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Careful assessment and individualized care, provided by a skilled multidisciplinary care team, are emphasized in the holistic approach to neuropalliative care, which considers physical, psychological, social, spiritual, and existential aspects for people with neuromuscular diseases. In this episode, Gordon Smith, MD, FAAN, speaks with David J. Oliver, PhD, FRCP, FRCGP, FEAN, author of the article "Neuropalliative Care in Neuromuscular Disorders" in the Continuum® December 2025 Neuropalliative Care issue. Dr. Smith is a Continuum® Audio interviewer and a professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. Oliver is an honorary professor of Tizard Centre at the University of Kent in Canterbury, United Kingdom. Additional Resources Read the article: Neuropalliative Care in Neuromuscular Disorders Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @gordonsmithMD Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Smith: Hello, this is Dr Gordon Smith. Today I've got the great pleasure of interviewing Dr David Oliver about his article on neuropalliative care and neuromuscular disorders, which appears in the December 2025 Continuum issue on neuropalliative care. David, welcome to the Continuum podcast, and please introduce yourself to our audience. Dr Oliver: Thank you. It's a pleasure and a privilege to be here. I'm a retired consultant in palliative medicine in the UK. I worked at the Wisdom Hospice in Rochester for over thirty years, and I'm also an honorary professor at the University of Kent in Canterbury in the UK. I've had a long interest in palliative care in neurological diseases. Hopefully we can talk about a bit later. Dr Smith: I really look forward to learning a little bit more about your path and experiences. But I wonder if, before we get into the meat of neuropalliative care with a focus on neuromuscular, if maybe you can kind of set the stage by just defining palliative care. I mean, my experience is that people think of this in different ways, and a lot of folks think- hear palliative care, and they immediately go to end-of-life care or comfort care. So, what- how should we think about maybe the discipline of palliative care or neuropalliative care? Dr Oliver: I see palliative care as very much responding to people's needs, whether that's physical needs, psychological needs, social or spiritual or existential. So, it can be much earlier in the disease progression. And I think particularly for neurological diseases, early involvement may be very important. Dr Smith: That was actually going to be my first substantive question, really, was when to begin the conversation and what does that look like and how does it evolve over time. You have a really great figure in the article that kind of emphasizes the various stages within a patient's journey that, you know, palliative care can become involved. But I wonder if you could use ALS as a good example and describe what that looks like from when a patient is first diagnosed with ALS through their course? Dr Oliver: I think particularly in ALS at the beginning, soon after diagnosis, someone may have a lot of distress and a lot of questions that they need answering. This is a disease they've not had any contact with before. And they don't understand what's going on, they don't understand the disease. So, there may be a great need to have the opportunity to talk about the disease, what may happen, what is happening, how it's going to affect them and their family. As think time goes on, there may be later they develop swallowing problems, and that will need to be talking about a feeding tube and gastrostomy. And again, there may be a lot of issues for the person and their family. As they deteriorate, they may have respiratory problems and need to have discussion about ventilatory support, either by PAP, noninvasive ventilation, or even tracheostomy. And again, I think that's a big issue that needs wide discussion. And then it may be at the final few months of the disease, where they are deteriorating, that they may have increased needs, and their families may have those needs after the death. And I think often families bereaved from someone with a neurological disease such as ALS need a great deal of support, having many mixed emotions. There may be a feeling of relief that they're not involved in that caring, but then a feeling of guilt that they shouldn't be having those feelings. So, I think that can happen over a period of… what with ALS it may be two, three, four years, but it may be similar changes over time with any patient with a neurological disease. It may be ten or fifteen years with Parkinson's or five to ten years with a progressive supranuclear palsy, but there'll be this similar need to look at palliative care during their disease progression. Dr Smith: So, I'm curious at the time of diagnosis of ALS, how far out in the future do you provide information? So a specific question would be, do you talk about end-of-life management? In my experience, ALS patients are sometimes interested in knowing about that. Or do you really focus on what's in front of you in the next three to six months, for instance? Dr Oliver: I think it's both. Obviously, we need to talk about the next three to six months, but often giving patients the opportunity to talk about what's going to happen in the future, what may happen at the end of life, I think is important. And I think a disease like ALS, if they look it up on the Internet, they may have a lot of very distressing entries there. There's a lot about how distressing dying with ALS is. And actually confront those and discuss those issues early is really important. Dr Smith: So of course, the other thing that comes up immediately with an ALS diagnosis---or, for that matter, with any other neurodegenerative problem---is prognosis. Do you have guidance and how our listeners who are giving a diagnosis of ALS or similar disorder should approach the prognostication discussion? Dr Oliver: It's often very difficult. Certainly in the UK, people may have- be a year into their disease from their first symptoms before they're diagnosed, and I've seen figures, that's similar across the world. So, people may be actually quite way through their disease progression, but I do think we have to remember that the figures show that at five years, 25% of people are still alive, and 5 to 10% are still alive at ten years. We mustn't say you are going to die in the next two or three years, because that may not be so. And I think to have the vagueness but also the opportunity to talk, that we are talking of a deterioration over time and we don't know how that will be for you. I always stress how individual I think ALS is for patients. Dr Smith: One of the other concepts that is familiar with anyone who does ALS and clearly comes through in your article---which is really outstanding, by the way. So, thank you and congratulations for that---is the importance of multidisciplinary teams. Can you talk a little bit about how neuropalliative care sits within a multidisciplinary care model? Dr Oliver: I think the care should be multidisciplinary. Certainly in the UK, we recommended multidisciplinary team care for ALS in particular, from the time of diagnosis. And I think palliative care should be part of that multidisciplinary team. It may be a member of the team who has that palliative care experience or someone with specialist experience. Because I think the important thing is that everyone caring for someone with ALS or other neuromuscular diseases should be providing palliative care to some extent: listening to people, discussing their goals, managing their symptoms. And a specialist may only be needed if those are more complicated or particularly difficult. So, I think it is that the team needs to work together to support people and their families. So, looking at the physical aspects where the physiotherapist or occupational therapist may be very important, the psychologicals are a counsellor or psychologist. The social aspects, most of our patients are part of wider families, and we need to be looking at supporting their carers and within their family as well as the person. And so that may involve social work and other professionals. And the spiritual, the why me, their fears about the future, may involve a spiritual counsellor or a chaplain or, if appropriate, a religious leader appropriate to that- for that person. So, I think it is that wider care provided by the team. Dr Smith: I'm just reflecting on, again, your earlier answers about the Continuum of neuropalliative care. Knowing your patient is super valuable here. So, having come to know someone through their disease course must pay dividends as you get to some of these harder questions that come up later during the disease progression. Dr Oliver: I think that's the very important use of palliative care from early on in the diagnosis. It's much easier to talk about, perhaps, the existential fears of someone while they can still talk openly. To do that through a communication aid can be very difficult. To talk about someone's fear of death through a communication aid is really very, very difficult. The multidisciplinary team, I think, works well if all the members are talking together. So that perhaps the speech therapist has been to see someone and has noticed their breathing is more difficult, comes back and talks to the doctor and the physiotherapist. The social worker notices the speech is more difficult and comes back and speaks to the speech therapist. So, I think that sort of team where people are working very closely together can really optimize the care. And as you said, knowing the person, and for them to know you and to trust you, I think that's important. Those first times that people meet is so important in establishing trust. And if you only meet people when they're very disabled and perhaps not able to communicate very easily, that's really difficult. Dr Smith: I think you're reading my mind, actually, because I was really interested in talking about communication. And you mentioned a few times in your article about voice banking, which is likely to be a new concept for many of our listeners. And I would imagine the spectrum of tools that are becoming available for augmented communication for patients who have ALS or other disorders that impair speech must be impressive. I wonder if you could give us an update on what the state of the art is in terms of approaching communication. Dr Oliver: Well, I think we all remember Stephen Hawking, the professor from Cambridge, who had a very robotic voice which wasn't his. Now people may have their own voice on a communication aid. I think the use of whether it's a mobile phone or iPad, other computer systems, can actually turn what someone types into their own voice. And voice banking is much easier than it used