Clinical practice guidelines have evolved tremendously over the past few years. This episode looks at the updated medication guidelines for low back pain and why conservative movement-based care is your best option for relief.Episode Notes:Systematic review of guideline-recommended medications prescribed for treatment of low back painDesigned by a Podiatrist over 30 years ago after seeing similarities in many of the custom devices he was creating, PowerStep offers an affordable, same day solution that combines support and cushioning. Want to try a pair for yourself, click here for a free sample pair.The Smart Chiropractor powers your patient journey to provide you with more qualified leads, more new patients, better patient retention, and consistent reactivations, without any money spent on advertising.ChiroMatchMakers specializes in DC and CA hiring. We have over 100 positions available right now with salaries starting at $85K. Discover the available positions today by clicking here. Our members use research to GROW their practice. Are you interested in increasing your referrals? Discover the best chiropractic marketing you aren't currently using right here!
This week the hosts dissect new research that suggests moderate drinking may be good for the heart, and they discuss new guidelines surrounding taking preventative aspirin. Plus, they share a delicious recipe for a Chicken avocado Caprese salad.
It has been almost two months since medical students flew home to India from the war in Ukraine. While they deal with the trauma of their war experiences, students say the struggle is far from over. According to the regulations of the National Medical Commission, they will be disqualified from working as a doctor in India unless they finish their education in the same college. Now their future hangs in limbo. Most of these students are from small-town, middle-class families and have taken loans to support their Ukraine education. In this episode of The Suno India Show, host Suryatapa Mukherjee speaks to students Mohammed Mahtab Raza from East Champaran, Bihar; Satya from Delhi and Prajjwal Singwal from Rudraprayag, Uttarakhand. Guidelines for registration of Foreign Medical Graduates | NMC Ukraine crisis: NMC allows foreign medical graduates to complete internship in India – Hindustan Times SC asks NMC to help MBBS students hit by Ukraine crisis, coronavirus pandemic | The Indian Express West Bengal: Students from Ukraine to attend practicals in 17 medical colleges | TOI Karnataka: Medical students from Ukraine to continue studies in 60 state colleges | The Indian Express Poland and Hungary lend a helping hand to medical students in Ukraine | TOI See sunoindia.in/privacy-policy for privacy information.
This Friday, GoJo and Brandon are joined by Mike Golic Sr to discuss all the drama going on in College Football after Nick Saban's comments accusing Texas A&M / Jimbo Fisher and Jackson State / Deion Sanders of paying recruits to play for their football programs. Then, in a podcast edition of "Grilling Golic,” the guys address the best mailbag questions. If you or someone you know has a gambling problem, crisis counseling and referral services can be accessed by calling 1-800-GAMBLER (1-800-426-2537) (IL/IN/MI/NJ/PA/WV/WY), 1-800-NEXT STEP (AZ), 1-800-522-4700 (CO/NH), 888-789-7777/visit http://ccpg.org/chat (CT), 1-800-BETS OFF (IA), 1-877-770-STOP (7867) (LA), 877-8-HOPENY/text HOPENY (467369) (NY), visit OPGR.org (OR), call/text TN REDLINE 1-800-889-9789 (TN), or 1-888-532-3500 (VA). 21+ (18+ WY). Physically present in AZ/CO/CT/IL/IN/IA/LA/MI/ /NJ/NY/ PA/TN/VA/WV/WY only. Min. $5 deposit required. Eligibility restrictions apply. See http://draftkings.com/sportsbook for details.
"I've always had a heart for missions and the needy," writes a Guidelines' friend, "and our church does not support Christian missions. Sometimes I don't approve the decisions of the church and how the money is used. A bit extravagant at times.... What is right in God's eyes?"
Die Brainwashed - Radio Edition ist eine einstündige Show mit Musik von den Künstlern und Labels auf Brainwashed.com. 1. Hard Feelings, "Sister Infinity" (Hard Feelings) 2021 Domino 2. Patrick Q.Wright & Edward Ka-Spel, "Medusa Of A Thousand Cuts" (The Scarlet Trail of Stinging Tears) 2021 self-released 3. Jake Xerxes Fussell, "Love Farewell" (Good and Green Again) 2022 Paradise of Bachelors 4. Noveller, "Laura Palmer's Theme (Video Edit)" (Wrapped in Plastic) 2021 self-released 5. serpentwithfeet, "Shoot Ya Shot" (DEACON'S Grove) 2021 Secretly Canadian 6. Still, "Ahlam Wa Ish (feat. Winnie Lado)" (KIKOMMANDO) 2021 Pan 7. bela, "변주 1 Variation 1" (Guidelines) 2021 Éditions Appærent 8. Mark Trecka, "Radiance (feat. Walt McClements)" (Implication) 2021 Whited Sepulchre 9. Crazy Doberman, "as the wind winds tightly 'round the loom" (everyone is rolling down a hill or "the journey to the center of some arcane mystery and the entanglements of the vines and veins of the cosmic and unwieldy millieu encountered in the midst of that endeavor") 2021 Astral Spirits 10. Dear Laika, "Lilac Moon, Reflected Sun" (Pluperfect Mind) 2021 Memorials of Distinction 11. George T & Johnny Aux, "Amsterdam" (Making Excuses For You EP) 2021 Optimo 12. Tara Jane O'Neil, "This Girl's in Love With You" (His Majesty's Request: A Wink O'Bannon Select) 2021 Motorific Sounds # Brainwashed - Radio Edition Email podcast at brainwashed dot com to say who you are; what you like; what you want to hear; share pictures for the podcast of where you're from, your computer or MP3 player with or without the Brainwashed Podcast Playing; and win free music! We have no tracking information, no idea who's listening to these things so the more feedback that comes in, the more frequent podcasts will come. You will not be put on any spam list and your information will remain completely private and not farmed out to a third party. Thanks for your attention and thanks for listening. * http://brainwashed.com
Hearing God: Developing a Conversational Relationship with God; Dallas Willard Recently God has made me listen more as a result of losing my voice after an allergic reaction to something I ate. Today we look at Chapter 1. - 1. A paradox about hearing God - Learning to hear God's voice makes us more than someone who has knowledge.17 - The ongoing conversation - He references Adam & Eve, Enoch and Moses as examples of people with an ongoing conversation with God. However, I'm not sure that is precisely true. That might be an over literal understanding of Enoch's relationship with God. In any case, we have very little detail. - The UFO syndrome - We might sound a bit wacky if we start talking about hearing God. - "Why is it", comedian Lily Tomlin asks, "that when we speak to God we are said to be praying but when God speaks to us we are said to be schizophrenic?" Is. 58:9 Then you will call, and the LORD will answer; you will cry for help, and he will say: Here am I. “If you do away with the yoke of oppression, with the pointing finger and malicious talk, 10 and if you spend yourselves in behalf of the hungry and satisfy the needs of the oppressed, then your light will rise in the darkness, and your night will become like the noonday. 11 The LORD will guide you always; he will satisfy your needs in a sun-scorched land and will strengthen your frame. You will be like a well-watered garden, like a spring whose waters never fail. - Abiding include conversing - Jesus makes his home with his followers, John 14:23 “Jesus replied, “Anyone who loves me will obey my teaching. My Father will love them, and we will come to them and make our home with them.” - "The Spirit who inhabits us is not mute, restricting himself to an occasional nudge, a hot flash, a brilliant image or a case of goosebumps." 22 - How can we abide unless there is communication? John 15:15 I no longer call you servants, because a servant does not know his master's business. Instead, I have called you friends, for everything that I learned from my Father I have made known to you. Heb. 13:5 Keep your lives free from the love of money and be content with what you have, because God has said, “Never will I leave you; never will I forsake you.” Heb. 13:6 So we say with confidence, “The Lord is my helper; I will not be afraid. What can mere mortals do to me?” Matt. 28:20 and teaching them to obey everything I have commanded you. And surely I am with you always, to the very end of the age.” - One-to-one with God - God cares for his sheep individually, Psalm 23 - "The biblical record always presents the relationship between God and the believer as more like a friendship or family tie than like merely one person is arranging to take care of the needs of another." 23 - The paradox - Direct communication with God is in Christian history and in Scripture. Yet it is almost a taboo topic amongst Christians. - First steps toward a solution - If we believe in personal communication we must not neglect this area - Three general problems - 1. Gods communications come to us in many forms - 2. We may have the wrong motives - 3. We misconceive the very nature of our heavenly Father and of his intent for us. God is not our buddy - "The development of character, rather than direction in this, that, and the other matter, must be the primary purpose of the father. He will guide us, but he won't override us. That fact should make us use with caution the method of sitting down with a pencil and a blank sheet of paper and write down the instructions dictated by God for the day." - A conversational relationship - We are looking for a mature relationship. - We follow because we know his voice, When he has brought out all his own, he goes on ahead of them, and his sheep follow him because they know his voice. Jn 10:4 Next week we will go on to look at chapter 2 of the book which is titled “Guidelines for hearing from God". Please add your comments on this week's topic. We learn best when we learn in community. Do you have a question about teaching the Bible? Is it theological, technical, practical? Send me your questions or suggestions. Here's the email: [firstname.lastname@example.org](mailto:email@example.com). If you'd like a copy of my free eBook on spiritual disciplines, “How God grows His people”, sign up at my website: http://[www.malcolmcox.org](http://www.malcolmcox.org/). Please pass the link on, subscribe, leave a review. “Worship the LORD with gladness; come before him with joyful songs.” (Psalms 100:2 NIV11) God bless, Malcolm
Taken from the 2022 SRS Research Grant Outcome Symposium on March 5, 2022, join Virginie Lafage, PhD as they share the descriptions, guidelines, and general information for the SRS Research Grants.... Scoliosis Dialogues is a Scoliosis Research Society (SRS) podcast aimed at delivering the most current and trusted information to clinicians that care for patients with scoliosis and spinal deformities. From news in the world of spinal deformity, to discussions with thought leaders in the field, we aim to provide up-to-date, quality information that will impact the daily practice of spinal deformity.
