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Featuring perspectives from Prof Marina Chiara Garassino, Dr John V Heymach, Prof Solange Peters and Dr Jacob Sands, moderated by Dr Sands, including the following topics: Introduction (0:00) Role of Immune Checkpoint Inhibitors in Metastatic Non-Small Cell Lung Cancer (NSCLC) without a Targetable Tumor Mutation — Prof Peters (2:07) Targeted and Other Novel Therapeutic Strategies for Relapsed Metastatic NSCLC — Prof Garassino (26:30) Potential Role of TROP2-Targeted Antibody-Drug Conjugates in Advanced NSCLC — Dr Sands (50:19) Evolving Role of Immune Checkpoint Inhibitors in the Care of Patients with Nonmetastatic NSCLC — Dr Heymach (1:12:36) CME information and select publications

Normal pressure hydrocephalus (NPH) is a pathologic condition whereby excess CSF is retained in and around the brain despite normal intracranial pressure. MRI-safe programmable shunt valves allow for fluid drainage adjustment based on patients' symptoms and radiographic images. Approximately 75% of patients with NPH improve after shunt surgery regardless of shunt type or location. In this episode, Aaron Berkowitz, MD, PhD, FAAN, speaks with Kaisorn L. Chaichana, MD, author of the article “Management of Normal Pressure Hydrocephalus” in the Continuum® June 2025 Disorders of CSF Dynamics 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. Chaichana is a professor of neurology in the department of neurological surgery at the Mayo Clinic in Jacksonville, Florida. Additional Resources Read the article: Management of Normal Pressure Hydrocephalus 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: @LyellJ Guest: @kchaichanamd 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 Kaisorn Chaichana about his article on management of normal pressure hydrocephalus, which he wrote with Dr Jeremy Cutsforth-Gregory. The article appears in the June 2025 Continuum issue on disorders of CSF dynamics. Welcome to the podcast, and please introduce yourself to our audience. Dr Chaichana: Yeah, thank you for having me. I'm Kaisorn Chaichana. I'm a neurosurgeon at Mayo Clinic in Jacksonville, Florida. Part of my practice is doing hydrocephalus care, which includes shunts for patients with normal pressure hydrocephalus. Dr Berkowitz: Fantastic. Well, before we get into shunt considerations and NPH specifically, which I know is the focus of your article, I thought it would be a great opportunity for a neurologist to pick a neurosurgeon's brain a bit about shunts. So, to start, can you lay out for us the different types of shunts and shunt procedures, the advantages, disadvantages of each type of shunt, how you think about which shunt procedure should be used for which patient, that type of thing? Dr Chaichana: Yeah. So, there are different types of shunts, and the most common one that is used is called a ventricular peritoneal shunt. So, it has a ventricular catheter, it has a catheter that tunnels underneath the skin and it goes into the peritoneum where the fluid goes from the ventricular system into the peritoneum. Typically, the shunts are in the ventricle because that is the largest fluid-filled space in the brain. Other terminal areas include the atrium, which is really the jugular vein, and those are called ventricular atrial shunts. You can also have ventricular pleural shunts, which end in the pleural space and drain flui into the pleural space. Those are pretty much the most common ventricular shunts. There's also a lumboperitoneal shunt that drains from the lumbar spine, similar to a lumbar drain into the peritoneum. For the lumbar shunts, we don't typically have a lumbar pleural or lumbar atrial shunt just because of the pressure dynamics, because the lumbar spine is below the lung and as well as the atrium. And so, the drainage pattern is very different than ventricular peritoneal which is top to bottom. The most common shunt, why we use the ventricular peritoneal shunt the most, is because it has the most control. So, the peritoneum is set at a standard pressure in the intraabdominal pressure, whereas the ventricular atrial shunt depends on your venous return or venous pressure and your ventricular pleural shunt varies with inspiration and expiration. So, the easiest way for us to control the fluid, the ventricular system is through the ventricular peritoneal shunt. And that's why that's our most common shunt that we use. Dr Berkowitz: Fantastic. So, as you mention in the article, neurologists may be reluctant to offer a shunt to patients with NPH because many patients may not improve, or they improve only transiently; and out of fear of shunt complications. So, of course, as neurologists, we often only hear about a patient's shunt when there is a problem. So, we have this sort of biased view of seeing a lot of shunt malfunction and shunt infection. Of course, we might not see the patient if their shunt is working just fine. How common are these complications in practice, and how do you as a neurosurgeon weigh the risks against the often uncertain or transient benefits of a shunt in a patient with NPH who may be older and multiple medical comorbidities? How do you think about that and talk about it with patients? Dr Chaichana: When you hear about shunt complications, most of the shunt complications you hear about are typically in patients with congenital hydrocephalus. Those patients often require several shunt revisions just from either growing or the shunt stays in for a long time or the ventricular caliber is a lot less than some with normal pressure hydrocephalus. So, we don't really see a lot of complications with normal pressure hydrocephalus. So that shunt placement in these patients is typically pretty safe. The procedure's a relatively short procedure, around 30 minutes to 45 minutes to place a shunt, and we can control the pressure within the shunt setting so that we don't overdrain---which means too much fluid drains from the ventricular system---which can cause things like a subdural, which is probably the most common complication associated with normal pressure hydrocephalus. So, to obviate those risks, what we do is typically insert the shunt and then keep the shunt setting at a high setting. The higher the setting, the less it drains, and then we bring it slowly down based on the patient's symptoms to try to minimize the risk of this over drainage in the subdural hematoma while at the same time benefiting the patient. So, there's a concern for shunt in patients with normal pressure hydrocephalus. The concern or the complication risks are very low. The problem with normal pressure hydrocephalus, though, is that over time these patients benefit less and less from drainage or their disease process takes over. So, I do recommend placing this shunt as soon as possible just so that we can maximize their quality of life for that period of time. Dr Berkowitz: So, if I'm understanding you, then the risk of complication is more sort of due to the mechanical factors in patients with congenital hydrocephalus or sort of outgrowing the shunt, their pressure dynamics may be changing over time. And in your experience, an older patient with NPH, although they may have more medical comorbidities, the procedure itself is relatively quick and low-risk. And the actual complications due to mechanical factors, my understanding, are just much less common because the patient is obviously fully grown and they're getting one sort of procedure at one point in time and tend to need less revision, have less complication. Is that right? Dr Chaichana: Yeah, that's correct. The complication risk for normal hydrocephalus is a lot less than other types of hydrocephalus. Dr Berkowitz: That's helpful to know. While we're talking about some of these complications, let's say we're following a patient in neurology with NPH who has a shunt. What are some of the symptoms and signs of shunt malfunction or shunt infection? And what are the best studies to order to evaluate for these if we're concerned about them? Dr Chaichana: Yeah. So basically, for shunt malfunction, it's basically broken down into two categories. It's either overdrainage or underdrainage. So, underdrainage is where the shunt doesn't function enough. And so basically, they return to their state before the shunt was placed. So that could be worsening gait function, memory function, urinary incontinence are the typical symptoms we look for in patients with normal pressure hydrocephalus and underdrainage, or the shunt is not working. For patients that are having overdrainage, which is draining too much, the classic sign is typically headaches when they stand up. And the reason behind that is when there's overdrainage, there's less cerebrospinal fluid in their ventricular system, which means less intracranial pressure. So that when they stand up, the pressure differential between their head and the ground is more than when they're lying down. And because of that pressure differential, they usually have worsening headaches when standing up or sitting up. The other thing are severe headaches, which would be a sign of a subdural hematoma or focality in their neurological symptoms that could point to a subdural hematoma, such as weakness, numbness, speaking problems, depending on the hemisphere. How we work this up is, regardless if you're concerned about overdrainage or underdrainage, we usually start with a CAT scan or an MRI scan. Typically, we prefer a CAT scan because it's quicker, but the CAT scan will show us if the ventricular caliber is the same and/or the placement of the proximal catheter. So, what we look for when we see that CAT scan or that MRI to see the location of the proximal catheter to make sure it hasn't changed from any previous settings. And then we see the caliber of the ventricles. If the caliber of the ventricles is smaller, that could be a sign of overdrainage. If the caliber of the ventricles are larger, it could be a sign of underdrainage. The other thing we look for are subdural fluid collections or hydromas or subdural hematomas, which would be another sign of lower endocranial pressure, which would be a sign of overdrainage. So those are the biggest signs we look for, for underdrainage and overdrainage. Other things we can look for if we're concerned of the shunt is fractured, we do a shunt X-ray and what a shunt x-ray is is x-rays of the skull, the neck and the abdomen to see the catheter to make sure it's not kinked or fractured. If you're really concerned, you can't tell from the x-ray, another scan to order is a CT of the chest and abdomen and pelvis to look at the location of the catheter to make sure there's no brakes in the catheter, there's no fluid collections on the distal portion of the catheter, which would be a sign of shunt malfunction as well. Other tests that you can do to really exclude shunt malfunction is a shunt patency test, and what that is a nuclear medicine test where radionucleotide is injected into the valve and then the radionucleotide is traced over time or imaged through time to make sure that it's draining appropriately from the valve into the distal catheter into the peritoneum or the distal site. If there's a shunt malfunction that's not drainage, that radioisotope would remain stagnant either in the valve or in the catheter. There's overdrainage, we can't really tell, but there will be a quick drainage of the radioisotope. For shunt infection, we start with an imaging just to make sure there's not a shunt malfunction, and that usually requires cerebrospinal fluid to test. The cerebrospinal fluid can come from the valve itself, or it can come from other areas like the lumbar spine. If the lumbar spine is showing signs of shunt infection, then that usually means the shunt is infected. If the valve is aspirated with- at the bedside with a butterfly needle into the valve and that shows signs of shunt infection, that also could be a sign of infection. Dr Berkowitz: That's very helpful. You mentioned CT and shunt series. One question that often comes up when obtaining neuroimaging in patients with a shunt, who have NPH or otherwise, is whether we need to call you when we're doing an MRI to reprogram the shunt before or after. Is there a way we can know as a neurologists at the bedside or as patients carry a card, like with some devices where we know whether we have to call and bother our neurosurgery colleagues to get this MRI? Or if the radiology techs ask us, is this safe? And is the patient's shunt going to get turned off? How do we go about determining this? Dr Chaichana: Yeah, so unfortunately, a lot of patients don't carry a card. We typically offer a card when we do the shunt, but that card, there's two problems with it. One is it tells the model, but the second thing is it has to be updated any time the shunt is changed to a different setting. Oftentimes patients don't know that shunt setting, and often times they don't know that company brand that they use. There are different types of shunts with different types of settings. If there's ever concern as to what type of shunt they have, an x-ray is usually the best bet to see with a shunt series, or a skull x-ray. A lateral skull x-ray usually looks at the valve, and the valve has certain radio-dense markers that indicate what type of shunt it is. And that way you can call neurosurgery and we can always tell you what the shunt setting is before the MRI is done. Problem with an MRI scan if you do it without a shunt x-ray before is that you don't know the setting before unless the patient really knows or it's in the patient chart, and the MRI can need to change the setting. It doesn't usually turn it off, but it would change the setting, which would change the fluid dynamics within their ventricular system, which could lead to overdrainage or underdrainage. So, any time a patient needs MRI imaging, whether it's even the brain MRI, a spine MRI, or even abdominal MRI, really a shunt x-ray should be done just to see the shunt setting so that it could be returned to that setting after the MRI is done. Dr Berkowitz: So, the only way to know sort of what type of shunt it would be short of the patient knowing or the patient getting care at the same hospital where the shunt was placed and looking it up in the operative reports would be a skull film. That would then tell us what type of shunt is there and then the marking of the setting. And then we would be able to call our colleagues in neurosurgery and say, this patient is getting an MRI this is the setting, this is the type of shunt. And do we need to call you afterwards to come by and reprogram it? Is that right? Dr Chaichana: That's correct, yeah. Dr Berkowitz: Is there anything we would be able to see on there, or it's best we just- best we just call you and clarify? Dr Chaichana: The easiest thing to do is, when you get the skull x-ray, you can Google different types of shunts or search for different shunts, and they'll have markers that show the type of shunt it is as well as the setting that it's at. And just match it up with the picture. Dr Berkowitz: And as long as it's not a programmable shunt, there's no concern about doing the MRI. Is that right? Dr Chaichana: Correct. So, if it's a programmable shunt, even if it's MRI-compatible, we still like to get the setting before and make sure the setting after the MRI is the same. Nonprogrammable shunts can't be changed with MRI scans, and those don't need neurosurgery after the MRI scan, but it should be confirmed before the scan is done. Dr Berkowitz: Very helpful. Okay, so let's turn to NPH specifically. As you know, there's a lot of debate in the literature, some arguing, even, NPH might not even exist, some saying it's underdiagnosed. I think. I don't know if it was last year at our American Academy of Neurology conference or certainly in recent years, there was a pro and con debate of “we are underdiagnosing NPH” versus “we are overdiagnosing NPH.” What's your perspective as a neurosurgeon? What's the perspective in neurosurgery? Is this something we're underdiagnosing, and the times you shunt these patients you see miraculous results? Is this something that we're overdiagnosing, you get a lot of patients sent to that you think maybe won't benefit from a shunt? Or is it just really hard to say and some patients have shunt-responsive noncommunicating hydrocephalus of unclear etiology and either concurrent Parkinson's disease, Alzheimer's, cervical lumbar stenosis, neuropathy, vestibular problems, and all these other issues that play into multifactorial gait to sort of display a certain amount of the percentage of problem in a given patient or take overtime? What's your perspective if you're open to sharing it, or what's the perspective of neurosurgery? Is this debated as it is in neurology or this is just a standard thing you see and patients respond to shunt to some degree in some proportion of the time? And what are the sort of predictors you see in your experience? Dr Chaichana: Yeah, so, for me, I'd say it's too complicated for a neurosurgeon to evaluate. We rely on neurology to tell us whether or not they need a shunt. But I think the problem is, obviously, a part of the workout for at least the ones that I like to do, is that I want them to have a high-volume lumbar puncture with pre- and postgait analysis to see if there's really an objective measure of them improving. If they have an objective measure of improvement---and what's even better is that they have a subjective measure of improvement on top of the objective measure of improvement---then they benefit from a shunt. The problem is, some patients do benefit even though they don't have objective performance increases after a high-volume shunt. And those are the ones that make me the most worrisome to do the shunt, just because I don't like to do a procedure where there's no benefit for the patient. I do see, according to the literature as well, that there's around a 30 to 40%, even 50%, increase in gait function, even in patients that don't have large improvements following the high-volume lumbar puncture. And those are the most challenging patients for us as neurosurgeons because we'll put the shunt in, they say we're no better in terms of their gait, no better in terms of their urinary incontinence. We try to lower their shunt down to a certain setting and we're kind of stuck after that point. The good thing about NPH, though, is that, from the neurosurgery side, the shunt, like I said, is a pretty benign, low-risk procedure. So, we're not putting the patient through a very severe procedure to see if there's any benefit. So, in cases where we try to improve their quality of life in patients that don't have a benefit from high-volume lumbar puncture, we give them the odds of whether or not it's improving and say it might not improve. But because the procedure's minimally invasive, I think it's a good way to see if we can benefit their quality of life. Dr Berkowitz: Yeah, it's a very helpful perspective. Yeah, those are the most challenging cases on our side as well, right. If the patient- we think they may have NPH, or their gait and/or urinary and/or cognitive problems are- at least have a component of NPH that could be reversible, we certainly want to do the large volume lumbar puncture and/or consider a lumbar drain trial, all discussed in other articles and interviews for this issue of Continuum, But the really tough ones, as you said, there is this literature on patients who don't respond to the large-volume lumbar puncture for some reason but still may be shunt responsive. And despite all the imaging predictors and all the other ways we try to think about this, it's hard to know who's going to benefit. I think that's really a helpful perspective from your end that, as you say in the very beginning of your article, right, maybe there's a little bit too much fear of shunting on the neurology side because when we hear about shunts, it's often in the setting of complication. And so, we're not sort of getting the full spectrum of all the patients you shunt and you see who are doing just fine. They might not improve---the question is related to NPH---but at least they're not harmed by the shunt, and we're maybe overbiased and/or seeing a overly representative sample of negative shunt outcomes when they're actually not that common in practice. Is that a fair summary of your perspective? Dr Chaichana: Yeah, that's correct. So, I mean, complications can occur---and anytime you do a surgery, there are risks of complications---but I think they're relatively low for the benefit that we can help their quality of life. And the procedure's pretty short. So, the risk, it mostly outweighs the benefits in cases with normal pressure hydrocephalus. Dr Berkowitz: Very helpful perspective. So, well, thanks so much again. Today I've been interviewing Dr Kaisorn Chaichana about his article on management of normal pressure hydrocephalus, which he wrote with Dr Jeremy Cutsforth-Gregory. This article appears in the most recent issue of Continuum on disorders of CSF dynamics. Be sure to check out Continuum Audio episodes from this and other issues, and thank you 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.

