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Contributor: Aaron Lessen, MD Educational Pearls: The cause of Alzheimer's disease is multifactorial, but the most widely suspected mechanism is the amyloid cascade hypothesis: Beta-amyloid proteins accumulate in the central nervous system, forming plaques that impair neuronal function. In recent years, advances have led to the development of targeted therapies with monoclonal antibodies. These drugs: Work by degrading amyloid plaques Slow the rate of cognitive decline and disease progression Have major side effects, most notably the development of amyloid-related imaging abnormalities (ARIA) ARIA may present as edema, effusion, or microhemorrhages, which are only detectable on MRI Symptoms can include headache, vertigo, or focal neurologic deficits that mimic stroke For patients presenting to the emergency department with stroke-like symptoms, it is important to consider whether they have a history of Alzheimer's disease and whether they are taking these medications. This guides decisions about imaging and treatment: The work-up may require MRI, which can delay thrombolytic or endovascular therapy in patients with true strokeConversely, treating a patient with ARIA using thrombolytics increases the risk of bleeding and other complications References Ebell MH, Barry HC, Baduni K, Grasso G. Clinically Important Benefits and Harms of Monoclonal Antibodies Targeting Amyloid for the Treatment of Alzheimer Disease: A Systematic Review and Meta-Analysis. Ann Fam Med. 2024 Jan-Feb;22(1):50-62. doi: 10.1370/afm.3050. PMID: 38253509; PMCID: PMC11233076. Ma C, Hong F, Yang S. Amyloidosis in Alzheimer's Disease: Pathogeny, Etiology, and Related Therapeutic Directions. Molecules. 2022 Feb 11;27(4):1210. doi: 10.3390/molecules27041210. PMID: 35209007; PMCID: PMC8876037. Perneczky R, Dom G, Chan A, Falkai P, Bassetti C. Anti-amyloid antibody treatments for Alzheimer's disease. Eur J Neurol. 2024 Feb;31(2):e16049. doi: 10.1111/ene.16049. Epub 2023 Sep 11. PMID: 37697714; PMCID: PMC11235913. Summarized by Ashley Lyons, OMS3 | Edited by Ashley Lyons and Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/

What happens when a febrile infant presents at 61 days old? Are they suddenly low risk for invasive bacterial infections? In this episode, we explore the gray zone of managing febrile infants aged 61–90 days with the help of two new clinical prediction rules from PECARN. Joining us are two powerhouses in pediatric emergency medicine: Dr. Nate Kuppermann and Dr. Paul Aronson, who walk us through their recent study published in Pediatrics. We discuss why prior research has traditionally stopped at 60 days, what the new data shows about risk in this slightly older age group, and how these rules might help guide clinical decision-making. This study fills a long-standing gap—but should we start using the rules now? Tune in for a nuanced discussion on sensitivity, missed cases, practical application, and the future of risk stratification in young infants with fever. What is your practice in terms of work-up of 2-3 month old febrile infants? Will this change what you do? Hit us up social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Dr. Nate Kuppermann, Executive Vice President and Chief Academic Officer; Director, Children's National Research Institute; Department Chair, Pediatrics, George Washington University School of Medicine and Health Sciences Dr. Paul Aronson, Professor of Pediatrics (Emergency Medicine); Deputy Director, Pediatric Residency Program at Yale University School of Medicine Resources: “Hot” Off the Press: Infant Fever Rule Do I really need to LP a febrile infant with a UTI? Aronson PL, Mahajan P, Meeks HD, Nielsen B, Olsen CS, Casper TC, Grundmeier RW, Kuppermann N; PECARN Registry Working Group. Prediction Rule to Identify Febrile Infants 61-90 Days at Low Risk for Invasive Bacterial Infections. Pediatrics. 2025 Sep 1;156(3):e2025071666. doi: 10.1542/peds.2025-071666. PMID: 40854562; PMCID: PMC12432541. Kuppermann N, Dayan PS, Levine DA, Vitale M, Tzimenatos L, Tunik MG, Saunders M, Ruddy RM, Roosevelt G, Rogers AJ, Powell EC, Nigrovic LE, Muenzer J, Linakis JG, Grisanti K, Jaffe DM, Hoyle JD Jr, Greenberg R, Gattu R, Cruz AT, Crain EF, Cohen DM, Brayer A, Borgialli D, Bonsu B, Browne L, Blumberg S, Bennett JE, Atabaki SM, Anders J, Alpern ER, Miller B, Casper TC, Dean JM, Ramilo O, Mahajan P; Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN). A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatr. 2019 Apr 1;173(4):342-351. doi: 10.1001/jamapediatrics.2018.5501. PMID: 30776077; PMCID: PMC6450281. Pantell RH, Roberts KB, Adams WG, Dreyer BP, Kuppermann N, O'Leary ST, Okechukwu K, Woods CR Jr; SUBCOMMITTEE ON FEBRILE INFANTS. Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics. 2021 Aug;148(2):e2021052228. doi: 10.1542/peds.2021-052228. Epub 2021 Jul 19. Erratum in: Pediatrics. 2021 Nov;148(5):e2021054063. doi: 10.1542/peds.2021-054063. PMID: 34281996. **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

The only structure of fetal gastrointestinal tract (GIT) which is seen on routine second trimester anomaly scan is the fetal stomach. Under normal conditions, the fetal stomach "bubble" is seen on the left side of the fetal abdomen. This is a normal finding on an ultrasound and indicates the stomach's normal position. There are two functions of the fetal GIT: 1. Propulsive action by peristalsis which takes the swallowed amniotic fluid up to the small bowel; 2. Absorption – the amniotic fluid is absorbed through the fetal small bowel. When the stomach is found prenatally to be located on the right side, it is called dextrogastria. Today in our high-risk prenatal clinic, we encountered a patient whose fetus was found to have this rare condition dextrogastria. Is this an isolated issue? What does this mean for clinical outcomes. Listen in for details.1. Versteegh HP, Adams SD, Boxall S, Burge DM, Stanton MP. Antenatally diagnosed right-sided stomach (dextrogastria): A rare rotational anomaly. J Pediatr Surg. 2016 Feb;51(2):236-9. doi: 10.1016/j.jpedsurg.2015.10.060. Epub 2015 Nov 4. PMID: 26655213.2. A Case Report Of An Isolated Dextrogastria Diagnosed In First Trimester Ultrasound Screening: https://hjog.org/?p=35403. Docx MKF, Steylemans A, Govaert PIsolated dextrogastria in a newbornArchives of Disease in Childhood - Fetal and Neonatal Edition 2015;100:F513.4. https://www.researchgate.net/publication/43349867_Isolated_dextrogastria_A_case_report5. Aziz, S., König, S., Noor, H. et al. Isolated dextrogastria with eventration of right hemidiaphragm and hiatal hernia in an adult male. BMC Gastroenterol 22, 56 (2022). https://doi.org/10.1186/s12876-022-02127-x

All about gymnastics! We interview Dr. Elspeth Hart from Boston Children's on her latest article on Gymnastics Medicine and what to look out for when treating gymnasts in the orthopedic setting. We also highlight recent articles on the urgency of stable SCFE, a lesser-known method for pinning supracondylar humerus fractures, and short versus long leg casting for distal tibia physeal fractures. Your hosts are Tyler McDonald (University of South Alabama), and Stephanie Logterman (Arnold Palmer Hospital for Children), Josh Holt (University of Iowa), and Carter Clement (Manning Family Children's in New Orleans). Music by A. A. Aalto. Gymnastics Upper Extremity Article mentioned: Hart E, Bauer AS, Bae DS. Common upper extremity gymnastics injuries and gymnastic specific return to play protocols. J Pediatr Soc North Am. 2024 Feb 28;6:100016. doi: 10.1016/j.jposna.2024.100016. PMID: 40433250; PMCID: PMC12088353. Link to the non profit Gymnastics Medicine: Education and Research: GymnasticsMedicine.org Link to learn more about the 7th annual Gymnastics Medicine Symposium (use code "Gym15" to save 15% if interested in signing up!): Symposium 2025 - Gymnastics Medicine   References: 1. Hart E, Bair K, Broz J, Griffith K, Herrera-Set A, Lattimore D, Melvin E, Sweeney E. Gymnastics Medicine: A New Subspecialty in Sports Medicine. Curr Sports Med Rep. 2025 May 1;24(5):126-134. doi: 10.1249/JSR.0000000000001249. PMID: 40323057. 2. White AB, Keil LG, Bardsley H, Selberg C, Mansour A, Brooks AC, Manickam R, Mayassi HA, Zhao L, Uchtman M, Whitlock P, Stone J. How Urgent Are Stable SCFEs? A Multisite Retrospective Study of Surgical Timing and Complications Among Patients With Stable Slipped Capital Femoral Epiphysis. J Pediatr Orthop. 2025 Sep 1;45(8):485-491. doi: 10.1097/BPO.0000000000002997. Epub 2025 May 1. PMID: 40314216. 3. Grewal RS, Kitchen BT, Bomar JD, Cidambi EO, Dexter MJ, Edmonds EW, Pring ME, Upasani VV, Wallace CD, Pennock A. Displaced Distal Tibia Physeal Fractures: Short Leg Versus Long Leg Casting-A Prospective Study. J Pediatr Orthop. 2025 Aug 1;45(7):e614-e617. doi: 10.1097/BPO.0000000000002961. Epub 2025 Apr 7. PMID: 40191914. 4. Muto S, Niwa S, Fujihara Y, Ota H, Kumagai H. Comparative Analysis of Postoperative Rotational Malalignment in Pediatric Supracondylar Humerus Fractures: Cross Pinning Versus Lateral Para-olecranon Pinning. J Pediatr Orthop. 2025 Sep 1;45(8):458-465. doi: 10.1097/BPO.0000000000003000. Epub 2025 May 5. PMID: 40323798.

Suite à une conférence débat menée en janvier 2018 sur l'initiation de la dialyse, le choix de la modalité et la prescription, il a été recommandé le recours à la prise de décision partagée entre le patient et l'équipe de soins pour établir des objectifs de traitement permettant au patient d'atteindre ses propres objectifs de vie et au clinicien de prescrire une dialyse personnalisée de haute qualité1. Mais concrètement, qu'est-ce que la décision médicale partagée (DMP) ? Quels sont les avantages de la DMP et quels sont les moyens possibles pour la développer ?  Le Dr Pierre Housset, néphrologue au Centre Hospitalier Sud Francilien, répond à vos questions.   Invité : Dr Pierre Housset, néphrologue au Centre Hospitalier Sud Francilien Le Dr Housset déclare ne pas avoir de lien d'intérêt en rapport avec le sujet traité.   L'équipe :
 Animation :  Pyramidale Communication Production : Pyramidale Communication   Crédits : Pyramidale Communication, Sonacom   Ce podcast est uniquement destiné à des fins d'information. Si vous souhaitez contacter Baxter pour de plus amples informations ou pour signaler un événement indésirable, veuillez consulter notre site web à l'adresse suivante : https://www.baxter.fr/fr/contact-us   Références : 1. Chan CT et al. Dialysis initiation modality choice, access, and prescription: conclusions from Kidney Disease: Improving Goal Outcomes (KDIGO) Controversies Conference. Kidney International 2019 2. HAS, Patient et professionnels de santé : décider ensemble. 2013 3. Prieto-Velasco M, Quiros P, Remon C, Spanish Group for the Implementation of a Shared Decision Making Process for RRT Choice with Patient Decision Aid Tools (2015) The Concordance between Patients' Renal Replacement Therapy Choice and Definitive Modality: Is It a Utopia?. PLOS ONE 10(10): e0138811. 4. Ramer SJ, McCall NN, Robinson-Cohen C, Siew ED, Salat H, Bian A, Stewart TG, El-Sourady MH, Karlekar M, Lipworth L, Ikizler TA, Abdel-Kader K. Health Outcome Priorities of Older Adults with Advanced CKD and Concordance with Their Nephrology Providers' Perceptions. J Am Soc Nephrol. 2018 Dec;29(12):2870-2878. doi: 10.1681/ASN.2018060657. Epub 2018 Nov 1. PMID: 30385652; PMCID: PMC6287864. 5. Mendelssohn DC, et al. A prospective evaluation of renal replacement therapy modality eligibility. Nephrol Dial Transplant. 2009;24(2):555-561. 6. Oliver MJ, et al. Impact of contraindications, barriers to self-care and support on incident peritoneal dialysis utilization. Nephrol Dial Transplant. 2010; 25(8): 2737-2744. 7. de Jong RW, Stel VS, Rahmel A, Murphy M, Vanholder RC, Massy ZA, Jager KJ. Patient-reported factors influencing the choice of their kidney replacement treatment modality. Nephrol Dial Transplant. 2022 Feb 25;37(3):477-488. doi: 10.1093/ndt/gfab059. PMID: 33677544; PMCID: PMC8875472.