Dear Therapist/Therapist Assistant, Thank you for taking a few moments to learn more about what your patient with Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating neuropathy (CIDP) or a variant has been experiencing and how you better can help them on their road to recovery. Perhaps they already are well along on their journey, or they just may be getting started, but their experience to this point undoubtedly has been a frightening and stressful one. Some of a patient's greatest fears regarding therapy are that their therapist will not know what to do with them and/or will not understand their limitations, or that therapy will be so painful and/ or hard that they will not be able to move the next day.
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Party rentals have become a huge problem for Airbnb, so they're launching an anti-party crackdown. What to expect when booking - and major considerations for potential hosts. Also, there has been a lot of talk lately about student loans and the cost of college. Clark covers which degree programs have the best payback. When you can match your interests with an in-demand high-earning degree - career WIN. Airbnb Guidelines: Segment 1 Ask Clark: Segment 2 Profitable College Degrees: Segment 3 Ask Clark: Segment 4 Mentioned on the show: A Simple Way To Help Your Kid Build Credit Should You Redeem Credit Card Points for Travel Rewards or Cash Back? How To Cancel Private Mortgage Insurance Years Ahead of Schedule Clark.com resources Episode transcripts Clark.com daily money newsletter Consumer Action Center Free Helpline: 636-492-5275 Learn more about your ad choices: megaphone.fm/adchoices Learn more about your ad choices. Visit megaphone.fm/adchoices
In this episode, John talks with Aliki Katriou, who has extensive knowledge of classical technique, and contemporary styles and is world-renowned for her expertise with "extreme" vocals, about what singing with distortion is and how to start to introduce this technique into your singing. Episode Highlights: Aliki's inspiration and path to singing with distortion The different ways you can introduce distortion into the voice Do languages and voice types affect how easily you can find distortion? Guidelines for how to approach singing with distortion safely To learn more about Aliki Katriou, visit: www.aliki.katriou.com To learn more about John Henny, his best selling books, courses, and the Contemporary Voice Teacher Academy, visit: johnhenny.com
CNS is committed to maintaining the infrastructure to develop and disseminate high quality clinical practice guidelines to help clinicians confront a rapidly changing healthcare environment and improve patient outcomes. J. Bradley Elder, MD Brian L. Hoh, MD, MBA Sravanthi Koduri, MD
An interview with Dr. Jennifer Ligibel from Dana Farber Cancer Institute in Boston, MA and Dr. Catherine Alfano from Northwell Health Cancer Institute and Feinstein Institutes for Medical Research in New York, NY, co-chairs on "Exercise, Diet and Weight Management During Cancer Treatment: ASCO Guideline." This guideline addresses recommendations for exercise, diet, and weight management for adult patients undergoing active cancer treatment, highlighting where there is evidence to recommend interventions, and where future research is needed. Read the full guideline at www.asco.org/supportive-care-guidelines. TRANSCRIPT Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast series brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all the shows, including this one at asco.org/podcasts. My name is Brittany Harvey, and today I'm interviewing Dr. Jennifer Ligibel from Dana Farber Cancer Institute in Boston, Massachusetts, and Dr. Catherine Alfano from Northwell Health Cancer Institute, and Feinstein Institutes for Medical Research in New York, New York, co-chairs on 'Exercise, Diet and Weight Management During Cancer Treatment: ASCO Guideline'. Thank you for being here, Dr. Ligibel and Dr. Alfano. Dr. Jennifer Ligibel: Thanks for having us. Brittany Harvey: First, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The full conflict of interest information for this guideline panel is available online with the publication of the guideline in the Journal of Clinical Oncology. Dr. Ligibel, do you have any relevant disclosures that are directly related to this guideline topic? Dr. Jennifer Ligibel: I have no personal conflicts with this guideline. Brittany Harvey: Thank you. Dr. Alfano, do you have any relevant disclosures that are directly related to this guideline topic? Dr. Catherine Alfano: I have no conflicts. Brittany Harvey: Thank you. Then, getting into the content of this guideline. Dr. Ligibel, can you start us off with an overview of the scope of this guideline? Dr. Jennifer Ligibel: Sure. So, this guideline was developed to provide recommendations around exercise, diet, and weight management for patients undergoing active cancer treatment. We defined active cancer treatment as either the perioperative period or the period of time in which patients were receiving chemotherapy and/or radiation. This guideline specifically focuses on adult cancer patients and largely focuses on individuals undergoing treatment for curative intent. There were a number of reasons why we thought it was important to develop a guideline specifically for patients who were undergoing cancer treatment. There are a number of other guidelines that talk about the role of these types of lifestyle factors in preventing cancer, and also information widely available about the potential benefits of exercising more, consuming certain types of diets, or losing weight after cancer treatment is finished. But there's much less information about the feasibility and potential benefits and safety of increasing your exercise, changing your diet, or losing weight during cancer treatment. This is the time when oncology providers are primarily working with patients in a time when patients have a lot of questions about what they should be eating and what they should be doing. So, this guideline was developed to specifically try to provide guidance during treatment. Brittany Harvey: Yes, definitely an area in which guidance is very much needed. So, then Dr. Alfano, I'd like to next review the key recommendations of this guideline, starting with what are the recommendations regarding exercise during cancer treatment? Dr. Catherine Alfano: For exercise, the expert panel felt that the evidence was very strong. And so, oncology providers should recommend aerobic and resistance exercise during active treatment with curative intent because it can mitigate the side effects of cancer treatments. So, exercise has been shown during active cancer treatment to reduce fatigue, to either improve or preserve a patient's cardiorespiratory fitness, their physical functioning, their strength outcomes, and in some kinds of patients exercise has been shown to improve quality of life and reduce anxiety and depression. The evidence is not sufficient to recommend exercise specifically for improving cancer control outcomes yet. This is a source of ongoing study, but we felt that the evidence was strong enough that oncology providers should recommend aerobic and resistance exercise, and it should become the standard of care for all cancer patients. The second recommendation regarding exercise is that oncology providers may recommend pre-operative exercise for patients specifically undergoing surgery for lung cancer. So, this can be called prehab or pre-habilitation exercise. And this exercise has been shown to reduce outcomes like the length of hospital stay and postoperative complications. Brittany Harvey: Excellent. Thank you for reviewing those recommendations and the level of evidence behind them. So, then, Dr. Ligibel, what did the panel recommend regarding particular dietary patterns or foods for patients during cancer treatment? Dr. Jennifer Ligibel: One of the things that we recognized as a panel as we reviewed the evidence that shaped these guidelines was that there was much less evidence for both dietary factors and whether that was specific dietary patterns or some specific foods, as well as weight management, how those types of changes during treatment, affected outcomes, or even the feasibility of changing your diet or losing weight during cancer treatment. We, for this guideline, really relied on randomized trials to help shape our guidance, and we realized very quickly that there were few randomized trials testing dietary change or weight management during cancer treatment. So, as a panel, we debated for a long time about what we should say in this setting. We did find that there were a few randomized trials that specifically looked at neutropenic diets. We defined that as diets that omitted fresh fruits and vegetables for patients who had undergone treatment for hematologic malignancies, and in particular bone marrow transplants. Those studies were designed to look at whether those types of diets reduce the risk of infection. We did not see evidence that omitting fruits and vegetables during cancer treatment for those malignancies, reduced infection, and so the group provided a recommendation that neutropenic diets not be recommended for patients during cancer treatment, but we were unable to provide specific guidance regarding other dietary factors or the incorporation of specific foods during cancer treatment. As a group, we recognize the importance of a healthy diet for general health. But given that we were really looking at randomized trials of the effects of changing someone's diet during treatment, we ultimately did not make a recommendation for a particular diet during cancer treatment, but really called for more research with well-designed clinical trials to test the impact of things like plant-based diets, intermittent fasting, other types of diets for which there may be interesting preclinical evidence, but very little information in people about the benefits or even the safety of these types of diets during cancer