Podcasts about durham va medical center

While modern psychiatry has improved many patients' quality of life, it falls short in addressing their relational and spiritual needs? Can we draw on theological wisdom and scientific evidence to reframe our understanding of mental health care? Dr. Warren Kinghorn is a psychiatrist and theological ethicist whose work centers on the role of religious communities in caring for persons with mental health problems. He is jointly appointed to the faculties of Duke Divinity School and the Department of Psychiatry and Behavioral Sciences of Duke University Medical Center, and practices psychiatry at the Durham VA Medical Center.Check out the DMIN in Spiritual Formation and Relational Neuroscience here. Stay Connected: NEED spiritual direction or coaching that aligns with this podcast? Connect with Cyd Holsclaw here. Join the Embodied Faith community to stay connected and get posts, episodes, & resources. Support the podcast with a one-time or regular gift (to keep this ad-free without breaking the Holsclaw's bank).

JCO PO authors Dr. Michael J. Kelley and Dr. Katherine I. Zhou share insights into their JCO PO article, “Real-world Experience With Neurotrophic Tyrosine Receptor Kinase Fusion–positive Tumors and Tropomyosin Receptor Kinase Inhibitors in Veterans.” Host Dr. Rafeh Naqash, Dr. Kelley, and Dr. Zhou discuss the robust Veterans Affairs (VA) National Precision Oncology Program (NPOP), accurate identification of gene fusions, and toxicities landscape of TRK inhibitors. Click here to read the article! TRANSCRIPT Dr. Rafeh Naqash: Hello and welcome to JCO Precision Oncology Conversations, where we bring you engaging conversations with authors of clinically relevant and highly significant JCO PO articles. I'm your host, Dr. Rafeh Naqash, Social Media Editor for JCO Precision Oncology, and assistant professor at the OU Stephenson Cancer Center in the Division of Medical Oncology.   Today, I'm thrilled to be joined by Dr. Michael J. Kelley. Dr. Kelley is the executive director of Oncology for the Department of Veterans Affairs. He's also the chief of Hematology-Oncology at the Durham VA Medical Center, and also a Professor of Medicine at the Duke University School of Medicine. And he's also a member of the Duke Cancer Institute. We are also joined by Dr. Katherine I. Zhou who is a Hematology-Oncology fellow at the Duke University. Dr. Zhou also spent time at the Duke Medical Center as part of her fellowship training, which I believe is how this project that was led by her came to fruition.  So thank you both for joining today. This is going to be, hopefully, of very high interest to our listeners and I look forward to chatting with you both. Dr. Michael Kelley: Great, thanks for having us. Dr. Katherine Zhou: Thank you for having us. Dr. Rafeh Naqash: Thank you so much for joining. So I was very intrigued with this paper, and this paper follows a recent podcast that we had with Dr. Alexander Drilon, who's led some of the NTRK tropomyosin receptor kinase inhibitor studies that have been published in the last several years. And we had a very interesting discussion a couple of weeks back and I felt this was going to be a very interesting subsequent discussion into what was also an interesting discussion with Dr. Drilon. So what caught my attention is obviously the fact that you guys in this report, which is a real-world report, did not exactly see what we generally expect from clinical trials as far as response to target therapies in NTRK fusions.  So before I ask you questions related to this project, one of the very interesting things at least I found was the fact is that the Veterans Health Administration is the largest integrated health system. Studies, whether conducted in the UK, for that matter European countries, or in Canada, they have integrated health systems which we do not. But we do have this advantage of the VA trying to do things in a very unique, centralized manner. So I wanted to ask Dr. Kelley first, how is it that you have implemented this National Precision Oncology Program, the NPOP as you call it, into the VA precision medicine workflow and how does it help in conducting research studies like the one that you published in the JCO Precision Oncology? Dr. Michael Kelley: Yeah, thanks for that question, Dr. Naqash. The NPOP started in 2016 as a national program and right from the beginning it grew out of an effort that was a joint collaboration between both clinical operations in the VA and the Research Office or the Office of Research and Development. It was designed from the very beginning to support discovery, new knowledge generation, and identifying patients for clinical trials in addition to bringing them best-in-class molecular testing and a consultation service.  So it was initially funded out of the Cancer Moonshot 1 in 2016 when President Biden was then Vice President. The VA endorsed the model going forward in 2019 and now it's continued on and grown even bigger, it's expanded both in terms of scope and the complexity of the testing that's been done. So it was offered as services to facilities. They didn't have to do this, but I think they all saw the value of using NPOP to provide this group of services and that's what led to the generation of the robust underlying dataset that Dr. Zhou has used for this paper. Dr. Rafeh Naqash: Definitely. Thank you so much for that explanation. I did not know, and was not well aware, of how robust this program is. So I think it's a great learning opportunity for our listeners to know that a program like this exists. As we all know, there are different platforms, sequencing platforms, that each institution uses, whether it's commercial or whether it's in-house based. But the fact is, until and unless we have big pool datasets like the ones that you have generated or have access to, it's not easy to answer real-world questions.  So first of all, I'd like to congratulate you and the rest of the VA administration to set up a program like this that hopefully is helping in matching the right patients to the right therapies and in clinical trial approvals. Now, before we take a deeper dive into the study that Dr. Zhou led, I did want to ask you, you have access to this amazing centralized platform, what are the kind of sequencing strategies or platforms that you use as part of this program? And is there an incorporation of molecular tumor boards to help understand some of these sequencing results that sometimes can be a little complicated to understand even for oncologists who look at these reports on a daily basis? So could you tell us a little bit more about that, Dr. Kelley? Dr. Michael Kelley: Yeah, certainly. So the VA contracts for the sequencing service, currently we're contracting with Foundation Medicine and Tempus for the comprehensive genomic profiling. There are some other services, and before we started using Foundation, there were two other companies that we used. There is a molecular tumor board. Our molecular oncology tumor board is designed primarily for case-based education. But there's also an asynchronous on-demand consultation service that occurs electronically because we have a unified electronic health record system. So any oncology provider in the country can enter a request through what's called an interfacility consult. It comes to a team, that team vets that, discusses it with the appropriate experts; that includes molecular oncologists, molecular pathologists. A lot of oncology pharmacists have been trained at a course that's at the University of Kentucky.  