Podcasts about guidelines

In this conversation, Jessica Patterson and Florian Schmitzberger discuss the evolution of clinical practice guidelines (CPGs) from the Department of Defense (DOD) and their application in different contexts, particularly in light of the changes from the Global War on Terror (GWOT) to new healthcare environments. They emphasize the need for data to understand how these guidelines will perform in varied systems.TakeawaysThis isn't GWOT, this isn't Iraq, this isn't Afghanistan.Clinical practice guidelines (CPGs) evolved during GWOT.The performance of CPGs in different systems is uncertain.Data gathering is essential to assess guideline effectiveness.Understanding ground truth is crucial for guideline application.The DOD's CPGs were refined for specific contexts.New healthcare environments may challenge existing guidelines.The evolution of CPGs reflects changing military and healthcare needs.Questions arise about the adaptability of CPGs.Future research is needed to evaluate guideline performance.Chapters00:00 Introduction to the Podcast and Guests00:32 Data Collection and Research MethodologyFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

At the height of his reign, Solomon enjoyed wisdom, wealth, peace, and God's favor. But a quiet shift was taking place that eventually led him to worship other gods. In this lesson, we will look at the the choices that pulled Solomon away from God so we don't make the same mistakes. You may think you could never turn away from God, but I'm sure Solomon thought the same thing.

"We proposed a concept to the American Society of Clinical Oncology (ASCO), recognizing that extravasation management requires significant interdisciplinary collaboration and rapid action. There can occasionally be uncertainty or lack of clear guidance when an extravasation event occurs, and our objective was to look at this evidence with the expert panel to create a resource to support oncology teams overall. We hope that the guideline can help mitigate harm and improve patient outcomes," Caroline Clark, MSN, APRN, AGCNS-BC, OCN®, EBP-C, director of guidelines and quality at ONS, told Chelsea Backler, MSN, APRN, AGCNS-BC, AOCNS®, VA-BC, oncology clinical specialist at ONS, during a conversation about the ONS/ASCO Guideline on the Management of Antineoplastic Extravasation. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by January 2, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge related to the management of antineoplastic extravasation. Episode Notes  Complete this evaluation for free NCPD. ONS/ASCO Guideline on the Management of Antineoplastic Extravasation ONS Podcast™ episodes: Episode 391: Pharmacology 101: Antibody–Drug Conjugates Episode 335: Ultrasound-Guided IV Placement in the Oncology Setting Episode 145: Administer Taxane Chemotherapies With Confidence Episode 127: Reduce and Manage Extravasations When Administering Cancer Treatments ONS Voice articles: Access Devices and Central Lines: New Evidence and Innovations Are Changing Practice, but Individual Patient Needs Always Come First New Extravasation Guidelines Provide Recommendations for Protecting Patients and Standardizing Care Standardizing Venous Access Assessment and Validating Safe Chemo Administration Drastically Lowers Rates of Adverse Venous Events This Organization's Program Trains Non-Oncology Nurses to Deliver Antineoplastic Agents Safely ONS books: Access Device Guidelines: Recommendations for Nursing Practice and Education (fourth edition) Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition) Clinical Guide to Antineoplastic Therapy: A Chemotherapy Handbook (fourth edition) ONS courses: Complications of Vascular Access Devices (VAD) and IV Therapy ONS Fundamentals of Chemotherapy and Immunotherapy Administration™ ONS Oncology Treatment Modalities Clinical Journal of Oncology Nursing articles: Chemotherapy Extravasation: Incidence of and Factors Associated With Events in a Community Cancer Center Standardized Venous Access Assessment and Safe Chemotherapy Administration to Reduce Adverse Venous Events Oncology Nursing Forum article: Management of Extravasation of Antineoplastic Agents in Patients Undergoing Treatment for Cancer: A Systematic Review ONS huddle cards: Antineoplastic Administration Chemotherapy Immunotherapy Implanted Venous Port ONS position statements: Administration (Infusion and Injection) of Antineoplastic Therapies in the Home Education of the Nurse Who Administers and Cares for the Individual Receiving Antineoplastic Therapies ONS Guidelines™ for Extravasation Management ONS Oncologic Emergencies Learning Library ONS/ASCO Algorithm on the Management of Antineoplastic Extravasation of Vesicant or Irritant With Vesicant Properties in Adults American Society of Clinical Oncology (ASCO) Podcast: Management of Antineoplastic Extravasation: ONS-ASCO Guideline To discuss the information in this episode with other oncology nurses, visit the ONS Communities.  To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "The focus of this guideline was specifically on intravenous antineoplastic extravasation or when a vesicant or an irritant with vesicant properties leaks out of the vascular space. This can cause an injury to the patient that's influenced by several factors including the specific drug that was involved in the extravasation, whether it was DNA binding, how much extravasated, the affected area, and individual patient characteristics." TS 1:48 "The panel identified and ranked outcomes that mattered most with extravasation. Not surprising, one of the first was tissue necrosis. Like, 'How are we going to prevent tissue necrosis and preserve tissue?' The next were pain, quality of life, delays in cancer treatment: How is an extravasation going to delay cancer treatment that's vital to the patient? Is an extravasation also going to result in hospitalization or additional surgical interventions that would be burdensome to the patient? ... We had a systematic review team that then went in and summarized the data, and the panel applied the grading of recommendations, assessment, development, and evaluation (GRADE) criteria, grading quality of evidence and weighing factors like patient preferences, cost, and feasibility of an intervention. From there, they developed their recommendations." TS 7:35 "The panel, from the onset, wanted to make sure we had something visual for our readers to reference. They combined evidence from the systematic review, other scholarly sources, and their real-world clinical experience to make this one-page supplementary algorithm. They wanted it to be comprehensive and easy to follow, and they included not only those acute management steps but also guidance on 'How do I document this and what are the objective and subjective assessment factors to look at? What am I going to tell the patient?' In practice, for use of that, I would compare it to your current processes and identify any gaps to inform policies in your individual organizations." TS 16:34 "The guidelines don't take place of clinician expertise; they're not intended to cover every situation, but a situation that keeps coming up that we should talk about as a limitation, is we're seeing these case reports of tissue injury with antibody–drug conjugate extravasation. There's still not enough evidence to inform care around the use of antidotes with those agents, so this still needs to be addressed on a case-by-case basis. We still need publication of those case studies, what was done, and outcomes to help inform direction." TS 19:24 "Beyond the acute management is to ensure thorough documentation regarding extravasation. Whether you're on electronic documentation or on paper, are the prompts there for the nurse to capture all of the factors that should be captured regarding that extravasation? The size, the measurement, the patient's complaints. Is there redness? Things like that. And then within the teams, everyone should know where to find that initial extravasation assessment so that later on, if they're in a different clinic, they have something to go by to see how the extravasation is healing or progressing. ... I think there's an importance here, too, to our novice oncology nurses and their preceptors. This could be anxiety-provoking for the whole team and the patient, so we want to increase confidence in management. So, I think using these resources for onboarding novice oncology nurses is important." TS 22:34

Send us a textDeep dive into how ketogenic diets and carbohydrate intake effect exercise performance, and misconceptions in sports nutrition.TOPICS DISCUSSED:Insulin as a powerful metabolic hormone: regulates nutrient storage across tissues, overriding others like glucagon to promote fat and glucose storage during abundance.Glucagon & GLP-1 roles in metabolism: Glucagon mobilizes liver glucose during scarcity; GLP-1, amplified in drugs like Ozempic, suppresses hunger but originated as a diabetes treatment.Transition to ketosis in fasting or low-carb diets: Low insulin enables fat breakdown into ketones for brain fuel, allowing survival for weeks without food, with adaptation taking about four weeks.Hypoglycemia vs. glycogen depletion: Low blood sugar causes fatigue and irritability due to brain energy deficit, while muscle glycogen levels do not directly limit performance.Ketogenic diets & exercise performance: Studies show no difference in endurance after adaptation, with some athletes performing better on low-carb due to enhanced fat oxidation.High-carb diets in athletes: In one study, about 30% developed prediabetes-like fasting glucose elevations, linked to total carb intake, despite leanness and fitness.Misconceptions in sports nutrition: Guidelines recommend 60-90g carbs/hour, but evidence shows 10g suffices to maintain blood sugar and performance, avoiding insulin spikes that impair fat use.Individual variability in diet response: Athletes vary in optimal fuel sources; it's possible to by athletic and lean but also metabolically unhealthy.PRACTICAL TAKEAWAYS:For workouts over ~60 minutes, consume ~10g carbs per hour (e.g., a third of a banana) to maintain blood sugar and prevent fatigue, regardless of overall diet.Allow at least four weeks for adaptation when trying a ketogenic diet, enabling the body to fully transition to the ketogenic state.Monitor personal responses to carb intake, as high levels can elevate fasting glucose even in fit individuals; consider lower-carb options if experiencing metabolic issues.Prioritize metabolic flexibility through varied diets or fasting periods to improve energy stability, but consult resources for proper formulation to support health.ABOUT THE GUEST: Andrew Koutnik, PhD earned a PhD in biomedical sciences with a focus on exercise physiology and metabolic health, informed by his personal diagnosis of type 1 diabetes in childhoodSupport the showAffiliates: Lumen device to optimize your metabolism for weight loss or athletic performance. MINDMATTER gets you 15% off. AquaTru: Water filtration devices that remove microplastics, metals, bacteria, and more from your drinking water. Through link, $100 off AquaTru Carafe, Classic & Under Sink Units; $300 off Freestanding models. Seed Oil Scout: Find restaurants with seed oil-free options, scan food products to see what they're hiding, with this easy-to-use mobile app. KetoCitra—Ketone body BHB + electrolytes formulated for kidney health. Use code MIND20 for 20% off any subscription (cancel anytime) For all the ways you can support my efforts