to be. Only a few years ago, someone would have to read for an hour or two hours so the computer could pick up all the different aspects of their voice. Now it's a few minutes. And it has been even- I've known that people have taken their answer phone off a telephone and used that to produce a voice that is very, very near to the person. So that when someone does type out, the voice that comes out will be very similar to their own. I remember one video of someone who'd done this and they called their dog, and the dog just jumped into the air when he suddenly heard his master's voice for the first time in several months. So, I think it's very dramatic and very helpful for the person, who no longer feels a robot, but also for their family that can recognize their father, their husband, their wife's speech again. Dr Smith: Very humanizing, isn't it? Dr Oliver: There is a stigma of having the robotic voice. And if we can remove that stigma and someone can feel more normal, that would be our aim. Dr Smith: As you've alluded to, and for the large majority---really all of our ALS patients, barring something unexpected---we end up in preparing for death and preparing for end of life. I wonder what advice you have in that process, managing fear of death and working with our patients as they approach the end of their journey. Dr Oliver: I think the most important thing is listening and trying to find what their particular concerns are. And as I said earlier, they may have understood from what they've read in books or the Internet that the death from ALS is very distressing. However, I think we can say there are several studies now from various countries where people have looked at what happens at the end of life for people with ALS. Choking to death, being very distressed, are very, very rare if the symptoms are managed effectively beforehand, preparations are made so that perhaps medication can be given quickly if someone does develop some distress so that it doesn't become a distressing crisis. So, I think we can say that distress at the end of life with ALS is unusual, and probably no different to any other disease group. It's important to make sure that people realize that with good symptom control, with good palliative care, there is a very small risk of choking or of great distress at the end of life. Dr Smith: Now, I would imagine many patients have multiple different types of fear of death; one, process, what's the pain and experience going to be like? But there's also being dead, you know, fear of the end of life. And then this gets into comments you made earlier about spirituality and psychology. How do you- what's your experience in handling that? Because that's a harder problem, it seems, to really provide concrete advice about. Dr Oliver: Yeah. And so, I think it's always important to know when someone says they're frightened of the future, to check whether it is the dying process or after death. I've got no answer for what's going to happen afterwards, but I can listen to what someone may have in their past, their concerns, their experience. You know, is their experience of someone dying their memories of someone screaming in pain in an upstairs bedroom while they were a child? Was their grandfather died? Trying to find out what particular things may be really a problem to them and that we can try and address. But others, we can't answer what's going to happen after death. If someone is particularly wanting to look at that, I think that may be involving a spiritual advisor or their local spiritual/religious leader. But often I think it's just listening and understanding where they are. Dr Smith: So, you brought up bereavement earlier and you discussed it in the article. In my experience is that oftentimes the families are very, very impacted by the journey of ALS. And while ALS patients are remarkably resilient, it's a huge burden on family, loved ones, and their community. Can you talk a bit about the role of palliative care in the bereavement process, maybe preparing for bereavement and then after the loss of their loved one? Dr Oliver: Throughout the disease progression, we need to be supporting the carers as much as we are the patient. They are very much involved. As you said, the burden of care may be quite profound and very difficult for them. So, it's listening, supporting them, finding out what their particular concerns are. Are they frightened about what's going to happen at the end of life as well? Are they concerned of how they're going to cope or how the person's going to cope? And then after the death, it's allowing them to talk about what's happened and how they are feeling now, cause I think having had that enormous input in care, then suddenly everything stops. And also, the support systems they've had for perhaps months of the carers coming in, the doctor, the nurse, the physiotherapist, everyone coming in, they all stop coming. So, their whole social system suddenly stops and becomes much reduced. And I'm afraid certainly in the UK if someone is bereaved, they may not have the contact with their friends and family because they're afraid to come and see them. So, they may become quite isolated and reduced in what they can do. So, I think it's allowing them to discuss what has happened. And I think that's as important sometimes for members of the multidisciplinary team, because we as doctors, nurses and the wider team will also have some aspects of bereavement as we face not seeing that person who we've looked after for many years and perhaps in quite an intensive way. So, we need to be looking at how we support ourselves. And I think that's another important role of the multidisciplinary team. I always remember in our team, sometimes I would say, I find this person really difficult to cope with. And the rest of the people around the team would go have a sigh of relief because they felt the same, but they didn't like to say. And once we could talk about it, we could support each other and work out what we could do to help us help the patient in the most effective way. Dr Smith: Well, David, I think that's a great point to end on. I think you've done a really great job of capturing why someone would want to be a palliative care specialist or be involved in palliative care, because one of the themes throughout this conversation is the very significant personal and care impact that you have on patients and families. So, I really appreciate your sharing your wisdom. I really encourage all of our listeners to check out the article, it's really outstanding. I wonder if maybe you might just briefly tell us a little bit about how you got into this space? It's obviously one for which you have a great deal of passion and wisdom. How did you end up where you are? Dr Oliver: I became interested in palliative care as a medical student, and actually I trained as a family doctor, but I went to Saint Christopher's Hospice following that. I had actually had contact with them while I was a medical student, so I worked Saint Christopher's Hospice in South London when Dame Cecily Saunders was still working there. And at that time Christopher's had sixty-two beds, and at least eight of those beds were reserved for people with ALS or other neurological diseases. And I became very involved in one or two patients and their care. And Dame Sicily Saunders asked me to write something on ALS for their bookshelf that they had on the education area. So, I wrote, I think, four drafts. I went from sort of C minus to just about passable on the fourth draft. And that became my big interest in particularly ALS, and as time went on, in other neurological diseases. When I went to the Wisdom Hospice as a consultant, I was very keen to carry on looking after people with ALS, and we involved ourselves with other neurological patients. That's how I got started. Having that interest, listening to patients, documenting what we did became important as a way of showing how palliative care could have a big role in neurological disease. And over the years, I've been pressing again and again for the early involvement of palliative care in neurological diseases. And I think that is so important so that there can be a proper holistic assessment of people, that they can build up the trust in their carers and in the multidisciplinary team so that they can live as positively as possible. And as a result of that, that their death will be without distress and with their family with them. Dr Smith: Well, David, you've convinced and inspired me, and I'm confident you have our listeners as well. Thank you so much for a really informative, enjoyable, inspiring conversation. Dr Oliver: Thank you for inviting me. Dr Smith: Again, today I've been interviewing Dr David Oliver about his article on neuropalliative care and neuromuscular disorders, which appears in the December 2025 Continuum issue on neuropalliative care. Be sure to check out Continuum Audio episodes from this and other issues, and thanks to our listeners for joining us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Tune into this podcast to revisit discussions led by global experts, Karine Lacombe, MD, PhD, and Chloe Orkin, MBChB, FRCP, MD, featuring the latest updates on HIV treatment and prevention from the 2025 IDWeek and EACS conferences.Topics covered include:Real-world safety and efficacy of long-acting ARTART switch: preferences, treatment satisfaction, changes in weight and metabolic parameters, and HBV reactivation riskInvestigational therapiesUpdates on long-acting PrEP: persistence, use in people with substance use disorder, and coadministration with gender-affirming hormone therapyHIV and STI screening with PrEPSTI prevention To download the accompanying slides, visit the program page for this episode:https://bit.ly/3MGvegMPresenters:Karine Lacombe, MD, PhDProfessor of MedicineSorbonne UniversityHead of Infectious Diseases UnitSt Antoine Hospital, AP-HPParis, FranceChloe Orkin, MBChB, FRCP, MDProfessor of Infection and InequitiesDean for Healthcare TransformationQueen Mary University of LondonFaculty of Medicine and DentistryHonorary Consultant PhysicianBarts Health NHS TrustLondon, United KingdomGet access to all of our new episodes by subscribing to the Decera Clinical Education Infectious Diseases Podcast on Apple Podcasts, YouTube Music, or Spotify. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Als Experte zu Gast ist Prim. Univ.-Prof. Dr. Mag. Eugen Trinka, FRCP, Leiter der Universitätsklinik für Neurologie, Neurologische Intensivmedizin und Neurorehabilitation der Paracelsus Medizinischen Privatuniversität am Campus Christian-Doppler-Klinik. Die Moderation übernimmt Dr.in Judith Jud, Medizinische Universität Wien, Ambulanz für Epilepsie.Die Folge behandelt praxisrelevante Aspekte der Diagnostik, Differentialdiagnose und Therapieentscheidung und richtet sich an neurologisch tätige Ärztinnen und Ärzte.