En este episodio exploramos el fascinante y oscuro mundo de las asesinas seriales a través del libro “Damas Asesinas” de Tori Telfer. Analizamos historias reales de mujeres que dejaron una huella criminal en la historia, así como los contextos sociales y psicológicos que rodearon sus actos.Acompáñanos en esta charla llena de curiosidad literaria y un toque de suspenso.Recursos mencionados en este episodio:

Did you know that C-Section birth is referenced in Shakespeare's Macbeth? Cesarean Section is the most common laparotomy in the world, and yest we are still learning surprising facts about it. This episode we will summarize 2publications which have recently been released. One is from the American Journal of Perinatology (September 2025 ) and the other is from the AJOG (August 2025 ). Does a primary C-section on a laboring uterus have a different risk of PAS in the subsequent pregnancy compared to a non-labored uterus? And what is the percentage of patients who experience “pain” at time of C-section? Listen in for the surprising data.1. Kashani Ligumsky L, Lopian M, Jeong A, Desmond A, Elmalech A, Many A, Martinez G, Krakow D, Afshar Y. Impact of Labor in Primary Cesarean Delivery on Subsequent Risk of Placenta Accreta. Am J Perinatol. 2025 Sep 16. doi: 10.1055/a-2693-8599. Epub ahead of print. PMID: 40957594.2. Somerstein, Rachel. I feel pain, not pressure: a personal and methodological reflection on pain during cesarean delivery. American Journal of Obstetrics & Gynecology, Volume 0, Issue 0 (EPub Ahead of Print)

Most doctors dream about leaving the ER grind, but here's what's remarkable: Dr. Nico Grundmann didn't just escape - he built something that's actually changing how we think about mental healthcare at scale.In this conversation, Sam sits down with Dr. Grundmann, an emergency physician who took his systems-thinking background and created something unprecedented: a five-location ketamine practice that's generating the kind of data insurance companies actually pay attention to. We're talking about going from solo practitioner to managing 30 team members while maintaining the clinical rigor that makes this work sustainable.What makes this conversation essential listening? Dr. Grundmann's approach shows exactly how individual practices can drive policy-level change - but it requires thinking beyond your patient panel to the broader healthcare system. His story proves that with the right framework, you can build something that's both profitable and positioned to influence national coverage decisions.If you've ever wondered how to scale beyond a single clinic without losing clinical quality, or if you're curious about what it really takes to collect data that insurance companies respect, this conversation will give you the roadmap you need.What You'll Learn in This Episode

La versión ePub de mi nuevo libro de microrrelatos ya está disponible para reservar (en preventa) en las tiendas digitales:- Amazon: https://amzn.eu/d/7T7wfYw- Apple Books: https://books.apple.com/us/book/taletober-ii/id6752802456?l=es&ls=1- Google Play Books: https://play.google.com/store/books/details?id=f0mIEQAAQBAJ- Kobo (aún no disponible, pero creo que estará en este enlace: https://www.kobo.com/search?Query=1230009380103El próximo día 30 de septiembre podrás comprar la versión en papel (tapa blanda) y, quienes lo hayan comprado en digital durante la preventa, lo recibirán en su dispositivo electrónico.Ahora la publicación en Apple Books se realiza a través de este enlace: https://authors.apple.com/ Dime qué te ha parecido este capitulo y deja un comentario en ivoox o Spotify.Si lo prefieres, envíame un correo electrónico a la dirección de gmail almadailypodcast. En redes soy @almajefi y me encuentras en X / Twitter, Bluesky, Threads, Instagram y Telegram.Y ahora también puedes seguirme en substack: https://substack.com/@almajefi

Contributor: Aaron Lessen, MD Educational Pearls: What is a Nursemaid's Elbow? A condition in which an elbow gets partially pulled out of place (a radial head subluxation) Usually happens in kids under 5 because the ligaments around their elbow are still loose. A common situation is when an adult pulls a child up by the hand or swings them by the arms. The sudden tug causes the radius to slip out of its normal spot at the elbow joint. How are they identified? These don't normally need an xray The child will often hold their arm close to their side and refuse to use it There's usually no swelling or obvious deformity. Treatment? Reduce the radial head subluxation. There are two possible techniques: Flexion and supination. Start with the arm extended and pronated. Then supinate the forearm. Then bend the elbow up all the way. Hyper-pronation. One hand stabilizes just above the child's elbow, the other holds the wrist. Start with the arm extended. Hyperpronate the forearm. Listen/feel for a click The child is normally back to normal quickly, if not get the xray Which is better? Hyperpronation (Aksel, 2025) 10% first attempt failure rate Flexion-pronation has a 25% first attempt failure rate References Aksel G, Küka B, İslam MM, Demirkapı F, Öztürk İ, İşlek OM, Ademoğlu E, Eroğlu SE, Satıcı MO, Özdemir S. Comparison of supination/flexion maneuver to hyperpronation maneuver in the reduction of radial head subluxations: A randomized clinical trial. Am J Emerg Med. 2025 Feb;88:29-33. doi: 10.1016/j.ajem.2024.11.026. Epub 2024 Nov 18. PMID: 39579408. Ulici A, Herdea A, Carp M, Nahoi CA, Tevanov I. Nursemaid's Elbow - Supination-flexion Technique Versus Hyperpronation/forced Pronation: Randomized Clinical Study. Indian J Orthop. 2019 Jan-Feb;53(1):117-121. doi: 10.4103/ortho.IJOrtho_442_17. PMID: 30905991; PMCID: PMC6394198. Summarized by Jeffrey Olson, MS4 | Edited by Jeffrey Olson and Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/

En este episodio de Mentes Literales platicamos sobre un tema que nos afecta a todos: el sueño. Inspirados en el libro Por qué dormimos de Matthew Walker, exploramos cómo el descanso transforma nuestra salud, nuestra memoria y hasta nuestra forma de relacionarnos con los demás.Entre anécdotas, descubrimientos y datos sorprendentes, reflexionamos sobre esas noches en las que dormir parece un lujo y no una necesidad. ¿Qué pasa en nuestro cerebro cuando cerramos los ojos? ¿Por qué soñar es tan vital como respirar? Y lo más importante: ¿qué podemos hacer para dormir mejor en un mundo que nunca se detiene?Prepárate para acompañarnos en una charla relajada y muy humana, donde más que dar respuestas absolutas, compartimos lo que aprendimos y cómo lo vivimos día a día. ★ Support this podcast on Patreon ★

In this episode, we review the newly published 2025 ACC/AHA hypertension guidelines. Key Concepts Instead of the Pooled Cohort Equations (PCE) from 2013, the 2025 hypertension guidelines recommend a new risk equation called PREVENT, which incorporates new risk factors and does not include race as part of the risk calculation. The guidelines recommend starting two antihypertensive medications for initial therapy in stage II hypertension and one antihypertensive medication for stage I hypertension. The guidelines no longer recommend specific first-line therapies for black patients. Instead, all patients without compelling indications should be initiated on a thiazide, ACE inhibitor, ARB, or dihydropyridine calcium channel blocker regardless of race/ethnicity. All patients should have a blood pressure goal of < 130/80 mmHg. Some patients may consider a more stringent goal of < 120/80 if they have diabetes or are at a higher risk of future ASCVD events. References Jones DW, Ferdinand KC, Taler SJ, Johnson HM, Shimbo D, Abdalla M, Altieri MM, Bansal N, Bello NA, Bress AP, Carter J, Cohen JB, Collins KJ, Commodore-Mensah Y, Davis LL, Egan B, Khan SS, Lloyd-Jones DM, Melnyk BM, Mistry EA, Ogunniyi MO, Schott SL, Smith SC Jr, Talbot AW, Vongpatanasin W, Watson KE, Whelton PK, Williamson JD. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025 Aug 14. doi: 10.1161/CIR.0000000000001356. Epub ahead of print. PMID: 40811497.

Dive into the second half of our envenomation series! Dr. Jonathan Ford, a UC Davis Medical Toxicologist and Professor of Emergency Medicine, returns to the podcast to tackle scorpions and spiders. We're going beyond the basics to discuss the "why" and "how" of these bites and stings. Learn about the neurotoxic effects of bark scorpion venom and the life-threatening airway risks. Explore the mechanism behind black widow bites that leads to intense pain and spasms, and the crucial role of antivenom in severe cases. Plus, we're setting the record straight on a common myth—the brown recluse—and the proper supportive care for its nasty bite. Join us to discover the latest evidence-based approaches that could change how you manage your next bite or sting. Have you had a patient with a serious or challenging envenomation?  How did you manage it? Share your story with us social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. Jonathan Ford, Professor of Emergency Medicine and Medical Toxicologist at UC Davis Resources: Quan D. North American poisonous bites and stings. Crit Care Clin. 2012 Oct;28(4):633-59. doi: 10.1016/j.ccc.2012.07.010. PMID: 22998994. Levine M, Friedman N. Terrestrial envenomations in pediatric patients: identification and management in the emergency department. Pediatr Emerg Med Pract. 2021 Sep;18(9):1-24. Epub 2021 Sep 2. PMID: 34403224.. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In this episode, we're diving into the administrative side of the job and sharing top tips for managing your schedule, staying organized, and creating a sustainable workflow. From choosing the right scheduling system to the importance of consistent habits, we'll help you become a reliable and trusted teacher by building a system that ensures you're always on time and ready to teach. I want to hear from you! Share your thoughts and follow the podcast on Instagram and Facebook @pilatesteachersmanual. Full show notes, episode transcription, and chapter markers can be found on the podcast website here: http://bit.ly/pilatesteachersmanual. Be sure to subscribe to the podcast for updates, and rate and review wherever you listen!  Episodes now available on YouTube: *https://bit.ly/YouTubePTM*Email pilatesteachersmanual@oliviabioni.com with your feedback.  Show Notes:   You can purchase the EPUB or PDF version of the book here and convert to a Kindle friendly file here: https://amazon.com/sendtokindleSupport the podcast:   Get your copy of Pilates Teachers' Manual: The Book at https://book.oliviabioni.com/pilatesteachersmanualVisit https://shop.oliviabioni.com for podcast merch! Visit https://links.oliviabioni.com/affiliates to take advantage of some sweet savings!Episode Music:Workout Dance Day EDM by Diamond_Tunes, in compliance with Pixabay's Content License (https://pixabay.com/service/license-summary/)Listen/download: https://pixabay.com/music/dance-workout-dance-day-edm-123377/Support the show

In 2023, we released 2 episodes on obstructive sleep apnea (OSA) and adverse pregnancy. Now, on September 16, 2025, a new publication from JAMA Network Open adds more insights to disturbed sleep and adverse pregnancy outcomes. How does insomnia affect pregnancy? And is there any data on night shift work and its altered circadian rhythms on adverse pregnancy outcomes? Listen in for details. 1. Ross N, Baer RJ, Oltman SP, et al. Ischemic Placental Disease and Severe Morbidity in Pregnant Patients With Sleep Disorders. JAMA Netw Open. 2025;8(9):e2532189. doi:10.1001/jamanetworkopen.2025.321892. Cai C, Vandermeer B, Khurana R, et al. The Impact of Occupational Shift Work and Working hours during Pregnancy on Health Outcomes: a systematic Review and Meta-Analysis.American Journal of Obstetrics and Gynecology. 2019;221(6):563-576. doi:10.1016/j.ajog.2019.06.051.3. Dominguez JE, Cantrell S, Habib AS, Izci-Balserak B, Lockhart E, Louis JM, Miskovic A, Nadler JW, Nagappa M, O'Brien LM, Won C, Bourjeily G. Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology Consensus Guideline on the Screening, Diagnosis, and Treatment of Obstructive Sleep Apnea in Pregnancy. Obstet Gynecol. 2023 Aug 1;142(2):403-423. doi: 10.1097/AOG.0000000000005261. Epub 2023 Jul 5. PMID: 37411038; PMCID: PMC10351908.4. Kader M, Bigert C, Andersson T, et al . Shift and Night Work During Pregnancy and Preterm Birth-a Cohort Study of Swedish Health Care Employees. International Journal of Epidemiology. 2022;50(6):1864-1874. doi:10.1093/ije/dyab135.STRONG COFFEE PROMO: 20% Off Strong Coffee Companyhttps://strongcoffeecompany.com/discount/CHAPANOSPINOBG