Dustin Poirier's last fight is this weekend. You know, allegedly. All relevant disclaimers apply. Still, if anyone deserves to ride off into the sunset with his legacy intact and his chin held high, it's Cool Dusty P. Call it cliché if you want, but they really don't make them like him anymore. On this episode: hear our discussion of his upcoming third fight against Max Holloway this weekend at UFC 318. Plus, Derrick Lewis out here: Throwing. Them. Bungalows. And how did we know someone would correctly identify the CME as the MMA show to ask about Conor McGregor's dick pic? Learn more about your ad choices. Visit megaphone.fm/adchoices

Crypto News: Bitcoin hits $123,000 and pulls backl. Fed, FDIC, & OCC give Banks guidance on crypto and stablecoins. XRP Futures and Ondo Finance Tokenization news.Show Sponsor -

Dr Haley Ellis from Massachusetts General Hospital in Boston, Dr Christopher Lieu from the University of Colorado Cancer Center in Aurora, Dr Sara Lonardi from the Veneto Institute of Oncology IOV-IRCCS in Padua, Italy, and Dr Kanwal Raghav from The University of Texas MD Anderson Cancer Center in Houston discuss patient cases and provide their perspectives on clinical datasets informing the care of patients with HER2-positive gastrointestinal cancer.  CME information and select publications here.