Dr. DebWhat if I told you that the stomach acid medication you’re taking for heartburn is actually causing the problem it’s supposed to solve that your doctor learned virtually nothing about nutrition, despite spending 8 years in medical school. That the very system claiming to heal you was deliberately designed over a hundred years ago by an oil tycoon, John D. Rockefeller, to create lifelong customers, not healthy people. Last week a patient spent thousands of dollars on tests and treatments for acid reflux, only to discover she needed more stomach acid, not less. The medication keeping her sick was designed to do exactly that. Today we’re exposing the greatest medical deception in modern history, how a petroleum empire systematically destroyed natural healing wisdom turned medicine into a profit machine. And why the treatments, keeping millions sick were engineered that way from the beginning. This isn’t about conspiracy theories. This is a documented history that explains why you feel so lost about your own body’s needs welcome back to let’s talk wellness. Now the show where we uncover the root causes of chronic illness, explore cutting edge regenerative medicine, and empower you with the tools to heal. I’m Dr. Deb. And today we’re diving into how the Rockefeller Medical Empire systematically destroyed natural healing wisdom and replaced it with profit driven systems that keeps you dependent on treatments instead of achieving true health. If you or someone you love has been running to the doctor for every minor ailment, taking acid blockers that seem to make digestive problems worse, or feeling confused about basic body functions that our ancestors understood instinctively. This episode is for you. So, as usual, grab a cup of coffee, tea, or whatever helps you unwind. Settle in and let’s get started on your journey to reclaiming your health sovereignty all right. So here we are talking about the Rockefeller Medical Revolution. Now, what if your symptoms aren’t true diagnosis, but rather the predictable result of a medical system designed over a hundred years ago to create lifelong customers instead of healthy people. Now I learned this when I was in naturopathic school over 20 years ago. And it hasn’t been talked about a lot until recently. Recently. People are exposing the truth about what actually happened in our medical system. And today I want to take you back to the early 19 hundreds to understand how we lost the basic health wisdom that sustained humanity for thousands of years. Yes, I said that thousands of years. This isn’t conspiracy theory. This is documented history. That explains why you feel so lost when it comes to your own body’s needs. You know by the turn of the 20th century. According to meridian health Clinic’s documentation. Rockefeller controlled 90% of all petroleum refineries in America and through ownership of the Standard Oil Corporation. But Rockefeller saw an opportunity that went far beyond oil. He recognized that petrochemicals could be the foundation for a completely new medical system. And here’s what most people don’t know. Natural and herbal medicines were very popular in America during the early 19 hundreds. According to Staywell, Copper’s historical analysis, almost one half of medical colleges and doctors in America were practicing holistic medicine, using extensive knowledge from Europe and native American traditions. People understood that food was medicine, that the body had natural healing mechanisms, and that supporting these mechanisms was the key to health. But there was a problem with the Rockefeller’s business plan. Natural medicines couldn’t be patented. They couldn’t make a lot of money off of them, because they couldn’t hold a patent. Petrochemicals, however, could be patented, could be owned, and could be sold for high profits. So Rockefeller and Andrew Carnegie devised a systematic plan to eliminate natural medicine and replace it with petrochemical based pharmaceuticals and according to E. Richard Brown’s comprehensive academic documentation in Rockefeller, medicine men. Medicine, and capitalism in America. They employed the services of Abraham Flexner, who proceeded to visit and assess every single medical school in us and in Canada. Within a very short time of this development, medical schools all around the us began to collapse or consolidate. The numbers are staggering. By 1910 30 schools had merged, and 21 had closed their doors of the 166 medical colleges operating in 19 0, 4, a hundred 33 had survived by 1910 and a hundred 4 by 1915, 15 years later, only 76 schools of medicine existed in the Us. And they all followed the same curriculum. This wasn’t just about changing medical education. According to Staywell’s copper historical analysis. Rockefeller and Carnegie influenced insurance companies to stop covering holistic treatments. Medical professionals were trained in the new pharmaceutical model and natural solutions became outdated or forgotten. Not only that alternative healthcare practitioners who wanted to stay practicing in alternative medicine were imprisoned for doing so as documented by the potency number 710. The goal was clear, create a system where scientists would study how plants cure disease, identify which chemicals in the plants were effective and then recreate a similar but not identical chemical in the laboratory that would be patented. E. Richard Brown’s documents. The story of how a powerful professional elite gained virtual homogeny in the western theater of healing by effectively taking control of the ethos and practice of Western medicine. The result, according to the healthcare spending data, the United States now spends 17.6% of its Gdp on health care 4.9 trillion dollars in 2023, or 14,570 per person nearly twice as much as the average Oecd country. But it doesn’t focus on cure. But on symptoms, and thus creating recurring clients. This systematic destruction of natural medicine explains why today’s healthcare providers often seem baffled by simple questions about nutrition why they immediately reach for a prescription medication for minor ailments, and why so many people feel disconnected from their own body’s wisdom. We’ve been trained over 4 generations to believe that our bodies are broken, and that symptoms are diseases rather than messages, and that external interventions are always superior to supporting natural healing processes. But here’s what they couldn’t eliminate your body’s innate wisdom. Your digestive system still functions the same way it did a hundred years ago. Your immune system still follows the same patterns. The principles of nutrition, movement and stress management haven’t changed. We’ve just forgotten how to listen and respond. We’re gonna take a small break here and hear from our sponsor. When we come back. We’re gonna talk about the acid reflux deception, and why your cure is making you sicker, so don’t go away all right, welcome back. So I want to give you a perfect example of how Rockefeller medicine has turned natural body wisdom upside down, the treatment of acid, reflux, and heartburn. Every single day in my practice I see patients who’ve been taking acid blocker medications, proton pump inhibitors like prilosec nexium or prevacid for years, not for weeks, years, and sometimes even decades. They come to me because their digestive problems are getting worse, not better. They have bloating and gas and nutrition deficiencies. And we’re seeing many more increased food sensitivities. And here’s what’s happening in the Us. Most people often attribute their digestive problems to too much stomach acid. And they use medications to suppress the stomach acid, but, in fact symptoms of chronic acid, reflux, heartburn, or gerd, can also be caused by too little stomach acid, a condition called hyper. Sorry hypochlorhydria normal stomach acid has a Ph level of one to 2, which is highly acidic. Hydrochloric acid plays an important role in your digestion and your immunity. It helps to break down proteins and absorb essential nutrients, and it helps control viruses and bacteria that might otherwise infect your stomach. But here’s the crucial part that most people don’t understand, and, according to Cleveland clinic, your stomach secretes lower amounts of hydrochloric acid. As you age. Hypochlorhydria is more common in people over the age of 40, and even more common over the age of 65. Webmd states that the stomach acid can produce less acid as a result of aging and being 65 or older is a risk factor for developing hypochlorhydria. We’ve been treating this in my practice for a long time. It’s 1 of the main foundations that we learn as naturopathic practitioners and as naturopathic doctors, and there are times where people need these medications, but they were designed to be used short term not long term in a 2,013 review published in Medical News today, they found that hypochlorhydria is the main change in the stomach acid of older adults. and when you have hypochlorydria, poor digestion from the lack of stomach, acid can create gas bubbles that rise into your esophagus or throat, carrying stomach acid with them. You experience heartburn and assume that you have too much acid. So you take acid blockers which makes the underlying problem worse. Now, here’s something that will shock you. PPI’s protein pump inhibitors were originally studied and approved by the FDA for short-term use only according to research published in us pharmacists, most cases of peptic ulcers resolve in 6 to 8 weeks with PPI therapy, which is what these medications were created for. Originally the American family physician reports that for erosive esophagitis. Omeprazole is indicated for short term 4 to 8 weeks. That’s it. Treatment and healing and done if needed. An additional 4 to 8 weeks of therapy may be considered and the University of Minnesota College of Pharmacy, States. Guidelines recommended a treatment duration of 8 weeks with standard once a day dosing for a PPI for Gerd. The Canadian family physician, published guidelines where a team of healthcare professionals recommended prescribing Ppis in adults who suffer from heartburn and who have completed a minimum treatment of 4 weeks in which symptoms were relieved. Yet people are taking these medications for years, even decades far beyond their intended duration of use and a study published in Pmc. Found that the threshold for defining long-term PPI use varied from 2 weeks to 7 years of PPI use. But the most common definition was greater than one year or 6 months, according to the research in clinical context, use of Ppis for more than 8 weeks could be reasonably defined as long-term use. Now let’s talk about what these acid blocker medications are actually doing to your body when used. Long term. The research on long term PPI use is absolutely alarming. According to the comprehensive review published in pubmed central Pmc. Long-term use of ppis have been associated with serious adverse effects, including kidney disease, cardiovascular disease fractures because you’re not absorbing your nutrients, and you’re being depleted. Infections, including C. Diff pneumonia, micronutrient deficiencies and hypomagnesium a low level of magnesium anemia, vitamin, b, deficiency, hypocalcemia, low calcium, low potassium. and even cancers, including gastric cancer, pancreatic cancer, colorectal cancer. And hepatic cancer and we are seeing all of these cancers on a rise, and we are now linking them back to some of these medications. Mayo clinic proceedings published research showing that recent studies regarding long-term use of PPI medication have noted potential adverse effects, including risks of fracture, pneumonia, C diff, which is a diarrhea. It’s a bacteria, low magnesium, low b 12 chronic kidney disease and even dementia. And a 2024 study published in nature communications, analyzing over 2 million participants from 5 cohorts found that PPI use correlated with increased risk of 15 leading global diseases, such as ischemic heart disease. Diabetes, respiratory infections, chronic kidney disease. And these associations showed dose response relationships and consistency across different PPI types. Now think about this. You take a medication for heartburn that was designed for 4 to 8 weeks of use, and when used long term, it actually increases your risk of life, threatening infections, kidney disease, and dementia. This is the predictable result of suppressing a natural body function that exists for important reasons. Hci plays a key role in many physiological processes. It triggers, intestinal hormones, prepares folate and B 12 for absorption, and it’s essential for absorption of minerals, including calcium, magnesium, potassium, zinc, and iron. And when you block acid production, you create a cascade of nutritional deficiencies and immune system problems that often manifest as seemingly unrelated health issues. So what’s the natural approach? Instead of suppressing stomach acid, we need to support healthy acid production and address the root cause of reflux healthcare. Providers may prescribe hcl supplements like betaine, hydrochloric acid. Bhcl is what it’s called. Sometimes it’s called betaine it’s often combined with enzymes like pepsin or amylase or lipase, and it’s used to treat hydrochloric acid deficiency, hypochlorhydria. These supplements can help your digestion and sometimes help your stomach acid gradually return back to normal levels where you may not need to use them all the time. Simple strategies include consuming protein at the beginning of the meal to stimulate Hcl production, consume fluids separately at least 30 min away from meals, if you can, and address the underlying cause like chronic stress and H. Pylori infections. This is such a sore subject for me. So many people walk around with an H. Pylori infection. It’s a bacterial infection in the stomach that can cause stomach ulcers, causes a lot of stomach pain and burning. and nobody is treating the infection. It’s a bacterial infection. We don’t treat this anymore with antibiotics or antimicrobials. We treat it with Ppis. But, Ppis don’t fix the problem. You have to get rid of the bacteria once the bacteria is gone, the gut lining can heal. Now it is a common bacteria. It can reoccur quite frequently. It’s highly contagious, so you can pick it up from other people, and it may need multiple courses of treatment over a person’s lifetime. But you’re actually treating the problem. You’re getting rid of the bacteria that’s creating the issue instead of suppressing the acid. That’s not fixing the bacteria which then leads to a whole host of other problems that we just talked about. There are natural approaches to increase stomach acid, including addressing zinc deficiency. And since the stomach uses zinc to produce Hcl. Taking probiotics to help support healthy gut bacteria and using digestive bitters before meals can be really helpful. This is exactly what I mean about reclaiming the body’s wisdom. Instead of suppressing natural functions, we support them instead of creating drug dependency, we restore normal physiology. Instead of treating symptoms indefinitely, we address the root cause and help the body heal itself. In many cultures. Bitters is a common thing to use before or after a meal. But yet in the American culture we don’t do that anymore. We’ve not passed on that tradition. So very few people understand how to use bitters, or what bitters are, or why they’re important. And these basic things that can be used in your food and cooking and taking could replace thousands of dollars of medication that you don’t really need. That can create many more problems along the way. Now, why does your doctor know nothing about nutrition. Well, I want to address something that might shock you all. The reason your doctor seems baffled when you ask about nutrition isn’t because they’re not intelligent. It’s because they literally never learned this in medical school statistics on nutritional education in medical schools are staggering and help explain why we have such a health literacy crisis in America. According to recent research published in multiple academic journals, only 27% of Us. Medical schools actually offer students. The recommended 25 h of nutritional training across 4 years of medical school. That means 73% of the medical schools don’t even meet the minimum standards set in 1985. But wait, it gets worse. A 2021 survey of medical schools in the Us. And the Uk. Found that most students receive an average of only 11 h of nutritional training throughout their entire medical program. and another recent study showed that in 2023 a survey of more than a thousand Us. Medical students. About 58% of these respondents said they received no formal nutritional education while in medical school. For 4 years those who did averaged only 3 h. I’m going to say this again because it’s it’s huge 3 h of nutritional education per year. So let me put this in perspective during 4 years of medical school most students spend fewer than 20 h on nutrition that’s completely disproportionate to its health benefits for patients to compare. They’ll spend hundreds of hours learning about pharmaceutical interventions, but virtually no time learning how food affects health and disease. Now, could this be? Why, when we talk about nutrition to lower cholesterol levels or control your diabetes, they blow you off, and they don’t answer you. It’s because they don’t understand. But yet what they’ll say is, people won’t change their diet. That’s why you have to take medication. That’s not true. I will tell you. I work with people every single day who are willing to change their diet. They’re just confused by all the information that’s out there today about nutrition. And what diet is the right diet to follow? Do I do, Paleo? Do I do? Aip? Do I do carnivore? Do I do, Keto? Do I do? Low carb? There’s so many diets out there today? It’s confusing people. So I digress. But let’s go back. So here’s the kicker. The limited time medical students do spend on nutrition office often focuses on nutrients think proteins and carbohydrates rather than training in topics such as motivational interviewing or meal planning, and as one Stanford researcher noted, we physicians often sound like chemists rather than counselors who can speak with patients about diet. Isn’t that true? We can speak super high level up here, but we can’t talk basics about nutrition. And this explains why only 14% of the physicians believe they were adequately trained in nutritional counseling. Once they entered practice and without foundational concepts of nutrition in undergrad work. Graduate medical education unsurprisingly falls short of meeting patients, needs for nutritional guidance in clinical practice, and meanwhile diet, sensitive chronic diseases continue to escalate. Although they are largely preventable and treatable by nutritional therapies and dietary. Lifestyle changes. Now think about this. Diet. Related diseases are the number one cause of death in the Us. The number one cause. Yet many doctors receive little