Dr. Cathy Goldstein, AP, is the founder of Tru Energy Skincare and a licensed Acupuncture Physician with over 30 years of clinical experience. A graduate of the New England School of Acupuncture in 1988, she has dedicated her career to integrating natural healing principles with modern innovations in wellness and beauty. Driven by a passion for non-invasive, health-centered solutions, she developed Tru Energy Skincare to harness the power of pure, natural ingredients in restoring the skin's vitality. Her signature creation, the All-Natural FaceLift System, is scientifically formulated to target the deeper layers of skin responsible for visible signs of aging. The system pairs advanced botanical formulations with the proprietary Energy Optimizing Wand to stimulate circulation, enhance cellular energy, and firm the skin naturally. Drawing on her background in Eastern medicine, Dr. Cathy infuses each product with a holistic approach that addresses beauty from the inside out. Get 15% discount off all TruEnergy products using my code at checkout - DRSTEVE15 Join us as we explore:How Cathy Goldstein built a revolutionary skincare product by leveraging the fundamentals of functional gut health, Traditional Chinese Medicine, addressing the “issues out of the tissues” and cutting-edge frequency imprinting.Why Cathy congruency tests and NET to ascertain if her patients actually believe they can be in good health.The critical importance of the lymphatic system for health, including skin health, face sweating and patented TruEnergy products and protocols that support optimal lymph function.The power of mirror neurons and how Cathy mirrored this natural technology in TruEnergy products, and how the commonplace use of Botox is blocking this fundamental human connection system.Exploring Cathy's daily detox and skin protocol. Contact:Website - https://truenergyskincare.comMentions:Techniques - Neuro Emotional Technique, https://www.netmindbody.com/more-information/what-is-net/Study - Monti DA, Tobia A, Stoner M, Wintering N, Matthews M, He XS, Doucet G, Chervoneva I, Tracy JI, Newberg AB. Neuro emotional technique effects on brain physiology in cancer patients with traumatic stress symptoms: preliminary findings. J Cancer Surviv. 2017 Aug;11(4):438-446. doi: 10.1007/s11764-017-0601-8. Epub 2017 Feb 8. PMID: 28181091Support the showFollow Steve's socials: Instagram | LinkedIn | YouTube | Facebook | Twitter | TikTokSupport the show on Patreon:As much as we love doing it, there are costs involved and any contribution will allow us to keep going and keep finding the best guests in the world to share their health expertise with you. I'd be grateful and feel so blessed by your support: https://www.patreon.com/MadeToThriveShowSend me a WhatsApp to +27 64 871 0308. Disclaimer: Please see the link for our disclaimer policy for all of our content: https://madetothrive.co.za/terms-and-conditions-and-privacy-policy/

Silvia and Rodrigo are joined by Dr Ray Wang, Director of the multidisciplinary Foundation of Caring Lysosomal Storage Disorder Program at the Children's Hospital of Orange County. Silvia asks Dr Wang and Rodrigo (who also happens to be a researcher in this field) about cutting-edge advances in LSD research: from base editing in Pompe disease and patient-specific in vivo gene editing, to new biomarkers and scoring systems in Gaucher disease, insights into lipid dysregulation across lysosomal storage disorders, and the first clinical trial of anakinra in Sanfilippo syndrome. Papers discussed include: Christensen CL, et al Base editing rescues acid α-glucosidase function in infantile-onset Pompe disease patient-derived cells. Mol Ther Nucleic Acids. 2024 May 21;35(2):102220. doi: 10.1016/j.omtn.2024.102220. PMID: 38948331; PMCID: PMC11214518. Starosta RT, et al Predicting liver fibrosis in Gaucher disease: Investigation of contributors and development of a clinically applicable Gaucher liver fibrosis score. Mol Genet Metab. 2025 Feb;144(2):109010. doi: 10.1016/j.ymgme.2025.109010. Epub 2025 Jan 3. PMID: 39788861. Kell P, et al Secondary accumulation of lyso-platelet activating factors in lysosomal storage diseases. Mol Genet Metab. 2025 Jun 17;145(4):109180. doi: 10.1016/j.ymgme.2025.109180. Polgreen LE, et al Anakinra in Sanfilippo syndrome: a phase 1/2 trial. Nat Med. 2024 Sep;30(9):2473-2479. doi: 10.1038/s41591-024-03079-3. Epub 2024 Jun 21. Erratum in: Nat Med. 2024 Sep;30(9):2693. doi: 10.1038/s41591-024-03207-z. Musunuru K, et al Patient-Specific In Vivo Gene Editing to Treat a Rare Genetic Disease. N Engl J Med. 2025 Jun 12;392(22):2235-2243. doi: 10.1056/NEJMoa2504747.

Contributor: Ricky Dhaliwal, MD Educational Pearls: Angioedema in anaphylaxis Histamine and mast cell-mediated pathway Treatment: First line: epinephrine for vasoconstriction and bronchodilation Second line: H1 and H2 antihistamines such as Benadryl and famotidine ACE inhibitor-induced angioedema Different pathway from anaphylaxis ACE inhibitor-induced angioedema is mediated by bradykinins Therefore, anaphylaxis medications are not beneficial in patients with ACE inhibitor-induced angioedema Leading cause of drug-induced angioedema in the US Patients most commonly present with swelling of the lips, tongue, or face Treatment: Airway management: varies depending on the severity and progression of the presentation If awake nasointubation is required, LMX is a 5% lidocaine water-soluble solution that provides anesthesia to the oropharynx Medications: Icatibant is a synthetic bradykinin B2-receptor antagonist that can be used in acute treatment Tranexamic acid (TXA) inhibits the plasmin-dependent formation of bradykinin, but the data on this treatment are mixed and limited Fresh frozen plasma (FFP) is thought to degrade high levels of bradykinin with subsequent resolution of angioedema Discontinue ACE inhibitor References Bork K, Wulff K, Hardt J, Witzke G, Staubach P. Hereditary angioedema caused by missense mutations in the factor XII gene: clinical features, trigger factors, and therapy. J Allergy Clin Immunol. 2009 Jul;124(1):129-34. doi: 10.1016/j.jaci.2009.03.038. Epub 2009 May 27. PMID: 19477491. Bova M, Guilarte M, Sala-Cunill A, Borrelli P, Rizzelli GM, Zanichelli A. Treatment of ACEI-related angioedema with icatibant: a case series. Intern Emerg Med. 2015 Apr;10(3):345-50. doi: 10.1007/s11739-015-1205-9. Epub 2015 Feb 10. PMID: 25666515. Karim MY, Masood A. Fresh-frozen plasma as a treatment for life-threatening ACE-inhibitor angioedema. J Allergy Clin Immunol. 2002 Feb;109(2):370-1. doi: 10.1067/mai.2002.121313. PMID: 11842313. Pathak GN, Truong TM, Chakraborty A, Rao B, Monteleone C. Tranexamic acid for angiotensin-converting enzyme inhibitor-induced angioedema. Clin Exp Emerg Med. 2024 Mar;11(1):94-99. doi: 10.15441/ceem.23.051. Epub 2023 Aug 1. PMID: 37525579; PMCID: PMC11009700. Simons FE. First-aid treatment of anaphylaxis to food: focus on epinephrine. J Allergy Clin Immunol. 2004 May;113(5):837-44. doi: 10.1016/j.jaci.2004.01.769. Erratum in: J Allergy Clin Immunol. 2004 Jun;113(6):1039. Dosage error in article text. PMID: 15131564. Summarized by Meg Joyce, MS2 | Edited by Meg Joyce & Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/

Learning Objectives:By the end of this two-part series, listeners should be able to discuss:The physiologic rationale supporting the use of high-frequency percussive ventilation (Volumetric Diffusive Respiration, or HFPV).Patient populations most likely to benefit from HFPV.Key published evidence that informs our use of HFPV in pediatric critical care.An expert approach to managing a patient with HFPV.Next steps in research that will direct our understanding of the use of HFPV in pediatric critical care.About our Guest: Dr. John Lin is a Professor of Pediatrics at Washington University in St. Louis. He serves as the Critical Care Fellowship Program Director and Medical Director of Respiratory Care at St. Louis Children's Hospital. His academic interests are aimed at the implementation of specific task-based processes and systems-based interventions that increase team performance. References:Butler AD, Dominick CL, Yehya N. High frequency percussive ventilation in pediatric acute respiratory failure. Pediatr Pulmonol. 2021 Feb;56(2):502-508. doi: 10.1002/ppul.25191. Epub 2020 Dec 8. PMID: 33258557; PMCID: PMC7902396.Linda Melchor. (2021, July 22). High-Frequency Percussive Ventilation – Using the VDR, or HFPV-4. Criticalcarenow.Com.Salim, A., & Martin, M. (2005). High-frequency percussive ventilation. Critical Care Medicine, 33(Supplement), S241–S245. https://doi.org/10.1097/01.CCM.0000155921.32083.CEDominick, C., Nickel, A. J., & Yehya, N. (2022). High Frequency Percussive Ventilation in Viral Bronchiolitis: Do We Need a Standardized Approach to HFPV Management? Https://Home.Liebertpub.Com/Rcare, 67(7), 893–894. https://doi.org/10.4187/RESPCARE.10247White, B. R., Cadotte, N., McClellan, E. B., Presson, A. P., Bennett, E., Smith, A. G., & Aljabari, S. (2022). High-Frequency Percussive Ventilation in Viral Bronchiolitis. Respiratory Care, 67(7), 781–788. https://doi.org/10.4187/respcare.09350Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

En este episodio nos adentramos en un thriller psicológico que te mantendrá al borde del asiento: No te despiertes de Liz Lawler.La historia nos presenta a Alex Taylor, una joven doctora que despierta en una situación aterradora: amarrada en una mesa de hospital, sometida a un juego macabro. Pero lo peor no es lo que ha vivido, sino que nadie parece creerle. ¿Es víctima de una conspiración? ¿O su mente le está jugando una trampa cruel?Un episodio perfecto para quienes aman los thrillers psicológicos donde la línea entre la verdad y la mentira es casi invisible. ★ Support this podcast on Patreon ★

This is the eighth chapter “Calm And Insight” from the book: Buddhadhamma: The Laws Of Nature And Their Benefits To Life by Bhikkhu P. A. Payutto (Somdet Phra Buddhaghosacariya) Published by Buddhadhamma FoundationCopyright © Buddhadhamma Foundation 2021Translated by Robin Philip Moore Editor: Bhikkhu Kovilo, typesetting: Bhikkhu Gambhīro Download this e-book in PDF, EPUB and MOBI formats atContinue reading "“Calm And Insight” Chapter 8 From Buddhadhamma: The Laws Of Nature And Their Benefits To Life"

This is a fascinating podcast episode from Dr. Lipid himself on desmosterol.  What is it?  How do we measure it?  Why should we care? Pharmacists are well-positioned to guide patients in understanding the role of desmosterol, how medications may influence its levels, the options for measuring it, and the steps to take if levels are too high or too low. Dr. Thomas Dayspring: linkedin.com/in/thomas-dayspring-md-facp-fnla-3aaa876 or @DrLipid on X  Tamara Ruggles, PharmD: linkedin.com/in/tamara-ruggles-491882251 Resource on lipids recommended by Dr. Dayspring: https://familyheart.org/ Wages PA, Kim HH, Korade Z, Porter NA. Identification and characterization of prescription drugs that change levels of 7-dehydrocholesterol and desmosterol. J Lipid Res. 2018 Oct;59(10):1916-1926. doi: 10.1194/jlr.M086991. Epub 2018 Aug 7. PMID: 30087204; PMCID: PMC6168312.  Available at:  https://pubmed.ncbi.nlm.nih.gov/30087204/  The Geriatric Pharmacy Focus podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