And we have a lot of experience in doing this since that service was set up in 2016 as well, right from the beginning, because we understood the complexity of the data and the need for every oncologist across our enterprise to have access to the very best interpretation of that.  We also have educational sessions that are integrated into the molecular tumor board time slot we call primers in terms of the underlying science of why you do the interpretations the way you do. And then there's also some additional education that we'll be endeavoring to offer to our staff and our oncologists coming up this year. Dr. Rafeh Naqash: Excellent. It sounds like you definitely have taken this into a very multidisciplinary approach where you're incorporating oncologists, pharmacists, and perhaps even genetic counselors and then, obviously, keeping the patient at the center and trying to find the best possible therapies that are most relevant for that individual.   Now, going to Dr. Zhou's study here. Dr. Zhou, first of all, it's great to see a fellow lead a study and then especially, I think you're our first fellow on the podcast. We've had a lot of different individuals, but we have not had a fellow before. So thanks for coming.  Could you tell us, for our listeners, what drove your interest into NTRK fusions? As we know, they are rare, something that is not commonly seen, and we do have clinical trial data in this space. So what was the idea behind looking at a real-world data set? Did you start out with a hypothesis or were you just interested to see how targeting these fusions in the real-world setting, actually, what kind of results does it lead to? Dr. Katherine Zhou: Yeah, well, first of all, thanks for the question. And I do just want to mention that although I did sort of bring this project to the finish line, it was started by another fellow, Vishal Vashistha. So just wanted to mention that. And I think the interest was really just that NTRK is such a rare fusion and just a difficult one to be able to study, like you said, in the real-world setting. And we have the advantage of having so much data through the VA and through NPOP, specifically. And so having seen such great results with the TRK inhibitors and clinical trials, I think there's this big question of how that translates into the real-world setting. We have the ability to do that with our large patient population. Dr. Rafeh Naqash: Excellent. And again, it's nice to acknowledge the support that you had from the other individual who co-led this study. Now, since you would have, I'm guessing, done most of the analysis here and looked into the whole idea of the kind of results that you saw—and from my understanding, you looked at the entire VA data set and tried to understand first the incidence or frequency of NTRK fusions and also responses to treatment, which I think is the main message—but could you tell us a little bit more about the data set? How did you acquire the data set, and what it took to analyze? Because obviously every project has a very unique story, and I'm guessing there's one very unique story here, since as a fellow you have limited time to do all this interesting work. So how did you navigate that and analyze and work with some of the things that you had to look at to get to the results? Dr. Katherine Zhou: Yeah, so again, this was work that was done with multiple people involved, of course. And we used what we had, the resources we had available, some tools we had available through the VA. So first, looking at NPOP and looking at patients who are sequenced through NPOP, we could just find all the ones who had an NTRK rearrangement of some kind. The second way we went about finding patients was through the CDW or the Corporate Data Warehouse where we could see which patients were prescribed larotrectinib or entrectinib and kind of go backwards from there and see which of those patients had NTRK alterations or specifically NTRK rearrangements. And so we combined the patients from both of those different methods to come up with our cohort at the end of 33 patients with NTRK rearrangements and 12 patients who are treated with TRK inhibitors. Dr. Rafeh Naqash: Excellent. Could you walk us through what was the subsequent analysis as far as how many NTRK fusions? I know you mentioned in the paper about DNA versus RNA-based testing. So how many were DNA-based, how many were RNA-based? I think there's some element of ctDNA-based testing also, or what tumor types those people had so that we get an understanding of what's the landscape of the findings that you had. Dr. Katherine Zhou: Sure. Since this is a real-world setting, as you may expect, the vast majority of the sequencing was done through tissue DNA sequencing, and that was the case. So for the 25 patients who were sequenced through NPOP that we found who had NTRK rearrangements, 23 of them had tissue DNA sequencing. And then one was tissue DNA RNA, and one was cell-free DNA sequencing. And so using that and being able to go back and look at how many patients have been sequenced in NPOP in total, we could kind of come up with a yield, although the numbers are very small. But we do see that there does seem to be probably a lower yield, for example, with cell-free DNA sequencing, as one might expect.  And then looking at our total group of 33 patients, if we look at what types of cancers they had, we did have quite a few patients just based on prevalent tumors at the VA, I think, and in the population, prostate cancer was common, lung cancer, and then we had smaller numbers of colon and bladder, and I think there's a pancreatic cancer patient. We did have some of these rarer tumor types that more commonly have NTRK fusions as well, so like papillary thyroid carcinoma, and salivary gland cancers as well as soft tissue sarcomas. Dr. Rafeh Naqash: Question for you, Dr. Kelley, related to this data set: do you think that given that the denominator that you have is a unique population, the VA population, that's often males, they're usually above the age of 18, could the frequency have been influenced by that denominator where you may not have been able to capture, let's say, some of the rarer tumors that happen in the younger patient population, for that matter? Could that be a little bit of a bias here?  