to no nutritional education in medical school, and according to current health statistics from 2017 to march of 2020. Obesity prevalence was 19.7% among us children and adolescents affecting approximately 14.7 million young people. About 352,000 Americans, under the age of 20, have been diagnosed with diabetes. Let me say this again, because these numbers are astounding to me. 352,000 Americans, under the age of 20, have been diagnosed with diabetes with 5,300 youth diagnosed with type, 2 diabetes annually. Yet the very professionals we turn to for health. Guidance were never taught how food affects these conditions and what drug has come to the rescue Glp. One S. Ozempic wegovy. They’re great for weight loss. They’re great for treating diabetes. But why are they here? Well, these numbers are. Why, they’re here. This is staggering to put 352,000 Americans under the age of 20 on a glp, one that they’re going to be on for the rest of their lives at a minimum of $1,200 per month. All we have to do is do the math, you guys, and we can see exactly what’s happening to our country, and who is getting rich, and who is getting the short end of the stick. You’ve become a moneymaker to the pharmaceutical industry because nobody has taught you how to eat properly, how to live, how to have a healthy lifestyle, and how to prevent disease, or how to actually reverse type 2 diabetes, because it’s reversible in many cases, especially young people. And we do none of that. All we do is prescribe medications. Metformin. Glp, one for the rest of your life from 20 years old to 75, or 80, you’re going to be taking medications that are making the pharmaceutical companies more wealth and creating a disease on top of a disease on top of a disease. These deficiencies in nutritional education happen at all levels of medical training, and there’s been little improvement, despite decades of calls for reform. In 1985, the National Academy of Sciences report that they recommended at least 25 h of nutritional education in medical school. But a 2015 study showed only 29% of medical schools met this goal, and a 2023 study suggests the problem has become even worse. Only 7.8% of medical students reported 20 or more hours of nutritional education across all 4 years of medical school. This systemic lack of nutrition, nutritional education has been attributed to several factors a dearth of qualified instructors for nutritional courses, since most physicians do not understand nutrition well enough to teach it competition for curriculum time, with schools focusing on pharmaceutical interventions rather than lifestyle medicine and a lack of external incentives that support schools, teaching nutrition. And ironically, many medical schools are part of universities that have nutrition departments with Phd. Trained professors who could fill this gap by teaching nutrition in medical schools but those classes are often taught by physicians who may not have adequate nutritional training themselves. This explains so much about what I see in my practice. Patients come to me confused and frustrated because their primary care doctors can’t answer basic questions about how food affects their health conditions. And these doctors aren’t incompetent. They simply were never taught this information. And the result is that these physicians graduate, knowing how to prescribe medications for diabetes, but not how dietary changes can prevent or reverse it. They can treat high blood pressure with pharmaceuticals, but they may not know that specific nutritional approaches can be equally or more effective. This isn’t the doctor’s fault. It’s the predictable result of medical education systems that was deliberately designed to focus on patentable treatments rather than natural healing approaches. And remember this traces back to the Rockefeller influence on medical education. You can’t patent an apple or a vegetable. But you can patent a drug now. Why can’t we trust most medical studies? Well this just gets even better. I need to address something that’s crucial for you to understand as you navigate health information. Why so much of the medical research you hear about in the news is biased, and why peer Review isn’t the gold standard of truth you’ve been told it is. The corruption in medical research by pharmaceutical companies is not a conspiracy theory. It’s well documented scientific fact, according to research, published in frontiers, in research, metrics and analytics. When pharmaceutical and other companies sponsor research, there is a bias. A systematic tendency towards results serving their interests. But the bias is not seen in the formal factors routinely associated with low quality science. A Cochrane Review analyzed 75 studies of the association between industry, funding, and trial results, and these authors concluded that trials funded by a drug or device company were more likely to have positive conclusions and statistically significant results, and that this association could not be explained by differences in risk of bias between industry and non-industry funded trials. So think about that. According to the Cochrane collaboration, industry funding itself should be considered a standard risk of bias, a factor in clinical trials. Studies published in science and engineering ethics show that industry supported research is much more likely to yield positive outcomes than research with any other sponsorship. And here’s how the bias gets introduced through choice of compartor agents, multiple publications of positive trials and non-publication of negative trials reinterpreting data submitted to regulatory agencies, discordance between results and conclusions, conflict of interest leading to more positive conclusions, ghostwriting and the use of seating trials. Research, published in the American Journal of Medicine. Found that a result favorable to drug study was reported by all industry, supported studies compared with two-thirds of studies, not industry, supported all industry, supported studies showed favorable results. That’s not science that’s marketing, masquerading as research. And according to research, published in sciencedirect the peer review system which we’re told ensures quality. Science has a major limitation. It has proved to be unable to deal with conflicts of interest, especially in big science contexts where prestigious scientists may have similar biases and conflicts of interest are widely shared among peer reviewers. Even government funded research can have conflicts of interest. Research published in pubmed States that there are significant benefits to authors and investigators in participating in government funded research and to journals in publishing it, which creates potentially biased information that are rarely acknowledged. And, according to research, published in frontiers in research, metrics, and analytics, the pharmaceutical industry has essentially co-opted medical knowledge systems for their particular interests. Using its very substantial resources. Pharmaceutical companies take their own research and smoothly integrate it into medical science. Taking advantage of the legitimacy of medical institutions. And this corruption means that much of what passes for medical science is actually influenced by commercial interests rather than pursuant of truth. Research published in Pmc. Shows that industry funding affects the results of clinical trials in predictable directions, serving the interests of the funders rather than the patients. So where can we get this reliable, unbiased Health information, because this is critically important, because your health decisions should be based on the best available evidence, not marketing disguised as science. And so here are some sources that I recommend for trustworthy health and nutritional information. They’re independent academic sources. According to Harvard Chan School of public health their nutritional, sourced, implicitly states their content is free from industry, influence, or support. The Linus Pauling Institute, Micronutrient Information Center at Oregon State University, which, according to the Glendale Community college Research Guide provides scientifically accurate information about vitamins, minerals, and other dietary factors. This Institute has been around for decades. I’ve used it a lot. I’ve gotten a lot of great information from them. Very, very trustworthy. According to the Glendale Community College of Nutrition Resource guide Tufts, University of Human Nutritional Research Center on aging is one of 6 human nutrition research centers supported by the United States Department of Agriculture, the Usda. Their peer reviewed journals with strong editorial independence though you must still check funding resources. And how do you evaluate this information? Online? Well, according to medlineplus and various health literacy guides when evaluating health information medical schools and large professional or nonprofit organizations are generally reliable sources, but remember, it is tainted by the Rockefeller method. So, for example, the American College of cardiology. Excuse me. Professional organization and the American Heart Institute a nonprofit are both reliable sources. Sorry about that of information on heart health and watch out for ads designed to look like neutral health information. If the site is funded by ads they should be clearly marked as advertisements. Excuse me, I guess I’m talking just a little too much now. So when the fear of medicine becomes deadly. Now, I want to address something critically important that often gets lost in conversations about health, sovereignty, and questioning the medical establishment. And while I’ve spent most of this episode explaining how the Rockefeller medical system has created dependency and suppressed natural healing wisdom. There’s a dangerous pendulum swing happening that I see in my practice. People becoming so fearful of pharmaceutical interventions that they refuse lifesaving treatments when they’re genuinely needed. This is where balance and clinical judgment become absolutely essential. Yes, we need to reclaim our basic health literacy and reduce our dependency on unnecessary medical interventions. But there are serious bacterial infections that require immediate antibiotic treatment, and the consequences of avoiding treatment can be devastating or even fatal. So let me share some examples from research that illustrate when antibiotic fear becomes dangerous. Let’s talk about Lyme disease, and when natural approaches might not be enough. The International Lyme Disease Association ilads has conducted extensive research on chronic lyme disease, and their findings are sobering. Ileds defines chronic lyme disease as a multi-system illness that results from an active and ongoing infection of pathogenic members of the Borrelia Brdorferi complex. And, according to ilads research published in their treatment guidelines, the consequences of untreated persistent lyme infection far outweigh the potential consequences of long-term antibiotic therapy in well-designed trials of antibiotic retreatment in patients with severe fatigue, 64% in the treatment arm obtained clinically significant and sustained benefit from additional antibiotic therapy. Ilas emphasizes that cases of chronic borrelia require individualized treatment plans, and when necessary antibiotic therapy should be extended their research demonstrates that 20 days of prophylactic antibiotic treatment may be highly effective for preventing the onset of lyme disease. After known tick bites and patients with early Lyme disease may be best served by receiving 4 to 6 weeks of antibiotic therapy. Research published in Pmc. Shows that patients with untreated infections may go on to develop chronic, debilitating, multisystem illnesses that is difficult to manage, and numerous studies have documented persistent Borrelia, burgdorferi infection in patients with persistent symptoms of neurological lyme disease following short course. Antibiotic treatment and animal models have demonstrated that short course. Antibiotic therapy may fail to eradicate lyme spirochetes short course is a 1 day. One pill treatment of doxycycline. Or less than 20 days of antibiotics, is considered a short course. It’s not long enough to kill the bacteria. The bacteria’s life cycle is about 21 days, so if you don’t treat the infection long enough, the likelihood of that infection returning is significant. They’ve also done studies in the petri dish, where they show doxycycline being put into a petri dish with active lyme and doxycycline does not kill the infection, it just slows the replication of it. Therefore, using only doxycycline, which is common practice in lyme disease may not completely eradicate that infection for you. So let’s talk about another life threatening emergency. C. Diff clostridia difficile infection, which represents another example where antibiotic treatment is absolutely essential, despite the fact that C diff itself is often triggered by antibiotic use. According to Cleveland clinic C. Diff is estimated to cause almost half a million infections in the United States each year, with 500,000 infections, causing 15,000 deaths each year. Studies reported by Pmc. Found thirty-day Cdi. Mortality rates ranging from 6 to 11% and hospitalized Cdi patients have significantly increased the risk of mortality and complications. Research published in Pmc shows that 16.5% of Cdi patients experience sepsis and that this increases with reoccurrences 27.3% of patients with their 1st reoccurrence experience sepsis. While 33.1% with 2 reoccurrences and 43.2% with 3 or more reoccurrences. Mortality associated with sepsis is very high within hospital 30 days and 12 month mortality rates of 24%, 30% and 58% respectively. According to the Cdc treatment for C diff infection usually involves taking a specific antibiotic, such as vancomycin for at least 10 days, and while this seems counterintuitive, treating an antibiotic associated infection with more antibiotics. It’s often lifesaving. Now let’s talk about preventing devastating complications. Strep throat infections. Provide perhaps the clearest example of when antibiotic treatment prevents serious long-term consequences, and, according to Mayo clinic, if untreated strep throat can cause complications such as kidney inflammation and rheumatic fever. Rheumatic fever can lead to painful and inflamed joints, and a specific type of rash of heart valve damage. We also know that strep can cause pans pandas, which is a systemic infection, often causing problems with severe Ocd. And anxiety and affecting mostly young people. The research is unambiguous. According to the Cleveland clinic. Rheumatic fever is a rare complication of untreated strep, throat, or scarlet fever that most commonly affects children and teens, and in severe cases it can lead to serious health problems that can affect your child’s heart. Joints and organs. And research also shows that the rate of development of rheumatic fever in individuals with untreated strep infections is estimated to be 3%. The incidence of reoccurrence with a subsequent untreated infection is substantially greater. About 50% the rate of development is far lower in individuals who have received antibiotic treatment. And according to the World health organization, rheumatic heart disease results from the inflammation and scarring of the heart valves caused by rheumatic fever, and if rheumatic fever is not treated promptly, rheumatic heart disease may occur, and rheumatic heart disease weakens the valves between the chambers of the heart, and severe rheumatic heart disease can require heart surgery and result in death. The who states that rheumatic heart disease remains the leading cause of maternal cardiac complications during pregnancy. And additionally, according to the National Kidney foundation. After your child has either had throat or skin strep infection, they can develop post strep glomerial nephritis. The Strep bacteria travels to the kidneys and makes the filtering units of the kidneys inflamed, causing the kidneys to be able to unable or less able to fill and filter urine. This can develop one to 2 weeks after an untreated throat infection, or 3 to 4 weeks after an untreated skin infection. We need to find balance. And here’s what I want you to understand. Questioning the medical establishment and developing health literacy doesn’t mean rejecting all medical interventions. It means developing the wisdom to know when they’re necessary and lifesaving versus when they’re unnecessary and potentially harmful. When I see patients with confirmed lyme disease, serious strep infections or life. Threatening conditions like C diff. I don’t hesitate to recommend appropriate therapy but I also work to support their overall health address, root causes, protect and restore their gut microbiome and help them recover their natural resilience. The goal isn’t to avoid all medical interventions. It’s to use them wisely when truly needed, while simultaneously supporting your body’s inherent healing capacity and addressing the lifestyle factors that created the vulnerability. In the 1st place. All of this can be extremely overwhelming, and it can be frightening to understand or learn. But remember, the power that you have is knowledge. The more you learn about what’s actually happening in your health, in understanding nutrition. in learning what your body wants to be fed, and how it feels, and working with practitioners who are holistic in nature, natural, integrative, functional, whatever we want to call that these days. The more you can learn from them, the more control you have over your own health and what I would urge you to do is to teach your children what you’re learning. Teach them how to live a healthy lifestyle, teach them how to keep a clean environment. This is how we take back our own health. So thank you for joining me today on, let’s talk wellness. Now, if this episode resonated with you. Please share it with someone who could benefit from understanding how the Rockefeller medical system has shaped our approach to health, and how to reclaim your body’s wisdom while using medical care appropriately when truly needed. Remember, wellness isn’t just about feeling good. It’s about understanding your body, trusting its wisdom, supporting its natural healing capacity, and knowing when to seek appropriate medical intervention. If you’re ready to explore how functional medicine can help you develop this deeper health knowledge while addressing root causes rather than just managing symptoms. You can get more information from serenityhealthcarecenter.com, or reach out directly to us through our social media channels until next time. I’m Dr. Dab, reminding you that your body is your wisest teacher. Learn to listen, trust the process, use medical care wisely when needed, and take care of your body, mind, and spirit. Be well, and we’ll see you on the next episode.The post Episode 250 -The Great Medical Deception first appeared on Let's Talk Wellness Now.

