Podcasts about ekgs

New article in JAMA asks the age-old question: Are routine EKGs in asymptomatic healthy adults helpful? Dr. McGinn and guest experts review the evidence and latest guidelines. Guests:Dr. Ankita SagarSystem Vice President for Clinical Standards and Variation Reduction, Physician EnterpriseAssociate Clinical Professor of Medicine, Creighton UniversityDr. Gary GreensweigSystem Senior Vice President and Interim Chief Medical & Quality Officer (CMQO), CommonSpirit HealthStudies referenced: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2820721?guestAccessKey%3Db122716f-826f-4a09-82cb-e32aa6fa0f43%26&sa=D&source=calendar&ust=1733927688755673&usg=AOvVaw39iMVRrJYFLIVN1EdHa6mlGuidelines referenced:https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cardiovascular-disease-risk-screening-with-electrocardiographyhttps://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/cw-ekg.html

A whistleblower snitched on an allegedly cheating MA plan, leading to a huge negotiated settlement, in our Medicare Advantage Minute. EKGs, ECGs and how Medicare covers them is the subject of our tribute to: "Your Medicare Benefits 2024" The balance of the episode is given over to an analysis of the recorded and requested Medicare supplement rate increases. Conclusion? Medical inflation is still with us and Medicare supplement rate increases exceeding historical averages will plague the industry for the foreseeable future. Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)                   Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; Simplest & Easiest Guide Ever!" on Amazon.com. Return to leave a short customer review & help future readers. Official website: https://www.MedicareForTheLazyMan.com.

She's been homeless before. It's no big deal. https://demolisten.bigcartel.com/product/search-warrant-unlawful-demonstration-cassette  Intro Music: Die Kreuzen- Think For Me Submit music to demolistenpodcast@gmail.com. Become a patron at https://www.patreon.com/demolistenpodcast. Leave us a message at (260)222-8341 Queue: Bobo, Gnome, Spam Caller, Calau, Early Graves, EKGs, Bad World, NOXO, Refuse To Lose, Grim Statistic https://boboband.bandcamp.com/album/bootleg https://goblinrecordsaus.bandcamp.com/album/i-like-it-ep https://phagetapes.bandcamp.com/album/bad-connection https://calau.bandcamp.com/album/c-l-u https://www.youtube.com/watch?v=HmwOB-Tmvs8 https://killenemyrecords.bandcamp.com/album/ekgs  

Let’s talk about VO2 max—a laboratory cardiovascular performance test that began rising to prominence in the mainstream medical, fitness, and biohacking communities in the 2010’s as an excellent way to measure general cardiovascular health, disease risk, and longevity potential. It’s great to see the integration of performance-oriented metrics into wellness and medicine, and in this episode, I tell you all about VO2 max, its ability to predict your longevity, why some say it’s a superior way of predicting longevity, as well as why it can, in some ways, be overrated. In this episode, I discuss all aspects of the VO2 max test—what it is, what it means, how to train for it, and how it rose to prominence, despite being a key performance metric for endurance athletes to predict competitive potential for decades. I explain how the VO2 max test works (by measuring your amount of oxygen usage as the test gets increasingly harder), why most cardiologists are now touting VO2 max as superior to anything found in bloodwork, EKGs, and other routine screenings, the insights about your health that you can learn from taking the test, why the VO2 max test can be overrated, why the performance metric Running Economy is considered a better predictor of competitive success than VO2 max in elite running circles, the reason why VO2 max scores vary between men and women, and more! LINKS: Brad Kearns.com B.rad’s Superfruits B.rad’s Shopping Page B.rad’s Whey Protein Superfuel We appreciate all feedback, and questions for Q&A shows, emailed to podcast@bradventures.com. If you have a moment, please share an episode you like with a quick text message, or leave a review on your podcast app. Thank you! Check out each of these companies because they are absolutely awesome or they wouldn’t occupy this revered space. Seriously, I won’t promote anything that I don't absolutely love and use in daily life: Ketone-IQ: Save 30% off your first subscription order & receive a free six-pack of Ketone-IQ with https://ketone.com/BRAD Peluva: Comfortable, functional, stylish five-toe minimalist shoe to reawaken optimal foot function. Use code BRADPODCAST for 15% off! Mito Red Light: Photobiomodulation light panels to enhance cellular energy production, improve recovery, and optimize circadian rhythm. Use code BRAD for 5% discount! GAINSWave: Enhance sexual function with high frequency shockwave therapy. Buy 6 and get one treatment free with code: BRAD Take The Cold Plunge online course! B.rad Whey + Creatine Superfuel: Premium quality, all-natural supplement for peak performance, recovery, and longevity. Now available in Vanilla Bean, Cocoa bean, Peanut Butter, and Unflavored! Online educational courses: Numerous great offerings for an immersive home-study educational experience Primal Fitness Expert Certification: The most comprehensive online course on all aspects of traditional fitness programming and a total immersion fitness lifestyle. Save 25% on tuition with code BRAD! Male Optimization Formula with Organs (MOFO): Optimize testosterone naturally with 100% grassfed animal organ supplement Brad's Favorites on Amazon I have a newly organized shopping experience at BradKearns.com/Shop. Visit here and you can navigate to my B.rad Nutrition products (for direct order or Amazon order), my library of online multimedia educational courses, great discounts from my affiliate favorites, and my recommended health&fitness products on Amazon.See omnystudio.com/listener for privacy information.

Summary In this episode, Sean and Terry discuss various aspects of E&M audits, focusing on compliance, documentation, and the importance of accurate patient records. They share personal anecdotes and insights into the challenges faced by healthcare providers in maintaining proper documentation and the implications of upcoding. The conversation emphasizes the need for thoroughness in patient care and the potential pitfalls of inadequate documentation. Takeaways E&M audits are crucial for compliance in healthcare. Accurate documentation is essential to avoid upcoding. Independent historians play a significant role in patient history. Providers must review and sign off on clinical staff documentation. Using templates should not replace personalized patient care. Documentation must reflect the actual patient encounter. EKGs require proper interpretation and documentation to be valid. Healthcare providers should avoid generic notes in patient records. Communication between providers is key to effective patient care. Incomplete documentation can lead to legal and financial repercussions.

[Ep51] You're listening to Episode 24 of 30 ... for National Podcast Post Month! Aka - NaPodPoMo.This episode's featured topic is 12-lead EKGs post-ROSC. How soon is too soon? Does the timing even matter?Quick Links:Results of PEACE studyNational Association of EMS Physicians articleAbout National Podcast Post MonthThe event gives everyone in the podcast community a chance to challenge their skills by posting an episode every day for the entire month of November! So that's what High-Fidelity Conversations will be doing. In order to keep my sanity, the episodes will be shorter (a few minutes), and the topics will be all over the place (still healthcare-themed). Each of the episodes associated with this event will be marked with "NaPodPoMo" somewhere in the title, so you know when all this chaos starts and ends. I hope you enjoy this adventure for November! We'll be back to our normal, monthly pattern for December.Do you have ideas for future guests or topics on this podcast? Maybe you have some thoughts on how to improve the show? If that sounds like you, take a moment to answer the 3 questions on our anonymous feedback survey!Podcast artwork was made with the awesome resources from CanvaMusic and Sound FX for the show obtained from Pixabay and Pond5Email the show at hfconversations@gmail.comClosed Captioning Resources:Podnews article (for Apple/Android phones and Google Chrome browsers)Microsoft Windows article (live captions for Windows users)Apple article (live captions for Mac users)Disclaimer:The thoughts and opinions expressed in this podcast belong solely to those saying them, and do NOT represent the positions, strategies or opinions of Trinity Health, or Mount Carmel Health System. This podcast is intended for educational and entertainment purposes only. Nothing in this podcast establishes a patient care relationship with you, the listener. The host(s) and guests of this show are NOT your healthcare provider and if you need medical attention, seek an appropriate and qualified professional. 

America Out Loud PULSE with Dr. Peter McCullough and Malcolm – I find myself without a candidate -- with the looming possibility that our elections could be theater... I do get tight-chested and get irregular beating, but my ECGs and EKGs are fine. Should I worry?... How long does the spike protein from the vax last in the body?... The vaccine exhausts the T-cells and makes the body IGg4 tolerant, but is this true for everyone?

America Out Loud PULSE with Dr. Peter McCullough and Malcolm – I find myself without a candidate -- with the looming possibility that our elections could be theater... I do get tight-chested and get irregular beating, but my ECGs and EKGs are fine. Should I worry?... How long does the spike protein from the vax last in the body?... The vaccine exhausts the T-cells and makes the body IGg4 tolerant, but is this true for everyone?

Ein EKG (Elektrokardiogramm) schreiben ist kein Problem, aber die Interpretation treibt dir die Schweißperlen auf die Stirn? Wie du entspannter mit dem Ausdruck umgehst, ob du dafür immer ein EKG-Lineal brauchst und welche Veränderungen du wirklich erkennen können solltest: all das erfährst du in dieser Folge! Außerdem haben wir uns mit Christoph Burchert zusammengeschalten. Er ist Notfallsanitäter und Profi der EKG Interpretation. Aber du erfährst nicht nur, nach welchem Schema er EKGs betrachtet, sondern auch wie er die Zukunft von Diagnoseprogrammen und KI in diesem Bereich einschätzt. Vielen Dank Chris, dass du unser Gast bist! Wenn du dich mit unserem Gast connecten möchtest, dann schau bei ihm vorbei: www.der-chb.de oder auf LinkedIn: https://de.linkedin.com/in/christoph-burchert-70b46821 Du interessierst dich für das 21. DRK-Rettungsdienst-Symposium vom 21.–22.11.2024 in Kassel? Alle Infos dazu findest du hier: https://www.drk-hessen.de/seminare/rettungsdienst/rettungsdienst-symposium.html Sende uns Feedback an: audio@thieme.de Oder schreibe uns direkt auf Instagram: Mike @mmike_94 Gabi @fraufachsprache Diese Podcast-Folge ist nur als Audio verfügbar. Unser Fallbeispiel zu Beginn der Folge ist wie immer fiktiv und frei erfunden. Sound Effekte: © 2010 Adobe Systems Incorporated Dieser Podcast enthält Produktplatzierungen.

Gail Gould is the The CPR and Safety Lady and she teaches us what to do in case of a seizure or chocking, live on the radio. There's much more to learn on the subject of first aid like knowing how to use the automatic defibrillators every building is supposed to have and even using EKGs to detect heart problems in young men. Go to www.cprandsafetylady.com and Gail can come teach you the course.

In this conversation, Liz Rohr interviews Jennifer Carlquist, a physician assistant with extensive experience in cardiology, who discusses the assessment and management of chest pain.They covered: - Assessing cardiac versus noncardiac chest pain- Assessing risk for MI and when to send patients to the ED or not- What EKG findings to watch out for, and how to learn more to build your ekg reading confidence (and what's new!)- What we can do for patients to assess and manage heart disease risk, including labs and tests to check in primary care (including the coronary calcium score, LPa, and homocysteine)- How to communicate and collaborate effectively with ER providers- Further resources to learn if you're in cardiology or interested in making the switch from primary careTakeaways- Consider both cardiac and non-cardiac causes of chest pain, especially in female patients with atypical symptoms.- Take a detailed history, including risk factors and family history, and be aware of red flags that may indicate a more serious condition.- Recognize the limitations of certain diagnostic tests, such as EKGs and troponin levels, and consider a CTA with FFR for outpatient testing.- Collaboration between primary care providers and the ER is crucial, and concise reporting of findings is key to effective communication.- Differentiating between hyperkalemia T-waves and hyperacute T-waves can be challenging, but hyperkalemia T-waves are pointy and hyperacute T-waves are more blunted and broad-based.- Inverted T-waves in leads other than AVR and V1, especially if they are symmetric, can indicate the need for urgent evaluation.- Q-waves can form within an hour of an infarction, and a small Q-wave in lead III without other abnormalities may be a normal finding.- When learning EKG interpretation, it is important to start with understanding what a normal EKG should look like and then focus on high-risk findings.- Inflammation is a significant risk factor for heart disease, and non-traditional risk factors such as psoriasis and early menses should be considered.- Lab tests such as the coronary calcium score, LPa, and homocysteine can provide valuable information in assessing heart disease risk.- Magnesium supplementation can be beneficial for patients with palpitations and hypertension, but the specific type and dose should be tailored to the individual.- Primary care providers play a crucial role in assessing heart disease risk and can collaborate with cardiologists to order appropriate tests and make informed decisions.- The three-day EKG challenge and the Cardiology Fundamentals Mentorship program are valuable resources for learning and advancing in cardiology.- The importance of fostering a supportive and collaborative environment in healthcare to provide the best care for patients.For a full transcript and conversation chapters, visit the blog https://www.realworldnp.com/blog/assessing-chest-pain______________________________© 2024 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.

As part of our community health partnership with Valley Health, this month we discuss when you should visit an Urgent Care, an Urgent Care Express, or the Emergency Room. Our conversation with Dr. Vanessa Banks, Medical Director for the Southern Region for Valley Health Urgent Care systems, and Kristy Shannon, Senior Director of Urgent Care for Valley Health focuses on differentiating between when to visit an urgent care center and when an emergency room visit is necessary. Dr. Banks and Kristy explain what constitutes urgent care services. They discuss the operational hours, facilities, and types of treatments available at Valley Health's Urgent Care locations compared to their Urgent Care Express locations. Dr. Banks provides insight into what an emergency room visit entails and shares her background in emergency medicine. They both emphasize that common ailments like mild dehydration, vertigo, minor fractures, and less severe injuries can be efficiently treated at urgent care centers. They explain some common scenarios where patients might be confused about whether to visit an emergency room or urgent care center. They discuss how urgent care can be a faster and sometimes more suitable option for non-life-threatening issues. Kristy explains the convenience of making online reservations for urgent care to save time. Throughout the conversation, both guests share real-life examples, outlining cases that should immediately go to the emergency room, such as severe chest pain, significant bleeding, or major fractures. Dr. Banks notes the importance of addressing symptoms early to avoid complications and explains the significance of certain diagnostic capabilities, like EKGs and blood tests, which are typically beyond the urgent care scope. The conversation wraps up with Kristy informing listeners about the availability of virtual urgent care services, which provide another convenient option for non-critical health consultations. Dr. Banks encourages listeners to utilize urgent care services when appropriate and not to hesitate to seek professional medical advice when needed. To hear more conversations in our Community Health series, click here.

