. He outlines a repeatable framework: regulate yourself, relate to their emotions e.g., frustration over wasted time, seek understanding, and collaboratively solve problems while offering choices. They discuss avoiding defensiveness, acknowledging experiences even if "wrong", empowering staff with boundaries, and knowing when to escalate for safety. Perfect for physicians and teams facing post-COVID edge in offices or hospitals.If tense encounters leave you or your staff drained, this blueprint empowers you to de-escalate safely, foster trust, and reduce burnout, making you the office hero.Three Actionable Takeaways:Regulate yourself first to avoid fueling the fire: When facing an eruption, pause for deep breaths or a quick mental reset, remind yourself they're protecting something vital (health, time, money). This prevents defensiveness, decoupling you from being seen as the "threat," and sets the stage for calm rapport-building.Relate and reflect to build connection: Acknowledge their emotion with muted words like "frustrated" or "concerned", avoid "angry" to prevent pushback. Reflect on their experience: "This probably isn't how you planned to spend your afternoon, I can see how frustrating that is." Genuinely show you care to shift from adversaries to allies, using nonverbal cues like tone for authenticity.Solve collaboratively and set boundaries: Offer options for control e.g., "We can slot you in two weeks or add you to the waitlist, which works?". If inappropriate (e.g., profanity, threats), give a choice: "I'd like to help, but I can't if you continue speaking that way—let's adjust, or I'll need to involve my manager." Know your office's escalation protocol (e.g., security) for safety.About the Show:Succeed In Medicine covers patient interactions, burnout, career growth, personal finance, and more. If you're tired of dull medical lectures, tune in for real-world lessons we should have learned in med school!About the Guest:Luke Wiesner has been a conflict specialist since 2014, offering mediation, coaching, training, and facilitation to workplaces, families, communities, and individuals. He's partnered with hundreds of organizations across industries, including healthcare, where he's helped physicians, surgeons, and teams de-escalate patient conflicts, improve communication, and resolve issues in clinical and office settings. LinkedIn: Luke Wiesner Website: https://www.lukewiesner.comAbout the Host:Dr. Bradley Block – Dr. Bradley Block is a board-certified otolaryngologist at ENT and Allergy Associates in Garden City, NY. He specializes in adult and pediatric ENT, with interests in sinusitis and obstructive sleep apnea. Dr. Block also hosts Succeed In Medicine podcast, focusing on personal and professional development for physiciansWant to be a guest?Email Brad at brad@physiciansguidetodoctoring.com or visit www.physiciansguidetodoctoring.com to learn more!Socials:@physiciansguidetodoctoring on Facebook@physicianguidetodoctoring on YouTube@physiciansguide on Instagram and Twitter This medical podcast is your physician mentor to fill the gaps in your medical education. We cover physician soft skills, charting, interpersonal skills, doctor finance, doctor mental health, medical decisions, physician parenting, physician executive skills, navigating your doctor career, and medical professional development. This is critical CME for physicians, but without the credits (yet). A proud founding member of the Doctor Podcast Network!Visit www.physiciansguidetodoctoring.com to connect, dive deeper, and keep the conversation going. Let's grow! Disclaimer:This podcast is for informational purposes only and is not a substitute for professional medical, financial, or legal advice. Always consult a qualified professional for personalized guidance. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Colorectal Cancer — 5-Minute Journal Club Issue 1 with Dr Scott Kopetz: Current and Future Role of Tumor-Informed Circulating Tumor DNA Assays

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Play Episode Listen Later Jan 6, 2026 20:48

Featuring an interview with Dr Scott Kopetz, including the following topics: Circulating tumor DNA (ctDNA)-based molecular residual disease (MRD) and survival among patients with resectable colorectal cancer (CRC) in the CIRCULATE-Japan GALAXY trial (0:00) ctDNA for detection of MRD in patients with CRC in the BESPOKE CRC and INTERCEPT trials (3:11) Clinical utility of including ctDNA monitoring in standard CRC surveillance (11:11) ctDNA analysis guiding adjuvant therapy for CRC in the DYNAMIC and CIRCULATE-North America trials (15:52) CME information and select publications

Episode 164: Is Your New Year's Resolution to Get More Professional Development for Yourself and Your Team? If Not, It Should Be

Medical Money Matters with Jill Arena

Play Episode Listen Later Jan 6, 2026 12:08

Send us a textNew year, new goals… but how many of us actually prioritize professional development as a resolution?Most people jump into January thinking about eating better, working out more, maybe saving some money or getting more sleep. And those are all important. But here's something that often gets left off the list—and it might be the most important investment you can make: developing yourself as a leader, and investing in the growth of your team.If that hasn't made it onto your list of resolutions, I'm going to make the case for why it should be. In fact, I'd argue it might be the single most strategic move you can make this year—for yourself, your organization, and your team.Whether you're a physician leader, an operations executive, or a practice administrator, staying stagnant is not an option. The world of healthcare is simply changing too fast. The workforce is demanding more than just a paycheck. And organizations that don't evolve—well, they start to fall behind pretty quickly.Today, we're diving into the “why” and the “how” of professional development in 2026: how to get started, what it can look like, and how to avoid the all-too-common trap of underinvesting in your own growth—and that of the people around you.Please Follow or Subscribe to get new episodes delivered to you as soon as they drop! Visit Jill's company, Health e Practices' website: https://healtheps.com/ Subscribe to our newsletter, Health e Connections: http://21978609.hs-sites.com/newletter-subscriber Want more formal learning? Check out Jill's newly released course: Physician's Edge: Mastering Business & Finance in Your Medical Practice. 32.5 hours of online, on-demand CME-accredited training tailored just for busy physicians. Find it here: https://healtheps.com/physicians-edge-mastering-business-finance-in-your-medical-practice/ Purchase your copy of Jill's book here: Physician Heal Thy Financial Self Join our Medical Money Matters Facebook Group here: https://www.facebook.com/groups/3834886643404507/ Original Musical Score by: Craig Addy at https://www.underthepiano.ca/ Visit Craig's website to book your Once in a Lifetime music experience Podcast coaching and development by: Jennifer Furlong, CEO, Communication Twenty-Four Seven https://www.communicationtwentyfourseven.com/