Dr. Michael Kelley: Definitely. The population of veterans that have cancer that is treated in the Veterans Health Administration do represent generally adult males in the United States, but there is some skewing in certain regards. One of them is towards a higher frequency of smoking status. So not current smoking, which is actually about the same as the national average of about 11%, but the former smoking rate is about twice as high as it is in the rest of the United States. So we may have a lower frequency of some actionable variants in cancers in general because there's a higher etiological role for tobacco smoke in our population. But overall, looking at adult men if we look at like EGFR mutations, our incidence of EGFR mutations in adenocarcinoma is similar to what is reported in other real-world evidence bases from the United States, which is significantly lower than that which is found in academic medical centers. Dr. Rafeh Naqash: Thank you. I'm a big fan personally of real-world data sets. I do a lot of this with some other collaborators and generally, I do phase I trials, which is why I'm interested in precision medicine. And two weeks back, actually, I had a patient with prostate cancer, who ended up having NTRK fusion on a liquid biopsy. Now, you do talk about some of this related to in-frame or out-of-frame fusions and how that can have interesting aspects related to the kinase domain functionality and RNA expression. Dr. Zhou, for the sake of our listeners, could you briefly describe why understanding some of that is important and what implications it has? Dr. Katherine Zhou: Yeah, so I think the oncogenic NTRK fusion that we think of and that's being targeted by the TRK inhibitors is a fusion 5-prime of a protein that forms a dimer and on the 3-prime end is the kinase domain of the tropomyosin receptor kinase. And so you have to have some kind of a gene fusion that results in not only the transcription of that RNA fusion, RNA transcript, but then the translation of that fusion protein. So that needs to be, like you mentioned, that has to be in frame so that the entire protein is translated and expressed and it needs to include the kinase domain. It can't be the other end of the NTRK gene. And both of the genes need to be in the same orientation, of course. And then also the partner gene probably matters in that the ones that we know that actually cause activation of this oncogene are the ones that sort of spontaneously dimerize. And so that's a lot of requirements that we don't necessarily see when we just get, for example, a DNA sequencing result that says there's an NTRK rearrangement. Dr. Rafeh Naqash: Excellent way to describe the importance of understanding the functionality of the activated oncogenic fusion. Now, I know here in most of the patients that you have is DNA sequencing and I'm sure you'll talk about some of the results. And when you connect the results to the kind of data that you have, do you think not having the RNA assessment played a role in not knowing perhaps whether those fusions were functionally active?  Dr. Katherine Zhou: Yes, I think we can't know for sure without having the RNA sequencing data. But certainly, that is a pattern in our small number of patients that we saw and something that makes sense just in terms of the mechanism of this oncogenic fusion protein. So I think that is a question of when should we be doing RNA sequencing to confirm that a fusion that we see on DNA sequencing is actually transcribed into RNA and how do we use RNA sequencing in a cost-effective and useful way to be able to detect more of these NTRK fusions that are actually clinically relevant. Dr. Rafeh Naqash: I absolutely agree with you and this is an ongoing debate. I know some platforms, commercial platforms that is, have incorporated RNA sequencing both bulk or whole transcriptome as part of their platform assessments, but it's still not made inroads into some other sequencing platforms that are commercially used. So it's an ongoing debate, but at the same time helping people understand that certain fusions need some level of RNA assessments to understand whether they're functionally active or not. Which again has implications, as you pointed out in terms of therapies are extremely relevant.   Now, going to the results, which again was very interesting, could you tell us about the findings from the therapeutic standpoint that you observed and what your thoughts are about why you saw those results which were very different from what one would have expected?  Dr. Katherine Zhou: Right. So in the clinical trials of larotrectinib and entrectinib, there were quite high objective response rates on the order of 60%, 70%, even almost 80%. In our very small real-world group of 12 patients who were treated with TRK inhibitors, nobody had an objective response and five patients had stable disease and everybody else, the other seven patients, progressed.  And so the question is why did we see such a big difference compared to the trials? I sort of think of this as two big buckets. One is the population that we were looking at. So this is a real-world population. For example, in the clinical trials, there were almost no Black or African American patients, whereas here we had about 30%-40% Black or African American patients.  Because it's a VA population, it was very heavily male, of course, the age groups are also different in that we didn't have children in the VA population whereas children were included in the trials. And the tumor types also differed because I think in the trials, which makes sense, there's a bias towards tumor types that have more NTRK fusions, and some of the tumor types we were looking at are just common tumor types like prostate and lung cancer where NTRK fusions are not common. But just because there are so many patients with these cancers, we did see them. And so certain of these groups, particularly certain racial and ethnic groups as well as certain tumor types, were not really represented in the trial to the extent that we can make conclusions about whether TRK inhibitors are effective in this population. So that's one.  