Podcasts about disseminated

Highlights of the JAANP issue topics: NPs in Taiwan, Clinical pharmacogenomics, Workplace bias, KetoPrescribed + program, Continuous glucose monitoring, Social determinants of health among people with T2DM, Journal club, Virtual book clubs, Stroke readmission guidelines, Medical aid in dying, Disseminated gonorrhea

In this episode, we review the high-yield topic of ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Acute Disseminated Encephalomyelitis (ADEM)⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ from the Neurology section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets

Host Roz is joined by Ramsey Hachem, MD (Washington University School of Medicine in Saint Louis) and AJT Editorial Fellow Helen Tsai, MD (Montefiore Medical Center)  [03:30] Disseminated vaccine-induced varicella infection in a kidney transplant recipient [06:50] Safety and Immunogenicity of the Live-Attenuated Varicella Vaccine in Pediatric Solid Organ Transplant Recipients: A Systematic Review and Meta-Analysis [10:34] (Editorial) Balancing the live virus vaccine scales: protection vs risk [14:22] Outcomes after flow cytometry crossmatch-positive lung transplants managed with perioperative desensitization [19:25] Lung transplantation despite preformed donor-specific anti-HLA antibodies: 9-year single-center experience [23:00] (Editorial) What is a Clinically Significant Donor-Specific Antibody Before Lung Transplantation? [25:38] Deceased Donor Kidneys from Higher Distressed Communities are Significantly Less Likely to be Utilized for Transplantation [35:11] (Editorial) Understanding the mechanisms and implications of the association between community distress and organ non-utilization [37:18] Sex as a Biological Variable: Mechanistic Insights and Clinical Relevance in Solid Organ Transplantation

Lead Story:   US tobacco companies selectively disseminated hyper-palatable foods into the US food system: Empirical evidence and current implications Addiction Hyper-palatable foods (HPF) contain fat and sodium, fat and simple sugars, and carbohydrate and sodium at specific thresholds to induce hyperpalatability, creating an artificially rewarding experience. This study compared tobacco companies who owned food companies to food companies not owned by tobacco companies, with regard to hyperpalatability between 1988 and 2001. Upon review of industry documents, this study found that tobacco companies “selectively disseminated” HPF into the US market. Tobacco-owned foods were 29% more likely to be classified as fat and sodium HPF and 80% more likely to be classified as carbohydrate and sodium HPF than foods that were not tobacco-owned. As late as 2018, market saturation of fat and sodium HPF was close to 60% and carbohydrate and sodium HPF was almost 20% regardless of tobacco ownership. Further research should consider the links between industries to appreciate potential impact on public health.   Read this issue of the ASAM Weekly Subscribe to the ASAM Weekly Visit ASAM

In this episode, we discuss competence 7. stakeholder management and communication management. The professional practice criteria are PP1.1 Determined stakeholder interests, and levels of influence for a project. PP1.2 Produced a communication plan and undertaken effective stakeholder engagement based upon it. PP1.3 Monitored effectiveness of the communication plans and stakeholder engagement activities. PP1.4 Adjusted the communication plan and responded to any changing stakeholder engagement needs. PP1.5 Employed relevant communication methods and media to meet stakeholder requirements and expectations. PP1.6 Disseminated clear, timely and relevant information to stakeholders. PP1.7 Obtained, and responded to, feedback from stakeholders which may have an impact on a project.   For more guidance on the Association for Project Management Chartered Project Professional (ChPP), or any other project management training, please visit www.parallelprojecttraining.com or call 0118 321 5030

OPINION: Debunk the US-crafted and disseminated deception on our disputes with China | August 30, 2023Subscribe to The Manila Times Channel - https://tmt.ph/YTSubscribe Visit our website at https://www.manilatimes.net Follow us: Facebook - https://tmt.ph/facebook Instagram - https://tmt.ph/instagram Twitter - https://tmt.ph/twitter DailyMotion - https://tmt.ph/dailymotion Subscribe to our Digital Edition - https://tmt.ph/digital Check out our Podcasts: Spotify - https://tmt.ph/spotify Apple Podcasts - https://tmt.ph/applepodcasts Amazon Music - https://tmt.ph/amazonmusic Deezer: https://tmt.ph/deezer Stitcher: https://tmt.ph/stitcherTune In: https://tmt.ph/tunein#TheManilaTimes Hosted on Acast. See acast.com/privacy for more information.

Ben Criddle talks BYU sports every weekday from 3 to 7 pm.Today's Co-Hosts: Ben Criddle (@criddlebenjamin)Subscribe to the Cougar Sports with Ben Criddle podcast:Apple Podcastshttps://itunes.apple.com/us/podcast/cougar-sports-with-ben-criddle/id99676

This is the first of a special podcast series on obstetric critical care.  I am joined on this series by Dr. Elizabeth Garchar, MD, FACOG.  She is an OB/GYN and Maternal Fetal Medicine (MFM) specialist who has a special interest in obstetric critical care.  She is also unique in that she flies regularly with our critical care transport teams and acts as one of our Assistant Medical Directors for the flight program.  So, Dr. Garchar has unique insight into managing this population in transport. This podcast focuses on severe postpartum hemorrhage.  We discuss the epidemiology and risk factors as well as the nuances of diagnosis, specifically how blood loss is actually quantified in this setting.  We also go through the importance of point-of-care ultrasound to help identify and manage the causes of postpartum hemorrhage.  Then, we transition to the discussion of management, focusing on the medical management of uterine atony, and also go over advanced interventions such as uterine packing, balloon tamponade devices, and REBOA.  Finally, Dr. Garchar discusses the indication and procedure for emergent hysterectomy as well as the post-procedure management critical care transport crews may have to perform.   References   Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. Oct 2017;130(4):e168-e186. doi:10.1097/aog.0000000000002351 Abdel-Aleem H, Singata M, Abdel-Aleem M, Mshweshwe N, Williams X, Hofmeyr GJ. Uterine massage to reduce postpartum hemorrhage after vaginal delivery. Int J Gynaecol Obstet. Oct 2010;111(1):32-6. doi:10.1016/j.ijgo.2010.04.036 Abul A, Al-Naseem A, Althuwaini A, Al-Muhanna A, Clement NS. Safety and efficacy of intrauterine balloon tamponade vs uterine gauze packing in managing postpartum hemorrhage: A systematic review and meta-analysis. AJOG Glob Rep. Feb 2023;3(1):100135. doi:10.1016/j.xagr.2022.100135 Aibar L, Aguilar MT, Puertas A, Valverde M. Bakri balloon for the management of postpartum hemorrhage. Acta Obstet Gynecol Scand. Apr 2013;92(4):465-7. doi:10.1111/j.1600-0412.2012.01497.x Bagga R, Jain V, Kalra J, Chopra S, Gopalan S. Uterovaginal packing with rolled gauze in postpartum hemorrhage. MedGenMed. Feb 13 2004;6(1):50. Borger van der Burg BLS, van Dongen T, Morrison JJ, et al. A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination. Eur J Trauma Emerg Surg. Aug 2018;44(4):535-550. doi:10.1007/s00068-018-0959-y Castellini G, Gianola S, Biffi A, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major trauma and uncontrolled haemorrhagic shock: a systematic review with meta-analysis. World J Emerg Surg. Aug 12 2021;16(1):41. doi:10.1186/s13017-021-00386-9 Collaborators WT. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. May 27 2017;389(10084):2105-2116. doi:10.1016/S0140-6736(17)30638-4 Cunningham FG, Nelson DB. Disseminated Intravascular Coagulation Syndromes in Obstetrics. Obstet Gynecol. Nov 2015;126(5):999-1011. doi:10.1097/AOG.0000000000001110 D'Alton M, Rood K, Simhan H, Goffman D. Profile of the Jada(R) System: the vacuum-induced hemorrhage control device for treating abnormal postpartum uterine bleeding and postpartum hemorrhage. Expert Rev Med Devices. Sep 2021;18(9):849-853. doi:10.1080/17434440.2021.1962288 Dildy GA, 3rd. Postpartum hemorrhage: new management options. Clin Obstet Gynecol. Jun 2002;45(2):330-44. doi:10.1097/00003081-200206000-00005 Dueckelmann AM, Hinkson L, Nonnenmacher A, et al. Uterine packing with chitosan-covered gauze compared to balloon tamponade for managing postpartum hemorrhage. Eur J Obstet Gynecol Reprod Biol. Sep 2019;240:151-155. doi:10.1016/j.ejogrb.2019.06.003 Erez O. Disseminated intravascular coagulation in pregnancy: New insights. Thrombosis Update. 2022;6doi:10.1016/j.tru.2021.100083 Erez O, Mastrolia SA, Thachil J. Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management. Am J Obstet Gynecol. Oct 2015;213(4):452-63. doi:10.1016/j.ajog.2015.03.054 Erez O, Othman M, Rabinovich A, Leron E, Gotsch F, Thachil J. DIC in Pregnancy - Pathophysiology, Clinical Characteristics, Diagnostic Scores, and Treatments. J Blood Med. 2022;13:21-44. doi:10.2147/JBM.S273047 Feng S, Liao Z, Huang H. Effect of prophylactic placement of internal iliac artery balloon catheters on outcomes of women with placenta accreta: an impact study. Anaesthesia. Jul 2017;72(7):853-858. doi:10.1111/anae.13895 Higgins N, Patel SK, Toledo P. Postpartum hemorrhage revisited: new challenges and solutions. Curr Opin Anaesthesiol. Jun 2019;32(3):278-284. doi:10.1097/ACO.0000000000000717 Ji SM, Cho C, Choi G, et al. Successful management of uncontrolled postpartum hemorrhage due to morbidly adherent placenta with Resuscitative endovascular balloon occlusion of the aorta during emergency cesarean section - A case report. Anesth Pain Med (Seoul). Jul 31 2020;15(3):314-318. doi:10.17085/apm.19051 Kellie FJ, Wandabwa JN, Mousa HA, Weeks AD. Mechanical and surgical interventions for treating primary postpartum haemorrhage. Cochrane Database Syst Rev. Jul 1 2020;7(7):CD013663. doi:10.1002/14651858.CD013663 Kogutt BK, Vaught AJ. Postpartum hemorrhage: Blood product management and massive transfusion. Semin Perinatol. Feb 2019;43(1):44-50. doi:10.1053/j.semperi.2018.11.008 Levi M, Toh CH, Thachil J, Watson HG. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol. Apr 2009;145(1):24-33. doi:10.1111/j.1365-2141.2009.07600.x Liu C, Gao J, Liu J, et al. Predictors of Failed Intrauterine Balloon Tamponade in the Management of Severe Postpartum Hemorrhage. Front Med (Lausanne). 2021;8:656422. doi:10.3389/fmed.2021.656422 Lohano R, Haq G, Kazi S, Sheikh S. Intrauterine balloon tamponade for the control of postpartum haemorrhage. J Pak Med Assoc. Jan 2016;66(1):22-6. Maier RC. Control of postpartum hemorrhage with uterine packing. Am J Obstet Gynecol. Aug 1993;169(2 Pt 1):317-21; discussion 321-3. doi:10.1016/0002-9378(93)90082-t Makin J, Suarez-Rebling DI, Varma Shivkumar P, Tarimo V, Burke TF. Innovative Uses of Condom Uterine Balloon Tamponade for Postpartum Hemorrhage in India and Tanzania. Case Rep Obstet Gynecol. 2018;2018:4952048. doi:10.1155/2018/4952048 Natarajan A, Alaska Pendleton A, Nelson BD, et al. Provider experiences with improvised uterine balloon tamponade for the management of uncontrolled postpartum hemorrhage in Kenya. Int J Gynaecol Obstet. Nov 2016;135(2):210-213. doi:10.1016/j.ijgo.2016.05.006 Natarajan A, Kamara J, Ahn R, et al. Provider experience of uterine balloon tamponade for the management of postpartum hemorrhage in Sierra Leone. Int J Gynaecol Obstet. Jul 2016;134(1):83-6. doi:10.1016/j.ijgo.2015.10.026 Okoye HC, Nwagha TU, Ugwu AO, et al. Diagnosis and treatment of bbstetrics disseminated intravascular coagulation in resource limited settings. Afr Health Sci. Mar 2022;22(1):183-190. doi:10.4314/ahs.v22i1.24 Ordonez CA, Manzano-Nunez R, Parra MW, et al. Prophylactic use of resuscitative endovascular balloon occlusion of the aorta in women with abnormal placentation: A systematic review, meta-analysis, and case series. J Trauma Acute Care Surg. May 2018;84(5):809-818. doi:10.1097/TA.0000000000001821 Papageorgiou C, Jourdi G, Adjambri E, et al. Disseminated Intravascular Coagulation: An Update on Pathogenesis, Diagnosis, and Therapeutic Strategies. Clin Appl Thromb Hemost. Dec 2018;24(9_suppl):8S-28S. doi:10.1177/1076029618806424 Pingray V, Widmer M, Ciapponi A, et al. Effectiveness of uterine tamponade devices for refractory postpartum haemorrhage after vaginal birth: a systematic review. BJOG. Oct 2021;128(11):1732-1743. doi:10.1111/1471-0528.16819 Quandalle A, Ghesquiere L, Kyheng M, et al. Impact of intrauterine balloon tamponade on emergency peripartum hysterectomy following vaginal delivery. Eur J Obstet Gynecol Reprod Biol. Jan 2021;256:125-129. doi:10.1016/j.ejogrb.2020.10.064 Rattray DD, O'Connell CM, Baskett TF. Acute disseminated intravascular coagulation in obstetrics: a tertiary centre population review (1980 to 2009). J Obstet Gynaecol Can. Apr 2012;34(4):341-347. doi:10.1016/S1701-2163(16)35214-8 Revert M, Rozenberg P, Cottenet J, Quantin C. Intrauterine Balloon Tamponade for Severe Postpartum Hemorrhage. Obstet Gynecol. Jan 2018;131(1):143-149. doi:10.1097/AOG.0000000000002405 Sadek S, Lockey DJ, Lendrum RA, Perkins Z, Price J, Davies GE. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in the pre-hospital setting: An additional resuscitation option for uncontrolled catastrophic haemorrhage. Resuscitation. Oct 2016;107:135-8. doi:10.1016/j.resuscitation.2016.06.029 Schmid BC, Rezniczek GA, Rolf N, Saade G, Gebauer G, Maul H. Uterine packing with chitosan-covered gauze for control of postpartum hemorrhage. Am J Obstet Gynecol. Sep 2013;209(3):225 e1-5. doi:10.1016/j.ajog.2013.05.055 Shimada K, Taniguchi H, Enomoto K, Umeda S, Abe T, Takeuchi I. Hospital transfer for patients with postpartum hemorrhage in Yokohama, Japan: a single-center descriptive study. Acute Med Surg. Jan-Dec 2021;8(1):e716. doi:10.1002/ams2.716 Simpson KR. Update on Evaluation, Prevention, and Management of Postpartum Hemorrhage. MCN Am J Matern Child Nurs. Mar/Apr 2018;43(2):120. doi:10.1097/NMC.0000000000000406 Singer KE, Morris MC, Blakeman C, et al. Can Resuscitative Endovascular Balloon Occlusion of the Aorta Fly? Assessing Aortic Balloon Performance for Aeromedical Evacuation. J Surg Res. Oct 2020;254:390-397. doi:10.1016/j.jss.2020.05.021 Snyder JA, Schuerer DJE, Bochicchio GV, Hoofnagle MH. When REBOA grows wings: Resuscitative endovascular balloon occlusion of the aorta to facilitate aeromedical transport. Trauma Case Rep. Apr 2022;38:100622. doi:10.1016/j.tcr.2022.100622 Soued M, Vivanti AJ, Smiljkovski D, et al. Efficacy of Intra-Uterine Tamponade Balloon in Post-Partum Hemorrhage after Cesarean Delivery: An Impact Study. J Clin Med. Dec 28 2020;10(1)doi:10.3390/jcm10010081 Stensaeth KH, Sovik E, Haig IN, Skomedal E, Jorgensen A. Fluoroscopy-free Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for controlling life threatening postpartum hemorrhage. PLoS One. 2017;12(3):e0174520. doi:10.1371/journal.pone.0174520 Suarez S, Conde-Agudelo A, Borovac-Pinheiro A, et al. Uterine balloon tamponade for the treatment of postpartum hemorrhage: a systematic review and meta-analysis. Am J Obstet Gynecol. Apr 2020;222(4):293 e1-293 e52. doi:10.1016/j.ajog.2019.11.1287 Theron GB, Mpumlwana V. A case series of post-partum haemorrhage managed using Ellavi uterine balloon tamponade in a rural regional hospital. S Afr Fam Pract (2004). May 11 2021;63(1):e1-e4. doi:10.4102/safp.v63i1.5266 Tran QK, Hollis G, Beher R, et al. Transport of Peripartum Patients for Medical Management: Predictors of Any Intervention During Transport. Cureus. Nov 2022;14(11):e31102. doi:10.7759/cureus.31102 Weir R, Lee J, Almroth S, Taylor J. Flying with a Safety Net: Use of REBOA to Enable Safe Transfer to a Level 1 Trauma Center. Journal of Endovascular Resuscitation and Trauma Management. 2022;5(3)doi:10.26676/jevtm.v5i3.214 Wu Q, Liu Z, Zhao X, et al. Outcome of Pregnancies After Balloon Occlusion of the Infrarenal Abdominal Aorta During Caesarean in 230 Patients With Placenta Praevia Accreta. Cardiovasc Intervent Radiol. Nov 2016;39(11):1573-1579. doi:10.1007/s00270-016-1418-y Zeng KW, Ovenell KJ, Alholm Z, Foley MR. Postpartum Hemorrhage Management and Blood Component Therapy. Obstet Gynecol Clin North Am. Sep 2022;49(3):397-421. doi:10.1016/j.ogc.2022.02.001  See omnystudio.com/listener for privacy information.