treatment. Brittany Harvey: Understood, I appreciate you outlining the nuance of that recommendation, and also the areas for future research, which we can get into a little bit more in a little bit. So then, in the last category of recommendations, Dr. Alfano, what does the guideline state regarding interventions to promote intentional weight loss or avoidance of weight gain during cancer treatment? Dr. Catherine Alfano: So, when our panel reviewed the evidence for weight loss or the avoidance of weight gain during cancer treatment, unfortunately, we decided that ultimately, there's insufficient evidence right now to recommend either for or against intentional weight loss or the prevention of weight gain during active treatment to improve outcomes related to the quality of life or things like treatment toxicities, or ultimately cancer control outcomes. Brittany Harvey: Thank you, Dr. Alfano, for that recommendation, as well. So, Dr. Ligibel, in your view, what is the importance of this guideline? And how will it impact both clinicians and patients? Dr. Jennifer Ligibel: This guideline is really the first large-scale effort to pull together all of the data from randomized trials about the effects of changing your lifestyle, exercising more, in particular, changing your diet, changing your weight during cancer treatment. I think that as a panel, we found very clear and consistent evidence as Dr. Alfano outlined, that exercise has concrete benefits for patients during cancer treatment. I think that this is really an important call to action, both for providers in speaking about these topics to their patients, but also for payers. And as we think about our healthcare system, about how we're going to support patients in becoming more active in a safe way during their cancer treatment. I think that it's very important that we recognize that encouraging physical activity is not just telling people that they should go out and do it. We really need to think about how we support patients in making these types of lifestyle changes in a sustained way. So, I think that this guideline really provides clear evidence that exercise is important. It also provides clear evidence that we need more research in other areas. Patients are asking their oncology providers every day, what they should be eating, whether they should be thinking about losing weight, and we really don't have clear evidence to guide these conversations at this point. I do think it's important to recognize that as a panel, we all felt very strongly that this guideline should not be interpreted as saying that a healthy diet or maintaining a healthy weight during treatment wasn't important. But we were really struck by the dearth of high-level evidence to be able to help our patients make informed choices and I think that's something that, from this guideline, we really need to come up with a plan be better able to ask the question that comes up in the clinic every day of, 'Doctor, what should I eat?' Brittany Harvey: Those are excellent points. I appreciate the panel looking critically at the evidence that's actually out there to try and determine recommendations. So then, Dr. Ligibel just mentioned a few areas in which more research is needed. So, Dr. Alfano, what are the outstanding questions regarding optimal diet, weight management, and exercise during active cancer treatment? Dr. Catherine Alfano: Being treated for cancer makes many patients feel like they have no control over their health and that causes them enormous anxiety. Patients are really looking for things that they can do to take the reins of control back over their health to improve their long-term health and well-being during treatment. I want to underscore the importance of the oncology team in helping patients improve their exercise. Research has shown that 50% of patients undergoing cancer treatment are not getting enough exercise. Patients want to receive guidance about exercise from their oncology team. And importantly, patients whose oncology clinicians discuss exercise with them are more likely to make these healthy behavior changes. So, it really underscores the importance of the oncology team in helping patients to access these important components of their health that they're asking for. The appropriate referral for exercise in patients undergoing treatment for cancer can really depend on several factors such as comorbidities, treatment toxicities, and the patient's pre-existing physical activity level. For example, many patients can safely perform unsupervised exercise, but others may need supervised cancer-specific exercise because they've got problems that they need to deal with clinically supervised exercise or to participate in a formal cancer rehabilitation program prior to undertaking exercise on their own. I want to highlight for everyone that there are national efforts that are focusing on building referral algorithms and clinical decision support tools to help point to the most safe, feasible, and effective intervention for a given patient. Brittany Harvey: Excellent. Well, thank you both so much for outlining the recommendations here and describing the nuance that the expert panel went through. It was certainly a large effort that you've helped lead. And so, I want to thank you so much for your work on these guidelines, and for your time today, Dr. Ligibel and Dr. Alfano. Dr. Jennifer Ligibel: Thanks for having us. Dr. Catherine Alfano: Thank you. Brittany Harvey: Thank you to all of our listeners for tuning in to the ASCO guidelines podcast series. To read the full guideline go to www.asco.org/supportive-care-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in iTunes or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.
In this Hot Flash, we do a quick and dirty overview of one of the most serious perimenopausal symptoms - heavy menstrual flow. We define what constitutes too much bleeding, when to be concerned and what to do about it. ****IMPORTANT NOTE at about 8min and 10 seconds in I mention not taking iron at higher dose than 8 mg per day without monitoring - it sounds like I say 80mg but it's 8(eight)! Truly, any iron supplementation outside of food sources should be monitored with lab testing to ensure proper dosing and prevent complicationhttps://www.kindara.com/https://helloclue.com/Testing ferritin to evaluate iron stores: https://medlineplus.gov/lab-tests/ferritin-blood-test/Evidence for dosing iron every other day: https://pubmed.ncbi.nlm.nih.gov/31413088/Iron IVs for treating iron deficiency: What to Know About Iron Infusions for Anemia Treatment - GoodRxDairy and heavy menses: What Dairy Does to Periods • Lara Briden - The Period RevolutionarySlow Flow: https://vitanica.com/online-store/slow-flow-60-capsules/ (no affiliation)Acupuncture case study: Acupuncture treatment for dysfunctional uterine bleeding in an adolescent - PMC (nih.gov)Ibuprofen for heavy menses: Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding - PubMed (nih.gov)Tranexemic acid for heavy menses:Tranexemic Acid (Lysteda) for Cyclic Heavy Menstrual Bleeding - STEPS - American Family Physician (aafp.org)Guidelines for progesterone therapy and a review oftreatment options for heavy mense from CeCor: Very Heavy Menstrual Flow | The Centre for Menstrual Cycle and Ovulation Research (ubc.ca)Hormonal IUD for treatment of heavy menses: Reproductive Health Access Project | Contraceptive Pearl: Progestin IUD as Treatment for Menorrhagia - Reproductive Health Access Project (reproductiveaccess.org)Oral Birth Control - new brands with bioidentical estrogens for management of perimenopasual heavy menses: Natazia: Official patient website or About NEXTSTELLIS | NEXTSTELLIS®(drospirenone and estetrol tablets) Uterine ablation: Uterine Ablation as a Treatment for Severe Menorrhagia – Naturopathic Doctor News and Review (ndnr.com)Myomectomy for fibroids: Myomectomy – Fibroid Treatment CollaborativeSex after hysterectomy: Post Hysterectomy Sex: Your Guide To Sex After Hysterectomy (dofeve.org)Health impact of hysterectomy and age of menopause: What We Know about the Long-Term Risks of Hysterectomy for Benign Indication—A Systematic Review - PMC (nih.gov)
Beef Supply Drivers Handling Cattle Semen Quail and Pasture Burning 00:01:06—Beef Supply Drivers--Livestock economist Lee Schulz of Iowa State University provides this week's cattle market commentary: he goes over what the USDA's latest World Agricultural Supply and Demand Estimates report said about international beef trade...and he gets into a new analysis he's done on the factors influencing the U.S. beef supply here in 2022, and which of those will have lasting impacts on supply over the next couple of years 00:12:07—Handling Cattle Semen--K-State beef reproduction specialist Sandy Johnson reminds cow-calf producers running an A-I program of the guidelines for handling beef semen before administering it...with the objective of preserving the viability of that product prior to and during insemination 00:23:06—Quail and Pasture Burning--On this week's wildlife management segment, K-State wildlife specialist Drew Ricketts goes over a new study of prescribed grass burning and the impact on quail nesting success Send comments, questions or requests for copies of past programs to firstname.lastname@example.org. Agriculture Today is a daily program featuring Kansas State University agricultural specialists and other experts examining ag issues facing Kansas and the nation. It is hosted by Eric Atkinson and distributed to radio stations throughout Kansas and as a daily podcast. K‑State Research and Extension is a short name for the Kansas State University Agricultural Experiment Station and Cooperative Extension Service, a program designed to generate and distribute useful knowledge for the well‑being of Kansans. Supported by county, state, federal and private funds, the program has county Extension offices, experiment fields, area Extension offices and regional research centers statewide. Its headquarters is on the K‑State campus in Manhattan.