Dr Haley Ellis from Massachusetts General Hospital in Boston, Dr Christopher Lieu from the University of Colorado Cancer Center in Aurora, Dr Sara Lonardi from the Veneto Institute of Oncology IOV-IRCCS in Padua, Italy, and Dr Kanwal Raghav from The University of Texas MD Anderson Cancer Center in Houston discuss patient cases and provide their perspectives on clinical datasets informing the care of patients with HER2-positive gastrointestinal cancer.  CME information and select publications here.

In this episode, Jesus Berdeja, MD; Amrita Krishnan, MD, FACP; and Sagar Lonial, MD, FACP, discuss key topics with CELMoD therapy for multiple myeloma, including: Mechanistic differences between CELMoDs and IMiDsEmerging data with CELMoDs and their potential therapeutic roles across the disease continuum of multiple myelomaThe clinical implications of MRD negativity as a surrogate marker of long-term outcomes in clinical trials in multiple myelomaPresenters:Jesus Berdeja, MDDirector of Myeloma ResearchGreco-Hainsworth Centers for ResearchTennessee OncologyNashville, TennesseeAmrita Krishnan, MD, FACPDirector, Judy and Bernard Briskin Center for MyelomaExecutive Director of HematologyCity of Hope Orange CountyProfessor of Hematology/HCTCity of Hope Cancer CenterIrvine, CaliforniaSagar Lonial, MD, FACPChair and ProfessorDepartment of Hematology and Medical OncologyAnne and Bernard Gray Family Chair in CancerChief Medical OfficerWinship Cancer InstituteEmory UniversityAtlanta, GeorgiaContent based on an online CME program supported by an independent educational grant from Bristol Myers Squibb.Link to full program: https://bit.ly/3IwbslQ

Dr. Novitsky's message is clear:“It's never too late to start strength training."Whether you're in your 30s or 70s, building muscle and improving strength is one of the best things you can do for your body and mind."In this inspiring episode, obesity medicine expert, Ali Novitsky MD, MD dives deep into the transformative power of strength training, especially its profound benefits for anti-aging, longevity, and overall health. With a special focus on individuals aged 70 and older, Dr. Novitsky shares why now is the perfect time to begin — or restart — your strength journey, no matter your age or fitness level.

In this episode of Bowel Sounds Summer School, hosts Drs. Jennifer Lee and Peter Lu have taken highlights from past episodes on eosinophilic esophagitis (EoE) and put them into a special episode jam-packed with clinical pearls. Former expert guests Dr. Glenn Furuta, Dr. Amanda Muir, Dr. Rachel Chevalier, and Dr. Mike Wilsey explain how to diagnose, treat, and monitor patients with EoE.Our Bowel Sounds Summer School series will include 4 episodes each summer on big topics in our field, artisanally crafted for the ears of listeners of all stages from the young student to the seasoned attending.Learning ObjectivesReview clinical presentation and diagnostic criteria for eosinophilic esophagitis (EoE)Review dietary and medication treatment options for EoE Review methods of monitoring treatment response in EoEFeatured EpisodesGlenn Furuta - Eosinophilic EsophagitisAmanda Muir - Navigating the Challenges of Eosinophilic Esophagitis ManagementRachel Chevalier - Update on Topical Steroids for EoEMike Wilsey - Esophageal Strictures in ChildrenSupport 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.

Featuring perspectives from Dr Haley Ellis, Dr Sara Lonardi and Dr Kanwal Raghav, moderated by Dr Christopher Lieu, including the following topics: Introduction (0:00) Gastroesophageal Cancers — Dr Lonardi (1:54) Biliary Tract Cancers — Dr Ellis (39:20) Colorectal Cancer — Dr Raghav (1:07:10) CME information and select publications

In episode 62 we discuss the article “Oral vs Extended-Release Injectable Naltrexone for Hospitalized Patients with Alcohol Use Disorder.” Magane KM, et al.Oral vs Extended-Release Injectable Naltrexone for Hospitalized Patients With Alcohol Use Disorder: A Randomized Clinical Trial. JAMA Intern Med. 2025 Jun 1;185(6):635-645. We also discuss reduced overdose deaths and changes in buprenorphine labelling to include higher doses. NPR:Drug deaths plummet among young Americans as fentanyl carnage eases Federal Register:Modifications to Labeling of Buprenorphine-Containing Transmucosal Products for the Treatment of Opioid Dependence --- This podcast offers category 1 and MATE-ACT CME credits through MI CARES and Michigan State University. To get credit for this episode and others, go tothis link to make your account, take a brief quiz, and claim your credit. To learn more about opportunities in addiction medicine, visitMI CARES. CME: https://micaresed.org/courses/podcast-addiction-medicine-journal-club/ --- Original theme music:composed and performed by Benjamin Kennedy Audio editing: Michael Bonanno Executive producer:Dr. Patrick Beeman A podcast fromArs Longa Media --- This is Addiction Medicine Journal Club with Dr. Sonya Del Tredici and Dr. John Keenan. We practice addiction medicine and primary care, and we believe that addiction is a disease that can be treated. This podcast reviews current articles to help you stay up to date with research that you can use in your addiction medicine practice. Learn more about your ad choices. Visit megaphone.fm/adchoices

Creator of the philosophy The Art of Bending TimeYou can find her work at Michelleniemeyer.com, LinkedIn and can text CLARITY to 33777 to get supportMichelle talks about a turning point in her life where she ended up in the ER and how this changed her perspective on health and nutrition after she was later diagnosed with PBCIs burnout in our control?Michelle says that the things that cause burnout are not in our control, but you can impact how you respond and how you look at the worldShe recommends focusing on the things that you enjoy in your day, meditating on themMichelle talks about some of the struggles she had as a lawyer and how it was difficult to not see the benefit of her work for 8 months to a year sometimesLearn to be in the moment, if you are thinking about the future all the time you will suffer anxiety and if you are thinking about the past, you will be depressedSetting goals is important, you need to be working towards something in life and figure out an action plan to accomplish themMake sure they are goals that YOU want, as opposed to something that someone else wants for youDelegate certain tasks, ask for help, don't always micromanageStep back and allow others to learn and growMichelle talks about how shifting from running all the time to enjoying walks outside improved her health and prevented injuryShe talks about the importance of getting enough sleep and movementNutrition can be medicineMichelle talks about a big case she was working on and how some dedicated, focused time, away from distractions, with adequate rest and movement, helped her throughTake care of yourself before you take care of patients To get focused work done, you need to set up your environment correctly and remove distractionsOne distraction can make you lose precious focus one a given taskMultitasking is a mythBurnout happens when people don't feel any meaning in what they're doingSometimes switching jobs or careers will not solve burnout, but establishing some good habits can recreate the fulfillment in your current job againYou don't see the light when you stay doing the same stuffSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Dr Matthew D Galsky from The Tisch Cancer Institute in New York, New York, Prof Andrea Necchi from the IRCCS San Raffaele Hospital in Milan, Italy, and Prof Thomas Powles from the Barts Cancer Institute in London provide their perspectives on clinical scenarios and datasets informing the care of patients with urothelial bladder cancer. CME information and select publications here.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/XDB865. CME credit will be available until June 26, 2026.Tailwinds of Innovation in SCLC: Exploring the Therapeutic Potential of ADCs In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Daiichi Sankyo, Inc.Disclosure information is available at the beginning of the video presentation.

Beef: Beef prices are finally starting to cool after the July 4th holiday – but how fast will they fall, and which cuts will drop first? With low production still keeping things tight, we're not in freefall territory yet… but if you're buying ribeyes, strips, or grinds, you'll want to hear what's coming next.Poultry: Chicken remains the go-to protein, with wings in tight supply and prices climbing again. Breasts and tenders are steady for now – but with hot summer temps affecting animal intake and a new avian flu case on the radar, will this balanced market stay steady... or tip?Grains: Prices are down across corn, soy, and wheat, but with crops thriving in the fields and new tariffs shaking up export dynamics, how long will this calm last?Pork: Bacon lovers, brace yourselves—bellies are climbing and could hit $200 soon. But beyond bacon? The rest of the pork market is cooling off… for now.Dairy: A calm week on the dairy front—but is it the quiet before a dip? With butter holding steady and cheese prices barely budging, the market might just be gearing up for a slide.Savalfoods.com | Find us on Social Media: Instagram, Facebook, YouTube, Twitter, LinkedIn

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/XDB865. CME credit will be available until June 26, 2026.Tailwinds of Innovation in SCLC: Exploring the Therapeutic Potential of ADCs In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Daiichi Sankyo, Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/XDB865. CME credit will be available until June 26, 2026.Tailwinds of Innovation in SCLC: Exploring the Therapeutic Potential of ADCs In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Daiichi Sankyo, Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/XDB865. CME credit will be available until June 26, 2026.Tailwinds of Innovation in SCLC: Exploring the Therapeutic Potential of ADCs In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Daiichi Sankyo, Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/XDB865. CME credit will be available until June 26, 2026.Tailwinds of Innovation in SCLC: Exploring the Therapeutic Potential of ADCs In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Daiichi Sankyo, Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/XDB865. CME credit will be available until June 26, 2026.Tailwinds of Innovation in SCLC: Exploring the Therapeutic Potential of ADCs In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Daiichi Sankyo, Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/XDB865. CME credit will be available until June 26, 2026.Tailwinds of Innovation in SCLC: Exploring the Therapeutic Potential of ADCs In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Daiichi Sankyo, Inc.Disclosure information is available at the beginning of the video presentation.