Jonathan Barratt, PhD, FRCP - 2025 Congress Highlights From Houston, Texas: Breaking Down the Data Driving Therapeutic Developments in IgA Nephropathy

Jonathan Barratt, PhD, FRCP - 2025 Congress Highlights From Houston, Texas: Breaking Down the Data Driving Therapeutic Developments in IgA Nephropathy

Jonathan Barratt, PhD, FRCP - 2025 Congress Highlights From Houston, Texas: Breaking Down the Data Driving Therapeutic Developments in IgA Nephropathy

Jonathan Barratt, PhD, FRCP - 2025 Congress Highlights From Houston, Texas: Breaking Down the Data Driving Therapeutic Developments in IgA Nephropathy

The Age of AI, Dharma, and Reality with Deepak Chopra Deepak Chopra, MD, FACP, FRCP, is a consciousness explorer and a world-renowned pioneer in integrative medicine and personal transformation. Dr. Chopra is co-founder of DeepakChopra.ai, his AI twin and well-being advisor. He also co-founded Cyberhuman.ai, a transformative suite of personalized health and well-being solutions. He is a Clinical Professor of Family Medicine and Public Health at the University of California, San Diego, and serves as a senior scientist with Gallup Organization. He is also an Honorary Fellow in Medicine at the Royal College of Physicians and Surgeons of Glasgow. TIME Magazine has described Dr. Chopra as “one of their top 100 most influential people.” He is the author of over 95 books, translated into over forty-three languages, including numerous New York Times bestsellers. His bestselling books include The Seven Spiritual Laws of Success; Ageless Body, Timeless Mind; Quantum Healing; The Book of Secrets; You Are the Universe; Life After Death; and The Way of the Wizard. His most recent book is Digital Dharma: How AI Can Elevate Spiritual Intelligence and Personal Well-Being. His mission is to create a more balanced, peaceful, joyful, and healthier world. His website is DeepakChopra.com. Deepak shares how artificial intelligence (AI) can become a tool for awakening rather than destruction. While acknowledging that technological progress has surpassed our emotional and spiritual evolution, he offers insight into how we can utilize AI to support our own movement toward wisdom, compassion, and dharma. Used consciously, it can help us remember who we are, deepen our spiritual intelligence, and live in greater alignment with our higher self. New Thinking Allowed CoHost, Emmy Vadnais, OTR/L, is an intuitive healer and health coach based in St. Paul, Minnesota. Emmy is the founder of the Intuitive Connections and Holistic OT communities. She is the author of Intuitive Development: How to Trust Your Inner Knowing for Guidance With Relationships, Health, and Spirituality. Her website is https://emmyvadnais.com (Recorded on November 5, 2025) For a short video on How to Get the Most From New Thinking Allowed, go to https://youtu.be/aVbfPFGxv9o Check out our new website for the New Thinking Allowed Foundation at http://www.newthinkingallowed.org. There you will find our incredible, searchable database as well as our new, FREE QUARTERLY MAGAZINE. Also, opportunities to shop and to support our video productions. There, you can also subscribe to our FREE, WEEKLY NEWSLETTER! For a complete, updated list with links to all of our videos, see https://newthinkingallowed.com/Listings.html. Check out New Thinking Allowed’s AI chatbot. You can create a free account at https://ai.servicespace.org When you enter the space, you will see that our chatbot is one of several you can interact with. While it is still a work in progress, it has been trained on 1,600 NTA transcripts. It can provide intelligent answers about the contents of our interviews. It’s almost like having a conversation with Jeffrey Mishlove. To buy a high-quality, printed version of the New Thinking Allowed Magazine, go to nta-magazine.magcloud.com. To join the NTA Psi Experience Community on Facebook, see https://www.facebook.com/groups/1953031791426543/. To download and listen to audio versions of the New Thinking Allowed videos, visit our podcast at https://itunes.apple.com/us/podcast/new-thinking-allowed-audio-podcast/id1435178031. Download and read Jeffrey Mishlove’s Grand Prize essay in the Bigelow Institute competition, Beyond the Brain: The Survival of Human Consciousness After Permanent Bodily Death. https://www.bigelowinstitute.org/docs/1st.pdf If you would like to join our team of volunteers, helping to promote the New Thinking Allowed YouTube channel on social media, editing and translating videos, creating short video trailers based on our interviews, helping to upgrade our website, or contributing in other ways (we may not even have thought of), please send an email to friends@newthinkingallowed.com. To order Intuitive Development by Emmy Vadnais, click here: https://amzn.to/35sbLIA. To order Digital Dharma by Deepak Chopra, go to: https://amzn.to/4oBmEOl To order New Thinking Allowed Dialogues: Is There Life After Death? click on https://amzn.to/3LzLA7Y To order Russell Targ: Ninety Years of ESP, Remote Viewing, and Timeless Awareness, go to https://amzn.to/4aw2iyr To order UFOs and UAP – Are We Really Alone?, go to https://amzn.to/3Y0VOVh

Jonathan Barratt, PhD, FRCP - 2025 Congress Highlights From Houston, Texas: A Fresh Look at the Data Driving Targeted Therapeutic Developments in IgA Nephropathy

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete EBAC/CME information, and to apply for credit, please visit us at PeerView.com/WMS865. EBAC/CME credit will be available until December 2, 2026.Putting the Puzzle Together in Advanced Ovarian and Cervical Cancers: Translating Evidence Into Practice for Approved and Emerging ADCs In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from Genmab.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete EBAC/CME information, and to apply for credit, please visit us at PeerView.com/WMS865. EBAC/CME credit will be available until December 2, 2026.Putting the Puzzle Together in Advanced Ovarian and Cervical Cancers: Translating Evidence Into Practice for Approved and Emerging ADCs In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from Genmab.Disclosure information is available at the beginning of the video presentation.

Jonathan Barratt, PhD, FRCP - 2025 Congress Highlights From Houston, Texas: A Fresh Look at the Data Driving Targeted Therapeutic Developments in IgA Nephropathy

Jonathan Barratt, PhD, FRCP - 2025 Congress Highlights From Houston, Texas: A Fresh Look at the Data Driving Targeted Therapeutic Developments in IgA Nephropathy

Jonathan Barratt, PhD, FRCP - 2025 Congress Highlights From Houston, Texas: A Fresh Look at the Data Driving Targeted Therapeutic Developments in IgA Nephropathy

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA information, and to apply for credit, please visit us at PeerView.com/UAD865. CME/MOC/AAPA credit will be available until November 20, 2026.Harnessing the Power of ADCs in Gynecologic Cancers: Expert Insights for Practice Integration In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by independent educational grants from AstraZeneca, Daiichi Sankyo, Inc., and Gilead Sciences, Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/EBAC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/SGD865. CME/MOC/EBAC/NCPD/CPE/AAPA/IPCE credit will be available until December 12, 2026.Charting New Paths in the Treatment of ER+, HER2- MBC: Seeking Clarity and Consensus Through Evidence-Aligned Clinical Cases In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA information, and to apply for credit, please visit us at PeerView.com/UAD865. CME/MOC/AAPA credit will be available until November 20, 2026.Harnessing the Power of ADCs in Gynecologic Cancers: Expert Insights for Practice Integration In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by independent educational grants from AstraZeneca, Daiichi Sankyo, Inc., and Gilead Sciences, Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/EBAC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/SGD865. CME/MOC/EBAC/NCPD/CPE/AAPA/IPCE credit will be available until December 12, 2026.Charting New Paths in the Treatment of ER+, HER2- MBC: Seeking Clarity and Consensus Through Evidence-Aligned Clinical Cases In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA information, and to apply for credit, please visit us at PeerView.com/UAD865. CME/MOC/AAPA credit will be available until November 20, 2026.Harnessing the Power of ADCs in Gynecologic Cancers: Expert Insights for Practice Integration In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by independent educational grants from AstraZeneca, Daiichi Sankyo, Inc., and Gilead Sciences, Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/EBAC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/SGD865. CME/MOC/EBAC/NCPD/CPE/AAPA/IPCE credit will be available until December 12, 2026.Charting New Paths in the Treatment of ER+, HER2- MBC: Seeking Clarity and Consensus Through Evidence-Aligned Clinical Cases In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA information, and to apply for credit, please visit us at PeerView.com/UAD865. CME/MOC/AAPA credit will be available until November 20, 2026.Harnessing the Power of ADCs in Gynecologic Cancers: Expert Insights for Practice Integration In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by independent educational grants from AstraZeneca, Daiichi Sankyo, Inc., and Gilead Sciences, Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA information, and to apply for credit, please visit us at PeerView.com/UAD865. CME/MOC/AAPA credit will be available until November 20, 2026.Harnessing the Power of ADCs in Gynecologic Cancers: Expert Insights for Practice Integration In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by independent educational grants from AstraZeneca, Daiichi Sankyo, Inc., and Gilead Sciences, Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA information, and to apply for credit, please visit us at PeerView.com/UAD865. CME/MOC/AAPA credit will be available until November 20, 2026.Harnessing the Power of ADCs in Gynecologic Cancers: Expert Insights for Practice Integration In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by independent educational grants from AstraZeneca, Daiichi Sankyo, Inc., and Gilead Sciences, Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/EBAC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/SGD865. CME/MOC/EBAC/NCPD/CPE/AAPA/IPCE credit will be available until December 12, 2026.Charting New Paths in the Treatment of ER+, HER2- MBC: Seeking Clarity and Consensus Through Evidence-Aligned Clinical Cases In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

Fear of virologic failure is a major barrier to ensuring that people living with virally suppressed HIV are receiving the most optimal antiretroviral therapy (ART) regimen for them. Stream this Medical Minute to learn more about key guideline recommendations regarding ART switch and reassuring clinical data regarding efficacy, tolerability, and quality of life associated with switching a suppressive ART regimen. Topics covered include:Efficacy of switching to 2-drug oral ART: real-world evidenceReal-world analyses of virologic failure with switch to long-acting cabotegravir plus rilpivirinePatient selection to reduce risk of virologic failure with switch Regimen-specific switch considerationsPresenters:Dima Dandachi, MD, MPH, FIDSA, FACPAssociate Professor of MedicineDivision of Infectious DiseasesUniversity of MissouriMedical DirectorHIV Treatment and Prevention Program, MUHCMedical DirectorBoone County Public Health and Human ServicesColumbia, MissouriChloe Orkin, MBChB, FRCP, MDProfessor of Infection and InequitiesDean for Healthcare TransformationQueen Mary University of LondonFaculty of Medicine and DentistryHonorary Consultant PhysicianBarts Health NHS TrustLondon, United KingdomLink to full program and accompanying slides:https://bit.ly/3KPN0xbGet access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Sanjay Popat, FRCP, PhD - Don't Forget About HER2: Clinical Insights and Novel Therapies for HER2-Mutant NSCLC From ESMO 2025

Sanjay Popat, FRCP, PhD - Don't Forget About HER2: Clinical Insights and Novel Therapies for HER2-Mutant NSCLC From ESMO 2025