“Good morning Dr. Sala,” writes a friend of Guidelines, “I have a question to ask you. I am confused about tithing, and I want to be obedient to God's Word. I understand a tenth is required, and in Malachi 3:10 that it should be brought into the storehouse which I assume means the church. I have been giving half to church and another half [to missions]. Sometimes I don't approve of the decisions of the church and how the money is used. What is right in God's eyes?”
Mandy's 18-year-old daughter talks candidly about what it's like growing up in a nextTalk home. From social media to modesty, screen guidelines to expectations and the development of her faith -- we're covering a lot of ground that we hope will be helpful.Support the show
On this episode of Hands in Motion we are joined by Mia Erickson, PT, CHT, EdD and Marsha Lawrence, PT, DPT, CHT - both physical therapists and certified hand therapists - to discuss knowledge translation. We discuss what it is, how it is different from evidence-based practice and how it currently and will continue to effect treatment in hand therapy. Reference Links CPG's 1. AAOS Quality Programs and Guidelines: https://www.aaos.org/quality/quality-programs/upper-extremity-programs/ (https://www.aaos.org/quality/quality-programs/upper-extremity-programs/) 1. AOTA Evidence Based Practice Resources (includes systematic reviews, critically appraised topics, practice guidelines, evidence infographics): https://www.aota.org/advocacy/advocacy-news/2022/~/link.aspx?_id=A23190F777B84A0FB7B8EA162F954B1C&_z=z (AOTA EBP Resources) 2. APTA Clinical Practice Guidelines: https://www.apta.org/patient-care/evidence-based-practice-resources/cpgs/cpg-development/published-cpgs (List of published CPG's) 3. APTA Evidence Based Practice Resources: (includes tests and measures, clinical summaries, interventions and link to CPG's in progress) https://www.apta.org/patient-care/evidence-based-practice-resources (APTA EBP Resources) 4. Choose Wisely: https://www.choosingwisely.org/clinician-lists/ (Choose Wisely Clinician List) 5. Choose Wisely: https://www.choosingwisely.org/patient-resources/ (Choose Wisely patient list) 6. ECRI Guidelines Trust: https://guidelines.ecri.org/ (https://guidelines.ecri.org/) 7. JOSPT Published CPG list: https://www.jospt.org/topic/clinpracguide?code=jospt-site (https://www.jospt.org/topic/clinpracguide?code=jospt-site) Guest Bio: Marsha Lawrence has been a PT for over 40 years, a CHT since 1991 and earned her DPT in 2019. She has practiced hand rehabilitation in a variety of settings on the East Coast and in the Midwest. She served on ASHT's Board of Directors as the Practice Division Director and as a Board Member at-Large. She presently serves as the Practice Affairs Coordinator for the APTA Academy of Hand and Upper Extremity, their Chief Delegate to the APTA's House of Delegates, the Federal Affairs Liaison for the Academy, serves on APTA's Public Policy and Advocacy Committee and on the Board of Directors for the American Hand Therapy Foundation.
The American Urological Association just announced new Guidelines for the treatment of interstitial cystitis. It's the first update in 7 years, and it's big for pelvic rehab professionals!We basically have an entire category of treatment ("behavioral and non-pharmacological") that we are unique qualified to administer.Among the highlights (and things we've been advocating for...The AUA specifically calls out that Kegel exercises should not be done for patients with ICAdditional studies showing Elmiron has limited efficacy (or, in several trials, no efficacy at all) in treating IC over a placebo, as well as the chance for long-term eye damageAcknowledging an elimination diet (and not the 'IC Diet') is the gold standard for nutritional careHere's the link to the new AUA Guidelines for IC - hope you enjoy the 'sode!IC: Holistic Evaluation & TreatmentIf you're looking for the resource to go through all the physical therapy treatments, demonstrations of techniques on patients, medical management and everything you need to quarterback your patient's care, check out the IC: Holistic Evaluation & Treatment course! (www.pelvicptrising.com/ic)Pelvic PT Rising Business Mentorship - New Cohort!For the first time in over a year we are offering new spots in our Business Mentorship to cash-based pelvic health providers! Our mentees on average have doubled their case load and increased revenue by over $125,000 in the first year of working with us! We have 25 new spots available - for more information or to apply, visit www.pelvicptrising.com/mentoring.Shout Out and Get in Touch!If you're enjoying the podcast, please take a few seconds to take a screenshot and put it up in your Instagram Stories and tag Nicole (@nicolecozeandpt). Or send us an email at Nicole@PelvicSanity.com with your thoughts, questions or ideas. We'd love to hear from you!About UsNicole and Jesse Cozean founded PelvicSanity Physical Therapy together in 2016. It grew quickly into one of the largest cash-based physical therapy practices in the country. They run Pelvic PT Rising, providing both clinical and business resources exclusively tailored to pelvic PTs.
UN human rights experts that https://www.reuters.com/article/us-myanmar-rohingya-facebook/u-n-investigators-cite-facebook-role-in-myanmar-crisis-idUSKCN1GO2PN (chronicled) Facebook's https://www.nytimes.com/2018/10/15/technology/myanmar-facebook-genocide.html (role) in spreading hate speech in Myanmar concluded that it played a “determining role” in the genocide against the Rohingya people. Facebook's own https://www.theverge.com/2018/11/6/18068104/facebook-business-social-responsibility-myanmar-report (investigation) into the situation also found fault with the company's practices, and made various recommendations for how it should develop a human rights strategy to protect against such things from happening again. Today, we're going to hear from a refugee from the violence, who is with other Rohingya refugees in a camp in Cox's Bazar, Bangladesh, as well as three human rights advocates. And we'll learn about another complaint filed by sixteen Rohingya youth to Ireland's Organisation for Economic Co-operation and Development, the OECD, that argues that Facebook violated the OECD Guidelines for Multinational Enterprises by allowing its platform to be used to incite violence against them and their community. The remedy sought by these refugees is for Facebook to divest from a portion of its 2017 profits and provide remediation for their community in the form of educational activities and facilities in Cox's Bazar. Please note that the connection to Cox's Bazar was not perfect- if you have any trouble making out a word here or there, you can refer to the transcript at the Tech Policy Press website.
The Filtrate:Joel TopfNayan AroraSophia AmbrusoSwapnil HiremathSpecial Guest:Jade TeakallJeff Perl, Great Twitter handle, PD_PerlsEditor:Joel TopfShow Notes:ISPD 2022 Peritonitis GuidelinesNephJC DiscussionDimitrios Oreopoulos obituary in JASN. Peritoneal Dialysis International: Journal of the International Society for Peritoneal DialysisThe draft board: Google DocThe PROMPT Study showing delayed peritonitis treatment increases the risk of treatment failure: The Relationship Between Presentation and the Time of Initial Administration of Antibiotics With Outcomes of Peritonitis in Peritoneal Dialysis Patients: The PROMPT StudyEmbedded PD catheters: Complications and catheter survival with prolonged embedding of peritoneal dialysis cathetersNikhil Shah asking questions about fungal prophylaxisQuestion 1Question 2Icodextrin antibiotic compatibility: Stability and compatibility of antibiotics in peritoneal dialysis solutions or in Tweet Form.Nikhil Shah on having antibiotics at homeTweet thread about the things we do for little reason regarding getting people listed for transplant.Regarding the trend in duration of antibiotics: Duration of Antibiotic Therapy: Shorter Is Better‘Spelling the Dream' Review: Netflix's Inspiring Spelling Bee Doc Is an Unexpected Rallying CryABC KidneyHome Dialysis University was May 1, 2The Grand Canyon, second largest hole in the ground.