Drs. Durga Borkar and Yashaswini Singh join host Dr. Jay Sridhar to discuss their recent publication regarding private equity (PE) acquisition and access to retinal detachment surgery. According to the study, physicians in PE-acquired practices decreased their number of retinal detachment repairs by nearly 20% after acquisition, potentially negatively impacting access to care and patient outcomes. Discussed in today's podcast: Singh Y, Cardenas GB, Torabzadeh H, Whaley CM, Borkar D. Private Equity-Owned Physician Practices Decreased Access To Retinal Detachment Surgery, 2014-22. Health Affairs. 2025 May;44(5):589-596. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Featuring perspectives from Dr Matthew D Galsky, Prof Andrea Necchi and Prof Thomas Powles, moderated by Dr Galsky, including the following topics: Introduction (0:00) Current and Future Management of Muscle-Invasive Bladder Cancer — Prof Powles (1:14) Novel Intravesical Therapies Under Evaluation for Nonmetastatic Urothelial Bladder Cancer (UBC) — Prof Necchi (24:48) Selection and Sequencing of Therapy for Metastatic UBC — Dr Galsky (44:52) CME information and select publications

Dr Jeremy Abramson from Massachusetts General Hospital in Boston, Dr Joshua Brody from the Tisch Cancer Institute in New York, New York, Dr Christopher Flowers from The University of Texas MD Anderson Cancer Center in Houston, Dr Ann LaCasce from Dana-Farber Cancer Institute in Boston, Massachusetts, and Dr Tycel Phillips from City of Hope Comprehensive Cancer Center in Duarte, California, discuss patient cases and provide their perspectives on clinical datasets informing the care of patients with non-Hodgkin lymphoma. CME information and select publications here.

Bart Charles returns, and we're not mad about it. This week, we unpack the buzz around Hem-Fir now being deliverable on the CME lumber contract—try to stay with us, it's worth it. Gregg walks through what's happening in the cash markets and how deep the inventory buying goes. Then we all weigh in on how much of the upcoming CVD/AD action is already priced in. As usual, we gave away more trading insight than we should've… but if you're listening, we figure you earned it. Contact the show members at: Charles@AtlanticForest.Com Gregg@Sitkainc.com Ashley@Sitkainc.com

Have you ever dreamed of working in a more holistic, patient-centered way—without having to start your own practice from scratch? If so, you're going to love today's episode. We're diving into the growing field of integrative and functional medicine—especially for those who want the stability of an employed role while practicing in a more meaningful, whole-person way. In this episode, I'm joined by Lisa McDonald, founder of Integrative Connections, a leading job board and recruiting service for integrative and functional medicine. Lisa is not a physician, but her own healing journey through functional medicine inspired her to help others find their way into this meaningful field. She shares what these roles really look like and how to find your path into one. Whether you're just starting to explore this field or wondering what kind of training might be helpful, Lisa offers practical tips, personal stories, and lots of encouragement for taking that first step—or simply testing the waters. You can find the show notes for this episode and more information by clicking here: www.doctorscrossing.com/episode224 In this episode we're talking about: What is integrative and functional medicine? Why are more physicians seeking to incorporate these modalities into how they care for patients? What kinds of patients and conditions do these practices typically see? The training and certifications that can increase your knowledge and help you stand out Typical visit length, scheduling, and expectations in integrative jobs How to explore these roles and ask the right questions in interviews Advice for physicians curious about pivoting into integrative or functional care Links for this episode: https://integratedconnects.com https://integratedconnects.com/professional-development/ https://www.linkedin.com/in/lisapmcdonald/ Andrew Weil Center For Integrative Medicine - 2-year fellowship with several onsite weeks in AZ https://awcim.arizona.edu/education/fellowship Institute for Functional Medicine - can be fully remote, but also in-person conferences. Free 1.5 hour CME course https://ifm.org Episode #23: Curious About Integrative and Functional Medicine? Carpe Diem Resume Kit - Converting your CV to a resume helps recruiters better understand why you are a great match for a specific job. My resume kit will guide you through creating a polished resume for your desired job. Templates are included as well as a bonus on writing your cover letter. Reach out to us at team@doctorscrossing.com for more information!

Crain's residential real estate reporter Dennis Rodkin and host Amy Guth discuss the latest news from the local market, including record-breaking sales in Chicago's higher housing tier and Cook County's push for affordable modular homes.Plus: Office demand freefall resumes as downtown vacancy reaches a new record high, Rivian's micro-EV spinoff valued at $1 billion, Blue Cross parent renames Medicare offerings following Cigna deal and CME debates the meaning of "trading floor" as $2 billion trial gets underway.

Featuring perspectives from Dr Jeremy S Abramson, Dr Joshua Brody, Dr Christopher Flowers, Dr Ann LaCasce and Dr Tycel Phillips, moderated by Dr Abramson, including the following topics: Introduction (0:00) Selection and Sequencing of Available Therapies for Diffuse Large B-Cell Lymphoma — Dr Flowers (2:24) Evolving Management Paradigm for Mantle Cell Lymphoma — Dr Phillips (31:53) Integration of Novel Therapies into the Management of Follicular Lymphoma — Dr LaCasce (54:51) Integrating Bispecific Antibodies into the Management of Non-Hodgkin Lymphoma (NHL) — Dr Brody (1:11:22) Current Role of CAR T-Cell Therapy in Various NHL Subtypes — Dr Abramson (1:37:55) CME information and select publications