Atualize-se sobre as novas definições e terminologias da menopausa propostas pelo mais recente guideline e entenda como essas mudanças impactam o diagnóstico e a abordagem clínica.Endocrinologia descomplicada para médicos e residentes. Aqui você encontra conteúdos sobre atualização médica, casos clínicos e preparação para provas de título.

Psychotherapist and patient advocate Sara Rands discusses her article "Early-onset breast cancer: a survivor's story." Sara shares her harrowing journey of finding a lump at age 32 despite having no family history and receiving a stage 3C diagnosis. She highlights the terrifying reality that mammograms often miss tumors in dense tissue and challenges the medical community to address why young women are frequently dismissed or misdiagnosed. The conversation addresses the rising incidence of early-onset disease, racial disparities in mortality rates, and the desperate need for research focused on younger populations. We must demand better screening tools to ensure mothers get the chance to see their children grow up. Our presenting sponsor is Microsoft Dragon Copilot. Microsoft Dragon Copilot, your AI assistant for clinical workflow, is transforming how clinicians work. Now you can streamline and customize documentation, surface information right at the point of care, and automate tasks with just a click. Part of Microsoft Cloud for Healthcare, Dragon Copilot offers an extensible AI workspace and a single, integrated platform to help unlock new levels of efficiency. Plus, it's backed by a proven track record and decades of clinical expertise, and it's built on a foundation of trust. It's time to ease your administrative burdens and stay focused on what matters most with Dragon Copilot, your AI assistant for clinical workflow. VISIT SPONSOR → https://aka.ms/kevinmd SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended

The microhematuria guideline just changed. Here's what clinicians need to know. In this episode of BackTable Urology, Dr. Daniel Barocas (Vanderbilt University) joins host Dr. Ruchika Talwar to break down the 2025 updates to the American Urological Association (AUA) Microhematuria Guideline and why these changes matter in everyday practice. --- SYNPOSIS They walk through the evidence driving the updates, including revised risk stratification and the expanding role of urinary biomarkers. The conversation highlights how these recommendations affect patient evaluation, imaging decisions, and shared decision-making, with an emphasis on balancing cancer detection, patient burden, and responsible use of healthcare resources. --- TIMESTAMPS 00:00 - Introduction01:33 - What Prompted the Guidelines Update?02:59 - Challenges of a Negative Microhematuria Evaluation06:21 - Initial Evaluation Guidelines07:58 - Risk Stratification18:11 - Imaging in Hematuria Workups21:16 - Use of Urinary Biomarkers33:25 - Potential Future Guideline Updates37:17 - Takeaways for Urologists --- RESOURCES AUA/SUFU Microhematuria Guidelinehttps://www.auanet.org/guidelines-and-quality/guidelines/microhematuria

Nausea shouldn't be the most memorable part of surgery. We take a clear, evidence-based look at postoperative nausea and vomiting, from identifying who's at risk to building smarter prophylaxis bundles and choosing the right rescue when prevention falls short. With guest insights from Dr. Connie Chung, we unpack the Fourth Consensus Guidelines, translate them into practical workflows, and explore how Amisulpride—an atypical D2 antagonist—changes the game with an FDA indication for rescue after failed prophylaxis.We start by shrinking baseline risk: consider regional anesthesia when feasible, leverage TIVA with propofol, avoid nitrous and volatiles in longer cases, hydrate well, and spare opioids with multimodal analgesia. Then we scale prophylaxis to risk: dexamethasone at induction, 5-HT3 antagonists at the end, transdermal scopolamine for select patients, and low-dose Droperidol where appropriate. When prophylaxis fails, we explain why repeating ondansetron rarely helps and how switching classes boosts rescue success. Along the way, we map the safety terrain for D2 antagonists—QT prolongation, extrapyramidal risks, anticholinergic effects—so you can individualize care for elderly patients, those on antipsychotics, or anyone with potential drug interactions.We also dig into what's new: contemporary analyses of Droperidol at antiemetic doses, and growing evidence that Amisulpride pairs well with Ondansetron or Dexamethasone to improve outcomes. Pediatric pearls include TIVA, fluids, and a two-drug prophylaxis backbone for longer or higher-risk cases. The result is a practical, stepwise approach you can apply tomorrow—reduce risk, layer mechanisms, and rescue smartly—to cut PACU delays, avoid unplanned admissions, and deliver a recovery that feels as good as the surgical fix.If this deep dive helps your practice, follow, share with your team, and leave a quick review to help others find the show. Tell us your go-to PONV bundle and whether your site stocks Amisulpride.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/287-a-new-era-for-ponv-safety-guidelines-and-smarter-rescue/© 2025, The Anesthesia Patient Safety Foundation

Drs. Mahinda Yogarajah, Benjamin Tolchin, and Jon Stone discuss recommendations for clinicians, patients, and other stakeholders on the management of functional seizures.  Show citation: Tolchin B, Goldstein LH, Reuber M, et al. Management of Functional Seizures Practice Guideline Executive Summary: Report of the AAN Guidelines Subcommittee. Neurology. 2026;106(1):e214466. doi:10.1212/WNL.0000000000214466  Show transcript:  Dr. Mahinda Yogarajah: Welcome to this edition of Neurology Minute. I'm your host for this. My name's Mahinda Yogarajah. I've just finished interviewing Dr. Ben Tolchin and Jon Stone for this week's Neurology® Podcast. For today's Neurology Minute, I'm hoping Ben can tell us the main points of the podcast and the paper discussed in that podcast. Dr. Ben Tolchin: We discussed the AAN guideline on the Management of Functional Seizures. This is the first American Academy of Neurology evidence-based guideline on functional neurologic disorder. It includes a systematic review of the randomized controlled trials relating to the treatment of this disorder, which found that psychological interventions are possibly effective in improving the chance of achieving freedom from functional seizures, in reducing the frequency of functional seizures, in improving quality of life, and in improving anxiety. In addition to the systematic review, there are clinical recommendations based on the systematic review and on related evidence. The recommendations deal with all stages of the diagnosis, management, and treatment of functional seizures and are particularly relevant to neurologists caring for patients with functional seizures. In addition, there are recommendations for future research relating to the diagnosis and management of functional seizures. Dr. Mahinda Yogarajah: Thank you, Ben. For more information, I'd recommend go to the main podcast or go and have a read of the article that's been published in Neurology® on the Management of Functional Seizures Practice Guidelines.

Dr. Mahinda Yogarajah talks with Drs. Benjamin Tolchin and Jon Stone about recommendations for clinicians, patients, and other stakeholders on the management of functional seizures.  Read the related article in Neurology®. Disclosures can be found at Neurology.org. 

