Podcasts about empiric

We take another break as we are joined by Prof. Wendy Sligl, formidable ID and ICU doc, to discuss the critical topic of optimizing antibiotic prescribing in critical care settings. The discussion covers various aspects of antibiotic use, including the importance of timely administration, the role of communication in ensuring effective treatment, and the nuances of dosing strategies such as loading doses and continuous infusions. The conversation also delves into the duration of antibiotic therapy, emphasizing the need for individualized treatment based on patient response. Takeaways:Infections are common in intensive care units, and sepsis is a life-threatening condition.Identifying the clinical syndrome is crucial for appropriate antibiotic therapy.Empiric therapy is often necessary before culture data is available.Timely administration of antibiotics is linked to better patient outcomes.Communication among healthcare teams is essential for effective antibiotic delivery.Loading doses can help achieve therapeutic levels quickly in critically ill patients.Continuous infusions of certain antibiotics may improve clinical outcomes.Shorter courses of antibiotics can be as effective as longer ones.Monitoring patient response is key to adjusting antibiotic therapy.Consulting infectious disease specialists can enhance treatment strategies.Chapters:00:00Introduction to Antibiotic Optimization01:07Understanding Infections and Sepsis02:47Emergency Room Protocols for Antibiotic Administration04:56Identifying Sepsis and Administering Antibiotics06:33Communication and Timeliness in Antibiotic Delivery08:42Optimizing Antibiotic Dosing Strategies10:59Pharmacodynamics and Continuous Infusions12:44Duration of Antibiotic Therapy18:52Monitoring and Adjusting Antibiotic Treatment21:39The Debate on Antibiotic Duration26:37Specific Infections and Treatment Duration31:24Practical Strategies for Antibiotic Stewardship32:43Rapid Fire Questions on Antibiotic Use

This week Nick talks to Duncan GarroodDuncan Garrood is CEO of Empiric Student Property, Originally trained as a scientist, he transitioned into the corporate world, spending 20 years at Unilever in various global roles across production, sales, and marketing. He played a key role in expanding business operations, including launching an ice cream division in China. Over the years, he took on leadership roles in hospitality, aviation, and leisure, overseeing transformations at companies like Punch Taverns and Ten Entertainment. His career has been defined by adaptability, embracing opportunities across different industries, and executing successful turnaround strategies and large-scale expansions. Nick and Duncan discuss strategic growth, transformation, and market positioning, particularly in the student property sector with Empiric Student Property. Duncan emphasised the importance of aligning business strategy with market demand, particularly in catering to international and postgraduate students seeking a premium, boutique accommodation experience. They explored the challenges of acquiring and optimizing property portfolios, adapting to economic shifts, and navigating investment landscapes. Duncan also highlighted the role of data-driven decision-making, customer-centric business models, and maintaining a strong brand identity, drawing parallels between his past experiences in multinational corporations and property investment. Duncan's Book Choice was:I, Robot - Isaac Asimovhttps://onlineshop.oxfam.org.uk/i-robot/product/HD_302753825?sku=HD_302753825Duncan's Music Choice was:Pink Floyd - Shine On You Crazy Diamondhttps://open.spotify.com/track/6pnwfWyaWjQiHCKTiZLItrThis content is issued by Zeus Capital Limited (“Zeus”) (Incorporated in England & Wales No. 4417845), which is authorised and regulated in the United Kingdom by the Financial Conduct Authority (“FCA”) for designated investment business, (Reg No. 224621) and is a member firm of the London Stock Exchange. This content is for information purposes only and neither the information contained, nor the opinions expressed within, constitute or are to be construed as an offer or a solicitation of an offer to buy or sell the securities or other instruments mentioned in it. Zeus shall not be liable for any direct or indirect damages, including lost profits arising in any way from the information contained in this material. This material is for the use of intended recipients only.

This episode gives a nod to the show's history while also hinting at the variety of topics discussed. A Journey Through the Microscopic World – Highlights from some memorable episodesEpisodes featured in this recap:EP 49: No spleen, how mean! - Asplenia_ Antibiotic prophylaxisEP 59: What's all the buzz about_ Malaria diagnosticsEP 33: Would you rather, the antibiotics version_ Empiric therapy for community acquired meningitisEP 50: HIV in the USA _ Diagnosing HIV in the USAEP 58: Findings from FIDSSA part 2_ Rabies update and outbreak response EP 44: Highlights from the PathRed Congress 2023 - Part 1_Emerging viral infectionsEP 62: Myco-moments: Interviews from the 4th AIDS-related Mycoses Workshop: The immunology of Oral candidiasisEP 61: "Prescription Ice cream" Book review and interview: Advice to young medical doctors and studentsEP 53 : Appropriate use of β-lactam - β-lactamase inhibitor combinations _ Rapid genetic testing, know your syndromic antibiograms, and diagnostic stewardshipWE'D LOVE YOUR FEEDBACK ON THIS EPISODE – Visit the Microbe Mail website to sign up for updates Follow on:Instagram: Microbe_MailX/Twitter: @microbemailFacebook: MicrobeMailTiktok: @microbe.mailWatch this episode on our new YouTube channel: Microbe MailE-mail us: mail.microbe@gmail.com

Hoy escuchamos: Hamlet- Acto de fe, Messugah- Broken cog, Xpresidentx- El paseo de los tristes (con Hora Zulú), Álgar- Atrévete, Badana- Lucharé. Entrevista Empiric: Empiric- There´s more power, Empiric- Mission. The Halo Effect- Cruel perception.Escuchar audio

Duncan Garrood, CEO of Empiric Student Property, a FTSE 250 company with a portfolio valued at over £1 billion, delivering premium accommodation to students across the UK. Duncan has a proven track record in transforming companies and driving customer-centric success. He's led teams across various industries, including retail, pubs, hospitality, food and entertainment, always with a focus on delivering exceptional customer experiences and fostering motivated, high-performing teams. I sat down with Duncan to discuss a broad range of subjects which covered some of the following topics: * Career Foundations – The early experiences that shaped his leadership style. * Scaling Global Brands – His insights from taking brands international. * Turning Around Struggling Companies – The strategies behind reviving underperforming businesses. * Proving Doubters Wrong – His approach to overcoming challenges and silencing critics. * Navigating Complex Legislation – How he adapts strategies to meet government regulations. * Operational Excellence – Driving efficiencies in student accommodation cluster management. * What It Means to Be Truly Customer-Centric – Redefining customer-centricity in real estate. * Investing in Innovative Assets – Comparing cookie-cutter accommodations with boutique, character-driven designs. * UK Student Accommodation – Understanding supply vs. demand and market segmentation.   Oh and one last question - who are the People, what Property, and in which Place Duncan would invest should he have £500m of capital at his disposal. Catch the full episode which will be live on Youtube, Spotify and Apple NOW! The People Property Place Podcast

Episode Notes In this episode, Dr. April Dyer, one of our DASON Clinical Pharmacist Liaisons, talks to us about source specific order sets leading to improved empiric therapy in the ED in a 200 bed hospital. The article reviewed in this episode can be found here: https://academic.oup.com/ofid/advance-article/doi/10.1093/ofid/ofad677/7491622# To learn more about DASON, please visit: https://dason.medicine.duke.edu

Prophylactic, therapeutic, and empiric use of antimicrobial agents by AORNJournal