Episode 143: Pulmonary Cocci BasicsDr. Lovedip Kooner explains the history, diagnosis, and treatment of pulmonary coccidioidomycosis (cocci for short.) Disseminated cocci infection was also discussed. Dr. Arreaza added some anecdotes of patients seen with this infection.  Written by Lovedip Kooner, MD. Comments by Hector Arreaza, MD. You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Definition:Coccidioidomycosis, also known as Valley Fever, is an infection caused by the fungi Coccidioides immitis and Coccidioides posadasii. Coccidioides is also referred to as cocci. Generally speaking, C. immitis is found in California and C. posadasii is found in Arizona, and Central and South America. More recently Cocci has also been found as far north as Washington and British Columbia. History:The fungal infection was first reported by Wernicke and Posadas in Argentina in 1892 where they described a case where a man had cutaneous cocci of the head, arm, and trunk. To this day, the head is preserved in Argentina. 4 For many years, only disseminated cases were recognized and described as “coccidioidal granulomas.” The work of Dixon and Gifford in 1935 elucidated that a pneumonic disease of unknown cause termed “San Joaquin Valley Fever” was, in fact, the primary coccidioidal infection and the port of entry of almost all coccidioidal disease. Initial infection occurs predominantly by inhalation of aerosolized arthroconidia and rarely by direct cutaneous inoculation.1,2Coccidioides spp. survive best in areas with low rainfall (12–50 cm per year), limited winter freezes, and alkaline soils. With climate change models, predicting the geographical range expansion.These dimorphic fungi exist in a mycelial form in the soil. Coccidioides species have been found in animal burrows near the Kern River and in Armadillo burrows in South American countries like Brazil. The mycelia produce arthroconidia (spores) that are ultimately airborne and inhaled.The inoculum required for infection is low and in animal models as few as a single arthroconidium may cause infection.3 Infection:Once arthroconidia are inhaled into the lung, there is typically a 1-3-week incubation period. The arthroconidia undergo morphologic changes into spherules, which are large structures that contain endospores.4 As spherules mature, they rupture and release endospores. Endospores can be spread hematogenous or through lymphatics to essentially any organ, leading to the development of new spherules and potentially disseminated disease.5 Not everyone who inhales the arthroconidia gets the infection. Clinical Manifestations.About 60% of patients who inhale arthroconidia are asymptomatic. 30% have a mild respiratory illness, like the flu. 10% have a more serious disease course and are diagnosed. Other symptoms may include fever, drenching night sweats, and weight loss. Extreme fatigue that limits baseline activity may also raise concerns. Symptom onset up to 2 months after endemic exposure should lead to coccidioidomycosis on the differential. Coccidioidomycosis cases have been documented in Michigan, Europe, and China. These cases were of people who traveled to endemic areas for as little as a few days and then were later diagnosed. 1-3% of all coccidioidomycosis cases are disseminated, severe, or chronic pulmonary infections. If undiagnosed, coccidioidomycosis may lead to significant morbidity and mortality. Dissemination sites include the skin, lymph nodes, bones, and Central Nervous System (CNS) which is the most severe. Any organ can be infected, including documented cases of the prostate and adrenal gland. Arreaza: Recap: 60% are subclinical, 30% are mild, 10% serious, 1-3% are disseminated. What are some risk factors for severe infection? Should I stop biking?Risk factors for severe infection:Severe pulmonary infections can happen in anyone but occur more commonly in diabetics, tobacco users, and people older than 65 years of age.Oceanic or Filipino ethnicity and black or African American have a higher rate of dissemination. Immunosuppression, including HIV, transplant patients, and immunosuppressive medications like corticosteroids or TNF-alpha inhibitors have been shown to be risk factors for dissemination. Pregnant patients, particularly in the third trimester have higher rates of severe infection as well.Arreaza: How do we diagnose the disease?Diagnosis:Diagnosis is commonly made serologically. EIA (enzyme immunoassay) is used more often. There are more false positives than false negatives and varies by manufacturer. Kern County Health Department uses Immunodiffusion IgG and IgM and Complement Fixation are used. Immunodiffusion IgG and IgM are scaled by non-reactive, weakly reactive, reactive and strongly reactive. Compliment fixations are scaled by a ratio/dilution. Serum Compliment fixations

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.06.28.544680v1?rss=1 Authors: Vandepas, L. E., Crim, R. N., Gilbertson, E., Yonemitsu, M. A., Unsell, E., Metzger, M. J., Lacy-Hulbert, A., Goetz, F. W. Abstract: Disseminated neoplasia (DN) is a form of cancer in bivalve molluscs that has been reported in some cases to be a transmissible cancer. Neoplastic cells are highly proliferative, and infection is often lethal. Some commercially valuable bivalve species (mussels, cockles, soft-shell clams, oysters) are affected by outbreaks of disseminated neoplasia, making disease diagnosis and mitigation an important issue in aquaculture and ecological restoration efforts. Here we describe a minimally invasive, non-lethal method for high-throughput screening for disseminated neoplasia in basket cockles (Clinocardium nuttallii). Basket cockles are native to the North American Pacific coast from California to Alaska. There is recent concern from some Coast Salish Tribes regarding an observed long-term decline in cockle populations in Puget Sound, WA. This has led to increased interest in monitoring efforts and research to improve our understanding of the mechanisms of observed basket cockle population dynamics, including assessing prevalence of disease, such as disseminated neoplasia. The rapid, non-lethal hemolymph smear screening method presented here to diagnose DN in adult C. nuttallii can be applied at field sites at low financial cost, and in a validation study of 29 animals the results were identical to that of the gold standard method, tissue histology. Due to the similar morphology of DN in different bivalves, this method can likely be generally applied for use in any bivalve species. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

Looking for more information on this topic? Check out the Disseminated Intravascular Coagulation brick. If you enjoyed this episode, we'd love for you to leave a review on Apple Podcasts.  It helps with our visibility, and the more med students (or future med students) listen to the podcast, the more we can provide to the future physicians of the world. Follow USMLE-Rx at: Facebook: www.facebook.com/usmlerx Blog: www.firstaidteam.com Twitter: https://twitter.com/firstaidteam Instagram: https://www.instagram.com/firstaidteam/ YouTube: www.youtube.com/USMLERX Learn how you can access over 150 of our bricks for FREE: https://usmlerx.wpengine.com/free-bricks/ from our Musculoskeletal, Skin, and Connective Tissue collection, which is available for free. Learn more about Rx Bricks by signing up for a free USMLE-Rx account: www.usmle-rx.com You will get 5 days of full access to our Rx360+ program, including nearly 800 Rx Bricks.  After the 5-day period, you will still be able to access over 150 free bricks, including the entire collections for General Microbiology and Cellular and Molecular Biology.

Series Epiphany 2023 The Light Has Appeared Originally aired 02/26/2023

In this episode, we review the high-yield topic of Disseminated Intravascular Coagulation (DIC) from the Heme section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

“Consider your patient's diagnosis. What kind of cancer do they have? And ask yourself, ‘Could this patient be in disseminated intravascular coagulation (DIC)? Is there something more that we should be doing or looking at?'” Leslie Smith, RN, APRN-CNS, DNP, BMTCN®, AOCNS®, oncology clinical specialist at the National Institutes of Health in Bethesda, MD, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS. Smith discussed the nursing considerations for the management of DIC. This episode is part of a series about oncologic emergencies; the others are linked in the episode notes. You can earn free NCPD contact hours after listening to this episode by completing the evaluation linked below. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by October 7, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Episode Notes Complete this evaluation for free NCPD. Previous Oncology Nursing Podcast episodes on oncologic emergencies ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition) ONS courses: Oncologic Emergencies Treatment and Symptom Management—Oncology RN Essentials in Oncologic Emergencies for the Advanced Practice Provider ONS Huddle Cards™ DIC Huddle Card ONS Prevention of Bleeding Symptom Intervention and Guideline UpToDate Information from Cleveland Clinic Information from the National Heart, Lung, and Blood Institute To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From Today's Episode “If the D-dimer is high, that is indicative of a clotting issue occurring. So, the next step for the nurse would be to look for the lab or ask for an order—you can order a DIC panel in some institutions—but look at coagulation labs. And really care and support these patients. DIC is not a disease in itself; it is a symptom of a disease, it is a syndrome. And it's indicative of another problem occurring.” Timestamp (TS) 07:09 “In the chronic form, patients who live in a chronic inflammatory state—maybe from arthritis or whatever the process is—their coagulopathy will not be as severe as an acute form. They may have an elevated prothrombin time (PT) or partial thromboplastin time (PTT). Their platelets may be a little bit low and their fibrinogen may be just a little bit low, but it's not life-threatening. And in an acute stage of DIC, it is life-threatening.” TS 08:43 “If we are taking care of patients who have received CAR T cells, for example, nurses know to monitor for cytokine release syndrome, we're watching for fever, we're watching the C-reactive protein levels or the ferritin levels, and we're treating appropriately via tocilizumabs . . . preventing DIC that way. Patients who are at risk for developing sepsis. . . . watching for signs of impeding infection . . . . Those types of things can prevent DIC from occurring.”  TS 12:26 “I think it can be a little bit confusing for the nurse because they're vague symptoms. So, if you have a patient that is maybe thrombocytopenic, you could attribute, ‘Well, they have all this petechiae from their thrombocytopenia.' It's difficult. That's why you need to really draw a lab. . . . It is not just one lab or one sign or symptom that will diagnosis DIC. There's no one thing that tells you that the patient has DIC. You need to look at all the lab work to make that determination.” TS 14:15 “Nurses are going to support the patient with transfusions. . . . And this will help in an attempt to normalize the lab or at least get the factors and the platelets back up. And then treating the disease. . . . And then in addition, if the patient is infected or septic, administering the antibiotics.” TS 16:26 “DIC is often thought—especially by patients or family—that once you start that chemotherapy or the antibiotics, that the DIC will go away. That is not true. It can take days to weeks for the DIC to resolve itself. It's not something that is going to happen overnight. The patient will need to continue to be supported.” TS 18:13 “Consider what is the diagnosis of your patient. If they have cancer, what kind of cancer do they have? And ask the question to yourself, ‘Could this patient be in DIC? Is there something more that we should be doing or looking at?'” TS 19:22

In this episode we review the pathophysiology, diagnosis, and approach to the patient with DIC. Listen closely for some key tips on diagnostic scores and the trap of an inappropriately normal fibrinogen! Written by: Dr. Stefan Jevtic (Internal Medicine Resident), reviewed by Dr. Siraj Mithoowani (Hematologist) and Dr. John Neary (General Internist).  