This week's topics include avoiding chemotherapy-induced neuropathy, predictive value of screening EKGs, use of medicines to treat opioid use disorder, and trends in CVD in the U.K.

Welcome to the Feel Better Feel Great Podcast! I'm Dr. Andrea McSwain, and if you're just discovering this show, I'm thrilled to have you join us. As a dedicated DO, I've always been driven by the pursuit of understanding the root cause of issues. With a background in conventional OBGYN training and a deep connection to five generations of classical Osteopathic tradition, coupled with my upbringing in a holistic environment, I bring a unique expertise to the table. Whether you're currently struggling with health concerns or simply aiming to enhance your well-being, this podcast is here to equip you with practical tools for feeling your best. I am an expert, but you are an expert in you! Let's embark on a journey to not just feeling good, but to feeling great! In this episode, we explore the heart from both conventional and holistic perspectives. As an OB/GYN, I share my fascination with the heart's embryological development and delve into its anatomy and physiology. We'll discuss conventional evaluations and treatments, including EKGs, stress tests, and blood tests. I also touch on common heart conditions like hypertension, coronary artery disease, and heart failure, providing insights on their prevention and management. Additionally, we'll explore the mental and emotional aspects of heart health, emphasizing the importance of stress management, sleep patterns, and overall well-being. Join me as we blend medical science with holistic health to better understand and care for our hearts. Show notes: https://micenterhm.com/podcast/    Join our Facebook community: https://www.facebook.com/groups/146473462706996  Want more tools to feel GREAT? Online courses: https://drmcswain.com Supplements: Shop now with code FEELGREAT15 for 15% off your first order! https://shopvrx.com/ Follow me on social!  https://www.facebook.com/drmcswain  https://www.instagram.com/dr.mcswain/ https://www.linkedin.com/in/dr-andrea-mcswain/ Music: Mykola Sosin

Management approach for electrical storm!For a deep dive into EKGs in wide complex tachycardias, take a look at this awesome lecture by Amal Mattu.References to articles mentioned in the podcast:Cheskes et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022 Nov 24;387(21):1947-1956Ortiz et al. Randomized comparison of intravenous procainamide vs. intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia: the PROCAMIO study. Eur Heart J 2017;38(17):1329-1335Song et al. Association of Dexmedetomidine With New-Onset Atrial Fibrillation in Patients With Critical Illness. JAMA Netw Open 2023;6(4):e239955Wang etc. Effect of Dexmedetomidine on Tachyarrhythmias After Cardiac Surgery: A Systematic Review and Meta-Analysis. J Cardiovasc Pharmacol 2022;79(3):315-324Zhong et al. Dexmedetomidine Reduces Incidences of Ventricular Arrhythmias in Adult Patients: A Meta-Analysis. Cardiol Res Pract 2022;5158362Do et al. Thoracic Epidural Anesthesia Can Be Effective for the Short-Term Management of Ventricular Tachycardia Storm. J Am Heart Assoc. 2017 Oct 27;6(11):e007080Tian et al. Effective Use of Percutaneous Stellate Ganglion Blockade in Patients With Electrical Storm. Circ Arrhythm Electrophysiol. 2019;12(9):e007118Batnyam et al. Safety and Efficacy of Ultrasound-Guided Sympathetic Blockade by Proximal Intercostal Block in Electrical Storm Patients. JACC Clin Electrophysiol 2024;10(4):734-746

Introducing our new in-office lab services! This year, we're all about making life easier for our busy patients. Now, you can collect all your labs, including EKGs, right here in our office. It's a one-stop shop for wellness, whether it's tracking changes in your body throughout your wellness journey or preparing labs for surgery. During your weight loss journey, it's not just about seeing progress on the scale; we also want to monitor crucial health markers like cholesterol. Our goal is to help you live better and feel your best. We're dedicated to health and wellness and find it important to be with you every step of the way! Listen to this week's episode to learn more about how our comprehensive services can benefit you.

Dr. Ron Razmi discusses his book, AI Doctor: The Rise of Artificial Intelligence in Healthcare, which focuses on the applications of AI in various areas of healthcare. Ron talks about AI as a foundational technology that uses statistical methods to analyze data and understand its meaning. It can be applied to various areas, such as coding and documentation, and can create algorithms to analyze heartbeats and detect abnormal rhythms.   AI Use in Diagnostics In diagnostics, AI can be helpful in analyzing clean structured data, such as radiology files from CAT scans or MRIs. AI can be trained to identify bleeding or abnormalities on these scans, but it must be trained on specific abnormalities. Currently, AI excels in radiology due to the digitized and structured data, but it's not as effective in narrative formats. Ron states that AI's applications in healthcare are vast and deep, and while it's still in its early stages, it has the potential to revolutionize various sectors, including healthcare. AI Tools in Radiology and Triage AI is increasingly being used in various fields, including radiology, dermatology, and sound AI. In radiology, AI tools are helping radiologists identify potential issues that might have been missed in traditional workflows. There are applications that read CAT scans for bleeding and stroke in acute settings, allowing radiologists to quickly identify and treat stroke patients. This helps in regaining function and ensuring patient recovery. AI can also aid in triage, prioritizing tasks based on urgency.    AI in Dermatology In dermatology, AI applications can help diagnose skin lesions. Additionally, sonar technology can be used to monitor people's activity and detect falls. This passive data collection method allows AI to analyze the signals and take action, reducing the need for manual data entry and manual data input. This technology is particularly effective for elderly individuals who may not want to be monitored with cameras, as 50% of falls occur in the bathroom. This technology is particularly useful for those who prefer to stay home but still need constant monitoring, such as those in assisted or independent living facilities.    AI in Cardiology In cardiology, AI tools can help read EKGs, which are crucial for diagnosing heart conditions. Historically, algorithms have been used to read EKGs, but they were often basic and inaccurate. AI has shown great promise in finding abnormalities on single lead data collection, as it can discern the rhythm of an EKG from a live core or smartphone application. This field-based data collection could significantly reduce the simple analytic and downstream work needed by clinicians in the medical staff.    AI in Therapeutics AI takes action in therapeutics, such as providing assistance to patients with mental health issues. AI chatbots can interact with patients who need help and provide frontline assistance until they see a mental health professional. Generative AI has improved natural language processing capabilities, which has been a problem area for AI in healthcare due to the heavy use of medical jargon in doctor's notes. This will allow for more efficient interactions with healthcare consumers and better guidance in their care. However, there is still much work to be done in this promising area.   Technology and Medication Adherence in Healthcare The conversation turns to medication adherence, which is a significant problem in healthcare. Long-term studies show that people who have had a heart attack are more likely to stay compliant with their medications, with the refill rate for statins being the highest documented rate. However, most people do not follow their prescription advice. Technology is part of the solution to this problem. AI technology can potentially analyze data and interact with patients at the appropriate moment to ensure they are aware of the needs, issues, and dates of medication use or the lack of, which is crucial in healthcare.    How AI Helps Doctors AI applications in healthcare can help alleviate the burden of documentation work for physicians and nurses. One example is the use of AI in critical care settings, where doctors often spend time typing notes into the electronic health record, which can lead to missed information and negatively impact the quality of care. AI can also analyze conversations using natural language processing, which can identify the meaning of words and improve communication. For example, AI can listen to conversations and extract key elements that need to be documented, allowing doctors to focus on the patient and generate notes in their preferred format. AI can also perform downstream tasks, such as prescribing medication, making referrals, and creating prior authorization letters. This could save time for medical staff, preventing them from seeing more patients and making them less productive. Another use case could be for AI to assist nurses in creating notes for patients based on interaction with them, reducing the time spent documenting. This could make a significant difference in the quality of care and well-being since it allows medical professionals to focus on the patient instead of taking notes.    Evaluating AI Healthcare Applications Ron's book goes beyond cheerleading and emphasizes the business and clinical barriers to adoption. He talks about the importance of evaluating the business model of AI products or applications, considering the incentives of buyers and the potential for job loss or revenue reduction. As an investor, he suggests considering the pain points that AI could address, such as staff shortages and burnout, and how AI could help medical centers and pharmaceutical companies improve their clinical trials. Ron also discusses the importance of understanding the value proposition of AI products in medical settings. He shares his experience as an investor in the healthcare AI space, advising companies and funds on identifying great use cases and evaluating barriers. Ron recommends reading sources like healthcare AI digests, health tech news, and interviews with experts to stay informed about trends and the latest AI applications.    Timestamps: 04:00 AI applications in radiology and dermatology, including AI-assisted diagnosis and triage 10:54 Using AI to analyze passive data collection from sonar/radar in indoor environments for health monitoring, including fall detection and heart rate measurement  15:12 AI in healthcare, particularly in diagnostics and therapeutics 21:22 Using AI technology to improve medication adherence 26:40 AI applications in healthcare, including documentation assistance and quality of care 34:41 AI in healthcare, investment considerations, and product evaluation 39:44 AI in healthcare with a former doctor turned investor   Links: LinkedIn: https://www.linkedin.com/in/ronald-m-razmi-md-2b55b8/ The Book: AI Doctor: The Rise of Artificial Intelligence in Healthcare   Unleashed is produced by Umbrex, which has a mission of connecting independent management consultants with one another, creating opportunities for members to meet, build relationships, and share lessons learned. Learn more at www.umbrex.com.

How many EKGs does an emergency doctor interpret per shift? How many seconds of undivided attention can be devoted to those readings? Let's go over 7 key findings you can't miss for occlusive myocardial infarctions, with EMRA*Cast host Will Smith, MD, and emergency physician Domenico Mastandrea, DO, of Nuvance Health.

How To Read 12 Lead EKGs by Albuquerque Fire Rescue

Welcome to Episode 34 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 34 of “The 2 View” – pertussis, computer interpretation of EKGs, TB, FQ side effects, and incidental findings Pertussis Best Practices for Healthcare Professionals on the Use of Polymerase Chain Reaction (PCR) for Diagnosing Pertussis. Pertussis: Use of PCR for diagnosis. Cdc.gov. Published January 12, 2023 https://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-pcr-bestpractices.html Specimen Collection and Diagnostic Testing. Cdc.gov. Published October 11, 2023 https://www.cdc.gov/pertussis/clinical/diagnostic-testing/specimen-collection-diagnosis.html Treatment. Cdc.gov. Published September 16, 2022 https://www.cdc.gov/pertussis/clinical/treatment.html Computer Interpretation of EKGs Bracey A, Meyers HP, Smith SW. Emergency physicians should interpret every triage ECG, including those with a computer interpretation of “normal.” Am J Emerg Med. PubMed. National Library of Medicine: National Center for Biotechnology Information. Published May 2022 https://pubmed.ncbi.nlm.nih.gov/35361516/ Deutsch A, Poronsky K, Westafer L, Visintainer P, Mader T. Validity of Computer-interpreted “Normal” and “Otherwise Normal” ECG in Emergency Department Triage Patients. West J Emerg Med. PubMed. National Library of Medicine: National Center for Biotechnology Information. Published January 2024 https://pubmed.ncbi.nlm.nih.gov/38205978/ Tuberculosis CDCTB. TB Testing & Diagnosis. cdc.gov Published July 26, 2022 https://www.cdc.gov/tb/topic/testing/default.htm Global Tuberculosis Institute. Treating Latent TB Infection (LTBI). YouTube. Published November 29, 2022 https://www.youtube.com/watch?v=Udq-65YuLlo Niknejad M, Gaillard F. Tuberculosis (pulmonary manifestations). In: Radiopaedia.org. Radiopaedia.org; 2010. Revised January 5, 2024 https://radiopaedia.org/articles/tuberculosis-pulmonary-manifestations-1?lang=us Fluoroquinolone Antibiotic Side Effects Farkas J. PulmCrit - Six reasons to avoid fluoroquinolones in the critically ill. PulmCrit (EMCrit). Published August 1, 2016 https://emcrit.org/pulmcrit/fluoroquinolone-critical-illness/ FDA Drug Safety Podcast: FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects. U.S. fda.gov Published January 19, 2022 https://www.fda.gov/drugs/fda-drug-safety-podcasts/fda-drug-safety-podcast-fda-updates-warnings-oral-and-injectable-fluoroquinolone-antibiotics-due Highlights of Prescribing Information: CIPRO. fda.gov https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019537s086lbl.pdf Stanley I. Mother is left unable to walk after taking just three ANTIBIOTIC pills to treat a UTI: Disabled vet husband she previously cared for is also in a wheelchair. DailyMail.com. Published February 22, 2024 https://www.dailymail.co.uk/health/article-13111327/young-mother-unable-walk-antibiotic-pills-uti.html Tilley C. “Killer” antibiotic that's STILL being prescribed to 15m Americans a year: Widow of singer Bobby. DailyMail.com. Published March 2, 2024 https://www.dailymail.co.uk/health/article-13115607/Bobby-Caldwell-wife-fluoroquinolone-antibiotics.html Incidental Findings Incidental Findings. acr.org. American College of Radiology https://www.acr.org/Clinical-Resources/Incidental-Findings Schleicher S. DermDx: Suspicious Mole on Sole of Foot. Clinical Advisor. Published February 16, 2024 https://www.clinicaladvisor.com/slideshow/derm-dx/dermdx-suspicious-mole-foot/?elqtrack=True&hmemail=1f%2FJfEV7hN5vJr6vg%2FQRqK0NA6IXtyO3&hmsubid&nid=1639413404&sha256email=092493d8223fdfa40d9e995176d13e5fc5b5211674db9deb440c025fd462c80c Viennet M, Tapia S, Cottenet J, Bernard A, Ortega-Deballon P, Quantin C. Increased risk of colon cancer after acute appendicitis: a nationwide, population-based study. EClinicalMedicine. Published August 30, 2023 https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00373-5/fulltext 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 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. Be sure to listen in and see what we have to share!