Welcome to the Olink® Proteomics in Proximity podcast!  Below are some useful resources mentioned in this episode:  Olink tools and software·       Olink® Explore HT, Olink's most advanced solution for high-throughput biomarker discovery, measuring 5400+ proteins simultaneously with a streamlined workflow and industry-leading specificity: https://olink.com/products-services/exploreht/  UK Biobank Pharma Proteomics Project (UKB-PPP), one of the world's largest scientific studies of blood protein biomarkers conducted to date, https://www.ukbiobank.ac.uk/learn-more-about-uk-biobank/news/uk-biobank-launches-one-of-the-largest-scientific-studies  World Health Organization (2003). Adherence to long-term therapies: evidence for action (PDF). Geneva: World Health Organisation. ISBN 978-92-4-154599-0 Research articles and news·       Thermo Fisher Scientific's Olink Platform Selected for World's Largest Human Proteome Studyhttps://ir.thermofisher.com/investors/news-events/news/news-details/2025/Thermo-Fisher-Scientifics-Olink-Platform-Selected-for-Worlds-Largest-Human-Proteome-Study/default.aspx·       Hamilton Se-Hwee Oh et al 2025. Plasma proteomics links brain and immune system aging with healthspan and longevityhttps://www.nature.com/articles/s41591-025-03798-1. Nature Medicine (2025)·       Song, Y., Abuduaini, B., Yang, X. et al. Identification of inflammatory protein biomarkers for predicting the different subtype of adult with tuberculosis: an Olink proteomic study. Inflamm. Res. 74, 60 (2025). https://doi.org/10.1007/s00011-025-02020-9·       Ferhan Qureshi et al 2023. Analytical validation of a multi-protein, serum-based assay for disease activity assessments in multiple sclerosis. Proteomics clinical application 2023·       Dhindsa, R.S., Burren, O.S., Sun, B.B. et al. Rare variant associations with plasma protein levels in the UK Biobank. 2023 Nature, DOI: 10.1038/s41586-023-06547-xhttps://www.nature.com/articles/s41586-023-06547-x·       Sun, B.B., Chiou, J., Traylor, M. et al.  Plasma proteomic associations with genetics and health in the UK Biobank. 2023 Nature, DOI: 10.1038/s41586-023-06592-6 https://www.nature.com/articles/s41586-023-06592-6 https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehac495/6676779·       Eldjarn GH, et al. Large-scale plasma proteomics comparisons through genetics and disease associations. Nature. 2023 Oct;622(7982):348-358. doi: 10.1038/s41586-023-06563-xhttps://www.nature.com/articles/s41586-023-06563-x#Sec44·        Carrasco-Zanini et al 2024 Proteomic prediction of common and rare diseases. https://www.nature.com/articles/s41591-024-03142-z . NatureMedicine volume 30,  pages2489–2498 (2024)·       Watanabe K, Wilmanski T, Diener C, et al. Multiomic signatures of body mass index identify heterogeneous health phenotypes and responses to a lifestyle intervention.https://www.nature.com/articles/s41591-023-02248-0·       Petrera A, von Toerne C, Behlr J, et al. Multiplatform Approach for Plasma Proteomics: Complementarity of Olink Proximity Extension Assay Technology to Mass Spectrometry-Based Protein Profiling. (2020) Journal of Proteome Research, https://pubs.acs.org/doi/pdf/10.1021/acs.jproteome.0c00641·       Multicenter Collaborative Study to Optimize Mass Spectrometry Workflows of Clinical Specimens. Kardell O, von Toerne C, Merl-Pham J, König AC, Blindert M, Barth TK, Mergner J, Ludwig C, Tüshaus J, Eckert S, Müller SA, Breimann S, Giesbertz P, Bernhardt AM, Schweizer L, Albrecht V, Teupser D, Imhof A, Kuster B, Lichtenthaler SF, Mann M, Cox J, Hauck SM. J Proteome Res. 2024 Jan 5;23(1):117-129. doi: 10.1021/acs.jproteome.3c00473. Epub 2023 Nov 28. PMID: 38015820 https://pubs.acs.org/doi/10.1021/acs.jproteome.3c00473·       Wei, S., Shen, R., Lu, X. et al. Integrative multi-omics investigation of sleep apnea: gut microbiome metabolomics, proteomics and phenome-wide association study. Nutr Metab (Lond) 22, 57 (2025). https://doi.org/10.1186/s12986-025-00925-0·       Liu, L., Li, M., Qin, Y. et al. Childhood obesity and insulin resistance is correlated with gut microbiome serum protein: an integrated metagenomic and proteomic analysis. Sci Rep 15, 21436 (2025). https://doi.org/10.1038/s41598-025-07357-z·       Zhang, Xiaotao et al.Modulating a prebiotic food source influences inflammation and immune-regulating gut microbes and metabolites: insights from the BE GONE trial. eBioMedicine, Volume 98, 104873 (2023.).  10.1016/j.ebiom.2023.104873·      &nb...

Learning Objectives:By the end of this two-part series, listeners should be able to discuss:The physiologic rationale supporting the use of high-frequency percussive ventilation (Volumetric Diffusive Respiration, or HFPV).Patient populations most likely to benefit from HFPV.Key published evidence that informs our use of HFPV in pediatric critical care.An expert approach to managing a patient with HFPV.Next steps in research that will direct our understanding of the use of HFPV in pediatric critical care.About our Guest: Dr. John Lin is a Professor of Pediatrics at Washington University in St. Louis. He serves as the Critical Care Fellowship Program Director and Medical Director of Respiratory Care at St. Louis Children's Hospital. His academic interests are aimed at the implementation of specific task-based processes and systems-based interventions that increase team performance. References:Butler AD, Dominick CL, Yehya N. High frequency percussive ventilation in pediatric acute respiratory failure. Pediatr Pulmonol. 2021 Feb;56(2):502-508. doi: 10.1002/ppul.25191. Epub 2020 Dec 8. PMID: 33258557; PMCID: PMC7902396.Linda Melchor. (2021, July 22). High-Frequency Percussive Ventilation – Using the VDR, or HFPV-4. Criticalcarenow.Com.Salim, A., & Martin, M. (2005). High-frequency percussive ventilation. Critical Care Medicine, 33(Supplement), S241–S245. https://doi.org/10.1097/01.CCM.0000155921.32083.CEDominick, C., Nickel, A. J., & Yehya, N. (2022). High Frequency Percussive Ventilation in Viral Bronchiolitis: Do We Need a Standardized Approach to HFPV Management? Https://Home.Liebertpub.Com/Rcare, 67(7), 893–894. https://doi.org/10.4187/RESPCARE.10247White, B. R., Cadotte, N., McClellan, E. B., Presson, A. P., Bennett, E., Smith, A. G., & Aljabari, S. (2022). High-Frequency Percussive Ventilation in Viral Bronchiolitis. Respiratory Care, 67(7), 781–788. https://doi.org/10.4187/respcare.09350Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

In this Complex Care Journal Club podcast episode, Ms. Kathryn Knight and Dr. Brian K. Jordan discuss a national survey of families of children with medical complexity on access to home health nursing. They describe the impact of the nursing shortage on families, development of a nonprofit resource that facilitates connections between families and home nursing, and outline next steps from this work. Learn more about Hello Nurze: www.hellonurze.com Find additional details about the F.A.C.E.S. Project: www.hellonurze.com/p/faces-project SPEAKERS Kathryn Knight, BBA Co-Founder & Executive Director, Hello Nurze Brian K. Jordan, MD, PhD Associate Professor Oregon Health & Science University HOST Emily J. Goodwin, MD Clinical Associate Professor of Pediatrics University of Missouri Kansas City School of Medicine Pediatrician, General Academic Pediatrics Beacon Program Children's Mercy Kansas City DATE Initial publication date: September 8, 2025. JOURNAL CLUB ARTICLE Knight K, Knight G, Jordan BK. The Impact of the Lack of Access to Home Health Nursing on Families of Children with Medical Complexity in the United States. Home Healthc Now. 2025 Jul-Aug 01;43(4):213-220. doi: 10.1097/NHH.0000000000001356. Epub 2025 Jul 7. PMID: 40619624. OTHER ARTICLES REFERENCED Baker CD, Martin S, Thrasher J, Moore HM, Baker J, Abman SH, Gien J. A Standardized Discharge Process Decreases Length of Stay for Ventilator-Dependent Children. Pediatrics. 2016 Apr;137(4):e20150637. doi: 10.1542/peds.2015-0637. Epub 2016 Mar 10. PMID: 26966133; PMCID: PMC4811306. Hello Nurze. Connecting families and in-home nurses. Accessed August 27, 2025. https://www.hellonurze.com Moore PE, Boyer D, O'Connor MG, Baker CD, Rettig JS, Sterni L, Halbower A, Wilson KC, Thomson CC. Pediatric Chronic Home Invasive Ventilation. Ann Am Thorac Soc. 2016 Jul;13(7):1170-2. doi: 10.1513/AnnalsATS.201603-196CME. PMID: 27388405; PMCID: PMC5462000. TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/as/87x9cmw5xfnkkt74v5g5pv3/Jordan_and_Knight_Final_Transcript__9-5-25‌ Clinicians across healthcare professions, advocates, researchers, and patients/families are all encouraged to engage and provide feedback! You can recommend an article for discussion using this form: https://forms.gle/Bdxb86Sw5qq1uFhW6. Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Knight K, Jordan BK, Goodwin EJ. From Crisis to Connection: Matching Families with Home Nursing Support in Complex Care. 09/2025. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/from-crisis-to-connection-matching-families-with-home-nursing-support-in-complex-care.

Dr. Lindsay Andras from Children's Hospital of Los Angeles joins the show to discuss her recent randomized control trial comparing outcomes of functional bracing and spica casting for pediatric femoral shaft fractures. Drs. Andras and co-author Dr. Julia Sanders share insights from their experience conducting a randomized control trial and the pearls and pitfalls of implementing the functional brace. The lightning round highlights articles on spinal involvement in hereditary multiple osteochondromas, outcomes of pediatric multi-ligamentous knee injuries, and the impact of Pavlik harness treatment on breastfeeding efficacy.   Your hosts are Will Morris (Scottish Rite for Children in Dallas), Julia Sanders (Children's Hospital of Colorado), Tyler McDonald (University of South Alabama), and Steph Logterman (Arnold Palmer Hospital for Children). Music by A. A. Aalto.   Disclosure: Drs. Lindsay Andras and Julia Sanders each receive royalties from Orthopediatrics who produce a version of the fracture brace discussed in this episode.   References: 1. Andras LM, Sanders JS, Phan TN, Purtell SR, Gasca J, Wren TAL, Sim AT, Skaggs D, Kramer A, Chavez M, Kay R. A Prospective, Randomized Comparison of Functional Bracing and Spica Casting for Femoral Fractures Showed Equivalent Early Outcomes. J Bone Joint Surg Am. 2025 Jun 26;107(16):1769-1776. doi: 10.2106/JBJS.24.01081. PMID: 40570075. 2. Casey VF, Chandler CC, Graham GD, Frick SL. Dynamic Femur Fracture Brace vs Hip Spica Cast for Pediatric Femoral Shaft Fractures: A Retrospective Comparative Cohort Study. J Pediatr Soc North Am. 2025 May 23;12:100203. doi: 10.1016/j.jposna.2025.100203. PMID: 40704087; PMCID: PMC12284357. 3. Lang PJ, Feroe A, Franco H, Hussain ZB, Tepolt FA, Kocher MS. Outcomes of Operative Management of Multi-Ligament Knee Injuries in an Adolescent Population: A Retrospective Case Series. J Pediatr Soc North Am. 2024 Feb 5;5(4):742. doi: 10.55275/JPOSNA-2023-742. PMID: 40432936; PMCID: PMC12088175. 4. Bram JT, Tracey OC, Trotzky Z, Jones RH, Jochl O, Cirrincione PM, Nichols E, Dodwell ER, Scher DM, Doyle SH, Sink EL. Pavlik Harness Treatment for Infantile Hip Dysplasia Lowers Breastfeeding Self-efficacy. J Pediatr Orthop. 2025 Sep 1;45(8):e701-e705. doi: 10.1097/BPO.0000000000002976. Epub 2025 Apr 21. PMID: 40256838. 5. Legler J, Benaroch LR, Pirshahid AA, Serhan O, Cheng D, Bartley D, Carey T, Rasoulinejad P, Singh S, Thornley P. Rate of Spinal Osteochondromas Diagnosed in Pediatric Patients With Hereditary Multiple Osteochondromas: A Systematic Review and Meta-Analysis. J Pediatr Orthop. 2025 Sep 1;45(8):e718-e723. doi: 10.1097/BPO.0000000000002975. Epub 2025 Apr 23. PMID: 40266849.