This week, Marianna sits down with John Faragon to go over some of this year's highlights in the world of HIV care. Tune in to hear all about new drug regimens, updated guidelines, and more. -- Resources in this episode: Guidelines for the Use of Antiretroviral Agents in Adults & Adolescents with HIV: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/whats-new2025 Update of the Drug Resistance Mutationsin HIV-1: https://www.iasusa.org/wp-content/uploads/2025/03/33-2-mutations.pdfClinical Recommendation for the Use of Injectable Lenacapavir as HIV PrEP: https://www.cdc.gov/mmwr/volumes/74/wr/mm7435a1.htmAntiretroviral Postexposure Prophylaxis after Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV: https://www.cdc.gov/mmwr/volumes/74/rr/rr7401a1.htm-- Help us track the number of listeners our episode gets by filling out this brief form! (https://www.e2NECA.org/?r=AQX7941)--Want to chat? Email us at podcast@necaaetc.org with comments or ideas for new episodes. --Check out our free online courses: www.necaaetc.org/rise-courses--Download our HIV mobile apps:Google Play Store: https://play.google.com/store/apps/developer?id=John+Faragon&hl=en_US&gl=USApple App Store: https://apps.apple.com/us/developer/virologyed-consultants-llc/id1216837691

Show Notes: https://wetflyswing.com/859 Presented By: Mountain Waters Resort, San Juan Rodworks, Montana Fly Fishing Lodge Tellis Katsogiannos has spent decades at the highest level of fly casting, earning world champion titles while helping shape how modern anglers think about efficiency, control, and simplicity. In this episode, Tellis shares how competitive casting sharpened his understanding of techniques, and how those lessons translate directly to real fishing situations. We also head to Sweden and Atlantic salmon water, where Scandi systems and Spey-style thinking demand precision over power. From line design at Guideline to teaching anglers how to improve without overthinking, this conversation connects elite casting, salmon culture, and innovation into one clear framework for better fly fishing. Show Notes: https://wetflyswing.com/859

Join primary care physicians Kate, Gary, Henry and Mark as they discuss 4 new POEM (Patient Oriented Evidence that Matters), chosen for their potential to change practice and improve patient outcomes: Mediterranean diet to prevent diabetes, an update to the community-acquired pneumonia guideline, coffee or decaf for afib, and safety of meds for acute agitation in the elderly. North Dakota Academy of Family Physicians Conference in Big Sky: https://www.ndafp.org/cme/big-sky-conference/ Essential Evidence Plus and all the POEMs: www.essentialevidenceplus.comMed diet to prevent diabetes: https://pubmed.ncbi.nlm.nih.gov/40854218/ Safety of meds for agitation in elderly: https://pubmed.ncbi.nlm.nih.gov/40275439/Updated pneumonia guidelines from ATS/IDSA: https://pubmed.ncbi.nlm.nih.gov/40679934/ Coffee or decaf with afib:  https://pubmed.ncbi.nlm.nih.gov/41206802/

On this episode Fred Goldstein invites Sheena Crosby, PharmD, BCGP, Inflammatory Bowel Disease Clinical Pharmacist at the Mayo Clinic in Florida. Sheena breaks down the American College of Gastroenterology's (ACG) updated guidelines for ulcerative colitis and Crohn's disease, highlighting major shifts in treatment strategy, including the move toward earlier use of advanced therapies and updated goals focused on symptom control, mucosal healing, and sustained remission. She also outlines the critical payer considerations emphasized in the guidelines—from eliminating unnecessary step-therapy requirements to ensuring timely access to induction and maintenance therapy—changes that have direct implications for patient outcomes and health-system performance. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

Updated Guidelines for Perioperative Cardiovascular Management for Noncardiac Surgery   Guest: Michael Cullen, M.D. Host: Kyle Klarich, M.D.   This episode of Mayo Clinic's “Interviews With the Experts” reviews the assessment of patients with known or suspected cardiovascular disease undergoing noncardiac surgery.  Dr. Michael Cullen discusses recommendations from 2024 ACC/AHA perioperative guidelines regarding medication management before and after noncardiac surgery, including recommendations for antiplatelet therapy and bridging anticoagulation.  Finally, he highlights new recommendations in the recent 2024 ACC/AHA perioperative guidelines and compare these guidelines to the 2022 European Society of Cardiology perioperative guidelines.   Topics Discussed: How should clinicians approach the assessment of a patient prior to noncardiac surgery? How should physicians and APPs manage cardiac medications around the time of noncardiac surgery? What are some of the new recommendations in the 2024 ACC/AHA guidelines for perioperative management prior to noncardiac surgery? How do the 2024 ACC/AHA perioperative guidelines differ from the 2022 ESC noncardiac surgery guidelines?   Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode.   Podcast episode transcript found here.

Show notes at pharmacyjoe.com/episode1089 In this episode, I'll discuss a study that addresses the controversy over giving patients with viral infections antibiotics in the Community Acquired Pneumonia guidelines.

On today's episode: Could long COVID be caused by reviving latent infections? Food allergies in children have been decreasing… but why? All that and more today on All Around Science...RESOURCESCould Hidden Infections Be Fueling Long COVID? | Rutgers University. Guidelines for Early Food Introduction and Patterns of Food Allergy | American Academy of PediatricsRandomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy | NEJMCommon loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis | Nature GeneticsEarly Peanut Exposure May Explain Fall in Child Allergies—But Is It Safe? | NewsweekFood Allergy Management and Prevention Support Tool for Infants and ToddlersAdvice to feed babies peanuts early and often helped thousands of kids avoid allergies | PBSCREDITS:Writing - Bobby Frankenberger & Maura ArmstrongBooking - September McCrady THEME MUSIC by Andrew Allenhttps://twitter.com/KEYSwithSOULhttp://andrewallenmusic.com Hosted on Acast. See acast.com/privacy for more information.

Klinisch Relevant ist Dein Wissenspartner für das Gesundheitswesen. Drei mal pro Woche, nämlich dienstags, donnerstags und samstags, versorgen wir Dich mit unserem Podcast und liefern Dir Fachwissen für Deine klinische Praxis. Weitere Infos findest Du unter https://klinisch-relevant.de

Yesterday, out-going mayor Eric Adams appointed four members to the Rent Guidelines Board, creating a major obstacle to mayor-elect Zohran Mamdani's key campaign promise to freeze the rent for rent stabilized tenants. David Brand, housing reporter at WNYC and Gothamist, discusses the Adams appointees, Mamdani's appointment of Leila Bozorg as his housing czar, and reports back on the outcome of several housing bills voted on by the City Council yesterday. 

In our latest episode, Deputy Editor Dr. Zam Kassiri (University of Alberta) interviews authors Dr. German González (Pontificia Universidad Católica Argentina), Dr. Rebecca Ritchie (Monash University), Dr. Pooneh Bagher (University of Nebraska Medical Center), and Dr. Hiroe Toba (Kyoto Pharmaceutical University) about the latest Guidelines in Cardiovascular Research article by Sveeggen et al. that helps researchers tackle the sources of variability in experimental models of diet-induced cardiometabolic syndrome. This podcast is a must-listen for any researcher using a diet-induced food model of disease. The authors discuss different food composition with details about type and source of fat and macronutrients, as well as environmental factors that can influence metabolic outcomes. These guidelines serve as a framework for researchers to optimize dietary interventions in cardiometabolic syndrome models and improve the predictive value of preclinical findings for translational applications. Listen now to hear more, including bonus multi-language summaries in both Spanish and Japanese.   Timothy M. Sveeggen, Pooneh Bagher, Hiroe Toba, Merry L. Lindsey, Rebecca H. Ritchie, Verónica J. Miksztowicz, and Germán E. González Guidelines for diet-induced models of cardiometabolic syndrome Am J Physiol Heart Circ Physiol, published October 7, 2025. DOI: 10.1152/ajpheart.00359.2025

Most Kiwis wonder: How much do I actually need to retire – and what will I really spend?In this episode, Ed and Andrew sit down with Associate Professor Claire Matthews, the researcher behind Massey University's Retirement Expenditure Guidelines, to unpack what current retirees spend and what that means for your plans.You'll learn:What the latest 2025 retirement spending numbers revealHow to use – and how not to use – the Retirement Expenditure GuidelinesWhat to do if the big retirement numbers feel overwhelmingThis episode gives you a clear, evidence-based way to understand what retirement might actually cost – and how to build a plan without getting lost in the numbers.Don't forget to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠create your free Opes+ account and Wealth Plan here⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠.For more from Opes Partners:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Sign up for the weekly Private Property newsletter⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠TikTok⁠⁠⁠⁠⁠⁠⁠⁠

In October, 2025 the American Heart Association issued updated CPR guidelines, first full revision of lifesaving resuscitation guidance since 2020. In this podcast Henry Mayo cardiology nurse practitioner Tamar Avakian discusses the new CPR guidelines.

Show notes at

Obesity affects more than 1 billion people worldwide and is recognized by the World Health Organization as a chronic, relapsing disease. WHO recently published a guideline in JAMA on the use and indications of GLP-1 therapies for the treatment of #obesity in adults. Francesca Celletti, MD, PhD, and Ezekiel Emanuel, MD, PhD, join JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, to discuss. Related Content: World Health Organization Guideline on the Use and Indications of Glucagon-Like Peptide-1 Therapies for the Treatment of Obesity in Adults

Are you drowning in wedding "etiquette guidelines"? Everyone has an opinion on invitation wording, cash bars, inviting kids, wedding day transportation, and what traditions absolutely SHOULD be included in the wedding day.  There's nothing like planning a wedding to suddenly have everyone you've ever known come out of the woodwork with their opinions, right? Where wedding planning gets overwhelming is when ideas of what a wedding "should" look like are in conflict with our budget, our wants, and our personalities.  And of course, an added layer of stress arises when you and your partner come from different backgrounds, and one of you thinks paying $10,000 for a photographer is completely reasonable, and the other wants to spend $10,000 total on the entire wedding. But no matter where you're from, I'm a firm believer in your wedding day being an expression and celebration of you & your partner.  At the end of the day, you're making a really special commitment to one another, and looking to celebrate the occasion with your loved ones.  That's it! Spoiler alert, I don't necessarily have a right / wrong, ok / not ok answer for every single piece of wedding etiquette, because look, there is just so much gray area here.  I could sit here all day and say, it's never ok to do that, it's always better to do that, but that's not actuality, that's not the world we live in.   I thought it would be helpful to take a list of common etiquette and rules that are flying around out there, and have a critical conversation about each one so that you can decide what's right for YOU.  Which leads me perfectly into, Please trust that you ALWAYS have the support from me to ditch what everyone else is doing, and craft your day, your way.  No this doesn't mean being blatantly rude or disagreeable to your family, or sneaking behind your partner to sabotage something that you know they really want, or failing to honor your guests who are committing significant time & resources to participate in your wedding and support you.  Obviously use common sense, compromise and understanding throughout your engagement.   But these commonly held wedding etiquette rules & beliefs can by all means be adjusted and updated to serve you and your unique priorities.    LINKS & RESOURCES mentioned in today's show: Setting up a Facebook Group for your wedding guests Some Couples Are Charging Their Wedding Guests to Attend