If carcass disposal is part of your work as a wildlife control professional then you need to watch this video. On today's edition of the Living The Wildlife Podcast with Host and wildlife control consultant Stephen Vantassel takes us through an overview of how wildlife control professionals should manage carcass disposal according to EPA guidelines.…
In this episode, we talk about the conclusion of the Brenner v. Oregon/NCAA case and the finding that the NCAA was negligent but no damages were paid. We discuss allegations against Alabama tampering with recruits. Coach Saban denies it but says that it is hard to control third-parties. The NCAA issues new NIL guidelines and starts to put some rules in place to help calm the NIL storm! --- Send in a voice message: https://anchor.fm/twolawyers/message
An interview with Dr. David Schiff from the University of Virginia Medical Center in Charlottesville, VA, Dr. Michael Vogelbaum from Moffitt Cancer Center in Tampa, FL, and Dr. Vinai Gondi from Northwestern Medicine Cancer Center Warrenville and Proton Center in Warrenville, IL, authors on "Radiation Therapy for Brain Metastases: American Society of Clinical Oncology Guideline Endorsement of the American Society for Radiation Oncology Guideline." An ASCO endorsement panel endorsed the "Radiation Therapy for Brain Metastases: an ASTRO Clinical Practice Guideline," and the authors review the endorsement process and key points in this episode. Read the full guideline endorsement at www.asco.org/neurooncology-guidelines. TRANSCRIPT Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast series, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all the shows including this one at asco.org/podcasts. My name is Brittany Harvey, and today I'm interviewing Dr. David Schiff, from the University of Virginia Medical Center in Charlottesville, Virginia, Dr. Michael Vogelbaum from Moffitt Cancer Center in Tampa, Florida, and Dr. Vinai Gondi from Northwestern Medicine Cancer Center Warrenville and Proton Center in Warrenville, Illinois, authors on 'Radiation Therapy for Brain Metastases: American Society of Clinical Oncology Guideline Endorsement of the American Society for Radiation Oncology Guideline'. Thank you for being here, Dr. Schiff, Dr. Vogelbaum, and Dr. Gondi. Drs. Schiff, Vogelbaum, and Gondi: Our pleasure. Brittany Harvey: First, I'd like to note that ASCO takes great care in the development of its guideline products and ensures that the ASCO conflict of interest policy is followed for each guideline product. The full conflict of interest information for this guideline endorsement panel is available online with the publication in the Journal of Clinical Oncology. Dr. Schiff, do you have any relevant disclosures that are directly related to this topic? Dr. David Schiff: No relevant disclosures, Brittany. Brittany Harvey: Thank you. And Dr. Vogelbaum, do you have any relevant disclosures that are related to this topic? Dr. Michael Vogelbaum: I have no relevant disclosures. Brittany Harvey: Thank you. And Dr. Gondi, do you have any relevant disclosures that are related to this topic? Dr. Vinai Gondi: Brittany, my only relevant disclosure is that I served as vice-chair of the guidelines that we're discussing today, but otherwise, no relevant disclosures. Brittany Harvey: Excellent! Thank you all. So, then starting us off, Dr. Schiff, what is the scope of this guideline endorsement? And how does it intersect with the recently published 'Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline'? Dr. David Schiff: Sure. A little bit of background, from the start of the joint ASCO and SNO guideline effort, we had the participation of radiation oncologists, in addition to neurosurgeons, medical oncologists, and neuro-oncologists. As we were getting underway, ASTRO reached out asking to participate formally as well. They had been planning to update their brain metastasis guidelines but were a year or two away from getting started. And they recognized it would be redundant for them to create comprehensive guidelines that covered chemotherapy, immunotherapy, and surgery as our guidelines were poised to do. By participating with ASCO and SNO, they were able to have their task force focus specifically on key questions related to radiation oncology practices. In particular, the ASTRO project went into considerable depth on issues of radiation and radiosurgery dose, fractionation schemes, and the risk of radiation complications. These were areas that our guidelines didn't address. Several members of the ASTRO task force including their chair, Paul Brown, and co-chair Dr. Gondi were members of our committee, and we added Dr. Brown as a co-chair to our committee when ASTRO came on board. The overlap between our two groups helped ensure that our recommendations were in harmony. Brittany Harvey: So, then, Dr. Vogelbaum, can you provide us with an overview of how the ASCO guideline endorsement process works? Dr. Michael Vogelbaum: Sure, Brittany. So, as Dr. Schiff mentioned, ASCO had convened a guidelines panel to develop the new 'Treatment for Brain Metastasis: ASCO-SNO-ASTRO Guideline'. And this was a multidisciplinary panel that he and I co-chaired and was anchored by a guideline specialist from ASCO, Hans Messersmith, and the process was that we had evaluated recent literature pertaining to the treatment of the brain metastases, and so, we had a very good understanding of what was supported by high-quality evidence and what was not there yet, as a group. So, when ASTRO came to ASCO and asked whether or not we would be interested in endorsing their guidelines, we were already prepared with all the evidence. And so, the same panel got together again, to evaluate the ASTRO guidelines. And we did this, again, in a very structured manner. We reviewed the guideline questions and recommendations, compared them to the evidence, and went through the same type of review and polling process that we had when we had developed our own original guidelines. In the end, we had a conversation with the ASTRO guidelines leadership about some of the points that we raised questions about, and we were able to reach an accommodation that allowed us to fully endorse the ASTRO guidelines. Brittany Harvey: Thank you, Dr. Vogelbaum for that overview of the endorsement process. So, then, Dr. Gondi, what are the key recommendations of the ASTRO guideline? Dr. Vinai Gondi: Thank you, Brittany. As Dr. Schiff and Dr. Vogelbaum outlined, ASTRO commissioned a list of key questions that they sought to address specifically to inform the radiotherapeutic management of brain metastases. And to address these questions, ASTRO not only convened a panel of expert radiation oncologists across the country but also engaged with the Agency for Healthcare Research and Quality (AHRQ) to create a comparative effectiveness evidence review, in addition to our own high-level evidence review to address these questions. The four key questions that were addressed in the ASTRO guidelines are: Number one: What are the indications for stereotactic radiosurgery alone for patients with intact brain metastases? Number two: What are the indications for observation, preoperative radiosurgery or post-operative radiosurgery, or whole-brain radiotherapy in patients with resected brain metastases? Number three: What are the indications for whole-brain radiotherapy for patients with intact brain metastases? Number four: What are the risks of symptomatic radionecrosis with whole-brain radiotherapy and/or stereotactic radiosurgery for patients with brain metastases? The recommendations that were made are based on a high-level review of a considerable amount of literature over the past several years that addressed these specific questions. I would encourage the listeners to this podcast to read through the guidelines to understand the specific nuances of each of those recommendations. Brittany Harvey: Excellent! Thank you for that overview. Then, in addition to what Dr. Gondi just said, Dr. Vogelbaum, were there any additional points of discussion raised by the ASCO endorsement panel? Dr. Michael Vogelbaum: Brittany, yes, there was an area of discussion where we needed to interact with the ASTRO guidelines leadership, as I mentioned earlier, and it really related to that key question one that Dr. Gondi described, which is what are the indications for SRS alone for patients with intact brain metastasis. The approach that had been strongly endorsed by ASCO was that there would be a multidisciplinary approach to decision making. And really the benefit of that, the value of that radiosurgery really comes in the form of the interaction between the radiation oncologist and the neurosurgeon. The way that the original proposal had been formulated, there was a size cut-off that was higher than we thought was appropriate for really endorsing that kind of conversation between the radiation oncologist and the neurosurgeon. And so really, we proposed that we bring that cut-off down further, there actually was another subpart to the guideline that had looked at a lower cut-off, but did not specifically call out that interaction between the neurosurgeon and the radiation oncologist. And we felt it would be more appropriate to insert that at that cut-off rather than the larger lesion cut-off. And after a conversation, there was agreement, that was really the only guideline or subpart of the guidelines where there was any real debate or discussion. For the rest of it, the comments that came up from the panel were easily addressed and it really just came down to this one modification. And fortunately, ASTRO agreed, and we were able to go ahead and complete the endorsement. Brittany Harvey: Great! It's great that this was able to be a complete endorsement of that guideline. So, then, Dr. Gondi, in your view, what is the importance of this guideline endorsement? And how will it affect ASCO members? Dr. Vinai Gondi: Thank you, Brittany. A number of responses to that. Number one is, as Dr. Vogelbaum, outlined the purpose of these guidelines was meant to be patient-centric and patient-focused, that we had patient champions who had navigated, who are part of the guideline development team, but also to be multidisciplinary. And so, the type of input and feedback we received from the ASCO team was super valued and valuable, as we were formulating these guidelines and Dr. Vogelbaum outlined a good example. Number two, it had been almost a decade since the last guidelines had come out from ASTRO related to brain metastases management. And much has happened in our field over the past several years that has been practice-changing. We have several novel and innovative radiotherapy technologies and techniques, such as the emergence of radiosurgery, the use of novel radioprotectants, such as hippocampal avoidance, and memantine, but also the emergence of innovative and novel neurosurgical interventions and CNS active systemic therapies. So, the modern management of brain metastases has really undergone quite a revolution over just the past few years, and it is important that these guidelines be updated to reflect those changes, but also to inform radiation oncologists on the contemporary management of brain metastases and in evidence-based care. So, we believe that these guidelines will significantly impact ASCO members. Certainly, those who are radiation oncologists, as brain metastases are some of the most common patients that radiation oncologists manage in the community and in academic centers, but also for other members of ASCO medical oncologists, surgeons to understand sort of the nuances of radiotherapy management that is evidence-based, so they can have a patient-centered, patient-focused, multidisciplinary discussion with their radiation oncologist as well. Brittany Harvey: Those are excellent points for clinicians on the management for brain metastases. So, then finally, Dr. Schiff, Dr. Gondi just mentioned how these guidelines are patient-centric. So, how will these guideline recommendations impact patients with brain metastases? Dr. David Schiff: Yeah, well, I think what I'm about to say is really going to echo what Dr. Gondi just said. You know, 20 years ago, patients diagnosed with brain metastases were typically immediately referred to a radiation oncologist, they almost always got whole-brain radiation therapy, the median survival was about four months, and many, if not most patients, died from their brain metastases. The situation has really changed recently. With the rapid advances in management from new therapies, and well-designed clinical trials in recent years, outcomes have markedly improved, it's probably less than a quarter of patients now who succumb to their intracranial disease. But at the same time, decision-making for patients has become much more complicated. Nowadays, medical oncologists may reach out initially to neurosurgeons for consideration of radiosurgery or surgical resection, or in some circumstances utilize systemic therapy as a first step. Conversely, a patient might see a neurosurgeon first, who may or may not be aware that there's appropriate immunotherapy or targeted agent that might make sense prior to going on to radiosurgery. It's obviously a challenge for sub-specialists to keep up with all the emerging clinical trial data and new drugs. Our two sets of guidelines provide a roadmap for physicians of different expertise to help determine what types of therapies or referral should be considered when brain metastases are found. The end result of all this is improved control of intracranial disease and improved quality of life for the patients. Brittany Harvey: Absolutely. Those are key points. It's excellent to see these guidelines, and the overarching 'Treatment for Brain Metastases: ASCO-ASTRO-SNO Guideline' be published. So, I want to thank you all for your time today, Dr. Schiff, Dr. Vogelbaum, and Dr. Gondi. Thank you for all of your work on these guidelines. Dr. Michael Vogelbaum: My pleasure. Dr. Vinai Gondi: Thank you for having us. Dr. David Schiff: Thank you, Brittany. It was great to participate in this important project. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast series. To read the full guideline endorsement go to www.asco.org/neurooncology-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in iTunes or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.