Learn how to sharpen your pediatric intubation skills and make evidence-based decisions at the bedside. Today, Dr. Pradip Kamat, Dr. Monica Gray, and Dr. Rahul Damania expertly dissect the nuances of selecting optimal induction agents for critically ill children in the PICU. Through engaging, real-world case scenarios, our hosts guide you through drug choices in complex situations such as cardiogenic shock, septic shock, and elevated intracranial pressure—always prioritizing hemodynamic stability and patient safety. Gain valuable insights into the advantages, limitations, and clinical pearls of agents like propofol, fentanyl, ketamine, and midazolam, along with practical strategies for rapid sequence intubation, neuromuscular blockade, and individualized patient care. Don't miss this high-yield discussion, packed with actionable knowledge!Show Highlights:Induction agents for endotracheal intubation in critically ill childrenClinical scenarios highlighting optimal choices of induction agents and neuromuscular blockersImportance of maintaining hemodynamic stability during intubationPharmacology and clinical considerations of various induction agents (e.g., propofol, ketamine, fentanyl, etomidate)Use of neuromuscular blocking agents (NMBAs) in pediatric intubationDifferences between depolarizing and non-depolarizing neuromuscular blockersRisks associated with specific induction agents in patients with cardiac dysfunction or septic shockModified rapid sequence intubation (RSI) techniques for unstable patientsKey takeaways for managing critically ill pediatric patients requiring intubationPractical tips for optimizing intubation conditions and minimizing complicationsReferences:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care 6th Edition. Chapters 127 - 135, Pages 1510 - 1610Hendrix JM, Regunath H. Intubation Endotracheal Tube Medications. [Updated 2025 Jan 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459276/Agrawal, Dewesh. Rapid sequence intubation (RSI) in children for emergency medicine: Medications for sedation and paralysis. UpToDate. Last updated Dec 4, 2024.Vanlinthout LE, Geniets B, Driessen JJ, Saldien V, Lapré R, Berghmans J, Uwimpuhwe G, Hens N. Neuromuscular-blocking agents for tracheal intubation in pediatric patients (0-12 years): A systematic review and meta-analysis. Paediatr Anaesth. 2020 Apr;30(4):401-414. doi: 10.1111/pan.13806. Epub 2020 Mar 9. PMID: 31887248.Tarquinio KM, Howell JD, Montgomery V, Turner DA, Hsing DD, Parker MM, Brown CA 3rd, Walls RM, Nadkarni VM, Nishisaki A; National Emergency Airway Registry for Children; Pediatric Acute Lung Injury and Sepsis Investigators Network. Current medication practice and tracheal intubation safety outcomes from a prospective multicenter observational cohort study. Pediatr Crit Care Med. 2015 Mar;16(3):210-8. doi: 10.1097/PCC.0000000000000319. PMID: 25581629.Conway JA, Kharayat P, Sanders RC Jr, Nett S, Weiss SL, Edwards LR, Breuer R, Kirby A, Krawiec C, Page-Goertz C, Polikoff L, Turner DA, Shults J, Giuliano JS Jr, Orioles A, Balkandier S, Emeriaud G, Rehder KJ, Kian Boon JL, Shenoi A, Vanderford P, Nuthall G, Lee A, Zeqo J, Parsons SJ, Furlong-Dillard J, Meyer K, Harwayne-Gidansky I, Jung P, Adu-Darko M, Bysani GK, McCarthy MA, Shlomovich M, Toedt-Pingel I, Branca A, Esperanza MC, Al-Subu AM, Pinto M, Tallent S, Shetty R, Thyagarajan S, Ikeyama T, Tarquinio KM, Skippen P, Kasagi M, Howell JD, Nadkarni VM, Nishisaki A; National Emergency Airway Registry for Children (NEAR4KIDS) and for the Pediatric Acute Lung Injury and Sepsis Investigators...

According to the J Am Acad Orthop Surg Glob Res Rev. (2024), the incidence of pelvic ring injuries is 34.3 per 100,000 with trauma being the most obvious causation. Women account for approximately 69.7% of these injuries, 23% of which occur in women of childbearing age. In this specific patient population, concern is raised about one's future reproductive capability and method of delivery. The normal bony pelvic movements that occur during vaginal delivery are crucial for accommodating the passage of the fetus through the birth canal; this allows for the normal cardinal phases of labor to occur. These movements involve the widening and shifting of various pelvic joints and bones, primarily influenced by hormonal changes and the mechanical forces exerted by the baby. So, it is reasonable to ask if a patient with pelvic fractures and fixation can safely allow a trial of labor. Is a history of pelvic fractures with surgical fixation an indication for primary cesarean section? If it's not, in what scenario would a primary c-section be best after a pelvic fracture? Listen in for details. 1.Pelvic Fractures in Women of Childbearing Age.Cannada LK, Barr J. Clinical Orthopaedics and Related Research. 2010;468(7):1781-9. doi:10.1007/s11999-010-1289-5.2.Birth Outcomes Following Pelvic Ring Injury: A Retrospective Study. Hsu CC, Lai CY, Chueh HY, et al. BJOG : An International Journal of Obstetrics and Gynaecology. 2023;130(11):1395-1402. doi:10.1111/1471-0528.17487.3.Pregnancy and Delivery After Pelvic Fracture in Fertile-Aged Women: A Nationwide Population-Based Cohort Study in Finland. Vaajala M, Kuitunen I, Nyrhi L, et al. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2022;270:126-132. doi:10.1016/j.ejogrb.2022.01.008.4.Pregnancy Outcomes After Pelvic Ring Injury.Vallier HA, Cureton BA, Schubeck D. Journal of Orthopaedic Trauma. 2012;26(5):302-7. doi:10.1097/BOT.0b013e31822428c5.5.Caesarean Section Rates Following Pelvic Fracture: A Systematic Review. Riehl JT. Injury. 2014;45(10):1516-21. doi:10.1016/j.injury.2014.03.018.6.Unstable Pelvic Fractures in Women: Implications on Obstetric Outcome. Davidson A, Giannoudis VP, Kotsarinis G, et al. International Orthopaedics. 2024;48(1):235-241. doi:10.1007/s00264-023-05979-4.7.Management of Pelvic Injuries in Pregnancy.Amorosa LF, Amorosa JH, Wellman DS, Lorich DG, Helfet DL. The Orthopedic Clinics of North America. 2013;44(3):301-15, viii. doi:10.1016/j.ocl.2013.03.0058.Effect of Trauma and Pelvic Fracture on Female Genitourinary, Sexual, and Reproductive Function.Copeland CE, Bosse MJ, McCarthy ML, et al. Journal of Orthopaedic Trauma. 1997 Feb-Mar;11(2):73-81. doi:10.1097/00005131-199702000-00001.9. The Rate of Elective Cesarean Section After Pelvic or Hip Fracture Remains High Even After the Long-Term Follow-Up: A Nationwide Register-Based Study in Finland. Vaajala M, Kuitunen I, Liukkonen R, et al.European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2022;277:77-83. doi:10.1016/j.ejogrb.2022.08.10. Bajerová M, Hruban L. Movements of the pelvic bones of expectant mothers during vaginal delivery. Ceska Gynekol. 2024;89(4):335-342. English. doi: 10.48095/cccg2024335. PMID: 39242210. 11. Lewis AJ, Barker EP, Griswold BG, Blair JA, Davis JM. Pelvic Ring Fracture Management and Subsequent Pregnancy: A Summary of Current Literature. J Am Acad Orthop Surg Glob Res Rev. 2024 Feb 6;8(2):e23.00203. doi: 10.5435/JAAOSGlobal-D-23-00203. PMID: 38323930; PMCID: PMC10849384.12. Childbirth after Pelvic Fractures: Debunking the Myths: https://ota.org/sites/files/legacy_abstracts/ota09/otapa/OTA090132.htm13. Davidson A, Giannoudis VP, Kotsarinis G, Santolini E, Tingerides C, Koneru A, Kanakaris NK, Giannoudis PV. Unstable pelvic fractures in women: implications on obstetric outcome. Int Orthop. 2024 Jan;48(1):235-241. doi: 10.1007/s00264-023-05979-4. Epub 2023 Sep 15. PMID: 37710070

Contributor: Alec Coston, MD Educational Pearls: Hepatic encephalopathy (HE) is defined as a disruption in brain function that results from impaired liver function or portosystemic shunting. Manifests as various neurologic and psychiatric symptoms such as confusion, inattention, and cognitive dysfunction Although ammonia levels have historically been recognized as important criteria for HE, the diagnosis is ultimately made clinically. An elevated ammonia level lacks sensitivity and specificity for HE Trends in ammonia levels do not correlate with disease improvement or resolution A 2020 study published in the American Journal of Gastroenterology evaluated 551 patients diagnosed with hepatic encephalopathy and treated with standard therapy Only 60% of patients had an elevated ammonia level, demonstrating the limitations of ammonia levels However, a normal ammonia level in a patient with concern for HE should raise suspicion for other pathology. In patients with cirrhosis presenting with neuropsychiatric symptoms, consider HE as the diagnosis after excluding other potential causes of altered mental status (i.e., Seizure, infection, intracranial hemorrhage) The primary treatment is lactulose Works by acidifying the gastrointestinal tract. Ammonia (NH₃) is converted into ammonium (NH₄⁺), which is poorly absorbed and subsequently eliminated from the body Also exerts a laxative effect, further enhancing elimination References: Haj M, Rockey DC. Ammonia Levels Do Not Guide Clinical Management of Patients With Hepatic Encephalopathy Caused by Cirrhosis. Am J Gastroenterol. 2020 May;115(5):723-728. doi: 10.14309/ajg.0000000000000343. PMID: 31658104. Lee F, Frederick RT. Hepatic Encephalopathy-A Guide to Laboratory Testing. Clin Liver Dis. 2024 May;28(2):225-236. doi: 10.1016/j.cld.2024.01.003. Epub 2024 Jan 30. PMID: 38548435. Vilstrup, Hendrik1; Amodio, Piero2; Bajaj, Jasmohan3,4; Cordoba, Juan1,5; Ferenci, Peter6; Mullen, Kevin D.7; Weissenborn, Karin8; Wong, Philip9. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study Of Liver Diseases and the European Association for the Study of the Liver. Hepatology 60(2):p 715-735, August 2014. | DOI: 10.1002/hep.27210 Weissenborn K. Hepatic Encephalopathy: Definition, Clinical Grading and Diagnostic Principles. Drugs. 2019 Feb;79(Suppl 1):5-9. doi: 10.1007/s40265-018-1018-z. PMID: 30706420; PMCID: PMC6416238. Summarized by Ashley Lyons, OMS3 | Edited by Ashley Lyons & Jorge Chalit, OMS4 Get your tickets to Tox Talks Event, Sept 11, 2025: https://emergencymedicalminute.org/events-2/ Donate: https://emergencymedicalminute.org/donate/  

En este episodio de Mentes Literales nos adentramos en el oscuro universo de la autora islandesa Yrsa Sigurdardóttir con su novela El grito, parte de la serie Los casos de Freyja.Una historia inquietante que mezcla lo policial con lo psicológico, donde un hallazgo macabro destapa secretos enterrados y desencadena una investigación llena de giros inesperados. Con la atmósfera fría y sombría de Islandia como telón de fondo, seguimos a la psicóloga forense Freyja y al inspector Huldar en un caso que los pondrá a prueba tanto profesional como personalmente. ★ Support this podcast on Patreon ★

You use ketamine. I use ketamine. We all use ketamine. But… how safe it is, really? A new study out of Toronto suggests 30% of patients who receive ketamine have adverse events, a rate higher than seen in the ED. What are we to make of this? I bring Dr Remle Crowe on to discuss…Citations:1.     Kwong JL, Verbeek PR, Leong YC, Turner L, Huiskamp M, Drennan IR, Francom S, Ropp S, Cheskes S: Paramedic use of ketamine for severe agitation and violence. Can J Emerg Med. doi: 10.1007/s43678-025-00963-w (Epub ahead of print).2.     Fernandez AR, Bourn SS, Crowe RP, Bronsky ES, Scheppke KA, Antevy P, Myers JB: Out-of-Hospital Ketamine: Indications for Use, Patient Outcomes, and Associated Mortality. Annals of Emergency Medicine. 2021;78(1):123–31.3.     Brown LH, Crowe RP, Pepe PE, Miller ML, Watanabe BL, Kordik SS, Wampler DA, Page DI, Fernandez AR, Bourn SS, et al.: Adverse events following emergent prehospital sedation of patients with behavioral emergencies: A retrospective cohort study. The Lancet Regional Health - Americas. 2022;May;9:100183.

We programme strength, cardio, and mobility — but almost never relaxation. Yet research shows Progressive Muscle Relaxation lowers stress, calms anxiety, improves mood, and even deepens the most restorative stages of sleep.In this episode, I break down the evidence — from large systematic reviews to athlete studies — and then guide you through a full Progressive Muscle Relaxation session. You'll finish not just knowing why relaxation matters, but experiencing its benefits in real time.Study 1: Muhammad Khir S, Wan Mohd Yunus WMA, Mahmud N, Wang R, Panatik SA, Mohd Sukor MS, Nordin NA. Efficacy of Progressive Muscle Relaxation in Adults for Stress, Anxiety, and Depression: A Systematic Review. Psychol Res Behav Manag. 2024 Feb 1;17:345-365. doi: 10.2147/PRBM.S437277. PMID: 38322293; PMCID: PMC10844009.Study 2: Simon KC, McDevitt EA, Ragano R, Mednick SC. Progressive muscle relaxation increases slow-wave sleep during a daytime nap. J Sleep Res. 2022 Oct;31(5):e13574. doi: 10.1111/jsr.13574. Epub 2022 Mar 30. PMID: 35355351; PMCID: PMC9786620.Study 3: Battaglini MP, Pessôa Filho DM, Calais SL, Miyazaki MCOS, Neiva CM, Espada MC, de Moraes MG, Verardi CEL. Analysis of Progressive Muscle Relaxation on Psychophysiological Variables in Basketball Athletes. Int J Environ Res Public Health. 2022 Dec 19;19(24):17065. doi: 10.3390/ijerph192417065. PMID: 36554945; PMCID: PMC9778808.