On this episode of GMM, we are joined by cardiologist and assistant professor Dr. Kramer Wahlberg. We discuss patient success stories, the overlap between law and medicine, and mental health impacts on heart health. Tune in for even more here.   Co-Hosts: Caity Decara: caitlin.decara@med.uvm.edu Haley Bayne: haley.bayne@med.uvm.edu

Join us aboard the waves as we delve into the intricate world of EKGs and Valve Dynamics with John Bielinski, a seasoned expert in emergency medicine. Despite the backdrop of gentle ocean waves, John brings a wealth of knowledge and experience to the table, guiding us through the complexities of cardiac diagnostics and physiology. Get ready to embark on a journey of learning and discovery with TALK EM Podcast!   Thanks for listening!

In the dynamic world of entrepreneurship, stories often unfold in unexpected ways. Dr. David Albert's journey from the son of a prominent politician during the Watergate era to a trailblazing entrepreneur in the medical technology sector is a captivating tale of resilience, innovation, and the pursuit of a passion that transcends traditional boundaries. His company, according to PitchBook, has already raised $50M+.

Tune in to the TALKEM podcast and embark on a thrilling journey through the captivating realm of EKG interpretation!

Dr. Jerry Haas has been at LJC helping patients feel comfortable and well cared for before, during, and after surgery for over 25 years. When Dr. Haas isn't by patients' side during surgery, he's there throughout their weight loss journey to help them safely reach their goals as the director of our medical weight loss program, Signature Skinny Shot.While serving the Navy on an aircraft carrier as a general medical officer, Dr. Haas' senior medical officer would always tell him he'd be a great anesthesiologist. He took these words seriously. After two years of serving the Navy, he completed his three-year anesthesia residency, and he's been keeping patients safe ever since.Learn more about anesthesia at LJC on our episode Is Anesthesia Dangerous? We Asked Our AnesthesiologistLa Jolla Cosmetic is located just off the I-5 San Diego Freeway at 9850 Genesee Ave, Suite 130 in the Ximed building on the Scripps Memorial Hospital campus.To learn more, go to https://www.ljcsc.com/ or follow the team on Instagram The La Jolla Cosmetic Podcast is a production of The Axis: http://www.theaxis.io/

In this episode of the Nurse Dose Podcast, join your host, Sean, an experienced ICU nurse, as we delve into the essential topic of Electrocardiography (EKG) basics tailored for the Intensive Care Unit. Sean takes the lead in breaking down the fundamentals of interpreting EKGs, offering valuable insights for nurses, students, and healthcare enthusiasts. Instagram: @nursedosepodcast ICU Study Guides and Cheat Sheets: nursedosepodcast.etsy.com www.nursedose.org This podcast is intended for informational and educational purposes only. It is not intended to provide medical advice or to substitute for the advice provided by your own physician or other medical professionals. The information contained herein is not intended to diagnose, treat, cure, or prevent any disease. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional. The opinions expressed in this podcast are those of the host and guests and do not necessarily reflect the views of any medical institution, organization, or employer. By listening to this podcast, you agree to hold harmless the host, guests, and any associated parties from any and all liability or damages arising from your use of the information provided.

Welcome to another enlightening episode of 'TALK EM,' where we dive into the intricate world of electrocardiograms (EKGs) with our esteemed host, John Bielinski. This episode is a must-listen for medical professionals, students, and anyone interested in understanding the vital art of EKG interpretation. John Bielinski brings his expertise and unique teaching style to the table, simplifying the often daunting task of EKG analysis. Known for his ability to make complex medical concepts accessible, John introduces powerful mnemonics and practical strategies to decode the mysteries of the EKG. This episode isn't just about learning; it's about mastering EKGs in a way that sticks. Whether you're a seasoned practitioner looking to sharpen your skills or a medical student grappling with EKGs for the first time, this episode offers invaluable insights. John's approachable methods and mnemonic techniques will transform how you view EKGs, turning complex readings into clear, understandable patterns. Join us on 'TALK EM' for an episode that's not just educational but transformative. Equip yourself with the knowledge and confidence to interpret EKGs accurately and efficiently, as John Bielinski guides you through the process with ease and expertise. Tune in now to 'EKG Mastery with John Bielinski: Unlocking the Code with Mnemonics' and take the first step towards EKG proficiency

In this special edition of Public Health Matters, your host, Dr. Christina Madison, takes you on an exciting journey through the wonders of the Consumer Electronics Show (CES) 2024. As a public health pharmacist, Dr. Madison explores the cutting-edge developments in health tech, wearable devices, and artificial intelligence showcased at CES. Check out the video here. Key Innovations Highlighted Innovations: Vivoo: An at-home urine test kit allowing users to test for various conditions, providing color-coded results for easy interpretation. MyHixel: AI-assisted technology addressing male sexual health, offering an app and personal lubricant for climax control. Neurologic: A video-based health and wellness measurement solution enabling virtual health monitoring and data transmission to health care professionals. Bodylog: An award-winning wearable tech monitoring EKG and heart health, with a unique capability to record pre-and post-fall data for better emergency response. Assistive Technology: WIM Robotics: A Korean-developed exoskeleton assisting people with limited mobility, enabling walking, climbing stairs, and resistance training. LetinAR Wearable Glasses: A revolutionary device offering augmented reality capabilities, particularly in medical imaging. Dr. Madison shares her experience of viewing EKGs, chest X-rays, and CT scans through these wearable glasses. Health and Hygiene Innovations: Germ Pass: A company specializing in rapid germ-killing solutions, particularly targeting the virus causing COVID-19. HyperVSN: Known for 3D holograms, adding a futuristic touch to personal and business presentations. Automotive Innovations: Dr. Madison explores the safety features and AI integration in the automotive sector, highlighting Mercedes Benz's internal assistant and Hyundai's flying car.

In this captivating episode of the Stories to Create Podcast, our host, Cornell Bunting, engaged in a riveting conversation with Dr. Nadine (Deanie) Singh, DNP, APRN, FNP-BC. Mrs. Singh is not only the Founder and CEO of Premier Mobile Health Services but also a distinguished Doctor of Nursing, with a rich history in primary care clinical expertise spanning over two decades. During the episode, Dr. Singh delved into her extensive nursing background, highlighting her proficiency in health promotion, disease prevention, and the management of both acute and chronic disorders and diseases. She passionately described her mission of motivating and guiding patients toward wellness, emphasizing the pivotal role of healthy dietary choices and physical fitness in achieving this goal. Dr. Singh's work extends to providing invaluable services, including overseeing a patient's comprehensive care by prescribing medications and treatments, conducting and interpreting diagnostic tests, such as x-rays, EKGs, and lab work, and diagnosing and treating a wide spectrum of chronic and acute conditions, ranging from injuries to infections, diabetes, and high blood pressure. The episode also touched upon Dr. Singh's remarkable personal journey, from her challenging times in Jamaica to her pursuit of a better life in the United States. In addition to her clinical responsibilities, she serves as an educator for future medical professionals in her role as a Preceptor for numerous Nurse Practitioner students. Furthermore, Dr. Singh is an advocate for the underserved and underinsured populations, actively participating in organizations such as the Lee County Homeless Coalition, the Mobile Healthcare Association, and the Lee County Nurse Practitioner Association, and serving as a Board Member of Zeal Technical Institute. Her commitment to these causes is further exemplified by her position on the Board of Directors of the National Association of Free and Charitable Clinics. Join us in this insightful episode as we unravel the remarkable journey and impactful contributions of Dr. Nadine (Deanie) Singh, a true luminary in the healthcare field. Support the showThank you for tuning in with EHAS CLUB - Stories to Create Podcast

Important items during the pre-participation exam that might identify an athlete at risk for a cardiac pathology, common cardiac pathologies found during the PPE, and disqualifying cardiac conditions.  Timestamps 2:17- Important components that may identify an athlete at risk for a cardiac pathology 4:10- Role of the family history 5:17- EKGs during PPEs 7:33- COVID history and risk for cardiac pathology 9:18- Common cardiac pathologies the AT may come across 11:11- Risk of having a heart murmur 13:43- Role BP plays in cardiac pathology risk 17:21- Disqualifying cardiac conditions 20:40- Starting the conversation about disqualifying cardiac conditions Action Item: What are some of the key red flags for a cardiologist referral? -- AT CORNER FACEBOOK GROUP: ⁠https://www.facebook.com/groups/atcornerpodcast⁠ Instagram, Website, YouTube, and other links: ⁠atcornerds.wixsite.com/home/links⁠ EMAIL US: atcornerds@gmail.com SAVE on ⁠Medbridge⁠: Use code ATCORNER to get $150 off your subscription SAVE on ⁠Precision AT⁠: Use code ATCORNER for 15% off all home study courses ⁠Season 1 CEU Multi-pack⁠: Get all of your season 1 CEUs in one pack! Music: Jahzzar (betterwithmusic.com) CC BY-SA -- -Sandy & Randy

Medical imaging is a prevalent cog in the healthcare industry. Millions of images can be stored in a single location and provide use cases not just in radiology, X-rays, CT scans, MRIs, and EKGs, but also for post-op wounds, dermatology and more. Medical imaging is being extended into more use cases, such as digital pathology, where slides are scanned for later analysis. These millions of images have to be stored somewhere, and more and more hospitals are looking toward the cloud to provide that data storage - specifically AWS FSx using NetApp ONTAP storage. In this episode, Sasha Paegle of AWS and Kim Garriott of NetApp talk about the Amazon FSxN cloud solution for Medical Imaging.