Emergencies happen in hematology and oncology. This is a fact. But how do we manage these emergencies? Look no further. In this episode, we talk all about our second hematologic emergency: disseminated intravascular coagulation (DIC) with an added bonus of an intro to thrombotic microangiopathic anemias (TMAs).Be sure to check out episode 009 on thrombocytopenia for a general approach and differential!Disseminated intravascular coagulation (DIC):Workup: CBCCMPPT, PTT, INRFibrinogenPeripheral smear - concern for schistocytes. Example of these cells from ASH image bank: https://imagebank.hematology.org/image/60306/schistocytes?type=upload#:~:text=A%20schistocyte%20is%20present%20in,angles%20and%2For%20straight%20borders.Basic mechanism of DIC is consumption of clotting factors leading to coagulopathy Need to be weary of thrombotic microangiopathy: Small blood clots forming in the small vessels leading to endothelial damage, which cause shear stress on the RBCs, which then break down into a schistocyte (AKA triangulocyte or helmet cell) Examples: thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS)Management (our opinion!): - Repeat coags q4-6 hours initially (but base interval based on patient) NOTE: INR Is NOT a good assessment of “clotting status” in these situations- Repeat fibrinogen q4-6 hours initially (but base interval based on patient); keep fibrinogen >100 with cryoprecipitate in more stable patients; consider higher thresholds for more acutely ill patients (such as >150) - Repeat CBC q6-8 hours initially; can provide platelets if low, especially if they are bleeding - Workup and treatment for trigger of DIC (infection, trauma, medications, etc.)How does cirrhosis affect data interpretation?- Use clinical context to determine if labs are acutely abnormal or if they have signs/symptoms to suggest underlying liver dysfunction- In the acute setting, always just replace what is missing! How can you tell the difference between nutritional deficiencies vs. consumption (as in with DIC?)- Factor activity levels! Consider checking: Factor 8 (made in endothelium), Factor 5 (Vit K independent), Factor 7 (vitamin K dependent) - If all down, then consider DIC- If Vit K-dependent low, then nutritional deficiency Reference:https://ashpublications.org/blood/article/131/8/845/104418/How-I-treat-disseminated-intravascular-coagulation - Great How I Treat article from Blood Please visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

Episode 89: Gonorrhea Basics. Written by Robert BensacenezRobert, Dr. Schlaerth, and Dr. Arreaza discuss the basics of gonorrhea, including presentation, treatment, and even a potential gonococcal vaccine.Introduction: Gonorrhea is commonly known as “the clap” or “the drip”. This ancient disease, described as “the perilous infirmity of burning” in a book called The History of Prostitution, has been treated with many remedies throughout history, including mercury, sulfur, silver, multiple plants, and even gold. Today we will discuss the clinical features, diagnosis, and current therapy of gonorrhea. By the way, did you know that gonorrhea in Spanish is used as an insult in Colombia? Well, now you know it. Definition: Gonorrhea is a sexually transmitted disease caused by the bacterium Neisseria gonorrhoeae (common name gonococcus), which is a gram-negative, intracellular, aerobic, diplococci. This disease leads to genitourinary tract infections such as urethritis, cervicitis, pelvic inflammatory disease (PID), and epididymitis. This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. ___________________________Gonorrhea. Written by Robert Besancenez, MS4, Ross University School of Medicine. Moderated and edited by Hector Arreaza, MD. Discussion participation by Katherine Schlaerth, MD. Epidemiology: The disease primarily affects individuals between 15–24 years of age (half of the STI patients in the US). CDC estimates that approximately 1.6 million new gonococcal infections occurred in 2018. Incidence rates are highest among African Americans, American Indians, and Hispanic populations.Transmission is sexual (oral, genital, or anal) or perinatal (causing gonococcal conjunctivitis in neonates). Risk factors include unsafe sexual behaviors (lack of barrier protection, multiple partners, men who have sex with men (MSM), and asplenia, complement deficiencies. Individuals with low socioeconomic status are at the highest risk: poor access to medical treatment and screening, poor education, substance use, and sex work. Presentation: The incubation period is ~ 2–7 days, and sometimes patients do not develop any symptoms. Urogenital infection: Gonorrhea is commonly asymptomatic, especially in women, which increases the chance of further spreading and complications. When symptoms are present, typical symptoms include purulent vaginal or urethral discharge (purulent, yellow-green, possibly blood-tinged). Discharge is less common in female patients. Urinary symptoms include dysuria, urinary frequency, and urgency. Male: - Typical presentation is urethritis. - Penile shaft edema without other signs of inflammation.- Epididymitis: unilateral scrotal fullness sensation, scrotal swelling, redness, tenderness, relief of pain with elevation of scrotum —Prehn Sign— and positive cremasteric reflex.- Robert: Prostatitis: fever, chills, general malaise, pelvic or perineal pain, cloudy urine, prostate tenderness (examine prostate gently). Female: - Cervicitis: Friable cervix and discharge (purulent, yellow, malodorous), - PID: pelvic or lower abdominal pain, dyspareunia, fever, cervical discharge, cervical motion tenderness but also uterine or adnexal tenderness, abnormal intermenstrual bleeding. PID can be subclinical and diagnosed retroactively when tubal occlusion is discovered as part of a workup for infertility. PID can cause Fitz-Hugh-Curtis syndrome (perihepatitis with RUQ pain).- Bartholinitis presents with introitus pain, edema, and discharge from the labia. - Vulvovaginitis may occur but is rare (due to the tissue preference of gonococci)Extragenital infection: Proctitis: Rectal purulent discharge, possible anorectal bleeding and pain, rectal mucosa inflammation, or rectal abscess (less common).Pharyngitis: sore throat, pharyngeal exudate, cervical lymphadenitis.  Disseminated gonococcal infection (DGI): Triad of arthritis, pustular skin lesions, and tenosynovitis.  As mentioned in Episode 46, on December 23, 2020, the California Department of Public Health (CDPH) sent a “Dear Colleague” letter to warn the medical community about the increased cases of DGI in California and Michigan. Increased cases may be caused by decreased STD testing and treatment because of the COVID-19 pandemic, and not necessarily because of a more virulent strain of gonorrhea. Later, treatment of gonorrhea was updated because of resistance.  Epidemiology: ∼ 2% of cases. Most common in individuals younger than 40 years old, the female to male ratio is 4:1. A history of recent symptomatic genital infection is uncommon. Asymptomatic infections increase the risk of dissemination due to delayed diagnosis and treatment. Clinical features: Two distinct clinical presentations are possible. Arthritis-dermatitis syndrome:Polyarthralgias: migratory, asymmetric arthritis that may become purulent.Tenosynovitis: simultaneous inflammation of several tendons (e.g. fingers, toes, wrist, ankle).Dermatitis: vesicular, pustular, or maculopapular lesions, possibly with a necrotic or hemorrhagic center.  Most commonly distributed on the trunk, extremities (sometimes involving the palms and soles). Typically, < 10 lesions with a transient course (subside in 3–4 days). Additional manifestations: fever and chills (especially in the acute phase). Purulent gonococcal arthritis: Abrupt inflammation in up to 4 joints (commonly knees, ankles, and wrists). No skin manifestations, rarely tenosynovitis. Genitourinary manifestations in only 25% of affected individuals. Not to be confused with reactive arthritis.  Health care providers living in California: Order Nucleic acid amplification test (NAAT) and culture specimens from urogenital, extragenital mucosal sites (e.g., pharyngeal and rectal), and from disseminated sites (e.g., skin, synovial fluid, blood, and cerebrospinal fluid) before initiating empiric antimicrobial treatment for patients with suspected DGI. Report within 24 hours of diagnosis to the California Department of Public Health. Complications of DGI: sepsis with endocarditis, meningitis, osteomyelitis, or pneumonia. Diagnosis of gonorrhea: The test of choice is Nucleic acid amplification testing (NAAT) of first-catch urine or swabs of urethra, endocervix and pharynx, and synovial fluid in disseminated infection. Other possible tests: gram stains and bacterial cultures (Thayer-Martin agar, useful for antibiotic resistance, results may take 48 hours, sensitivity is lower than NAAT.)Synovial fluid analysis: Appearance of fluid can be clear or cloudy (purulent), high Leukocyte count (up to 50,000 cells/mm3): especially segmented neutrophils, gram stain positive in < 25% of cases. Treatment: Ceftriaxone and doxycycline for uncomplicated cases, but may require different approaches in case of allergies or intolerance to these antibiotics, or in severe cases.  Uncomplicated gonorrhea (affecting cervix, urethra, rectum, pharynx)First-line treatment: single-dose ceftriaxone 500 mg IM (1 G for patients >150 Kg) PLUS doxycycline 100 mg PO twice a day for 7 days If a chlamydial infection has not been excluded.During pregnancy: Ceftriaxone PLUS single-dose azithromycin 1 gram PO(doxy is contraindicated – teratogen) Complicated gonorrhea (salpingitis, adnexitis, PID/ epididymitis, orchitis)Single-dose ceftriaxone IM PLUS doxycycline PO for 10–14 days  (women may require additional administration of Metronidazole PO for 14 days).  DGICeftriaxone IV every 24 hours for 7 days In case Chlamydia infection has not been ruled out: PLUS doxycycline PO twice a day for 7 daysDrainage of purulent joint(s) Sequelae: Without treatment, a prolonged infection may lead to complications, such as hymenal and tubal synechiae that lead to infertility in women. Prevention:-Screening for gonorrhea (USPSTF recommendations, September 2021, Grade B): Annual NAAT screening of gonorrhea AND chlamydia for sexually active women ≤ 24 years (including pregnant persons) or > 25 years with risk factors (e.g. new or multiple sex partners, sex partner with an STI, etc.). Evaluate for other STIs if positive (e.g. chlamydia, syphilis, and HIV).  There is insufficient evidence to recommend for or against screening gonorrhea in asymptomatic males (Grade I).In all patients: Evaluate and treat the patient's sexual partners from the past 60 days. Provide expedited partner therapy if the timely evaluation of sexual partners is not feasible. Single-dose cefixime PO (if chlamydia has been excluded in the patient) OR Single-dose cefixime PO PLUS doxycycline PO for 7 days. Sexual partners must be treated simultaneously to avoid reinfections. A possible gonococcal vaccine: A gonococcal vaccine is theoretically possible, let's remember that the meningococcal vaccine exists. Meningococcus is closely related to gonococcus. A study published in 2017 showed that MeNZB® (a vaccine used in New Zealand until 2011 to fight against a meningitis epidemic) provided partial protection against gonorrhea. Food for thought for you guys. Conclusion: Let's remember to screen asymptomatic women for gonorrhea, identify symptomatic patients and start treatment promptly, and prevent serious complications, and more importantly, let's promote safe sex practices to prevent this disease.Now we conclude our episode number 89 “Gonorrhea Basics”. Gonorrhea affects mainly the urogenital area, but it can spread to the pharynx, rectum, skin, and even joints. When you see septic arthritis in patients with high risk for gonorrhea, suspect disseminated gonococcal infection and start treatment promptly. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created for educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Robert Besancenez, and Katherine Schlaerth. Audio edition: Suraj Amrutia. See you next week! _____________________References:Seña, Arlene C, MD, MPH; and Myron S Cohen, MD.  Treatment of uncomplicated Neisseria gonorrhoeae infections, UpToDate, updated on Jan 27, 2022. Accessed on April 5, 2022. https://www.uptodate.com/contents/treatment-of-uncomplicated-neisseria-gonorrhoeae-infections Ghanem, Khalil G, MD, PhD. Clinical manifestations and diagnosis of Neisseria gonorrhoeae infection in adults and adolescents, UpToDate, updated on Sep 17, 2021, accessed on April 5, 2022. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-neisseria-gonorrhoeae-infection-in-adults-and-adolescents Klausner, Jeffrey D, MD, MPH. Disseminated gonococcal infection, UpToDate, updated on March 3, 2022. Accessed on April 5, 2022. https://www.uptodate.com/contents/disseminated-gonococcal-infection Petousis-Harris H, Paynter J, Morgan J, et al. Effectiveness of a group B OMV meningococcal vaccine on gonorrhea in New Zealand – a case control study. Abstract presented at: 20th International Pathogenic Neisseria Conference. Manchester, UK; 2016. 

Take Home Points Classically, herpes zoster will present with rash and pain in a dermatomal distribution Immunocompromised patients are at greater risk for significant complications of zoster, including visceral dissemination and zoster ophthalmicus Appropriate therapy includes antiviral therapy within 72 hours of onset of symptoms and analgesia for acute neuritis Disseminated zoster and zoster ophthalmicus ... Read more The post REBEL Core Cast 78.0 – Herpes Zoster appeared first on REBEL EM - Emergency Medicine Blog.

Dr. Magnus Boesen discusses his abstract, "Magnetic Resonance Imaging Criteria at Onset to Differentiate Pediatric MS from Acute Disseminated Encephalomyelitis". Show references: https://index.mirasmart.com/aan2022/  

Reported gonorrhea cases have more than doubled in recent years. Untreated gonorrhea may occasionally cause potentially fatal conditions, such as infective endocarditis. In this episode, Dr. Carl Boodman, infectious disease and medical microbiology fellow at the University of Manitoba, discusses a case of disseminated gonococcal infection in a 54- year old man who presented to ER with a new heart murmur. The case was described in a recent CMAJ article, which explains that the patient had developed an aortic root abscess and a fistula from his right ventricle to the aortic root.Dr. Boodman tells Dr. Blair Bigham and Dr. Mojola Omole that, while severe cases of disseminated gonococcal infection such as this remain relatively rare, he is seeing more of them in Manitoba. He emphasizes the importance of detecting and treating gonococcal infection before it has a chance to progress.Gonorrhea is just one of the bacterial STIs on the rise. Drs. Bigham and Omole also speak with Dr. Jason Wong, a Public Health and Preventive Medicine specialist in BC, about what's behind the rise in STIs and about what lessons can be learned from the relative decline in HIV infections.