Breast cancer is an hormone responsive malignancy, meaning it may use estrogen and progesterone, reduced in high quantities during a pregnancy, for growth. However, as medical evidence evolves quickly, physicians have come to understand that breast cancer diagnosis during pregnancy doesn't always mean worse prognoses. While older studies- including meta analysis-reflected worse prognoses for pregnancy related breast cancer compared to non-pregnancy related cases, these studies either included studies from the 1960s and 70s when diagnosis and treatment were radically different, had inconsistent definitions of PABC, and/or were poorly age and staged matched. Therefore, as stated in the new UK (Aug 2025) guidance, “the applicability to modern day practice of the findings from these reports is limited”. The more updated clinical stance is that, “By using diagnostic and treatment pathways for women with {pregnancy related breast cancer} which are as close as possible to women with non-pregnancy related breast cancer, similar outcomes can be achieved” (RCOG Green Top recommendations No 12). In this episode, we will summarize key points from the recently released Green Top Guidance No 12 (25 Aug 2025) which has shifted the perspective on treating breast cancer DURING pregnancy. 1. Cubillo A, Morales S, Goñi E, Matute F, Muñoz JL, Pérez-Díaz D, de Santiago J, Rodríguez-Lescure Á. Multidisciplinary consensus on cancer management during pregnancy. Clin Transl Oncol. 2021 Jun;23(6):1054-1066. doi: 10.1007/s12094-020-02491-8. Epub 2020 Nov 16. PMID: 33191439; PMCID: PMC8084770.2. https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/pregnancy-and-breast-cancer-green-top-guideline-no-12/3. Sundermann AC, Cate JM, Campbell AK, Dotters-Katz SK, Myers ER, Federspiel JJ. Maternal morbidity and mortality among patients with cancer at time of delivery. Am J Obstet Gynecol. 2023 Sep;229(3):324.e1-324.e7. doi: 10.1016/j.ajog.2023.06.008. Epub 2023 Jun 7. PMID: 37295633; PMCID: PMC10593119.

En este episodio de Mentes Literales nos adentramos en un libro que combina misterio, humor y una buena dosis de ingenio: Resolvemos Asesinatos. Una lectura fresca y entretenida que nos lleva a seguir a un peculiar grupo de personajes que, lejos de ser detectives profesionales, se lanzan a descifrar crímenes con más entusiasmo que experiencia.Comentamos qué fue lo que más nos atrapó de la trama, los giros inesperados que nos sacaron una sonrisa y cómo la autora logra darle un aire ligero a un tema tan oscuro como los asesinatos. Además, compartimos nuestras impresiones sobre los protagonistas, sus dinámicas y cómo este libro puede ser una gran opción para quienes buscan misterio sin perder el toque divertido.Prepárate para una charla relajada, con anécdotas y risas, mientras recomendamos una historia que demuestra que cualquiera, con suficiente curiosidad (y algo de locura), puede intentar resolver un asesinato.Consulta "Resolvemos Asesinatos" en GoodreadsConsulta más información sobre la serie de TV que mencionamos ★ Support this podcast on Patreon ★

LibreOffice is dumping Windows (OK, not all of Windows), there's anime catgirls keeping the kernel safe, and FFmpeg makes a major new release. Kdenlive has a release, Thunderbird has announced ThunderMail, and one of the hosts gives CachyOS a spin. For tips we're covering Gnome System Extensions, using WirePlumber for volume control, hacks for waking your monitor back up, and unbuffer for keeping your colors where they belong. You can find the show tips at http://bit.ly/45Nszrr and come back next week for more! Host: Jonathan Bennett Co-Hosts: Rob Campbell, Jeff Massie, and Ken McDonald Download or subscribe to Untitled Linux Show at https://twit.tv/shows/untitled-linux-show Want access to the ad-free video and exclusive features? Become a member of Club TWiT today! https://twit.tv/clubtwit Club TWiT members can discuss this episode and leave feedback in the Club TWiT Discord.

Ready for a deep dive into a real-life pediatric ICU situation? Today, Dr. Pradip Kamat, Dr. Monica Gray, and Dr. Rahul Damania will walk you through the case of a seven-year-old girl with Hemoglobin SC (HbSC) disease, who presents with abdominal swelling, pneumonia, low oxygen, and pain.In this episode, our team unpacks the spleen's anatomy and its crucial role in immunity, then zooms in on how sickle cell disease can throw a wrench in splenic function. You'll hear how they approach the diagnosis and management of acute splenic sequestration crisis, sharing clinical pearls along the way. Plus, they'll break down why quick recognition is so important and discuss strategies for both immediate and long-term care in pediatric sickle cell patients. Don't miss these practical insights from the frontlines of pediatric critical care!Show Highlights:Case study of a seven-year-old girl with hemoglobin SC diseasePresentation of symptoms: abdominal distension, pneumonia, hypoxia, and body painDiscussion of acute splenic sequestration crisis as a complication of sickle cell diseaseAnatomy and physiology of the spleenThe role of the spleen in sickle cell disease and how sickled cells affect splenic functionAcute splenic sequestration crisis, including clinical features and laboratory evaluationsManagement strategies for acute splenic sequestration crisis in the ICUImportance of blood transfusions and supportive care in treatmentProphylactic measures to prevent recurrence of splenic sequestrationEducational emphasis on recognizing clinical signs and the need for timely interventionReferences:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 88. Hemoglobinopathies. Baender, MA, Marsh Anne. Pages: 1457-1470Rogers' textbook of pediatric intensive care: Hematologic Emergencies. McCory MC, Bhar S, and Blaine E. Pages 2003-2005Brousse V, Buffet P, Rees D. The spleen and sickle cell disease: the sick(led) spleen. Br J Haematol. 2014 Jul;166(2):165-76. doi: 10.1111/bjh 12950. Epub 2014 May 26. PMID: 24862308.Waleed S, Aldabsa M, Gouher S. Splenic Sequestration Induced by Parvovirus B19: A Case Report. Cureus. 2024 May 23;16(5):e60937. doi: 10.7759/cureus. 60937. PMID: 38915956; PMCID: PMC11195323.Solanki DL, Kletter GG, Castro O. Acute splenic sequestration crises in adults with sickle cell disease. Am J Med. 1986 May;80(5):985-90. doi: 10.1016/0002-9343(86)90649-2. PMID: 3706382.Karna B, Jha SK, Al Zaabi E. Hemoglobin C Disease. [Updated 2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559043/

Drs. Whitney Hartlage (@whithartlage11) and Sam Windham join Dr. Ryan Moenster to discuss updates in the diagnosis and management of community-acquire pneumonia. Hear from our guests on the role of rapid diagnostic tests such as multiplex PCR and urinary antigen tests in the inpatient and outpatient setting, considerations for initiating steroids and withholding macrolides, and when to use short antibiotic durations. Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/. Visit our website! https://breakpoints-sidp.org/ References: Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, Cooley LA, Dean NC, Fine MJ, Flanders SA, Griffin MR, Metersky ML, Musher DM, Restrepo MI, Whitney CG. 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. PMID: 31573350; PMCID: PMC6812437. Chaudhuri D, Nei AM, Rochwerg B, Balk RA, Asehnoune K, Cadena R, Carcillo JA, Correa R, Drover K, Esper AM, Gershengorn HB, Hammond NE, Jayaprakash N, Menon K, Nazer L, Pitre T, Qasim ZA, Russell JA, Santos AP, Sarwal A, Spencer-Segal J, Tilouche N, Annane D, Pastores SM. 2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia. Crit Care Med. 2024 May 1;52(5):e219-e233. doi: 10.1097/CCM.0000000000006172. Epub 2024 Jan 19. PMID: 38240492. Odeyemi Y, Tekin A, Schanz C, Schreier D, Cole K, Gajic O, Barreto E. Comparative effectiveness of azithromycin versus doxycycline in hospitalized patients with community acquired pneumonia treated with beta-lactams: A multicenter matched cohort study. Clin Infect Dis. 2025 May 16:ciaf252. doi: 10.1093/cid/ciaf252. Epub ahead of print. PMID: 40378193. Butler AM, Nickel KB, Olsen MA, Sahrmann JM, Colvin R, Neuner E, O'Neil CA, Fraser VJ, Durkin MJ. Comparative safety of different antibiotic regimens for the treatment of outpatient community-acquired pneumonia among otherwise healthy adults. Clin Infect Dis. 2024 Oct 23:ciae519. doi: 10.1093/cid/ciae519. Epub ahead of print. PMID: 39442057; PMCID: PMC12355227. Furukawa Y, Luo Y, Funada S, Onishi A, Ostinelli E, Hamza T, Furukawa TA, Kataoka Y. Optimal duration of antibiotic treatment for community-acquired pneumonia in adults: a systematic review and duration-effect meta-analysis. BMJ Open. 2023 Mar 22;13(3):e061023. doi: 10.1136/bmjopen-2022-061023. PMID: 36948555; PMCID: PMC10040075 Schober T, Wong K, DeLisle G, et al. Clinical outcomes of rapid respiratory virus testing in emergency departments. JAMA Intern Med. 2024;184(5):528-536. Clark T, Lindsley K, Wigmosta T, et al. Rapid multiplex PCR for respiratory viruses reduces time to result and improves clinical care: results of a systematic review and meta-analysis. J Infect. 2023;86(5):462-475. May L, Robbins EM, Canchola JA, Chugh K, Tran NK. A study to assess the impact of the cobas point-of-care RT-PCR assay (SARS-CoV-2 and Influenza A/B) on patient clinical management in the emergency department of the University of California at David Medical Center. J Clin Virol. 2023:168:105597. Cartuliares MB, Rosenvinge FS, Mogensen CB, Skovsted TA, Andersen SL, Østergaard C, et al. Evaluation of point-of-care multiplex polymerase chain reaction in guiding antibiotic treatment of patients acutely admitted with suspected community-acquired pneumonia in Denmark: a multicentre randomised controlled trial. PLoS Med. 2023;20:e1004314. doi: 10.1371/ journal.pmed.1004314. Vaughn VM, Dickson RP, Horowitz JK, Flanders SA. Community-acquired pneumonia: a review. JAMA. 2024;332(15):1282-1295. Davis MR, McCreary EK, Trzebucki AM. Things we do for no reason – ordering Streptococcus pneumoniae urinary antigen in patients with community-acquired pneumonia. Open Forum Infect Dis. 2024;11(3):ofae089. Centers for Disease Control and Prevention. Laboratory Testing for Legionella. Updated June 9, 2025. Accessed July 13, 2025. https://www.cdc.gov/legionella/php/laboratories/index.html. Jain S, Self WH, Wunderink RG. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015;373(5):415-427. Kamat IS, Ramachandram V, Eswaran H, Guffey D, Musher DM. Procalcitonin to distinguish viral from bacterial pneumonia: a systematic review and meta-analysis. Clin Infect Dis. 2020;70(3):538-542. Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single blinded intervention trial. Lancet. 2004;363:600–7. doi: 10.1016/S0140- 6736(04)15591-8. Schuetz P, Christ-Crain M, Thomann R, Falconnier C, Wolbers M, Widmer I, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA. 2009;302:1059–66. Schuetz P, Muller B, Christ-Crain M, Stolz D, Tamm M, Bouadma L, et al. Procalci- € tonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Datab System Rev. 2017;10(10):CD007498. doi: 10.1002/14651858. cd007498.pub2. Huang DT, Yealy DM, Filbin MR, Brown AM, Chang C-CH, Doi Y, et al. Procalcitonin-guided use of antibiotics for lower Respiratory tract infection. New Engl J Med. 2018;379:236–49. doi: 10.1056/NEJMoa1802670. Dequin PF, Meziani F, Quenot JP, et al. Hydrocortisone in severe community-acquired pneumonia. N Engl J Med. 2023;389(19):1623-1634. doi:10.1056/NEJMoa2215145. Gupta AB, Flanders SA, Petty LA, et al. Inappropriate diagnosis of pneumonia among hospitalized adults. JAMA Intern Med. 2024;184(5):548-556. Jones BE, Chapman AB, Ying J, et al. Diagnostic Discordance, Uncertainty, and Treatment Ambiguity in Community-Acquired Pneumonia: A National Cohort Study of 115 U.S. Veterans Affairs Hospitals. Ann Intern Med. 2024;177(9):1179-1189. doi:10.7326/M23-2505. Hartlage W, Imlay H, Spivak ES. The role of empiric atypical antibiotic coverage in non-severe community-acquired pneumonia. Antimicrob Steward Healthc Epidemiol. 2024;4(1):e214. doi:10.1017/ash.2024.453. Dinh A, Barbier F, Bedos JP, et al. Update of guidelines for management of community acquired pneumonia in adults by the French Infectious Disease Society (SPILF) and the French-Speaking Society of Respiratory Diseases (SPLF). Endorsed by the French Infectious Disease Society (SPILF) and the French-Speaking Society of Respiratory Diseases (SPLF); endorsed by the French Intensive Care Society (SRLF), the French Microbiology Society (SFM), the French Radiology Society (SFR), and the French Emergency Society (SFMU). Respir Med and Res. 2025. El Moussaoui R, de Borgie CAJM, van den Broek P, et al. Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate-severe community acquired pneumonia: randomised, double blind study. BMJ. 2006;332(7554):1355. doi:10.1136/bmj.332.7554.1355. Dinh A, Ropers J, Duran C, et al. Discontinuing β-lactam treatment after 3 days for patients with community-acquired pneumonia: a randomized, non-inferiority trial. Lancet. 2021;397(10280):1195-1203.