You can also listen to this episode on Apple Podcasts or Spotify!Manish Agrawal MD and Paul Thambi MD are oncologists who have spent decades caring for patients with cancer. They realized early in their careers that chemotherapy could treat the cancer—but what about the emotional, psychological and spiritual impact of facing mortality? When they learned about the potential for medications like MDMA and psilocybin to help people gain access to parts of their minds they didn't know existed—and to address the human experience of suffering—they quit their day jobs as practicing cancer doctors to found Sunstone Therapies, the sole psychedelic-assisted therapy research and treatment center in the Washington, D.C. area.  The data are increasingly clear: these non-addictive substances hold the power to expand consciousness and improve quality of life.When guided by a trained therapist in the appropriate setting, even one experience with a psychedelic medication can help people unlock closed doors in their minds and to feel safe enough to explore its contents. They can be the catalyst for patients' ability re-route well-worn pathways of negative and maladaptive thoughts, feelings and behaviors.It turns out that science and spirituality aren't mutually exclusive.On this episode of Beyond the Prescription, Drs. McBride, Agrawal and Thambi discuss the inseparability of physical and mental health; the promise of psychedelic therapy to treat the psychological impact of cancer and other diseases such as PTSD, anxiety, and depression; and their shared excitement about the potential for these drugs to fundamentally expand the standard of care in medicine. Bios:Manish Agrawal, MDManish brings an extensive background and experience that spans medicine, engineering, philosophy, and ethics to his role as CEO of Sunstone Therapies. Driven by a deep interest in healing, Manish is particularly passionate about whole person healing and the transformative potential of psychedelic therapies. Manish previously held the position of Co-Director of Clinical Research at Maryland Oncology Hematology, where he dedicated 15 years to the care of cancer patients. He completed a fellowship at the National Cancer Institute, National Institutes of Health, and his residency at Georgetown University Medical Center.Paul Thambi, MDPaul brings deep experience in oncology care and clinical trial design to his role as Chief Medical Officer at Sunstone. He is a proponent of strong organizational culture and strives to create a compassionate, open and accepting workplace to advance whole person healing in medicine. As a medical oncologist, Paul developed important and meaningful relationships with patients, witnessessing their emotional and physical distress upon diagnosis and throughout treatment, leading him to explore psychedelic therapies to improve the emotional and mental health of patients fighting cancer. Paul completed his oncology fellowship at the National Cancer Institute and, prior to pursuing medicine, he began his professional career in engineering and consulting.Join Dr. McBride every Monday for a new episode of Beyond the Prescription.You can subscribe on Apple Podcasts, Spotify, or on her Substack at https://lucymcbride.substack.com/podcast. You can sign up for her free weekly newsletter at lucymcbride.substack.com/welcome.Please be sure to like, rate, and review the show!The transcript of the show is here![00:00:00] Dr. Lucy McBride: Hello, and welcome to my office. I'm Dr. Lucy McBride, and this is Beyond the Prescription, the show where I talk with my guests like I do my patients, pulling the curtain back on what it means to be healthy, health as more than the absence of disease. As a primary care doctor, I've realized that patients are more than their cholesterol and their weight. We are the integrated sum of complex parts. Our stories live in our bodies. I'm here to help people tell their story, and for you to imagine and potentially get healthier from the inside out. You can subscribe to my free weekly newsletter at lucymcbride.substack.com and to the show on Apple Podcasts, Spotify, or wherever you get your podcasts. So let's get into it and go Beyond The Brescription. [00:01:03] Buckle your seatbelt. Today we are going to talk about one of my favorite subjects, the re emerging field of psychedelic medicine. I truly believe it is going to change the landscape of modern mental health care in this country. I cannot wait to introduce you to my guests today, Dr. Manish Agarwal and Dr. Paul Thambi. They are oncologists who have spent decades caring for patients with cancer. They realized early in their careers that chemotherapy could treat the cancer, but what about the whole person? What about the emotional, psychological, and spiritual impact of facing a hard diagnosis and mortality? When they learned about the potential for psychedelic medicines like MDMA and psilocybin to address patients' whole health, to offer some acceptance and insight and access to the patient's interiority in ways that they had never seen before, Paul and Manish left their day jobs as practicing cancer doctors to found Sunstone Therapies. [00:02:13] This is where I am now sending some of my patients, not just to face cancer diagnoses, but also for anxiety, depression, and PTSD. Sunstone Therapies is the sole psychedelic assisted therapy research and treatment center in the Washington, D. C. area. The goal of Sunstone is to better treat the emotional and psychological impact of cancer and other disorders. Paul and Manish are contributing to the fundamental expansion of the standard of care in medicine and it is a wonderful thing to be part of and to watch. Paul and Manish, thank you so much for joining me today on the podcast.[00:02:53] Dr. Paul Thambi: It's a pleasure to be here. Thanks for having us.[00:02:55] Dr. Manish Agarwal: Yeah, it's great having you. Thank you. [00:02:57] LM:  The two of you together have backgrounds in medicine, engineering, philosophy, data science, and research, yet you landed in the field of psychedelics for a reason. Tell me why that is. What is so exciting about this field to you?[00:03:15] MA: Paul and I both have been practicing oncologists for almost 20 years, and over time we got really good at taking care of cancer patients, their physical symptoms, but their quality of life was not always directly proportional to how they physically felt. And over time it really starts eating away at you, that you're not able to take care of the emotional health of cancer patients.[00:03:35] When we saw this emerging field and started looking at the data, We visited and learned about it and then got training and explored to see is this real. And that's what sort of led us down this path is, for me personally I've always been into philosophy, that's why I have my masters in philosophy.[00:03:54] I've been interested in the human side of medicine not just the science side. Both have fascinated me and this really brought both of them together. The reason that Paul and I both went into medicine is to treat people and to make them feel better. And really, for the cancer patient, for any patient, you have to take care of everything, not just the physical symptoms.[00:04:14] PT: Everything that Manish said is echoed in my life and how I was drawn to this. And I think there were a few patients that really suffered emotionally that really hit home for me. And I carried that pain from what they went through with me. And when Manish showed me the data on psychedelic assistive therapy, it wasn't really the data, it was really more these YouTube videos where we saw how there were a couple of patients on the NYU trial and the Hopkins trial, and how they were before they went on that treatment and after. And there was a palpable change that you could feel through the video even, and it was just something that I wanted to be able to see if we can bring to our patients. [00:05:00] LM: Can you give me an example of a patient who has been served by this treatment, maybe a cancer patient? I'd love to hear an anecdote.[00:05:08] MA: There's a young patient with kids and a serious cancer, and had struggled with depression, didn't know anything about psychedelics, but really applied. And to see the change in his life, he's changed the relationship with his mother, who had a hard time with her son having cancer. And he was able to have a conversation with her afterwards, saying, I want my mom back.[00:05:29] And then he was bleeding, when he went home for something else, he got a cut. And his young boy sat up and said, “Dad, are you dying?” And he was able to sit and have a conversation with him. He said, I would never be able to do those things before. And he was able to really sense into that. And then the other group that's really, I've sort of been really blown away by is the military that we've been treating recently.[00:05:51] They have such complex things that they've seen, such complex trauma. And they've tried everything. I mean everything. For a military person to come and seek this care is not easy because the entire institution, it can affect their career if they talk about mental health. So they're desperate and to see the lives that are turned around, I literally wouldn't believe it if I didn't see it.[00:06:15] And it's been powerful to see them going from, thinking about suicide regularly, to really no meaning, to a sense of despair, to not where everything is great and perfect, but they're having a fundamental change, and they want to live, and they want to reconnect, and they're building their lives back together.[00:06:33] LM: I mean, that says everything that you need to know about why this is important. Acceptance, hope, peace, which isn't possible every day of the week, nor is it mutually exclusive with ongoing pain, as humans experience a myriad emotions on a day to day basis. But to think that there's something out there that could give people more agency and acceptance is pretty extraordinary given that we've had pretty poor tools to help people with emotional health and mental health. And so I guess my question to you is then, how do you see the psychedelics changing the way we think about mental health?[00:07:19] PT: One of the things that can help to do is just to shine a light on this is a part of our health that we need to focus on. There is now these tools that are being talked about that can be helpful, perhaps more helpful than the existing tools and that allows people to start talking about their emotional health more to their doctors, to their family.[00:07:44] And in terms of how these medicines can help, I think it's not just the medicine. I just want to talk a little bit more about that because the medicine does some things and would act on some of the same receptors that SSRIs act, but there's more to it than the medicine. You talked about it being an experience and it is that, and it's not always that it finds stories that are hidden, sometimes those stories are there and people feel them all the time, but they turn away from them. And what you need to do, what we're starting to learn with this is that you need to create an environment, a container as it's called in this space, that feels safe, that allows people to trust and be vulnerable in that space.[00:08:32] So that when they experience those fears, and some of those stories may be hidden, some of them may be ones that they've lived with their whole lives, but now they can look at those. They can be with that story that they've felt, and face it. Because they feel a sense of trust, and they're with therapists or people who care about them.[00:08:53] Who created a relationship with them that allow them to go deep into that story and find the pieces of that story that serve them and the, and the pieces of the story that don't and talk about that, integrate that into their lives, integrate that into their conversations with their families. It's that that does the healing more so than the medicine or as much as the medicine.[00:09:17] LM: It's such an important point because I see patients Who I will kind of raise this idea to—people who have complex PTSD or who are facing terminal diagnosis. And sometimes they'll say to me, well, I tried mushrooms in college and [it] didn't do much then. And I just had a bad experience. I remind them that that set and setting matters so much.[00:09:40] And I think it's such a good point that it's not just the medicine.It's the ability to feel vulnerable and safe, which is sort of this mystical aspect of the medications and then to face some things that you already did know you had and that weren't hidden. I think that's a great point.[00:09:57] MA: Yeah, I mean, I think it's actually pretty nuanced in all of that, because one thing I tell people is, I think psychedelics allow you to access psychic material like no other thing that I know of. But they're not a magic bullet. And if MDMA cured PTSD, I tell people that anyone that goes to a rave wouldn't have PTSD anymore.[00:10:22] But lots of people go to raves and still have PTSD. And so it must be more than the medicine. So it's not to take away from it, because I think you have access, but it is again, the context or, or how it's received. And so, it's like any medicine, the wrong dosage in the wrong context can be harmful or beneficial.[00:10:37] And what you talked about, I think, is really nuanced, and I think it's important. We actually call it sometimes therapy assisted by psychedelics. Because a relationship allows you to really trust, and to trust yourself, and to go deep. And if you have that sense of trust, you're able to access material that you may not otherwise be able to.[00:10:56] And a lot of times, sometimes injury or things occurred in a relationship and to have another wiring of your brain in a healthy relationship, to be witnessed when you were in pain or just to be held or to be supported is a different experience now than it might have been the time that it happened. And you're able to almost nurture that younger part of yourself.[00:11:18] And so that's, it's really, it is quite cutting edge and that's one of the things that fascinated us because it's not… people want medicine therapy. It's like, it's really this combination of the two and, and so you can emphasize one, emphasize the other, but without the two and done in concert and the right setting, it just is not as effective.[00:11:37] And so, you know, for us the therapists and the medicine are super important, but so is everything else. So the way the room is set up, the furniture, the music. The person that answers the phone, the way you're received, the way the follow up is. Because if you think about it, we all are sort of on alert, and you get a sense in your gut, can I trust this place? Can I trust this institution? Can I trust this store? We have relationships with people and institutions, and you start… some part of your psyche that's assessing for danger knows, how deep can I go? And so, you really have to build a place that tries to reassure even the unconscious part that it's okay to go deep here.[00:12:18] LM: I think it's such a good point. And because I was going to ask you how much… let's take psilocybin, for example, which is the active ingredient in mushrooms, how much of that feeling of safety and trust is the chemical itself, and how much is the therapist, the experience of, you know, calling the front desk, scheduling, seeing the lighting, seeing the room, because I have patients who are in therapy for 30 years, even, who trust their therapist, who feel safe, they have a comfortable experience, but they aren't actually making the kind of progress that you sometimes see in patients who have three experiences with psychedelics in the right setting.[00:13:08] MA: I don't think it's medicine that causes the trust. I think it's the environment. I think the medicine brings to the surface the issues that are there, and without the trust, you are not able to process them. And so, yeah, if they have a trusting relationship with their therapist, that's probably a really important piece, but then it's also deeper than that.[00:13:29] Can the therapist handle whatever material comes up? Are they able to be with that? Do they know how to navigate that? And so, if there's distress or anxiety or fear, what they don't necessarily need is reassurance or minimizing of it, and it's how to navigate those waters that's a different skill set than traditional therapy. I don't think the medicine in itself causes trust, it just amplifies what's there, but in a therapeutic relationship trust can be built, and trust is an intrinsic part of each one of us, but it's to rediscover that.[00:13:58] LM: Such a great point.[00:14:00] PT: I echo all of that. I think also, what the medicine does is when you feel that trust, the medicine is a catalyst for you to go into those crevices that you talked about within the story. It may be a story that you know about, but now there's going to be chapters of that story that were hidden to you. And if you feel the trust, it allows you to do that in a way that I think is hard to do on your own. So there is that catalyst that you get from the medicine around that.[00:14:30] LM: It's so gratifying to hear you talk about these sort of mystical and, and visible elements of the human experience because, again, I think that's what's missing in modern medicine, at least in the United States. We don't think about the 364 days a year you're not sitting with your doctor as health.[00:14:52] We don't think about the way we feel in our bodies, the way we think, our self perception, the way we approach stress or vulnerabilities as health. When actually there are direct physical impacts of chronic stress on our bodies. There's direct physical impact of what you described as a vigilance.[00:15:16] In fact, so many patients I see have been diagnosed with anxiety. And we'll use the word anxiety kind of casually, because it's so commonly used, people know the word, but, but actually when you dig deeper with a lot of these patients who have “anxiety” it's not necessarily that they worry excessively, or that they feel even anxious, they don't even often identify with that word, but that's the code in their charts: F41.9, but a more nuanced description of the way they feel, I think, is this vigilance, this sort of emotional, behavioral, and then sometimes medical reaction to feeling threatened that stems from an experience or set of experiences in their childhood. And we talk about adverse childhood experiences having physical and emotional mental health manifestations later in life.[00:16:06] But I see patients all the time who have been diagnosed with anxiety, but whose symptoms stem directly from some adverse childhood set of experiences or experience. And then they have hypertension, binge eating, cardiovascular disorder, cardiovascular disease, racing thoughts, sort of like a twitchiness physically and emotionally when they are faced with stress. And I think that those are the people, as far as I understand it, who have had PTSD who are being studied first and foremost with psychedelics. Is that right?[00:16:41] PT: Yeah, that's right. Right now, that's the indication that has shown the most benefit with MDMA.[00:16:45] MA: Yeah, and to piggyback on, I mean, you've made a couple of points, I guess, and we should probably just touch on them. I think just working backwards… the last point, I think that if people do have these feelings of anxiety or depression, and I think when, um, a disservice we've done is pathologize them, that somehow that's the problem.[00:17:05] And it actually is a sign of health because they're having a normal reaction to abnormal situations. And so, what trauma can sometimes be is that when you're very young you have a situation that was very difficult. But you responded normally, you would feel anxious or you'd feel depressed or sad. But then you didn't have support in that situation and so it got stuck.[00:17:27] And then, now you react when things arise, your body, your psyche has a visceral memory of that, of that lack of safety or that issue that occurred. And so, it's not that the person is a problem, it's not a pathology. They had a normal response to an abnormal situation, whether it was an abusive family member or neglect or abandonment, whatever it was.[00:17:50] It's just that, that situation isn't occurring now. And they need support to be able to work out of that. And what they do, what I've seen sometimes, is that actually becomes their superpower. So they get really sensitive. If you had power issues and somebody that powered over you wasn't, you get really sensitive to that.[00:18:07] And you know in your body when something might be happening even before your mind does. And so, it's turning that story to say it's not a problem as much as how you can move on with it. And then the only other comment I was going to make is on the first part you were saying around, medicine, not looking at these other aspects of our emotional health and I think it's a historical time, really. I think for much of history, the shamans were the physicians and there was a connection between the mind, body, and spirit. And then to great progress, we developed a great scientific understanding of the body and develop antibiotics and other things that help us live a lot longer.[00:18:47] And that's helped us, but then because your blood pressure is good and because your coronaries are clean and you don't have cancer, it doesn't mean you're happy. Now I think things are turning again, that the human is not just a biological entity, but it's also a spiritual, emotional, psychological… whatever you want to call it.[00:19:06] And until you have all of that together. You're just not going to feel fully human. And so before there was this science versus religion or science versus woo woo or whatever it is. But I think more and more you'll see really respected neurobiology labs that are starting to, to talk about that. And you're doing MRIs of monks of brains and you're seeing that meditation causes certain changes.[00:19:27] And then when we do MRIs of patients on psychedelics, going back to your point on vigilance, there is something called the default mode network. And that part of the brain is always looking for problems. It's the default mode. It's being vigilant. And that's the part that quiets down, other parts of the brain wake up, and they're able to start connecting.[00:19:49] And so science now is backing up what's happening. And so there's not so much this tension there, and people are wanting to both be physically and emotionally whole.[00:19:58] LM: It makes so much sense. I've heard Roland Griffiths talk about the experience that long term meditators can have as being the closest to the experience or benefits of psychedelic. Is that something you agree with?[00:20:18] PT: Yeah, I think that, that makes sense. I mean, I think deep meditation allows you to see or feel things that you're feeling with a little bit of removal from that. And that allows you to have a different perspective. So, there is a correlation that can be made.[00:20:36] LM: So, when people look at the New York Times and they see an article about psychedelic medicine, I think they automatically, in many cases, go to two thoughts. One, aren't these recreational drugs that are just for people in rock concerts in the 1960s? And two, that doesn't apply to me. This is for people who are really far gone. And so I'd love for you to speak to the sort of stigma around psychedelic medicine, where that comes from.[00:21:08] PT: Yeah, and Michael Pollan talks a lot about this in, in his book How to Change Your Mind and how there was social and maybe political pressure around creating stigma. So I think that's some of what happened and then also you get into the 1980s where, you know, this is your brain on drugs, those commercials that would come out that really heightened my sensitivity as a child growing up in the 80s around that.[00:21:34] And I think those are things that are hard to release. And now that we're starting to understand, and this is coming up again, psychedelics, realizing that these have been around for millennia. And they've been used by cultures as rites of passage for ways to solve the problems of a community. And I think now that those stories are coming back up and also the scientific data which provides people with a level of comfort, especially those people that have this fear of addiction and drugs and all of those things that I had when I was a kid, knowing that this is coming up in the medical institution. Along with the stories from the past are allowing for people to see this in a different way and to accept it more… I think one of the reasons that people feel safe doing this is that, especially like in the environments that we have at Sunstone, where it is in a sort of a medical environment, where our office, where we treat people, is on the campus of a hospital, and they can see the hospital out the window.[00:22:36] And we're clinicians that have treated patients before as doctors, and it's in a research setting. That allows them to overcome that stigma, to feel safe as they embark on this thing they were told never to do in the past.[00:22:51] LM: And so what do you make of this kind of... Emerging industry where people are taking the medicines off label with various healers and going on retreats in Costa Rica, because I worry, I don't know if you worry that if the set and setting are not appropriate, if the person who is supposed to be the guide isn't trained or perhaps worse, if the recipient of the therapeutic isn't aware of the potential risks and isn't guided in an appropriate way, then, then we might end up losing all the ground and getting these medications approved through the appropriate medical channels. Do you have that concern? [00:23:32] MA: For sure, to some degree I do. I mean, I think there are probably great practitioners around some of those settings, but there's just no way to filter through that. And what I worry about, and I get more worried about, is the longer we're doing this, because we're treating complex PTSD patients, they're complicated. And things that come up, if you're not trained and equipped to do that well, it actually... it causes more harm. In fact, I was speaking with a senior psychedelic therapist who's worked for MAPS in Colorado, and she does only things legally, but she does a lot of integration work, and it's integration work for people that did psychedelics underground.[00:24:17] And the biggest thing that she sees... As people got re-traumatized because they would have an experience and it was severe and the therapist wasn't able to be there. So then again, it felt like what I'm feeling is not okay, which is a feeling that they had the first time. And so she's having to rework through that.[00:24:35] So in that way there's legitimate concern. And the other thing that I worry about is, we've seen this, that you talk to people, they seem fine, or you have one assessment of their mental condition, but it gets more complex and even they're not aware of it fully. And so you have to be really prepared for that.[00:24:56] And the other point I was going to make is what you said, what you asked initially about the underground. But then you also said, people said, I'm not as sick, or how about that stigma? So I think there's a real stigma around mental health. There's a stigma around psychedelics and there's a stigma around mental health.[00:25:13] And so this is both. What it still surprises me time and time again is that people just under report their symptoms, but they still seek it out. So there's sort of this dance. They're like kind of… I'm really kind of okay because it's how they dealt with it. It's like we don't have an environment where you're able to be sad or anxious and there's not something wrong with you and so people play it down and… this is totally anecdotal, but I swear it's worse with men. We'll see, they'll come in, and they're like, I'm fine, I'm fine, and then you, well I drink a lot, and then, yeah, I guess I have feelings of sadness, and then you do the scale, and it's like, wow.[00:25:53] I think it's even harder for men to admit their emotional struggles and that's just a generality, but overall I think there's a collusion of denial around our emotional state and somehow you just have to be, present a certain way, and there's something wrong with you if you're struggling.[00:26:07] LM: I mean, I have a couple of thoughts about that. One is thank you for saying out loud that men are more walled off than women to a woman. No, I'm kidding. I think you're generalizing, but yes, let's just acknowledge that we are very self aware species, women, that is. Secondly, I think we all have a level of denial.[00:26:22] I think denial serves us sometimes, right. Denial is a way of partitioning off pain so that we can cope and function. But then when denial takes on a life of its own and the stuff that is in the denial closet is sort of seeping through the edges and like running out of the bottom of the closet and informing our health, that's when denial is no longer serving us. It's when it's actually in the driver's seat. So it strikes me that the experience, in an appropriate setting with a psychedelic, could help people pull that wall down or open that closet and, and take a look inside and maybe rethink how they approach that thing they didn't think they could approach.[00:27:08] And then secondly, yeah, mental health still has a bad rap when, as you both know, we all have mental health. It's not a feature you can kind of opt out of as like the human without the mental health. And as you said earlier as well, we tend to medicalize and pathologize mental health.[00:27:30] So in a way that's good because we are acknowledging that these have medical consequences, that an anxiety disorder is a medical condition, as opposed to just a personality flaw, which was what some people think of it as. But we also tend to label and sort and diagnose conditions that are just normal.[00:27:50] Like, of course, when someone has been raised by an alcoholic parent and they have been conditioned to sort of be a certain way, sort of invisible or good or not a problem, that is going to have an impact on their health such that when they get into a therapist's office or a doctor's office in their forties and their maybe that's not depression.[00:28:13] Maybe you had a response to an experience and sure the symptoms are that of depression, but it's actually something more complex, more nuanced. And so I'm not really asking you a question. I'm just making an observation that we're up against a lot as we market these medicines and therapeutics to people because of the stigma around mental health because of the stigma around drugs But I think if it's done well—which is why Sunstone and other research institutions exist—if it's done well, and we can actually help people understand that their interior lives their past their stories have relevance to their health. And that yes, having clean coronary arteries and nice blood pressure is great, but it's not sufficient for health, then it really, I do think is going to change the way we think about health.[00:29:04] It's already changed it for me. It's just that it's not legal yet in DC. And I haven't tried psychedelic medicine. I want to, it has changed the way I think about emotional health. I mean, I've been thinking about mental health and health in this way, my whole career, but I don't think modern medicine has given doctors really permission to do that.[00:29:20] And so I wonder what you think is in the pipeline. Are these things going to be FDA approved in the next five years, ten years? Are people going to be able to access these therapeutics? Are there going to be enough guides to appropriately shepherd people through the process? What are we looking at in the next year or five years.[00:29:41] MA: I just want to comment a little bit on what you said around the denial piece. I think that denial actually is quite healthy. And on where your neurological system was, when you experienced something, it might've been, it probably was overwhelming and the proper and healthy response would have been denial and to put it into a box.[00:30:00] It's just that now it's not necessary and it's not integrating back into your life. And so I'm very wary of pathologizing any of these things because they're usually healthy. It's just in the context now. And so I just make that one point and the other one around the mental health issue that, it's good that we're talking about it, but I think that we wouldn't want a life without emotions, right?[00:30:23] If you push down your anxiety and your fear, you also push down your joy and happiness and love, the things that we humans live for. And so they sort of go both hand in hand and you can't have both of those.[00:30:38] LM: Yeah, sort of like when we talk about alcohol when we're sort of self medicating, right? It blunts distress, but also blunts joy, libido, life. So you can't selectively numb. You also can't selectively be the human without an emotional life because that wouldn't be good. Then we'd all be like chat GPT or AI, right?[00:31:00] PT: Yeah, yeah, and it just, I'm just going to piggyback on that denial part of things too, because I think one of the things that's important to remember is that people have built up these ways of denial, of sort of pushing things away. Psychedelics, like we mentioned before, can be a catalyst to break through that denial.[00:31:17] That can be, you can lose your balance when that happens. So I just want to highlight again how important it is to have that integration and that container afterwards because you can't feel that way afterwards. You have to be with people that help you find that centeredness again. [00:31:35] And in terms of access and what's happening, we talked about how MDMA has been studied in PTSD for some time now. And there are two phase three trials. They're showing significantly positive results. And that might be the first medication that gets approved as a psychedelic for PTSD outside of esketamine, which has been approved for depression. And that might happen in the next year or two and we will hope for that.[00:32:01] And psilocybin is behind that in terms of how it's being used in various types of depression, and more and more information is coming out around that looks good, and perhaps if it continues to look good, that could be the next medication that gets approved. We'll see. So I think those are the things that are happening in terms of access and how we get this to people if they are approved, if they do show that they are effective, You're right, I don't think our healthcare system is built for this right now and there aren't enough therapists that are trained in this to treat everyone that has PTSD or even a half the people that have PTSD that might qualify for MDMA or for psilocybin in some sort of depression. And that's what we're thinking a lot about.[00:32:48] We have investigated how to do this in a group setting, with group preparation, taking the medicine as a group, and having integration as a group. We find it is not only a way that introduces efficiencies, but we also see therapeutic healing with that approach, too. To be able to be connected with another group of people that have something similar to what you have or what you're going through, whether that be cancer or PTSD or depression, and to develop this bond during the sessions that you have with each other around preparation and integration, we think that's probably going to be therapeutic, too.[00:33:29] That model also allows for more people to be trained on this. So, we're trying to think about how to do that from a group setting. We're trying to think about how digital tools can be used to improve or to give us efficiencies in this setting, but also remembering that there's compassion that's needed with this, so not to overuse digital processes. We're thinking about that as well. How do you do scheduling and other things? So, I think there's a number of problems to be solved around access, but they're solvable.[00:34:00] LM: And so if you're listening to this and you're thinking to yourself, wow, I've been in therapy for 10 years. I'm on Prozac, but I still feel anxious. I'm sure there's some parts of me I haven't really discovered. This sounds really interesting. Or if you're just listening and want to try psychedelics, where would you go?[00:34:18] Would you have to enroll in a clinical trial? Would you call Sunstone? Would you wait until MDMA is approved? What would you do if you were curious and wanted to participate in the research or the therapeutic elements here?[00:34:31] MA: I think the first thing you would do is look for a clinical trial. And so, there are many, many places now that are doing research throughout the country and internationally. And certainly at Sunstone, we have five studies open now, and we will have another three more open this year. We have them in depression and anxiety and PTSD and cancer and family members of cancer patients and so there's other places that have that. So I think that's sort of the most rigorous way to get that. And I do think that some medicines, as Paul said, will be approved next year. I think that, I cannot underemphasize the importance of the context and the safety. What you don't want is to do something and get worse and so you want to make sure that you have safety if you're not good on that road.[00:35:16] And I think we've talked a lot about the upsides of psychedelics and we're talking about that because so much of mental health right now, we don't have great treatments for, but we're still really in early days and we still have a lot to learn. Who's most going to benefit? Which people are completely contraindicated for?[00:35:36] How do you get people ready? And so I understand the hype because people are desperate. And at the same time, I want to be cautious in that I think we're still learning about how to use these powerful medicines.[00:35:50] LM: Yeah, I mean, I think one thing I am concerned about in particular, and I know this is out there in the public, is the potential risk for someone, particularly in their 20s who may be predisposed to schizophrenia. Is there a link between the use of psychedelic drugs and either the awakening or the schizophrenia or mental illness?[00:36:09] Plus, as you've already talked about, this idea of not having the right set and setting not having the appropriately trained guide or the feeling on the patient side of of safety and trust such that people get worse. So what are the absolute contraindications right now in your mind?[00:36:28] PT: Some of them are around people who have a tendency towards manic episodes. Like bipolar disorder with mania because that has been described where people had manic episodes after having a psychedelic experience, so I think that's one firm contraindication right now, at least in research trials. [00:36:49] The others are—there are some cardiac effects that people worry about with some of the psychedelic medicines, so if there's a history of abnormal heart rhythms or a potential tendency to have an abnormal heart rhythm, that's another contraindication. Some of them like MDMA have sympathomimetic effects, which means they can cause the heart rate to go up and the blood pressure to go up. So if someone doesn't have controlled high blood pressure, or if they have underlying heart disease, they may need to get evaluated with a stress test and things like that to show that things would be safe if those conditions happen.[00:37:27] LM: And what about, so many Americans are on SSRIs, so is there a contraindication? For people who are on SSRIs or who are on any other medications at all?[00:37:38] MA: In terms of the SSRIs, right now we taper people off of them, and it's less about safety as much as efficacy, that we think it might blunt the depth of the response of a psychedelic. Although there are ongoing studies that are bringing some of that into question, and so they probably do work maybe at a higher dose, and so it's not an absolute contraindication, it's certainly not a contraindication for safety, it's just a, you might limit its efficacy.[00:38:02] LM: Interesting.[00:38:03] MA: And some of the drugs that can prolong the QTC, there's some concern around that, and so we certainly do EKGs on all the patients.[00:38:11] LM: What is so great about the way you're describing the research is that you have a healthy level of respect for these medications. You have enthusiasm, but it is tempered with appropriate caution. So thank you guys for joining me. It's been so fun learning about Sunstone. I've been grateful to you guys for taking some of my patients into your clinical trials, and I can't wait to see what's next.[00:38:37] PT: Thanks for having us, Lucy.[00:38:39] MA: Yeah, it's just been great getting to know you.[00:39:03] LM: Thank you all for listening to Beyond the Prescription. Please don't forget to subscribe, like, download, and share the show on Apple Podcasts, Spotify, or wherever you catch your podcasts. be thrilled if you liked this episode to rate and review it. And if you have a comment or question, please drop us a line at info@lucymcbride.com. The views expressed on this show are entirely my own and do not constitute medical advice for individuals. That should be obtained from your personal physician. Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