 Normal pressure hydrocephalus (NPH) is a clinical syndrome of gait abnormality, cognitive impairment, and urinary incontinence. Evaluation of CSF dynamics, patterns of fludeoxyglucose (FDG) uptake, and patterns of brain stiffness may aid in the evaluation of challenging cases that lack typical clinical and structural radiographic features. In this episode, Katie Grouse, MD, FAAN, speaks with Aaron Switzer, MD, MSc, author of the article “Radiographic Evaluation of Normal Pressure Hydrocephalus” in the Continuum® June 2025 Disorders of CSF Dynamics 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. Switzer is a clinical assistant professor of neurology in the department of clinical neurosciences at the University of Calgary in Calgary, Alberta, Canada. Additional Resources Read the article: Radiographic Evaluation of Normal Pressure Hydrocephalus 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 Aaron Switzer about his article on radiographic evaluation of normal pressure hydrocephalus, which he wrote with Dr Patrice Cogswell. This article appears in the June 2025 Continuum issue on disorders of CSF dynamics. Welcome to the podcast, and please introduce yourself to our audience. Dr. Switzer: Thanks so much for having me, Katie. I'm a neurologist that's working up in Calgary, Alberta, Canada, and I have a special interest in normal pressure hydrocephalus. So, I'm very happy to be here today to talk about the radiographic evaluation of NPH. Dr Grouse: I'm so excited to have you here today. It was really wonderful to read your article. I learned a lot on a topic that is not something that I frequently evaluate in my clinic. So, it's really just a pleasure to have you here to talk about this topic. So, I'd love to start by asking, what is the key message that you hope for neurologists who read your article to take away from it? Dr. Switzer: The diagnosis of NPH can be very difficult, just given the clinical heterogeneity in terms of how people present and what their images look like. And so, I'd like readers to know that detailed review of the patient's imaging can be very helpful to identify those that will clinically improve with shunt surgery. Dr Grouse: There's another really great article in this edition of Continuum that does a really great job delving into the clinical history and exam findings of NPH. So, I don't want to get into that topic necessarily today. However, I'd love to hear how you approach a case of a hypothetical patient, say, where you're suspicious of NPH based on the history and exam. I'd love to talk over how you approach the imaging findings when you obtain an MRI of the brain, as well as any follow-up imaging or testing that you generally recommend. Dr. Switzer: So, I break my approach down into three parts. First, I want to try to identify ventriculomegaly and any signs that would support that, and specifically those that are found in NPH. Secondly, I want to look for any alternative pathology or evidence of alternative pathology to explain the patient's symptoms. And then also evaluate any contraindications for shunt surgery. For the first one, usually I start with measuring Evans index to make sure that it's elevated, but then I want to measure one of the other four measurements that are described in the article, such as posterior colossal angle zed-Evans index---or z-Evans index for the American listeners---to see if there's any other features that can support normal pressure hydrocephalus. It's very important to identify whether there are features of disproportionately enlarged subarachnoid space hydrocephalus, or DESH, which can help identify patients who may respond to shunt surgery. And then if it's really a cloudy clinical picture, it's complicated, it's difficult to know, I would usually go through the full evaluation of the iNPH radscale to calculate a score in order to determine the likelihood that this patient has NPH. So, the second part of my evaluation is to rule out evidence of any alternative pathology to suggest another cause for the patient's symptoms, such as neurodegeneration or cerebrovascular disease. And then the third part of my evaluation is to look for any potential contraindications for shunt surgery, the main one being cerebral microbleed count, as a very high count has been associated with the hemorrhagic complications following shunt surgery. Dr Grouse: You mentioned about your use of the various scales to calculate for NPH, and your article does a great job laying them out and where they can be helpful. Are there any of these scales that can be reasonably relied on to predict the presence of NPH and responsiveness to shunt placement? Dr. Switzer: I think the first thing to acknowledge is that predicting shunt response is still a big problem that is not fully solved in NPH. So, there is not one single imaging feature, or even combination of imaging features, that can reliably predict shunt response. But in my view and in my practice, it's identifying DESH, I think, is really important---so, the disproportionately enlarged subarachnoid space hydrocephalus---as well as measuring the posterior colossal angle. I find those two features to be the most specific. Dr Grouse: Now you mentioned the concept of the NPH subtypes, and while this may be something that many of our listeners are familiar with, I suspect that, like myself when I was reading this article, there are many who maybe have not been keeping up to date on these various subtypes. Could you briefly tell us more about these NPH subtypes? Dr. Switzer: Sure. The Japanese guidelines for NPH have subdivided NPH into three different main categories. So that would be idiopathic, delayed onset congenital, and secondary normal pressure hydrocephalus. And so, I think the first to talk about would be the secondary NPH. We're probably all more familiar with that. That's any sort of pathology that could lead to disruption in CSF dynamics. These are things like, you know, a slow-growing tumor that is obstructing CSF flow or a widespread meningeal process that's reducing absorption of CSF, for instance. So, identifying these can be important because it may offer an alternative treatment for what you're seeing in the patient. The second important one is delayed onset congenital. And when you see an image of one of these subtypes, it's going to be pretty different than the NPH because the ventricles are going to be much larger, the sulcal enfacement is going to be more diffuse. Clinically, you may see that the patients have a higher head circumference. So, the second subtype to know about would be the delayed onset congenital normal pressure hydrocephalus. And when you see an image of one of these subtypes, it's going to be a little different than the imaging of NPH because the ventricles are going to be much larger, the sulcal enfacement is going to be more diffuse. And there are two specific subtypes that I'd like you to know about. The first would be long-standing overt ventriculomegaly of adulthood, or LOVA. And the second would be panventriculomegaly with a wide foramen of magendie and large discernomagna, which is quite a mouthful, so we just call it PAVUM. The importance of identifying these subtypes is that they may be amenable to different types of treatment. For instance, LOVA can be associated with aqueductal stenosis. So, these patients can get better when you treat them with an endoscopic third ventriculostomy, and then you don't need to move ahead with a shunt surgery. And then finally with idiopathic, that's mainly what we're talking about in this article with all of the imaging features. I think the important part about this is that you can have the features of DESH, or you can not have the features of DESH. The way to really define that would be how the patient would respond to a large-volume tap or a lumbar drain in order to define whether they have this idiopathic NPH. Dr Grouse: That's really helpful. And for those of our listeners who are so inclined, there is a wonderful diagram that lays out all these subtypes that you can take a look at. I encourage you to familiarize yourself with these different subtypes. Now it was really interesting to read in your article about some of the older techniques that we used quite some time ago for diagnosing normal pressure hydrocephalus that thankfully we're no longer using, including isotope encephalography and radionuclide cisternography. It certainly made me grateful for how we've come in our diagnostic tools for NPH. What do you think the biggest breakthrough in diagnostic tools that are now clinically available are? Dr. Switzer: You know, definitely the advent of structural imaging was very important for the evaluation of NPH, and specifically the identification of disproportionately enlarged subarachnoid space hydrocephalus, or DESH, in the late nineties has been very helpful for increasing the specificity of diagnosis in NPH. But some of the newer technologies that have become available would be phase-contrast MRI to measure the CSF flow rate through the aqueduct has been very helpful, as well as high spatial resolution T2 imaging to actually image the ventricular system and look for any evidence of expansion of the ventricles or obstruction of CSF flow. Dr Grouse: Regarding the scales that you had referenced earlier, do you think that we can look forward to more of these scales being automatically calculated and reported by various software techniques and radiographic interpretation techniques that are available or going to be available? Dr. Switzer: Definitely yes. And some of these techniques are already in development and used in research settings, and most of them are directed towards automatically detecting the features of DESH. So, that's the high convexity tight sulci, the focally enlarged sulci, and the enlarged Sylvian fissures. And separating the CSF from the brain tissue can help you determine where CSF flow is abnormal throughout the brain and give you a more accurate picture of CSF dynamics. And this, of course, is all automated. So, I do think that's something to keep an eye out for in the future. Dr Grouse: I wanted to ask a little more about the CSF flow dynamics, which I think may be new to a lot of our listeners, or certainly something that we've only more recently become familiar with. Can you tell us more about these advances and how we can apply this information to our evaluations for NPH? Dr. Switzer: So currently, only the two-dimensional phase contrast MRI technique is available on a clinical basis in most centers. This will measure the actual flow rate through the cerebral aqueduct. And so, in NPH, this can be elevated. So that can be a good supporting marker for NPH. In the future, we can look forward to other techniques that will actually look at three-dimensional or volume changes over time and this could give us a more accurate picture of aberrations and CSF dynamics. Dr Grouse: Well, definitely something to look forward to. And on the topic of other sort of more cutting-edge or, I think, less commonly-used technologies, you also mentioned some other imaging modalities, including diffusion imaging, intrathecal gadolinium imaging, nuclear medicine studies, MR elastography, for example. Are any of these modalities particularly promising for NPH evaluations, in your opinion? Do you think any of these will become more popularly used? Dr. Switzer: Yes, I think that diffusion tract imaging and MR elastography are probably the ones to keep your eye out for. They're a little more widely applicable because you just need an MR scanner to acquire the images. It's not invasive like the other techniques mentioned. So, I think it's going to be a lot easier to implement into clinical practice on a wide scale. So, those would be the ones that I would look out for in the future. Dr Grouse: Well, that's really exciting to hear about some of these techniques that are coming that may help us even more with our evaluation. Now on that note, I want to talk a little bit more about how we approach the evaluation and, in your opinion, some of the biggest pitfalls in the evaluation of NPH that you've found in your career. Dr. Switzer: I think there are three of note that I'd like to mention. The first would be overinterpreting the Evans index. So, just because an image shows that there's an elevated Evans index does not necessarily mean that NPH is present. So that's where looking for other corroborating evidence and looking for the clinical features is really important in the evaluation. Second would be misidentifying the focally enlarged sulci as atrophy because when you're looking at a brain with these blebs of CSF space in different parts of the brain, you may want to associate that to neurodegeneration, but that's not necessarily the case. And there are ways to distinguish between the two, and I think that's another common pitfall. And then third would be in regards to the CSF flow rate through the aqueduct. And so, an elevated CSF flow is suggestive of NPH, but the absence of that does not necessarily rule NPH out. So that's another one to be mindful of. Dr Grouse: That's really helpful. And then on the flip side, any tips or tricks or clinical pearls you can share with us that you found to be really helpful for the evaluation of NPH? Dr. Switzer: One thing that I found really helpful is to look for previous imaging, to look if there were features of NPH at that time, and if so, have they evolved over time; because we know that in idiopathic normal pressure hydrocephalus, especially in the dash phenotype, the ventricles can become larger and the effacement of the sulci at the convexity can become more striking over time. And this could be a helpful tool to identify how long that's been there and if it fits with the clinical history. So that's something that I find very helpful. Dr Grouse: Absolutely. When I read that point in your article, I thought that was really helpful and, in fact, I'm guessing something that a lot of us probably aren't doing. And yet many of our patients for one reason or other, probably have had imaging five, ten years prior to their time of evaluation that could be really helpful to look back at to see that evolution. Dr. Switzer: Yes, absolutely. Dr Grouse: It's been such a pleasure to read your article and talk with you about this today. Certainly a very important and helpful topic for, I'm sure, many of our listeners. Dr. Switzer: Thank you so much for having me. Dr Grouse: Again, today I've been interviewing Dr Aaron Switzer about his article on radiographic evaluation of normal pressure hydrocephalus, which he wrote with Dr Patrice Cogswell. This article appears in the most recent issue of Continuum on disorders of CSF dynamics. 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.

In this episode of the Friends of NPACE Podcast, Dr. Heather Jackson PhD, FNP-BC, NEA-BC, FAANP joins us for a discussion concerning the intersection of pain and sleep. For APPs learn about keys to assessment and intervention with this episode. This episode carries 0.5 CE and Category 1 CME. This podcast is supported by a generous educational grant by Haleon. To redeem your CE credit visit the NPACE Learning Center where this episode is available for free with a CE certificate redeemable upon completion.

Claudio Milstein, PhD joins the podcast to discuss the concept of unified care in managing voice, swallowing, and upper airway disorders. Dr. Milstein explains the importance of interdisciplinary collaboration in optimizing patient outcomes and shares details about an exciting upcoming CME on unified care.