Welcome to Teeth & Titanium, Episode 58 – Craniums & Clavicles This episode features: Current Events-   The Team is back-   Oscar's new addition-   Wendall's zone coverage-   Oscar's TNT ICOMS critique-   Is a Michelin Star restaurant worth it? Fan mail-   Response to Dr. Engelstad's Episode Resident reminder            -  Preoperative evaluation Journal Club-   Keep the Change-   Value of Personal Engagement Versus Delegation in Surgical Practice-   Alveoloplasty: A Paradigm Shift to a More Efficient Surgical Technique Recommendations            - Wendall's classics            - Oscar's poetry            - How to break a clavicle while having fun Be sure to subscribe so you never miss an episode! Apple / Spotify / Google / Online links Thanks to the CAOMS/ICOMS for their continued support of this podcast. https://www.caoms.com.  If you would like to contact us, be a guest, or would like to submit a topic for Resident Reminder or Journal club, please email us at: teethandtitaniumOMFS@gmail.com Hosted by Dr. Wendall Mascarenhas & Dr. Oscar DalmaoProduced by Dr. Brad W. Ray Articles/Books cited in this episode: AAOMS Anesthesia Office Evaluation Manual; https://7157e75ac0509b6a8f5c-5b19c577d01b9ccfe75d2f9e4b17ab55.ssl.cf1.rackcdn.com/MHFRHKOX-PDF-2-487959-4451953868.pdf Dodson TB. Keep the Change. J Oral Maxillofac Surg. 2025 Aug;83(8):917-918. Kaban LB, Posnick JC. Value of Personal Engagement Versus Delegation in Surgical Practice. J Oral Maxillofac Surg. 2025 Aug;83(8):919-921. Buschman JA. Alveoloplasty: A Paradigm Shift to a More Efficient Surgical Technique. J Oral Maxillofac Surg. 2025 Aug;83(8):996-999. doi: 10.1016/j.joms.2025.04.016. Epub 2025 Apr 30.

In this episode, we're diving headfirst into the world of baby wearing with Jordan Morillo, a perinatal health OT, certified babywearing consultant, and toddler mom. We're talking everything from the ABCs of carrier choices to spotting a perfect carry (and avoiding the not-so-perfect ones). You'll learn how to safely position your baby, back carry like a pro, tandem wear without losing your mind, and even breastfeed on the go. We tackle fears, hot-weather hacks, and ethical carrier picks, so whether you're a newbie or a seasoned wearer, you'll walk away confident, informed, and ready to rock that baby wearing life. 00:00 Introduction and Importance of Baby Wearing 05:42 Key Safety Components: The ABCs of Baby Wearing 08:53 Understanding the M Position for Baby's Legs 15:21 Choosing the Right Baby Carrier 20:59 Addressing Common Concerns and Misconceptions 25:03 Risks and Benefits of Baby Wearing 29:36 Special Considerations for NICU and Preemie Babies 33:40 Misleading Marketing and Safety Testing 39:22 Addressing Baby's Discomfort with Carriers 39:45 Tips for Easing Baby into Baby Wearing 41:05 Understanding Baby's Resistance to Carriers 45:14 Debunking Myths: Baby Wearing and Clinginess 48:52 Breastfeeding Benefits and Baby Wearing 50:55 Toddler Wearing: Tips and Techniques 54:44 Tandem Wearing: Managing Two Kids 56:21 Forward Facing: When and How 01:00:21 Favorite Carriers for Different Scenarios 01:07:44 Water Safe Baby Wearing 01:11:22 Final Thoughts and Takeaways   Guest Bio: Jordan Morillo is a perinatal health OT, certified babywearing consultant, and toddler mom, who is passionate about empowering families with the knowledge they need to babywear safely, comfortably, and with confidence. She provides parent support through worldwide virtual 1:1 consultations, home health services, and by sharing free resources and tutorials on social media. INSTAGRAM: Connect with HeHe on IG  Connect with HeHe on YouTube   Connect with Jordan on IG    BIRTH EDUCATION: Join The Birth Lounge here for judgment-free childbirth education that prepares you for an informed birth and how to confidently navigate hospital policy to have a trauma-free labor experience!   Download The Birth Lounge App for birth & postpartum prep delivered straight to your phone!   LINKS MENTIONED: Visit Motherhoodtherapyservices.janeapp.com to book a consultation with Jordan!  Babywearing Resources Everyday Carriers Hoppediz Primeo – https://hoppediz.de/en/baby-carriers/primeo A buckle carrier that's perfect for smaller babies. Neko Tiny – https://www.nekoslings.com/en/ A stretchy wrap–buckle hybrid carrier for newborns. Solly Baby – https://sollybaby.com/ Lightweight stretchy wraps designed for comfort in the early months. Boba – https://boba.com/ Known for soft structured carriers and stretchy wraps. Ring Slings – Popular ones are from Sakura Bloom https://sakurabloom.com/collections/ring-sling and Mama & Roos https://www.mama-roo.com/collections/ring-slings Easy to adjust and stylish for on-the-go babywearing. Onbuhimo Buckle Carrier Strap-and-back-only carrier, ideal for toddlers who want up and down often. Forward Facing Options – ErgoBaby Omni https://ergobaby.com/omni-breeze-baby-carrier and Tula Explore https://babytula.com/products/explore-baby-carrier Safe forward-facing carry for older babies. Jordan's favorite ethical/organic brands:  Ethically made, sustainable carriers with thoughtful design. Hope & Plum https://www.hopeandplum.co/collections/baby-carriers Heritage Baby Designs https://heritagebaby.ca/ LoveHeld https://loveheld.com/collections/shop-all-baby-carriers  Beluga Baby https://belugababy.ca/ Size Inclusive Carriers Ring Slings – Sakura Bloom https://sakurabloom.com/collections/ring-sling, Mama & Roos https://www.mama-roo.com/collections/ring-slings Adjustable and versatile for all body types. Woven Wraps – Didymos https://www.didymos.de/en/Baby-Wraps/, Oscha Slings https://oschaslings.com/collections/baby-wraps Endless tying options for perfect fit and comfort. Keep Close(r) – https://keepcloser.com/ Designed specifically with plus-size parents in mind. Kinderpack – https://kindercarry.com/ Extended sizes and supportive structure for all bodies. Integra Baby – https://integrababy.co.uk/ Lightweight carriers with adjustable straps for inclusivity. Hope & Plum – https://www.hopeandplum.co/collections/baby-carriers Ring slings made for every parent's comfort. LoveHeld – https://loveheld.com/collections/shop-all-baby-carriers Soft, ethically made carriers with flexible sizing. Tula Belt Extenders – https://babytula.com/products/tula-waistband-extenders Expand Tula carriers for a more inclusive fit. Meh Dai Carriers – Didymos https://www.didymos.de/en/Meh-Dai/, BabyHawk https://babyhawk.com/ Tie-on carriers with a customizable fit. Lamb (Europe) – https://lamb-babycarriers.com/ European-made woven carriers, size-friendly. WildBird – https://wildbird.co/ Long-tail ring slings for flexible carrying options. Water Wearing Carriers Integra Solar – https://integrababy.co.uk/collections/integra-solar Quick-drying, lightweight carrier for water activities. Hope & Plum Hemp Sling – https://www.hopeandplum.co/collections/baby-carriers Breathable sling, perfect for summer and pool days. LoveHeld Hemp Carrier – https://loveheld.com/collections/shop-all-baby-carriers Durable hemp blend, suitable for water and sun. Aloha & Light Eco Silk Hemp Blend – https://alohaandlight.com/ Soft, eco-friendly slings designed for hot climates. Beachfront Baby – https://beachfrontbabywraps.com/ Mesh Meh Dais and wraps made for swimming and beach days. Gustine Mesh Sling – https://gustinebabycarriers.com/ Breathable mesh sling perfect for water play. RESEARCH: Study on reduction of PMADs: Randomized controlled trial to prevent postpartum depressive symptomatology: An infant carrier intervention. Little EE, Bain L, Hahn-Holbrook J. J Affect Disord. 2023 Nov 1;340:871-876. doi: 10.1016/j.jad.2023.08.044. Epub 2023 Aug 15. PMID: 37586649. Study on decreased cry time when worn: Increased Carrying Reduces Infant Crying: A Randomized Controlled Trial.Urs A. Hunziker; Ronald G. Barr. Pediatrics (1986) 77 (5): 641–648 Vital signs regulation:  https://pubmed.ncbi.nlm.nih.gov/39369660/ 

Jasmine Gonzalvo, PharmD, MPH, CDCES, FADCES, joins this episode to discuss the importance of curiosity, effective communication and cultural sensitivity in diabetes care. She shares her personal approach to exploring barriers to insulin in clients and highlights how motivational interviewing can be a powerful tool in navigating treatment conversations—especially when addressing common misconceptions about insulin. The conversation emphasizes the importance of open-ended questions, recognizing personal biases, and creating safe spaces for honest dialogue. By nurturing relationships and meeting patients where they are, diabetes care and education specialists can better support lasting behavior change and improve health outcomes.This episode is sponsored by Lilly. ResourcesA link to the insulin myths tip sheet mentioned in this episode is coming soon. ReferencesNahid Dehghan-Nayeri, Fatemeh Ghaffari, Tahereh Sadeghi, Naser Mozaffari; Effects of Motivational Interviewing on Adherence to Treatment Regimens Among Patients With Type 1 Diabetes: A Systematic Review. Diabetes Spectr 1 May 2019; 32 (2): 112–117.Guy E H M Rutten, Heidi Van Vugt, Eelco de Koning - Person-centered diabetes care and patient activation in people with type 2 diabetes: BMJ Open Diabetes Research & Care 2020;8:e001926.Entwistle VA, Carter SM, Cribb A, McCaffery K. Supporting patient autonomy: the importance of clinician-patient relationships. J Gen Intern Med. 2010 Jul;25(7):741-5. doi: 10.1007/s11606-010-1292-2. Epub 2010 Mar 6. PMID: 20213206; PMCID: PMC2881979. Listen to more episodes of The Huddle at adces.org/perspectives/the-huddle-podcast.Learn more about ADCES and the many benefits of membership at adces.org/join.