The second part, I think we've already talked about some, is just the method of detecting these NTRK fusions and how many of these NTRK fusions were actually truly producing oncogenic fusion proteins. And I tried to sort of categorize some of these fusions as being canonical in that they've been more studied. We know the partner gene, they are known to produce an oncogenic protein and to respond to TRK inhibitors. But actually of the four patients who had what we called canonical fusions, all four of them had stable disease at least, whereas the ones that were noncanonical mostly did not have a response or have even stable disease and mostly just progressed. And so then you wonder whether they even had the actual target protein we thought we were targeting. So this is where the real-world setting we're not doing the RNA sequencing or this additional testing to confirm that it's an oncogenic fusion protein. Dr. Rafeh Naqash: And I do see in your results there's a patient especially—you pointed out canonical and noncanonical fusions—you have a patient with a papillary thyroid cancer that I believe had a stable disease for close to two years plus. Is there anything interesting apart from an NTRK fusion in that specific patient where certain co-mutation could have played a role or certain other factors that do you think played into the fact that this patient had stable disease but didn't respond on the TRK inhibitor? Dr. Katherine Zhou: I don't have a great answer for that. I think this is one of the cancers that was well represented in the trials and that commonly has NTRK, or more likely has NTRK fusions. And this was a well-studied canonical NTRK fusion. So I think those are all reasons. The question of co-mutations I think is really interesting. We didn't have the data for every single patient, but for the ones we looked at a lot of the time, NTRK fusions are mutually exclusive with other driver mutations. So we didn't see a whole lot of commutations that we could sort of differentiate between responders or stable disease and progression.  Dr. Rafeh Naqash: Thank you. Going to the toxicities, as a phase I trialist myself toxicity is the bane of my existence where we have to label toxicities, attribute toxicities, understand toxicities. The trial, obviously, as you very well know, that in the trials, they didn't have a lot of toxicities that caused patients to come off or required significant dose reductions, which is not the case compared to what you saw. Could you tell us a little bit about the landscape of toxicities for TRK inhibitors and what you saw in your cohort? That, again, I feel was interesting.  Dr. Katherine Zhou: Of the 12 patients, I think two-thirds of them had either dose reduction or interruption or discontinuation, or some combination of the above. The toxicities we saw were more common than, or at least led to discontinuation and interruption and dose reduction more commonly than in the trials. But the toxicities we saw were also seen in the clinical trials. So LFT elevations, creatinine elevations, neurotoxicity, some cytopenias. We didn't actually see a whole lot of that, but those were present as well, and then some sort of nonspecific things like fatigue. And so, as much as we could tell from retrospective trial review, at least these were severe enough to lead to holding the drug. Dr. Rafeh Naqash: Thank you so much, Dr. Zhou. Question for you, Dr. Kelley. Putting this into perspective, the analysis that you did, how would you connect it to other real-world questions that one could answer using these kinds of data sets? So basically, what are the lessons learned from this amazing program that you guys have run successfully and are, I'm guessing, expanding in different directions? And how can you use a program like this to look at some of these unique questions using real-world data sets? Dr. Michael Kelley: There are a couple of, I guess, next steps for us that are based off this study and other information that we've gotten in other analyses from our NPOP data set. So, first of all, access to an RNA-Seq test. So that has been resolved to some extent, in that we now have two options for comprehensive genomic profiling, one of which does have RNA-Seq.  And then the other approach that we're doing is to do more robust data generation. So we're going to be launching a study to collect prospective data on patients who are treated with off-label drugs. And as part of that, we will also have an on-label cohort for rare populations or any investigator in the VA who's interested in a particular drug or a particular genetic variant. They'll be able to tie into this protocol, and we will then collect data from across the system prospectively, which we think will improve the quality to some degree.  And then thirdly, I think there's an opportunity to merge the initial generation of data in rare genetic types or other populations, which are highly selected by doing a distributed type of clinical trial where patients can be enrolled in prospective treatment trials. So we're not just generating data based on their real-world exposure to FDA-approved drugs, but we're generating data as we're developing the new drugs, we can have a much more heterogeneous and representative population of patients enrolled in clinical trials. So this is called the decentralized clinical trial model. We're starting to launch some trials with industry partners in this area to test out the model. If it works, I think we'll be able to help contribute to the knowledge that we all can use in terms of the patient types, the patient characteristics, but also some of the different tumor characteristics, and also to bring clinical trial opportunities to a more representative group. A lot of the initial clinical trials are done in urban areas, rural populations in VA are about a third of our patients live in rural areas, compared to only 14% of the country. So we think this is a very important diversity issue that should be addressed. Those are some of the ways that we're taking a lesson from this trial and other data that we have to sort of bring it forward. Dr. Rafeh Naqash: Those are excellent next steps and I think the kind of work that the VA is doing and this specific program, Precision Oncology Program, the NPOP program is doing, it's definitely setting up a unique standard in the United States where we have been limited by not having a centralized database. So setting something up of this sort hopefully will help answer a lot of these unique, interesting questions as you have access to data. And then the fact that you mentioned decentralized clinical trials and trying to cater to this access issue for patients in the VA system, I think that would be huge.  And again, I congratulate you and your team on these efforts, and once again, thank you for joining us today and making JCO Precision Oncology a destination for your interesting work. We hope to see more of this work subsequently and hopefully, I get a chance to talk to you more about all the exciting stuff that you guys are leading within the VA health system.  Thank you for listening to JCO Precision Oncology Conversations. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all ASCO shows at asco.org/podcast.  The purpose of this podcast is to educate and inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Bios: Michael J. Kelley, MD, is Executive Director of Oncology for the Department of Veterans Affairs, Chief of Hematology-Oncology, Durham VA Medical Center, Professor of Medicine at Duke University School of Medicine and Member of the Duke Cancer Institute. Katherine I. Zhou, MD, PhD is a hematology-oncology fellow at Duke University. She also spends time at the Durham VA Medical Center as part of her fellowship training. COIs: Michael J. Kelley, MD Research Funding: Novartis (Inst), Bristol-Myers Squibb (Inst), Regeneron (Inst), Genentech (Inst), EQRx (Inst) Katherine I. Zhou, MD, PhD: No disclosures  