Tom Casey tells us how a health scare jump started his change in life that lead to the birth of Griffin Home Service. This guy is awesome. Dave Young: Welcome to the Empire Builders Podcast, teaching business owners the not so secret techniques that took famous businesses from mom and pop to major brands. Stephen Semple is a marketing consultant, story collector, and storyteller. I'm Stephen's sidekick and business partner Dave Young. Before we get into today's episode, a word from our sponsor, which is, well, it's us, but we're highlighting ads we've written and produced for our clients. So here's one of those. [Colair Cooling & Heating Ad] Stephen Semple: Hey everyone, Stephen Semple with the Empire Builders Podcast. And boy, we've been giving Dave Young a lot of time off lately, so we've kicked them off yet another podcast. And today I have with me someone who I've been really looking forward to interviewing. It's Tom Casey from Griffin Home Services in Florida. Tom has got an exciting story because Tom is the entrepreneur that a lot of us are striving to be. Started a business, bootstrapped it, built it up, went through fast growth, sold it for a big old whack of cash, and right now is not yet living the dream. He updated me that he's still working on the workout, but he is living a life with a big bank account, so that's always fun. So what I wanted you to share with us today, Tom, is a little bit of that story because I think it's great. We've shared in this podcast these stories of all these businesses that are big today, and we do go back to the beginning, but it's also very different for people to hear the story from a real live person who's gone through it. And I also find it kind of funny how you ended up starting an air conditioning business, reluctantly starting an air conditioning business in Florida. So maybe you could start off with just telling us a little bit about yourself and how all of that came about. Tom Casey: Sure. Appreciate you guys having us on. I listen to the podcast, so now I get to star in one of them. It's very exciting for me. I can't wait to brag to my kids. Stephen Semple: There you go. Tom Casey: I'm a third generation SOB, which you know, but the listeners maybe don't, meaning I'm a son of a boss, grew up in the business running tools with my dad, that typical home service kind of story for the sons. My grandparents started delivering coal and ice actually back in the day before there was such thing as heating and cooling. Worked with my dad for many, many years. Partners with him, loved every minute of it. Had a great experience. Back a while ago like most contractors, we go to the doctor when a limb has been removed. We don't go for regular things. And so as you get older, if you have a good partner, my wife makes the appointment. It's time for your annual checkup, which I go begrudgingly. And this one year, about maybe 10-11 years ago, I went and thought I'd be in and out, and it didn't quite go that way. They did the EKG, they came back and forth about six EKGs later. My doctor walked in, had been my doctor for 10 plus years and said, "Hey, I don't know what's going on, but I'm going to send you over to the cardiologist. There's something happening that we can't do here in this office." So got in my car, called my wife, "How'd you make out?" Hey, thanks for doing this. Now I'm going to the cardiologist's office. Went there, did a bunch of tests. Two or three days later I'm doing a stress test, failed that. And in less than a week I'm going under the knife for who knows what. It's like one of those get your affairs in orders thing. And so my kids were all still younger and still home, and it was a very emotional thing. I wrote them all letters just in case, which is a surreal experience. And so go to the hospital that Monday morning, first surgery because it could potentially be anything, right? They don't even know.