On this week's episode of The Prepping Academy, we welcome a special guest, John Jacob Schmidt, founder of AmRRON, for a discussion on the history of AmRRON and what the future holds. We also discuss his new project, AmRRON Reloaded, and efforts to grow the ranks of individuals capable of effectively communicating in any emergency situation. Remember, the annual AmRRON national grid down communications exercise takes place later in July. It is your opportunity to test your skills and see what information you can receive during the exercise. Remember, if you do not have communications when the balloon goes up, you are just another refugee staring at your dead cell phone, wondering what just happened. Join PrepperNet.Net - https://www.preppernet.netPrepperNet is an organization of like-minded individuals who believe in personal responsibility, individual freedoms and preparing for disasters of all origins.PrepperNet Support the showPlease give us 5 Stars! www.preppingacademy.com Contact us: https://preppingacademy.com/contact/ www.preppernet.net Amazon Store: https://amzn.to/3lheTRTwww.forrestgarvin.com

What are some of the paradoxes of racial justice work? Why is it important to recognize those paradoxes so we can navigate them?In this series on healthcare and social disparities, Dr. Jill Wener, a board-certified Internal Medicine specialist, anti-racism educator, meditation expert, and tapping practitioner, interviews experts and gives her own insights into multiple fields relating to social justice and anti-racism. In this episode, Jill interviews Prof. Susan Sturm of Columbia Law School. They explore the importance of community and context and doing the challenging work of racial justice. Prof. Sturm shares examples of how the work of racial justice lifts all of us up, not just people who are impacted by racism and oppression, and the importance of using the platforms and privilege that we have.Susan Sturm is the George M. Jaffin Professor of Law and Social Responsibility and the founding director of the Center for Institutional and Social Change at Columbia Law School. Her work focuses on building the capacity of people and institutions to reduce discrimination, confront racism, transform the justice system, and move toward full participation in educational, legal, and cultural institutions.Along with numerous scholarly publications, Professor Sturm is the author, with Lani Guinier, of Who's Qualified: A New Democracy Forum on the Future of Affirmative Action. Her new book, entitled What Might Be: Confronting Racism to Transform Our Institutions, was published in February 2025 by Princeton University Press.LINKShttps://whatmightbe.me**Our website www.consciousantiracism.comYou can learn more about Dr. Wener and her online meditation and tapping courses at www.jillwener.com, and you can learn more about her online social justice course, Conscious Anti Racism: Tools for Self-Discovery, Accountability, and Meaningful Change at https://theresttechnique.com/courses/conscious-anti-racism.If you're a healthcare worker looking for a CME-accredited course, check out Conscious Anti-Racism: Tools for Self-Discovery, Accountability, and Meaningful Change in Healthcare at www.theresttechnique.com/courses/conscious-anti-racism-healthcareJoin her Conscious Anti-Racism facebook group: www.facebook.com/groups/307196473283408Follow her on:Instagram at jillwenerMDLinkedIn at jillwenermd

To kick of Season 4 of Med Student Over Easy, we do a rewind of a fan favorite from Season 3, EM Resources, where Kaitlin is joined by John Casey, Marco and Mark to discuss resources Medical Students can use to help them learn about and practice EM. Don't forget, EM Over Easy (our parent show) is the official Podcast of the American College of Osteopathic Emergency Physicians. Visit acoep.org to learn more about their next CME event!

The standard treatment for muscle-invasive urothelial carcinoma (MIUC) has been radical surgery combined with cisplatin-based chemotherapy for eligible patients. However, over 50% of patients face metastatic progression after surgery. This non-CME webinar, presented by a urology expert, will discuss how patients with UC at high risk of recurrence after radical resection may benefit from adjuvant immunotherapy, emphasize the role of multidisciplinary communication in patient care, and review a subcutaneous immunotherapy option for the adjuvant treatment of UC.

Dr. Emma Jones is a hospice and palliative care physician, also worked as a pediatric oncologist and pediatrician. She's been in the field for over 10 years and is active in helping healthcare professionals with burnout in the modern medical system. She is the author of The Phoenix Blueprint, Emerging Stronger from the Blaze of Healthcarehttps://www.emmajonesmd.comBoundaries are important to set up in your work. Proper emotional boundaries with your patients are important to maintain your separation from another personYou can see another person's emotions, recognize them and understand that they are not your emotions True empathy does not improve your ability to provide patient careRecognize when you do take on another person's burden so you can do the work to set it downWe have to always remember to be patient centered. When you express empathy or share a personal experience with someone it should be serving a clinical purpose. It should never be done to help you process somethingIs the patient benefiting from you relating to their experience?Would you be better off to discuss your experience with a therapist or family member?Spending more time to reassure and answer patient questions will save time in the long run and allows you to fully address the chief concern over the chief complaintRapport is developed not with time but can be done instantly by simply being a human beingUnconditional positive regard is viewing the patient or coworker or whoever you are interacting with in a positive lightThis allows you to interact better with the patients you see, viewing the problem as the enemy and not each otherPositive attitudes, smiling and friendly behavior can be culturally discouraged in medicine and this needs to change, of course some situations call for a reserved attitude, but many do notGiving away happiness and positivity does not take something away from you, it actually gives you more joyWe talk about mentoring and teaching the next generation of medical professionalsAdvocacy for policy change is one of the last chapters of the book because you really have to overcome burnout in order to have the energy and motivation to take those stepsYou must restore yourself to help make changes to the systemWe talk about the pit fall of perfectionism. Perfectionism is different than excellence Perfectionism is a habit that does not servePerfectionism is when you try to bring things from the circle of concern into your circle of control - it doesn't workSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Dr Harold Burstein, Dr Javier Cortés, Prof Rebecca A Dent, Dr Kevin Kalinsky, Dr Joyce O'Shaughnessy and moderator Dr Hope S Rugo present data informing treatment decision-making for patients with metastatic breast cancer at the 2025 ASCO annual meeting. CME information and select publications here.

Andrew Brodsky—a Harvard Business School doctoral graduate, award-winning business professor, management consultant, and expert in virtual communication at The University of Texas at Austin—has dedicated his career to unraveling the intricacies of virtual communication. Diagnosed with cancer as a teenager, his treatment led to a lifelong immune deficiency, which has resulted in years of his life being confined primarily to the virtual realm. This personal experience has given him a unique understanding of the challenges and nuances of communicating from a distance.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.

Featuring perspectives from Dr Harold J Burstein, Dr Javier Cortés, Prof Rebecca A Dent, Dr Kevin Kalinsky, Dr Hope S Rugo and Dr Joyce O'Shaughnessy, moderated by Dr Rugo, including the following topics: Introduction (0:00) Optimizing the Management of HER2-Positive Metastatic Breast Cancer (mBC) — Dr Cortés (3:52) Individualized Selection of Up-Front Therapy for Patients with HR-Positive, HER2-Negative mBC — Dr Kalinsky (23:10) Available Therapies for Patients with HR-Positive, HER2-Negative Disease Progressing on CDK4/6 Inhibition — Dr Burstein (48:09) Current and Potential Future Role of HER2-Targeted Therapy for HER2-Low and HER2-Ultralow Disease — Dr O'Shaughnessy (1:04:00) Current and Future Strategies for Patients with Endocrine-Refractory HR-Positive mBC — Dr Rugo (1:22:28) Selection and Sequencing of Therapy for Patients with Metastatic Triple-Negative Breast Cancer — Prof Dent (1:42:51) CME information and select publications

Featuring perspectives from Dr Andrea Cercek, Dr Arvind Dasari, Dr J Randolph Hecht, Dr Pashtoon Kasi and Prof Eric Van Cutsem, moderated by Dr Hecht, including the following topics: Introduction (0:00) Role of Circulating Tumor DNA (ctDNA) Evaluation in Nonmetastatic Colorectal Cancer (CRC) — Dr Dasari (2:20) Role of Immune Checkpoint Inhibitors in the Management of Nonmetastatic Microsatellite Instability-High (MSI-H) CRC — Dr Cercek (28:32) Management of Oligometastatic Disease and Hepatic-Only Metastases in CRC; Role of ctDNA Evaluation in Metastatic Disease — Dr Kasi (54:07) Role of Immune Checkpoint Inhibitors in the Management of MSI-H Metastatic CRC (mCRC) — Dr Hecht (1:14:34) Identification and Care of Patients with mCRC and Actionable Genomic Alterations — Prof Van Cutsem (1:38:17) CME information and select publications

This episode explores the challenges and intricacies of trading uranium futures. Mark Longo and Dan Gramza discuss a listener question about the viability and current status of uranium futures listed on CME, revealing the lack of volume, industrial participation, and official dissemination. They suggest alternatives such as trading uranium-related ETFs, stocks, and even blockchain options. The hosts emphasize the importance of liquidity and risk management, providing listeners with insights into the broader implications of trading in esoteric and illiquid markets.   01:07 Introduction to Futures Markets 02:10 Exploring Uranium Futures 03:47 Challenges in Trading Uranium Futures 08:15 Alternative Uranium Investment Options 16:21 Final Thoughts and Resources  

If you're a medical writer today, you're no stranger to tight deadlines, dense source material, and the pressure to deliver educational content that is both engaging and evidence-based. These demands are particularly acute in the world of continuing medical education (CME), where accuracy, clarity, and relevance matter more than ever. As the medical writing landscape evolves, so do the tools that support us. Among the most promising of these is MACg, a generative AI-powered assistant that helps medical writers streamline document analysis, content creation, and research. For writers working in CME or adjacent fields, MACg offers more than convenience—it offers a meaningful shift in how we work. Tune in to learn how I'm using MACg as a collaborative partner in my workflow rather than a replacement for my creative process.  Resources Grab your fee trial of MACg Summer Script Camp