Dr. Laura Caputo describes her current education and faculty development projects, ways to forge one's own path as an educator, and how to “make the VA fun for learners.” Dr. Laura Caputo is a Hospitalist at the Durham VA Medical Center and an Assistant Professor at Duke University School of Medicine.

Joel Boggan, MD, MPH, of the Durham VA Medical Center talks about his experience with the Evidence Synthesis Program at VA, working with Veteran populations, and how quality improvement methodologies can be used to improve health services in Primary Care settings.

Today's episode features two successful senior level executive women in healthcare. We have Gayle Capozzalo, MSPH, Executive Director of The Equity Collaborative, which is part of the Carol Emmott Foundation - a national nonprofit dedicated to achieving fully inclusive gender equity in healthcare leadership and governance and retired Executive Vice President/Chief Strategy Officer of Yale New Haven Health System. Also joining us is Morgan Jones, MSPH, Vice President of Strategic Planning and Business Development for Duke Health and Board Member of the Carol Emmott Foundation. Morgan was previously interim assistant director (Assistant Chief Operating Officer) and strategic planner at the Durham VA Medical Center.  Gayle and Morgan will discuss how to position yourself as a woman in the industry – how to acquire the necessary skills to be a successful leader and offer personal insight as senior level executives in the field.

VA's first tumor laboratory was established at the Hines VA Hospital. Since then, VA has gone on to become a lead in cancer care, establishing studies, linking cigarette smoking with cancer, and creating breakthroughs for veterans and the world. Katie and Shawn sit in a two-part conversation with two of VA's most respected leaders and researchers: Dr. Michael Kelly, professor of Medicine at Duke University and Chief Oncology at the Durham VA Medical Center.  As National Program Director for Oncology for the Department of Veterans Affairs, Dr. Kelley directs policy and program development that affect the more than 50,000 Veterans diagnosed with cancer each year.

Emergency medicine physician Heatherlee Bailey, MD, FAAEM, FCCM of the Durham VA Medical Center and family medicine physician Scott Hartman, MD of the University of Rochester Medical Center discuss the latest COVID-19 vaccine booster recommendations. *This episode was recorded on May 17, 2022 and produced in partnership with the American Academy of Family Physicians and the Society of Critical Care Medicine. 

Rania Awaad is a a Clinical Associate Professor in the Stanford Department of Psychiatry and Behavioral Sciences and pursues her clinical practice through the department's community psychiatry track. She is also a researcher and the Director of the Stanford Muslims and Mental Health Lab where she mentors and oversees multiple lines of research focused on Muslim mental health. Through community partnerships established by the Stanford Department of Psychiatry, she is currently the Psychiatric Director of the El Camino Women's Medical Group (Mountain View and San Jose) where she pursues her interest in women's mental health. Additionally, through another community partnership with the Stanford Department of Psychiatry, she serves as the Clinical Director of the Bay Area branch of the Khalil Center (Santa Clara), a spiritual wellness center pioneering the application of traditional Islamic spiritual healing methods to modern clinical psychology. • Warren Kinghorn is a psychiatrist whose work centers on the role of religious communities in caring for persons with mental health problems and on ways in which Christians engage practices of modern health care. Jointly appointed within Duke Divinity School and the Department of Psychiatry and Behavioral Sciences of Duke University Medical Center, he is co-director of the Theology, Medicine, and Culture Initiative and is a staff psychiatrist at the Durham VA Medical Center. He has written on the moral and theological dimensions of combat trauma and moral injury, on the moral and political context of psychiatric diagnosis, and on the way that St. Thomas Aquinas' image of the human as wayfarer might inform contemporary practices of ministry and mental health care. • Co-sponsors: Duke Graduate Christian Fellowship, LuMin Austin, Nueces Mosque • Please like, share, subscribe to, and review this podcast. Thank you!

Men and their loved ones often ask what can be done to decrease their risk of getting aggressive prostate cancer and improve their overall outcomes if they do end up getting prostate cancer.  In honor of September's Prostate Cancer Awareness Month, I'm happy to present you with one of our most popular episodes from the archives, which features Dr. Stephen Freedland, a prostate cancer expert, and focuses on the role that diet and lifestyle play in the development and progression of prostate cancer. He will bring you up to speed today with all you need to know. Stay tuned for more! Dr. Stephen Freedland is a true visionary on the role of lifestyle and diet in prostate cancer. He wears many different hats. He is the Director of the Center for Integrated Research in Cancer and Lifestyle, Associate Director of Cedars-Sinai Cancer for Education and Training, Professor in the Division of Urology at the Cedars-Sinai Medical Center in Los Angeles, and a staff physician at the Durham VA Medical Center.  His approach to cancer prevention and awareness focuses on treating the whole patient, not just the disease, by combining traditional western medicine with complementary holistic interventions. His research interests include the role of diet, lifestyle, and obesity in prostate cancer development and progression, prostate cancer amongst racial groups, and restratification for men with prostate cancer.  He has published over 600 studies. He sits on the editorial board for Cancer Prevention Research, European Urology, International Journal of Urology, and Nature Reviews Urology, among others. He also serves as Editor-in-Chief for Prostate Cancer and Prostatic Diseases. He completed his urology residency training at UCLA and a fellowship in urologic oncology at Johns Hopkins. Before joining Cedars-Sinai, he was at Duke University as an associate professor in the Division of Urology.  Disclaimer: The Prostate Health Podcast is for informational purposes only. Nothing in this podcast should be construed as medical advice. By listening to the podcast, no physician-patient relationship has been formed. For more information and counseling, you must contact your personal physician or urologist with questions about your unique situation. Show highlights: The link between obesity and aggressive prostate cancer. Men could potentially reduce the risk of getting prostate cancer by losing weight. Dr. Freedland talks about whether there is a particular diet that works best for everyone with prostate cancer. The truth regarding the association between a high-fat diet and the risk of getting prostate cancer. Avoiding sugar is the only area where all diets concur. Dr. Freedland recommends following whole food diets. What we know at this point about links to sugar and prostate cancer. The biggest challenge that prostate cancer patients face with their diet. Dr.Freedland shares some tips and advice for sticking to a healthy diet. What Dr. Freedland recommends for his patients in terms of exercise and habits for a healthy prostate. Links:  Follow Dr. Pohlman on Twitter and Instagram - @gpohlmanmd  Get your free What To Expect Guide (or find the link here, on our podcast website)   Join our Facebook group  Follow Dr. Pohlman on Twitter and Instagram  Go to the Prostate Health Academy to sign up for the wait-list for our bonus video content.  You can access Dr. Pohlman's free mini webinar, where he discusses his top three tips to promote men's prostate health, longevity, and quality of life here.  

In this episode, Dr. Daniel Motta-Calderon chats with Dr. Anuj Dalal, an academic hospitalist at Brigham and Women's Hospital, and Dr. Lindsey Wu, teaching hospitalist at the Durham VA Medical Center. The discussion begins with a case of a patient presenting with atypical chest pain at the time of admission. Dr. Wu shares her degree of certainty about the case, and she teaches us about the causes and consequences of not addressing diagnostic uncertainty in the hospital setting. We later learn about the patient's hospital course and find out that the patient experienced a delayed diagnosis. Dr. Dalal walks through the concept of diagnostic error and its relevance for patient safety. The conversation closes with ways to address diagnostic uncertainty and how to create a culture of diagnostic safety among trainees, in addition to some tips to become better diagnosticians.