Extra Points' Matt Brown and D1.ticker's Bryan Fischer continue to discuss the fallout from the newest NCAA guidelines surrounding NIL but this time bring on KennyHertz Perry attorney and former D1 basketball player Mit Winter to discuss what you actually need to know and how the landscape is changing for all parties involved. Plus, don't forget you can get 15% off your Homefield Apparel order by using the promo code EXTRAPOINTS. You can also sign up for D1.ticker at https://www.d1ticker.com and check out Collegiate Sports Connect at https://csconnect.live/sign-up.
The following question refers to Section 4.11 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Christian Faaborg-Andersen, answered first by UCSF resident Dr. Jessie Holtzman, and then by expert faculty Dr. Laurence Sperling. Dr. Laurence Sperling is the Katz Professor in Preventive Cardiology at the Emory University School of Medicine and Founder of Preventive Cardiology at the Emory Clinic. Dr. Sperling was a member of the writing group for the 2018 Cholesterol Guidelines, serves as Co-Chair for the ACC's Cardiometabolic and Diabetes working group, and is Co-Chair of the WHF Roadmap for Cardiovascular Prevention in Diabetes. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #12 Medically supervised cardiac rehabilitation programs after ASCVD events and for patient with heart failure carries a Class I recommendation. However, placement of referrals, uptake and enrollment after referral, and rigor of rehabilitation all remain inconsistent. What minimum cumulative duration of cardiac rehabilitation has been chosen as a threshold of effectiveness for cardiac rehabilitation by the European Society of Cardiology? A. 100-300 minutes, 10 sessions B. 300-500 minutes, 16 sessions C. 500-700 minutes, 22 sessions D. 700-1000 minutes, 28 sessions E. >1000 minutes, 36 sessions Answer #12 The correct answer is E: >1000 minutes across 36 sessions. Cardiac rehabilitation is a comprehensive, multidisciplinary intervention not just including exercise training and physical activity counselling, but also education, risk factor modification, diet/nutritional counselling, and vocational and psychosocial support. A broad evidence base demonstrates that multidisciplinary cardiac rehabilitation and prevention programs after ASCVD events or revascularization reduce recurrent cardiovascular hospitalizations, myocardial infarction, and cardiovascular mortality. In patients with chronic HF (mainly HFrEF), exercise based cardiac rehabilitation (EBCR) may improve all-cause mortality, reduce hospital admissions, and improve exercise capacity and quality of life. Such programs include a wide array of activities including physical activity, risk factor modification, psychosocial support, nutrition counseling, and more. Despite the heterogenous design of clinical trials, cardiac rehabilitation has been shown to be a cost-effective intervention. Based upon the available review data, the European Association of Preventive Cardiology and the European Society of Cardiology proposed minimum standards for secondary prevention cardiac rehabilitation programs. Based upon a comprehensive review of the literature, ESC recommends that cardiac rehabilitation be multidisciplinary, supervised by health professionals, and start as soon as possible after a cardiovascular event. Cardiac rehabilitation should include both aerobic and muscular resistance tailored to the fitness level of the participant, should carry a duration of >1000 minutes in total, and should exceed 36 sessions total. While uptake remains limited, electronic prompts within the medical record and automatic referrals should be considered to enhance referral and participation. Future research should continue to explore the benefit of home-based cardiac rehabilitation with or without telemonitoring. Lastly, studies have shown that uptake remains lower among women, and targeted programs should be undertaken to address such disparities. Main Takeaway Current European Society of Cardiology guidelines provide a Class I (LOE A) recommendation for the participation in multidisciplinary cardiac rehabilitation programs for the secondary prevention of ASCVD events including revascularization and in individuals with heart failure (mainly HFrEF) to improve patient outcomes.
The following question refers to Section 6.1 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Christian Faaborg-Andersen, answered first by UCSD cardiology fellow Dr. Harpreet Bhatia, and then by expert faculty Dr. Eugenia Gianos.Dr. Gianos specializes in preventive cardiology, lipidology, cardiovascular imaging, and women's heart disease; she is the director of the Women's Heart Program at Lenox Hill Hospital and director of Cardiovascular Prevention for Northwell Health.The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association.The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #10 Ms. DW is a 67-year-old woman with a history of coronary artery disease and prior percutaneous coronary intervention in 2019 with a drug-eluting stent to the proximal left anterior descending artery. They have transitioned to your clinic from a previous provider, and their LDL is 134 mg/dL. What would be the ESC recommended goal LDL-C level for this patient? A.
The Mitzva of Sefirat Ha'omer requires counting the proper number each night during the Omer period. If a person forgot to count the Omer one night, then he should count during the following day without a Beracha, and thereafter continues counting each night with a Beracha, as usual. Even if a person forgot to count the Omer on several successive nights, so long as he counted during the day in each instance he continues counting the Omer with a Beracha. If, however, a person forgot to count the Omer one night and did not count at all during the following day, then he may no longer recite the Beracha over the counting of the Omer. He should continue counting each night, but without reciting a Beracha.For this reason, many congregations have the practice to count the Omer aloud – without the Beracha – each morning during Shacharit, after the Kaddish following the Chazan's repetition. This is intended to ensure that anyone who forgot to count the Omer the previous night will at least count that day, so that he may resume counting the subsequent night with a Beracha. It should also be noted that although praying with a Minyan is of great importance throughout the year, it is particularly critical during the Sefira period, as one is far more likely to forget to count the Omer when he prays privately than when he prays with a Minyan.If a person cannot remember whether or not he counted the Omer one night, and he did not count during the following day, does he continue to count with a Beracha, or must he count without a Beracha, given the possibility that he missed a day?Chacham Ovadia Yosef, in his work Chazon Ovadia (Laws of Yom Tov, p. 238), rules that a person in such a case continues to count with a Beracha, as this situation involves a "Sefeik-Sefeika," or "double doubt." First, there is the question of whether or not the person indeed neglected to count the Omer. But in addition, even if he had neglected to count, it is unclear whether or not Halacha follows the opinion that one who misses a day of counting can no longer count the subsequent nights. According to some authorities, each night of the Omer constitutes an independent Mitzva, and thus forgetting to count one night does not affect one's obligation on the subsequent nights. Hence, in a situation where one is unsure whether or not he counted, two points of uncertainty are involved, in which case we may be lenient and allow the individual to continue counting the Omer with a Beracha.Chacham Ovadia adds yet another factor, namely, the position of the Rif (Rabbi Yitzchak Alfasi, Morocco, 1013-1103) and the Rambam (Rabbi Moshe Maimonides, Spain-North Africa, 1135-1204) that counting the Omer constitutes a Torah obligation even nowadays. With regard to Torah law, we rule stringently in situations of uncertainty. Thus, according to the view of these authorities, a person who is unsure whether or not he must count the Omer is obligated to do so. Although we generally do not follow this position of the Rif and the Rambam, their view represents yet another consideration for requiring a person in such a situation to continue counting the Omer with a Beracha.Summary: A person who forgets to the count the Omer one night should count during the following day without a Beracha, and then resume counting that night with a Beracha. If one forgets to count one night and does not count during the following day, either, then he resumes counting the subsequent night without reciting a Beracha. If one cannot remember whether or not he counted one day, he continues counting with a Beracha.