Some conditions are rare. Some conditions are difficult to understand. Some conditions are difficult to treat. ADEM is all 3. A sometimes devastating condition affecting completely normal children, ADEM is an upsetting and challenging condition. Treatment this aggressively is important. Mainstays of treatment are steroids, IVIG, and plasma exchange. But: […]

In this episode, we review the high-yield topic of Disseminated Intravascular Coagulation (DIC) from the Hematology section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbulletsIn this episode --- Send in a voice message: https://anchor.fm/medbulletsstep1/message

In this episode, Dr. Cameron will be discussing the case of a 66-year-old man with Bannwarth syndrome with urinary retention in early Lyme disease.“Physicians need to be aware of the rare neurological manifestations of [Lyme neuroborreliosis] … Prompt diagnosis and treatment with antibiotics can reduce unnecessary imaging, patient anxiety, and, most importantly, avert debilitating complications.”Omotosho and colleagues described this case in an article entitled “A Unique Case of Bannwarth Syndrome in Early Disseminated Lyme Disease.”  Omotosho YB, Sherchan R, Ying GW, Shayuk M. A Unique Case of Bannwarth Syndrome in Early Disseminated Lyme Disease. Cureus. Apr 25 2021;13(4):e14680. doi:10.7759/cureus.14680You can hear more about these cases through his blogs, social media, and YouTube. Sign up for our newsletter to keep up with these cases.How to Connect with Dr. Daniel Cameron:Check out his website: https://www.DanielCameronMD.com/Call his office: 914-666-4665Email him: DCameron@DanielCameronMD.com Send him a request:  https://danielcameronmd.com/contact-daniel-cameron-md/Like him on Instagram: https://www.instagram.com/drdanielcameron/Join his Facebook group: https://www.facebook.com/danielcameronmd/Follow him on Twitter: https://twitter.com/DrDanielCameronSign up for his newsletter: https://www.DanielCameronMD.com/Subscribe and ring the bell: https://www.youtube.com/user/danielcameronmd/ Leave a review on iTunes or wherever else you get your podcasts.We, of course, hope you'll join the conversation, connect with us and other readers, ask questions, and share your insights. Dr. Cameron is a Lyme disease expert and the author "Inside Lyme: An expert's guide to the science of Lyme disease." He has been treating adolescents and adults for more than 30 years.Please remember that the advice given is general and not intended as specific advice as to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.

Krissy Dilger of SRNA was joined by Dr. Farrah Mateen and Dr. Cindy Wang for an Ask the Expert Podcast on "Acute Disseminated Encephalomyelitis (ADEM): Diagnosis and Treatment Guidelines." The experts begin by providing an overview of ADEM, including a brief definition, signs and symptoms in the acute phase, and potential causes. The physicians then discuss diagnostic tests and how other disorders are ruled out. They talk about acute treatments and long-term care for people with ADEM. Finally, the experts provide information on research being conducted on ADEM.

Disseminated intravascular coagulation (DIC) is a consumption coagulopathy that can be devastating for your patient. In this episode, learn the pathophysiology of DIC, how to recognize it, and what we do to address it (hopefully before it results in life-threatening hemorrhage). As a bonus, there are a few PodQuiz questions at the end to test your understanding. If you love quizzing in this way, then check out my private podcast, Study Sesh! For show notes and references, view the article here.

Victoria Arlen is a television personality for ESPN, as well as an actress, speaker, model, and former American paralympian swimmer. Victoria's life drastically changed in 2006 at the age of eleven when she developed two rare conditions known as Transverse Myelitis and Acute Disseminated Encephalomyelitis. This was an incredibly rare scenario and Victoria quickly lost the ability to speak, eat, walk and move. She slipped into a vegetative state in which doctors had written her off as a lost cause. Victoria spent nearly four years “locked” inside her own body completely aware of what was going on just unable to move or communicate. Doctors believed there was little hope of survival and recovery was unlikely. Victoria, however, was not ready to give up. In 2010 after almost four years, she began the nearly impossible fight back to life. Learning how to speak, eat and move all over again.

Welcome to Episode 007 (cue the James Bond music please) of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 7 of “The 2 View” A Wolf in Sheep's Clothing Birnbaumer, Diane MD. A Wolf in Sheep's Clothing: Serious Causes of Common Complaints. Advanced Emergency Medicine Boot Camp. September 2019. Las Vegas. Accessed June 29, 2021. Subarachnoid Hemorrhage Carpenter CR, Hussain AM, Ward MJ, et al. Spontaneous Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Examination, Imaging, and Lumbar Puncture with an Exploration of Test Thresholds. Acad Emerg Med. PubMed.gov. Published September 6, 2016. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/27306497/ Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. Published 2012. Accessed June 29, 2021. https://www.ahajournals.org/doi/full/10.1161/str.0b013e3182587839 Headache. Acep.org. Published June 2019. Accessed June 29, 2021. https://www.acep.org/patient-care/clinical-policies/headache/ Hine, J MD, Marcolini, E MD. Aneurysmal Subarachnoid Hemorrhage. EM:RAP CorePendium. Emrap.org. Published September 17, 2020. Accessed June 29, 2021. https://www.emrap.org/corependium/chapter/recTI59VW0TPBpesx/Aneurysmal-Subarachnoid-Hemorrhage Kim YW, Neal D, Hoh BL. Cerebral aneurysms in pregnancy and delivery: pregnancy and delivery do not increase the risk of aneurysm rupture. Neurosurgery. PubMed.gov. Published February 2013. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/23147786/ Marcolini E, Hine J. Approach to the Diagnosis and Management of Subarachnoid Hemorrhage. West J Emerg Med. NCBI. Published February 28, 2019. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404699/ Ogilvy, C MD, Rordorf, G MD, Singer, R MD. Aneurysmal subarachnoid hemorrhage: Clinical manifestations and diagnosis. UpToDate. Uptodate.com. Updated February 25, 2020. Accessed June 29, 2021. https://www.uptodate.com/contents/aneurysmal-subarachnoid-hemorrhage-clinical-manifestations-and-diagnosis?search=subarachnoid%20hemorrhage&source=searchresult&selectedTitle=1~150&usagetype=default&display_rank=1 Ottawa Subarachnoid Hemorrhage (SAH) Rule for Headache Evaluation. Mdcalc.com. Accessed June 29, 2021. https://www.mdcalc.com/ottawa-subarachnoid-hemorrhage-sah-rule-headache-evaluation Subarachnoid Hemorrhage, no LP. EM:RAP. Emrap.org. Published May 2020. Accessed June 29, 2021. https://www.emrap.org/episode/emrap2020may/subarachnoid Gonococcal Arthritis Klausner, J MD, MPH. Disseminated gonococcal infection. UpToDate. Uptodate.com. Updated January 7, 2021. Accessed June 29, 2021. https://www.uptodate.com/contents/disseminated-gonococcal-infection Li R, Hatcher JD. Gonococcal Arthritis. In: StatPearls. StatPearls Publishing. Published July 26, 2020. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/books/NBK470439/ Milne, Wm. MD. SGEM#335: Sisters Are Doin' It for Themselves…Self-Obtained Vaginal Swabs for STIs. Thesgem.com. Published June 26, 2021. Accessed June 29, 2021. https://www.thesgem.com/2021/06/sgem335-all-by-myselfself-obtained-vaginal-swabs-for-stis/ Ventura, Y MD, Waseem, M MD, MS. Disseminated Gonococcal Infection: Emergency Department Evaluation and Treatment. Emdocs.net. Published May 17, 2021. Accessed June 29, 2021. http://www.emdocs.net/disseminated-gonococcal-infection-emergency-department-evaluation-and-treatment/ Epiglottitis Abdallah C. Acute epiglottitis: Trends, diagnosis and management. Saudi J Anaesth. Published July-September 2012. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498669/ Ames WA, Ward VM, Tranter RM, Street M. Adult epiglottitis: an under-recognized, life-threatening condition. Br J Anaesth. Oxford Academic. Published November 1, 2000. Accessed June 29, 2021. https://academic.oup.com/bja/article/85/5/795/273886 Dowdy RAE, Cornelius BW. Medical Management of Epiglottitis. Anesth Prog. Published July 6, 2020. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342809/ Farkas, J. Epiglottitis. Emcrit.org. Published December 18, 2016. Accessed June 29, 2021. https://emcrit.org/ibcc/epiglottitis/ Mayo-Smith M. Fatal respiratory arrest in adult epiglottitis in the intensive care unit. Implications for airway management. Chest. PubMed.gov. Published September 1993. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/8365325/ Roberts, J MD, Roberts, M ACNP, PNP. Nasal Endoscopy for Urgent and Complex ED Cases. Lww.com. Published October 28, 2020. Accessed June 29, 2021. https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=110 Wolf M, Strauss B, Kronenberg J, Leventon G. Conservative management of adult epiglottitis. Laryngoscope. PubMed.gov. Published February 1990. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/2299960/ Wellens Syndrome Wellens Syndrom EKG Sign: See full show notes here: https://bit.ly/3eSyzp0 Cadogan M, Buttner R. Wellens Syndrome. Life in the Fastlane. Litfl.com. Published June 4, 2021. Accessed June 29, 2021. https://litfl.com/wellens-syndrome-ecg-library/ Smith S. Wellens' missed. Then returns with Wellens' with dynamic T-wave inversion. Dr. Smith's ECG Blog. Blogspot.com. Published May 4, 2011. Accessed June 29, 2021. http://hqmeded-ecg.blogspot.com/2011/05/wellens-missed-then-returns-with.html?m=1 Wellens Syndrome ECG Recommended Book Resources for the Month Merck. The Merck Manual of Patient Symptoms. (Porter RS, ed.). Merck; 2008. Schaider JJ, Barkin RM, Hayden SR, et al., eds. Rosen and Barkin's 5-Minute Emergency Medicine Consult. 4th ed. Lippincott Williams and Wilkins; 2010. Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Last month we asked you a trivia question regarding the very first NP program – who was the duo that began the program and what was the first NP specialty program? The correct answer was Dr. Loretta Ford and Dr. Henry Silver. The first NP specialty program was pediatrics. We'll be sending Lindsey Harvey, MSN, FNP-BC to the November Original EM Boot Camp Gratis for providing that answer! We can't wait to see you and all of the other registrants in November in Las Vegas! Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to.

Acute disseminated encephalomyelitis (ADEM) is a rare, monophasic autoimmune condition affecting the brain and spinal cord. The symptoms of ADEM can be variable, given that lesions can present in multiple areas of the central nervous system. ADEM shares certain clinical characteristics with other demyelinating conditions such as pediatric multiple sclerosis and transverse myelitis, but it also has important defining characteristics. To learn more about this condition, John and Ryan speak with Lana Harder, Ph.D., ABPP-CN, who is a founding member and current Co-Director of the Children's Medical Center Pediatric Demyelinating Disease Clinic. Show notes are available at www.NavNeuro.com/73 _________________ If you'd like to support the show, here are a few easy ways: 1) Get APA-approved CE credit for listening to select episodes: www.NavNeuro.com/INS  2) Tell your friends and colleagues about it 3) Subscribe (free) and leave an Apple Podcasts rating/review: www.NavNeuro.com/itunes 4) Contribute to the discussion in the comments section of the website (click the episode link listed above) or on Twitter (@NavNeuro)   Thanks for listening, and join us next time as we continue to navigate the brain and behavior! [Note: This podcast and all linked content is intended for general educational purposes only and does not constitute the practice of psychology or any other professional healthcare advice and services. No professional relationship is formed between hosts and listeners. All content is to be used at listeners' own risk. Users should always seek appropriate medical and psychological care from their licensed healthcare provider.]

On this episode Davin discusses how so called activists of the Black community are intentionally misleading their followers with false information, And why the GQP voted down a commission to investigate the January 6, 2021 attack on the U.S. Capitol! --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/davain/support

MIB Agents OsteoBites S2 Ep 13: Scott Sauer, PhD on “Preventing Osteosarcoma Lethal Recurrence by Targeting Disseminated Tumor Cells” ... Guest Information: Scott Sauer, PhD Head of Preclinical Discovery Vuja De Sciences, Inc. (www.vujade-life.com) ... Dr. Scott Sauer is a cancer researcher with multidisciplinary training in the fields of cancer biology, immunotherapy and organic chemistry. This diverse expertise provides a unique perspective to address unmet medical needs in cancer recurrence and metastasis. Scott received his PhD at Duke University in organic chemistry and a BS from the University of Maryland. After his PhD work, Dr. Sauer began his postdoctoral training at the Duke University Medical Center. His postdoctoral work was in cancer biology focusing on mechanisms of therapeutic resistance and disease progression. During this time, Scott received numerous postdoctoral awards including his work on the interplay between cancer progression and environmental toxicants. Dr. Sauer's work was among the top three finalists for our 2021 OutSmarting Osteosarcoma grant. ... Panelists Kara Skrubis, MIB Junior Board Member and OsteoWarrior Amy Woodcheke, Physician's Assistant and Childhood Cancer Survivor Ann Graham, OsteoWarrior & Executive Director of MIB Agents ... What We Do PROGRAMS: ✨ End-of-Life MISSIONS ✨ Gamer Agents ✨ Warrior Mail ✨ Prayer Agents ✨ Healing Hearts Bereaved Parent Support ✨ Ambassador Agents - Peer Support EDUCATION for physicians, researchers and families: ✨ OsteoBites, weekly webinar & podcast with thought leaders and innovators in Osteosarcoma ✨ MIB Book: Osteosarcoma: From our Families to Yours RESEARCH ✨ Annual MIB FACTOR Research Conference ✨ Funding $100,000 annually for OS research ✨ MIB Testing & Research Directory ✨ The Osteosarcoma Project partner with Broad Institute of MIT and Harvard .... OsteoBites is made possible by listeners like you. Please consider donating to MIB Agents or be an All Star Agent by being a monthly supporter. Kids are still dying with 40+ year old treatments. Help us MakeItBetter. www.mibagents.org Osteosarcoma Resources: www.MIBagents.org/contact Dr. Sauer Contact: scott.sauer@vujade-life.com Vuja De Sciences: https://vujade-life.com/ MIB Limited Edition Sunflower Tee & Tank: https://www.bonfire.com/make-it-better-together/ --- Support this podcast: https://anchor.fm/mibagents/support

This episode covers disseminated intravascular coagulation!