Today, Mitch and Isi discuss all things fruit; the horrors of hairy fruits and mushy apples, Mitch's preference for a cold and crunchy banana, watermelon life-hacks, surviving on coconuts, the versatilities of apples and question; what the hell a lemon posset is and if Halle Berry is actually a fruit? Interactive Transcript Support Easy English and get interactive transcripts and bonus content for all our episodes: easyenglish.fm/membership Transcript Mitch: [0:00] 12345678. Isi: [0:05] 12645678 What? 1264567. Mitch: [0:12] Easy English! Intro Mitch: 0:34 (Hello!) Hiya, welcome to the new episode of the Easy English Podcast. That is so formal. Isi: [0:39] I don't like to look at you while we record it. I have to laugh. Mitch: [0:44] We're so far away again. Isi: [0:46] Hello, down there, in the hallway. Mitch: [0:49] Yeah, it feels like we're in a hallway. Isi: [0:51] I will just directly say it. Mitch, We had The Big Veg Show (The Veg Cast. ) The Veg Cast. I hope people enjoyed it because I said it already, what comes this week. And it's The Big, Big Fruit Show. Mitch: [1:05] The Fruit Show, The Veg Cast and The Fruit Show. Isi: [1:07] Yeah, we couldn't do it both last time, so we need to talk about fruits. Mitch: [1:11] It wouldn't have been fair, though, to have thrown fruits on the ends of veg, because fruits don't... shouldn't be disrespected like that. Isi: [1:17] But fruits have a better life. Most of them are very sugary, so people usually like them more than veg. I would say. Mitch: [1:25] But we're savoury people. No, that sounds like... (We are savoury people.) That's actually a compliment. Because you can be a very unsavoury. Isi: [1:33] Will you make us a drink? Because I wanna ask our listeners for something, in between. Mitch: [1:37] Okay, feels like you're booting me out of the room, to say something private. Isi: [1:41] No, I just want a drink. Mitch: [1:42] If you'd like to listen to this podcast, without Mitch, give us a thumbs up. Isi: [1:46] What I wanted to ask, today is a little bit of a favour. You might know that, in podcast apps, where you listen to us. Um, there are several of podcast apps. It does help, if you give us a review of our podcast, on some apps you can leave a comment about our podcast. And this interaction, if you give like, a response to our podcast, will help others to find our podcast. So, if you could just today, if you like our podcast, take a second out of your day and see in your app where you can leave us a review, a comment, a rating That will be fantastic. It's weird to ask for things, but I think it would be really, really, really nice if you could help us with this. Anyway, and also, if you have questions for our podcast or for us, write us an email to podcast@english.video or on easyenglish.fm. You can also leave us an audio message. We have a section called 'Unhelpful Advice' and we are still waiting for your problems and issues to solve. Okay, now Mitch is back and we can go on with fruits. (Is margarita a fruit?) Topic of the Week Isi: [3:09] I have a few questions first, and then I would guide you through the world of fruits. Um, what is... (Come with me.) What is your favourite fruit? Mitch: [3:14] Off the top of my head, I'm thinking strawberries, but it probably isn't. But strawberries are just like, a solid fruit. Isi: [3:21] So I wanted to say peach, I really like a really good peach, but peach can be really shit as well. Mitch: [3:32] I know what yours is and it's my like, curveball, because when you... when you think of fruits, you think of sweetness. But I think, actually, if we were to really go into it, what fruit we eat the most, especially you, It would be a sour fruit. Isi: [3:48] Lemon. Yeah, lemon is probably my favourite fruit because I eat it most. Mitch: [3:53] It's my favourite pudding. Anything with lemon? Isi: [3:54] I love citrus fruits. Anyway, I love lime, love oranges... favourite pudding. Mitch: [3:59] Yeah. Anything with a lemon on it. (Lemon cake.) Lemon drizzle, for shizzle, ma nizzle, Lemon cheesecake. Isi: [4:05] Lemon posset. (Lemon posset.) Posset. Posset. Such a thing I've learned in England. Um, with watching 'Come Dine With Me'. Everybody does a lemon posset. It sounds so posh. I don't even know really what it is. It's a lemon cream or something. A lemon posset And they're always like; "for dessert, I have a lemon posset". And then you hear the other people talking in the off later in the car, and they're like; "a lemon posset, everybody's doing a lemon lemon posset and hers was not particularly good". Mitch: [4:38] I don't know what it is either. We should make one, just to sound fancy. Isi: [4:42] Lemon posset. Mitch: [4:43] Last night we had a lemon posset. Wasn't it just absolutely delightful, lemon posset. Isi: [4:47] I'll look it up now. Mitch: [4:48] I'm always very disappointed by nectarines. Isi: [4:53] Yeah! (Yeah.) Good nectarines are good. Mitch: [4:55] Yeah, but that's the... that's my I've never had a fully ripe one. I think ever. Isi: [5:01] I just looked up my least favourite fruit, and it's not in my list. So, we we have to do the list together. Um, a gooseberry Mitch: [5:10] You don't like gooseberries? Isi: [5:11] No, they're hairy. They're a weird mix of sweet and sour. And you know what they are... mushy. Mitch: [5:18] Er... mushy. Isi: [5:20] Don't like mushy foods at all. Mushy apples; urgh! Mushy bananas; urgh! Mitch: [5:26] Yeah. Oh, yeah! That That's my pet peeve. I love bananas, but they have to be kind of, not quite ripe. Isi: [5:37] No, yours are the least ripe I've ever seen. Mitch: [5:40] And in the fridge. Cold and crunchy. And probably my least favourite fruit is like a warm, mushy banana. Urgh! Urgh! Oh, I feel sick. Yours is gooseberry, because they're a bit hairy. Isi: [5:57] Yeah, gooseberry and my favourite. I don't know if my favourite would be lemon, but it has to be, because that's what I eat most. Mitch: [6:02] Uh, when you say a hairy fruit is a bit gross, isn't it? Like, have you ever eaten a kiwi? And you've forgotten to take off a little bit of the skin? And you're like, Ugh, what is that? And it's a bit of a hairy skin. Isi: [6:11] Actually, I recently learned that a lot of people eat it with the skin. You can eat the skin. You just eat it like that. Mitch: [6:16] That's disgusting. Isi: [6:17] OK, my favourites are strawberry, peach, mango, lemon. Mitch: [6:21] Yeah. Oh, I have one as well. Sorry. Do we have time for this last one? (No, we do.) I really want to use it more, but I don't know how to use it. And maybe, if anyone has a good recipe or a good way to like, cook it or prepare it. I really, really like rhubarb. Isi: [6:38] I love rhubarb. (I love the taste of rhubarb.) Rhubarb season is at the same time as strawberry. Mitch: [6:44] Oh, really? (I think so.) But I don't really know how to do it, but maybe someone who's listening can send us either a voice message to easyenglish.fm or write to us at podcast@easyenglish.video. Isi: [6:57] Yeah. Um... how do you? Yeah, how do you eat rhubarb in England? I've only seen it in cakes in... in Germany, I can just say we cook it, with a hell lot of sugar. (Where? In the oven or in a pan?) in a in a pot. (In a pot?) Yeah, you cook it and it kind of gets like this soupy, slimy mass. Sounds disgusting. It's quite good. And you can eat it with strawberries or with like, a vanilla sauce or something like this. Let's go now, through the berries. Strawberry, we already talked about. (Good berry.) Blueberry. Mitch: [7:28] I really like blueberries. Isi: [7:32] You like it more than me. We eat it basically every day. I still eat them. They're nice. Mitch: [7:36] Blueberry muffin. Isi: [7:38] Yeah, but you know what I don't like? And you often do it. Blueberry smoothies. Mitch: [7:43] Oh, I love the blueberry smoothy. Isi: [7:44] Too much blueberry. Then it is overbearing, isn't it? I like blueberries, I like them... I actually like both parts of them. Some are like, really big and not so sour, but really like, fresh. And then there're the little ones, that are super sour, both are good. Mitch: [7:58] Blueberries are... is a not safe for work fruit because, the skin always manages to sort of, somehow wrap itself around your teeth. Isi: [8:05] Mm, Yeah. And what is very English and maybe you can say how it's used here, is blackcurrant. Mitch: [8:15] Just someone saying blackcurrant makes you think of being like three years old with a glass of blackcurrant squash. I'm sure many other kids from the who grew up in the nineties, might think of that. Isi: [8:25] Which are the ones that we often see on our walks. Just recently, we saw a lot of them. They look like raspberries, but black. Mitch: [8:32] Oh, isn't that a gooseberry (No.) Blackberry? Yeah. Must be. Isi: [8:36] Like you don't know what a gooseberry is. Google Gooseberry now, so that you understand my. Mitch: [8:42] Goose... berry. They're not hairy. Isi: [8:47] They are hairy. Mitch: [8:49] Yeah? In this, they're not. Wait, it looks a bit like a grape. Which ones are hairy, though? Hairy fruits. Google is suggesting; "Are you thinking of Halle Berry?" Isi: [9:09] We stop with the berries, I'm not educated enough on berries. So citrus fruits, love citrus fruits. Mitch: [9:13] Yeah, absolutely. I have an issue, though. That I've never figured out, is that I don't know the difference between an orange, a tangerine and a clementine. I couldn't tell you what was what, or are they all types of oranges? Are clementines also oranges? And... is that what it is? Isi: [9:32] Clementines are the ones that you eat around like... (But is it an orange?) in winter and around Christmas and you peel them, right? That's clementines. Well yeah, I guess they're part of an orange. Then you have. Do you know kumquats? Mitch: [9:43] Yeah. Is that an orange? (Yeah. Blood oranges.) Oh, nice in a cocktail. Isi: [9:49] Valencia oranges. Best for juicing. Tangerines, juice for sweeter take on orange juice. Okay. Mitch: [9:56] Really, Tangerine? Isi: [9:58] Navel. Navel oranges, most common variety. And Seville/Seville Oranges. Perfect for marmalades. There you go. But these are the... that was the ultimate guide to winter oranges and tangerines. So there must be others as well. Mitch: [10:14] Right. Oranges is like the franchise. And then inside the franchise, there's different types. (Businesses of oranges.) Isi: [10:24] Ok, lime; amazing. (Love limes.) Ah, lime on... in drinks, on food. Basically, you can... you can put a bit of lime juice on nearly every food and it's good. Mitch: [10:35] Yeah. Really. Isi: [10:36] Melons. What's your favourite melon? Mitch: [10:41] Oh, I only know water and just like the yellow... what are the yellow melons called? (It says your honey dew.) Honey melon? Isi: [10:49] I like most, honey. (Really?) And then watermelon. Mitch: [10:51] More than... really. Isi: [10:54] Yeah, because I... I came to terms with watermelon, because you like it a lot. And we often have it in summer. And it's nice. It has to be good. We learnt how they have to look, but cannot explain it now, because I already forgot. Mitch: [11:06] Life hack. Not what you expect. It's the opposite of what you're expecting. Isi: [11:10] Yeah. Look it up. Google it. (The less round) How should the watermelon look? Mitch: [11:12] The less circular, the better, right? I think it was. Isi: [11:16] I think, yeah. And it should even be a bit yellow and weird. Mitch: [11:18] Yeah, circle and green is just not good. It has to be sort of like oblong and a bit brown and a bit yellow, I think. Isi: [11:25] Well, look it up yourself, please. I hope you don't have guarantees on that. So watermelon is nice. I like watermelon a lot, in a combination with, like, um, savoury, um, like feta, for example. Mitch: [11:36] Oh, yeah. Good shout Isi: [11:37] Um, feta cheese, watermelon, some balsamic... (Glaze.) glaze. And, um, some mint leafs. So, that's really good. Mitch: [11:50] I love the glaze. We should get that on Asda. Isi: [11:53] I'm getting hungry again. We always do this before food. Um, and but honey is also good. Also good with cheese. (Honey's not fruit!) Uh, honey melon, sorry. That also works very well. People that eat meat often eat it with, uh, in Germany, at least with ham. (Really?) That works very well, yeah. Mitch: [12:12] Oh yeah, we have ham and pineapple. Isi: [12:14] See. Stone fruits, Mitch. Cherries. Mitch: [12:19] I like cherries. (Like, or love?) Just like, 'cos you... It's a lot of. Is that when you're eating, there's a lot of this noise, like this. Not for say, for work, either. Just like the... blueberry. Isi: [12:41] Yeah, I'm not a big fan of cherries. I have to say I eat them, but I don't buy them, ever. Mitch: [12:47] I don't know what you do with it. They're selfish veg... like, fruits right? They don't really go with anything else, do they? What have you ever had a cherry with? Isi: [12:54] Yeah. And also like, cherry juice or so. It's too intense. Um, OK, we go in the world of tropical fruits. Bananas, we already talked about. (Yeah!) Coconuts, we had coconut yoghurt today. Mitch: [13:05] Coconut milk, I like. Coconut milk in any Asian dish. Isi: [13:11] Yeah, coconut milk is good. Do you like coconut meat or flesh? Or how do you call that? Mitch: [13:18] Doesn't it give you diarrhoea? (No! you've never eaten coconut?) I played a survival game once on the PlayStation. And if you... If you eat too many, you have diarrhoea for two days. Isi: [13:28] Oh dear, Oh! You know, Amarula is from the marula fruit. Mitch: [13:34] Oh, I love Amarula. Isi: [13:36] And I think the fruit is eaten by elephants. And that's why the big elephant is on it. Mitch: [13:40] Ah, that makes sense. Amarula fruit. Isi: [13:44] What do we forget? Oh, well, we forgot the big, I think the, the fruits of both our nations, probably. (Go on.) What is the... the fruit, that exactly now you get. Mitch: [14:00] Potatoes aren't fruit. The fruit of our nation? Both our nations? Isi: [14:08] Apples. Mitch: [14:09] Oh yeah, how did I not think about that. Isi: [14:12] Apples are eaten all day, every day. Apple juice, apple sauce. Apple sauce is a very English thing. Oh no, actually very German, too. With Reibekuchen. Mitch: [14:19] I tell you what is a very English thing with apples. (Apple mint sauce.) Cider. Isi: [14:26] Cider. Yeah, you see, it is a fruit of your nation. Mitch: [14:28] Have you ever had a proper cider? Isi: [14:32] Uh, I have... I have had cider... (Not Strongbow.) recently, at at our friends in London. I had cider. Mitch: [14:38] Did you? Oh, yeah, you did. Isi: [14:39] Yeah, a tiny glass, a cute little, tiny glass to try it. But it was too sweet for my liking. Mitch: [14:45] Oh God. Doesn't it make you realise that western... northwestern fruits are so boring, in comparison? Do you know what I mean? Do you think there are Mexican people saying; "Oh, do you know what I really love? Apples." Isi: [14:58] Maybe. Yeah, for sure. (No.) Yes. Mitch: [14:59] No. Not when you've got limes. I'm jealous. Let's go live in Mexico and just drink margaritas and mojitos all day. (Maybe we should do that. You know.) Caipirinhas. Isi: [15:10] We had apples today in our big yoghurt, with different fruits. Then it's OK. Um, the apples that I had were really small apples and like, red and green. And they were like, I only like apples when they are sour and hard. No mushy, no sweet, no nothing. Mitch: [15:25] Oh, really? Uh, we never talked about this. How have we never spoken about our favourite type of apple. Isi: [15:32] I know. I like Blackburn. (Blackburn?) Braeburn. Sorry. (Blackburn!) Blackburn is a place here. Bra. Braeburn, Braeburn, Braeburn. Mitch: [15:42] And what's your least favourite? Oh, there's actually way more than I ever heard. Isi: [15:45] I don't know what the mushy ones are called. Mitch: [15:48] I hate a pink lady. Isi: [15:50] Aren't they not mushy. Mitch: [15:52] They can get pretty mushy. That and a jazz. (Mashy, or mushy?) Mushy. That and a jazz apple. I like a Granny Smith. Isi: [16:01] Are those the green ones. (The green hard sour, more sour ones. ) Mm. Yeah, that's better. I also don't really like, uh, apple juice. Apple sauce, yes. Apple sauce was a good Reibekuchen. Which is like a... basically like a... hash browns. It's a bit like a big hash brown, isn't it? With apples. Mitch: [16:16] Yeah, that's right. Deep fried eggy, soaked, potato. (Grated potato.) Grated potato with egg and... Isi: [16:24] Made into like a dough with egg and... Mitch: [16:24] Did you know there's so many... one, two... there's Granny Smith, Fuji, Pink Lady, Honey Crisp, Envy, Gala, Pazazz, Jazz, Red Delicious, Braeburn, Cameo, Holston, Golden Delicious, Lady Alice, Hidden Rose Ambrosia... there's so many apples. Isi: [16:44] Oh, yeah. Jazz apple. I just see it here. Mitch: [16:45] 25 types of apples. Incredible. Isi: [16:48] Probably even more. Mitch: [16:49] Can I tell you one you've not mentioned yet, which I really like. I love plantain. Isi: [16:55] Ooh, I love plantain, too. Is that a fruit or a veg? Mitch: [16:58] Isn't it just a savoury banana? Isi: [17:01] Yeah, it is, but, uh, it's not the same as a... it's not... it's not the same as a banana. Mitch: [17:05] Mm. In, uh, England, because of Jamaican, uh, connections. Empiric connections, I might... might add. uh, it's quite often you can find plantain. And specifically, one thing I love. I'm not in ages. Plantain crisps. Salted plantain crisps. Isi: [17:22] Hm. So good. I love plantain. Absolutely love it. Plantain, you can also have sweet, by the way, if you wait long enough, you can also bake them. Mitch: [17:31] Oh right, maybe that's what I should get instead of bananas. Isi: [17:35] Hm... you cannot have them in your yoghurt. Um, do you... do you, uh, know a pomelo? I don't know if it if this is in English the same. It's written the same as I would say it in German. It's pomelo. (You know it?) Yeah. ( What is that?) Pomelo. Um, Google it. Mitch: [17:54] Po... pomelo, pomelo? Isi: [17:55] I mean, yeah, it looks a bit like a melon from outside. It is more like an orange. (Oh, yeah, it does.) Or like a grapefruit. Look from inside. It looks more. Mitch: [18:03] It has segments as well. Isi: [18:04] It has segments like oranges or grapefruits, and it is very dry. You can really break off the segments, sometimes. It's not that all the juice... like, it's not messy. Um, I like it, it's super, super healthy. I think. Mitch: [18:19] It has anti-aging properties. (You see!) Fights cancer. Isi: [18:22] Better get to know about it. Yeah. No, it's really healthy. It's really good. I mean, this list is long. I could now just, go up and down with it. Sweet Dakota rose watermelon. Mitch: [18:35] People gonna ask; what... what did you do on your Friday night? Isi: [18:38] Tawa tawa, tawa tawa. I don't know. Uh, what do we do? Mitch: [18:43] You'll never guess what. We had a wild night. (What is a Thornberry?) We spoke about fruit. Isi: [18:44] I've heard of a thornberry. I think we have to stop The Big Fruit Cast now. Mitch: [18:54] Fruit Show? Isi: [18:54] Um, OK, we have to stop this now. The fruits are taking over my mind. Um, it was nice to talk to you about fruits. Mitch: [19:04] Yeah, I feel like I know you better now that I know that you like a Granny Smith. Isi: [19:07] I... I don't even know a Granny Smith. (Oh, you said you like the green ones.) Ah so, yeah. Ah so. Mitch: [19:09] Ah so. Sour fruits, are the best kind of fruits. Isi: [19:16] Sour foods in general, yeah. Yeah, everything has to be sour, not bananas, though. Mitch: [19:21] Cheers to that, on your margarita. Isi: [19:24] And, um yeah, hope you like fruits. It's healthy. Eat them. Five a day. Bye. (And I hope all your dreams come true.) Te-ra! (Te-ra!)

Paddy has been busy.Whether it's his day job as an Advisor & Investor, as Chair of the hugely successful Pathways to Property Initiative, or in the many other roles he has held or currently holds.We talked in great detail about Paddy's journey starting his own businesses, and what success will look like for him in relation to Diversity and Inclusion.Paddy gives his advice for anyone looking to make a change and we also find out whether his parents thought he has a proper job… P.S. Please HIT THAT FOLLOW BUTTON, it really helps, and have a listen on the links below.As always, I asked Paddy to recommend future guests for me to speak to on the podcast, he recommended Chris Holloway from Yugo & Vedran Kosoric from Empiric, we look forward to recording episodes with you both soon. Apple - https://apple.co/3Pps3rzSpotify - https://open.spotify.com/show/4R2ltPkgTBtPaIKdLP5pT8 To find out how you can be involved in the podcast, email me gareth@methodavenue.com Follow Method Avenue on social.Tiktok https://www.tiktok.com/@methodavenueInstagram https://www.instagram.com/methodavenue/LinkedIn https://www.linkedin.com/company/methodavenue/Youtube https://www.youtube.com/@methodavenue/

Episode Notes In this episode of the DASON Digest Podcast, DASON Clinical Pharmacist Liaison Dr. Jeannette Bouchard talks to us about clinical risk scores to improve empiric antimicrobial selection for outpatient complicated urinary tract infections. The article reviewed in this episode can be found here: https://academic.oup.com/ofid/article/10/8/ofad319/7198038#413122181 For more information about DASON, please visit: https://dason.medicine.duke.edu

18.09.23 Pt 2 - How often do you think about the Roman Empire? Leigh-Ann questions Gareth and Bakh'abantu about living on an island floating in the middle of the ocean… and Shea Karssing joins to discuss the life of a freelancer. www.cliffcentral.com