Normal pressure hydrocephalus (NPH) is a clinical syndrome characterized by the triad of gait apraxia, cognitive impairment, and bladder dysfunction in the radiographic context of ventriculomegaly and normal intracranial pressure. Accurate diagnosis requires consideration of clinical and imaging signs, complemented by tests to exclude common mimics. In this episode, Lyell Jones, MD, FAAN speaks with Abhay R. Moghekar, MBBS, author of the article “Clinical Features and Diagnosis of Normal Pressure Hydrocephalus” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Moghekar is an associate professor of neurology at Johns Hopkins University School of Medicine in Baltimore, Maryland. Additional Resources Read the article: Clinical Features and Diagnosis of Normal Pressure Hydrocephalus 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: @LyellJ 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 Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today I'm interviewing Dr Abhay Moghekar, who recently authored an article on the clinical features and diagnosis of normal pressure hydrocephalus for our first-ever issue of Continuum dedicated to disorders of CSF dynamics. Dr Moghekar is an associate professor of neurology and the research director of the Cerebrospinal Fluid Center at Johns Hopkins University in Baltimore, Maryland. Dr Moghekar, welcome, and thank you for joining us today. Why don't you introduce yourself to our listeners? Dr Moghekar: Thank you, Dr Jones. I'm Abhay Moghekar. I'm a neurologist at Hopkins, and I specialize in seeing patients with CSF disorders, of which normal pressure hydrocephalus happens to be the most common. Dr Jones: And let's get right to it. I think most of our listeners who are neurologists in practice have encountered normal pressure hydrocephalus, or NPH; and it's a challenging disorder for all the reasons that you outline in your really outstanding article. If you were going to think of one single most important message to our listeners about recognizing patients with NPH, what would that be? Dr Moghekar: I think I would say there are two important messages. One is that the triad is not sufficient to make the diagnosis, and the triad is not necessary to make the diagnosis. You know these three elements of the triad: cognitive problems, gait problems, bladder control problems are so common in the elderly that if you pick 10 people out in the community that have this triad, it's unlikely that even one of them has true NPH. On the other hand, you don't need all three elements of the triad to make the diagnosis because the order of symptoms matters. Often patients develop gait dysfunction first, then cognitive dysfunction, and then urinary incontinence. If you wait for all three elements of the triad to be present, it may be too late to offer them any clear benefit. And hence, you know, it's neither sufficient nor necessary to make the diagnosis. Dr Jones: That's a really great point. I think most of our listeners are familiar with the fact that, you know, we're taught these classic triads or pentads or whatever, and they're rarely all present. In a way, it's maybe a useful prompt, but it could be distracting or misleading, even in a way, in terms of recognizing the patient. So what clues do you use, Dr Moghekar, to really think that a patient may have NPH? Dr Moghekar: So, there are two important aspects about gait dysfunction. Say somebody comes in with all three elements of the triad. You want to know two things. Which came first? If gate impairment precedes cognitive impairment, it's still very likely that NPH is in the differential. And of the two, which are more- relatively more affected? So, if somebody has very severe dementia and they have a little bit of gait problems, NPH is not as likely. So, is gait affected earlier than cognitive dysfunction, and is it affected to a more severe degree than cognitive dysfunction? And those two things clue me in to the possibility of NPH. You still obviously need to get imaging to make sure that they have large ventricles. One of the problems with imaging is large ventricles are present in so many different patients. Normal aging causes large ventricles. Obviously, many neurodegenerative disorders because of cerebral atrophy will cause large ventricles. And there's an often-used metric called as the events index, which is the ratio of the bitemporal horns- of the frontal horns of the lateral ventricles compared to the maximum diameter of the skull at that level. And if that ratio is more than 0.3, it's often used as a de facto measure of ventriculomegaly. What we've increasingly realized is that this ratio changes with age. And there's an excellent study that used the ADNI database that looked at how this ratio changes by age and sex. So, in fact, we now know that an 85-year-old woman who has an events index of 0.37 which would be considered ventriculomegaly is actually normal for age and sex. So, we need to start adopting these more modern age- and sex-appropriate age cutoffs of ventriculomegaly so as not to overcall everybody with big ventricles as having possible NPH. Dr Jones: That's very helpful. And I do want to come back to this challenge that we've seen in our field of overdiagnosis and underdiagnosis. But I think most of us are familiar with the concept of how hydrocephalus could cause neurologic deficits. But what's the latest on the mechanism of NPH? Why do some patients get this and others don't? Dr Moghekar: Very good question. I don't think we know for sure. And it for a long time we thought it was a plumbing issue. Right? And that's why shunts work. People thought it was impaired CSF absorption, but multiple studies have shown that not to be true. It's likely a combination of impaired cerebral blood flow, biomechanical factors like compliance, and even congenital factors that play a role in the pathogenesis of NPH. And yes, while putting in shunts likely drains CSF, putting in a shunt also definitely changes the compliance of the brain and affects blood flow to the subcortical regions of the brain. So, there are likely multiple mechanisms by which shunts benefit, and hence it's very likely that there's no single explanation for the pathogenesis of NPH. Dr Jones: We explored this in a recent Continuum issue on dementia. Many patients who have cognitive impairment have co-pathologies, multiple different causes. I was interested to read in your article about the genetic risk profile for NPH. It's not something I'd ever really considered in a disorder that is predominantly seen in older patients. Tell us a little more about those genetic risks. Dr Moghekar: Yeah, everyone is aware of the role genetics plays in congenital hydrocephalus, but until recently we were not aware that certain genetic factors may also be relevant to adult-onset normal pressure hydrocephalus. We've suspected this for a long time because nearly half of our patients who come to us to see us in clinic with NPH have head circumferences that are more than 90th percentile for height. And you know, that clearly indicates that this started shortly at the time after birth or soon afterwards. So, we've suspected for a long time that genetic factors play a role, but for a long time there were not enough large studies or well-conducted studies. But recently studies out of Japan and the US have shown mutations in genes like CF43 and CWH43 are disproportionately increased in patients with NPH. So, we are discovering increasingly that there are genetic factors that underlie even adult onset in patients. There are many more waiting to be discovered. Dr Jones: Really fascinating. And obviously getting more insight into the risk and mechanisms would be helpful in identifying these patients potentially earlier. And another thing that I learned in your article that I thought was really interesting, and maybe you can tell us more about it, is the association between normal pressure hydrocephalus and the observation of cervical spinal stenosis, many of whom require decompression. What's behind that association, do you think? Dr Moghekar: That's a very interesting study that was actually done at your institution, at Mayo Clinic, that showed this association. You know, as we all get older, you know, the incidence of cervical stenosis due to osteoarthritis goes up, but the incidence of significant, clinically significant cervical stenosis in the NPH population was much higher than what we would have expected. Whether this is merely an association in a vulnerable population or is it actually causal is not known and will need further study. Dr Jones: It's interesting to speculate, does that stenosis affect the flow of CSF and somehow predispose to a- again, maybe a partial degree for some patients? Dr Moghekar: Yeah, which goes back to the possible hydrodynamic theory of normal pressure hydrocephalus; you know, if it's obstructing normal CSF flow, you know, are the hydrodynamics affected in the brain that in turn could lead to the development of hydrocephalus. Dr Jones: One of the things I really enjoyed about your article, Abhay, was the very strong clinical focus, right? We can't just take an isolated biomarker or radiographic feature and rely on that, right? We really do need to have clinical suspicion, clinical judgment. And I think most of our listeners who've been in practice are familiar with the use and the importance of the large-volume lumbar puncture to determine who may have, and by exclusion not have, NPH, and then who might respond to CSF diversion. And I think those of us who have been in this situation are also familiar with the scenario where you think someone may have NPH and you do a large-volume lumbar puncture and they feel better, but you can't objectively see a difference. How do you make that test useful and objective in your practice? What do you do? Dr Moghekar: Yeah, it's a huge challenge in getting this objective assessment done carefully because you have to remember, you know, subconsciously you're telling the patients, I think you have NPH. I'm going to do this spinal tap, and if you walk better afterwards, you're going to get a shunt and you're going to be cured. And you can imagine the huge placebo response that can elicit in our subjects. So, we always like to see, definitely, did the patient subjectively feel better? Because yes, that's an important metric to consider because we want them to feel better. But we also wanted to be grounded in objective truths. And for that, we need to do different tests of speed, balance and endurance. Not everyone has the resources to do this, but I think it's important to test different domains. Just like for cognition, you know, we just don't test memory, right? We test executive function, language, visuospatial function. Similarly, walking is not just walking, right? It's gait speed, it's balance, and it's endurance. So, you need to ideally test at least most of these different domains for gait and you need to have some kind of clear criteria as to how are you going to define improvement. You know, is a 5% improvement, is a 10% improvement in gait, enough? Is 20%? Where is that cutoff? And as a field, we've not done a great job of coming up with standardized criteria for this. And it varies currently, the practice varies quite significantly from center to center at the current time. Dr Jones: So, one of the nice things you had in your article was helpful tips to be objective if you're in a lower-resource setting. For you, this isn't a common scenario that someone encounters in their practice as opposed to a center that maybe does a large volume of these. What are some relatively straightforward objective measures that a neurologist or someone else might use to determine if someone is improving after a large-volume LP? Dr Moghekar: Yeah, excellent question, Dr Jones, and very practically relevant too. So, you need to at least assess two of the domains that are most affected. One is speed and one is balance. You know, these patients fall ultimately, right, if you don't treat them correctly. In terms of speed, there are two very simple tests that anybody can do within a couple of minutes. One is the timed “up-and-go” test. It's a test that's even recommended by the CDC. It correlates very well with faults and disability and it can be done in any clinic. You just need about ten feet of space and a chair and a stopwatch, and it takes about a minute or slightly more to do that test. And there are objective age-associated norms for the timed up-and-go test, so it's easy to know if your patient is normal or not. The same thing goes for the 10-meter walk test. You do need a slightly longer walkway, but it's a fairly easy and well-standardized test. So, you can do one of those two; you don't need to do both of them. And for balance, you can do the 30-second “sit-to-stand”; and it's literally, again, 30 seconds. You need a chair, and you need somebody to watch the patient and see how many times they can sit up and stand up from a seated position. Then again, good normative data for that. If you want to be a little more sophisticated, you can do the 4-stage balance test. So, I think these are tests that don't add too much time to your daily assessment and can be done with even trained medical assistants in any clinic. And you don't need a trained physical therapist to do these assessments. Dr Jones: Very practical. And again, something that is pretty easily deployed, something we do before and then after the LP. I did see you mentioned in your article the dual timed up-and-go test where it's a simultaneous gait and executive function test. And I've got to be honest with you, Dr Moghekar, I was a little worried if I would pass that test, but that may be beyond the scope of our time today. Actually, how do you do that? How do you do the simultaneous cognitive assessment? Dr Moghekar: So, we asked them to count back from 100, subtracting 3. And we do it particularly in patients who are mildly impaired right? So, if they're already walking really good, but then you give them a cognitive stressor, you know, that will slow them down. So, we reserve it for patients who are high-performing. Dr Jones: That's fantastic. I'm probably aging myself a little here. I have noticed in my career, a little bit of a pendulum swing in terms of the recognition or acceptance of the prevalence of normal pressure hydrocephalus. I recall when I was a resident, many, many people that we saw in clinic had normal pressure hydrocephalus. Then it seemed for a while that it really faded into the background and was much less discussed and much less recognized and diagnosed, and less treated. And now that pendulum seems to have swung back the other way. What's behind that from your perspective? Dr Moghekar: It's an interesting backstory to all of this. When the first article about NPH was published in the Newman Journal of Medicine, it was actually a combined article with both neurologists and neurosurgeons on it. They did describe it as a treatable dementia. And what that did is it opened up the floodgates so that everybody with any kind of dementia started getting shunts left, right, and center. And back then, shunts were not programmable. There were no antibiotic impregnated catheters. So, the incidence of subdural hematomas and shunt-related infections was very high. In fact, one of our esteemed neurologists back then, Houston Merritt, wrote a scathing editorial that Victor and Adam should lose their professorships for writing such an article because the outcomes of these patients were so bad. So, for a very long period of time, neurologists stopped seeing these patients and stopped believing in NPH as a separate entity. And it became the domain of neurosurgeons for over two or three decades, until more recently when randomized trials started being done early on out of Europe. And now there's a big NIH study going on in the US, and these studies showed, in fact, that NPH exists as a true, distinct entity. And finally, neurologists have started getting more interested in the science and understanding the pathophysiology and taking care of these patients compared to the past. Dr Jones: That's really helpful context. And I guess that maybe isn't rare when you have a disorder that doesn't have a simple, straightforward biomarker and is complex in terms of the tests you need to do to support the diagnosis, and the treatment itself is somewhat invasive. So, when you talk to your patients, Dr Moghekar, and you've established the diagnosis and have recommended them for CSF diversion, what do you tell them? And the reason I ask is that you mentioned before we started recording, you had a patient who had a shunt placed and responded well, but continued to respond over time. Tell us a little bit more about what our patients can expect if they do have CSF diversion? Dr Moghekar: When we do the spinal tap and they meet our criteria for improvement and they go on to have a shunt, we tell them that we expect gait improvement definitely, but cognitive improvement may not happen in everyone depending on what time, you know, they showed up for their assessment and intervention. But we definitely expect gait improvement. And we tell them that the minimum gait improvement we can expect is the same degree of improvement they had after their large-volume lumbar puncture, but it can be even more. And as the brain remodels, as the hydrodynamics adapt to these shunts… so, we have patients who continue to improve one year, two years, and even three years into the course of the intervention. So, we're, you know, hopeful. At the same time, we want to be realistic. This is the same population that's at risk for developing neurodegenerative disorders related to aging. So not a small fraction of our patients will also have Alzheimer's disease, for example, or go on to develop Lewy body dementia. And it's the role of the neurologist to pick up on these comorbid conditions. And that's why it's important for us to keep following these patients and not leave them just to the neurosurgeon to follow up. Dr Jones: And what a great note to end on, Dr Moghekar. And again, I want to thank you for joining us, and thank you for such a wonderful discussion and such a fantastic article on the clinical diagnosis of normal pressure hydrocephalus. I learned a lot reading the article, and I learned a lot more today just in the conversation with you. So, thank you for being with us. Dr Moghekar: Happy to do that, Dr Jones. It was a pleasure. Dr Jones: Again, we've been speaking with Dr Abhay Moghekar, author of a wonderful article on the clinical features and diagnosis of NPH in Continuum's first-ever issue dedicated to disorders of CSF dynamics. Please check it out. 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 Surgical Management of BPH (2025) CME Available: https://auau.auanet.org/node/43193 Acknowledgements: This educational series is supported by an independent educational grant from Olympus Corporation of the Americas. After participating in this CME activity, participants will be able to: 1. Utilize the AUA Clinical Guideline on the Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia in practice. 2. Determine the appropriate role and clinical expectation for current technologies, including pivotal studies, based on evidence. 3. Interpret the current clinical results and compare the patient experiences of these treatments in relation to more established and even abandoned treatments for patient groups with similar characteristics. 4. Differentiate between each of the new technologies for treating BPH/LUTS based on both their mode-of-action and the quality of their supporting evidence.