In this episode, we cover disseminated intravascular coagulation. It sounds bad, because it is. Come listen and refresh your skills around supporting the bleed-bleedy versus the cloth-clotty, how to differentiate DIC and chronic liver failure and a few more juicy clinical pearls.

Welcome to Ask Stago, the weekly podcast for Hemostasis laboratory professionals.   This week, with our expert Paul Riley, Scientific Business Development Manager, Cécile Hourquet and Audrey Carlo will cover the usage of fibrin related markers in the diagnosis of disseminated intravascular coagulopathy.   Litterature: Baglin T. Disseminated intravascular coagulation: diagnosis and treatment. BMJ 1996; 312: 683-7 Iba T, Di Nisio M, Thachil J, Wada H, Asakura H, Sato K, Kitamura N, Saitoh D. Revision of the Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) diagnostic criteria using antithrombin activity. Crit Care. 2016 Sep 14;20:287 Taylor FB Jr, Toh CH, Hoots WK, Wada H, Levi M; Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH). Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001 Nov;86(5):1327-30 JAAM; Iba T, Di Nisio M, Thachil J, Wada H, Asakura H, Sato K, Kitamura N, Saitoh D. Revision of the Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) diagnostic criteria using antithrombin activity. Crit Care. 2016 Sep 14;20:287 Boral BM, Williams DJ, Boral LI. Disseminated Intravascular Coagulation. Am J Clin Pathol 2016; 146: 670-80 Wada H, Sakuragawa N. Are fibrin-related markers useful for the diagnosis of thrombosis? Semin Thromb Hemost 2008; 34: 33-8 Toh JMH, Ken-Drorb G, Downey D, Abram ST. The clinical utility of fibrin-related biomarkers in sepsis Blood Coagulation and Fibrinolysis 2013, 24:00–00 Gris JC, Cochery-Nouvellon E, Bouvier S, Jaber S, Albanese J, Constantin JM, Orban JC, Morel J, Leone M, Deras P, Elotmani L, Lavigne-Lissalde G, Lefrant JY. Clinical value of automated fibrin generation markers in patients with septic shock: a SepsiCoag ancillary study. Br J Haematol. 2018 Nov;183(4):636-647 (Singh N, Prasad Pati H, Tyagi S, Datt Upadhyay A, Saxena R. Evaluation of the Diagnostic Performance of Fibrin Monomer in Comparison to D-Dimer in Patients With Overt and Nonovert Disseminated Intravascular Coagulation. Clin Appl Thromb / Hemost 2015; 1-6.). (Park KJ, Kwon EH, Kim HJ, Kim SH. Evaluation of the diagnostic performance of fibrin monomer in disseminated intravascular coagulation. Korean J Lab Med. 2011; 31: 143-7.).

Full article: https://www.ajronline.org/doi/abs/10.2214/AJR.20.24364 While the primary manifestations of COVID-19 are respiratory in nature—it has become clear as we take care of patients and learn more that COVID can have an effect on the nervous system. On this podcast, Edgar Perez, MD discusses MRI findings of COVID related-Disseminated Leukoencephalaopathy, which should remain an important differential consideration in COVID patients with neurologic manifestations.

Welcome To The MedFlashGo Podcast. This Is Your Daily 4 Minutes Or Less Rapid Review for medical students. Topics are based on medical board examinations including USMLE, COMLEX, And Shelf Exams. We release a new episode every weekday! In this question of the day, Sean asks students to identify the correct laboratory values in the condition stated. These questions are powered by MedFlashGo The First Voice-based interactive medical question bank currently available on Alexa. This tool allows medical students to study medical topics and be interactively tested without the use of a screen. You can study on your couch, in your car, and on the move without the use of a screen. To get access to the free audio-interactive question bank, click here or go to your Alexa application and search medflashgo In the skills section. To learn more details go to medflashgo.com and check out our frequently asked questions section. Please know that these questions were creatively designed by medical students and physicians for the purpose of education and do not replace health information given from your health professionals. We have tried our best to make sure the information is accurate please, so please let us know if you find any errors and we will be sure to correct them. --- Send in a voice message: https://anchor.fm/medflashgo/message

This episode covers disseminated intravascular coagulation!

Host: Dr. Bobbi Conner Producer: Topher Conlan

Nesse episódio Iago apresenta um caso de poliartralgia para Fred, Rapha e nosso convidado especial Dr Edgar Reis, preceptor da residência de Reumatologia na UNIFESP. Comente conosco o que achou do episódio e do diagnóstico lá no @tadeclinicagem no Instagram ou pelo e-mail tadeclinicagem@gmail.com. MINUTAGEM (0:34) Apresentação do convidado Dr. Edgard Reis (3:07) Início do caso clínico e anamnese (6:24) Comentário sobre dor articular (11:34) Dica do exame físico na artrite (20:05) O que esperar do exame físico? (22:51) Continuação da história clínica e exame físico (26:32) Organização etiológica da poliartrite (38:02) Comentário sobre FR e anti-CCP (52:17) Exames complementares, o que pedir? (52:17) Resultado de exames e fim do caso (53:49) Salves (55:55) Resposta do desafio anterior (56:45) Desafio da semana REFERÊNCIAS 1- VISSER, Henk et al. How to diagnose rheumatoid arthritis early: a prediction model for persistent (erosive) arthritis. Arthritis & Rheumatism, v. 46, n. 2, p. 357-365, 2002. 2- UPTODATE Jul 2020 Robert H Shmerling, MD. Evaluation of the adult with polyarticular pain. 3- UPTODATE Jul 2020 PJW Venables. Diagnosis and differential diagnosis of rheumatoid arthritis 4- UPTODATE Jul 2020 Jeffrey D Klausner. Disseminated gonococcal infection 5- UPTODATE Jul 2020 Don L Goldenberg, Daniel J Sexton. Septic arthritis in adults 6- UPTODATE Jul 2020 Dafna D Gladman, Christopher Ritchlin. Clinical manifestations and diagnosis of psoriatic arthritis