I break down NACA from a guidelines perspective. I cover down payment and credit requirements, DTI needed, income limits, fees and why the process takes longer for some than it does for others. Email: email@example.com Home Buyer Education Courses- coinsnculture.gumroad.com/l/rHHKs Credit Course- coinsnculture.gumroad.com/l/yfZAqW IG- https://www.instagram.com/coinsnculture/ Merch- https://houserichbrand.myshopify.com/ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app
This week on the podcast we have a GREAT interview with CPO of Guideline and Rockstar Program graduate - Christine Rimer. Christine's journey through coaching is really awe-inspiring. Listen to today's episode to hear how coaching helped her get clear on what she wanted, what she brought to the table, and how she gained belief in being calm and centered - regardless of checking everything off the list! If this episode inspired you, thank you for leaving a review on Apple Podcasts https://www.sarahmoody.com/itunes You can also comment on this podcasts Instagram post or take a screenshot of you listening on your device and post it to your Instagram Stories, LinkedIn, or Twitter. Tag me. @sarahlmoodyFull shownotes can be found at sarahmoody.com/podcasts/89
In this edition of the podcast, Anthony and Josh discuss the news that the ACC is closing in on eliminating divisions and readjusting the scheduling process as early as 2023 and the new guidelines from the NCAA on NIL and tell you how it affects the Tar Heels moving forward. If you or someone you know has a gambling problem, crisis counseling and referral services can be accessed by calling 1-800-GAMBLER (1-800-426-2537) (IL/IN/MI/NJ/PA/WV/WY), 1-800-NEXT STEP (AZ), 1-800-522-4700 (CO/NH), 888-789-7777/visit http://ccpg.org/chat (CT), 1-800-BETS OFF (IA), 1-877-770-STOP (7867) (LA), 877-8-HOPENY/text HOPENY (467369) (NY), visit OPGR.org (OR), call/text TN REDLINE 1-800-889-9789 (TN), or 1-888-532-3500 (VA). 21+ (18+ WY). Physically present in AZ/CO/CT/IL/IN/IA/LA/MI/ /NJ/NY/ PA/TN/VA/WV/WY only. Min. $5 deposit required. Eligibility restrictions apply. See http://draftkings.com/sportsbook for details.
Bomani Jones is joined by Holly Anderson of Channel 6 to discuss the NCAA's latest set of guidelines for NIL and booster involvement (1:42), as well as a previously untold story of the two of them trying to sneak into a high school football game in Miami (18:11). Plus, David Dennis of Andscape discusses his new book "The Movement Made Us", which chronicles the extraordinary story of the Civil Rights Movement of the 1960's, and its living legacy embodied in Black Lives Matter (24:10).
The following question refers to Section 4.6 of the 2021 ESC CV Prevention Guidelines. The question is asked by student Dr. Shivani Reddy, answered first by NP Carol Patrick, and then by expert faculty Dr. Eileen Handberg. Dr. Handberg is an Adult Nurse Practitioner, Professor of Medicine, and Director of the Cardiovascular Clinical Trials Program in the Division of Cardiovascular Medicine at the University of Florida. She has served as Chair of the Cardiovascular Team Section and the Board of Trustees with the ACC and is the President Elect for the PCNA. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #10 Ms. DW is a 67-year-old woman with a history of coronary artery disease and prior percutaneous coronary intervention in 2019 with a drug-eluting stent to the proximal left anterior descending artery. They have transitioned to your clinic from a previous provider, and their LDL is 134 mg/dL. What would be the ESC recommended goal LDL-C level for this patient? A.
Gabe Ikard and Teddy Lehman give the latest Oklahoma football updates including Davis Beville committing to OU, the betting odds released for Big 12 football and CBS' post-spring top 25 having OU at #4 (5:12). The Athletic's Chris Vannini joins Gabe and Teddy to discuss the potential elimination of divisions in conferences in college football and the latest on NIL after the NCAA issued their new guidelines (44:14). Gabe and Teddy give their “Winners/Losers of the Week:” Miami Dolphins, Josh Lambo, Tom Brady and the Philadelphia 76ers (1:13:33). •Use promo code ‘ted' for 10% off at https://opolisclothing.com/ •Follow us on Twitter: https://twitter.com/OK_Breakdown?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor •Follow us on Instagram: https://www.instagram.com/ok_breakdown/?hl=en Learn more about your ad choices. Visit megaphone.fm/adchoices
How do you counsel patients on beta blockers? Is one beta-blocker better than the other? What is preferred: ACEi, ARBs or ARNIs? What are the pros and cons of each? How does spironolactone compare to eplerenone? When do you stop mineralocorticoid receptor antagonist? What are risks with SGLT2 inhibitors? How do you initiate GDMT? Which meds do you start first and in what order?Show notes, Transcript and References: https://www.coreimpodcast.com/2022/05/11/5-pearls-on-guideline-directed-medical-therapy/Sponsor: https://go.amboss.com/GDMTGet CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time stamps:03:13 Pearl 112:14 Pearl 220:36 Pearl 326:42 Pearl 432:16 Pearl 5Tags: IM Core, CoreIM, heart failure with reduced ejection fraction, GDMT, treatment, cardiology
The following question refers to Section 4.3 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Maryam Barkhordarian, answered first by pharmacy resident Dr. Anushka Tandon, and then by expert faculty Dr. Noreen Nazir. Dr. Noreen Nazir is Assistant Professor of Clinical Medicine at the University of Illinois at Chicago, where she is the director of cardiac MRI and the preventive cardiology program. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #9 Mr. A is a 28-year-old man who works as an accountant in what he describes as a “desk job” setting. He shares that life got “a little off-track” for him in 2020 between the COVID-19 pandemic and a knee injury. His 2022 New Years' resolution is to improve his overall cardiovascular and physical health. He has hypertension and a family history of premature ASCVD in his father, who died of a heart attack at age 50. Prior to his knee injury, he went to the gym 3 days a week for 1 hour at a time, split between running on the treadmill and weightlifting. He has not returned to the gym since his injury and has been largely sedentary, although he is trying to incorporate a 20-minute daily walk into his routine. Which of the following exercise-related recommendations is most appropriate? A. A target of 75-150 minutes of vigorous-intensity or 150-300 minutes of moderate-intensity aerobic physical exercise weekly is recommended to reduce all-cause mortality, CV mortality, and morbidity. B. Bouts of exercise less than 30 minutes are not associated with favorable health outcomes. C. Exercise efforts should be focused on aerobic activity, since only this type of activity is associated with mortality and morbidity benefits. D. Light-intensity aerobic activity like walking is expected to have limited health benefits for persons with predominantly sedentary behavior at baseline. Answer #9 The correct answer is A. There is an inverse relationship between moderate-to-vigorous physical activity and CV morbidity/mortality, all-cause mortality, and incidence of type 2 diabetes, with additional benefits accrued for exercise beyond the minimum suggested levels. The recommendation to “strive for at least 150-300 min/week of moderate-intensity, or 75-150 min/week of vigorous-intensity aerobic physical activity, or an equivalent combination thereof” is a Class 1 recommendation per the 2021 ESC guidelines, and a very similar recommendation (at least 75 minutes of vigorous-intensity or 150 minutes of moderate-intensity activity) is also Class 1 recommendation per 2019 ACC/AHA primary prevention guidelines. Both the ESC and ACC/AHA provide examples of activities grouped by absolute intensity (the amount of energy expended per minute of activity), but the ESC guidelines also offer suggestions for measuring the relative intensity of an activity (maximum/peak associated effort) in Table 7, which allows for a more individualized, customizable approach to setting activity goals. Importantly, individuals who are unable to meet minimum weekly activity recommendations should still be encouraged to stay as active as their abilities and health conditions allow to optimize cardiovascular and overall health. Choice B is incorrect, as data suggests physical activity episodes of any duration, including
Jonas Knox, Brady Quinn and LaVar Arrington react to the NCAA's new guidelines regarding NIL and boosters. Stephen Ross makes more money off the F1 race in Miami than all the homes games for the Dolphins and Brady recalls the time Romeo Crennel didn't let him walk during graduation. See omnystudio.com/listener for privacy information.