Sanjay Popat, FRCP, PhD - Don't Forget About HER2: Clinical Insights and Novel Therapies for HER2-Mutant NSCLC From ESMO 2025

What if your sleepless nights weren't just a part of aging but the silent accelerator of it?Michelle MacDonald welcomes Dr. Woganee Filate, physician, sleep researcher, and women's health advocate, to tackle one of the most overlooked pillars in women's health: sleep. Dr. Filate unpacks why women experience a unique midlife sleep crisis, what's really behind it from biology to social dynamics and how to reclaim restorative rest. They discuss evidence-based strategies for improving sleep during menopause, how sleep impacts everything from metabolism to emotional regulation, and why a healthy sleep routine is foundational for personal growth, a healthy mindset, and long-term fitness. Whether you're in perimenopause or just struggling to rest, this episode is a must-listen.Favorite Moments:1:35 Why Sleep Is the Most Overlooked Pillar in Women's Health7:05 The Hidden Link Between Sleep Loss and Long-Term Health span13:18 Why Sleep Problems in Women Are Dismissed and Misunderstood29:38 One Year on CPAP: A Personal Sleep Apnea Recovery Story“Sleep is the land of infinite second chances—if tonight was bad, tomorrow's a fresh start.” — Dr. Woganee Filate GUEST: DR. WOGANEE FILATE BHSC, MD, FRCP©, CO-FOUNDER LUME WOMEN + HEALTHWebsite | LinkedIn | Instagram | NewsletterFull Guest Bio: Dr. Woganee Filate is a passionate and dedicated adult respirologist and sleep medicine physician committed to providing comprehensive, evidence-based and patient-centered care. She has a wealth of experience in diagnosing and managing respiratory and sleep disorders. Her interests include educating patients on the changes in sleep during the menopause transition and what can be done to optimize sleep during this key life stage. In addition to her medical degree, Dr. Filate holds a Master of Health Science, with a focus on Community Health & Epidemiology, from the University of Toronto. CONNECT WITH MICHELLEWebsite | Instagram | YouTube | Facebook | XFull Michelle Bio: Michelle MacDonald is the creator of the FITNESS MODEL BLUEPRINT™ and host of the Stronger By Design™ podcast. Known globally for her transformation programs, Michelle empowers women to redefine aging through evidence-based strength training, nutrition, and mindset practices. Since 2012, she has coached thousands of women online, leveraging her expertise as a Physique Champion and ISSA Strength and Conditioning Specialist. She co-founded Tulum Strength Club and established The Wonder Women (TWW), inspiring countless transformations including her mother, Joan MacDonald (Train With Joan™). Michelle continues to lead the charge in women's fitness, launching the Stronger by Design™ fitness app in fall 2024.Where to Watch/Listen:WebsiteApple PodcastsSpotifyYouTubeLeave a rating for this podcast with one click

In this educational podcast discussion, Carlos M. De Castro, MD, and David Dingli, MD, PhD, FRCP, FRCPEd, FACP, FRCPath, explore paroxysmal nocturnal hemoglobinuria (PNH). They trace the evolution of treatment from early complement inhibitors to today's expanding therapeutic options, emphasizing how these advances have transformed patient outcomes and quality of life. The conversation blends clinical insights with practical considerations for therapy selection and patient care, including:The pathogenesis of PNH and the role of complement activationLandmark therapies such as eculizumab and ravulizumabAdvances in proximal inhibitors (eg, pegcetacoplan, iptacopan, danicopan)Quality-of-life considerations, treatment personalization, and emerging therapiesPresenters:Carlos M. De Castro, MDProfessor of Medicine, DUMCDivision of Malignant Hematology and Cellular TherapyDepartment of MedicineDuke UniversityDuke Cancer InstituteDurham, North CarolinaDavid Dingli, MD, PhD, FRCP, FRCPEd, FACP, FRCPathConsultant Hematologist and Director of Bone Marrow Transplant ProgramProfessor of MedicineDivision of HematologyMayo Clinic College of Medicine and ScienceRochester, MinnesotaLink to full program:https://bit.ly/3Jtjqgr Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/JYH865. CME credit will be available until October 20, 2026.The Earlier the Better in Lung Cancer: Multispecialty Guidance on Screening, Diagnosis and Management of Resectable NSCLC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/JYH865. CME credit will be available until October 20, 2026.The Earlier the Better in Lung Cancer: Multispecialty Guidance on Screening, Diagnosis and Management of Resectable NSCLC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/JYH865. CME credit will be available until October 20, 2026.The Earlier the Better in Lung Cancer: Multispecialty Guidance on Screening, Diagnosis and Management of Resectable NSCLC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/JYH865. CME credit will be available until October 20, 2026.The Earlier the Better in Lung Cancer: Multispecialty Guidance on Screening, Diagnosis and Management of Resectable NSCLC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/JYH865. CME credit will be available until October 20, 2026.The Earlier the Better in Lung Cancer: Multispecialty Guidance on Screening, Diagnosis and Management of Resectable NSCLC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/JYH865. CME credit will be available until October 20, 2026.The Earlier the Better in Lung Cancer: Multispecialty Guidance on Screening, Diagnosis and Management of Resectable NSCLC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc.Disclosure information is available at the beginning of the video presentation.

Jonathan Barratt, PhD, FRCP - Preserve and Prevent: Expert Perspectives on Optimizing Outcomes in Patients With IgAN

Jonathan Barratt, PhD, FRCP - Preserve and Prevent: Expert Perspectives on Optimizing Outcomes in Patients With IgAN

What if your menstrual cycle, cholesterol, and even your VO₂ max could predict your future health? Most women aren't tracking what really matters—until it's too late.Michelle MacDonald welcomes Dr. Amy Louis-Bayliss, a MD and women's preventive health expert, to uncover the six key metrics that can radically improve how women age. With decades of experience in emergency medicine and specialized training in menopause, Dr. Amy breaks down complex topics like cholesterol, A1C, body composition, VO₂ max, blood pressure, and cycle health in a way that is both actionable and empowering. She shares how understanding these markers, not just your weight, can shift you from reactive care to proactive, personalized health optimization. Favorite Moments:2:33 The Six Tests Every Woman Over 40 Needs to Take11:27 Why Women Shouldn't Fear Cholesterol Meds—Or Estrogen21:50 Think You Feel Fine? Your Blood Pressure Might Say Otherwise34:56 The Shocking Truth About Thin Women and Muscle Loss"You can feel good, but that's not the same as measuring." – Dr. Amy Louis-BaylissGUEST: DR. AMY LOUIS-BAYLISS BHSc, MD, FRCP©, CEO LUME WOMEN + HEALTHWebsite | Contact | LinkedIn | Instagram | NewsletterFull Guest Bio: Dr. Amy Louis-Bayliss has been an MD for almost 20 years, spending most of her career as an emergency medicine specialist with two additional years of training as a menopause specialist in Hamilton and Oakville. Dr. Louis-Bayliss is an advocate for women's healthy aging – her interest in menopause and healthy aging stems from years of treating and managing disease in the ER once it was already “too late”. Amy sits on the advisory board for the National Menopause Show. She is passionate about educating women to build self-agency when it comes to disease-prevention.CONNECT WITH MICHELLEWebsite | Instagram | YouTube | Facebook | XFull Michelle Bio: Michelle MacDonald is the creator of the FITNESS MODEL BLUEPRINT™ and host of the Stronger By Design™ podcast. Known globally for her transformation programs, Michelle empowers women to redefine aging through evidence-based strength training, nutrition, and mindset practices. Since 2012, she has coached thousands of women online, leveraging her expertise as a Physique Champion and ISSA Strength and Conditioning Specialist. She co-founded Tulum Strength Club and established The Wonder Women (TWW), inspiring countless transformations including her mother, Joan MacDonald (Train With Joan™). Michelle continues to lead the charge in women's fitness, launching the Stronger by Design™ fitness app in fall 2024.Where to Watch/Listen:WebsiteApple PodcastsSpotifyYouTube