Drs. Claire Burbick and Edith Marshall authors of "Benefits and challenges of creating veterinary antibiograms for empiric antimicrobial selection in support of antimicrobial stewardship and advancement of one-health goals in: American Journal of Veterinary Research - Ahead of print (avma.org)" discuss veterinary antibiograms. Hosted by Associate Editor Dr. Sarah Wright and Editor-in-Chief Dr. Lisa Fortier.INTERESTED IN SUBMITTING YOUR MANUSCRIPT TO JAVMA OR AJVR?JAVMA: https://avma.org/JAVMAAuthorsAJVR: https://avma.org/AJVRAuthorsFOLLOW US:JAVMA:Facebook: Journal of the American Veterinary Medical Association - JAVMA | FacebookInstagram: JAVMA (@avma_javma) • Instagram photos and videosTwitter: JAVMA (@AVMAJAVMA) / Twitter AJVR: Facebook: American Journal of Veterinary Research - AJVR | FacebookInstagram: AJVR (@ajvroa) • Instagram photos and videosTwitter: AJVR (@AJVROA) / TwitterJAVMA and AJVR LinkedIn: https://linkedin.com/company/avma-journals#VeterinaryVertexPodcast #JAVMA #AJVRINTERESTED IN SUBMITTING YOUR MANUSCRIPT TO JAVMA ® OR AJVR ® ? JAVMA ® : https://avma.org/JAVMAAuthors AJVR ® : https://avma.org/AJVRAuthorsFOLLOW US:JAVMA ® : Facebook: Journal of the American Veterinary Medical Association - JAVMA | Facebook Instagram: JAVMA (@avma_javma) • Instagram photos and videos Twitter: JAVMA (@AVMAJAVMA) / Twitter AJVR ® : Facebook: American Journal of Veterinary Research - AJVR | Facebook Instagram: AJVR (@ajvroa) • Instagram photos and videos Twitter: AJVR (@AJVROA) / Twitter JAVMA ® and AJVR ® LinkedIn: https://linkedin.com/company/avma-journals

Empiric dose reductions for variant DPYD alleles isn't necessarily new, but the outcomes of patients treated with those dose reductions isn't well described. Dutch researchers provide some much needed evidence. Link: https://pubmed.ncbi.nlm.nih.gov/?term=37639651 Is there a role for ICIs in dMMR/MSI-h pancreatic cancer? This retrospective says, uh maybe probably. Link: https://pubmed.ncbi.nlm.nih.gov/?term=37625102

Empiric vs deliberate TQ TQ conversion vs. replacement Conversion of TQ to pressure dressing and pressure dressing to non-pressure dressing TQ risks- amputation, compartment syndrome, neurologic or muscle injury, renal failure and more

In this episode, Kyle Molina, PharmD, BCIDP, provides an overview of treatment of skin and soft tissue infections (SSTIs) and challenges in practice. Listen as he gives perspectives on:Guideline recommendations for treatment of purulent and nonpurulent SSTIsLogistical challenges with IV and oral antibioticsPros and cons of various locations of careData supporting the safety and efficacy of long-acting lipoglycopeptides for treatment of SSTIsUse of long-acting lipoglycopeptides in special populations of interest, including patients with obesity, diabetes, and injection drug useOverall place in therapy of long-acting lipoglycopeptides for SSTIs Faculty:Kyle Molina, PharmD, BCIDPInfectious Diseases Clinical PharmacistScripps Green HospitalLa Jolla, CaliforniaLink to full program: CCO: https://bit.ly/3J4mg8hProCE: https://bit.ly/3P0vB4E

Empiric and Halachik certainty are different. Often, when we need Halachik certainty, empiric certainty is insufficient. However, when we have empiric certainty there are times we don't need Halachik certainty.  Sources

Show notes at pharmacyjoe.com/episode797. In this episode, I’ll discuss empiric dosing of vancomycin for patients on CRRT. The post 797: What is a good empiric dose of vancomycin for patients on CRRT? appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode797. In this episode, I’ll discuss empiric dosing of vancomycin for patients on CRRT. The post 797: What is a good empiric dose of vancomycin for patients on CRRT? appeared first on Pharmacy Joe.

Episode 123: Spontaneous Bacterial Peritonitis.  Kaitlen defines spontaneous bacterial peritonitis (SBP) and also explains the diagnosis and management.  Written by Kaitlen Roy-Ross, MS4, Ross University School of Medicine. Moderated by Hector Arreaza, MD. Definition:An ascitic fluid infection with no obvious surgically treatable intra-abdominal source (bowel perforation, abscess, perforated ulcer). Commonly seen in patients with cirrhosis and ascites. Patients may have symptoms of fever, abdominal pain, abdominal tenderness, altered mental status, and hypotension.Etiology: The most common pathogens (75%) are gram-negative aerobic organisms. Klebsiellapneumoniae accounts for 50% of the cases. Gram-positive aerobic bacteria (Streptococcus pneumoniae or viridans group streptococcus) account for the remaining cases. Some report E. coli as the most common cause of SBP. Random information: in Korea, Aeromonas hydrophila is an important pathogen of SBP during the summer. Diagnosis: To diagnose SBP, a paracentesis should be performed to analyze the ascitic fluid prior to treating the patient with antibiotics.The ascitic fluid should be analyzed for the following: PMN (Polymorphonuclear cell) count: > or = to 250 cells/mm3 Aerobic and anaerobic culturesSerum ascites albumin gradient (serum albumin-ascitic albumin): this measures portal pressure.If the gradient is > 1.1 = portal HTN is present (cirrhosis, heart failure, large liver malignancy, alcoholic hepatitis, portal vein thrombosis) – SBP is likely.If the gradient is 6 mg/ suggests a gallbladder perforation. No SBP.Treatment:The treatment for spontaneous bacterial peritonitis is broad-spectrum antibiotics. Empiric treatment is indicated if a patient with ascites has any of the following:Temperature > 100 FAbdominal pain or tendernessAltered mental statusPMN in ascitic fluid > 250 (but if there is bacteria in ascitic fluid, start antibiotics stat)Alcohol-induced hepatitis*Important note: Patients on beta blockers should have them permanently discontinued prior to treatment for SBP as beta blockers are associated with worse outcomes. In one study, patients on beta blockers had a 58% increase in mortality risk compared to patients not treated with beta-blockers. Beta-blockers were also associated with higher rates of hepatorenal syndrome and longer lengths of hospital stay.1st line treatment- 3rd generation Cephalosporin Cefotaxime 2g IV Q8H (preferred) or Ceftriaxone 2 g per day2nd line treatment- Carbapenems. Usually reserved for patients with severe disease/critical illness.3rd line- Fluoroquinolones- Cipro 400 mg IV BID to patients with normal renal function. (Patients should not get this if they already receiving it prophylactically.)Duration of treatment:5 days, then re-assess the patient's PMN count:PMN 250 or greater than pre-treatment PMN count > look for a surgical source of infection.If PMN is > 250 but less than pre-treatment value, continue ABX for 48 more hours and then repeat paracentesis. Note: In general, ascitic fluid PMN count should be reduced by at least 25% after 48 hours of antibiotic therapy.Renal failure is the major cause of death in patients with SBP and develops in 30-40 % of the patients. We can decrease this risk by administering IV albumin. IV albumin should be given when the creatinine is > 1 mg/dl, the blood urea nitrogen is > 30 mg/dl, or the total bilirubin is > 4 mg/dl. Treatment with octreotide or midodrine is helpful if renal failure develops.Prevention:Antibiotic prophylaxis can be given to patients with risk factors for SBP. Some risk factors include prior history of SBP, variceal hemorrhage, or an ascites fluid protein concentration of

In this episode, Marion Elligsen, BScPhm, MSc, RPh, ACPR; Keith S Kaye, MD, MPH; and Andrew Shorr, MD, MPH, MBA, discuss key considerations for selecting empiric antibiotic regimens in patients with HABP/VABP in the intensive care unit, including: The role of novel β-lactam/β-lactamase inhibitor combinationsUse of clinical predictions scores (eg, Drug Resistance in Pneumonia [DRIP] score) to predict risk for pneumonia caused by multidrug-resistant pathogensApplication of rapid diagnostic testing in critically ill patients with pneumonia, including current limitationsImplementation of advanced antibiograms and clinical prediction scoresClinical utility of biomarkers for pneumonia (eg, procalcitonin)Application of updated nosocomial pneumonia classifications in clinical practiceFaculty:Marion Elligsen, BScPhm, ​ MSc, RPh, ACPR​Practice-Based Researcher​Sunnybrook Research Institute​Antimicrobial Stewardship Pharmacy Lead​Department of Pharmacy​Sunnybrook Health Sciences Centre​Toronto, Ontario, Canada​Keith S. Kaye, MD, MPHChief  Division of Allergy, Immunology and Infectious DiseasesProfessor of MedicineRutgers Robert Wood Johnson Medical SchoolNew Brunswick, New JerseyAndrew Shorr, MD, MPH, MBA​Director​Pulmonary and Critical Care Medicine​Medstar Washington Hospital Center​Washington, DC​Content based on a CME program supported by an educational grant from Merck Sharp & Dohme Corp. Link to full program:https://bit.ly/3HaZpYwLink to downloadable slideset:https://bit.ly/3UxHoqr

Divya A. Khandekar, PharmD, MS (Twitter: @pharmdiv) describes the etiology of febrile neutropenia in patients with hematological malignancies, summarizes guideline-based recommendations for antibiotic discontinuation in patients with febrile neutropenia and discusses primary literature supporting early antibiotic discontinuation in patients with febrile neutropenia. For more pharmacy content, follow Mayo Clinic Pharmacy Residency Programs @MayoPharmRes or the host, Garrett E. Schramm, Pharm.D., @garrett_schramm on Twitter! You can also connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

The topics, stocks and shares mentioned/discussed include: A quick valuation strategy FTSE 100 FTSE 250 FTSE All-share DAX 40 AIM All-share Hedging Takeovers, TakeUNDER & Profit warnings Aveva Group & Schneider Glencore / GLEN Rio Tinto / RIO BHP Group / BHP Inflation Energy Crisis Gfinity / GFIN Esports & Gaming Darktace / DARK SOTP / Intrinsic value Empiric Student Property / ESP BooHoo / BOO Unite Group / UTG ITM Power / ITM Momentum in the portfolio Assessing Macro environment Scaling in Greatland Gold / GGP Food & Fuel Poverty Energy Crisis / Cost of Living Crisis Menphys Charity & its Martin O'Neill event Investing Trading The Twin Petes Challenge 2022 / Charity fundraise for the BACK UP Charity The Twin Petes Investing podcasts will be linked to and written about on the Conkers3 website and also on the WheelieDealer website . Thank you for reading this article and listening to this podcast, we hope you enjoyed it. Please share this article with others that you know will find it of interest.

Show notes at pharmacyjoe.com/episode736. In this episode, I'll discuss empiric vs pre-emptive antifungal therapy. The post 736: Empiric vs Diagnostic Approach to Antifungal Therapy for High-Risk Neutropenic Patients with Persistent Fever appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode736. In this episode, I ll discuss empiric vs pre-emptive antifungal therapy. The post 736: Empiric vs Diagnostic Approach to Antifungal Therapy for High-Risk Neutropenic Patients with Persistent Fever appeared first on Pharmacy Joe.

RANTING with a side of RANTING... and just a bit more RANTING. Topics included in today's episode: Veterinarians being thrown under the bus Empiric antibiotic usage and culture/sensitivity Giving cancer to everything Sticking it to some snooty alphabet soup people Stress dreams Chemo buddies and MORE!   WE HAVE PATREON! Please support your favorite ranting veterinarians :) Patreon: https://www.patreon.com/AllVetsAreOff Twitter: @AllVetsAreOff Merch: https://allvetsareoff.threadless.com/ Email: Allvetsareoff@gmail.com  

Seppo Rinne, MD, PhD, BS of the Center for Healthcare Organization and Implementation Research (CHOIR) talks about his work with the EMPIRIC QUERI partnered evaluation. The mission of EMPIRIC QUERI is to improve VA’s electronic health record modernization (EHRM) by ensuring that it is informed by frontline clinician and staff experiences. EMPIRIC is identifying challenges and best practices to support clinicians and inform the nationwide Cerner rollout.

In this episode of Crypto Over Coffee, Hashoshi breaks down the very real scenario that another Bitcoin crash sends the price of BTC to $10-13k. Conditions in the crypto bear market related to notable bankruptcies of 3AC, Celsius, and Voyager in the wake of the Terra LUNA collapse could pair with macroeconomic conditions to create the perfect storm. Also covered in this video is updates on Ethereum Merge, USDC, and StarkNet.

It's 1AM and the emergency department is calling about *insert terrifying foregut problem you haven't seen since you were an intern here* and you wake up in a cold sweat to realize it was just a dream…this time. Tune in to this clinical challenge episode for some tips and tricks for managing foregut nightmares with Drs. Mike Weykamp, Nicole White, Andrew Wright, and Nick Cetrulo from the University of Washington's Minimally Invasive Surgery team.  Referenced articles and videos:  1.     Rodriguez-Garcia HA, Wright AS, Yates RB. Managing obstructive gastric volvulus: challenges and solutions. Open Access Surgery. 2017 https://www.dovepress.com/getfile.php?fileID=35414 2.     Yates RB. Giant PEH: Management Principles for Unique Clinical Circumstances. 2017 SAGES Annual Meeting. Houston, TX. 2017 https://www.youtube.com/watch?v=vq6cZL2-pho 3.     Millet I, Orliac C, Alili C, Guillon F, Taourel P. Computed tomography findings of acute gastric volvulus. Eur Radiol. 2014.  https://pubmed.ncbi.nlm.nih.gov/25278244/ 4.     Mazaheri P, Ballard DH, Neal KA, Raptis DA, Shetty AS, Raptis CA, Mellnick VM. CT of Gastric Volvulus: Interobserver Reliability, Radiologists' Accuracy, and Imaging Findings. AJR Am J Roentgenol. 2019.  https://pubmed.ncbi.nlm.nih.gov/30403524/ 5.     Barmparas G, Alhaj Saleh A, Huang R, Eaton BC, Bruns BR, Raines A, Bryant C, Crane CE, Scherer EP, Schroeppel TJ, Moskowitz E, Regner JL, Frazee R, Campion EM, Bartley M, Mortus JR, Ward J, Margulies DR, Dissanaike S. Empiric antifungals do not decrease the risk for organ space infection in patients with perforated peptic ulcer. Trauma Surg Acute Care Open. 2021. https://pubmed.ncbi.nlm.nih.gov/34079912/ 6.     Horn CB, Coleoglou Centeno AA, Rasane RK, Aldana JA, Fiore NB, Zhang Q, Torres M, Mazuski JE, Ilahi ON, Punch LJ, Bochicchio GV. Pre-Operative Anti-Fungal Therapy Does Not Improve Outcomes in Perforated Peptic Ulcers. Surg Infect (Larchmt). 2018. https://pubmed.ncbi.nlm.nih.gov/30036134/ 7.     Wee JO. Gastric Volvulus in Adults. In: UpToDate, Louie BE (Ed), UpToDate, Waltham, MA. (Accessed on May 15, 2022.) https://www.uptodate.com/contents/gastric-volvulus-in-adults Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Drs. Kate DeSear (@IDPharmD_Kate) and Frank Tverdek (@FTverdek) join Dr. Julie Ann Justo (@julie_justo) to discuss the practice of empiric escalation in this episode of our gram-negative resistance series. Listen in for encouragement on following your intuition and tips on how, when, and why to practice this other side of antimicrobial stewardship. Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/ References Clinical and Laboratory Standards Institute. Access Our Free Resources: M100 and M60. Accessed at https://clsi.org/standards/products/free-resources/access-our-free-resources/ Gallagher JC, et al. Open Forum Infect Dis. 2018 Oct 31;5(11):ofy280. doi: 10.1093/ofid/ofy280. PMID: 30488041. Castan B, et al. Infect Dis Now. 2021 Sep;51(6):532-539. doi: 10.1016/j.idnow.2021.05.003. Epub 2021 May 17. PMID: 34015539. Cultrera R, et al. Antibiotics (Basel). 2020 Sep 24;9(10):640. doi: 10.3390/antibiotics9100640. PMID: 32987821. Strich JR, et al. Clin Infect Dis. 2021 Feb 16;72(4):611-621. doi: 10.1093/cid/ciaa061. PMID: 32107536. Montravers P, Bassetti M. Curr Opin Infect Dis. 2018 Dec;31(6):587-593. doi: 10.1097/QCO.0000000000000490. PMID: 30299359. Strich JR, Heil EL, Masur H. J Infect Dis. 2020 Jul 21;222(Suppl 2):S119-S131. doi: 10.1093/infdis/jiaa221. PMID: 32691833. Kumar A, et al. Crit Care Med. 2006 Jun;34(6):1589-96. doi: 10.1097/01.CCM.0000217961.75225.E9. PMID: 16625125. Hibbard ML, et al. Surg Infect (Larchmt). 2010 Oct;11(5):427-32. doi: 10.1089/sur.2009.046. PMID: 20818984. Rosa RG, Goldani LZ, dos Santos RP. BMC Infect Dis. 2014 May 23;14:286. doi: 10.1186/1471-2334-14-286. PMID: 24884397. Benanti GE, et al. Antimicrob Agents Chemother. 2019 Jan 29;63(2):e01813-18. doi: 10.1128/AAC.01813-18. PMID: 30509935.