How can laughter become one of your most powerful leadership tools? In this episode, Kevin welcomes Adam Christing to explore how humor can foster trust, connection, and engagement in the workplace. Adam shares practical strategies for leaders, including his framework of five "laugh languages": self-effacing humor that builds authenticity, the art of poking fun without causing harm, in-jokes that strengthen team bonds, and techniques like amplification and wordplay that enhance storytelling and communication. Adam emphasizes the importance of "planned spontaneity," the idea that intentional preparation allows humor to land naturally and meaningfully. Listen For 00:00 Introduction 00:28 Why humor matters for leaders 01:20 Podcast purpose and live participation 02:05 Guest introduction: Adam Christing 03:44 Big idea: humor builds trust 05:05 Why Adam wrote the book 06:31 Everyone has a sense of humor 07:42 Is humor risky for leaders? 08:16 Guidelines for using humor intentionally 10:17 Humor even in serious situations 11:08 Laugh Language: Poke (self-facing humor) 13:40 How to poke safely as a leader 19:57 Laugh Language: In-jokes 20:34 Knowing your audience 22:10 Leaders aren't trying to be comedians 23:41 Humor strengthens connection 24:49 Laugh Language: Amplify 25:09 Using exaggeration effectively 26:57 Laugh Language: Wordplay 28:11 Test humor in communication 29:12 Planned spontaneity 30:05 Simple ways to spark humor (questions) 31:05 How to recover when humor fails 32:56 Where leaders should start with humor 33:41 Listening for others' humor styles 36:45 Where to find Adam and his book 37:46 Conclusion Adam's Story: Adam Christing is the author of The Laughter Factor: Five Humor Tactics to Link, Lift, and Lead. He is one of America's most sought-after professional speakers and masters of ceremonies. With a signature blend of humor and heart, Adam has hosted events for a wide range of organizations—from Stanford University to the Green Bay Packers. As a humor expert and the founder and CEO of Clean Comedians®, Adam champions the power of laughter to inspire, connect, and create unforgettable experiences, without the need for profanity or politics. Adam has been featured on Entertainment Tonight and in more than 100 podcasts, TV, and radio programs. His warm-hearted comedy has delighted over a million people across 49 U.S. states, as well as in Canada, Europe, and Asia. https://adamchristing.com/ https://thelaughterfactor.com/ https://quiz.tryinteract.com/#/68878f40feaa82001501542a https://www.linkedin.com/in/adam-christing/   This Episode is brought to you by... Flexible Leadership is every leader's guide to greater success in a world of increasing complexity and chaos.  Book Recommendations The Laughter Factor: The 5 Humor Tactics to Link, Lift, and Lead by Adam Christing How to Win Friends & Influence People by Dale Carnegie Like this? Humor that Works with (An)Drew Tarvin You Have More Influence Than You Think with Vanessa Bohns Join Our Community If you want to view our live podcast episodes, hear about new releases, or chat with others who enjoy this podcast join one of our communities below. Join the Facebook Group Join the LinkedIn Group    

Doctors Sara and Lisa discuss the podcast episodes over the year. We talk about our longer term learning points, how the year has gone and what's to come. ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it's release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Mamas Mamas, Nieves Gonzalo, and Erick Schampaert take a look at the latest guidelines for chronic coronary syndromes and how they relate to complex PCI.

Analyst firm Forrester has projected that AI-native cloud solutions could generate $20 billion in revenue by 2026, significantly reshaping enterprise IT operations. However, the transition to these solutions raises concerns about governance gaps that could lead to outages. Organizations are increasingly redesigning their systems across various sectors, including education and infrastructure financing, to manage the risks associated with AI. This shift is underscored by a recent Gallup poll indicating that 45% of U.S. employees are using AI at work, reflecting a growing reliance on AI tools for operational efficiency.The term "SLOP" has been designated as Merriam-Webster's 2025 Word of the Year, highlighting the cultural implications of AI's integration into daily communication. This term encapsulates the challenges of quality control in AI outputs, as the rapid scaling of AI tools often outpaces human judgment. Managed Service Providers (MSPs) are urged to focus on helping clients discern which AI outputs are reliable and which require scrutiny, emphasizing the need for quality control over mere automation.In the education sector, a notable trend is the adoption of oral exams to assess student learning, ensuring evaluations reflect genuine understanding rather than reliance on AI-generated content. Additionally, major tech companies like Microsoft and Google are adopting innovative financing strategies, such as short-term leasing agreements for computing power, to mitigate financial risks associated with AI infrastructure investments. These strategies allow companies to scale their AI capabilities while maintaining flexibility in their financial commitments.For MSPs and IT service leaders, the evolving landscape of AI presents both challenges and opportunities. The emphasis on governance and quality control in AI tools indicates a shift in how organizations will approach AI adoption, necessitating new validation steps and risk models. MSPs can leverage this moment by providing guidance on AI evaluation and compliance, ensuring that clients can navigate the complexities of AI integration while minimizing potential liabilities. Four things to know today 00:00 AI Adoption Surges as Forrester, Gallup, and Merriam-Webster Signal a Quality Problem04:40 -Education and Big Tech Respond to AI by Reworking Assessment and Risk Models07:13 OMB Uses Procurement Power to Set Federal Standards for Truthful, Unbiased AI Tools09:11 Disney Sets AI Rules:  This is the Business of Tech.    Supported by:  https://cometbackup.com/?utm_source=mspradio&utm_medium=podcast&utm_campaign=sponsorship

Dharma Talk given Sunday, December 14, 2025.

Listen in as Jay H. Shubrook, DO, FACOFP, FAAFP, and Chrisopher Weber, MD, FAAP, FACP, CSCS, daBOM, FOMA, discuss the latest advances in caring for patients with overweight or obesity in the primary care setting, including:The Lancet Commission's new obesity definitions and diagnostic criteriaKey data on incretin-based antiobesity medications like semaglutide and tirzepatideBest practices for patient discussionsStrategies for incorporating new evidence in your primary care practicePresentersJay H. Shubrook, DO, FACOFP, FAAFPProfessor and DiabetologistDepartment of Clinical Sciences and Community HealthTouro University California College of Osteopathic MedicineVallejo, CaliforniaChristopher Weber, MD, FAAP, FACP, CSCS, daBOM, FOMABariatric Services Medical Director, Ascension WisconsinObesity Medicine Director, Ascension Columbia St Mary's Bariatric CenterTrustee, Obesity Medicine AssociationAdjunct Assistant Professor of PediatricsMedical College of WisconsinMilwaukee, WisconsinLink to full program:https://bit.ly/4rG7QQp Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Despite a range of effective prevention tools, HIV incidence continues to rise in Canada, with stark disparities across ethnicity, gender, Indigeneity and geography. Updated Canadian guidelines on HIV pre- and post-exposure prophylaxis reflect scientific advances since 2017 and address both new formulations and persistent barriers to equitable access.Dr. Darrell Tan, lead author and clinician scientist at St. Michael's Hospital, outlines several prophylaxis options now available. Daily oral tenofovir disoproxil fumarate with emtricitabine is close to 100 per cent effective with perfect adherence and remains forgiving of occasional missed doses. Long-acting injectable cabotegravir, administered every two months, shows even greater effectiveness in trials largely because it reduces the adherence challenges associated with daily pills, though cost and availability continue to limit uptake.Natasha Lawrence, a community health worker at Women's Health in Women's Hands Community Health Centre in Toronto, reports that most women she serves have never heard of pre-exposure prophylaxis. Many people perceive their HIV risk as low until discussions explore relationship dynamics, including uncertainty about partner fidelity or difficulty negotiating condom use. She highlights how power imbalances and gender-based violence shape women's risk and may limit the practicality of daily pills. Long-acting injectables can offer greater privacy and autonomy for some women, reducing the risk of partner detection. Public health messaging, she stresses, must be co-designed with communities to ensure cultural relevance and avoid stigma.Clinicians should initiate sexual health conversations routinely, not only when patients raise concerns. Pre-exposure prophylaxis can be discussed during visits for contraception, mental health or other routine care. When patients express interest, access should not be limited by rigid criteria. Long-acting options may be especially helpful for women who face safety or privacy concerns in their relationships.For more information from our sponsor, go to medicuspensionplan.comComments or questions? Text us.Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.You can find Blair and Mojola on X @BlairBigham and @DrmojolaomoleX (in English): @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

Send us a textA packed hallway at the ACNM Annual Meeting turned into the perfect backdrop for a clear, compassionate deep dive on adolescent gynecology. We talk candidly about what really helps teens feel safe in care: transparent consent, real confidentiality, and avoiding unnecessary pelvic exams. From there, we walk through the high-yield topics every clinician faces with young patients—irregular cycles after menarche, painful periods that derail school days, and the difference between normal discharge and vaginitis that needs treatment.We spotlight the red flags that can't be missed, especially ovarian torsion posing as vague lower abdominal pain, and why transabdominal ultrasound often beats transvaginal imaging for adolescents. You'll hear how we build a thorough menstrual history that captures timing, flow, and impact on daily life; how we normalize the maturing hypothalamic-pituitary-ovarian axis; and where first-line therapies like NSAIDs, combined pills, progestin-only methods, and levonorgestrel IUDs fit. We also lay out a patient-led approach to contraception counseling—centered on goals like bleeding control, privacy, and ease of use—while weaving in emergency contraception, STI screening strategies, and the crucial role of the HPV vaccine in preventing cervical and other cancers.Throughout, we keep the focus on trauma-informed practice. That means offering safe words like stop and out during exams, letting teens handle instruments to reduce fear, and moving complex conversations to when patients are fully dressed. We include considerations for transgender and gender-diverse adolescents, from menstrual suppression to reputable clinical resources. By combining practical tools with a respectful tone, this episode gives you a roadmap to adolescent gyn that improves comfort, detects danger early, and builds trust that lasts into adulthood.If this conversation helps you care for teens with more confidence, subscribe, share with a colleague, and leave a quick review to help others find the show.

Podcast Family, we have covered PCOS on this show many times in the past; and yet- again, there is new information! A new publication from AJOG (Gray journal) describes a new meta-analysis on preconception/continued metformin use in the first trimester. Is this helpful? How does this contrast with the 2023 international guidance update on PCOS? Listen in for details. 1. ASRM: Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome (2023)2. Cheshire J, Garg A, Smith P, Devall AJ, Coomarasamy A, Dhillon-Smith RK. Preconception and first-trimester metformin on pregnancy outcomes in women with polycystic ovary syndrome: a systematic review and meta-analysis. Am J Obstet Gynecol. 2025 Dec;233(6):530-547.e8. doi: 10.1016/j.ajog.2025.05.038. Epub 2025 Jun 3. PMID: 40473092.3. Løvvik TS, Carlsen SM, Salvesen Ø, et al. Use of Metformin to Treat Pregnant Women With Polycystic Ovary Syndrome (PregMet2): A Randomised, Double-Blind, Placebo-Controlled Trial. The Lancet. Diabetes & Endocrinology. 2019;7(4):256-266. doi:10.1016/S2213-8587(19)30002-6.4. Teede HJ, Tay CT, Laven J, et al. Recommendations From the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Fertility and Sterility. 2023;120(4):767-793. doi:10.1016/j.fertnstert.2023.07.025.