Recently, ACR released two treatment guidelines for JIA. One updating pharmacologic management and another for non-pharmacologic therapies. We have lead author, Dr. Karen Onel, taking us through a deep dive on these, in an episode close to Jon's heart
Shuchi Talati, former chief of staff of the Department of Energy's Office of Fossil Energy & Carbon Management, discusses the need for strong governance to balance the potential benefits of carbon dioxide removal technologies with environmental and social risks. --- This episode is the first in a three-part series that will explore governance challenges surrounding the transition to clean energy. In early April, the Intergovernmental Panel on Climate Change released its latest assessment report, which warned that the global carbon budget to keep climate warming below 1.5 degrees Celsius is quickly being exhausted, and that the use of technologies to remove carbon dioxide from the atmosphere has become “unavoidable” if climate damages are to be limited. The report has been followed by announcements from leading technology companies of more than $2 billion dollars in commitments to commercialize carbon dioxide removal (CDR) technologies. The IPCC report, and financing commitments, point to increasing acceptance of emerging climate technologies that were once viewed as options of last resort to address climate change. In the podcast Shuchi Talati, scholar in residence with the Forum for Climate Engineering Assessment at American University, discusses the governance of these emerging climate technologies which, despite their promise, raise concerns around their potential impacts on ecosystems, economies and issues of social equity, and even over the pace of decarbonization itself. Shuchi Talati is scholar in residence with the Forum for Climate Engineering Assessment at American University, and former chief of staff for the Office of Fossil Energy & Carbon Management at the Department of Energy. Related Content For Solar Geoengineering, Daunting Policy Questions Await https://kleinmanenergy.upenn.edu/podcast/for-solar-geoengineering-daunting-policy-questions-await/ Guidelines for Successful, Sustainable, Nature-Based Solutions.https://kleinmanenergy.upenn.edu/research/publications/guidelines-for-successful-sustainable-nature-based-solutions/ Energy Policy Now is produced by The Kleinman Center for Energy Policy at the University of Pennsylvania. For all things energy policy, visit kleinmanenergy.upenn.edu See omnystudio.com/listener for privacy information.
This question refers to Sections 3.1 of the 2021 ESC CV Prevention Guidelines. The question is asked by CardioNerds Academy Intern, student Dr. Hirsh Elhence, answered first by internal medicine resident at Beaumont Hospital and soon to be Mayo Clinic cardiology fellow and Dr. Teodora Donisan and then by expert faculty Dr. Eugene Yang. Dr. Yang is professor of medicine of the University of Washington where he is medical director of the Eastside Specialty Center and the co-Director of the Cardiovascular Wellness and Prevention Program. Dr. Yang is former Governor of the ACC Washington Chapter and current chair of the ACC Prevention of CVD Section. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #8 Please read the following patient vignettes and choose the FALSE statement. A. A 39-year-old man who comes for a regular physical, has normal vitals and weight, denies any significant past medical or family history – does not need systematic cardiovascular disease (CVD) assessment. B. A 39-year-old woman who comes for a regular physical, has normal vitals and weight, and has a history of radical hysterectomy (no other significant past medical or family history) – could benefit from systematic or opportunistic CVD assessment. C. A 39-year-old woman who comes for a regular physical, has normal vitals except for a BMI of 27 kg/m2 and a family history of hypertension – requires a systematic global CVD assessment. D. A 39-year-old man who comes for a regular physical, has normal vitals and weight, and has a personal history of type I diabetes – requires a systematic global CVD assessment. Answer #8 Option A is an accurate statement, as systematic CVD risk assessment is not recommended in men < 40 years-old and women < 50 years-old, if they have no known cardiovascular (CV) risk factors. (Class III, level C) Option B is an accurate statement, as this patient had a radical hysterectomy, which means the ovaries have been removed as well and she is considered postmenopausal. Systematic or opportunistic CV risk assessment can be considered in men > 40 years-old and women > 50 years-old or postmenopausal, even in the absence of known ASCVD risk factors. (Class IIb, level C) Option C is a false statement and thus the correct answer, as the recommendations for global screening in this patient are not as strong and would require shared decision making. Opportunistic screening of blood pressure can be considered in her, as she is at risk for developing hypertension. Blood pressure screening should be considered in adults at risk for the development of hypertension, such as those who are overweight or with a known family history of hypertension. (Class IIa, level B) Option D is an accurate statement, as systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor (i.e., family history of premature CVD, familial hyperlipidemia, CVD risk factors such as smoking, arterial hypertension, DM, raised lipid level, obesity, or comorbidities increasing CVD risk). (Class I, level C) Additional learning points: Do you know the difference between opportunistic and systematic CVD screening? Opportunistic screening refers to screening without a predefined strategy when the patient presents for different reasons. This is an effective and recommended way to screen for ASCVD risk factors, although it is unclear if it leads to benefits in clinical outcomes. Systematic screening can be done following a clear strategy formally evaluating either the general population or targeted subpopulations (i.e., type 2 diabetics or patients with significant family history of CVD). Systematic screening results in improvements in risk factors but has no proven effect on CVD outcomes. Main Takeaway
Entering the legal process of any divorce feels frightening and overwhelming. For those entering high conflict divorce, the fear and confusion is escalated due to years of living in a dysfunctional marriage and the complexities involved when divorcing a high conflict personality. There is often a greater need to be in the court system due to the power imbalance in the relationship, the lack of transparency of one spouse, and the intimidation and bullying that repeatedly derails negotiations. For the high conflict divorce, it can be enormously valuable to take advantage of the court's ability to control the pace of the legal process, require a net worth statement and other financial documentation and include additional experts to help with custody and spousal support and asset distribution. Today's episode is filled with vital information on how to hire the right attorney, what to expect throughout the process, the do's and don'ts of communicating with your high conflict spouse and the vital importance of setting realistic expectations around custody and finances. Information is power, today's show will empower you to navigate your divorce with greater clarity and confidence. Request a Free Rapid Relief Call at www.rapidreliefcall.com For more information on Journey Beyond Divorce visit: www.jbddivorcesupport.com
The following question refers to Section 3.4 of the 2021 ESC CV Prevention Guidelines. The question is asked by student Dr. Adriana Mares, answered first by early career preventive cardiologist Dr. Dipika Gopal, and then by expert faculty Dr. Michael Wesley Milks. Dr. Milks is a staff cardiologist and assistant professor of clinical medicine at the Ohio State University Wexner Medical Center where he serves as the Director of Cardiac Rehabilitation and an associate program director of the cardiovascular fellowship. He specializes in preventive cardiology and is a member of the American College of Cardiology's Cardiovascular Disease Prevention Leadership Council. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #7 While you are on holiday break visiting your family, your aunt pulls you aside during the family gathering to ask a few questions about your 70-year-old uncle. He has hypertension, hyperlipidemia, type 2 diabetes mellitus, and moderate chronic obstructive pulmonary disease. His medications include Fluticasone/Salmeterol, Tiotropium, Albuterol, Lisinopril, Simvastatin, and Metformin. She is very concerned about his risk for heart disease as he has never had his “heart checked out.” She asks if the presence of COPD increases his chance of having heart disease. Which of the following statements would best answer her question? A. Systemic inflammation and oxidative stress caused by COPD promote vascular remodeling and a paradoxical ‘anticoagulant' state affecting all vasculature types. B. Although chronic COPD is associated with increased cardiovascular events, individual exacerbations have no impact on risk of cardiovascular events. C. Patients with mild-moderate COPD are 8-10x more likely to die from atherosclerotic cardiovascular disease than respiratory failure. D. Cardiovascular mortality increases proportionally with an increase in forced expiratory volume in 1 second (FEV1) Answer #7 The correct answer is C. Patients with mild-moderate COPD are 8-10x more likely to die from atherosclerotic cardiovascular disease than respiratory failure. Patients with COPD have a 2-3-fold increased risk of CV events compared to age-matched controls even when adjusted for tobacco smoking, a shared risk factor. This can be partly explained by other common risk factors including aging, hypertension, hyperlipidemia, and low physical activity. Interestingly, CVD mortality increases proportionally with a decrease (rather than increase) in FEV1, making answer choice D wrong (28% increase CVD mortality for every 10% decrease in FEV1). Additionally, COPD exacerbations and related infections are associated with a 4x increase in CVD events, making answer choice B incorrect. COPD has several effects on the vasculature which creates a ‘procoagulant' not ‘anticoagulant' effect on all vascular beds. This is associated with increased risk of cognitive impairment due to cerebral microvascular damage as well as increased risk of ischemic and hemorrhagic stroke. Main Takeaway The presence of COPD (even mild to moderate) has a significant impact on the incidence of non-fatal coronary events, stroke, and cardiovascular mortality mediated by inherent disease process and progression, risk factors (smoking, aging, hypertension, and hyperlipidemia), and systemic inflammation altering vasculature creating a ‘procoagulant' effect. The ESC gives a Class I indication (LOE C) to investigate for ASCVD and ASCVD risk factors in patients with COPD. Guideline Location 3.4.5, Page 3264. CardioNerds Decipher the Guidelines - 2021 ESC Prevention Series CardioNerds Episode Page CardioNerds Academy Cardionerds Healy Honor Roll CardioNerds Journal Club Subscribe to The Heartbeat Newsletter! Check out CardioNerds SWAG! Become a CardioNerds Patron!