Primary hyperparathyroidism is an underdiagnosed condition which leads to decreased bone mineral density, fracture, renal disease, among other symptoms that can decrease the quality of a patient's life. Moreover, once diagnosed, only a small fraction of patients with the diease end up being offered surgery. Whether it is because of misunderstood indications and benefits of surgery, non-localization of disease, or various other reasons, we thought it was worthwhile to review relevant literature. Hosts: Dr. Becky Sippel is an endowed professor of surgery at Division Chief of endocrine surgery at University of Wisconsin Madison and she is the most recent past president of the AAES.  She is an internationally recognized leader in the field of endocrine surgery. She has over 250 publications. She was the PI for a RCT which studies prophylactic central neck dissections which is a widely read and quoted study in endocrine surgery. Dr. Amanda Doubleday is a fellowship trained endocrine surgeon in private practice with an affiliation to UW Health. Her primary practice is with Waukesha Surgical Specialists in Waukesha WI.  Dr. Simon Holoubek is a fellowship trained endocrine surgeons affiliated with UW Health. He works for UW Health with privileges at UW Madison and UW Northern Illinois. His clinical interests are aggressive variants of thyroid cancer, parathyroid autofluorescence, and nerve monitoring.  Learning Objectives: 1 Understand the natural history of primary hyperparathyroidism and how the disease process can affect bone mineral density. 2 Learn about fracture risk associated with primary hyperparathyroidism. 3 Learn about decreased fracture risk in patients with primary hyperparathyroidism who have parathyroidectomy compared to those who are observed.  References: 1 Rubin MR, Bilezikian JP, McMahon DJ, Jacobs T, Shane E, Siris E, Udesky J, Silverberg SJ. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab. 2008 Sep;93(9):3462-70. doi: 10.1210/jc.2007-1215. Epub 2008 Jun 10. PMID: 18544625; PMCID: PMC2567863. https://pubmed.ncbi.nlm.nih.gov/18544625/ 2 Frey S, Gérard M, Guillot P, Wargny M, Bach-Ngohou K, Bigot-Corbel E, Renaud Moreau N, Caillard C, Mirallié E, Cariou B, Blanchard C. Parathyroidectomy Improves Bone Density in Women With Primary Hyperparathyroidism and Preoperative Osteopenia. J Clin Endocrinol Metab. 2024 May 17;109(6):1494-1504. doi: 10.1210/clinem/dgad718. PMID: 38152848. https://pubmed.ncbi.nlm.nih.gov/38152848/ 3 VanderWalde LH, Liu IL, Haigh PI. Effect of bone mineral density and parathyroidectomy on fracture risk in primary hyperparathyroidism. World J Surg. 2009 Mar;33(3):406-11. doi: 10.1007/s00268-008-9720-8. PMID: 18763015. https://pubmed.ncbi.nlm.nih.gov/18763015/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

This is a requested follow up to our most recent episode. Menopausal hormone therapy (HT) prescribing practices have evolved over the last few decades guided by the changing understanding of the treatment's risks and benefits. We know that dose, route of administration, and choice of agent (estradiol versus a more synthetic option, and micronized progesterone over other progestins.) alter the risk benefit ratio. Compared to natural progesterone, synthetic progestins have 10-100- fold greater activity. Synthetic MPA is vasoconstrictive while natural progesterone and drospirenone cause vasodilation and lower blood pressure. Micronized progesterone is bioidentical to the hormone made endogenously and has efficient oral absorption. Progestogens come in oral and transdermal forms, and it can also be given vaginally. Is there data that micronized progesterone is safer for the breast for a menopausal hormone therapy? This podcast topic recommendation comes from one of our podcast family members. Listen for details. 1. Gompel A. Micronized progesterone and its impact on the endometrium and breast vs. progestogens. Climacteric. 2012 Apr;15 Suppl 1:18-25. doi: 10.3109/13697137.2012.669584. PMID: 22432812.2. Stute P, Wildt L, Neulen J. The impact of micronized progesterone on breast cancer risk: a systematic review. Climacteric. 2018 Apr;21(2):111-122. doi: 10.1080/13697137.2017.1421925. Epub 2018 Jan 31. PMID: 29384406.3. Eden J. The endometrial and breast safety of menopausal hormone therapy containing micronised progesterone: A short review. Aust N Z J Obstet Gynaecol. 2017 Feb;57(1):12-15. doi: 10.1111/ajo.12583. PMID: 28251642.4. Asi N, Mohammed K, Haydour Q, Gionfriddo MR, Vargas OL, Prokop LJ, Faubion SS, Murad MH. Progesterone vs. synthetic progestins and the risk of breast cancer: a systematic review and meta-analysis. Syst Rev. 2016 Jul 26;5(1):121. doi: 10.1186/s13643-016-0294-5. PMID: 27456847; PMCID: PMC4960754.5.AHA J Circulation: Rethinking Menopausal Hormone Therapy: For Whom, What, When, and How Long? 2023

We've covered pre-oxygenation strategies and intubation alot on this podcast, mayber more than anyting else. We covered the definition of FPS in E74, the DEVICE trial on DL vs VL in E75, and the PREOXI trial of NIV vs Mask Pre-oxygenation in E86. Now we have another Preoxygenation paper, this one that reports no difference between preoxygenation with BVM and face mask. WTAF? Better listen, because it turns out words matter, definitions are... definitional, and we absolutely MUST read more than just the abstract.  Citations:1.     Gottlieb M, Alexander R, Love AK: Comparison of Preoxygenation Strategies for Intubation of Critically Ill Patients. Annals of Emergency Medicine. doi: 10.1016/j.annemergmed.2025.06.621 (Epub ahead of print).2.     Chou CD, Palakshappa JA, Haynie H, Garcia K, Long D, Gibbs KW, White HD, Ghamande S, Dagan A, Stempek S, et al.: Association of Two Preoxygenation Approaches With Hypoxemia During Tracheal Intubation: A Secondary Analysis. Annals of Emergency Medicine. doi: 10.1016/j.annemergmed.2025.06.003 (Epub ahead of print).3.     Pitre T, Liu W, Zeraatkar D, Casey JD, Dionne JC, Gibbs KW, Ginde AA, Needham-Nethercott N, Rice TW, Semler MW, et al.: Preoxygenation strategies for intubation of patients who are critically ill: a systematic review and network meta-analysis of randomised trials. The Lancet Respiratory Medicine. 2025;July;13(7):585–96.4.     Gibbs KW, Semler MW, Driver BE, Seitz KP, Stempek SB, Taylor C, Resnick-Ault D, White HD, Gandotra S, Doerschug KC, et al.: Noninvasive Ventilation for Preoxygenation during Emergency Intubation. N Engl J Med. doi: 10.1056/NEJMoa2313680 (Epub ahead of print).5.     Prekker ME, Driver BE, Trent SA, Resnick-Ault D, Seitz KP, Russell DW, Gaillard JP, Latimer AJ, Ghamande SA, Gibbs KW, et al.: Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. N Engl J Med. 2023;June 16;389(5):418–29.6.     Trent SA, Kaji AH, Carlson JN, McCormick T, Haukoos JS, Brown CA, National EARI: Video Laryngoscopy is Associated With First-Pass Success in Emergency Department Intubations for Trauma Patients: A Propensity Score Matched Analysis of the National Emergency Airway Registry. Ann Emerg Med. doi: 10.1016/j.annemergmed.2021.07.115 (Epub ahead of print).

In the second half of this two part episode, Dr. David Leon unpacks some of the most hotly debated topics in resuscitation—fluids, blood products, ECMO, and post-arrest care. He breaks down the pros and cons of crystalloids (yes, even the “pasta water” debate), explains why lactated Ringer's is often preferred over normal saline, and dips into the use of albumin and colloids. Dr. Leon also discusses the promise and challenges of extracorporeal life support (ECLS), the evolving role of targeted temperature management (TTM), and even peeks into what advances the future might hold. It's a thoughtful, forward-looking conversation every resuscitationist should hear. What do you think of Dr. Leon's tips? Are you using these tools in your practice? We'd love to hear from you. Share them with us on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. David Leon, Assistant Professor of Emergency Medicine and Anesthesia at UC Davis Resources: American Heart Association (AHA) Algorithms Perman SM, Elmer J, Maciel CB, Uzendu A, May T, Mumma BE, Bartos JA, Rodriguez AJ, Kurz MC, Panchal AR, Rittenberger JC; American Heart Association. 2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2024 Jan 30;149(5):e254-e273. doi: 10.1161/CIR.0000000000001194. Epub 2023 Dec 18. PMID: 38108133. **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In this episode of the Saving Lives Podcast, Eddy Joe breaks down a 2025 Journal of Critical Care study examining how the choice of the internal jugular vein for initial central line placement impacts outcomes when patients later need hemodialysis catheters. You'll learn why using the left IJV first may reduce the need for repeat procedures and complications. Essential insights for optimizing central line strategy in the ICU.The Vasopressor & Inotrope HandbookAmazon: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Affiliate Link)My Store: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)Citation: Gharaibeh KA, Abdelhafez MO, Guedze KEB, Siddiqi H, Hamadah AM, Verceles AC. Impact of initial jugular vein insertion site selection for central venous catheter placement on hemodialysis catheter complications. J Crit Care. 2025 Jun;87:155011. doi: 10.1016/j.jcrc.2024.155011. Epub 2025 Jan 3. PMID: 39755012.

When personalities clash, the users come last. Meanwhile, Chris' hyper-tuned setup stops being a toy and starts looking like a daily driver.Sponsored By:Managed Nebula: Meet Managed Nebula from Defined Networking. A decentralized VPN built on the open-source Nebula platform that we love. 1Password Extended Access Management: 1Password Extended Access Management is a device trust solution for companies with Okta, and they ensure that if a device isn't trusted and secure, it can't log into your cloud apps. Unraid: A powerful, easy operating system for servers and storage. Maximize your hardware with unmatched flexibility. Support LINUX UnpluggedLinks:

Send us a textWhole-Body Hypothermia for Neonatal Encephalopathy in Preterm Infants 33 to 35 Weeks' Gestation: A Randomized Clinical Trial.Faix RG, Laptook AR, Shankaran S, Eggleston B, Chowdhury D, Heyne RJ, Das A, Pedroza C, Tyson JE, Wusthoff C, Bonifacio SL, Sánchez PJ, Yoder BA, Laughon MM, Vasil DM, Van Meurs KP, Crawford MM, Higgins RD, Poindexter BB, Colaizy TT, Hamrick SEG, Chalak LF, Ohls RK, Hartley-McAndrew ME, Dysart K, D'Angio CT, Guillet R, Kicklighter SD, Carlo WA, Sokol GM, DeMauro SB, Hibbs AM, Cotten CM, Merhar SL, Bapat RV, Harmon HM, Sewell E, Winter S, Natarajan G, Mosquera R, Hintz SR, Maitre NL, Benninger KL, Peralta-Carcelen M, Hines AC, Duncan AF, Wilson-Costello DE, Trembath A, Malcolm WF, Walsh MC; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.JAMA Pediatr. 2025 Apr 1;179(4):396-406. doi: 10.1001/jamapediatrics.2024.6613.PMID: 39992674 Free PMC article. Clinical Trial.EBNEO Commentary: Is Therapeutic Hypothermia Beneficial to Infants Born Between 33 and 35 Weeks Gestation?Spahic H, Zoubovsky SP, Dietz RM.Acta Paediatr. 2025 Jul;114(7):1742-1743. doi: 10.1111/apa.70098. Epub 2025 Apr 18.PMID: 40251839 No abstract available.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Today's episode shares effective strategies for making group classes feel personal through using your clients' names before, during, and after class. We look at what you can do to learn names and why it's important to make an effort to build community in your classes. Tune in!I want to hear from you! Share your thoughts and follow the podcast on Instagram and Facebook @pilatesteachersmanual. Full show notes, episode transcription, and chapter markers can be found on the podcast website here: http://bit.ly/pilatesteachersmanual. Be sure to subscribe to the podcast for updates, and rate and review wherever you listen!  Episodes now available on YouTube: *https://bit.ly/YouTubePTM*Email pilatesteachersmanual@oliviabioni.com with your feedback.  Show Notes:   You can purchase the EPUB or PDF version of the book here and convert to a Kindle friendly file here: https://amazon.com/sendtokindleSupport the podcast:   Get your copy of Pilates Teachers' Manual: The Book at https://book.oliviabioni.com/pilatesteachersmanualVisit https://shop.oliviabioni.com for podcast merch! Visit https://links.oliviabioni.com/affiliates to take advantage of some sweet savings!Episode Music:Workout Dance Day EDM by Diamond_Tunes, in compliance with Pixabay's Content License (https://pixabay.com/service/license-summary/)Listen/download: https://pixabay.com/music/dance-workout-dance-day-edm-123377/Support the show

In this episode, we dive into a new pilot RCT exploring the addition of acetazolamide to furosemide in critically ill patients. We break down the study's methods, findings, and practical implications for fluid management in the ICU. Could this inexpensive, decades-old drug be the key to sustaining diuresis and preventing metabolic alkalosis? Tune in to find out.The Vasopressor & Inotrope HandbookAmazon: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Affiliate Link)My Store: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)Citation: Maeda A, Brown A, Spano S, Chaba A, Phongphithakchai A, Hikasa Y, Pattamin N, Kitisin N, Nübel J, Nielsen B, Holmes J, Peck L, Young H, Eastwood G, Bellomo R, Neto AS. Furosemide with adjunctive acetazolamide vs furosemide only in critically ill patients: A pilot two-center randomized controlled trial. J Crit Care. 2025 Apr;86:155002. doi: 10.1016/j.jcrc.2024.155002. Epub 2024 Dec 16. PMID: 39689380.