Functional movement disorders are a common clinical concern for neurologists. The principle of “rule-in” diagnosis, which involves demonstrating the difference between voluntary and automatic movement, can be carried through to explanation, triage, and evidence-based multidisciplinary rehabilitation therapy. In this episode, Gordon Smith, MD, FAAN speaks Jon Stone, PhD, MB, ChB, FRCP, an author of the article “Multidisciplinary Treatment for Functional Movement Disorder” in the Continuum® August 2025 Movement Disorders issue. Dr. Smith is a Continuum® Audio interviewer and a professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. Stone is a consultant neurologist and honorary professor of neurology at the Centre for Clinical Brain Sciences at the University of Edinburgh in Edinburgh, United Kingdom. Additional Resources Read the article: Multidisciplinary Treatment for Functional Movement Disorder Subscribe to Continuum®: shop.lww.com/Continuum Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @gordonsmithMD Guest: @jonstoneneuro Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. This exclusive Continuum Audio interview is available only to you, our subscribers. We hope you enjoy it. Thank you for listening. Dr Smith: Hello, this is Dr Gordon Smith. Today I've got the great pleasure of interviewing Dr Johnstone about his article on the multidisciplinary treatment for functional neurologic disorder, which he wrote with Dr Alan Carson. This article will appear in the August 2025 Continuum issue on movement disorders. I will say, Jon, that as a Continuum Audio interviewer, I usually take the interviews that come my way, and I'm happy about it. I learn something every time. They're all a lot of fun. But there have been two instances where I go out and actively seek to interview someone, and you are one of them. So, I'm super excited that they allowed me to talk with you today. For those of our listeners who understand or are familiar with FND, Dr Stone is a true luminary and a leader in this, both in clinical care and research. He's also a true humanist. And I have a bit of a bias here, but he was the first awardee of the Ted Burns Humanism in Neurology award, which is a real honor and reflective of your great work. So welcome to the podcast, Jon. Maybe you can introduce yourself to our audience. Dr Stone: Well, thank you so much, Gordon. It was such a pleasure to get that award, the Ted Burns Award, because Ted was such a great character. I think the spirit of his podcasts is seen in the spirit of these podcasts as well. So, I'm a neurologist in Edinburgh in Scotland. I'm from England originally. I'm very much a general neurologist still. I still work full-time. I do general neurology, acute neurology, and I do two FND clinics a week. I have a research group with Alan Carson, who you mentioned; a very clinical research group, and we've been doing that for about 25 years. Dr Smith: I really want to hear more about your clinical approach and how you run the clinic, but I wonder if it would be helpful for you to maybe provide a definition. What's the definition of a functional movement disorder? I mean, I think all of us see these patients, but it's actually nice to have a definition. Dr Stone: You know, that's one of the hardest things to do in any paper on FND. And I'm involved with the FND society, and we're trying to get together a definition. It's very hard to get an overarching definition. But from a movement disorder point of view, I think you're looking at a disorder where there is an impairment of voluntary movement, where you can demonstrate that there is an automatic movement, which is normal in the same movement. I mean, that's a very clumsy way of saying it. Ultimately, it's a disorder that's defined by the clinical features it has; a bit like saying, what is migraine? You know? Or, what is MS? You know, it's very hard to actually say that in a sentence. I think these are disorders of brain function at a very broad level, and particularly with FND disorders, of a sort of higher control of voluntary movement, I would say. Dr Smith: There's so many pearls in this article and others that you've written. One that I really like is that this isn't a diagnosis of exclusion, that this is an affirmative diagnosis that have clear diagnostic signs. And I wonder if you can talk a little bit about the diagnostic process, arriving at an FND diagnosis for a patient. Dr Stone: I think this is probably the most important sort of “switch-around” in the last fifteen, twenty years since I've been involved. It's not new information. You know, all of these diagnostic signs were well known in the 19th century; and in fact, many of them were described then as well. But they were kind of lost knowledge, so that by the time we got to the late nineties, this area---which was called conversion disorder then---it was written down. This is a diagnosis of exclusion that you make when you've ruled everything out. But in fact, we have lots of rule in signs, which I hope most listeners are familiar with. So, if you've got someone with a functional tremor, you would do a tremor entrainment test where you do rhythmic movements of your thumb and forefinger, ask the patient to copy them. It's very important that they copy you rather than make their own movements. And see if their tremor stops briefly, or perhaps entrains to the same rhythm that you're making, or perhaps they just can't make the movement. That might be one example. There's many examples for limb weakness and dystonia. There's a whole lot of stuff to learn there, basically, clinical skills. Dr Smith: You make a really interesting point early on in your article about the importance of the neurological assessment as part of the treatment of the patient. I wonder if you could talk to our listeners about that. Dr Stone: So, I think, you know, there's a perception that- certainly, there was a perception that that the neurologist is there to make a diagnosis. When I was training, the neurologist was there to tell the patient that they didn't have the kind of neurological problem and to go somewhere else. But in fact, that treatment process, when it goes well, I think begins from the moment you greet the patient in the waiting room, shake their hand, look at them. Things like asking the patient about all their symptoms, being the first doctor who's ever been interested in their, you know, horrendous exhaustion or their dizziness. You know, questions that many patients are aware that doctors often aren't very interested in. These are therapeutic opportunities, you know, as well as just taking the history that enable the patient to feel relaxed. They start thinking, oh, this person's actually interested in me. They're more likely to listen to what you've got to say if they get that feeling off you. So, I'd spend a lot of time going through physical symptoms. I go through time asking the patient what they do, and the patients will often tell you what they don't do. They say, I used to do this, I used to go running. Okay, you need to know that, but what do they actually do? Because that's such valuable information for their treatment plan. You know, they list a whole lot of TV shows that they really enjoy, they're probably not depressed. So that's kind of useful information. I also spend a lot of time talking to them about what they think is wrong. Be careful, that they can annoy patients, you know. Well, I've come to you because you're going to tell me what's wrong. But what sort of ideas had you had about what was wrong? I need to know so that I can deal with those ideas that you've had. Is there a particular reason that you're in my clinic today? Were you sent here? Was it your idea? Are there particular treatments that you think would really help you? These all set the scene for what's going to come later in terms of your explanation. And, more importantly, your triaging of the patient. Is this somebody where it's the right time to be embarking on treatment, which is a question we don't always ask yourself, I think. Dr Smith: That's a really great point and kind of segues to my next question, which is- you talked a little bit about this, right? Generally speaking, we have come up with this is a likely diagnosis earlier, midway through the encounter. And you talked a little bit about how to frame the encounter, knowing what's coming up. And then what's coming up is sharing with the patient our opinion. In your article, you point out this should be no different than telling someone they have Parkinson's disease, for instance. What pearls do you have and what pitfalls do you have in how to give the diagnosis? And, you know, a lot of us really weren't trained to do this. What's the right way, and what are the most common land mines that folks step on when they're trying to share this information with patients? Dr Stone: I've been thinking about this for a long time, and I've come to the conclusion that all we need to do with this disorder is stop being weird. What goes wrong? The main pitfall is that people think, oh God, this is FND, this is something a bit weird. It's in a different box to all of the other things and I have to do something weird. And people end up blurting out things like, well, your scan was normal or, you haven't got epilepsy or, you haven't got Parkinson's disease. That's not what you normally do. It's weird. What you normally do is you take a deep breath and you say, I'm sorry to tell you've got Parkinson's disease or, you have this type of dystonia. That's what you normally say. If you follow the normal- what goes wrong is that people don't follow the normal rules. The patient picks up on this. What's going on here? This doctor's telling me what I don't have and then they're starting to talk about some reason why I've got this, like stress, even though I don't- haven't been told what it is yet. You do the normal rules, give it a name, a name that you're comfortable with, preferably as specific as possible: functional tremor, functional dystonia. And then do what you normally do, which is explain to the patient why you think it's this. So, if someone's got Parkinson's, you say, I think you've got Parkinson's because I noticed that you're walking very slowly and you've got a tremor. And these are typical features of Parkinson. And so, you're talking about the features. This is where I think it's the most useful thing that you can do. And the thing that I do when it goes really well and it's gone badly somewhere else, the thing I probably do best, what was most useful, is showing the patient their signs. I don't know if you do that, Gordon, but it's maybe not something that we're used to doing. Dr Smith: Wait, maybe you can talk more about that, and maybe, perhaps, give an example? Talk about how that impacts treatment. I was really impressed about the approach to physical therapy, and treatment of patients really leverages the physical examination findings that we're all well-trained to look for. So maybe explore that a little bit. Dr Stone: Yeah, I think absolutely it does. And I think we've been evolving these thoughts over the last ten or fifteen years. But I started, you know, maybe about twenty years ago, started to show people their tremor entrainment tests. Or their Hoover sign, for example; if you don't know Hoover sign, weakness of hip extension, that comes back to normal when the person's flexing their normal leg, their normal hip. These are sort of diagnostic tricks that we had. Ahen I started writing articles about FND, various senior neurologists said to me, are you sure you should write this stuff down? Patients will find out. I wrote an article with Marc Edwards called “Trick or Treat in Neurology” about fifteen years ago to say that actually, although they're they might seem like tricks, there really are treats for patients because you're bringing the diagnosis into the clinic room. It's not about the normal scan. You can have FND and MS. It's not about the normal scan. It's about what you're seeing in front of you. If you show that patient, yes, you can't move your leg. The more you try, the worse it gets. I can see that. But look, lift up your other leg. Let me show you. Can you see now how strong your leg is? It's such a powerful way of communicating to the patient what's wrong with them diagnostically, giving them that confidence. What it's also doing is showing them the potential for improvement. It's giving them some hope, which they badly need. And, as we'll perhaps talk about, the physio treatment uses that as well because we have to use a different kind of physio for many forms of functional movement disorder, which relies on just glimpsing these little moments of normal function and promoting them, promoting the automatic movement, squashing down that abnormal pattern of voluntary movement that people have got with FND. Dr Smith: So, maybe we can talk about that now. You know, I've got a bunch of other questions to ask you about mechanism and stuff, but let's talk about the approach to physical therapy because it's such a good lead-in and I always worry that our physical therapists aren't knowledgeable about this. So, maybe some examples, you have some really great ones in the article. And then words of wisdom for us as we're engaging physical therapists who may not be familiar with FND, how to kind of build that competency and relationship with the therapist with whom you work. Dr Stone: Some of the stuff is the same. Some of the rehabilitation ideas are similar, thinking about boom and bust activity, which is very common in these patients, or grading activity. That's similar, but some of them are really different. So, if you have a patient with a stroke, the physiotherapist might be very used to getting that person to think and look at their leg to try and help them move, which is part of their rehabilitation. In FND, that makes things worse. That's what's happening in Hoover sign and tremor entrainment sign. Attention towards the limb is making it worse. But