In this episode, Keith S. Kaye, MD, MPH; Lilian Abbo, MD, FIDSA; and Jason M. Pogue, PharmD, discuss HABP/VABP and gram-negative resistance including:Epidemiology and burden of nosocomial bacterial pneumoniaPatient-specific risk factors for MDR pathogensImproving outcomes with the use of antibiogramsRecommended empiric therapy for clinically suspected VABPAntimicrobial resistance in HABP/VABPAlgorithms for gram-negative organism antibiotic-susceptibility testingUsing rapid diagnostic tests for HABP/VABPNew antimicrobial agents for MDR gram-negative infections with discussion of the 2021 IDSA guidance, and the following studies:ASPECT-NP: ceftolozane/tazobactam vs meropenemREPROVE: ceftazidime/avibactam vs meropenemRESTORE-IMI-1 imipenem/cilastatin/relebactam vs colistin + imipenemRESTORE-IMI-2: imipenem/cilastatin/relebactam vs piperacillin/tazobactamAPEKS-NP: cefiderocol vs meropenemCREDIBLE-CR: cefiderocol vs best available therapyProgram Director:Keith S. Kaye, MD, MPHChiefDivision of Allergy, Immunology and Infectious DiseasesProfessor of MedicineRutgers Robert Wood Johnson Medical SchoolNew Brunswick, New JerseyFaculty:Lilian Abbo, MD, FIDSAAssociate Chief Medical Officer in Infectious DiseasesJackson Health SystemProfessor of Infectious DiseasesDepartment of Medicine & Miami Transplant InstituteUniversity of Miami Miller School of MedicineMiami, FloridaJason M. Pogue, PharmDClinical ProfessorDepartment of Clinical PharmacyUniversity of Michigan College of PharmacyInfectious Diseases Clinical PharmacistMichigan MedicineAnn Arbor, MichiganContent based on a CME program supported by an educational grant from Merck Sharp & Dohme Corp.Follow along with a downloadable slideset at:https://bit.ly/3CEop6hLink to full program https://bit.ly/3i781lf

PBA #PLUS / GUTO PUTTI - KOMODO EMPIRIC MIX - MAURO PICOTTO - DIC 2021

Empiric's software platform and hardware sensors are being used to predict industrial equipment failure, remotely manage facilities in real-time, and improve quality assurance reporting processes across all industrial verticals. Our current focus is providing complete end-to-end visibility, for Life Sciences companies, of their cold chain. Empiric's software platform and hardware sensors are being used to predict industrial equipment failure, remotely manage facilities in real-time, and improve quality assurance reporting processes across all industrial verticals. Our current focus is providing complete end-to-end visibility, for Life Sciences companies, of their cold chain. Company Profile Link -  https://www.startupsteroid.com/founder?founderUserId=B9AF2A48-C3FB-4637-9B70-231E9EEDB472

Every once in awhile, I get lucky enough to interview a force of nature where I'm doing all I can to hang on for the ride. That was my experience today as I spoke to Jon Sinfield of the UK upstarts Memorist.Jon has a lot to say, and give me wonderfully eloquent and thoughtful answers to my oddly phrased questions. It was a joy to hear his take on everything from family loss to the surprising catharsis of swimming in pools of fecal matter.We'll let you percolate on the image of that for a moment and give nothing away... but rest assured, this interview is a ton of fun and full of wonderful surprises. Jon is going to be a legendary frontman, this much is evident.This is my conversation with the singer and lyricist of Memorist, Jon Sinfield, on the Rockstar Superhero Podcast.Time Codes:1:40 Living in the middle of United Kingdom3:50 Wales is a country7:00 Losing parents to cancer9:45 Pursuing the artist's nature13:00 Writing music as a band17:00 Describing the sound of Memorist20:00 Designing the Japanese styles23:00 The theme of the demon gods26:00 Coronavirus is your friend29:40 The band didn't like The Empiric33:00 Painful themes in the lyrics38:40 Mental health issues and addiction42:30 The Superhero Story45:50 Subliminal approaches for the listener49:30 James and Year of the Rat Records52:00 Swimming pools and fecal matter57:00 Touring cycles and the dream of the US1:01:00 Choosing the manner of deathThe opening track is called The Empiric, and provided courtesy of Memorist and Year of the Rat Records, copyright 2021, All Rights Reserved.Subscribe to both shows here: https://bit.ly/3airCvhWanna be on the show? Go here: https://calendly.com/rockstarsuperheroinstituteThe Rockstar Superhero Podcast examines the personal lives and creative careers of your favorite classic rock artists. We are obsessed with understanding the inner workings of the music business and all that it takes to remain in the public eye for as long as possible. Join us as we pursue conversations with legends and legends in the making.The Rockstar Superhero Radicals podcast was created to connect you directly to people, professional and private, who have lived lives worth discussing and offer solutions to our listeners, one heart at a time. If you are seeking truth and purpose beyond yourself, the Radicals podcast is for you.Copyright 2021 Rockstar Superhero Podcast - All Rights ReservedBecome a supporter of this podcast: https://www.spreaker.com/podcast/rockstar-superhero--4792050/support.

38 Gracias Episodio 38. #losnuestrosprimero. Hicimos un resumen de la josrnada olimpica de la federacion criolla vinotinto y el desenvolcimiento de nuestros atletas. Tambien ennuestra seccion #proyectolinkvenezuela converzamos con @empiricemotion Una productora de contenido digital y Podcast que llego para revolucionar. Me gustó mucho este episodio. . . Se les quiere. . . #podcast #podcaster #podcastvenezuela #radioweb #radiolatina #felicidad #cbd --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/efectopantricolas/message Support this podcast: https://anchor.fm/efectopantricolas/support

On this episode of the Adventures of Pipeman, Pipeman speaks to John from Memorist. John speaks much about their new single The Empiric which is about the situation regarding the pandemic right now in the UK, which is something they wouldn't typically make music about. John says you could substitute what's going on in the UK all over the western world. Pipeman talks about the lack of uniformity and gives the example of Florida giving each town the power to make their own rules. John also talks about how the song isn't just aimed at the governments in power but also the general public because the damage that could be done if you're wrong is huge. You can check out Memorist on Facebook and Instagram @memorist_uk and you can check out their music videos on the Dreambound Music channel. Memorist's new single Second Sequence comes out August 6th, with 3 other singles being released this year.Pipeman in the Pit is a music and interview segment of The Adventures of Pipeman Radio Show (#pipemanradio) and from The King of All Festivals while on The Pipeman Radio Tour. The live show is broadcast live on W4CY Radio (www.w4cy.com), W4VET Radio, and K4HD Radio - Hollywood Talk Radio (www.k4hd.com) part of Talk 4 Radio (www.talk4radio.com) on the Talk 4 Media Network (www.talk4media.com). This podcast is also available on Talk 4 Podcasting (www.talk4podcasting.com).Pipeman in the Pit features all kinds of music and interviews with bands & music artists especially in the genres of Heavy Metal, Rock, Hard Rock, Classic Rock, Punk Rock, Goth, Industrial, Alternative, Thrash Metal & Indie Music. Pipeman in the Pit also features press coverage of events, concerts, & music festivals. Pipeman Productions is an artist management company that sponsors the show introducing new local & national talent showcasing new artists & indie artists.Then there is The Pipeman Radio Tour where Pipeman travels the country and world doing press coverage for Major Business Events, Conferences, Conventions, Music Festivals, Concerts, Award Shows, and Red Carpets. One of the top publicists in music has named Pipeman the “King of All Festivals.” So join the Pipeman as he The Pipeman Radio Tour to Life right before your ears and eyes.

On this episode of the Adventures of Pipeman, Pipeman speaks to John from Memorist. John speaks much about their new single The Empiric which is about the situation regarding the pandemic right now in the UK, which is something they wouldn't typically make music about. John says you could substitute what's going on in the UK all over the western world. Pipeman talks about the lack of uniformity and gives the example of Florida giving each town the power to make their own rules. John also talks about how the song isn't just aimed at the governments in power but also the general public because the damage that could be done if you're wrong is huge. You can check out Memorist on Facebook and Instagram @memorist_uk and you can check out their music videos on the Dreambound Music channel. Memorist's new single Second Sequence comes out August 6th, with 3 other singles being released this year.Pipeman's Power of Music is a music and interview segment of The Adventures of Pipeman Radio Show (#pipemanradio) and from The King of All Festivals while on The Pipeman Radio Tour. The live show is broadcast live on W4CY Radio (www.w4cy.com), W4VET Radio, and K4HD Radio - Hollywood Talk Radio (www.k4hd.com) part of Talk 4 Radio (www.talk4radio.com) on the Talk 4 Media Network (www.talk4media.com). This podcast is also available on Talk 4 Podcasting (www.talk4podcasting.com).

On this episode of the Adventures of Pipeman, Pipeman speaks to John from Memorist. John speaks much about their new single The Empiric which is about the situation regarding the pandemic right now in the UK, which is something they wouldn't typically make music about. John says you could substitute what's going on in the UK all over the western world. Pipeman talks about the lack of uniformity and gives the example of Florida giving each town the power to make their own rules. John also talks about how the song isn't just aimed at the governments in power but also the general public because the damage that could be done if you're wrong is huge. You can check out Memorist on Facebook and Instagram @memorist_uk and you can check out their music videos on the Dreambound Music channel. Memorist's new single Second Sequence comes out August 6th, with 3 other singles being released this year.Take some zany and serious journeys with The Pipeman aka Dean K. Piper, CST on The Adventures of Pipeman also known as Pipeman Radio syndicated globally “Where Who Knows And Anything Goes”. Listen to & Watch a show dedicated to motivation, business, empowerment, inspiration, music, comedy, celebrities, shock jock radio, various topics, and entertainment. The Adventures of Pipeman is hosted by Dean K. Piper, CST aka “The Pipeman” who has been said to be hybrid of Tony Robbins, Batman, and Howard Stern. The Adventures of Pipeman has received many awards, media features, and has been ranked for multiple categories as one of the Top 6 Live Radio Shows & Podcasts in the world. Pipeman Radio also consists of multiple podcasts showing the many sides of Pipeman. These include The Adventures of Pipeman, Pipeman in the Pit, and Positively Pipeman and more. You can find all of the Pipeman Podcasts anywhere you listen to podcasts. With thousands of episodes that focus on Intertainment which combines information and entertainment there is something for everyone including over 5000 interviews with celebrities, music artists/bands, authors, speakers, coaches, entrepreneurs, and all kinds of professionals.Then there is The Pipeman Radio Tour where Pipeman travels the country and world doing press coverage for Major Business Events, Conferences, Conventions, Music Festivals, Concerts, Award Shows, and Red Carpets. One of the top publicists in music has named Pipeman the “King of All Festivals.” So join the Pipeman as he The Pipeman Radio Tour to Life right before your ears and eyes.All Pipeman Radio Podcasts are heard on Talk 4 Podcasting, iHeartRadio, Pandora, Amazon Music, Audible, Spotify, Apple Podcast, Google Podcasts and over 100 other podcast outlets where you listen to Podcasts. The following are the different podcasts to check out and subscribe to:•The Adventures of Pipeman•Pipeman Radio•Pipeman in the Pit•Positively PipemanFollow @pipemanradio on all social media outletsVisit Pipeman Radio on the Web at theadventuresofpipeman.com, pipemanradio.com, w4cy.com, talk4tv.com, talk4podcasting.comPhone/Text Contact – 561-506-4031Email Contact – dean@talk4media.com The Adventures of Pipeman is broadcast live daily at 8AM ET.The Adventures of Pipeman TV Show is viewed on Talk 4 TV (www.talk4tv.com).The Adventures of Pipeman Radio Show is broadcast on W4CY Radio (www.w4cy.com) and K4HD Radio (www.k4hd.com) – Hollywood Talk Radio part of Talk 4 Radio (www.talk4radio.com) on the Talk 4 Media Network (www.talk4media.com). The Adventures of Pipeman Podcast is also available on Talk 4 Podcasting (www.talk4podcasting.com), iHeartRadio, Amazon Music, Pandora, Spotify, Audible, and over 100 other podcast outlets.

Having recently signed to Year Of The Rat Records, UK metal outfit Memorist have plunged straight into a new era of music for the six piece, breaking away from the harder edged rock elements that have defined them over their first three singles and  pushing them more towards metalcore style leanings.After the success of those songs which attracted the attention of their new label, Memorist have kicked up another gear with their latest single The Empiric, enjoying the freedom and confidence that comes with self belief.Frontman Jon Sinfield joined HEAVY over the weekend to talk about the direction of the new single and Memorist's planned assault on the global music market."That was something we've been aiming for for a little while," he said, referring to the heaviness of The Empiric. "Our first three singles are really kind of traditionally band music - couple of guitars, bass, drums, vocals - and we've all had this fascination with things that are maybe a little more cinematic for a long time and how synthetic and electronic elements kind of blend with organic, traditional band stuff. I listen to loads of different kinds of music anyway, but I had been listening to drum and bass and quite a lot of industrial stuff, and we really wanted to try and get that sound in there. It was just a natural progression, really. Chris and I throughout lockdown were writing together, and I do a lot of electronic music production, so I was doing electronic stuff and blending it with what he was doing, and we just arrived at this sound which is what we've been hoping to achieve for a little while. I think we pretty much got it where we want it to be. We're pretty proud of it."In the full interview, Jon talks about the heavier direction the band is headed in, future new music, lyrical inspiration, entering the music world as a relatively new band after Covid, music as a weapon and more.