When a workplace injury happens, it is an indication that something within the organization didn’t function the way it was supposed to.  If your organizational goals are set up well, then you can readily identify where the failure was and address it.  Specific, Measurable, Agreed On, Realistic, Time Based - SMART goals are one way to help you and your organization develop a road map for safety success.  On this Episode of the MEMIC Safety Experts Podcast, I talk with Randy Klatt, CSP, Director for Region 2 Loss Control at MEMIC, to better understand how SMART goals can help you stay on the path for safety success.  Peter Koch: Hello, listeners, welcome to MEMIC Safety Experts podcast. Today, we're recording from the studios of Portland Pod. If a full service podcast, recording and production studio right here in South Portland, Maine. And if this podcast sounds good to you. Get a hold of Tanner. Down at PortlandPod.com. My name is Peter Kotch and I'm the host of the MEMIC Safety Experts podcast. I've worked for a number of different organizations and small businesses over the years. And if I've asked the person in charge of safety was important to them and their organization, the answer that they had was always yes. And I was considering that the other day, preparing for this podcast. And I took that question one step further. So what did I understand the safety goal for those companies I worked for, to be? The answer for many, was some form of. Well, nobody gets hurt or everyone goes home at the end of the day. Those really, truly aren't lofty goals, but under more scrutiny. None of those organizations consistently achieve them. Don't get me wrong. These were great companies to work for [00:01:00] and successful in many, many ways. And they consistently achieve the goals that they set. However, that safety goal remained elusive for most of them. Looking back, I realized that even in companies that had safety as a goal or priority, I, along with my co-workers, made choices or engaged in tasks that could have, should have and sometimes did put me in situations where I might have been and sometimes was injured. And in speaking to others, I found that there were similar experiences and responses. Yes, the company I worked for has a safety goal. They don't want me to get hurt. No, I don't always work safely, though. And if they took the question even further and explored what backed up the safety goal, I found that in many cases there was no organized plan or they use their insurance loss run to track progress or the goal was just way too general. Sometimes it was a fairly specific goal and everybody was responsible for it. So [00:02:00] effectively, if everyone's responsible, then no one's responsible. And in one organization, the goal was very specific. But it was never achieved. And the same goal was set year after year after year with we need to do a better job working safely. As the sendoff. So I don't think that my experiences is really unique. So I want to get all you listeners to take a challenge right now. Do you know what the safety goal is at the business or organization that you work for? Don't take too long. They should come to mind fairly quickly. Now, think about the following questions. With that safety goal that you have in mind, how are they measured and when does it get reviewed? Is there a timeframe for that goal? Is the goal, General, or does it target something specific? Who is responsible for that goal? Has your company ever even achieved that goal? You might be surprised, as I was, that the answers to those questions weren't as easy to find as you [00:03:00] thought. So why does it matter? Why can't the goal be that everybody goes home at the end of the day and then leave it at that? Well, it's fine if everyone does that all the time, without exception. But I don't know many organizations that don't have at least one workplace injury a year and often more than one when an injury happens. It's an indication that something within the organization didn't function the way it was supposed to. And if the goals are set up, well, then you can more easily identify what went wrong and address it. If not, then you're in the Spray and Pray School of Workplace Safety, and that's not a functional place to be Today, I'm speaking with Randy Klatt, CSP and director of Region two Lost Control at MEMIC. To better understand how smart goals can help you stay on the path for safety success. Randy's career spans emergency medicine and active duty Navy pilot, commercial airline pilot and aviation safety instructor at the university level. Randy [00:04:00] is the current director of Region two loss control at MEMIC, leading a team of consultants serving the central Maine and southern Maine areas. Randy, welcome to the podcast. Randy Klatt: Thank you, Peter. It's great to be here. Peter Koch: Awesome. Great to have you in the studio today, Randy. So let's jump right into it. You've had quite a bit of experience in large organizations where goal setting was an integral part of work life. So I guess the question to you to start things off is why set goals at all? Randy Klatt: So as a roadmap, as a method of reaching the end, whatever that end might be, we better have some goals along the way so that we know where we're going. We have people who understand what the responsibilities are going to be, how do we measure when we're there, all those sorts of things. So I just look at it as someone sent on a long trip with no compass. How do you figure out where you're going if you don't set it, especially with workplace safety? Because it is an elusive target. [00:05:00] It's a moving target and it takes a lot of work to get there. So if you're not organized and have a strategy and understand if you're failing or if you're winning, it's pretty hard to make any meaningful changes. Peter Koch: So let's talk specifically about safety goals, because in many organizations, the goal of safety is really no one gets hurt but to have a good goal and safety if we have a functional goal and safety. How can that really positively impact the organization overall? So what's the positive impact of a good, solid safety goal? Randy Klatt: Well, again, if you if you set a goal and you achieve it now, you know that you've made progress. And in the world of safety, of course, that goal is to prevent workplace injury. I understand when people say my goal is to have no one hurt. Safety is number one. You know, all those things are said. And I think they are genuinely. They come from the heart. People do believe that that's what they want. They don't want people hurt. But the real benefit [00:06:00] comes when you have a structure around that desire. We all want a lot of things in your personal life as well as your business life. And you know, you will not achieve them unless you have a goal set to do so. And then a structure around that to make it happen. And there's a lot of study out there about the human brain and what goals do for us, what it actually does to motivate behavior. And so back to your question about what does that do for an organization? Well, it actually helps you achieve that goal of getting no one hurt. Now, it may not be possible based on the size of a company and how much exposure you have to go from 100 injuries in one year down to zero the next. That's probably not going to happen. But a progressive improving program that is measurable and that is agreed upon by everybody in the strategy has been put [00:07:00] in place to achieve it. Certainly we pick away at those incidents as they occur and we learn from them and we set new goals. And eventually you find yourself in a place where a son of a gun. We actually did reduce injuries considerably and we've met our goal for the year. Now, we probably need another goal for next year and we'll continue that process, continual improvement is what it's all about. That's the way safety is. It never really ends. You know, as we know, safety never takes a holiday. So you have to continually work on it to make it better and better and better. And of course, the benefits, we could talk about that for a whole podcast. But the cost involved in human suffering and the way people feel when they're injured in the way it inhibits their lifestyle, it's just there are numerous benefits to having a safe and healthful workplace. Peter Koch: Sure. So let's take that concept a little further and talk about how there's obvious benefits if I can achieve the goal [00:08:00] of fewer injuries there. There is a cost benefit. There is a culture benefit. There's an employee health benefit that is overall healthy for the company. But there is also a consistency in habit establishment there. If you are able to set a goal and you're able to go back to it all the time and consider what makes the goal achievable, what you have to do to do that, if you're doing that consistently, it builds those habits. So if you go from a culture that has, take your example, 100 injuries a year and you want to bring it down to half of that in the first year or a quarter of that in the first year, you want to go to 50 injuries or 25 injuries. You got to change something. And in order to make those changes, you've got to identify what the change and then you have to consistently do those things. So if you do it over a year and you keep going back to that, you could pretty much establish some fairly good safety based habits, which, [00:09:00] again, you know, what gets expected is inspected. So if we do those things, we will achieve the goals, hopefully. Randy Klatt: Right. And I think all of that you just said can be summed up in the word culture. You use that a few times. It is the culture of my organization that we shall not have injuries. And I'm going to do everything as the company owner or the CEO or the general manager to make sure that happens. But simply saying that to people. Doesn't really make it work. So hanging up the banner in the facility that says safety is number one. Doesn't make safety happen. What makes it happen is the culture of the organization that supports that message or that goal at all levels. Not only supporting it, but actively doing something about it. As you said. If we don't change anything, nothing's going to change. There [00:10:00] are a lot of companies out there that have great safety records for a period of time. But when we really drill into it, they just got lucky because eventually that comes back to bite them. And they have a really poor year or several poor years or a catastrophic incident. There are other companies that aren't performing very well from a safety perspective, but have huge programs in place. But it's mostly compliance and it's fill in the blank. And it's lip service. And when we really get down to what's happening, the floor level, it isn't really significant for safety improvement. So that's why these goals have to be not only lofty and on the executive level. This year, we're going to reduce injuries by whatever. But they have to work their way all the way down to the newest new hire in orientation to talk about safety. And this is our goal for our company and this is the goal for [00:11:00] your department. You're going to and this is what your supervisor will expect you to do for your safety each day.  And this is what we're going to do at every level through the organization. And it's all going to be measurable and it's going to be assigned to people and they're going to be held responsible for it. And when all that happens at all levels, son of a gun. Now we do make change and injuries, like all other aspects of a business, turn out to be manageable for the vast majority of them. Peter Koch: That's a great point. Being able to establish behaviors and habits by looking at the corporate goal and then breaking it down so that corporate goal makes sense to each part of the organization, no matter how high up in the seats we are, how low on the totem pole that new hire might be so that they all understand what their responsibility is as [00:12:00] part of the success of that goal. Randy Klatt: Oh, that's clear. And we see it as safety consultants. We see it almost every day. We go into businesses and you sit down with the owner and he thinks safety is great or you meet with the safety committee and they're all eating their doughnuts and very happy and safety is doing well. But when I walked into that safety committee meeting, I walked by three hazards that were obvious in the hallway or, you know, the fire extinguishers are never inspected. The emergency exit was blocked. There's electrical cord that's damaged. There's material that people are trying to lift by hand when there's a hand truck or a forklift or a pallet jack to use. Everyone's in a hurry. They're rushing around. And if they're not being hurt, they're just lucky at that point. It's inevitable it's going to happen. So everything has to translate down to the daily activity. And again, a culture will support that. But if you want to look for a structure to put around that, something that will help everybody [00:13:00] understand how to set those goals, then we need some kind of template. And I think that. The smart goal template, which we are about to talk about here, is the way to go because or at least a way to go. I won't pretend to be the expert on all goals or all a psychology or even all safety. But I found these to be very helpful and make it easier for people to set goals that are actually going to be attained. Again, the owner will say there's not going to be any injuries. That's my goal. And I applaud that. And I say, yep, that's the way it should be. But that's not the way it's been for the last 20 years. Somebody got hurt every year. So you're, as you said earlier, you not reaching that. So what are we going to do to actually reach that goal? And that's when we can talk about S.M.A.R.T. That acronym. To help people understand it. There is some criticism out there like there is on [00:14:00] most things that I guess our goals are outdated or it's not what it's cracked up to be. It's not the magic bullet. Well, you're right. Absolutely it isn't, because it's not the acronym that's going to make things change. It's the people who understand what it means and how to use it and actually formulate proper goals and processes to make those happen. That's what's going to make the difference. So it's a tool like any other tool in the safety toolbox that I think will help people but it in of itself. Doesn't do anything. Peter Koch: No, you've got to take action in order for something to happen. It's not it's not the Alexa thing. Hey, Alexa, make me a goal. Randy Klatt: Yeah, it's not a smart speaker. Peter Koch: Thank gosh. It's done great. We can move on with our lives now. Someone else would take care of it. No, if you have the goal when you're speaking there, I was thinking that goals give you a reason for change. Like, if you don't have that goal, then there's no reason to change the behavior or the habit or the culture that might be causing [00:15:00] the circumstances for the injury to happen. So like you’re talking about, you go to talk to the safety committee and they're excited about what's happening there. They're the safety committee. We've just done this. But you've walked through and I've had that same experience walking through with the safety committee and in the stairway that's narrow enough to begin with. They have boxes stored on it, a propane tank stored on it and other equipment stored on it so that there's no way to actually get out of the office that's upstairs without going through all this stuff. There's got to be a reason to make that change. And if the goal is set appropriately, the goal then gives you a reason to change the behavior, to not walk past that, to understand that I can now take action and not that I can just take action, but I must take action because that's our goal. So it is a call to action if they're set correctly. Randy Klatt: Yup well said. And I [00:16:00] think this format can be used at any point in an organization's development. It can be used by any individual. And we can talk about long term goals, short term goals, business goals, personal goals. You want to lose weight this year. You want to lose ten pounds. Okay, there's a goal. What are you going to do to achieve it? Well, I'm going to hope I lose 10 pounds. Peter Koch: That's my goal. Yeah. Yeah. I hope. Randy Klatt: It doesn't work. Well, it may. It probably won't. And it won't last unless you actually have an action plan to put in place. You have something that is specific. Let's just say it's specific, measurable, attainable, realistic and timely. Peter Koch: There you go. Oh, here we go. Randy Klatt: Yeah. And there's your smart acronym. Peter Koch: So before we jump into that, can you talk a little bit about the pitfalls that companies will stumble into when they're setting goals that make those goals unachievable or [00:17:00] they make those goals so complex that they can't? So what are some of the pitfalls that you see companies falling into when they're setting goals? Randy Klatt: Two or three things come to mind right away. One is that the goal is too lofty a goal or too general a goal. Again, the top guy, nobody gets hurt. Now, you all carry that plan out for the year. It's not realistic for most cases. So the goal has to be realistic enough that it can actually be achieved. So we try to, we set people up to fail. If we do not set a goal, that is actually something that has a good chance of succeeding. The second problem is, even if it's a realistic goal, I often see that it doesn't translate to the lower levels of the organization or through all levels of the organization. It is a goal and it's been set by the safety committee or it's been set by management [00:18:00] or the general manager or the owner. But it doesn't get to the floor level. It doesn't get to the new hires. They don't understand it. I'm continually amazed when I do training with companies and I have a group in a room and I say, what's your safety goal for the year? Usually I get the deer in the headlights look. And then somebody says, well, nobody gets hurt. And we have that whole discussion about specific goals. But if I go ask someone on the floor or in a production area or on the job site or in the back office, what the safety goal is for the company. They don't even know if there is one. They've never even considered it. So your administrative support person in, say, a manufacturing company. It's just as important for that person to understand the goals, be in on that planning. Be part of the solution. And help the company to reach their goal [00:19:00] as it is for anyone on the floor. Because how many times have you seen the largest claim, the worst injury in a business is administrative support person with carpal tunnel syndrome or the back injury that occurred when they slipped in the parking lot on the way in, when they deal with hazardous materials and heavy machinery and all that all day long and no one is hurt there but someone else is with some mundane task of walking through the hallway that happened to be wet and they slipped and fell. So these goals have to be. Disseminated through the whole organization, and everybody has to be part of it. So clearly set a realistic goal. Advertise it. Publicize it. Make sure everybody understands it. And then put a structure in place where everyone is involved and everyone understands it. Every person in the building should be able to answer the question. What's your safety goal? You know either for the year or the day or the week or whatever you're asking them about. [00:20:00] If they just look at you like, well, I don't know. Or you can say what's who's on your safety committee? Who's your representative? And if they say, I didn't know we have a safety committee, well, there's your problem. So those lofty goals that have been set by the committee that they're all excited about have not made their way into where it really needs to go, where people will actually change or modify or train or replace equipment or inspect or hold people accountable for any and all of those things to actually make things change and to be safer. So set good goals and communicate it and have a structure in place to make it happen. Peter Koch: Perfect. So a good guide, one guide, because as we establish before, it's not, this is not the only road map to setting goals, but it is a pretty decent road map to setting goals and gives you almost a step by step way to outline [00:21:00] a goal that should function well for your company. And that's the S.M.A.R.T Acronym. So we talked about it before. Specific, measurable, assignable, realistic, time based. And we can get in the E.R part later on, but evaluated and reviewed. So let's break that right down and talk about each of those bits and pieces separately. So let's start with specific. What does it mean to set a specific goal? Randy Klatt: Just as it says, we have to be specific enough so that we can then understand what actions have to be taken to reach it. If it's too broad a goal to overarching. People aren't going to really know where to start with it. And we might not be sure that we've met it because it's too nebulous. So let's get a very specific goal. And when we talk about this S.M.A.R.T Acronym, you ask me about specific, we'll talk about the rest here as we go. But some of those letters can change. It depends on which version [00:22:00] you read. It can be updated. Typically, I don't think I've ever seen anything other than specific for the S and measurable for the M. Those are pretty universal and the T is always time associated in some way. It's either timely. Time related. Time framed. Something like that. The A and the R. Those can be a little bit different, depending on which version you read or which one would work best for you. I've seen Assignable, which I really like. That's the original from back in 1981 when this was first published. So assignable is good because that means it's someone is going to be held accountable for that goal, but it can also mean agreed upon. I've seen attainable, used very much like realistic could be relevant. I've seen a few other words for that letter as well. So sorry I got off track a little bit on you there. But in the end, it doesn't matter as much. Which one you use [00:23:00] as long as you use one. And it makes sense to you. And you don't leave one of those off if you leave off time framed or timely. Now, we don't really know when that ends. It's a continual process, and I know it is. But we have to know if we've made it at some point, probably end it and start over. But you can't leave it off if you leave off assignable or it's not realistic. Well, obviously, things aren't going to happen. Peter Koch: Yeah, it makes it harder. So if we if we roll back to specific and we talk about a phrase that we've used a number of times, like no one gets hurt or everyone goes home at the end of the day in one piece. That's kind of specific. Like no one gets hurt. So nobody here gets hurt. So, OK, but like you said, that's a fairly lofty goal, depending on what industry you're going to be in. Is it actually realistic to do that? And is it truly specific enough like that might be the objective for the organization to have zero injuries, but [00:24:00] a goal that supports that objective might have to be more specific. You might need to look at where your injury trends are. So I go back historically and look at my lagging indicators. And while these are the areas where most of the injuries are coming from, so maybe I need to set some goals in those areas to be more specific about what might be causing those injuries or what the challenges are. So once we find that specific topic, that area that we want to improve on, let's then talk about measurable. So measurable is another one of those pitfalls that we might think we know how to measure, but we might not have a mechanism in place. Who can you speak a little bit about what different ways there are to measure goals? Randy Klatt: Sure. Well, we're talking about workplace injuries here, of course. So I would stick to that area. So are we going to talk about OSHA recordable injuries, lost work time injuries, anything that requires a worker's comp claims, or are you going to talk claims in general? Or [00:25:00] we can talk incidents which are, of course, really important to identify. Go back to Heinrich's pyramid and find a three hundred incidents out there for every few injuries and one serious injury. So it depends on where you're forming these goals and what your area is. But at some point it has to be safety related and measurable. Now, that's when we're talking specifically about injuries. So let's take an example of a company that forms a goal of reducing OSHA recordable injuries by 10 percent for the next calendar year. So we've fulfilled the smart goal, assuming that we have assigned this to people to carry out. We've fit in the blocks. But as we mentioned earlier, simply forming that goal doesn't make it happen. So now what are we going to do? Well, now we have to set another goal and probably a whole bunch [00:26:00] of goals to follow this on in shorter timeframes and smaller overall view points. So let's go to each department and form goals that will support this. Let's form quarterly goals that will support this. Let's go to each supervisor and talk about site inspections. And you have to do one of those every week. OK. We can form a smart goal around that activity. Make sure that happens and then that will support the overall goal. So when we started with a smart goal that talked about reducing injuries, what we end up with is multiple goals that don't say anything about