Drs. Allison Zibelli and Arielle Heeke discuss the NATALEE trial's novel approach to high-risk HR+ breast cancer, the potential of delaying CDK4/6 inhibitors in HR+, HER2-negative mBC to decrease toxicities and costs in the SONIA trial, and de-escalation strategies in HER2+ early-stage breast cancer. TRANSCRIPT Dr. Allison Zibelli: Hello. I'm Dr. Allison Zibelli, your guest host for the ASCO Daily News Podcast today. I'm an associate professor of medicine and a breast medical oncologist at the Sidney Kimmel Cancer Center at Jefferson Health in Philadelphia. My guest today is Dr. Arielle Heeke, a breast medical oncologist at the Levine Cancer Institute at Atrium Health in North Carolina.  Today, we'll be discussing practice-changing studies and other key advances in breast cancer that were featured at the 2023 ASCO Annual Meeting.   Our full disclosures are available in the show notes and disclosures of all guests on the podcast can be found on our transcripts at asco.org/DNpod.   Arielle, it's great to speak with you today.   Dr. Arielle Heeke: Thank you so much for having me.  Dr. Allison Zibelli: Let's start with LBA500. This was the NATALEE trial of ribociclib and endocrine therapy as adjuvant treatment in patients with hormone receptor-positive HER2-negative early breast cancer. What are your key takeaways from the study, and how do you think this changes our approach to high-risk ER-positive breast cancer?  Dr. Arielle Heeke: Yeah, this was definitely the study for which many of us were waiting to see the results. It was exciting to see the results come through so quickly. As you mentioned, the NATALEE trial was a phase 3 study that evaluated three years of adjuvant ribociclib at a dose of 400 milligrams, which is a little different than what we're used to in the metastatic space at 600 milligrams. But essentially, it randomized patients to receive this 400-milligram dose with their adjuvant aromatase inhibitor therapy versus just the standard of care adjuvant endocrine therapy in patients that are high risk with early-stage breast cancer.   What made NATALEE somewhat unique is they defined high risk a little bit more broadly than we've seen in previous studies, such as monarchE. So, what I mean by that is NATALEE enrolled patients with stage 2 and 3 early-stage breast cancer. And notably, they allowed for patients that were lymph node-negative but had some other high-risk features, such as a grade 3 tumor or a grade 2 tumor with high-risk genomics, such as oncotype or a high Ki-67. So, by broadening who was eligible, NATALEE captured more patients at risk for recurrence. Of course, we know that recurrence is not specific for patients with lymph node-positive disease. We can see recurrence even with stage 1, but certainly, we start to see more recurrence risk as patients drift into stage 2 and stage 3.   In the NATALEE study, the majority of these patients did receive prior chemotherapy, which I also think is interesting. We've kind of seen in the metastatic space that sometimes chemotherapy can augment patients' responsiveness to CDK4/6 inhibitors. But specifically in NATALEE, 88% of patients had received prior chemotherapy, and ultimately, about a third of the patients were lymph node-negative.   So, diving into some of the results with this first analysis that we saw at ASCO, with the median follow-up for invasive disease-free survival of just 27.7 months, they were able to show that the risk for invasive disease was reduced by 25.2% with the addition of ribociclib plus endocrine therapy compared to endocrine therapy alone. And this three-year invasive disease-free survival rate was 90.4% for the combination therapy compared to 87.1% for endocrine therapy alone, which is an absolute difference of 3.3%. Additionally, patients treated with ribociclib and endocrine therapy had a 26.1% reduced risk for distant disease-free survival compared with endocrine therapy alone, and this was a rate of 90.8% for ribociclib with endocrine therapy compared to 88.6% with endocrine therapy alone, which correlates to an absolute benefit of 2.2%.    They did show results for overall survival as well, but again, follow-up was just a median of 27.7 months. So, data was essentially immature to show any true overall survival benefit from this approach. And in fact, only 20% of patients had completed three years of ribociclib at this data cutoff. And as a reminder, again, NATALEE involved ribociclib for three years compared to two years, which we've seen with other studies in this space.   Also, what was encouraging from NATALEE were the readouts for toxicities. Neutropenia is definitely a concern with this class of medication, and they were able to show that rates of neutropenia were overall lower than what we've seen in the pooled data in the metastatic space. And also that problematic QTc prolongation for which we have to get EKGs baseline two weeks and four weeks. They also showed that the likelihood of having QTc prolongation on this therapy was significantly less at that 400-milligram dose compared to 600.   I think the key takeaway is yes, this drug is effective as adjuvant therapy, which is perhaps not surprising since we've seen such promising results in the metastatic space, but numerically not as striking as what we have at this point with adjuvant abemaciclib, but of course, this is a newer study. We hope to see that continued separation of the curves as we were fortunate enough to see with the abemaciclib data, but obviously we'll be looking for additional analyses from NATALEE.    And then how this will change practice, of course, we'll have to wait to see if the therapy is approved for use in the adjuvant setting for early-stage hormone receptor-positive breast cancer, but it certainly will be a nice option for patients that struggle with GI toxicity kind of at baseline. But also, if they were previously on abemaciclib and were not able to tolerate due to the GI toxicity, this would be an option for them. Also, as mentioned, it's a broader patient population, so we can consider this perhaps for a patient with lymph node-negative disease.   Although we will have to ask ourselves that just because someone meets eligibility for the NATALEE  study, and if the therapy is ultimately approved, is it appropriate to give it to all those patients? Or do we need to still kind of think of this in the setting of the highest-risk patient, not just any patient with stage 2 plus disease? There was a lot of talk at the meeting, certainly about biomarkers and potentially using ctDNA to try to find these predictors of benefit from CDK4/6 inhibitor therapy, but obviously, still a long way to go before we can use that type of technology in this space.  Dr. Allison Zibelli: Thank you. Staying on the topic of CDK4/6 inhibitors, everybody was excited about the SONIA trial, which was LBA1000, and this trial was asking if we can delay using CDK4/6 inhibitors for newly diagnosed ER-positive HER2-negative metastatic breast cancer as a way to decrease both toxicity and cost. Tell us about this study.  Dr. Arielle Heeke: The SONIA trial was such a cool study to see, and the presenter reported findings in such a thought-provoking way. Really great to see this sort of work being done because I think we all wonder deep down in our gut, if more is more, or if we do need to kind of be a little bit more thoughtful about how we introduce these therapies certainly from a patient perspective. Patients that participate at ASCO [meetings] have been saying for years how important it is to consider the toxicities in terms of side effects, but also, of course, financial toxicities. So, it was great to see the SONIA trial at center stage.   Essentially, as you mentioned, it was a study that randomized patients in the first-line setting with metastatic hormone receptor-positive breast cancer to receive either first-line CDK4/6 inhibitor therapy or second-line CDK4/6 inhibitor therapy. So basically, there was a mandated crossover, so patients that received the CDK4/6 inhibitor first-line did not receive a second line and vice versa. Patients that were randomized to receive their endocrine therapy as monotherapy first line went on to receive CDK4/6 inhibitor at second-line. And the second-line endocrine therapy was fulvestrant in both of those situations.    We kind of run into this problem with patients now where we have so many therapies available to us that we don't typically run out of treatment options, but rather we run up against treatment toxicity or ultimate failure of the human body to keep up with the demands of ongoing therapy. So, again, while it's maybe somewhat attractive to start treatments earlier using things first-line rather than second-line or longer, just kind of post-CDK4/6 inhibitor progression, you know using this CDK4/6 inhibitor again with a different endocrine therapy backbone is probably not offering a meaningful benefit to that many patients. So this type of study is so necessary to really try to help us frame who needs those therapies sooner and longer or perhaps is there a substantial portion of patients that we don't need to put them through that sort of toxicity.   So that's the SONIA trial. Some things to note about the patient population, these patients were a bit older than what we've seen in some of our metastatic CDK4/6 inhibitor trials. There was a median age of 64 and 87% were postmenopausal. Additionally, just 40% had received prior chemotherapy. And as is true for most of our studies, 91% have received palbociclib on study with just 8% receiving ribociclib. And the choice of the CDK4/6 inhibitor was per the treating provider, and at the time of the of study globally, palbociclib was the more commonly prescribed CDK4/6 inhibitor. But over the last year or so, data has certainly emerged favoring ribociclib in the metastatic setting.   On the SONIA trial, patients were monitored for a median of 37.3 months. And looking at the primary endpoint of the second progression-free survival, which is defined as the time for random assignment to the second objective disease progression or death, for those patients who received first-line CDK4/6 inhibition, had a PFS2 of 31 months compared to 26.8 months with second-line CDK4/6 inhibitor use. And this slight difference was non-statistically significant. So the conclusion was that time to second progression was not impacted by whether or not a patient received first-line CDK4/6  inhibition or second-line CDK4/6 inhibition. Additionally, there were no differences in overall survival between the 2 arms with a median overall survival of 45.9 months with first-line CDK4/6 inhibitor use versus 53.7 months in second-line CDK4/6 inhibitor use.  And that actually equates to significant differences in time on drug. The median duration of CDK4/6 inhibitor use with first-line therapy was 24.6 months compared to 8.1 months with second-line use. And by being on therapy for an additional 16.5 months if you use CDK4/6 inhibitor first-line, this, of course, leads to increased toxicity and certainly increased financial burden. And it was estimated that for each patient that receives this therapy first-line, there is an additional $200,000 spent on getting them the CDK4/6 inhibitor first-line, whereas the results from SONIA suggested that whether you use it first-line or second-line, the outcomes are essentially exactly the same.   And then specific for the SONIA trial, by conducting the study, they saved approximately €25 million on drug expenditure during the conduct of the trial. It's just amazing when you take it to that scale. And then lastly just to mention, they looked at quality of life assessments as well and there were no differences in the two arms whether they got first-line or second-line CDK4/6 inhibition.  Dr. Allison Zibelli: I thought this study was remarkable, and it got a long ovation when it was presented at the meeting. I'm certainly going to use this strategy and prioritize who needs upfront CDK4/6 inhibitor therapy.  I think that we have to think of not just drug toxicity for our patients, but financial toxicity. A lot of these drugs have very high copays and the number one cause of bankruptcy in the United States is medical costs. So that's something we really have to keep in mind. I also thought it was very interesting that the study was designed in cooperation with the patient advocacy group and patients themselves were very enthusiastic about this study and helped design it and helped recruit to it. So all in all, I thought this was a remarkable study.    So moving on, LBA1013 was the TORCHLIGHT study of toripalimab versus placebo in combination with nab-paclitaxel for patients with metastatic or recurrent triple-negative breast cancer. Many of us are not familiar with toripalimab. Can you tell us about the drug and how it was used in this study?  Dr. Arielle Heeke: Yes, toripalimab is essentially an immunotherapy agent. It's an IgG4K monoclonal antibody that targets PD-1. In this study, TORCHLIGHT, patients were randomized to receive toripalimab versus placebo in combination with nab-paclitaxel in newly metastatic triple-negative breast cancer. The patients on study were randomized two to one to receive drug or placebo. The drug is given on day 1 of a 3-week cycle at 240 milligrams and then patients of course also receive nab-paclitaxel on a day 1 and day 8 schedule of a 21-day cycle. They did look at outcomes on the study based on PD-L1 positivity status and they assessed for PD-L1 with an IHC assay JS311 antibody that ultimately generated a combined positive score. And PD-L1 positivity was defined as a CPS of greater than or equal to one based off of this assay. In the study population, about a third of patients were- patients' tumors were CPS negative, a third had a CPS of 1 to 10 and about a quarter had a CPS of greater than or equal to 10. And then approximately 7% of the tumors had an unknown status.   And then getting right into the results, we were provided results in the PD-L1 positive subgroup as well as the whole patient population. Looking at the primary endpoint of PFS, there were significant improvements seen in median PFS with the addition of toripalimab to nab-paclitaxel, again in the first line setting with a median PFS of 8.4 months with the addition of the immunotherapy agent versus 5.6 months with placebo. And this was statistically significant.  And then in the intent to treat population, there were some numeric improvements, in median, progression-free survival at 8.4 months with the addition of toripalimab versus 6.9 months with placebo.   We also got some results with overall survival that were quite intriguing, although this initial analysis was not designed to necessarily prove statistically significant differences in overall survival. But again, there were some promising trends. Looking first at the PD-L1 positive subgroup, the median overall survival was 32.8 months with the addition of toripalimab versus 19.5 months with placebo. Breaking it down a little bit further based on CPS values, for a CPS of 1 to 10, median overall survival was 32.8 months versus 19.5 months. And then for those very high CPS or greater than or equal to ten, median overall survival was not reached in this group versus 18.3 months with placebo. Also, looking in the intent-to-treat population, there were also improvements in overall survival with the addition of toripalimab with a median overall survival of 33.1 months with the addition of immunotherapy versus 23.5 months with nab-paclitaxel alone. So potentially, depending on next steps of this study, we would potentially have an option to add immunotherapy that is not biomarker specific, meaning we can potentially provide toripalimab to all patients regardless of their PD-L1 status.  Dr. Allison Zibelli: Very interesting new drug to look forward to. So, one of the major themes of this year's meeting was de-escalation strategies. For example, LBA506 reported the three-year invasive disease-free survival of the PHERGain trial, which looked at eliminating chemotherapy for HER2-positive patients getting neoadjuvant therapy. Tell us about the design of this study and how will it impact the care of these patients?   Dr. Arielle Heeke: The design was very complicated. I had to look at it a few times to really make sure I got my head around it. But I think once you do figure it out, you can see how there might be a path forward in clinical practice. Although I think for all of this work, it's maybe not ready yet for primetime, but certainly thought-provoking. But the PHERGain clinical trial, I feel like we've heard about this study for a little while and this concept of de-escalation really kind of started in the HER2-positive space. But this study was a randomized study of chemotherapy de-escalation and early HER2-positive breast cancer using PET/CT as a marker of response to therapies that don't involve chemotherapy.   Patients were eligible for the study if they had stage 1 to 3a HER2-positive breast cancer with no prior therapy for breast cancer, and ultimately 356 patients were enrolled in a 1 to 4 randomization scheme with the majority of patients ultimately enrolled into the experimental group, which is called Group B. So, to break down Group A and Group B, Group A essentially were patients that receive typical standard of care, which at this point is TCHP for six cycles, neoadjuvantly or prior to surgery. Once they complete those cycles they move into surgery and then Herceptin-PERJETA adjuvantly for additional twelve cycles.  I should also note that this study was conducted prior to results of the KATHERINE trial that showed benefit of switching to adjuvant T-DM1 if there's residual disease. So, patients in Group A as well as Group B did not receive T-DM1 at any point. So, again, Group A is kind of your standard of care. Group B was the “experimental arm.” And so, what they did in this arm to assess potential de-escalation strategies, patients first received Herceptin-PERJETA alone for two cycles with or without endocrine therapy, if they were also hormone receptor-positive. But after those two cycles, they underwent a PET/CT, and then if a response was garnered, they would continue with Herceptin-PERJETA and again plus or minus endocrine therapy to complete six cycles total before proceeding on with surgery. Then if they were fortunate enough to achieve complete response at the time of surgery, then they just continued with Herceptin-PERJETA maintenance, whereas if they did not achieve a complete response at the time of surgery, then they actually received TCHP 6 times adjuvantly. So, the chemotherapy was introduced after surgery.   And then going back to that PET/CT time point, if patients did not achieve a response at that check-in point, after 2 cycles of Herceptin-PERJETA, at that point they were transitioned to chemotherapy with TCHP, again, for six cycles. So, either they could kind of ride all the way through if they got that complete response at the time of surgery with Herceptin-PERJETA only, or if at surgery there was residual disease, they went on to receive TCHP after surgery, or if they did not have a response on that interim PET/CT after 2 cycles of HP then they would go on to receive TCHP neoadjuvantly.    So, looking at the results, they actually had 2 primary endpoints. The first primary endpoint was rates of a complete response at the time of surgery in patients that had a PET response. So, PET responses were actually seen in nearly 80% of all the patients treated with Herceptin-PERJETA without chemotherapy. And in those PET responders, a complete response rate at the time of surgery was seen in approximately 38% of patients. So, 37.9% of PET responders actually achieved a complete response when they went to surgery after receiving Herceptin-PERJETA alone, which is pretty amazing. I mean, we're used to seeing higher complete response rates with neoadjuvant therapy for HER2-positive disease, but again, this is a chemo-free regimen so that is encouraging for that 38% of patients that really didn't need chemotherapy.   And then the second primary endpoint, and this was what we saw basically for the first time with the 2023 ASCO Meeting, was results for the 3-year invasive disease-free survival in Group B or this experimental de-escalation group. And ultimately it was shown that the three-year invasive disease-free survival and the intent to treat group B population was 95.4%, which met its statistical endpoint, or, basically the null hypothesis was rejected. They just needed some sort of outcome that was not worse in terms of the 3-year invasive disease-free survival of 89%.   And then looking actually at the patients that kind of did the best. So, the patients that were PET responders and achieved a complete response at the time of surgery and therefore really only ever received Herceptin-PERJETA, their three-year invasive disease-free survival was 98.8%. So, really very good. Additional endpoints they looked at in Group A and Group B were favorable in terms of three-year invasive disease-free survival in Group A, and then three-year distant disease-free survival and three-year overall survival in both groups, all approximately 98%. So, very favorable.   So, ultimately, these findings reflect a potential role for a chemotherapy-free treatment approach for some patients with early-stage HER2-positive breast cancer. And this particular study, they used PET/CT to influence chemotherapy decision-making, which potentially identified 1 in 3 patients who can omit chemotherapy. With that, 80% of patients receiving the response with a PET/CT, and then of that, 80%, again, 38% actually having that complete response. And ongoing work is also being done to look at other mechanisms to assess for an opportunity to de-escalate with MRI imaging or HER2DX testing to again try to identify patients who can potentially defer chemotherapy in this setting. I did not see from the results what proportion of patients were hormone receptor-positive, which I think is also interesting when thinking about chemotherapy de-escalation, can you lean a little bit more heavily on endocrine therapy? Perhaps we'll get that data in the future.   Dr. Allison Zibelli: That's a very important point.  I would like to thank you, Dr. Heeke, for coming on the podcast today and sharing your valuable insights with us. We really appreciate it.  Dr. Arielle Heeke: Absolutely. It was a great meeting to dive into. It's always exciting to see what comes out of ASCO in the breast space. We're usually well represented there, and I hope that these studies will lead to further exploration.   Dr. Allison Zibelli: And thank you to our listeners for joining us today. You'll find links to all abstracts discussed today in the transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts.  Disclaimer:   The purpose of this podcast is to educate and to 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.  Follow today's speakers:   Dr. Allison Zibelli   Dr. Arielle Heeke  @HeekeMD     Follow ASCO on social media:    @ASCO on Twitter   ASCO on Facebook   ASCO on LinkedIn      Disclosures:    Dr. Allison Zibelli:    None Disclosed   Dr. Arielle Heeke:   Honoraria: Merck  Consulting or Advisory Role: Jazz Pharmaceuticals, Caris Life Sciences, Amgen, Daiichi Sankyo/Astra Zeneca, Pfizer, AstraZeneca, Menarini, Genome Insight  Speakers' Bureau: Daiichi Sankyo/Astra Zeneca      