if the patient's on board with the diagnosis and understands it, they'll also see what you need to do, then, in the physio is actively use distraction in a very transparent way and say to the patient, look, I think if I get you to do that movement, and I'll film you, I think your movement's going to look better. Wouldn't that be great if we could demonstrate that? And the patient says, yeah, that would be great. We're kind of actively using distraction. We're doing things that would seem a bit strange for someone with other forms of movement disorder. So, the patients, for example, with functional gait disorders who you discover can jog quite well on a treadmill. In fact, that's another diagnostic test. Or they can walk backwards, or they can dance or pretend that they're ice skating, and they have much more fluid movements because their ice skating program in their brain is not corrupted, but their normal walking program is. So, can you then turn ice skating or jogging into normal walking? It's not that complicated, I think. The basic ideas are pretty simple, but it does require some creativity from whoever's doing the therapy because you have to use what the patient's into. So, if the patient used to be a dancer- we had a patient who was a, she was really into ballet dancing. Her ballet was great, but her walking was terrible. So, they used ballet to help her walk again. And that's incredibly satisfying for the therapist as well. So, if you have a therapist who's not sure, there are consensus recommendations. There are videos. One really good success often makes a therapist want to do that again and think, oh, that's interesting. I really helped that patient get better. Dr Smith: For a long time, this has been framed as a mental health issue, conversion disorder, and maybe we can talk a little bit about early life of trauma as a risk factor. But, you know, listening to you talk, it sounds like a brain network problem. Even the word “functional”, to me, it seems a little judgmental. I don't know if this is the best term, but is this really a network problem? Dr Stone: The word “functional”, for most neurologists, sounds judgmental because of what you associate it with. If you think about what the word actually is, it's- it does what it says on the tin. There's a disordered brain function. I mean, it's not a great word. It's the least worst term, in my view. And yes, of course it's a brain network problem, because what other organ is it going to be? You know, that's gone wrong? When software brains go wrong, they go wrong in networks. But I think we have to be careful not to swing that pendulum too far to the other side because the problem here, when we say asking the question, is this a mental health problem or a neurological one, we're just asking the wrong question. We're asking a question that makes no sense. However you try and answer that, you're going to get a stupid answer because the question doesn't make sense. We shouldn't have those categories. It's one organ. And what's so fascinating about FND---and I hope what can incite your sort of curiosity about it---is this disorder which defies this categorization. You see some patients with it, they say, oh, they've got a brain network disorder. Then you meet another patient who was sexually abused for five years by their uncle when they were nine, between nine and fourteen; they developed an incredibly strong dissociative threat response into that experience. They have crippling anxiety, PTSD, interpersonal problems, and their FND is sort of somehow a part of that; part of that experience that they've had. So, to ignore that or to deny or dismiss psychological, psychiatric aspects, is just as bad and just as much a mistake as to dismiss the kind of neurological aspects as well. Dr Smith: I wonder if this would be a good time to go back and talk a little bit about a concept that I found really interesting, and that is FND as a prodromal syndrome before a different neurological problem. So, for instance, FND prodromal to Parkinson's disease. Can you talk to us a little bit about that? I mean, obviously I was familiar with the fact that patients who have nonepileptic seizurelike events often have epileptic seizures, but the idea of FND ahead of Parkinson's was new to me. Dr Stone: So, this is definitely a thing that happens. It's interesting because previously, perhaps, if you saw someone who was referred with a functional tremor---this has happened to me and my colleagues. They send me some with a functional tremor. By the time I see them, it's obvious they've got Parkinson's because it's been a little gap. But it turns out that the diagnosis of functional tremor was wrong. It was just that they've developed that in the prodrome of Parkinson's disease. And if you think about it, it's what you'd expect, really, especially with Parkinson's disease. We know people develop anxiety in the prodrome of Parkinson's for ten, fifteen years before it's part of the prodrome. Anxiety is a very strong risk factor for FND, and they're already developing abnormalities in their brain predisposing them to tremor. So, you put those two things together, why wouldn't people get FND? It is interesting to think about how that's the opposite of seizures, because most people with comorbidity of functional seizures and epilepsy, 99% of the time the epilepsy came first. They had the experience of an epileptic seizure, which is frightening, which evokes strong threat response and has somehow then led to a recapitulation of that experience in a functional seizure. So yeah, it's really interesting how these disorders overlap. We're seeing something similar in early MS where, I think, there's a slight excess of functional symptoms; but as the disease progresses, they often become less, actually. Dr Smith: What is the prognosis with the types of physical therapy? And we haven't really talked about psychological therapy, but what's the success rate? And then what's the relapse rate or risk? Dr Stone: Well, it does depend who they're seeing, because I think---as you said---you're finding difficult to get people in your institution who you feel are comfortable with this. Well, that's a real problem. You know, you want your therapists to know about this condition, so that matters. But I think with a team with a multidisciplinary approach, which might include psychological therapy, physio, OT, I think the message is you can get really good outcomes. You don't want to oversell this to patients, because these treatments are not that good yet. You can get spectacular outcomes. And of course, people always show the videos of those. But in published studies, what you're seeing is that most studies of- case series of rehabilitation, people generally improve. And I think it's reasonable to say to a patient, that we have these treatments, there's a good chance it's going to help you. I can't guarantee it's going to help you. It's going to take a lot of work and this is something we have to do together. So, this is not something you're going to do to the patient, they're going to do it with you. Which is why it's so important to find out, hey, do they agree with you with the diagnosis? And check they do. And is it the right time? It's like when someone needs to lose weight or change any sort of behavior that they've just become ingrained. It's not easy to do. So, I don't know if that helps answer the question. Dr Smith: No, that's great. And you actually got right where I was wanting to go next, which is the idea of timing and acceptance. You brought this up earlier on, right? So, sometimes patients are excited and accepting of having an affirmative diagnosis, but sometimes there's some resistance. How do you manage the situation where you're making this diagnosis, but a patient's resistant to it? Maybe they're fixating on a different disease they think they have, or for whatever reason. How do you handle that in terms of initiating therapy of the overall diagnostic process? Dr Stone: We should, you know, respect people's rights to have whatever views they want about what's wrong with them. And I don't see my job as- I'm not there to change everyone's mind, but I think my job is to present the information to them in a kind of neutral way and say, look, here it is. This is what I think. My experience is, if you do that, most people are willing to listen. There are a few who are not, but most people are. And most of the time when it goes wrong, I have to say it's us and not the patients. But I think you do need to find out if they can have some hope. You can't do rehabilitation without hope, really. That's what you're looking for. I sometimes say to patients, where are you at with this? You know, I know this is a really hard thing to get your head around, you've never heard of it before. It's your own brain going wrong. I know that's weird. How much do you agree with it on a scale of naught to ten? Are you ten like completely agreeing, zero definitely don't? I might say, are you about a three? You know, just to make it easy for them to say, no, I really don't agree with you. Patients are often reluctant to tell you exactly what they're thinking. So, make it easy for them to disagree and then see where they're at. If they're about seven, say, that's good. But you know, it'd be great if you were nine or ten because this is going to be hard. It's painful and difficult, and you need to know that you're not damaging your body. Those sort of conversations are helpful. And even more importantly, is it the right time? Because again, if you explore that with people, if a single mother with four kids and, you know, huge debts and- you know, it's going to be very difficult for them to engage with rehab. So, you have to be realistic about whether it's the right time, too; but keep that hope going regardless. Dr Smith: So, Jon, there's so many things I want to talk to you about, but maybe rather than let me drive it, let me ask you, what's the most important thing that our listeners need to know that I haven't asked you about? Dr Stone: Oh God. I think when people come and visit me, they sometimes, let's go and see this guy who does a lot of FND, and surely, it'll be so easy for him, you know? And I think some of the feedback I've had from visitors is, it's been helpful to watch, to see that it's difficult for me too. You know, this is quite hard work. Patients have lots of things to talk about. Often you don't have enough time to do it in. It's a complicated scenario that you're unravelling. So, it's okay if you find it difficult work. Personally, I think it's very rewarding work, and it's worth doing. It's worth spending the time. I think you only need to have a few patients where they've improved. And sometimes that encounter with the neurologist made a huge difference. Think about whether that is worth it. You know, if you do that with five patients and one or two of them have that amazing, really good response, well, that's probably worth it. It's worth getting out of bed in the morning. I think reflecting on, is this something you want to do and put time and effort into, is worthwhile because I recognize it is challenging at times, and that's okay. Dr Smith: That's a great number needed to treat, five or six. Dr Stone: Exactly. I think it's probably less than that, but… Dr Smith: You're being conservative. Dr Stone: I think deliberately pessimistic; but I think it's more like two or three, yeah. Dr Smith: Let me ask one other question. There's so much more for our listeners in the article. This should be required reading, in my opinion. I think that of most Continuum, but this, I really truly mean it. But I think you've probably inspired a lot of listeners, right? What's the next step? We have a general or comprehensive neurologist working in a community practice who's inspired and wants to engage in the proactive care of the FND patients they see. What's the next step or advice you have for them as they embark on this? It strikes me, like- and I think you said this in the article, it's hard work and it's hard to do by yourself. So, what's the advice for someone to kind of get started? Dr Stone: Yeah, find some friends pretty quick. Though, yeah, your own enthusiasm can take you a long way, you know, especially with we've got much better resources than we have. But it can only take you so far. It's really particularly important, I think, to find somebody, a psychiatrist or psychologist, you can share patients with and have help with. In Edinburgh, that's been very important. I've done all this work with the neuropsychiatrist, Alan Carson. It might be difficult to do that, but just find someone, send them an easy patient, talk to them, teach them some of this stuff about how to manage FND. It turns out it's not that different to what they're already doing. You know, the management of functional seizures, for example, is- or episodic functional movement disorders is very close to managing panic disorder in terms of the principles. If you know a bit about that, you can encourage people around you. And then therapists just love seeing these patients. So, yeah, you can build up slowly, but don't- try not to do it all on your own, I would say. There's a risk of burnout there. Dr Smith: Well, Dr Stone, thank you. You don't disappoint. This has really been a fantastic conversation. I really very much appreciate it. Dr Stone: That's great, Gordon. Thanks so much for your time, yeah. Dr Smith: Well, listeners, again, today I've had the great pleasure of interviewing Dr Jon Stone about his article on the multidisciplinary treatment for functional neurologic disorder, which he wrote with Dr Alan Carson. This article appears in the August 2025 Continuum issue on movement disorders. Please be sure to check out Continuum Audio episodes from this and other issues. And listeners, thank you once again for joining us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. We hope you've enjoyed this subscriber-exclusive interview. Thank you for listening.