Dr Andrea Cercek from Memorial Sloan Kettering Cancer Center in New York, New York, Dr Arvind Dasari from The University of Texas MD Anderson Cancer Center in Houston, Dr Pashtoon Kasi from City of Hope Orange County in Irvine, California, Prof Eric Van Cutsem from University Hospitals Leuven in Belgium, and Dr J Randolph Hecht from the UCLA David Geffen School of Medicine in Santa Monica, California, discuss recent updates on available and novel treatment strategies for colorectal cancer. CME information and select publications here.

Dr Andrea Cercek from Memorial Sloan Kettering Cancer Center in New York, New York, Dr Arvind Dasari from The University of Texas MD Anderson Cancer Center in Houston, Dr Pashtoon Kasi from City of Hope Orange County in Irvine, California, Prof Eric Van Cutsem from University Hospitals Leuven in Belgium, and Dr J Randolph Hecht from the UCLA David Geffen School of Medicine in Santa Monica, California, discuss recent updates on available and novel treatment strategies for colorectal cancer. CME information and select publications here.

In our FIRST episode of the Bowel Sounds Summer School series, hosts Dr. Peter Lu and Dr. Temara Hajjat have taken highlights from past episodes on constipation and put them into a special episode jam-packed with clinical pearls.  Former expert guests Dr. Carlo Di Lorenzo, Dr. Lusine Ambartsumyan, Dr. Jose Garza, and Dr. Marc Benninga explain to us how they evaluate and treat the child with constipation.Our Bowel Sounds Summer School series will include four episodes each summer on big topics in our field, artisanally crafted for the ears of learners of all stages from the young student to the seasoned attending.Learning Objectives:1. Understand the importance of the physical exam in the evaluation of a child with constipation.2. Recognize the role that behavior plays in pediatric constipation.3. Review the medical management of the child with constipation.Featured Episodes:Carlo Di Lorenzo - Pediatric Constipation (October 2019)Jose Garza - Why Kids Poop Their Pants (February 2020)Marc Benninga - Intractable Constipation: The Dutch Perspective (May 2022)Lusine Ambartsumyan - Pediatric Constipation: What to Do When You Get Stuck (October 2024)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.

Drs. Akshay Thomas and Sarwar Zahid join for a journal club podcast discussion of three recent high-impact articles:Visual Fields in Diabetic Retinopathy (https://www.ophthalmologyretina.org/article/S2468-6530(25)00208-8/abstract)Gender Differences in Case Volume (https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2833393)Private Equity Practices and Retinal Detachment Volume (https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2024.01204?journalCode=hlthaff)Relevant Financial Disclosures: NoneYou can claim CME credits for prior episodes via the AAO website. Visit https://www.aao.org/browse-multimedia?filter=Audi

Featuring perspectives from Dr Joyce F Liu, Dr David M O'Malley, Dr Ritu Salani, Dr Alessandro D Santin and Dr Shannon N Westin, moderated by Dr Westin, including the following topics: Introduction (0:00) Up-Front Treatment for Advanced Ovarian Cancer (OC) — Dr Liu (2:00) Current Management of Relapsed/Refractory (R/R) OC; Promising Novel Agents and Strategies Under Investigation — Dr O'Malley (27:23) Role of HER2-Targeted Therapy in Advanced OC, Endometrial Cancer (EC) and Other Gynecologic Cancers — Dr Santin (50:22) First-Line Therapy for Advanced EC — Dr Westin (1:15:00) Current Therapeutic Options for R/R EC; Novel Investigational Strategies for Newly Diagnosed and Recurrent Disease — Dr Salani (1:36:45) CME information and select publications  

Drs. Elyse McGlumphy and Soshian Sarrafpour join host Dr. Andrew Pouw to talk about the range of and reasons for intraocular pressure (IOP) variance, as well as the studies debating its significance for glaucoma. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.