In this week's Parallax, Dr Ankur Kalra is joined by guests, Dr Rama Ellauzi, Dr Nandan Anavekar and Dr Anthony Kashou, also known as The EKG Guy. Together, they delve into cardiovascular education and the Global Cardiology University (GCU). The genesis of GCU traces back to Dr Kashou's time as an intern at Mayo Clinic. Recognizing the challenges of postgraduate education, Dr Kashou embarked on a journey to enhance early-level training. Drawing inspiration from his own struggle to comprehend electrocardiograms (EKGs), he set out to build a comprehensive database. This eventually led to the birth of GCU. Dr Ellauzi, Dr Anavekar and Dr Kashou share their passion for education and the devotion that drew them to the GCU. They explore the vision of GCU, which revolves around creating a community space where knowledge is shared, aligning with educational trends, and empowering learners. Through scientific content evaluation and a commitment to providing premium yet affordable materials, GCU embraces community ownership. As the team has grown, teachers and students now find themselves in the same virtual room, fostering a collaborative and supportive environment. The conversation moves to the platforms and interactions offered by GCU. Dr Ellauzi and Dr Kashou shed light on the diverse formats available. They discuss the process of content vetting, emphasizing the importance of explanations and foundations for learners at all levels. They stress that GCU, serves as a complementary resource, enhancing traditional education methods for learners at different stages of knowledge acquisition. How can we empower learners in the digital age? How do we build global learning communities and cultures? When should new knowledge become part of a curriculum? Questions and comments can be sent to “podcast@radcliffe-group.com” and may be answered by Ankur in the next episode. Guests: @nandananavekar, @EllauziRama, @TheEKGGuy host: @AnkurKalraMD and produced by: @RadcliffeCARDIO.

Pharmacist, Kevin Kaucher, joins us to discuss the ins and outs of nitro in acute coronary syndrome. Does it work? Is sublingual better than paste? Can it be dangerous? Come learn the latest on nitroglycerin.  For more info and to see the EKGs from the case: https://emspodcast.com/the-truth-about-nitro-separating-fact-from-fiction/  

Dr. JP shares her passion for poisons in this interactive podcast. Will our patient survive this podcast? It's up to you and the choices you make. Interested in aphrodisiacs? Want to know what EKGs have to do with mustaches, and what toads have to do with van Gogh?  Listen to find out. 

Dr. Paul Alexander Liberty Hour – D-dimers, high-sensitive troponin, chest MRIs, EKGs, etc., are badly needed to ensure complete safety. Pilots must refuse to fly without these tests, and this chatter by airlines about ONE pilot 'only' to cope with shortages due to their layoffs for no vaccine is outrageous and will kill many innocent people...

One of the most widely known and influential thinkers on management, Peter Drucker, once said, “The entrepreneur always searches for change, responds to it, and exploits it as an opportunity.”  In this movement to value, it's seems that the new players – innovators and disrupters with unbridled passion for entrepreneurialism – are going to be in the best position to be at the headwaters of a transformation in American healthcare. The financial incentives in the current model of healthcare are simply too entrenched to be overcome by most legacy incumbents worried about how value transformation will create demand destruction in their fee-for-service lines of business. We need a better way forward.  Now is the time to  throw away traditional economic principles to reshape healthcare in our country! Our promise to build a uniquely new American healthcare system that is patient-centered and economically viable will be realized by innovators like the one you will hear on this week's episode. We are joined this week by Thompson Aderinkomi, the Co-Founder and CEO of Nice Healthcare. Thompson has the mindset that if it's broken, you fix it…we as industry leaders shouldn't wait for someone else to figure out how we are going to win in this Race to Value!  Thompson is a health economist and entrepreneur that you should be listening to.  As the co-founder and CEO of Nice Healthcare, he has created a technology-enabled primary care clinic that delivers all care in the comfort of the patient's home and contracts directly with small employers. Thompson built this company in response to the economic dysfunction and lack of cost accountability that he observed in our broken healthcare system. According to Thompson, it will be necessary for innovators to lead the way since the legacy model is too entrenched to reform itself.  Listen to this incredible interview to find out why Thompson believes that value-based care (if done right) will ultimately lead to the bankruptcy of legacy companies!   Episode Bookmarks: 01:30 Introduction to Thompson Aderinkomi, the Co-Founder and CEO of Nice Healthcare. 02:30 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts! 03:30 In 2017, Thompson co-founded Nice Healthcare – an on-demand, in-home technology-enabled clinic that delivers comprehensive healthcare to employees of small and medium-sized businesses. 04:30 Thompson shares the horrific story of the poor healthcare his one-year old son received and how that shaped his entrepreneurial vision to start his company! 06:45 How the lack of consumer-centric innovation in healthcare harms the spirit and hurts patients financially. 08:00 Thompson's privilege allowed him and his family to overcome their poor healthcare experience unscathed…how many people do not have that fortune? (The inspiration for Nice Healthcare) 09:00 Referencing the famous article, “It's the Prices, Stupid,” by the late health economist Uwe Reinhardt where he argued that high prices explain most of why U.S. healthcare costs are so much higher than those in other advanced countries. 09:45 The problem with supplier-induced demand, where a  physician (i.e. the “supplier”) also serves the economic role as a consumer by generating their own demand. 10:15 Nice Healthcare is fully capitated (no fee-for-serve whatsoever) which allows it to offer unlimited virtual care and home visits, along with lab tests, drugs, xrays, and EKGs conducted in the home. 10:45 “The problem with healthcare is the unit price.” 12:00 Thompson explains the pricing inelasticity demand in healthcare and why that creates flawed incentives for consumer price gouging. 13:00 Profit maximization by increasing market share is not necessarily the modus operandi in healthcare when you can get away by charging whatever you want. 14:45 “Unless you create a completely new business model in healthcare, you are not going to change the price.”

Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery, and how Dr. Bloom achieved steady growth in just 3 years. I'm your host, Catherine Maley, author of Your Aesthetic Practice – What your patients are saying, as well as consultant to plastic surgeons, to get them more patients and more profits. Now, today's episode is called "Steady Growth in Just 3 Years — with Jason Bloom, MD". There is nothing easy about growing a new practice from scratch or even maintaining a growing practice, let alone achieving steady growth in just 3 years….no matter how old it is. There are too many factors in the way of making steady growth in just 3 years: Uber competition, which can stifle steady growth in just 3 years Advanced technology, which can deflate steady growth in just 3 years Fickle cosmetic patients, which can hinder steady growth in just 3 years, to name a few This week's Beauty and the Biz Podcast is one surgeon's story about how he opened his solo practice and grew it quickly from scratch and attained steady growth in just 3 years. Dr. Jason Bloom, a board-certified facial plastic & reconstructive surgeon in private practice in Bryn Mawr, PA, focuses on facial rejuvenation, rhinoplasty, non-surgical treatments and hair restoration to help fuel the steady growth he's attained in just 3 years. We talked about how he grew his solo practice and made steady growth in 3 years by being in the right location, hiring the right staff and taking good care of them, and how he networks to create a steady flow of referrals. There are lots of pearls in our discussion. Visit Dr. Bloom's Website P.S. If you haven't already, can you please subscribe to Beauty and the Biz and leave me a 5-star review so I can grow the audience? I would really appreciate it. Thank you!

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists.I'm Pradip Kamat coming to you from Children's Healthcare of Atlanta/Emory University School of Medicine and I'm Rahul Damania, from Cleveland Clinic Children's Hospital. We are two Pediatric ICU physicians passionate about all things MED-ED in the PICU. PICU Doc on Call focuses on interesting PICU cases & management in the acute care pediatric setting so let's get into our episode:Welcome to our Episode about a 14-year-old male who collapsed on the baseball field.Here's the case presented by Rahul:A 14-year-old male athlete was playing in a high school baseball tournament when he was hit in the chest with a pitched ball. The impact caused him to collapse on the field. Bystander CPR was begun given his unresponsiveness and emergency medical services were immediately called. The patient was transported to the hospital. Upon arrival, he was unresponsive and had no pulse. An electrocardiogram (ECG) showed ventricular fibrillation, and advanced cardiac life support was initiated. After several shocks and cardiac compressions, the patient regained a pulse and was transferred to the pediatric intensive care unit for further evaluation and management.To summarize key elements from this case, this patient has:Been struck by a high-velocity object in the chestSuffered a cardiac arrest, likely due to an arrhythmia from the blunt chest traumaThe presentation brings up a concern for Commotio Cordis, our topic of discussion today!We wanted to create this educational episode in light of the recent medical event experienced by the Buffalo Bill's safety Damar Hamlin. His blunt chest trauma, which led to cardiac arrest, has been postulated to be due to commotio cordis. At the date of this record, we are glad that Damar Hamlin is on the road to recovery.Absolutely, let's dive in more into this topic, Let's start with a short multiple-choice question:The 14-year-old described in our case suffered cardiac arrest after blunt chest trauma. Based on the working diagnosis of comottio cordis, what is the most likely EKG finding which may be seen in this patient?A. Ventricular fibrillationB. Ventricular tachycardiaC. Complete heart blockD. AsystoleThe correct answer is A. In a study published in JAMA (2002; 287(9):1142-1146) which used data from the US Commotio Cordis registry maintained by the Minneapolis Heart Institute Foundation, reported that the most common arrhythmia out of the 128 confirmed cases, 82 of which had EKGs which could be analyzed was ventricular fibrillation. Three patients had Vtach, 3 had Bradyarrhythmia and 1 had complete heart block. Although 40 patients had asystole, this was unlikely to be the initial rhythm after impact. Interestingly, the majority of these rhythms were recorded at the scene.Rahul, What is the definition of Commotio...

This edition of the CodeCast Podcast dives into denial management and appeals assistance for EKGs, and how to handle medical necessity denials. Your host, Terry Fletcher, will also discuss some other topics, such as being accurate on UTIs (Urinary Tract Infections) ICD-10-CM codes. The split/shared visits continue to confuse coders and providers on how to […] The post Claims Appeals Advice and More (Fixed Audio) appeared first on Terry Fletcher Consulting, Inc..

REFERENCE: Meyers, P., Weingart, S., Smith, S. (2018). The OMI Manifesto. Available: http://hqmeded-ecg.blogspot.com/2018/04/the-omi-manifesto.html

recorded on 23JAN2023 Welcome on board Flight 126 of the Squawk Ident Podcast - NOTAMs & EKGs On today's flight I am joined by Captain Roger, Rob D, and Alex D. Together we discuss scheduling snafus, Captain upgrades, complacency, old school training, pilot EKG issues and the FAA Aero Medical Division, the reason for the FAA system outage, Pilot Bonuses for SWA pilots, and much more. So sit back, relax, and enjoy the rest of the podcast. references: NOTAM failures EKG changes to Aero Medicals Tucker covers Steve's SubStack Dr. Thomas Levy interview SWA pilots receive their holiday bonuses Please visit Av8rtony.com for more show content, audio archives, cover art, Squawk Ident gear, audio feedback, and more. Original music & cover art by Av8rTony and produced at Av8r Sound Studios of Southern California. Facebook, Instagram, Twitter & YouTube user just search Squawk Ident Podcast Copyright © Squawk Ident 2023, All Rights Reserved Copyright © Av8r Sound Studios 2023, All Rights Reserved Squawk Ident by Av8rTony is licensed under a Creative Commons Attribution - 4.0 International License --- Send in a voice message: https://anchor.fm/squawkident/message Support this podcast: https://anchor.fm/squawkident/support

David Gornoski starts the show by reporting on a horrifying case of child abuse. Why isn't the footage from January 6 being released? Is Donald Trump carrying water for Big Pharma? Steve Kirsch calls in to talk about how the FAA has quietly admitted that the EKGs of pilots are no longer normal. Why is the FAA covering up the fact that the COVID vaccine has damaged the hearts of our pilots? Why is Biden fighting to bring back mask mandates? Check Steve Kirsch's Substack here. Visit A Neighbor's Choice website at aneighborschoice.com

28 years ago, the die was cast for how emergency department encounters were documented.  Since then, we've had note bloat, click fatigue, and too much attention placed on things that really didn't matter. All of that is slated to change in 2023 with dramatic new documentation guidelines (that today's guest calls ‘refreshing') are implemented. When was the last time you heard the word ‘refreshing' used when it came to charting? And a massive thank you and hat tip to my friend Matt DeLaney who now runs ERcast - he was the first to alert us to these guidelines and interviewed Jason when they were first announced.    Episode Sponsor: Ivy Clinicians. Curious if there's a better clinical opportunity out there? Ivy is the simplest way for physicians, PAs, and nurse practitioners to match with jobs they love. With Ivy, you can find all 5,549 emergency departments, filter by your preferences, and connect securely with the right employers. All for free. Guest bio: Jason Adler, MD is  a clinical assistant professor of emergency medicine at the  University of Maryland where he is also the director of compliance and reimbursement. He is also the vice  president of acute care solutions at LogixHealth. Mentioned in this episode: The Awake and Aware Physician conference sponsored by Wild Health. Jan 13-15 Sedona Arizona. Use the code CONSCIOUSPHYSICIAN for 15% off (that's 15% off the whole package – lodging, meals, the course) Interested in one-on-one coaching? Learn more at roborman.com To support the show - visit our Patreon site and help keep the wind in the sails. For full show notes visit our podcast page We Discuss: History and physical documentation are now at your discretion; Heavy value is placed on cognitive work and medical decision making; History from a non-patient source is valued in these guidelines; Ordering a test is equally valued as not ordering a test; Consideration of escalation or deescalation of care; In addition to documenting your shared-decision making conversations, your MDM should include; Population health - Stable means something different when it comes to documentation; Social determinants of health; There is a heightened emphasis of independent interpretations of separately billable procedures (EKGs, X-ray, CT, U/S); Jason's take home points; And More.

28 years ago, the die was cast for how emergency department encounters were documented.  Since then, we've had note bloat, click fatigue, and too much attention placed on things that really didn't matter. All of that is slated to change in 2023 with dramatic new documentation guidelines (that today's guest calls ‘refreshing') are implemented. When was the last time you heard the word ‘refreshing' used when it came to charting? And a massive thank you and hat tip to my friend Matt DeLaney who now runs ERcast - he was the first to alert us to these guidelines and interviewed Jason when they were first announced.    Episode Sponsor: Ivy Clinicians. Curious if there's a better clinical opportunity out there? Ivy is the simplest way for physicians, PAs, and nurse practitioners to match with jobs they love. With Ivy, you can find all 5,549 emergency departments, filter by your preferences, and connect securely with the right employers. All for free. Guest bio: Jason Adler, MD is  a clinical assistant professor of emergency medicine at the  University of Maryland where he is also the director of compliance and reimbursement. He is also the vice  president of acute care solutions at LogixHealth. Mentioned in this episode: The Awake and Aware Physician conference sponsored by Wild Health. Jan 13-15 Sedona Arizona. Use the code CONSCIOUSPHYSICIAN for 15% off (that's 15% off the whole package – lodging, meals, the course) Interested in one-on-one coaching? Learn more at roborman.com To support the show - visit our Patreon site and help keep the wind in the sails. For full show notes visit our podcast page We Discuss: History and physical documentation are now at your discretion; Heavy value is placed on cognitive work and medical decision making; History from a non-patient source is valued in these guidelines; Ordering a test is equally valued as not ordering a test; Consideration of escalation or deescalation of care; In addition to documenting your shared-decision making conversations, your MDM should include; Population health - Stable means something different when it comes to documentation; Social determinants of health; There is a heightened emphasis of independent interpretations of separately billable procedures (EKGs, X-ray, CT, U/S); Jason's take home points; And More.

Hot topic alert: should NPs be starting off in specialty practice?   Cardiology NP and Professor, Tranise Goodlow, aka Dr. G the NP is in the house to help you decide if it's a “good” or “right” idea for NPs to immediately go into specialties.   Dr. G also shares her own nursing journey, advice on learning EKGs, and what sparked her decision to create a platform for helping nurse practitioners.   Read today's show notes for more info and links from today's episode: https://www.theresumerx.com/118 If you enjoyed this episode and would like to support me in being able to create new & valuable content for The Nurse Becoming Podcast, buy me a coffee here ☕️

Australia continues to follow the footsteps of the communist regime. Teachers are suffering for not getting the jab, Social credit is on the rise, and kids are being fed bugs without the parent's knowledge. Maria Zeee joins us today to talk this dilemma. Patty Lermer joins the show to detail how she is promoting EKGs for kids who could suffer from unsuspecting myocarditis, and sudden heart failure. Keelin Darby joins the show to detail the unfair arrest of her husband Ben Darby, an Alabama officer who is being jailed for a "suicide-by-cop" case. Trump's former CDC director EXPOSES CDC fraud from the inside. The CDC is no longer a public heath agency, but it is now a political arm of the government! The CDC doesn't feed science to us, it just feeds us junk. Watch this new segment NOW at https://StewPeters.com! Visit our friends at Goldco! Call 855-706-GOLD or visit  https://goldco.com/spPrepare your family for famine and shortages by purchasing food through: https://heavensharvest.com/ Righteously stand against vaccine tyranny by supporting Christopher Key: https://www.vaccine-police.com/Check out https://nootopia.com/StewPeters for help increasing your mental & physical strength to battle the deep-state's KRYPTONITE plot against Americans! Get Dr. Zelenko's Anti-Shedding Treatment, NOW AVAILABLE FOR KIDS: https://zstacklife.com/ CACOA is a super food, and may be the missing link to strength and happiness. Buy it now: https://shop.earthechofoods.com/stew Go Ad-Free, Get Exclusive Content, Become a Premium user: https://www.stewpeters.com/subscribe/Follow Stew on Gab: https://gab.com/RealStewPeters See all of Stew's content at https://StewPeters.com Watch full episodes here: https://redvoicemedia.net/stew-full-shows Check out Stew's store: https://stewmerch.com