Today on Health in 2 Point 00, I air some of my grudges as we get into our deals for the day. In the third extension of their Series C, Medable gets another $78 million bringing their total to $217 million. Olive acquires Empiric Health, expanding into surgical data analytics – where does this fit in with Sean Lane's five-point strategic plan? Finally, Papa gets a $60 million raise and Anthem, Blackstone and K Health launch a joint venture.

Episode 41: Otitis Media.Diagnosis and treatment of acute otitis media in children, when to avoid antibiotics, use of short course of antibiotics, question of the week about polyarthralgia and fatigue.Today is February 22, 2021.  Question of the Month  by Claudia Carranza  A 49-year-old female comes to clinic reporting bilateral wrist and ankle pain for 1 month. The pain is worse with movement and responds well to ibuprofen. She denies joint swelling, warmth, or morning stiffness. She reports feeling more fatigued than usual this past month. You note on her chart that she was diagnosed with COVID-19 approximately 6 weeks ago for which she did not need to be hospitalized.  She denies history of diabetes, thyroid disease, lupus, rheumatoid arthritis, trauma, or anemia. She denies fecal, urinary, or vaginal bleeding, no headaches, no chest pain, no SOB or dizziness. Exam is remarkable for a “tired look” and tenderness to palpation at bilateral wrist and ankles. No signs of inflammation on joints is noted. What do you think is the etiology of this patient’s symptoms and what workup would you order (if any)? Let’s repeat the question: What do you think is the etiology of the symptoms in a 49-year-old female who complains of symmetrical POLYARTHRALGIA- and fatigue for 1 month, and what workup would you order (if any)? Send us your answer to rbresidency@clinicasierravista.org before March 22, 2021. The winner will be announced and will receive a prize.Introduction to episode:This week we announced 3 new chief residents. Dr Manny Tu will replace Dr Lisa Manzanares, a big supporter of this podcast and chief for more than 1 year, who graduated last week as didactics chief. Dr McGill and Dr Gomes will continue to be chiefs until they hand over the baton to Dr Gina Cha and Dr Alejandro Gonzalez-Perez. Congrats, dear residents! (or should we say sorry?)When you treat an infection, you need to know the recommended duration of treatment. Normally, the more severe an infection is, the longer the duration of treatment. In many instances, shorter courses of antibiotics can have similar efficacy to longer courses[1], and treating for shorter periods may also reduce the development of resistance and infections by C. difficile. Some infections in which this applies are, for example, community-acquired pneumonia (CAP), where treatment can be shortened to 3-5 days instead of 7-10 days; nosocomial pneumonia which can be treated for 7 days instead of 10-15 days; pyelonephritis, 5-7 days instead of 10-14 days; intra-abdominal infection (after source control) for 4 days instead of 10 days; COPD exacerbation, less than 5 days instead of more than 7 days; bacterial sinusitis, 5 days instead of 10; uncomplicated cellulitis, 5-6 days instead of 10 days. Of course, you must use your clinical judgement when deciding to use a shorter course of antibiotic treatment.As a reminder, FDA has also warned about the relationship between fluoroquinolones and an increased risk of aortic dissection. On their website, it states that “Health care professionals should avoid prescribing fluoroquinolones to patients who have an aortic aneurysm or are at risk for an aortic aneurysm, such as patients with peripheral atherosclerotic vascular diseases, hypertension, certain genetic conditions such as Marfan syndrome and Ehlers-Danlos syndrome, and elderly patients”. They also say you “may prescribe fluoroquinolones to these patients only when no other treatment options are available”[2]. Other safety concerns reported by FDA about fluoroquinolones include: significant decrease in blood sugar and certain mental health side effects, disabling side effects of the tendons, muscles, joints, nerves, and central nervous system, restriction in use for certain uncomplicated infections, peripheral neuropathy, and tendinitis and tendon rupture. Therefore, think about this warning before prescribing fluoroquinolones[2].This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. ____________________________Acute Otitis Media.Dr Katherine Schlaerth is a native of Pennsylvania. She graduated from Manhattan College and received her medical degree from the State University of New York, Buffalo. Dr. Schlaerth completed her pediatrics residency at Children’s Hospital LA and an Infectious disease fellowship at LAC-USC Medical Center. She is board certified in pediatrics, pediatric infectious diseases, family medicine and has a Certificate of Added Qualifications in Geriatrics. Dr. Schlaerth was an associate professor at Loma Linda and is an associate professor emeritus at USC. She has a special interest in research and has published in addiction medicine, child development and other areas.Some topics discussed during this episode included definition of otitis media; risk factors such as bottle feeding, tobacco exposure, viral illness; common symptoms such as fever, irritability, ear tugging; diagnosis by pneumatic otoscopy; erythema of tympanic membrane as a sign of otitis media; treatment with antibiotics; use of amoxicillin as the first line of treatment; amoxicillin/clavulanate if amoxicillin fails; use of azithromycin, cefdinir and ceftriaxone for treatment, prevention with vaccination against Hib, pneumococcus and influenza, and more.  Page BreakTips:Tip #1: TympanocentesisAlthough impractical in primary care, tympanocentesis may be done in children with severe, ongoing symptoms despite use of multiple antibiotics. Middle ear fluid can then be cultured and antibiotics adjusted based on bacterial sensitivities. Tip #2: Common pathogensCommon pathogens in neonates with acute otitis media include Group B streptococci, gram-negative enteric bacteria, and Chlamydia trachomatis. Empiric sepsis treatment should be started without delay, especially in neonates younger than 2 weeks with fever and acute otitis media.Tip #3: When to give antibioticsGive antibiotics in these cases: acute otitis media with otorrhea or severe symptoms at any age, and BILATERAL otitis without otorrhea in younger than 2-year-olds. Observation without initial antibiotics AND follow up in 48-72 hours is an option in low-risk children who are older than 2 years old with otitis WITHOUT otorrhea. Tip #4: Pain controlDon’t forget to treat pain related to otitis media. To provide short term pain relief, use acetaminophen, ibuprofen, or alternating between the two. Tip #5: Failure of treatmentFailure of antibiotic treatment occurs when the severe symptoms do not improve within 48 to 72 hours after initiation of treatment, or if acute otitis media is diagnosed again within 30 days after appropriate treatment.Tip #6: Duration of antibioticsFor patients under 2 years of age OR with severe symptoms, give PO antibiotics for 10 days; in patients older than 2 years without severe symptoms and without otorrhea, 5-7 days may be enough. Make sure parents understand that fever and ear pain may persist for 48-72 hours. Some signs to look for that warrant a trip back to clinic or the ER include vomiting, headaches, high fever, and pain behind the ears. If recovery is uneventful, follow up 3 months after completing antibiotics or during the next well child visit, whichever comes sooner.Tip #7: TympanostomyConsider tympanostomy tubes in children with 3 or more episodes of acute otitis media within 6 months, or 4 episodes within one year, with one episode in the preceding 6 months. After the mics turned off: Topical treatmentAfter having this conversation with Dr Shclaerth, she gave me this additional information about use of topical antibiotics in acute otitis media and otorrhea:Tympanic membrane perforation is not commonly seen in purulent otitis media, but often stops the pain because it is essentially the draining of an abscess, i.e. otitis media. A culture of the purulent material can be done if concern exists for unusual bacteria. Generally, the rupture of the tympanic membrane heals over rapidly. Topical ofloxacin and ciprofloxacin has not been studied extensively in the treatment of children with ACUTE otitis media with acute tympanic membrane perforation. These topical medications should be used for 7 to 10 days in children with CHRONIC suppurative otitis media or in otorrhea with TYMPANOSTOMY tube, in those cases, topical antibiotics are equivalent to oral therapy. However, ACUTE otitis media with tympanic membrane perforation is treated with ORAL antibiotics, not topical. ____________________________For your Sanity: Jokesby Steven Saito and Tana ParkerWhy are pediatricians always in a rush? They have little patients.I told my wife she was drawing her eyebrows too high. She looked surprised.Someone stole my mood ring. I don’t know how I feel about that.Why do cows were bells? Because their horns don’t work.Now we conclude our episode number 41 “Acute Otitis Media”. Dr Schlaerth explained when to use antibiotics and when to use a more conservative approach in the treatment of acute otitis media. Remember that antibiotics are not always the right answer, we want to avoid undesired side effects and prevent antibiotic resistance whenever possible. The question of the month is: What do you think is the etiology of the symptoms in a 49-year-old female who complains of symmetrical polyarthralgia and fatigue for 1 month, and what workup would you order (if any)? Send us your answer to rbresidency@clinicasierravista.org before March 22, 2021 and win a prize! Remember, even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Claudia Carranza, Valerie Civelli, Katherine Schlaerth, Alex Tompkins, Steven Saito, and Tana Parker. Audio edition: Suraj Amrutia. See you next week! _____________________References:Dimopoulos G, Matthaiou DK, Karageorgopoulos DE, Grammatikos AP, Athanassa Z, Falagas ME. Short- versus long-course antibacterial therapy for community-acquired pneumonia: a meta-analysis. Drugs. 2008;68(13):1841-54. doi: 10.2165/00003495-200868130-00004. PMID: 18729535. https://pubmed.ncbi.nlm.nih.gov/18729535/ FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics in certain patients, FDA, https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-increased-risk-ruptures-or-tears-aorta-blood-vessel-fluoroquinolone-antibiotics Gaddey HL, Wright MT, Nelson TN. Otitis Media: Rapid Evidence Review. Am Fam Physician. 2019 Sep 15;100(6):350-356. PMID: 31524361. https://pubmed.ncbi.nlm.nih.gov/31524361/ Wright D, Safranek S. Treatment of otitis media with perforated tympanic membrane. Am Fam Physician. 2009 Apr 15;79(8):650, 654. PMID: 19405408. https://pubmed.ncbi.nlm.nih.gov/19405408/ 

Educational Pearls: The CDC has made new formal recommendations for treating Gonorrhea due to increasing resistance to Rocephin and Azithromycin. New recommendations: Confirmed gonorrhea: Ceftriaxone 500 mg once Empiric treatment: Ceftriaxone 500 mg once followed by 7 days Doxycycline 100 mg BID No longer using Azithromycin due to high resistance Second line: Gentamycin IM Cefixime 800 mg oral Pharyngeal involvement has high resistance rates to second line agents and ceftriaxone is strongly preferred References St. Cyr S, Barbee L, Workowski KA, et al. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1911–1916. DOI: http://dx.doi.org/10.15585/mmwr.mm6950a6. Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.com/cme-courses/ and create an account.      

The challenges of healthcare are daunting, with costs amounting to almost 20% of the US GDP - twice the rate of any other developed nation. Empiric Health is a leading AI-powered clinical analytics company. Rick Adam and Justin Schaper, the CEO and CTO, talk about how they improve patient outcomes and the affordability of healthcare such as surgery, which alone is 60% of the cost of hospitals. The result is better predictions, and better surgical care, with a new approach to knee surgeries where patients are released an entire day earlier on average. You won't want to miss hearing about machine learning approaches - and how humans intelligence and machine intelligence can collaborate.

Rejoice! as our phenomenal guest Dr. Brad Hayward @bradleyjhayward (Weill Cornell Medicine) demystifies chronic cough for the primary care provider. Dr. Hayward, an internist, pulmonologist, intensivist AND palliative care physician sits down with us to discuss common causes for chronic cough, work up pearls and options for treatment. Follow him on Twitter, @BradleyJHayward. Listeners can claim free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date). We hope you enjoy learning from this episode as much as we enjoyed producing it!   Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!   Credits Written (including CME questions) and Produced by: Cyrus Askin MD Infographic by: Cyrus Askin MD Cover Art: Kate Grant MBChb, MRCGP Hosts: Matthew Watto MD, FACP; Stuart Brigham MD; Paul Williams MD, FACP    Editor: Emi Okamoto MD (written materials); Clair Morgan of nodderly.com Guest: Brad Hayward MD   Sponsors: Panacea Financial  This episode is supported by Panacea Financial, digital banking built for doctors, by doctors. At Panacea Financial you can have your own free personal banker and a support team that works around the clock- just like you do. Open your free checking account today at panaceafinancial.com Panacea Financial, a Division of Sonabank, Member FDIC     VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit.   Time Stamps   Sponsor - Panacea Financial panaceafinancial.comSponsor - VCU Health CE curbsiders.vcuhealth.org 00:00 Intro, disclaimer, guest bio; Guest one-liner and Pick of the Week* 06:23 Sponsor - Panacea Financial panaceafinancial.com 07:30 Case of Post Infectious Cough; Basic definitions for cough Important aspects of the history Empiric therapies for post-viral cough 22:50 Case of idiopathic chronic cough; Physical exam 29:20 Basic testing and empiric therapy for the common causes of chronic cough 41:51 When to refer to pulmonology; Therapy for idiopathic chronic cough; OTC cough meds 54:28 Take home message; Outro Sponsor - VCU Health CE curbsiders.vcuhealth.org   Links* 90 Day Fiancé (show)   Below Deck Mediterranean (show) Mastering Communication with Seriously Ill Patients by  Anthony Back, Robert Arnold & James Tulsky (book)    *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goal Listeners will develop a pragmatic approach to evaluating subacute and chronic cough in adult patients.   Learning objectives After listening to this episode listeners will be able to…   ... define sub-acute vs chronic cough ... build a repertoire of history questions geared towards identifying the etiology of cough in a patient ... build a toolbox of diagnostic studies / tests that can be used in the evaluation of cough ... marry history, physical and diagnostic studies into a coherent approach to diagnosing subacute and chronic cough through a tiered/logical approach ... understand empiric therapies for cough that may have an advantageous risk-reward profile, even in the absence of diagnosis  ... educate patients on common causes for subacute cough and chronic cough, as well as how to appropriately set expectations regarding symptoms severity and duration   Disclosures Dr. Hayward reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Askin CA, Hayward B, Williams PN, Brigham SK, Okamoto E, Watto MF. “241: Chronic Cough”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Original Air Date: November 9, 2020.   Tags Cough, dyspnea, asthma, COPD, eosinophil, IL-5, allergy, ENT, allergist, pulmonary, pulmonologist, PFT, spirometry,  post-nasal drip, GERD, reflux, eczema, rash, atopy, mucus, bronchiectasis, lung, antihistamine, CT, X-Ray,  smoking, vaping, birds, dust, cockroaches, steroids, ICS, inhaled, gabapentin,  primary care, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

For our first nonprofit, I interviewed Thea Chhim, the founder of Empiric, a nonprofit geared towards exposing underprivileged students in the Greater Boston area to STEM subjects. In this episode, Thea talks about Empiric and the process of creating a nonprofit. Website: https://www.empiricalstudy.org/ Instagram: https://www.instagram.com/empiricalstudy/ --- Send in a voice message: https://anchor.fm/mahathi-gopinathan/message