Many men and their loved ones want to know what they can do to reduce the risk of getting aggressive prostate cancer and improve their overall outcomes if they end up with prostate cancer.  Our guest for today's show, Dr. Stephen Freedland, is a prostate cancer expert and a leader in the field regarding the role of diet and lifestyle in the development and progression of prostate cancer.  Dr. Stephen Freedland is a true visionary when it comes to the role of lifestyle and diet in prostate cancer. He wears many different hats. He is the Director of the Center for Integrated Research in Cancer and Lifestyle, Associate Director of Cedars-Sinai Cancer for Education and Training, Professor in the Division of Urology at the Cedars-Sinai Medical Center in Los Angeles, and a staff physician at the Durham VA Medical Center.  His approach to cancer prevention and awareness focuses on treating the whole patient, not just the disease, by combining traditional western medicine with complementary holistic interventions. His research interests include the role of diet, lifestyle, and obesity in prostate cancer development and progression, prostate cancer amongst racial groups, and restratification for men with prostate cancer.  He has published over 600 studies. He sits on the editorial board for Cancer Prevention Research, European Urology, International Journal of Urology, and Nature Reviews Urology, among others. He also serves as Editor-in-Chief for Prostate Cancer and Prostatic Diseases. He completed his urology residency training at UCLA and a fellowship in urologic oncology at Johns Hopkins. Before joining Cedars-Sinai, he was at Duke University as an associate professor in the Division of Urology.  Be sure to stay tuned today as Dr. Freedland brings you up to speed with all you need to know about the role of diet and lifestyle in the development and progression of prostate cancer. Disclaimer: The Prostate Health Podcast is for informational purposes only. Nothing in this podcast should be construed as medical advice. By listening to the podcast, no physician-patient relationship has been formed. For more information and counseling, you must contact your personal physician or urologist with questions about your unique situation. Show highlights: Dr. Freedland talks about the link between obesity and aggressive prostate cancer. Dr. Freedland discusses the possibility of men reducing the risk of getting prostate cancer by losing weight. Dr. Freedland discusses whether there is a particular diet that works best for everyone concerning prostate cancer. Dr. Freedland looks at the truth regarding the association between a high-fat diet and the risk of getting prostate cancer. Avoiding sugar is the only area where all diets concur. Dr. Freedland recommends following whole food diets. Dr. Freedland talks about what we know at this point regarding links to sugar and prostate cancer. The biggest challenge that prostate cancer patients face with their diet. Dr.Freedland shares some tips and advice for sticking to a healthy diet. Dr. Freedland shares what he recommends for his patients in terms of exercise and habits for a healthy prostate. Links and resources:  Follow Dr. Pohlman on Twitter and Instagram - @gpohlmanmd  Get your free What To Expect Guide (or find the link here, on our podcast website)   Join our Facebook group  Follow Dr. Pohlman on Twitter and Instagram  Go to the Prostate Health Academy to sign up for the wait-list for our bonus video content.  You can access Dr. Pohlman's free mini webinar, where he discusses his top three tips to promote men's prostate health, longevity, and quality of life here.

Justin Johnson, MD serves as Director of Veteran Services at HopeWay. A board-certified psychiatrist who also serves in the U.S. Army Reserve, Dr. Johnson previously treated patients at the Durham VA Medical Center’s Iraq and Afghanistan combat Veteran center. Dr. Johnson is a North Carolina native, a graduate of UNC-Chapel Hill and Johns Hopkins School of Medicine, and completed his psychiatry residency at the Massachusetts General Hospital and McLean Hospital combined program at Harvard Medical School. He is currently an assistant consulting professor at Duke University School of Medicine. See omnystudio.com/listener for privacy information.

Warren Kinghorn is a psychiatrist whose work centers on the role of religious communities in caring for persons with mental health problems and on ways in which Christians engage practices of modern health care. Jointly appointed within Duke Divinity School and the Department of Psychiatry and Behavioral Sciences of Duke University Medical Center, he is co-director of the Theology, Medicine, and Culture Initiative and is a staff psychiatrist at the Durham VA Medical Center. He has written on the moral and theological dimensions of combat trauma and moral injury, on the moral and political context of psychiatric diagnosis, and on the way that St. Thomas Aquinas’ image of the human as wayfarer might inform contemporary practices of ministry and mental health care. 

In this episode, we are featuring a new podcast series, Women's Wisdom: Our Journey in Emergency Medicine from the AAEM Women in Emergency Medicine committee. This is the second episode of their podcast series and features, host Adria Ottoboni, MD FAAEM, Associate Professor at UCLA and special guest Heatherlee Bailey, MD FAAEM FCCM, Assistant Professor of Emergency Medicine at Durham VA Medical Center and President of the Society of Critical Care Medicine (SCCM). Listen to hear Dr. Bailey's journey in emergency medicine. Intro music by NICOCO, 'Quiberon,' from the album 'Nicoco,' powered by JAMENDO.

In this episode, Adria Ottoboni, MD FAAEM, Associate Professor at UCLA speaks with special guest Heatherlee Bailey, MD FAAEM FCCM, Assistant Professor of Emergency Medicine at Durham VA Medical Center and President of the Society of Critical Care Medicine (SCCM) about her journey in emergency medicine. Intro music by RogerThat, 'Uplifting Positive Corporate,' powered by JAMENDO.

In this episode, we are featuring a new podcast series, Women's Wisdom: Our Journey in Emergency Medicine from the AAEM Women in Emergency Medicine committee. This is the second episode of their podcast series and features, host Adria Ottoboni, MD FAAEM, Associate Professor at UCLA and special guest Heatherlee Bailey, MD FAAEM FCCM, Assistant Professor of Emergency Medicine at Durham VA Medical Center and President of the Society of Critical Care Medicine (SCCM). Listen to hear Dr. Bailey’s journey in emergency medicine. Intro music by NICOCO, 'Quiberon,' from the album 'Nicoco,' powered by JAMENDO.