injury but are preventing injury. Their goals related. They're actually activities that are proactive. There are things that we are going to do to prevent the injury. So our overall smart goal is about measuring how many people were hurt. But to support that, we better come up with a whole lot of goals. That [00:27:00] are all about activities designed to prevent those injuries. Peter Koch: And that's a pretty interesting point because the initial goal uses a lagging indicator as a measuring tool. So you're going to go back to that the OSHA log to determine whether or not you had 10 percent less injuries last year over this year, which assumes that you're actually recording. Of course, the injuries on the OSHA log, which is goes back to that measurable discussion. So what mechanisms do we have to actually measure the injuries that come in which might actually look into a different corner of your business? Do we have a mechanism to report injuries? Then do we have a mechanism to track those injuries, not just have them on the show log, but how are we actually looking at those? So the discussion about the S.M.A.R.T goal can take apart or unravel parts of your business to look a little [00:28:00] bit deeper, to see if you actually have mechanisms to manage the goal that you have. And then the beautiful part about what you said is, if done right and the overall goal of reducing injuries for your company gets pushed down to the different levels and departments within the company. Then we start measuring the leading indicators. Are you doing training in those areas where you might find those injuries? Is there injury reporting training going on even at that, the basic level? And is there technical training being done to help support engaging in the risk, the risky behaviors or the risky tasks that the individuals might have to deal with? Or even the non risky ones like you talked about before, parking lot, someone slipping and fall in the parking lot or the administrator who spends all day at their desk getting carpal tunnel. They're not engaging in the hazardous activities that their co-workers are on the factory [00:29:00] floor. But if they're needing to meet the goal, they have to make some change there as well. So there needs to be some leading indicators that can get measured for them. That's a that's a really great they really great thing about the S.M.A.R.T goals is it allows you to look more deeply within your organization to see what you're doing, measure what you're doing, and then look to see if you've actually achieved that. Randy Klatt: Correct. And if you're using the A as assignable, then you have held someone accountable for that goal. So often we see a failure in safety because basically no one is held accountable for it. The owner says there'll be no injuries everybody says Yep. Good idea. We all agree. Let's go do our work. Someone gets hurt and they go, oh, gosh, that's too bad. I'm sorry that happened. No one is held accountable for that injury. And again, I'm not looking for blame. That's not what it's about. It's causal factors. And these things happen for a reason. We [00:30:00] investigate. We find out the reasons. And that has to be. Ninety nine percent of time. It's a human failure of some kind. It's a failure of supervision. It's a failure of training it's a failure of equipment. It's something that should have been fixed, should have been assignable to someone. And then you hold people accountable for that so it won't happen again. So if my evaluation has things on it like productivity and sales and widgets going out the door and customer service and, you know, I'm a great guy to work with and yep, that's teamwork is wonderful. Those are all things that typically people are rated on. But you also have a safety piece of that in there that you were assigned these goals. And we use this format and you know about it. And you didn't do it or you did. Congratulations. Thank you. We did have a great safety year. So it helps to keep everybody. Focused on the goal? Peter Koch: Yeah, I think you're right. And then the [00:31:00] the individual or departments or a group of people who are assigned responsibility for that particular goal. Then when they know they're responsible, they can take responsibility for it. It's like the cord that's laying across the walkway. It's not my cord. It's not your cord. And I don't know whose cord it is, but everybody's walking across it. And I'm not responsible for picking it up until somebody falls across it and falls down and breaks something. Now, everybody's responsible for it because we didn't achieve the goal. But if someone was responsible to make sure the walkways were clear, now we can look to see were we successful. And can we celebrate or do we need to do some remedial training if we weren't successful? So that accountability or assign ability is a key part. Along with realistic, too. If I'm assigned a goal or a team is assigned a goal or a responsibility for it and it's not realistic, that has a really degrading quality to the [00:32:00] morale. As you look forward, if I'm assigned a goal that's not achievable, not realistic, then it doesn't help the safety situation or the safety culture whatsoever. Randy Klatt: It does not. And in fact, when I see that a common way that I see that is when there is actually a safety director or a safety coordinator, you know, someone's been assigned in the company, which, you know, generally speaking is a good step to take. Someone should lead that program. But the problem then becomes everybody's is, oh, well, that job is the safety director's job. And when things go badly, he or she is the one that gets the blame for it. When, in fact, in reference to everything else we've talked about today, it's an organizational effort. There are S.M.A.R.T goals that should be formed for every one that safety director cannot be will not be in all places at all times watching. All people cannot realistically be held accountable for everything that happens. Now, [00:33:00] it is very specifically in their job description, I'm sure, and in their evaluation, because they're a safety person and that should be that way. But in order to attain company wide or organization wide goals, they need help and they need everyone's help to do that. So the owner will come down hard on the safety director because they've got way too many injuries when in fact, I can look back to the owner and say, wait a minute, where were you last week? When was the last time you walked through the facility and noted the issues? Have you ever stood on the top rung of the ladder as a foreman when you knew you shouldn't you have responsibility in this program? So those are the things that would really help to have this format in place, keep everybody on the same page, support that safety director. And when things go well, everybody can take credit for it because it is a team sport. Peter Koch: Let's [00:34:00] pause for a moment and take a quick break. The MEMIC Safety Experts podcast is dedicated to discussing, describing and even debating workplace safety across all industries and applications with industry leaders, top executives and safety experts at MEMIC. Today, we've been speaking with Randy Klatt, director of Region two loss control at MEMIC, about S.M.A.R.T goals and how they can be used to help create a path to better safety performance. However, this S.M.A.R.T goal concept is only part of the roadmap to a successful safety culture. Do you lead people in your company, in your department, or maybe even in your work group? Then you'll want to check out our first episode with Randy Safety Leadership Walking the walk to find out more about how leaders can be successful and create a balance between safety, quality and productivity. You can find Randy's episode and more at MEMIC.com/podcast or check [00:35:00] us out on your favorite podcast platform and then subscribe since we drop new episodes every two weeks. You won't be inundated with notifications, but you'll never miss a new episode. Now let's get back to today's episode. Peter Koch: So to support that team, like with anything else, it needs to be or the goal needs to be refreshed in people's minds time after time after time. You think about any other goal that gets set in a company, whether it's a financial goal, a productivity goal, quality goal. You talk about those things sometimes daily, many times weekly, definitely quarterly and always annually. But from a safety standpoint, if you only look at that goal once a year, that might not be. That might not be appropriate for you. You might need to put it in front of you more frequently. So that time based [00:36:00] part of the Smart Goal acronym is a pretty key part. And not just to say, yep, we're going to look at it annually or it's going to be within this year. That's fine. But then when are you going to go back to it? How are you going to measure it so that we know where we are and can forecast where we're going before we actually get there? Because then you can make relevant change in stride instead of having to wait to the end of the year using the measurements of our lagging indicator and go, oh, we didn't make it. We got to be safer next year. So everybody be more careful. Thank you very much. Randy Klatt: Yeah, that that and that's exactly what we see most of the time. Even if a company has a goal for the year, which I think you have to set, I think that's important. Before you know it, 11 and a half months have gone by. And we look back at the goal and we say, oh, we didn't make it ah well it's because you didn't do anything differently. You didn't do anything to support that [00:37:00] overall overarching goal. That was a year long, even using the S.M.A.R.T format. You're never going to reach that goal simply by setting that goal. It has to be supported by multiple other goals with shorter terms. So, yes, let's review that overall goal every quarter or every month and then let's support that further by having the safety committee meet every month or having a team meet. Let's support their efforts by doing weekly facility inspections. Let's support it by doing tailgate talks or tool box talks every week on Monday mornings. Let's support it by doing quarterly all hands meetings, let's et cetera, et cetera, et cetera. So. The timeframe is important. All those things I just measured mentioned are measurable. If I do it at once a week, we should have 52 of [00:38:00] them. All right. Let's do a couple of vacation this take a few holidays. All right. Let's we're going to do forty five of them this year. There's your assignment. So now there's there are people that have very specific, measurable, attainable, assignable, realistic, timely goal. Just one. That fits the format, that will help support the overall goal of injury reduction. That goal in and of itself still isn't enough. That's one person doing some training once a week. We have to do some other things, too. So every company is different. But I do know the universal truth is that if you have injuries and you don't change something, you'll continue to have injuries. So let's get this S.M.A.R.T goal format and in big into the company and make it a part of our DNA. And you can use this on a daily basis. I always ask people how much of your to do list. Did you get done today? Peter Koch: Oh, [00:39:00] I got it all done. Randy Klatt: Yeah, sure. Peter Koch: Because I only set one thing. Randy Klatt: Yeah, well, at least it was realistic. Peter Koch: It was it was very realistic. Randy Klatt: But that's the point, of course, that, you know, S.M.A.R.T goals are not just that overall annual goal for safety. And these other things that we've talked about, but it can be used on a daily basis. I have a to do list. Am I going to get that to do list done today? Probably not. And that leads to frustration. It's we are in a society where we're trying to do more with less quite often. So you're never going to get it all done. So let's take the bites out of it that we can actually chew and let's break it down. Use the S.M.A.R.T goal format. So today I'm going to be very specific. I can do these three things and the measurable part is today if it's done or not. I'm assigning it to myself. I'll make it realistic. I could do only those things. And of course, time is today. So boom there is a S.M.A.R.T goal. I've taken my long to do list [00:40:00] and made it something that I can actually manage and then I'm going to feel better at the end of the day when I can check off that block that I've actually accomplished something. It feels pretty good. In fact, I'll even sometimes write down things on my to do list that I did. I forgot to write it down. I did. I write it down, then check it off. Peter Koch: Just so you could feel good? Randy Klatt: It feels so good. Peter Koch: Because sometimes it's the only thing that you've got done on your to do list. Randy Klatt: Well that that can be the case. And I understand environment can interrupt all this in a heartbeat. But if you don't start with a plan, if you don't have some kind of structure around it, you'll just be treading water forever. So I think this will really help everyone. Peter Koch: So let's talk a little bit about the ER part of S.M.A.R.T-ER goals, because those are two words tacked onto the end of the original acronym that hadn't always been there. But I think are fairly relevant to talk about, especially today and how fast paced business goes. So it's evaluated and reviewed. So [00:41:00] did you want to talk a little bit about the meeting of those two in the context of the smart goal? Randy Klatt: Sure. And it makes perfect sense once you've reached the end of that timeframe. So you've done S.M.A.R.T. Maybe we should do something else to evaluate how well it went if we made it or not. If the goal was successful or not, it's probably a good idea to evaluate the process. Did we learn anything along the way? If we did. Let's incorporate it into future training so that we can be even more successful down the road. So we should have an appraisal of our goal and how well it went and what we had to do to get there or perhaps why. We didn't make it. So that's the E in the evaluation process. And then the review is in a similar vein. Let's reflect upon it and we can adjust next year's goal. We've done some evaluation. We learned these things. Now as [00:42:00] we review and plan for next year or next month or next quarter, maybe we do need to change some things to make it a more realistic goal. Or we can push a little bit harder. Maybe we can be a little bit more aggressive because we learned this was actually achievable. So it's a good thing to add. Make it a smartah goal. That's how we say it in Maine there is no R. So that makes it a little bit tough, but it makes for a more closed loop process that we've now come full circle around and we're ready to go again for next year. Peter Koch: And I think that's a good framework for when I was listening to you about talk about evaluated. I thought about it could uncover those unintended consequences of your goal setting, like you might set a goal that excellent for the company. But as it trickles down into some of the different departments. There was an unintended consequence that was not healthy for the company. [00:43:00] It might have triggered a cultural change someplace where because of the way the goal was established or it was for lack of a better term, sold in that department to the people. It didn't go over very well. So that caused people to maybe not report injuries because they felt that they were going to be the ones that were going to make the company not achieve the goals. So they pulled it back. They didn't want to do that. So they let things go instead of being more open in their discussion, in their reporting. So evaluation can help, especially if you don't achieve the goal, can help look at or uncover those unintended consequences. And even if you do achieve the goal to look back and say, all right, so these are the reasons that we achieved it, that's really good. And then reviewing it to see if we can use those same tools again for next year and maybe, like you said, push a little harder or pull back a little bit and say, yeah, it wasn't really [00:44:00] realistic to say that we're going to go from one hundred injuries a year to 10. So we need to do something else for next year. So we're going to look at it in a little different way. And we only made it down to 80 injuries. So let's say we can take it now down to 50 instead of all the way back down to five. So it's a good, like you said, closed loop. It's a really good way to make sure that you are cycling your S.M.A.R.T goals or cycling your goals, that they are part of the company's overall health. And part of the company's overall success. They should always be part of that. If you're not, they're not there to help your company be successful, then it's not the right goal to have. Randy Klatt: Right. And if you as you evaluate and review, you may find some things that weren't great and other things that didn't you might have met your goal. But we can still eliminate some of the things that didn't work very well and replace them with something that did when you were talking there. The thing that came to my mind was back belts. Let's give everybody [00:45:00] a back belt because then we're going to reduce back injuries. Great. That's our S.M.A.R.T goal. Everybody's going to get one. It's measurable because they have it or not. It's assignable, each individual. It's realistic because we just bought it and we gave it to you its timeframed I guess in that sense that you're going to wear it all everyday, all the time. We find out later that didn't work. So maybe we should have evaluated and reviewed a little bit more often to really decide if that was a good idea. So pieces of equipment, particularly, we think they're going to be great and well, turns out maybe they weren't. So that evaluation process might be really important. Peter Koch: Yeah, very true. So just to recap here, before we get into our last section is a S.M.A.R.T goal, has a segment that's specific. It's measurable. It's assignable or achievable depending on what a you use. It's realistic and it's time related or it's in a box of time. It starts and it ends there. It's not one that just keeps going forever and ever and ever. And [00:46:00] then when you get to the end of that timeframe or you're within that cycle, there's an evaluation period and then there's a review period for it. So you can keep that goal going so that you can achieve the health of your company. So specific, measurable, assignable, realistic time related, evaluated and reviewed is the S.M.A.R.T.E.R acronym and just the review. Did I miss anything in there? Randy Klatt: No, I think you sum that up quite well with the last thing. The last statement we should try and make there is that it is not merely setting those goals to guarantee your success. It actually takes work. It's not a panacea here. So set the goals. And if. If you don't make it, if you set a goal with the S.M.A.R.T format and you don't make it, it's not really a failure of the model. It's a failure of what you implemented. So let's rework that in that. Make it S.M.A.R.T.E.R for next year or next quarter, next [00:47:00] week. And I think you'll find continual success if you continue that process. Peter Koch: It is interesting. I'm just reflecting back on a couple of conversations we had before the podcast. And we're talking about working with safety committees and setting S.M.A.R.T goals. And you get done with a smart goal and there's a sigh of relief. It's done. We set the goal. Yeah. But now the work starts. This is the time. What you've done is you set the roadmap for success. It's like getting, you know, putting your destination into Google Maps and then sitting in your driveway going. I hope I get there. No, you've got to actually follow the path. Follow. Take action. Follow the path and make sure you're always looking back at the goal so that the action is targeted. And that's a really important part to remember. Randy Klatt: Perfectly said. And that prompted my thought of safety committees, because I see a lot of them and most of them are failures. And it's because they come to a meeting. [00:48:00] They talk a little bit about safety and then they don't do anything until the next meeting and they do that twelve times a year and nothing really changes or happens. So if I were the leader of a safety committee, I would say, let's meet today. And in this meeting, we are going to assign a S.M.A.R.T goal project to every one of you. So in the next month, there's a time part of it. I want you to do this, this and this. So it's specific, measurable, assign it to you it's realistic, timely for the next meeting. And those are all activities that you are going to conduct in the workplace. And there are millions of them that we could think of but report back next month as to how those things went. And that might be actually a successful safety committee. Peter Koch: Yeah. Randy Klatt: It's not about the doughnuts that you get at eight o'clock in the morning on that one Monday a month. It's about what you do between the meetings and using the S.M.A.R.T format will really help people understand what to do. Peter Koch: Yeah, really good point. [00:49:00] Which brings us to our challenge. So I think that our listeners out there take this challenge. So go home or go back to your place of business and make a S.M.A.R.T goal. Find something that you want to change. Might be something at work. Could be productivity or quality based. Something at home. Might be something on your to do list and make a smart goal for that. Make it specific. Figure out a way to be able to measure it throughout the time that you're going to measure it. It's going to be assigned to you. Or maybe if you're a supervisor, you might assign it to someone within your team. And then as you talk to your team or think about it yourself, if it's your goal, is it truly realistic for you to do that? So make that smart goal and then follow through with it. Take action to see if you can achieve it, see if using this can actually make your goal setting process a little bit easier. Or at the very least, a little more structured so that you [00:50:00] can come up and actually be successful. One of the comments I make when I talk with business owners is it's great for you to have this goal of having fewer injuries. Fantastic. And if we get to next year and we're sitting here successful, that you've had fewer injuries. But you look back and you can't figure out why you got here or how you got here, then it's an exercise in futility because you can't replicate it. So a smart goal will help you to be able to replicate success if the smart goal is created correctly. So take that challenge. And if you've done that and you want to share your story, your success with us, go back to the MEMIC.com/podcast and leave us a comment there about what the S.M.A.R.T goal was and how successful you are with that. And we'd love to see how many responses we get from that. So please take that challenge and see how it functions for you. So, Randy, the last part for [00:51:00] you. Where can our listeners find some more resources about smart goals or developing goals overall? Randy Klatt: Well, certainly I would be remiss if I didn't recommend MEMIC's Web site and our safety director, which has hundreds of documents in there related to projects, checklists, inspection information, all sorts of tools that can be used to help you formulate your own goals. If you really want to just know more about S.M.A.R.T, well, do what everybody does. Go to your computer and type in S.M.A.R.T goals in your Web browser and you'll earn your search engine. You'll find plenty of information about it. Some of the different formats, S.M.A.R.T versus S.M.A.R.T.E.R, and those other letters that sometimes represent other words like attainable or achievable or is it assignable and make it fit for you. There's plenty of information out there about it. Bottom [00:52:00] line is, I want you all to figure out a way to make it work for your business, for your activities, personal or business. And make this place a little bit safer. One goal at a time. Peter Koch: Excellent. Randy, thanks. So that about wraps up our Safety Experts podcast. And thank you, Randy, for being here today and sharing your expertise with us. Randy Klatt: My pleasure. Peter Koch: Today, we've been speaking with Randy Klatt, CSP director for Region two loss control at MEMIC about S.M.A.R.T goals and its effect on workplace safety on the MEMIC Safety Experts podcast. If you have any questions for Randy or we'd like to hear more about our particular topic on our podcast. E-mail us at podcast@MEMIC.com. Also, check out our show notes that MEMIC.com/podcast where you can find links to resources for a deeper dive into this topic. Check out our Web site, MEMIC.com/podcast where you can find our podcast archive. While you're there, sign [00:53:00] up for our Safety Net blog so you never miss any of our articles or safety news updates. And if you haven't done so already, I'd appreciate it if you take a few minutes to review us on Stitcher, iTunes or whichever podcast service that you find us on. If you've already done that. Thank you. Because it helps us spread the word. Please consider sharing this show with a business associate friend or family member who you think will get something out of it. And as always, thank you for the continued support. And until next time, this is Peter Koch reminding you that listening to the MEMIC Safety Experts podcast is good, but using what you learned is even better.              