In this episode of the Female Athlete Nutrition Podcast, host Lindsey Elizabeth Cortes, a sports dietitian and lifelong athlete, delves into the complex world of sugar. Lindsey discusses the different types of sugars (glucose, fructose, galactose, and others) and explains the importance of carbohydrates for athletes. She differentiates between natural sugars, added sugars, and artificial sweeteners, emphasizing their roles and impacts on athletic performance.   The podcast also highlights the general dietary guidelines for sugar intake and how they apply differently to athletes. Lindsey shares practical examples, fun facts, and even personal anecdotes to help listeners understand and normalize sugar consumption, especially in the context of sports nutrition. This episode aims to empower female athletes to make informed choices about their nutrition to perform at their highest level.   Episode Highlights: 01:22 The Reality of Period Pain 03:00 Welcome to New and Returning Listeners 03:29 Diving into Sugar: Basics and Misconceptions 05:11 Fun Facts About Sugar 10:10 Understanding Different Types of Sugar 22:29 Natural vs. Added Sugars 27:30 Understanding Sugar in Fermented Foods 28:05 Addressing Relative Energy Deficiency in Sport (RED-S) 30:37 Exploring Sugar Substitutes and Artificial Sweeteners 33:51 The Impact of Sugar Alcohols on Health 40:35 Guidelines for Sugar Intake in Athletes 42:53 The Role of Simple Sugars in Athletic Performance 53:53 Concluding Thoughts on Sugar and Nutrition Resources and Links: For more information about the show, head to work with Lindsey on improving your nutrition, head to: http://www.lindseycortes.com/ Join REDS Recovery Membership: http://www.lindseycortes.com/reds WaveBye Supplements – Menstrual cycle support code LindseyCortes for 15% off: http://wavebye.co Previnex Supplements – Joint Health Plus, Muscle Health Plus, plant-based protein, probiotics, and more; code CORTES15 for 15% off: previnex.com Female Athlete Nutrition Podcast Archive & Search Tool – Search by sport, condition, or topic: lindseycortes.com/podcast Female Athlete Nutrition Community – YouTube, Instagram @‌femaleathletenutrition, and private Facebook group