In this episode, Adria Ottoboni, MD FAAEM, Associate Professor at UCLA speaks with special guest Heatherlee Bailey, MD FAAEM FCCM, Assistant Professor of Emergency Medicine at Durham VA Medical Center and President of the Society of Critical Care Medicine (SCCM) about her journey in emergency medicine. Intro music by RogerThat, 'Uplifting Positive Corporate,' powered by JAMENDO.

In this episode, we are featuring a new podcast series, Women's Wisdom: Our Journey in Emergency Medicine from the AAEM Women in Emergency Medicine committee. This is the second episode of their podcast series and features, host Adria Ottoboni, MD FAAEM, Associate Professor at UCLA and special guest Heatherlee Bailey, MD FAAEM FCCM, Assistant Professor of Emergency Medicine at Durham VA Medical Center and President of the Society of Critical Care Medicine (SCCM). Listen to hear Dr. Bailey's journey in emergency medicine. Intro music by NICOCO, 'Quiberon,' from the album 'Nicoco,' powered by JAMENDO.

QUERI Dissemination Coordinator Diane Hanks talks with Courtney Van Houtven, PhD, about her research evaluating the VA CARES caregiver support program. Dr. Van Houtven is a  research scientist with the HSR&D Center for Health Services Research in Primary Care at the Durham VA Medical Center.

Today we hear from Dr. Clarissa Diamantidis, an Assistant Professor in the Divisions of General Internal Medicine and Nephrology at Duke University and a nephrologist at the Durham VA Medical Center. In addition to seeing patients, Dr. Diamantidis works as a researcher and clinical educator. We ask about her career path and what advice she has for medical students and residents considering combining nephrology and clinical research. Music by Scott Holmes “Follow Your Dreams” licensed under CC BY-NC 4.0 

 with guest Dr. Warren Kinghorn You won’t want to miss this is an excellent podcast! Pastor Brad interviews Dr. Warren Kinghorn, who is both a psychiatrist and a theologian. He presents a unique perspective on mental health, both as a Christian and as a professional in psychiatry. Dr. Kinghorn also addresses how we can help people in the church with a mental health diagnosis, both for pastors and laypersons. He shares a lot of insights for pastors regarding their own mental health.  Dr. Kinghorn is an Assistant Professor of Psychiatry and Pastoral and Moral Theology, Duke University Medical Center and Duke Divinity School, Staff Psychiatrist, Durham VA Medical Center. Dr. Kinghorn is a psychiatrist whose work centers on the role of religious communities in caring for persons with mental health problems and on ways in which Christian communities engage practices of modern health care. Jointly appointed within Duke Divinity School and the Department of Psychiatry and Behavioral Sciences of Duke University Medical Center, he is a staff psychiatrist at the Durham VA Medical Center and core teaching faculty member of the Duke Psychiatry Residency Program. Within the Divinity School, he works closely with students and faculty members interested in exploring the ways in which theology and philosophy might constructively inform Christian engagement with modern medicine and psychiatry. His current scholarly interests include the moral and theological dimensions of combat-related post-traumatic stress disorder, the applicability of virtue theory to the vocational formation of clinicians and clergy, and the contributions of the theology and philosophy of St. Thomas Aquinas to contemporary debates about psychiatric diagnosis, psychiatric technology, and human flourishing. After listening to this podcast, we encourage you to email us at info@FreshHope.us with a comment or question that we will share on our next podcast.   If you are listening to this podcast on iTunes, we encourage you to leave a comment regarding the podcast. Or you can leave a voice message for us on the site:  www.FreshHope4MentalHealth.com Pastor Brad Hoefs, the host of Fresh Hope for Mental Health, is the founder of Fresh Hope Ministries, a network of Christian mental health support groups for those who have a diagnosis and their loved ones. In other words, Fresh Hope is a Christian mental health support group.  Brad was diagnosed with bipolar disorder in 1995. He is a weekly blogger for www.bphope.com (Bipolar Magazine). He is also a certified peer specialist and has been doing pastoral counseling since 1985. Brad is also the author of Fresh Hope: Living Well in Spite of a Mental Health Diagnosis, which is available on Amazon or at www.FreshHopeBook.com If you are interested in more information about Fresh Hope go to www.FreshHope.us or email info@FreshHope.us or call 402.932.3089. To donate to Fresh Hope go to http://freshhope.us/donate/  For a complete list of where Fresh Hope groups are presently meeting, go to www.FreshHope.us and click on “find a group.”  Or you may attain an online group of meetings of Fresh Hope by going to www.FreshHopeMeeting.com If you are interested in starting a Fresh Hope group within your faith community, contact Julie at Julie@FreshHope.us  Fresh Hope for Mental Health is a production of Fresh Hope Ministries.  Fresh Hope Ministries is a non-profit ministry.   The copyrights of this program belong to Fresh Hope Ministries and may not be duplicated without written permission.  All of the podcasts of Fresh Hope Today, as well as numerous other videos, are all available on our YouTube channel: Fresh Hope Network  Fresh Hope for Mental Health is on Facebook at  www.Facebook.com/FreshHopeforMentalHealth    