Dr. Michael Cosimini discusses gamification and games for clinical education. Dr. Cosimini is an Assistant Professor of Pediatrics at the Keck School of Medicine at USC, and the author of Empiric, a card game for learning guidelines-based antibiotic selection. [02:08] Challenges of Creating Games for a Clinical Setting [02:56] Gamification Versus Serious Games [07:22] How to Balance Between Entertainment and Education [08:09] Tabletop Games Versus Video Games [12:23] How Medical Students Can Apply Games to Their Learning [13:49] How Empiric Works [20:21] How to Find Out More About Michael & Empiric Gamification Versus Serious Games Many medical instructors already gamify their educational content, for example, by transforming a PowerPoint slide into a game of Jeopardy, giving out stickers for accomplishments, and having a leaderboard in class. An example of gamification in the literature is when surgical residents performing laparoscopic procedures were split into competing groups. The randomly selected students who trained in this gamified setting trained longer and performed better. Dr. Cosimini does support gamification, but he more strongly promotes “serious games” which go beyond gamifying existing educational content, to creating a game for the purpose of education, rather than pure entertainment. For example, the game GridlockED, which resembles Clue, trains players to handle emergency room throughput. Michael’s card game, Empiric for learning antibiotic selection is also a serious game. How to Balance Entertainment and Education in Games To help find the appropriate balance between entertainment and education, Dr. Cosimini emphasizes the importance of testing the outcome of a game, to see what students have actually learnt. As a rule of thumb, be respectful of the player’s time. Do not have a game that is long, unless there is evidence that shows that this contributes to the learning process. Tabletop Games Versus Video Games Dr. Cosimini promotes tabletop games over digital or video games for medical education. He cites a study by Mary Flanagan of Tiltfactor, a game design company. The study compared the iPad and tabletop version of Pox: Save the People, a game about disease spread. With the tabletop version, people tended to interact and work together more, which is important for the social aspect of learning. How Medical Students Can Apply Games to Their Education Creating their own card games might be too involved, and too time-consuming for a medical student. Students can instead use off-the-shelf card games from resources such as East Midlands Emergency Medicine Educational Media, #EM3, which provides games for learning about pediatric EKGs, pediatric dermatology, and pediatric and adult orthopedics. For instructors, Michael recommends MedEd. He of course also recommends his own game Empiric, for learning about antibiotic selection, and his upcoming game about emergency medicine. These games are more helpful for clinical education i.e. for medical students on their clinical rotations, or for residents, and less helpful for first and second year medical students. How Empiric Works Empiric is based on the American Academy of Pediatrics (AAP) Red Book, 2018-2021. Dr. Cosimini includes visual cues — such as color coding — for facts such as the mechanism of delivery and the spectrum of activity, to enable students to memorize facts more quickly. It can be difficult to keep up with the changing facts around antibiotic resistance, and other antibiotic research. Currently, Dr. Cosimini does this by updating the printable card decks online, after the research is updated. Check out Empiric’s Twitter, Instagram, Facebook, and website. The website includes a list of medical and non-medical card games. Sign up for a Free Coaching session with Chase DiMarco, sponsored by Prospective Doctor! You can also join the Med Mnemonist Mastermind FB Group today and learn more about study methods, memory techniques, and MORE! Do check out Read This Before Medical School. Like our FreeMedEd Facebook page and find our Medical Micro course, blog posts, and podcasts at FreeMedEd.org! Feel free to email any questions or comments.

This podcast presents, Dr. Patrick Carolan, a pediatric emergency medicine physician with Minneapolis Children's Hospital and Clinics of Minnesota, who discusses the evaluation of fever in the neonate and young infant.  Enjoy the podcast! Objectives:     Upon completion of this podcast, participants should be able to: Recognize the implications of fever in the young infant. Discuss the differential diagnosis of fever and critical illness in the young infant. Implement new concepts in risk stratification for evaluating fever in young infants. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks.  You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org. Click on the following link for your CME credit: CME Evaluation: "The Approach to Fever in the Young Infant" (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. SHOW NOTES: CHAPTER 1: Today we are talking about fever in the pediatric population, specifically those in the under 3-months of age. Dr. Pat Carolan of Children's Hospitals of Minnesota  will help us demystify fever in this age group.  Going back to the mid-70s, there was a search for criteria to find high-risk vs low-risk pediatric fevers. In the original study out of Boston, it was identified that 10% of the patients under age 2, with WBC greater than 15, and a temperature greater than 38.9C, had severe bacteremia. This was the first set of criteria focused on identifying high-risk infants. With the intro of HIb vaccine in the the late 80s-early 90s, and the pneumococcal vaccine in the mid-90s, there is a much lower prevalence of these infections. The few cases that occur now are due to those who have not received or are non-responders to the vaccine. The shift in study of pediatrics has now been to better differentiate high-risk vs low-risk febrile infants. What is considered a fever? The traditional definition of fever is a temperature over 100.4F. Pediatric fevers can be broken down into 3 groups. Those in 0-28 days are high-risk and regardless of a positive RSV or influenza test, get a full work up - including blood, urine, csf, cultures, antibiotics, and admission.  What if they are 0-28 days and they have otitis media or RSV? The clinical exam of otitis media in this aged population would be difficult, and even if the clinician had confidence in a focal finding, those at this age group are still at significant risk and would get a full work up. RSV would be unusual in a 2-week old and even if positive , that would be an usual finding, and again these neonates would still get a full work up. The rates of bacteremia in studies have shown that a full work up is warranted. Infants at 3-months are lower-risk, and in general, can usually be managed as outpatients with lab work. Risk for infants in the 2nd month of life is harder to determine and they are the target of risk stratification tools discussed later in this podcast. These are the "tweeners". Initially, assessment of these infants include that across the room pediatric triage triangle. How are they reacting to stimulus? What does their skin color look like? What is their body tone? Have the parents noted whether the infant is engaged in feeding? Are they tachycardiac? Infants can present with fever, but some infants that are septic, can present afebrile or hypothermic. Remember, it is important not to overlook a potential differential diagnosis, including congenital ductal lesions or metabolic abnormalities. CHAPTER 2: Risk stratification tools vary, but utilize biomarkers such as procalcitonin and CRP as key features of the pathways. Each tool mentioned today, PECARN, Stepwise and Rochester, all have high sensitivity and high-negative predictive values. Choosing the appropriate tool depends on the patient population, ability to run specific biomarker tests, and comfort level in the subsequent interpretation. For example, the availability of a facility to run a procalcitonin would determine whether a particular stratification tool could be used. The most recent study, conducted by PECARN or the Pediatric Emergency Care Applied Research Network, is a large, multicenter study that uses procalcitonin, absolute neutrophil count and urine analysis as the base of its pathway. The PECARN is structured as a decision tree, formatted in a way, to quote Dr. Carolan that "helps decision making in the trenches." Differentiating between the terms "serious" vs "invasive" infections. Serious infections include, but are not limited to bacterial, bone and joint infections, and UTIs. Invasive includes pneumococcal meningitis and HIB. In the simplest terms, invasive infections are of greater concern, and is "the stuff we want to treat immediately". Bacterial organisms of concern include: group B strep and gram negative organisms for neonates, pneumococcus and more rarely, HIV at 1-month and older. E.Coli, especially as a uro pathogen and Listeria, though rarer, makes the list of concern as well. An important viral organism of concern is Herpes Simplex Virus, which depending on the facility, is an add on order when running CSF. HSV has 3 main types, the most devistating a CNS infection, which presents with fever and seizures - whether focal or generalized. Pleocytosis, or WBC greater than 16 in CSF, is abnormal in those less than 28-days of age. WBC greater than 10 is abnormal for 2-3 months of age. An absence of pleocytosis does not exclude a central nervous infection by HSV. CHAPTER 3: At 2-months of age, infants that meet low-risk criteria, can be treated as an outpatient - if next day follow-up can be assured. Conservative treatment for those with a UTI that have an abnormal urine and positive biomarker, would get blood cultures, LP and antibiotics. The odds ratio is low, but gram negative CNS infections can be devastating and require extended treatment of antibiotics. The stratification tools, PECARN, Stepwise, and Rochester, help guide practice for these 2-month old infants or "tweeners", but it can still be difficult to decide whether or not to do an LP. There is still a place for practitioner gestalt, and if something feels not quite right, an LP is appropriate. Some infants are brought to the ER with reports of a fever, but upon presentation are afebrile. If a rectal temp performed at home, then it is regarded as a true fever, and the age appropriate work up should be started. Empiric treatment for infants include: Ampicillin and Cefotaxime. Cefotaxime is the go to for 3rd generation cephalosporin, instead of Rocephin, which can cause a rise in bilirubin in young infants. For those under 3-weeks, Acyclovir coverage is added till HSV is ruled out. Vancomycin would be used for those beyond 2-weeks of life with pneumococcus or staph infection with sepsis. Tamiflu is started for infants with positive influenza greater than 2-weeks and under 2-years of age, per CDC recommendations. For those infants who are not vaccinated, the plan of care does not change for those under 3-months or greater that are vaccinated. Intuitively, it would be suggested that they are at higher risk, but there is little data bout this specific group. Thanks for listening.

If you have thought about starting a career in the fitness industry but not known where to start then this podcast is a must-listen. I had the pleasure of speaking to Nicky Holland who is an award-winning personal trainer and also a tutor for Empiric middle east which is a fitness training provider who hosts certifications on different areas of fitness. Perhaps lockdown made you question your career path and you are looking for something rewarding with more flexible working hours, or maybe exercise is your passion and you want to share your personal experiences and transformation with other people. Whatever the reason you should give this podcast a listen to help you map out the journey and understand the right way to go about it. In a world suffering from obesity, heart disease, sedentary lifestyle and lack of knowledge around nutrition, the way I see it the more people we have preaching it the better. Let's just ensure the message is coming from a place of authenticity and education. If you are interested in learning more about the qualifications Nicky and empiric offer then be sure to check them out below @nicky_fitness@empiricmiddleeast If you would like to work with me personally n your health and fitness or join the movement wins community then you can find all the information on our website www.movement-wins.com @movementwins

Show notes at pharmacyjoe.com/episode522. In this episode, I ll discuss alternatives to ampicillin for empiric listeria coverage. The post 522: Alternatives to ampicillin for empiric listeria coverage appeared first on Pharmacy Joe.

On this week’s episode of Board Gaming with Education, Dustin sits down in person with Michael Cosimini, a pediatrician and teacher at Keck School of Medicine in Los Angeles, California. The two discuss Michael’s history with gaming as well as designing games and we get to learn about Michael’s antibiotic-based card game, Empiric. Michael tells how he transitioned the game from being used in his own classroom to being sold to other teachers around the world. The topic of reliable feedback comes up and Michael shares tips for beginner game designers on what to do to have the most success when starting their first game. Board Gaming with Education Updates- newsletter, YouTube - 1:48 Who is Michael Cosimini? - 2:44 Pizza and the Stock Market - 4:42 Games and Learning Monotonous Medical Material - 5:49 Empiric - 10:32 Game Design - 15:15 Playtesting and Feedback - 18:38 Last Words of Advice: Get Involved! - 24:09 Thumbs Up, Thumbs Down Rapid Fire Round - 26:40 Empiric Game: EmpiricGame.com Facebook: https://www.facebook.com/groups/609759219780965/ Twitter: @MichaelCosimini How can you support us? There are many free and paid ways to support the show. Be sure to check out our support page!  Support our podcast! Thank you to Purple Planet Music for the wonderful contribution of their song "Retro Gamer" for our Interview Segment. This song can be found in full on this music archive. Also, thank you to Kevin MacLeod (incompetech.com) for his creative commons 4.0 contribution of "Getting it Done" for our Thumbs Up, Thumbs Down Rapid Fire Round. Thank you to Dallas Welk, the editor of this episode! Always be sure to check out our show notes (website blog post) to read a recap of the episode topics and games mentioned in the episode. https://www.boardgamingwitheducation.com/michael-cosimini

Resa speaks with Medical Educators and Emergency Medicine Drs. Teresa Chan and Megan Stobart-Gallagher.  What are Serious Games?  How do those differ from using Game Mechanics in your medical education teaching?  The literature supports that adults like to play and games are effective.  They discuss Jane McGonigal, the power of games and highlight examples, such as Gridlocked, a game that could allow future doctors to learn systems approaches to patient management in a safe, low stakes environment., and Empiric, the antimicrobial card game designed for education for medical professionals. 

In this episode, we discuss how to create serious games for medical education with Dr. Michael Cosimini. Learn more about his card game, Empiric, which teaches about guideline based antibiotic selection in pediatrics. More information at @EmpiricGame or @ MichaelCosimini on Twitter or at EmpiricGame.com At Doctors Who Create, our podcasts are brought to you by Darlina Liu and Shiv Nadkarni. Music for this episode is credited to the band, Nightfloat. As always, please tweet us (@doctorscreate) with any questions, comments, or feedback!

Matthew DeLaney, MD  and Rick Pescatore, DO discuss the new IDSA updates regarding the diagnosis, disposition and treatment of patients with possible community acquired pneumonia. There is so much more to Urgent Care RAP each month? Click Here to hear more of what you need to be ready each day and we'll toss in 42 CME hours per year to boot. Pearls: When considering influenza, patients should be tested using NAAT rather than diagnosed clinically. Patients with test proven influenza and infiltrates on CXR should receive oseltamivir, regardless of duration of symptoms, in addition to appropriate antibiotics Patients should be risk stratified using a clinical decision tool, preferably PSI/PORT score,  to determine who is likely to benefit most from hospital admission. Procalcitonin is no longer recommended in the initial evaluation of patients with possible pneumonia.  At the end of 2019, the American Thoracic Society (ATS) and the Infectious Disease Society of America (IDSA) released the first update of the treatment guidelines for community acquired pneumonia (CAP) in >10 years.  IDSA now recommends more routine testing for influenza using nucleic acid amplification testing (NAAT) for influenza because of enhanced sensitivity of NAAT compared to older antigen based testing (>90% vs. ~50% sensitivity).  The IDSA now recommends that patients with test proven influenza and an infiltrate on CXR receive oseltamivir (regardless of duration of symptoms) in addition to appropriate antibiotics. 30% of deaths from influenza come from bacterial co-infection.  IDSA recommends risk stratifying patients with a Pneumonia Severity Index (PSI)/PORT score and recommends against relying heavily on a CURB-65 score to determine which patients will benefit from hospitalization.  Several questions on the PSI rely on lab testing which may not be available in UC, however, the parameters give guidance to factors associated with higher risk of adverse outcomes in patients with pneumonia. https://www.mdcalc.com/psi-port-score-pneumonia-severity-index-cap Clinical gestalt and assessment are also critical. Patients who appear ill and/or show signs of respiratory distress should be referred immediately to an ED. The guidelines also discuss major and minor criteria suggesting need for ICU admission including need for intubation, hypotension, tachypnea, and multilobar infiltrates. Multilobar pneumonia is a concerning finding and an independent predictor of poor outcome.  All patients with multilobar pneumonia should be referred to an ED for further evaluation. These guidelines suggest that, based on the low quality of evidence supporting utility, procalcitonin is no longer recommended in the diagnosis or treatment of CAP. There may be some limited utility in specific patients (mostly hospital inpatients) however, so this test is probably not going away, but having access to PCT testing from UC shouldn’t be a priority.    References: Metlay JP, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67. doi: 10.1164/rccm.201908-1581ST. PubMed PMID: 31573350 https://www.thennt.com/nnt/corticosteroids-treating-pneumonia/ Eliakim-Raz N, et al. Empiric antibiotic coverage of atypical pathogens for community-acquired pneumonia in hospitalized adults. Cochrane Database Syst Rev.  2012 Sep 12;(9):CD004418. doi: 10.1002/14651858.CD004418.pub4. Review.PubMed PMID: 22972070.