Jonathan Barratt, PhD, FRCP - The Gut–Kidney Axis and Beyond in IgA Nephropathy: A New Frontier in Precision Therapy

Jonathan Barratt, PhD, FRCP - The Gut–Kidney Axis and Beyond in IgA Nephropathy: A New Frontier in Precision Therapy

We are honored to have Farzana Hoque, MD, MRCP, FACP, FRCP, return to the Faculty Factory Podcast this week. This is her third appearance on the podcast, and this time she joins us to discuss her recently published article in the Journal of Brown Hospital Medicine entitled “WISE Framework: Teaching Guide for Early Career Hospitalists.” The article is based on the WISE Framework, which she formulated and discusses in depth during today's chat. As she notes at the start of the interview, it is applicable to all specialties, not just hospitalists. She currently serves as an Associate Professor of Internal Medicine in the Division of Hospital Medicine at Saint Louis University School of Medicine. She also co-directs the Medicine Sub-Internship at the Saint Louis University School of Medicine. Additionally, she is the Medical Director of Bordley Tower at SSM Health Saint Louis University Hospital. Dr. Hoque's previous two interviews with the Faculty Factory can be found here: Emotional Intelligence (EQ) for Unlocking Leadership Potential: https://facultyfactory.org/eq-leadership/ Embracing Culture Over Strategy: Lessons Learned in Academic Medicine: https://facultyfactory.org/farzana-hoque/ “After several days of thinking, I came up with this WISE framework. W stands for Watchful Observation; I for Insightful Awareness; S for Specific Feedback; and E for Empathic Communication,” she told us. Read Dr. Hoque's recent article in the Journal of Brown Hospital Medicine entitled “WISE Framework: Teaching Guide for Early Career Hospitalists”: https://pubmed.ncbi.nlm.nih.gov/40191700/. You can follow along with her guidance and clinical tips for residents and fellows, and much more by subscribing to her YouTube channel: https://www.youtube.com/@Dr.FarzanaHoque.

This month, we're talking about an infrequently discussed, but quite powerful, implement we have in our clinical toolkit for optimizing patient outcomes: our ears. HIV/sexual health physician, researcher, and author Rageshri Dhairyawan, M.B.B.S., FRCP, joins the pod to talk about the nuances of hearing our patients — i.e., listening to them, understanding and acknowledging their concerns, and incorporating it all into HIV care provision in a way that improves their long-term health and keeps them engaged in care.   Please support us by visiting the episode transcript on TheBodyPro: https://www.thebodypro.com/podcast/hiv/future-hiv-care-listening-patients-rageshri-dhairyawan-sep-2025   Our team: This podcast is hosted by Myles Helfand; our senior production manager is Alina Mogollon-Volk; our senior producer is Lizzie Warren; our associate production manager is Maui Voskova; our audio editor is Kim Buikema; and our executive producer is Myles Helfand.  

Today, Jim Garrity examines a critical issue in trial practice: whether an incomplete deposition—cut short when the deponent becomes unavailable—can be admitted at trial, particularly when the opposing party had no opportunity for cross-examination. Drawing on a new Sixth Circuit Court of Appeals decision and Rule 32 of the Federal Rules of Civil Procedure, Jim explores the court's decision, the key factors trial lawyers should argue for or against exclusion, and the balancing test that should be used when essential testimony hangs in the balance. Discover practical strategies for both offering and opposing use of incomplete deposition transcripts in high-stakes litigation. Thanks for listening!SHOW NOTESInsight Terminal Solutions, LLC v. Cecelia Financial Management, et al., No. 24-5222, 2025 WL 2434894 (6th Cir. August 25, 2025) (reversing trial court's ruling that deposition was categorically inadmissible because defendants did not have an opportunity to cross-examine a 30 B6 deponent before his death)Fed.R.Civ.P. 32(a) (setting three-part test for admissibility of deposition testimony at trial)Treharne v. Callahan, 426 F.2d 58 (3d Cir. 1970) (court upheld the district court's discretionary admission of written interrogatory answers given by the now-deceased defendant, even though the plaintiff could not cross-examine; under Federal Rules of Civil Procedure 26 and 33, answers to interrogatories can be used to the same extent as depositions, which are admissible if the witness is dead; further, the need for the evidence—being the only defense evidence—outweighed the lack of cross-examination, especially where death was not caused by the party offering the evidence and there was no fault involved)Duttle v. Bandler & Kass, 127 F.R.D. 46 (S.D.N.Y. 1989) (magistrate declined to exclude a deposition taken without defense counsel present, even though the witness died before cross-examination could occur; under Rule 32(a), depositions of deceased witnesses may be admitted if the party had notice and opportunity to participate, and the prejudice to the party proffering the deposition (who would lose critical evidence) outweighed potential prejudice to the opponent. Court proposed that any prejudice could be minimized by stipulating to facts the defense might have developed via cross-examination, reducing the impact of any lost impeachment opportunity)Derewecki v. Pennsylvania R. Co., 353 F.2d 436 (3d Cir. 1965) (trial and appeals courts admitted decedent's incomplete depositions as evidence, despite the absence of cross-examination by the defendant who had no chance to cross-examine before the witness died; Rule 26 authorized admission of depositions when the deponent is deceased as long as the circumstances justified it, and both parties had agreed the deposition was “completed” for evidentiary purposes; further, the harm in excluding the sole direct evidence of how the accident occurred outweighed the right to cross-examination. Courts must consider whether the lack of cross is due to fault; here, no such fault was shown)Waterman S. S. Corp. v. Gay Cottons, 414 F.2d 724 (9th Cir. 1969) (deposition of a witness who died before any cross-examination by the adverse party was admitted in bench trial; where there was no realistic possibility that cross-examination would have materially aided the party, exclusion was not required. Further, deposition testimony corroborated by other evidence; thus, lack of cross-examination did not affect the outcome)In re Reingold, 157 F.3d 904 (5th Cir. 1998) (testimony excluded at trial level; exclusion reversed. Trial court excluded party-plaintiff's perpetuation deposition, taken while the plaintiff was gravely ill and ended before cross-examination could be completed due to the witness's declining condition and ultimate death; Fifth Circuit held this exclusion to be a clear abuse of discretion and granted mandamus relief directing admission of the video deposition; FRCP 32(a) creates strong presumption favoring admission of a deceased witness's deposition. Exclusion is only justified by a specific and particularized showing of prejudice, such as stating what crucial areas would have been dealt with in cross-examination; a mere generalized complaint about the lack of cross is insufficient. Since the opposing party had already conducted a substantial deposition of the witness in prior proceedings, the risks of prejudice were further minimized)