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Colorectal Cancer — 5-Minute Journal Club Issue 1 with Dr Scott Kopetz: Current and Future Role of Tumor-Informed Circulating Tumor DNA Assays

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Play Episode Listen Later Jan 6, 2026 22:33

Colorectal Cancer — 5-Minute Journal Club Issue 1 with Dr Scott Kopetz: Current and Future Role of Tumor-Informed Circulating Tumor DNA Assays

university dna current informed tumors cme colorectal cancer circulating journal club texas md anderson cancer center future role minute journal assays

Play Episode Listen Later Jan 6, 2026 22:33

#510 Diverticulitis for the Hospitalist

The Curbsiders Internal Medicine Podcast

Play Episode Listen Later Jan 5, 2026 73:45

Diverticulitis Simplified: Imaging, Antibiotics, Diet, and When to Call Surgery Master diverticulitis! Learn how to distinguish uncomplicated from complicated disease, when to reach for antibiotics, and which patients need surgical consultation. We're joined by Dr. Bob Hollis (University of Alabama at Birmingham) and Dr. Andrew Webster (Emory University). Claim free CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Rapid Fire Questions Picks of the Week Case 1 Defining and Classifying Diverticulosis vs Diverticulitis History and Physical Exam Labs and Imaging Disposition: Admit or Discharge? Antibiotics: Who Needs them and How to Choose Duration of Antibiotic Therapy Diagnostic Pitfalls and Redflags Nutrition in the Hospitalized Patient with Diverticulitis Case 2 Surgery and IR Consultation Antibiotics in Diverticular Abscess Repeat Imaging in Undrainable Abscess Elective Surgery in Diverticulitis Case 3 Diverticulitis with Perforation Counseling Patients Undergoing Surgery Ostomy Reversal Timing Credits Writer, Producer, and Show Notes: Reaford Blackburn, Jr., MD Infographic and Cover Art: Caroline Coleman, MD Hosts: Monee Amin, MD and Meredith Trubitt, MD Reviewer: Rahul Ganatra Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guests: Bob Hollis, MD and Andrew Webster, MD Sponsor: FIGS Take 15% off your first order at Wearfigs.com with the code FIGSRX. Sponsor: Continuing Education Company Visit CMEmeeting.org/curbsiders and use promo code Curb30 for 30% off all online courses and webcasts. Sponsor: Gusto Try Gusto today at gusto.com/cribsiders, and get three months free when you run your first payroll.

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Has The Silver Boom Peaked Out? | Andy Schectman

Thoughtful Money with Adam Taggart

Play Episode Listen Later Jan 4, 2026 68:50

TO TAKE ADVANTAGE OF ANDY'S JUNK SILVER OFFER go to https://thoughtfulmoney.com/buygoldAfter hitting an all-time high of $83/oz in the futures market a week ago, silver has fallen down to $72/oz as of the time of this writing.Did the silver price boom just peak?Could we see a vicious plunge in price from here, as we did during the previous price peaks in 1980 and 2011?Or, are things truly different this time? And are new record highs lying ahead in 2026?In today's livestream Andy Schectman, CEO of precious metals dealer Miles Franklin, joined us to share his thoughts as well as take live audience Q&A.You can watch the replay here. But first an important reminder…In celebration of silver's run, Andy is kindly offering an exclusive discount to the Thoughtful Money audience:While supplies last, he's willing to sell us junk silver at $1.35 above spot.NOTE: this is higher than his previous offer to sell at $1 below spot, due to the recent CME margin hikes.If you'd like to take him up on this offer, or talk with him & his staff about any other questions/needs you have regarding buying or storing precious metals, just fill out the short form at https://thoughtfulmoney.com/buygold#goldprice #silverprice #junksilver_____________________________________________Thoughtful Money LLC is a Registered Investment Advisor Promoter.We produce educational content geared for the individual investor. It's important to note that this content is NOT investment advice, individual or otherwise, nor should be construed as such.We recommend that most investors, especially if inexperienced, should consider benefiting from the direction and guidance of a qualified financial advisor registered with the U.S. Securities and Exchange Commission (SEC) or state securities regulators who can develop & implement a personalized financial plan based on a customer's unique goals, needs & risk tolerance.IMPORTANT NOTE: There are risks associated with investing in securities.Investing in stocks, bonds, exchange traded funds, mutual funds, money market funds, and other types of securities involve risk of loss. Loss of principal is possible. Some high risk investments may use leverage, which will accentuate gains & losses. Foreign investing involves special risks, including a greater volatility and political, economic and currency risks and differences in accounting methods.A security's or a firm's past investment performance is not a guarantee or predictor of future investment performance.Thoughtful Money and the Thoughtful Money logo are trademarks of Thoughtful Money LLC.Copyright © 2025 Thoughtful Money LLC. All rights reserved.

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Acute Myeloid Leukemia — Proceedings from a Symposium Series Preceding the 67th ASH Annual Meeting and Exposition