Join us with our guest: Maureen Spencer, RN, M.Ed., CIC joining us to discuss an array of important topics: 1. Overuse and inappropriate prescribing of antibiotics worldwide is leading to the global healthcare issue of antibiotic resistance. 2. Empiric antibiotics are used consistently in healthcare when infection is suspected 3. Empiric antibiotics are prescribed to cover gram positive, gram negative and yeast infections until the final lab result is available 4. Overuse of antibiotics adversely effect the normal flora and microbiome in the body depleting colonies of bacteria that are necessary for digestion and protection. 5. When the microbiome is depleted other resistant species overgrow on the skin and in the systems of the body, especially the gut. 6. Multiple Drug Resistant organisms MDRO include MRSA, VRE, ESBL and CRE that will grow in patients who have been on antibiotics AND MUCH MORE.

  Open Orphan signs agreement with Empiric Logic Open Orphan, a European-focussed, rare and orphan drug consulting services platform, is pleased to announce it has signed a new strategic collaboration agreement ("the Collaboration") with Empiric Logic to build on the earlier work performed by Open Orphan and complete the build out of Open Orphan's Health Data platform, Europe's first rare disease, advocacy-led genomic database. Empiric Logic, a leading managed software service company which provides software to the Life Sciences, Pharma, Pharma Services and Biotech sectors, will incorporate its propriety, privacy preserving, and artificial intelligence enabled software into Open Orphan's Health Data platform to aid the collection and management capabilities of the software. The Collaboration is the final stage in the completion of Open Orphan's Genomic Health Data platform and will speed up its launch. The platform builds on the genomic analysis, database architecture know-how and prior professional experience between the founders of Empiric Logic and Maurice Treacy, Chief Commercial Officer at Open Orphan. Cathal Friel, Chief Executive of Open Orphan commented: "This is an exciting step towards the completion of our genomic Health Data platform, and we are delighted to have Empiric on board to help us quickly and securely become one of the largest databases of rare disease patients in Europe." Gareth O'Sullivan, CEO at Empiric Logic commented: "Empiric Logic is delighted to be supporting the Open Orphan team with the final steps of preparing the Genomic Health Data platform to accept first data. As part of the rollout of the Open Orphan database, it will be making substantial use of our artificial intelligence capabilities, such as for identification of rare-disease genetic mutations, but also for the potential identification of patients for clinical trials going forward."  

Join us with our guest: Maureen Spencer, RN, M.Ed., CIC joining us to discuss an array of important topics: 1. Overuse and inappropriate prescribing of antibiotics worldwide is leading to the global healthcare issue of antibiotic resistance. 2. Empiric antibiotics are used consistently in healthcare when infection is suspected 3. Empiric antibiotics are prescribed to cover gram positive, gram negative and yeast infections until the final lab result is available 4. Overuse of antibiotics adversely effect the normal flora and microbiome in the body depleting colonies of bacteria that are necessary for digestion and protection. 5. When the microbiome is depleted other resistant species overgrow on the skin and in the systems of the body, especially the gut. 6. Multiple Drug Resistant organisms MDRO include MRSA, VRE, ESBL and CRE that will grow in patients who have been on antibiotics AND MUCH MORE.

On this week’s show, recorded live at the first WB-40 Meetup, Chris & Matt speak to Steve Brown from Empiric, our wonderful hosts, about the initiative to get female students into tech work experience, Next Tech Girls. If you are interested in a WB-40 T-Shirt, then Chris still has plenty to sell. Tweet us at […]

Hi everyone, Recently Graeme and I were asked to help run a workshop here in WA for the ANZCA Emergency Response CPD programme - thanks for your help Graeme and Paras. Some of the key concepts were understanding blood products and the strategies / philosophies which have been used when deciding what to give in a major haemorrhage. We decided that this would make a great podcast discussion and so voila - here it is! We discuss: - massive transfusion protocols utilising empiric ratios of blood products (often heavy in FFP / plasma) versus the more targeted approach often based on rapid assessment of haemostasis using viscoelastic tests such as ROTEM / TEG. - the four deficits in haemostasis which can develop; 1 fibrinolysis, 2 fibrinogen deficiency, 3 platelet deficiency, 4 thrombin deficiency. -a description of the types of blood products available their pros / cons. - why the use of large volumes of plasma probably doesn't make sense and may in fact involve some harm to patients. - an alternative strategy for empiric therapy when rapid tests of coagulation are not available empiric treatment with tranexamic acid and fibrinogen. Thanks for another great dicsussion Graeme! USEFUL LINKS https://www.obsgynaecritcare.org/rotem/ https://www.obsgynaecritcare.org/rotem-real-cases-discussed/ LINKS Study showing decreased massive transfusion rate in trauma after change to goal directed ROTEM therapy in Switzerland.Anaesthesia. 2017 Nov;72(11):1317-1326. doi: 10.1111/anae.13920. Epub 2017 May 23. Change of transfusion and treatment paradigm in major trauma patients.Before and after the introduction of ROTEM guided fibrinogen concentrate at Liverpool Womens Hospital and improved outcomes. Introduction of an algorithm for ROTEM-guided fibrinogen concentrate administration in major obstetric haemorrhage. Anaesthesia. 2015 Feb;70(2):166-75. doi: 10.1111/anae.12859. Epub 2014 Oct 7

This is Convo By Design and after five years doing the podcast, after 200 podcast episodes and 150 videos on YouTube, this might be a good opportunity to republish some previous episodes of the show. Moving forward, as the schedule permits, which means I am going to try and publish these every week, but things happen… anyhow, moving forward and schedule permitting, I am going to publish a #ThrowbackThursday episode featuring guests you haven't heard from in a while….This episode is dedicated to the Convo By Design Social Lounge and Stage from the WestEdge Design Fair. We have created a design space for the event going on 5 years now. I wanted this episode to spotlight our designer from 2016, Ryan White. Ryan was a blast to work with. He is smart, creative and very professional in his approach. This design space did not just happen. There was a great deal of planning that went into it. There were challenges to overcome, some were daunting. What you are about to hear is a three part story, I met Ryan two weeks before the event to discuss the last minute Planning, you will then hear the conversation with event partners, Courtney Genovese from The Rug Company, Anne Lockwood Crowningsheild from Empiric and Orli Ben-Dor from Hollywood At Home. And to wrap it up, we circled back with Ryan at the end, just before we broke the space down. This was an amazing process and I will tell you, a little sad and relief, combined at the end. This was originally episode number 94 from December 2016. Thank you for listening to this episode of Convo By Design, if you enjoy this episode, please leave us a positive rating, it helps others find the show. You can also engage with the show on Instagram, Facebook and twitter. Enjoy the show.#Design #Architecture #ConvoByDesign #Interiors #Hollywood #WarnerBros #RyanWhiteDesign #WestEdgeDesignFair #HoolywoodAtHome #RugCompany #EmpiricConvo By Design - http://www.ConvoByDesign.com Empiric Studio - https://www.empiricstudio.comRyan White Designs - http://www.ryanwhitedesigns.comThe Rug Company - https://www.therugcompany.com/us-en/Hollywood At Home - https://www.hollywoodathome.com/collections/decor-1Convo By Design Podcast - https://itunes.apple.com/us/podcast/convo-by-design/id937267494?mt=2Convo By Design YouTube Channel - https://www.youtube.com/channel/UCKLsQtysPpe_zFkIN4MoAfg

  Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta. This month, we’re talking about a topic that is ripe for review this time of year. We’re talking Influenza… Diagnosis and Management. Nachi: Very appropriate as the cold is settling in here in NYC and we’re already starting to see more cases of influenza. Remember that as you listen through the episode, the means we’re about to cover one of the CME questions for those of you listening at home with the print issue handy. Jeff: This month’s issue was authored by Dr. Al Giwa of the Icahn School of Medicine at Mount Sinai, Dr. Chinwe Ogedegbe of the Seton Hall School of Medicine, and Dr. Charles Murphy of Metrowest Medical Center. Nachi: And this issue was peer reviewed by Dr. Michael Abraham of the University of Maryland School of Medicine and by Dr. Dan Egan, Vice Chair of Education of the Department of Emergency Medicine at Columbia University. Jeff: The information contained in this article comes from articles found on pubmed, the cochrane database, center for disease control, and the world health organization. I’d say that’s a pretty reputable group of sources. Additionally, guidelines were reviewed from the american college of emergency physicians, infectious disease society of america, and the american academy of pediatrics. Nachi: Some brief history here to get us started -- did you know that in 1918/1919, during the influenza pandemic, about one third of the world’s population was infected with influenza? Jeff: That’s wild. How do they even know that? Nachi: Not sure, but also worth noting -- an estimated 50 million people died during that pandemic. Jeff: Clearly a deadly disease. Sadly, that wasn’t the last major outbreak… fifty years later the 1968 hong kong influenza pandemic, H3N2, took between 1 and 4 million lives. Nachi: And just last year we saw the 2017-2018 influenza epidemic with record-breaking ED visits. This was the deadliest season since 1976 with at least 80,000 deaths. Jeff: The reason for this is multifactorial. The combination of particularly mutagenic strains causing low vaccine effectiveness, along with decreased production of IV fluids and antiviral medication because of the hurricane, all played a role in last winter’s disastrous epidemic. Nachi: Overall we’re looking at a rise in influenza related deaths with over 30,000 deaths annually in the US attributed to influenza in recent years. The ED plays a key role in outbreaks, since containment relies on early and rapid identification and treatment. Jeff: In addition to the mortality you just cited, influenza also causes a tremendous strain on society. The CDC estimates that epidemics cost 10 billion dollars per year. They also estimate that an epidemic is responsible for 3 million hospitalized days and 31 million outpatient visits each year. Nachi: It is thought that up to 20% of the US population has been infected with influenza in the winter months, disproportionately hitting the young and elderly. Deaths from influenza have been increasing over the last 20 years, likely in part due to a growing elderly population. Jeff: And naturally, the deaths that we see from influenza also disproportionately affect the elderly, with up to 90% occurring in those 65 or older. Nachi: Though most of our listeners probably know the difference between an influenza epidemic and pandemic, let’s review it anyway. When the number of cases of influenza is higher than what would be expected in a region, an epidemic is declared. When the occurrence of disease is on a worldwide spectrum, the term pandemic is used. Jeff: I think that’s enough epidemiology for now. Let’s get started with the basics of the influenza virus. Influenza is spread primarily through direct person-to-person contact via expelled respiratory secretions. It is most active in the winter months, but can be seen year-round. Nachi: The influenza virus is a spherical RNA-based virus of the orthomyxoviridae family. The RNA core is associated with a nucleoprotein antigen. Variations of this antigen have led to the the 3 primary subgroups -- influenza A, B, and C, with influenza A being the most common. Jeff: Influenza B is less frequent, but is more frequently associated with epidemics. And Influenza C is the form least likely to infect humans -- it is also milder than both influenza A or B. Nachi: But back to Influenza A - it can be further classified based on its transmembrane or surface proteins, hemagglutinin and neuraminidase - or H and N for short. There are actually 16 different H subtypes and 9 different N subtypes, but only H1, H2, H3, and N1 and N2 have caused epidemic disease. Jeff: Two terms worth learning here are antigen drift and anitgen shift. Antigen drift refers to small point mutations to the viral genes that code for H and N. Antigen shift is a much more radical change, with reassortment of viral genes. When cells are infected by 2 or more strains, a new strain can emerge after genetic reassortment. Nachi: With antigen shift, some immunity may be maintained within a population infected by a similar subtype previously. With antigen drift, there is loss of immunity from prior infection. Jeff: The appearance of new strains of influenza typically involves an animal host, like pigs, horses, or birds. This is why you might be hear a strain called “swine flu”, “equine flu”, or “avian flu”. Close proximity with these animals facilitates co-infection and genetic reassortment. Nachi: I think that’s enough basic biology for now, let’s move on to pathophysiology. When inhaled, the influenza virus initially infects the epithelium of the upper respiratory tract and alveolar cells of the lower respiratory tract. Viral replication occurs within 4 to 6 hours. Incubation is 18 to 72 hours. Viral shedding is usually complete roughly 7 days after infection, but can be longer in children and immunocompromised patients. Jeff: As part of the infectious process and response, there can be significant changes to the respiratory tract with inflammation and epithelial cell necrosis. This can lead to viral pneumonia, and occasionally secondary bacterial pneumonia. Nachi: The secondary bacterial pathogens that are most common include Staph aureus, Strep pneumoniae, and H influenzae. Jeff: Despite anything you may read on the internet, vaccines work and luckily influenza happens to be a pathogen which we can vaccinate against. As such, there are 3 methods approved by the FDA for producing influenza vaccines -- egg-based, cell-based, or recombinant influenza vaccine. Once the season’s most likely strains have been determined, the virus is introduced into the medium and allowed to replicate. The antigen is then purified and used to make an injection or nasal spray. Nachi: It isn’t easy to create vaccines for all strains. H3N2, for example, is particularly virulent, volatile, and mutagenic, which leads to poor prophylaxis against this particular subgroup. Jeff: In fact, a meta-analysis on vaccine effectiveness from 2004-2015 found that the pooled effectiveness against influenza B was 54%, against the H1N1 pandemic in 2009 was 61%, and against the H3N2 virus was 33%. Not surprisingly, H3N2 dominant seasons are currently associated with the highest rates of influenza cases, hospitalizations, and death. Nachi: Those are overall some low percentages. So should we still be getting vaccinated? The answer is certainly a resounding YES.. Despite poor protection from certain strains, vaccine effectiveness is still around 50% and prevents severe morbidity and mortality in those patients. Jeff: That’s right. The 2017-2018 vaccine was only 40% effective, but this still translates to 40% less severe cases and a subsequent decrease in hospitalizations and death. Nachi: But before we get into actual hospitalization, treatment, and preventing death, let’s talk about the differential. We’re not just focusing on influenza here, but any influenza like illness, since they can be hard to distinguish. The CDC defines “influenza-like illness” as a temperature > 100 F, plus cough or sore throat, in the absence of a known cause other than influenza. Jeff: Therefore, influenza should really be considered on the differential of any patient who presents to the ED with a fever and URI symptoms. The differential when considering influenza might also include mycoplasma pneumoniae, strep pneumoniae, adenovirus, RSV, rhinovirus, parainfluenza virus, legionella, and community acquired MRSA. Nachi: With the differential in mind, let’s move on to prehospital care. For the prehospital setting, there isn’t much surprising here. Stabilize and manage the respiratory status with all of your standard tools - oxygen for those with mild hypoxia and advanced airway maneuvers for those with respiratory distess. Jeff: Of note, EMS providers should use face masks themselves and place them on patients as well. As community paramedicine and mobile integrated health becomes more common, this is one potential area where EMS can potentially keep patients at home or help them seek treatment in alternate destinations to avoid subjecting crowded ED’s to the highly contagious influenza virus. Nachi: It’s also worth noting, that most communities have strategic plans in the event of a major influenza outbreak. Local, state, and federal protocols have been designed for effective care delivery. Jeff: Alright, so now that the EMS crew, wearing proper PPE of course, has delivered the patient, who is also wearing a mask, to the ED, we can begin our ED H&P. Don’t forget that patients present with a range of symptoms that vary by age. A typical history is 2-5 days of fever, nasal congestion, sore throat, and myalgias. You might see tachycardia, cough, dyspnea, and chills too. Nachi: Van Wormer et al conducted a prospective analysis of subjective symptoms to determine correlation with lab confirmed influenza. They found the most common symptoms were cough in 92%, fatigue in 91%, and nasal congestion in 84%, whereas sneezing was actually a negative predictor for influenza. Jeff: Sneezing, really? Can’t wait to get the Press-Gany results from the sneezing patient I discharge without testing for influenza based on their aggressive sneezes! Nachi: Aggressive sneezes…? I can’t wait to see your scale for that. Jeff: Hopefully I’ll have it in next month’s annals. In all seriousness, I’m not doing away with flu swabs just yet. In another retrospective study, Monto et al found that the best multivariate predictors were cough and fever with a positive predictive value of 79%. Nachi: Yet another study in children found that the predominant symptoms were fever in 95%, cough in 77%, and rhinitis in 78%. This study also suggested that the range of fever was higher in children and that GI symptoms like vomiting and diarrhea were more common in children than adults. Jeff: Aside from symptomatology, there are quite a few diagnostic tests to consider including viral culture, immunofluoresence, rt-pcr, and rapid antigen testing. The reliability of testing varies greatly depending on the type of test, quality of the sample, and the lab. During a true epidemic, formal testing might not be indicated as the decision to treat is based on treatment criteria like age, comorbidities, and severity of illness. Nachi: We’ll get to treatment in a few minutes, but diving a bit deeper into testing - there are 3 major categories of tests. The first detects influenza A only. The second detects either A or B, but cannot distinguish between them; and the third detects both influenza A and B and is subtype specific. The majority of rapid testing kits will distinguish between influenza A and B, but not all can distinguish between them. Fluorescent antibody testing by DFA is relatively rapid and yields results within 2 to 4 hours. Jeff: Viral culture and RT-PCR remain the gold standard, but both require more time and money, as well as a specialized lab. As a result, rapid testing modalities are recommended. Multiple studies have shown significant benefit to the usefulness of positive results on rapid testing. It’s safe to say that at a minimum, rapid testing helps decrease delays in treatment and management. Nachi: Looking a bit further into the testing characteristics, don’t forget that the positive predictive value of testing is affected by the prevalence of influenza. In periods of low influenza activity (as in the summer), a rapid test will have low PPV and high NPV. The test is more likely to yield false positive results -- up to 50% according to one study when prevalence is below 5%. Jeff: And conversely, in periods of high influenza activity, a rapid test will have higher PPV and lower NPV, and it is more likely to produce a false negative result. Nachi: In one prospective study of patients who presented with influenza-like illness during peak season, rapid testing was found to be no better than clinical judgement. During these times, it’s probably better to reserve testing for extremely ill patients in whom diagnostic closure is particularly important. And since the quality of the specimen remains important, empiric treatment of critically ill patients should still be considered. Jeff: Which is a perfect segway into our next topic - treatment, which is certainly the most interesting section of this article. To start off -- for mild to moderate disease and no underlying high risk conditions, supportive therapy is usually sufficient. Nachi: Antiviral therapy is reserved for those with a predicted severe disease course or with high risk conditions like long-standing pulmonary disease, pregnancy, immunocompromise, or even just being elderly. Jeff: Note to self, avoid being elderly. Nachi: Good luck with that. Anyway, early treatment with antivirals has been shown to reduce influenza-related complications in both children and adults. Jeff: Once you’ve decided to treat the patient, there are two primary classes of antivirals -- adamantane derivatives and neuraminidase inhibitors. Oh and then there is a new single dose oral antiviral that was just approved by the FDA… baloxavir marboxil (or xofluza), which is in a class of its own -- a polymerase endonuclease inhibitor. Nachi: The oldest class, the adamantane derivatives, includes amantadine and rimantadine. Then the newer class of neuraminidase inhibitors includes oseltamavir (which is taken by mouth), zanamavir (which is inhaled), and peramivir (which is administered by IV). Jeff: Oseltamavir is currently approved for patients of all ages. A 2015 meta analysis showed that the intention-to-treat infected population had a shorter time to alleviation of all symptoms from 123 hours to 98 hours. That’s over a day less of symptoms, not bad! There were also fewer lower respiratory tract complications requiring antibiotics and fewer admissions for any cause. Really, not bad! Nachi: Zanamavir is approved for patients 7 and older -- or for children 5 or older for disease prevention. Zanamavir has been associated with possible bronchospasm and is contraindicated in patients with reactive airway disease. Jeff: Peramivir, the newest drug in this class, is given as a single IV dose for patients with uncomplicated influenza who have been sick for 2 days or less. Peramavir is approved for patients 2 or older. This is a particularly great choice for a vomiting patient. Nachi: And as you mentioned before, just last month, the FDA approved baloxavir, a single dose antiviral. It’s effective for influenza type A or B. Note that safety and efficacy have not been established for patients less than 12 years old, weighing less than 40 kg, or pregnant or lactating patients. Jeff: Unfortunately, there has been some pretty notable antiviral resistance in the recent past, moreso with the adamantane class, but recently also with the neuraminidase inhibitors. In 2007-2008, an oseltamivir-resistant H1N1 strain emerged globally. Luckily, cross-resistance between baloxavir and the adamantanes or neuraminidase inhibitors isn’t expected, as they target different viral proteins, so this may be an answer this year, and in the future. Nachi: Let’s talk chemoprophylaxis for influenza.. Chemoprophylaxis with oseltamavir or zanamavir can be considered for patients who are at high risk for complications and were exposed to influenza in the first 2 weeks following vaccination, patients who are at high risk for complications and cannot receive the vaccination, and those who are immunocompromised. Jeff: Chemoprophylaxis is also recommended for pregnant women. For postexposure prophylaxis for pregnant women, the current recommendation is to administer oseltamivir. Nachi: We should also discuss the efficacy of treatment with antivirals. This has been a hotly debated topic, especially with regards to cost versus benefit… In a meta-analysis, using time to alleviation of symptoms as the primary endpoint, oseltamavir resulted in an efficacy of 73% (with a wide 95% CI from 33% to 89%). And this was with dose of 150mg/day in a symptomatic influenza patient. Jeff: Similarly zanamavir given at 10mg/day was 62% effective, but again with a wide 95% CI from 15% to 83%. And, of note, other studies have looked into peramivir, but have found no significant benefits other than the route of delivery. Nachi: In another 2014 study by Muthuri et al., neuraminidase inhibitors were associated with a reduction in mortality -- adjusted OR = 0.81 (with a 95% CI 0.70 to 0.93). Also when comparing late treatment with early treatment (that is, within 2 days of symptom onset), there was a reduction in mortality risk with adjusted OR 0.48 (95%CI 0.41-0.56). These associations with reduction in mortality risk were less pronounced and less significant in children. Jeff: Mortality benefit, not bad! They further found an increase in mortality hazard ratio with each day’s delay in initiation of treatment up to 5 days, when compared to treatment initiated within 2 days. Nachi: But back to the children for a second -- another review of neuraminidase inhibitors in children < 12 years old found duration of clinical symptoms was reduced by 36 hours among previously healthy children taking oseltamivir and 30 hours by children taking zanamivir. Jeff: I think that’s worth summarizing - According to this month’s author’s review of the best current evidence, use of neuraminidase inhibitors is recommended, especially if started within 2 days, for elderly patients and those with comorbidities. Nachi: Seems like there is decent data to support that conclusion. But let’s not forget that these medications all have side effects. Jeff: These drugs actually tend to be well tolerated.The most frequently noted side effect of oseltamavir is nausea and vomiting, while zanamavir is associated with diarrhea. Nachi: Amazing. Let’s talk disposition for your influenza patient. Jeff: Disposition will depend on many clinical factors, like age, respiratory status, oxygen saturation, comorbid conditions, and reliability of follow up care. Admission might be needed not only to manage the viral infection, but also expected complications. Nachi: If you’re discharging a patient, be sure to engage in shared decision making regarding risks and benefits of available treatments. Ensure outpatient follow up and discuss return to er precautions. Jeff: Also, the CDC recommends that these patients stay home for at least 24 hours after their fever has broken. Nachi: With that -- Let’s summarize the key points and clinical pearls from this month’s issue J: Even though influenza vaccine effectiveness is typically only 50%, this still translates to a decrease in influenza-related morbidity and mortality. 2. The CDC defines influenza-like illness as a temperature > 100 F with either cough or sore throat, in the absence of a known cause other than influenza. 3. When influenza is suspected in the prehospital setting, patients and providers should wear face masks to avoid spreading the virus. 4. In the emergency department, standard isolation and droplet precautions should be maintained for suspected or confirmed infections. 5. The most common symptoms of influenza in adults are cough, fatigue, nasal congestion, and fever. Sneezing is a negative predictor in adults. 6. In children, the most common presenting symptoms are fever, cough, and rhinitis. Vomiting and diarrhea is also more common in children than adults. 7. Rapid testing and identification results in decreased delays in treatment and management decisions. 8. During peak flu season, clinical judgement may be as good as rapid testing, making rapid testing less necessary. J: Rapid testing may be more beneficial in times of lower disease prevalence. 10. Empiric treatment of critically ill patients should be considered even if rapid testing is negative. J: For mild to moderate disease and no underlying high-risk conditions, supportive therapy is usually sufficient. 12.For more ill patients or those at substantial risk for complications, consider antiviral treatment. 13.Oseltamivir is approved for patients of all ages, and reduces the length of symptoms by one day. 14.When treating influenza, peramivir is an ideal agent for the vomiting patient. 15.Baloxavir is a new single-dose antiviral agent approved by the FDA in October 2018. It works in a novel way and is effective for treatment of influenza A and B. 16.Chemoprophylaxis with oseltamivir or zanamivir should be considered in patients who are immunocompromised or patients who are at elevated risk for complications and cannot receive the vaccination. 17.Consider oseltamivir as post exposure prophylaxis in pregnant women. 18.Neuraminidase inhibitors are associated with decreased duration of symptoms and complications, especially if started within 2 days of symptom onset. J: So that wraps up episode 23 - Influenza: Diagnosis and Management in the Emergency Department. N: Additional materials are available on our website for Emergency Medicine Practice subscribers. For our subscribers: be sure to go online to get your CME credit for this issue, which includes 3 pharmacology CME credits. J: Also, for our NP and PA listeners, we have a special offer this month: You can get a full year of access to Emergency Medicine Practice for just $199--including lots of pharmacology, stroke, and trauma CME--and so much more! To get this special deal, go to www.ebmedicine.net/APP. Again, that’s www.ebmedicine.net/APP. N: If you’re not a subscriber, consider joining today. You can find out more at www.ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credits. You’ll also get enhanced access to the podcast, including the images and tables mentioned. You can find everything you need to know at ebmedicine.net/subscribe. J: And the address for this month’s credit is ebmedicine.net/E1218. As always, the you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at emplify@ebmedicine.net with any comments or suggestions. Talk to you next month!    

Are spiritual intuitions and rational thought antithetical or complimentary? Topics include: - Interviews with leading physicists on the existence of God - Questions and answers on the nature of devotional life Class notes available at www.gitawisdom.org/podcast Questions? Join the Gita Wisdom Discussion Group on Facebook We are reading from Bhagavad Gita As It Is by A.C. Bhaktivedanta Swami Prabhupada

Are spiritual intuitions and rational thought antithetical or complimentary? Topics include: - Interviews with leading physicists on the existence of God - Questions and answers on the nature of devotional life Class notes available at www.gitawisdom.org/podcast Questions? Join the Gita Wisdom Discussion Group on Facebook We are reading from Bhagavad Gita As It Is by A.C. Bhaktivedanta Swami Prabhupada

Welcome to our weekly conversation show, discussing all the various entertainment that keeps us geeks from truly living our lives. Visit JD and the crew at www.poptardsgo.com The post CultPOP! 481 – Gutter Talk – Secret Empiric Nothings! appeared first on CultPOP!.

The BatTribble and Johnny Destructo grouse over Marvel's Secret Empire, bridges too far, Optimus Prime's wings and much more! --- Send in a voice message: https://anchor.fm/black-tribbles/message

Michael S. Weinstein, MD, FACS, FCCM, speaks with Zachariah Thomas, PharmD, about the article, A Multicenter Evaluation of Prolonged Empiric Antibiotic Therapy in Adult ICUs in the United States, published in Critical Care Medicine.

Michael S. Weinstein, MD, FACS, FCCM, speaks with Zachariah Thomas, PharmD, about the article, A Multicenter Evaluation of Prolonged Empiric Antibiotic Therapy in Adult ICUs in the United States, published in Critical Care Medicine.

Aired April 23: Empiric antibiotic choices for community acquired pnuemonia and clindamycin versus trimethoprim-sulfamethoxazole for skin and soft tissue infections. Fahad and Amol want you to understand the following: 1. A large, high quality RCT showed that there was no significant difference between an empiric treatment strategy of beta-lactam vs beta-lactam plus macrolide vs respiratory fluoroquinolone for ...The post Summer Replay: Community Acquired Pneumonia and Skin Infections appeared first on Healthy Debate.

This week: Empiric antibiotic choices for community acquired pnuemonia and clindamycin versus trimethoprim-sulfamethoxazole for skin and soft tissue infections. Fahad and Amol want you to understand the following: 1. A large, high quality RCT showed that there was no significant difference between an empiric treatment strategy of beta-lactam vs beta-lactam plus macrolide vs respiratory fluoroquinolone for the ...The post The Antibiotics Jam: Community Acquired Pneumonia and Skin Infections appeared first on Healthy Debate.