The Preserved Book is a short course brought to you by Al Madrasatu Al Umariyyah. Amidst the many false doubts that are thrown around about the religion of Islam, the preservation of The Qur’an is always a favourite for the non-Muslim orientalists.

Show notes at pharmacyjoe.com/episode496. In this episode, I’ll discuss whether alteplase can be used to treat COVID-19 patients with thrombotic disseminated intravascular coagulation. The post 496: Can alteplase be used to treat COVID-19 patients with thrombotic disseminated intravascular coagulation? appeared first on Pharmacy Joe.

It's week number *checks notes* four (?!) of CC in the 'tine, and now we're really... soft. This episode introduces Clarence, who we're sure will be a mainstay of the pod. Kinda like when Shrek 2 introduces Puss in Boots. Also: the difference between Target and Wal-Mart, the poet laureate of the post-apocalypse, hanky panky, and terrible British accents. Plus: more quarantine recs!   Send your missed connection stories to craigcripod@gmail.com. And don't forget to follow us on Instagram @craigsistentialcrisis and like us on facebook!

The National Heritage Council together with and the Congress of Traditional leaders of South Africa have urged government to disseminate information about the covid-19 pandemic in all indigenous languages. CONTRALESA says people in rural areas will be worst affected if the virus spreads. This as the number of corona virus cases in country now stands at 61. Contralesa's secretary general Zolani Mkiva says information about the corona virus needs to reach rural areas in a language people understand

Blackstone Minerals have been working hard on the Ta Khoa Nickel project since Scott Williamson had the last Coffee with Samso.  I have always liked nickel and I still think that the good times are not here yet.  What Scott and his team are trying to define is a Nickel Sulphide deposit that will be payable to mine.  As in the property investment strategies, location is the most important component which will determine the ingredients within the rock types.  I do feel that Blackstone Minerals are in the right address and the recent drilling proves that they are taping some good mantle materials. Form a geological point of view, these are critical components.  I do agree that there may be some sovereign issues but from what I am hearing, these are not creating any barriers.  As in these developing countries in Asia, economic development is of the utmost importance.  I have many business associates who tell me that Vietnam is no longer a sleepy place. Things are booming and the labour costs are no longer as they were in the past.  I am not saying that they are Western standards but they are definitely signs of economic growth. I have always enjoyed my conversation with Scott and this is another great conversation as we learn of the discovery of Platinum, Palladium and Gold discovery in their recent exploration.  Mobilisation of multiple rigs to the site is a great sign that money is going into the ground. It is a great update on Blackstone Minerals and their journey to develop the Ta Khoa Nickel Project.

Listen to episode 149 of the Digital and Social Media Sports podcast with Shawn Green and Daniel Kirschner, Co-Founders of Greenfly. 65 minute duration. Subscribe to the podcast via iTunes or listen on Stitcher Posted by Neil Horowitz Follow me on Twitter @njh287   Connect on LinkedIn    

Welcome to OBGYN Audiophile! A couple of free audio files will be  uploaded as podcasts over the next few weeks. They contain practice  questions and answers for those studying hard for their OBGYN oral  examination. Good luck to all of you. Hope you find these files helpful  to practice your oral exam skills while exercising, commuting or even  doing your dishes! Happy multitasking. For more files like this one,  please visit our website www.obgynaudiophile.com where files can be  purchased for a small fee. Again, Good Luck!  This episode contains questions and answers regarding DIC in Obstetrics. It is both a great popquiz for those of us on the labor units regularly and a perfect refresher for those in GYN only fellowships.  --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

   Anarchist World This Week                               26-9-18  . Disseminated institutional carcinoma . Liep Ojulo memorial . Peter Norman week 9th-16th October 2018 . ABC - Manufactured outrage . Invasion Day - Morrison dreaming . Fixated threat assessment centre . Budget savings - kick the poor till the money rolls out of their pockets  . Dr Joe Toscano . Toscano4thepublic . anarchistmedia.org . pibci.net . com/peternormancc . 0439 395 489 . P.o Box 20 Parkville 3052

Welcome to Side B of this week's session. A soulful music mix brought to you by none other than the wizard behind the Dukkan Show's sound, Toofless. #WelcomeToYourTribe The Dukkan Show is hosted by OT & Reem, powered by Toofless. See omnystudio.com/listener for privacy information.

Welcome to Side B of this week's session. A soulful music mix brought to you by none other than the wizard behind the Dukkan Show's sound, Toofless. #WelcomeToYourTribe The Dukkan Show is hosted by OT & Reem, powered by Toofless.

VP of the legendary Rock Steady Crew, Bboy Ynot, came through to Dubai to spend a week with the tribe. During his stay with OT and Reem, he obviously got behind the mic to share his thoughts on his trip to the Middle East, his experiences, culture, music, and dance, #WelcomeToYourTribe The Dukkan Show is hosted by OT & Reem, powered by Toofless. See omnystudio.com/listener for privacy information.

VP of the legendary Rock Steady Crew, Bboy Ynot, came through to Dubai to spend a week with the tribe. During his stay with OT and Reem, he obviously got behind the mic to share his thoughts on his trip to the Middle East, his experiences, culture, music, and dance, #WelcomeToYourTribe The Dukkan Show is hosted by OT & Reem, powered by Toofless.

This week we discuss the presentation and management of herpes zoster. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_112_0_Final_Cut.m4a Download Leave a Comment Tags: Infectious Diseases, Varicella Show Notes Take Home Points Classically, herpes zoster will present with rash and pain in a dermatomal distribution Immunocompromised patients are at greater risk for significant complications of zoster, including visceral dissemination and zoster ophthalmicus Appropriate therapy includes antiviral therapy within 72 hours of onset of symptoms and analgesia for acute neuritis Disseminated zoster and zoster ophthalmicus threatening sight should be treated with IV antivirals Read More Emergency Medicine Ireland: Tasty Morsels of EM 073: FRCEM Varicella Life in the Fast Lane: Herpes zoster ophthalmicus Core EM: Herpes Zoster Read More

This week we discuss the presentation and management of herpes zoster. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_112_0_Final_Cut.m4a Download Leave a Comment Tags: Infectious Diseases, Varicella Show Notes Take Home Points Classically, herpes zoster will present with rash and pain in a dermatomal distribution Immunocompromised patients are at greater risk for significant complications of zoster, including visceral dissemination and zoster ophthalmicus Appropriate therapy includes antiviral therapy within 72 hours of onset of symptoms and analgesia for acute neuritis Disseminated zoster and zoster ophthalmicus threatening sight should be treated with IV antivirals Read More Emergency Medicine Ireland: Tasty Morsels of EM 073: FRCEM Varicella Life in the Fast Lane: Herpes zoster ophthalmicus Core EM: Herpes Zoster Read More

Open Forum on Acute Disseminated Encephalomyelitis

Learning About Acute Disseminated Encephalomyelitis

Presented by Michael R. Foley, MD

Presented by Michael R. Foley, MD

Rare Genomics Institute RareShare Ask the Expert:Podcast Series, Disease Specific Q&A Sessions, For feedbacks contact, Scientific Director, Rare Genomics Institute: Deepa Kushwaha, deepa.kushwaha@raregenomics.org (Music credit: www.bensound.com)

Objective: Detection of disseminated tumor cells (DTCs) in the bone marrow (BM) of patients with breast cancer is associated with poor outcomes. Recent studies demonstrated that DTCs may serve as a prognostic factor in ovarian cancer. The aim of this 3-center study was to evaluate the impact of BM status on survival in a large cohort of patients with ovarian cancer. Materials and Methods: Four hundred ninety-five patients with primary ovarian cancer were included in this 3-center prospective study. Bone marrow aspirates were collected intraoperatively from the iliac crest. Disseminated tumor cells were identified by antibody staining and by cytomorphology. Clinical outcome was correlated with the presence of DTCs. Results: Disseminated tumor cells were detected in 27% of all BM aspirates. The number of cytokeratin-positive cells ranged from 1 to 42 per 2 x 10(6) mononuclear cells. Disseminated tumor cell status did correlate with histologic subtype but not with any of the other established clinicopathologic factors. The overall survival was significantly shorter among DTC-positive patients compared to DTC-negative patients (51 months; 95% confidence interval, 37-65 months vs 33 months; 95% confidence interval, 23-43 months; P = 0.023). In the multivariate analysis, BM status, International Federation of Gynecology and Obstetrics stage, nodal status, resection status, and age were independent predictors of reduced overall survival, whereas only BM status, International Federation of Gynecology and Obstetrics stage, and resection status independently predicted progression-free survival. Conclusions: Tumor cell dissemination into the BM is a common phenomenon in ovarian cancer. Disseminated tumor cell detection has the potential to become an important biomarker for prognostication and disease monitoring in patients with ovarian cancer.

Breast Cancer

Breast Cancer

Molluscum contagiosum is a common viral skin infection in children with atopic diathesis and not rare in HIV patients. We report a 45-year-old psoriasis patient who developed eruptive mollusca contagiosa during an antipsoriatic treatment with efalizumab. Copyright (C) 2008 S. Karger AG, Basel.

Introduction The prognostic significance of disseminated tumor cells in the bone marrow (DTC-BM) of breast cancer patients has been demonstrated in many studies. Yet, it is not clear which of the primary tumors' biological factors predict hematogenous dissemination. We therefore examined `tissue micro arrays' (TMAs) of 265 primary breast carcinomas from patients with known bone marrow ( BM) status for HER2, Topoisomerase IIa ( Top IIa), Ki 67, and p53. Methods BM analysis was performed by cytospin preparation and immunocytochemical staining for cytokeratin (CK). TMAs were examined by immunohistochemistry (IHC) for HER2, Top IIa, Ki 67 and p53, and fluorescence in situ hybridization ( FISH) for HER2. Results HER2 ( 2+/ 3+) was positive in 35/167 (21%) cases ( FISH 24.3%), Top IIa (> 10%) in 87/187 (46%), Ki 67 in 52/ 184 (28%) and p53 (> 5%) in 61/174 cases (34%). Of 265 patients, 68 (25.7%) showed DTC-BM with a median of 2/2 x 106 cells ( 1 to 1,500). None of the examined factors significantly predicted BM positivity. Significant correlation was seen between HER2 IHC and Top IIa ( p = 0.06), Ki 67 ( p = 0.031), and p53 ( p

Phenotyping of cytokeratin (CK) 18-positive cells in bone marrow is gaining increasing importance for future prognostic screening of carcinoma patients. Urokinase-type plasminogen activator receptor (uPA-R) is one example of a potential aggressive marker for those cells. However, a valid and reliable double staining method is needed. Using monoclonal antibodies against uPA-R and CK18, we modified an immunogold/alkaline phosphatase double staining protocol. UPA-R/CK18-positive tumor cell controls exhibited black uPA-R staining in 15–80 of cases and red CK18 staining in almost 100 of tumor cells. Isotype- and cross-matched controls were completely negative. Bone marrow from healthy donors was always CK18-negative. Reproducibility of CK18-positive cell detection was estimated in a series of specimens from 61 gastric cancer patients comparatively stained with the single alkaline phosphatase-anti-alkaline phosphatase (APAAP) and our double staining method (106 bone marrow cells/patient). In four cases, double staining could not reproduce CK18-positive cells. In 34 cases it revealed fewer or equal numbers, and in 23 cases more CK18-positive cells than the APAAP method. Overall quantitative analysis of detected cell numbers (838 in APAAP, range 1–280 in 106; double staining 808, range 0–253) demonstrated relative reproducibility of APAAP results by double staining of 97. Correlation of results between both methods was significant (p

Leukocytes play an important role in the development of disseminated intravascular coagulation (DIC). In the reperfusion phase of OLT a DIC-like situation has been described and has been held responsible for the high blood loss during this phase. We investigated the role of leukocytes in the pathogenesis of DIC in OLT by measuring the leukocytic mediators released upon activation (cathepsin B, elastase, TNF, neopterin) and the levels of thrombin-antithrombin III (TAT) complexes, seen as markers of prothrombin activation. Arterial blood samples were taken at 10 different time points during and after OLT. Samples were also taken of the perfusate released from the liver graft vein during the flushing procedure before the reperfusion phase. Aprotinin was given as a continuous infusion (0.2-0.4 Mill. KlU/hr) and its plasma levels were determined. Significantly elevated levels of neopterin (15-fold; P