#373 In this episode, Guy talked with Dr. Anona Blackwell, a respected medical consultant turned mystic. Dr. Blackwell shared her journey from traditional medicine to incorporating spirituality after witnessing unexplained phenomena in her practice. They discussed the integration of mind, body, and spirit in healthcare, the hidden costs of ignoring spiritual aspects in healing, and envisioned a future where science and spirituality coalesce in medical systems. Alongside her intriguing experiences and stories, Dr. Blackwell emphasizes the importance of love, community, and the interconnectedness of health and spirituality. The episode also touched on the potential of AI and energy fields in future medical practices. About Dr. Anona: Dr. Anona Blackwell is an academic physician and avid explorer of the natural world who has dedicated her life to understanding the intricate connections between science and spirituality. Her book, ‘From Medic to Mystic,' is inspired by her personal experiences and a deep-seated curiosity about the universe.  From her humble beginnings as the daughter of a bus driver and market gardener, growing up on a smallholding in rural Wales, Dr. Blackwell, BSc, AKC, FRCP, rose to become a leading authority in genitourinary medicine. She led a research team whose work transformed clinical practice in the UK, improving the health of millions of women by advancing the treatment of anaerobic/ bacterial vaginosis.  Immersed in orthodox medicine by day, she devoted her after-hours to the in-depth investigation of anomalous phenomena, energy healing, and metaphysics. Her innate psychic abilities offered profound insights into her patients' lives, psyches, and hidden traumas—insights that few modern doctors are privileged to experience. Key Points Discussed:  (00:00) - Doctor REVEALS How Ignoring Spirit Secretly Creates Illness in the Body (01:35) - Welsh Roots and Spirituality (02:41) - The Intersection of Medicine and Mysticism (03:28) - Historical Context of Spiritual Healing (05:09) - Personal Experiences with Spiritual Healing (06:04) - The Role of Emotions in Physical Health (06:58) - Medical Career and Spiritual Encounters (20:00) - Early Life and Spiritual Gifts (28:43) - Near-Death Experience and Its Impact (30:46) - Telepathic Awareness and Near-Death Experiences (31:29) - Bridging Worlds: Honoring Spiritual Principles (32:16) - Holistic Healing and Medical Integration (34:36) - Predetermined Life Paths and Free Will (44:18) - Spiritual Healing and Energy Forms (53:21) - The Future of Medicine and Social Connection (57:39) - The Importance of Love and Final Thoughts How to Contact Dr. Anona Blackwell:www.drblackwell.co.uk From Medic to Mystic: The True Story of an Academic Physician's Journey Into the Paranormal   About me:My Instagram: www.instagram.com/guyhlawrence/?hl=en Guy's websites:www.guylawrence.com.au www.liveinflow.co

Jonathan Barratt, PhD, FRCP - The Nephrology Journal Club: B-Cell Modulators and eGFR Endpoints in IgA Nephropathy

This month, we're taking stock of clinically noteworthy developments from the IAS Conference on HIV Science in July. On the docket: new (definitive?) data on the relationship between weight gain and ART; a range of studies on ART strategy, including treatment simplification, injectable ART in viremic patients, intermittent oral ART dosing, and PrEP safety in pregnancy; and a glimpse at updated WHO treatment guidelines. We also discuss the general vibe at this year's meeting — and some big news regarding Laura's professional career.   Please support us by visiting the episode transcript (which includes useful context links to relevant studies): https://www.thebodypro.com/podcast/hiv/future-hiv-care-ias-conference-highlights-aug-2025   The pod people: Our co-hosts are Laura Waters, M.D., FRCP, and Myles Helfand; our senior production manager is Alina Mogollon-Volk; our senior producer is Lizzie Warren; our associate production manager is Maui Voskova; our audio editor is Kim Buikema; and our executive producer is Myles Helfand.

Are deposition expenses busting your budget? In this episode, Jim Garrity spotlights a clever strategy conceived by a southern California litigator to sharply cut the costs of deposition transcripts. It's yet another effort by trial lawyers to combat the insane costs of stenographic reporting, and one worth trying. The show notes point to seventeen relevant filings on this issue, four federal rules, and a website for a service that is actively helping lawyers cut deposition costs.Like this podcast? Our production crew LOVES 5-star reviews. They're free, fast to leave, and provide us the kind of appreciative good vibes we crave. Would you mind taking ten seconds and clicking on the five-star rating? Thanks!SHOW NOTES:Note: All filings listed below are from the case Black v. City of San Diego, Case No. 21-cv-1990-RBM-JLB (S.D. Cal. Mar. 27, 2025)Plaintiff's Application For Leave To Conduct Deposition By Video And To Prepare Transcript Using Voice Recognition Technology According To FRCP Rule 30(b)(3)(A) (initial application by Plaintiff) PACER Doc. 153Defendants' Opposition To Plaintiffs Application For Leave To Prepare Deposition Transcript Using Voice Recognition Technology, PACER Doc. 160.Declaration Of Casey Stark In Support Of Plaintiffs Motion For Leave To Conduct Deposition By Video And To Prepare Transcript Using Voice Recognition Technology According To FRCP 30(b)(3)(A), PACER DOC. 153-1Defendant Tutterow's Notice Of Joinder In Defendant City Of San Diego's Opposition To Plaintiffs Ex Parte Application For Leave To Conduct Deposition By Video And Prepare Transcript Using Voice Recognition, PACER Doc. 162.Defendants Supplement To Opposition To Plaintiffs Application For Leave To Prepare Deposition Transcript Using Voice Recognition Technology, PACER Doc. 164Plaintiffs Reply To Opposition To Application For Leave To Conduct Deposition By Video And To Prepare Transcript Using Voice Recognition Technology According To FRCP Rule 30(b)(3)(A), PACER Doc. 165Second Supplemental Declaration Of Casey Stark In Support Of Plaintiff Motion For Leave To Conduct Deposition. Etc., PACER Doc. 170Defendants Second Supplement To Opposition To Plaintiffs Application For Leave To Prepare Deposition Transcript Using Voice Recognition Technology, PACER Doc. 171Order (Magistrate Judge) Denying Plaintiff's Application For Leave To Conduct Deposition By Video And To Prepare Transcript Using Voice Recognition Technology, PACER Doc. 172Plaintiff's Notice Of Objection To Order Denying Application For Leave To Conduct Deposition, Etc. PACER Doc. 173 (appealing magistrate judge's order to district judge)Defendant's Response To Plaintiff's Objection To Magistrate's Order Denying Claims Application For Leave, PACER Doc. 174Plaintiffs Opposition To Defendants Response To Player's Objection To Magistrate's Order Denying Plaintiff's Application, Etc., PACER Doc. 175Order (District Judge) Overruling Plaintiff's Objections, PACER Doc. 178Order Granting Joint Motion For Protective Order, PACER Doc. 32 (providing that certain information was to remain confidential)Modified Protective Order, PACER Doc. 156Readback.legal (reporting agency dedicated to reducing deposition -related costs; interview of Readback's Chief Legal Officer in podcast episode 87)1993 Committee Note to Fed. R. Civ. P. 26 (noting that where a deposition isn't stenographically recorded, transcripts are often later prepared by counsels' own law firmsFed. R. Civ. P. 30(b)(3)(a) (allowing lawyers to capture deposition testimony by stenographic means only, audio only, video only, or any combination of the three)FRCP 26(a)(3)(A)(ii) and FRCP 32(c) (providing that if counsel chooses to record a deposition by video only and plan to present it at trial or hearing, they must provide a transcript of the testimony to the other parties and the court)Readback.legal (innovative and budget-friendly service advertised as "certified, court-admissible deposition service built for legal professionals who need clarity, speed, and accuracy, without relying on outdated stenography")

Despite decades of effort and innovation since the groundbreaking To Err is Human report over 25 years ago, preventable harm in healthcare persists, and violence against healthcare workers continues to rise. With record understaffing, burnout, mandatory overtime, and mounting documentation demands, the pressure to provide safe care has never been higher nor the stakes more urgent. In this first episode of our new series focusing on safety in healthcare, we explore a bold shift toward "total systems safety" with two leaders at the forefront of this movement who know these challenges all too well. Patricia McGaffigan, RN, MS, CPPS, Senior Advisor for Patient and Workforce Safety at the Institute for Healthcare Improvement, and President of the Certification Board for Professionals in Patient Safety, and Donald Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow at the Institute for Healthcare Improvement, and former Administrator of the Centers for Medicare and Medicaid Services. Together, they continue to shape national safety efforts including IHI's Safer Together: National Action Plan to Advance Patient Safety the first public-private collaboration of its kind. Spearheaded by McGaffigan and bringing together 27 major organizations that had never collaborated before. The plan aims to restructure the very foundation of healthcare, building safety into every level of the system around four interlocking pillars. Leadership & Governance: Strong, visible leadership and policies that make safety a strategic priority. Workforce Safety & Well-Being: Protecting nurses and healthcare workers – physically and mentally – so they can care safely for others. Patient & Family Engagement: Partnering with patients and family caregivers as co-designers of safe care. Learning Systems: Creating feedback loops and continuous improvement so lessons from one hospital spread everywhere.   At the heart of this movement is a truth long understood by nurses: safety is not a checklist or a policy, it's a culture, a commitment, and a collective responsibility. As Patricia McGaffigan reminds us, “You can't have patient safety if you don't have a safe workforce.” And as Don Berwick warns, “The illusion that safety is a matter of individual effort is one of the most toxic notions in the whole safety enterprise. It is we, not me.” Nurses have always led by example, holding space for healing while navigating broken systems. Now, their leadership is essential in building the future of healthcare safety: one that protects not only patients, but the people who care for them. Where healthcare is not only safer, but also is a culture that ensures we're all Safer Together.