About Integrated Care Partners: To enhance already established standards of patient centered care, and improve the health of the population we serve by creating a system-wide community-based care coordination team and process.   Our Mission:  To be a high-performing network of integrated providers successfully delivering value-based population health.  Integrated Care Partners (ICP) is a physician-led, clinically integrated health care network whose mission is to assist our members in providing the highest quality care at the most reasonable cost for our patients in the current, rapidly changing medical environment. CONTACT: https://integratedcarepartners.org/about-us  About Sean Jeffery, PharmD Sean Jeffery, Pharm.D., CGP, FASCP  SeanJ12cropDr. Sean M. Jeffery is Director of Clinical Pharmacy Services at Integrated Care Partners, the care coordination and clinical integration arm of Hartford Healthcare Group. Within this accountable care organization, Dr. Jeffery is responsible for pharmacy network development and strategy, population health management, and provision of direct patient care through home-visitations for high-modifiable risk patients.   Dr. Jeffery is also a Clinical Professor at the University of Connecticut School of Pharmacy. His area of expertise is senior care pharmacy. Prior to joining Integrated Care Partners, Dr. Jeffery served as a consultant pharmacist for VA Connecticut’s Geriatrics Consult service from 1998 – 2015. During this time Dr. Jeffery also established a PGY2 Geriatrics Pharmacy Residency Program and served as Director from 2002 – 2015.  Dr. Jeffery has extensive association leadership experience including, serving as President and Chairman of the Board of Directors for the American Society of Consultant Pharmacists from 2012 – 2014 and Chairman of the American Association of Colleges of Pharmacy Geriatrics SIG in 2007 – 2008. He currently chairs the Polypharmacy Special Interest Group for the American Geriatrics Society and is a member of the Medication Therapy Management Technical Expert Panel (TEP) for the Center for Medicare and Medicaid Services. He co-founded the Coalition for Senior Medication Safety in New Haven, CT to raise awareness among seniors about medication safety. The coalition supports community efforts which, target medication education/management to low-income, immigrant communities.  He is a graduate of the University of Connecticut (BS) and Ohio State (PharmD) Universities and completed a post-graduate residency in geriatric pharmacy at the Duke Center for the Study of Aging and Durham VA Medical Center. Christina M. Polomoff, PharmD, BCACP, BCGP Dr. Christina Polomoff is a Population Health Clinical Pharmacist at Hartford Healthcare Integrated Care Partners. She is responsible for managing the complex pharmacy care needs of high-risk patients in addition to population health management strategies that focus on network pharmacy performance metrics. She is also an Assistant Clinical Professor at the University of Connecticut School of Pharmacy. Dr. Polomoff graduated from the University of Connecticut with her Doctor of Pharmacy and Business Minor in 2014. She completed her PGY1 residency at the VA Connecticut Healthcare System followed by a PGY2 ambulatory care residency at The Johns Hopkins Hospital. See omnystudio.com/listener for privacy information.

About Integrated Care Partners: To enhance already established standards of patient centered care, and improve the health of the population we serve by creating a system-wide community-based care coordination team and process.   Our Mission:  To be a high-performing network of integrated providers successfully delivering value-based population health.  Integrated Care Partners (ICP) is a physician-led, clinically integrated health care network whose mission is to assist our members in providing the highest quality care at the most reasonable cost for our patients in the current, rapidly changing medical environment. CONTACT: https://integratedcarepartners.org/about-us  About Sean Jeffery, PharmD Sean Jeffery, Pharm.D., CGP, FASCP  SeanJ12cropDr. Sean M. Jeffery is Director of Clinical Pharmacy Services at Integrated Care Partners, the care coordination and clinical integration arm of Hartford Healthcare Group. Within this accountable care organization, Dr. Jeffery is responsible for pharmacy network development and strategy, population health management, and provision of direct patient care through home-visitations for high-modifiable risk patients.   Dr. Jeffery is also a Clinical Professor at the University of Connecticut School of Pharmacy. His area of expertise is senior care pharmacy. Prior to joining Integrated Care Partners, Dr. Jeffery served as a consultant pharmacist for VA Connecticut's Geriatrics Consult service from 1998 – 2015. During this time Dr. Jeffery also established a PGY2 Geriatrics Pharmacy Residency Program and served as Director from 2002 – 2015.  Dr. Jeffery has extensive association leadership experience including, serving as President and Chairman of the Board of Directors for the American Society of Consultant Pharmacists from 2012 – 2014 and Chairman of the American Association of Colleges of Pharmacy Geriatrics SIG in 2007 – 2008. He currently chairs the Polypharmacy Special Interest Group for the American Geriatrics Society and is a member of the Medication Therapy Management Technical Expert Panel (TEP) for the Center for Medicare and Medicaid Services. He co-founded the Coalition for Senior Medication Safety in New Haven, CT to raise awareness among seniors about medication safety. The coalition supports community efforts which, target medication education/management to low-income, immigrant communities.  He is a graduate of the University of Connecticut (BS) and Ohio State (PharmD) Universities and completed a post-graduate residency in geriatric pharmacy at the Duke Center for the Study of Aging and Durham VA Medical Center. Christina M. Polomoff, PharmD, BCACP, BCGP Dr. Christina Polomoff is a Population Health Clinical Pharmacist at Hartford Healthcare Integrated Care Partners. She is responsible for managing the complex pharmacy care needs of high-risk patients in addition to population health management strategies that focus on network pharmacy performance metrics. She is also an Assistant Clinical Professor at the University of Connecticut School of Pharmacy. Dr. Polomoff graduated from the University of Connecticut with her Doctor of Pharmacy and Business Minor in 2014. She completed her PGY1 residency at the VA Connecticut Healthcare System followed by a PGY2 ambulatory care residency at The Johns Hopkins Hospital. See omnystudio.com/listener for privacy information.

Milites Christi, a Duke Divinity School student group, sponsored a panel discussion about the church's response to the rising rate of military suicide in America. Panelists included Amy Laura-Hall, associate professor of Christian ethics, and Warren Kinghorn, assistant professor of psychiatry and pastoral and moral theology, both of the Divinity School; the Rev. Heather Rodrigues, pastor of Duke Memorial United Methodist Church; and the Rev. John Oliver, chief of chaplain services at the Durham VA Medical Center.

Dr. Joseph Sirven will be interviewing staff from Durham VA Medical Center on the "Living With Epilepsy Program," a day long symposium that is sponsored by Duke University for patients and their families about living with epilepsy. This year's symposium will be held on November 7, 2009 at Duke University. Dr. Sirven is a Professor of Neurology at Mayo Clinic Arizona and Editor-in-Chief of Epilepsy.com/Professionals.