Dr. Alison Loren and Dr. Ann Partridge share the latest guideline from ASCO on the management of cancer during pregnancy. They highlight the importance of this multidisciplinary, evidence-based guideline and overarching principles for the management of cancer during pregnancy. Drs. Loren and Partridge discuss key recommendations from each section of the guideline, including diagnostic evaluation, oncologic management, obstetrical management, and psychological and social support. They also touch on the importance of this guideline and accompanying tools for clinicians and how this serves as a framework for pregnant patients with cancer. The conversation wraps up with a discussion on the unanswered questions and how future evidence will inform guideline updates.  Read the full guideline, "Management of Cancer During Pregnancy: ASCO Guideline" at www.asco.org/survivorship-guidelines TRANSCRIPT This guideline, clinical tools, and resources are available at www.asco.org/survivorship-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology, https://ascopubs.org/doi/10.1200/JCO-25-02115   Brittany Harvey: Hello and welcome to the ASCO Guidelines Podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one, at asco.org/podcasts. My name is Brittany Harvey, and today I am interviewing Dr. Alison Loren from the Perelman School of Medicine of the University of Pennsylvania and Dr. Ann Partridge from Dana-Farber Cancer Institute, co-chairs on "Management of Cancer During Pregnancy: ASCO Guideline." Thank you for being here today, Dr. Loren and Dr. Partridge. Dr. Alison Loren: Thanks for having us. Dr. Ann Partridge: It's a pleasure. Brittany Harvey: And then just before we discuss this guideline, I would 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 disclosures of potential conflicts of interest for the guideline panel, including Dr. Partridge and Dr. Loren who have joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. So then to dive into the meat of this guideline, to start us off, Dr. Loren, could you provide an overview of the scope and purpose of this new guideline on the optimal management of cancer during pregnancy? Dr. Alison Loren: Sure, thanks, Brittany. So this was really born out of I think a lot of passion and concern for this really vulnerable patient population. We have observed, and I am sure it is not any surprise to your audience, that the incidence of cancer in young people is increasing. And simultaneously, people are choosing to become pregnant at older ages, and so we are seeing more and more people with a cancer diagnosis during their pregnancy. And for probably obvious reasons, there is really no way to do randomized clinical trials in this population. And so really trying to assemble and articulate the best evidence for safely managing the diagnosis of cancer, the management of cancer once it is confirmed, being thoughtful about obviously the health of the mom, but also attending to potential risks to the developing fetus, and really just trying to be really comprehensive and balanced about all the choices for these patients when they are facing some really challenging decisions in a very emotionally fraught environment. And I think it is really emotionally fraught for the providers, too. You know, this is obviously an extremely intense, very emotional set of decisions, and so trying to provide a rudder essentially to sort of help people frame the questions and trying to make as evidence-based a set of recommendations as possible. Dr. Ann Partridge: And I would just add that "evidence-based" is a strong word here because typically our, as you just heard, our gold standard evidence is a randomized trial, but you can't do that in this setting, in general. And so, what we were able to do with the support of the phenomenal ASCO staff was to pull together kind of the world's literature on the safety and outcomes of treatments during pregnancy, as well as consensus opinion. And I think that is a really, really critical difference about this particular guideline compared to many of the other ones that ASCO does, where consensus and good judgment needed to kind of rule the day when evidence is not available. So, there is a lot of that in our recommendations. Dr. Alison Loren: That is such a good point. And I just, before we move forward, I just want to reflect that the composition of the panel was really broad and wide-ranging. We had maternal medicine specialists, we had legal and ethical experts, we had representatives who understand pharmaceutical industries' perspectives, and then medical oncologists representing the full spectrum of oncology diagnoses. And so it was a really diverse, in terms of expertise, panel, internationally composed to try to really get the best consensus that we could in the absence of gold standard evidence. Brittany Harvey: Absolutely. That multidisciplinary panel is really key to developing this guideline and, as you said, looking at the evidence and even though it does not reach the level of randomized trials, still critically evaluating it and reviewing that along with consensus to come up with optimal management for diagnosis and management of cancer during pregnancy. So then to follow that up, I would like to next review the key recommendations of the guideline across the main sections that the expert panel provided. First, I will throw this out to either of you, but what are the important general principles for the management of cancer during pregnancy? Dr. Ann Partridge: I think there were three major principles that we hammer home in the guidelines. One is that this is a team sport. It is multidisciplinary care that is necessary in order to optimize outcomes for the patient and potentially for the fetus. And that you really need to, from the beginning, bring in a coordinated team, including not just oncologists but obstetricians, maternal-fetal medicine specialists, neonatologists, ethics consultants, and obviously the patient and potentially her family. So that, I think, is one of the most important things. Second would be that obviously in a pregnancy, there are two potential patients and that the nuances of safety and risk from treatment is really wrapped up in where in the trimester of the pregnancy the patient is diagnosed, along with the kind of cancer that it is, both the urgency of treatment and the risk of the cancer, as well as the potential risks of any given intervention across the cancer continuum. It is a broad guideline in that regard. And then finally, and this is particularly timely given what is going on from a sociopolitical standpoint in the U.S., really thinking about informed consent and potential ethical as well as legal implications of some of the choices that patients might have when they are thinking about, in particular, continuing a pregnancy or potential termination. Dr. Alison Loren: And I will just add that I think that the key to all of this guidance is nuance and individualization and also making sure that patients and their care providers understand all the choices that are available to them and also the consequences of those choices. You know, nobody would choose to receive chemotherapy during pregnancy if that wasn't necessary. So there are risks to treatment, but there are also risks to not treatment. And making sure that in a suboptimal situation where you do not have a lot of evidence, trying to weigh, the best you can, the risks and benefits of all of the choices so that the patient can come to a decision about the treatment plan that is right for her. Brittany Harvey: Definitely. And those core concepts really set the stage for individualized care on what is necessary for appropriate multidisciplinary care, prioritizing both patient autonomy and informed decision making. With those core concepts and key principles in mind, I would like to move into the recommendations section of the guideline. So what are the key recommendations regarding diagnostic evaluation for pregnant patients with signs or symptoms of cancer? Dr. Alison Loren: I think the most important thing is to not delay, that there are very careful and well-thought-out recommendations for how to evaluate a potential cancer. And while there are certain things that we know can be harmful, particularly when certain dose thresholds are exceeded - for instance, abdominal imaging, there are certain radiographic thresholds that you don't want to exceed because of risk of harm to the embryo or fetus - there are still lots of options for diagnosing cancer during pregnancy. And again, thinking about the costs of not doing versus the cost of doing, right? It is really important to make the diagnosis of cancer if that is a consideration or a concern. And sometimes going directly to biopsies or getting definitive studies, even if there is a small risk to the developing fetus, is really essential because if the mom does not survive, of course, the fetus is also not going to survive. And so we need to be thinking first about the patient who is sitting in front of us, the woman who needs to know what is going on in her body so she can make good decisions about her health. So, I think that is a key principle in thinking about this. Brittany Harvey: Absolutely. So, following that diagnosis of a new or recurrent cancer, what is recommended for oncologic management of patients who are diagnosed with cancer during their pregnancy? Dr. Ann Partridge: So, I think the general principle is, again, cancer is such a wide number of diseases and even within diseases, a range of stages and risks and associated opportunities for risk reduction and/or treatment depending on the type of cancer. Just by example, in the work that I do, which is breast cancer, once someone has had a surgery in the early-stage setting, a lot of our treatment is about risk reduction. And that is very different than from what Alison does, which is treating people with leukemia, where it is kind of binary. If you do not treat, including with cytotoxic drugs, the patient and an unborn fetus will die, especially early in the pregnancy, obviously. So this is where cancers are very, very different. So I think taking the approach of what would you do if the patient were not pregnant? And what is the best treatment for that particular patient with that particular kind of cancer? And then applying the pregnancy and where the patient is in that pregnancy in terms of the trimester of the pregnancy, and what is safe and what is unsafe from the options that you would give her if she were not pregnant. And then if the patient is choosing to keep the pregnancy, which in my practice, many people come and they come to me because they want to hold onto their pregnancy and want to figure out how to make it work, coming up with a regimen that tries to give them kind of the best bang for the buck, the best possible breast cancer therapy with the least harm, when possible, to the fetus. It is a bit of a balance, right? And then we cannot always give people the best approach. And sometimes it comes down to making a decision to give up something that may improve their survival so as not to harm the fetus. And sometimes it goes the opposite direction where a patient will say, "Oh, that is going to improve my survival by 5% and you can't give it to me now? I am going to choose to terminate." Even though that is obviously a very, very difficult and challenging decision to make in this setting because they want to optimize their survival and ideally live on to potentially have another pregnancy in the future if that is something that is of interest to her. So these are really, really hard conversations as you can imagine, but that is kind of where we go. Dr. Alison Loren: Yeah, and I think this is where the need for more research and understanding is really key because sometimes questions come up. I guess I am thinking about like HER2-directed agents, which we know are contraindicated in pregnancy. But what about sequencing? Does it matter when you get it? Can you get it later? I think that is something that we don't really fully understand. And similarly, again, this is obviously like a breast cancer and blood cancer focused discussion because that is what we do, but thinking about managing blood cancers, certainly with acute lymphoblastic leukemia, there is actually a lot of options now that, you know, you could potentially use to temporize or sort of get somebody through a pregnancy relatively safely. I am focusing on the word "relatively" because we do not know what the long-term impact might be of potentially not optimal therapy in the long run. And then thinking about other things like timing of a bone marrow transplant relative to either delivery or termination. I mean, again, we really do not know what are the right sets of sort of timing considerations for those. So there are just a lot of unknowns. And I think trying to be sort of self-aware and humble and honest about those unknowns so that the patient can engage in the conversation in a way that is meaningful to her and make the decisions that make the most sense for her. I think the most important thing is to make sure that the patient feels supported and safe to make those decisions with as little regret as possible. Brittany Harvey: Yes, I think it is really important that you mentioned that there is a wide range of cancers here, and that means that care really needs to be individualized for each patient. I will also note, just in this section, that I found really informative while reading through the guideline the list of oncologic agents that may be offered in each individual trimester, whether it is contraindicated or it can be used with caution, or if there is relatively good safety data on it for prioritizing maternal treatment needs and balancing fetal safety at the same time. I think that is, that is really key. And I think readers will really like that section of the guideline to provide concrete information for them and their patients. Dr. Alison Loren: Thank you. We actually spent a lot of time on that table and just thinking about what it should look like, what the format ought to be, what the language ought to be. Because of course, at the end of the day, everything should be used with caution. So what does that actually mean? And we sort of tried to explicate that a little bit in like the footnotes. We really tried to leverage what we know from clinical experience, from package labels, from mechanism of action to try to be as clear and definitive as we could be without overstating or understating what we know. Dr. Ann Partridge: Yeah, and I think we are focusing on breast and leukemia because that is what we do. But the truth is much of the data comes from those two areas. Leukemia, not because it is so common, but because you do not really have choices to treat or not treat. And so for decades, they have been treating and saying, "We hope the progeny comes out okay." And for many agents it does. The babies are okay. And so, we have reasonable observational data. And then in breast cancer, there have been actually some prospective registry-type studies where people have been followed and treated when pregnant, and the progeny have been accounted for, and so we have some good experience in that way too. Again, not randomized trials, but at least data that suggests certain agents are safe. And increasingly, because of that, when we have had to treat patients, we have said, "Okay, let us do it on this registry so that we can at least learn from every patient that comes in in this situation." And so, I think we will have more and more data given the growing number of young adults with cancer and the delays in childbearing that are happening around the world, and particularly in Westernized countries. I wish we did not. We wish we did not see this problem, but of course, when we do, we have to make sure that we learn from it and try and get patients enrolled in these registries and any kinds of studies that are available. Dr. Alison Loren: Yeah, I will just underscore that to say that, you know, there is outcomes of pregnancy and then there is outcomes of pregnancy, right? So there is like, "Okay, the baby was born with 10 fingers and 10 toes, and they passed their Apgar, and they are doing all their developmental processes along the way." But what happens when they are 10 or 15 or 20? Are they maturing normally? Are they cognitively intact? And then, of course, it is really inseparable from what is the impact on a family of having the mom with cancer? And how does that impact childhood development and intellectual development? And so these are really, really important questions that are very difficult to answer given the longitudinal information that you need, but it is a really critical question that, you know, patients ask and we do not know the answer. Dr. Ann Partridge: Yeah, that actually leads me to one of the important principles in the guideline that is a little bit of a change from when I first started practicing, which is we have learned from the wider neonatology literature, as they have followed up on the children that were born prematurely, that it is actually better not to be premature and to keep the baby in utero as long as it is safe for the fetus and the mother as long as possible, ideally to term rather than delivering early and then giving the chemo after that or separating the chemo from before and after. We used to try and deliver early and then give agents, but now we typically will give agents that are safe to be given at the end of pregnancy, ideally close to term, a couple weeks out, to allow for the ability of count recovery, and you do not want to go into preterm labor with chemotherapy on board, but we used to go much earlier and have an argument with our maternal-fetal medicine doctors. "How early can you get them out?" And they would say, "How long can they stay in?" And increasingly, we have been able to try and compromise to go even later and allow the fetus to go to term because of the neonatal outcomes that in longer term there is a suggestion that the children are developing better in the long run if they are kept in utero for as long as possible. Dr. Alison Loren: Yeah, that is such a great point. I think that is probably the most important thing for people to take away. For anyone who sort of does this, I mean, no one does this regularly because it is a rare event, although I think it is increasing as I mentioned. But this idea that the third trimester is, most of us know, is primarily a time for growth. Most of the critical development has already occurred, and so administering most chemotherapy agents towards the end of the third trimester seems to be preferable long term than delivering them early. So that is a really big change. I think we used to try to sort of, "Oh, get them to 30 or 32 weeks and then deliver," but we really are trying to get them closer to term, 37 weeks or more, and then coordinating the treatment so that they are not nadiring, as Ann said, at the time of planned delivery. Brittany Harvey: Yes, and that is a really important point related to evidence-based care and why we have changed that practice. And so then that actually leads nicely into my next question. But as you both mentioned, this is an important collaboration between oncologists and obstetricians. So the next section of the guideline addresses obstetrical practice. And so beyond what is standard, what additional recommendations are there in obstetrical management for pregnant patients with cancer? Dr. Alison Loren: That is a great question. So I will say we were really struggling with like how much do we cover? Like this is an oncology guideline. We are not obstetricians. We certainly had great representation from our maternal-fetal medicine colleagues on the panel. But really trying to sort of give useful information without overstepping. And so I think that the main recommendations are to increase the frequency of fetal monitoring, make sure that there is close attention to blood counts in the patient. But I think there is really still a gap in terms of what we know about optimal management of a pregnant person who is receiving therapy and how to handle the pregnancy itself. The delivery should be a usual delivery. Our colleagues did not recommend a planned C-section. They recommended usual care in terms of planning for the delivery. Obviously, if a C-section is indicated, then it should be done, but it should not be planned this way because of the cancer diagnosis. And I guess the other thing that we mentioned in the guideline, although we were reluctant to push it too hard because of access to these specialized services, was evaluating the placenta after birth to ensure that there were no metastases in the placenta itself. Dr. Ann Partridge: Those are the main things, and judicious and prudent obstetrical care, as I think, you know, is trying to be practiced regularly with MFM. Typically these patients should be followed not by your average OB/GYN, but a maternal-fetal medicine specialist because these patients will have special concerns, especially if they are sick. So oftentimes, especially Alison's patients, are actually sick with leukemia. And so you are monitoring them a lot, whereas, you know, a breast cancer patient typically isn't sick, although they could get sick with their chemotherapy. And so we really want to hand-in-hand manage these patients with our MFM colleagues. Dr. Alison Loren: I think we also highlighted in the guideline just for the refresher purposes of the oncology community, generally which drugs that would be given in a normal oncology setting are safe to be given to a pregnant person. So we talked a little bit about what kinds of steroids are recommended, antiemetics, DVT prophylaxis, peripartum. These are things that we think about a lot in oncology, but just want to make sure that it sort of intersected appropriately with the care of a pregnant patient. Brittany Harvey: Definitely. That specialized care is really important for patients who are pregnant and have cancer. And then the last section of the recommendations addresses psychological and social support. As you both mentioned before, this is a highly emotional time and it can be difficult and challenging to make decisions. So what is recommended for the psychological and social support of pregnant patients with cancer? Dr. Ann Partridge: Well, as I said, it is really something that needs to be considered at the beginning, through the diagnostic period, all the way into survivorship. Ironically, even though it is a highly fraught, emotional situation, I find that my pregnant patients actually are extraordinarily resilient, and what they are really focused on often is the safety of the fetus, because again, many of the people that come to me, it is a highly wanted pregnancy. They are also focused on their own health, of course, and often you need to bring in social work, sometimes a psychologist, professionals who are there just to help manage their emotions while we are focusing on what do they need medically to be as healthy as possible, both for the again, the mother, the patient, and the fetus. It is very tricky, and I will say also bringing in sometimes people on the ethics team in the hospital to help, both from the "Are you recommending and giving something that is safe?" That is number one. And then number two, sometimes patients want to be treated with drugs that we do not have any safety data for in pregnancy. What are our obligations? I think most of us would say we would not treat someone if we do not have safety data and there is suspicion for concern. But where is that line in terms of the right thing to do by that patient? And so we are all beholden to our ethics colleagues to help us when we make decisions like that. You know, we all want to do right by the patient, but we have to uphold our oaths and legal obligations. I don't know if you have to add on that because it's very tricky. Dr. Alison Loren: It is, it is very hard. I mean, I think, you know, there is a lot of emotion, obviously any cancer diagnosis is extremely charged and people are already at sort of a heightened, you know, they are anticipating a new baby and planning around that. And so it is just an extremely disruptive is the smallest word I can think of to describe it. And I think that often there is a co-parent, there might be parents and in-laws and other siblings, and then there is care after delivery. And so it is just a very complex set of dynamics. And having both our ethics colleagues and our psychology and social work colleagues to sort of just pitch in and make sure that the patient is being supported. I think there are sometimes really difficult situations where maybe what the patient wants is different from what the father of the baby wants or what the rest of the family wants. And so that can be really challenging. And you never really know where those landmines are going to pop up. So it is good to have the team on board early and often. Dr. Ann Partridge: Yeah, I would add to that, the other thing here that I think is really important, like in all of medicine but especially in situations like this, this is where we have to be very careful as professionals not to impose our own ethical, moral, emotional, personal views on the patient and to try to reserve judgment as much as possible. We are their navigator with the most important evidence and information that we can provide in the current situation. And that is where this guideline is extraordinarily helpful, we hope, for clinicians in the years to come. And at the same time, we cannot necessarily impose our own views and what we would do on a patient or what we tell our daughters, sisters, friends, family members. It is very tricky in that way. And so sometimes not just support for the patient, but support for the care team may be warranted in some of these very fraught situations. Dr. Alison Loren: Yeah, that is such a great point. And I was sort of thinking that too. I mean, it is, of course, the patient is front and center, but these are really difficult situations to navigate. And I will just add also that a lot of times these patients end up in academic centers, which I think is that's where the expertise or even just the experience may be. But the downside of that is that, you know, the teams are constantly changing. You have a new resident, you have a new intern, you have a new attending, a new fellow. And so, you know, the patients may be subjected to lots of different ways of communicating and sometimes those perceived differences can be really challenging. So sort of team huddles to sort of make sure that everybody is reading from the same script and everyone is comfortable with how the information is being presented so that the patient does not feel more confused or more overwhelmed, that they are kind of getting a consistent message from the whole team that, "This is what we know, this is what we are recommending, here are your other choices, and here are the pros and cons of each of these options." Brittany Harvey: Yes, I think you have both touched on this and that bringing in appropriate experts to support both clinicians and patients and their decision-making and their mental health is really important for this section of the guideline. We have already discussed this a fair bit throughout our conversation, but in your view, what is the importance of this guideline and how will it impact both clinicians and pregnant patients diagnosed with cancer? Dr. Ann Partridge: I could start with that. We just talked about experts and having them all around, but the fact is most people do not have the experts all around when they are dealing with this. And I think this is, you know, an expert-based, evidence-based guideline where having this in one's back pocket, whether you are in rural Montana or at a major cancer center on either coast, you will be armed with the latest and the greatest in terms of what we know and what we do not know, and some very helpful algorithms for how to think through the process of dealing with a patient who is diagnosed during pregnancy, whichever type of cancer it is. We could not cover every single specific thing about every cancer, although it is a pretty long guideline and there is a lot of nuance in there. So you might find a lot about specific cancers. And I think that that will be very, very helpful for people who are faced with this situation in the clinics just to frame it out, think through. Sometimes there is no answer that is the perfect answer and then, you know, using this as kind of a scaffolding and phoning a friend who may have more experience to help guide you and guide the patient, most importantly. I think it will be very helpful in that regard. Dr. Alison Loren: Yeah, I think so too. And I have talked about that we are working on this guideline and the anecdotal feedback has been, "This is so helpful." Like there really has not been, I think, an all-in-one place, diagnostic considerations, radiographic considerations, staging, treatment, all the modalities, surgical, radiation, systemic chemotherapy. We tried to include, when we could, novel agents including targeted agents and monoclonal antibodies and bispecifics and cellular immunotherapies and non-cellular immunotherapies. We really, really tried to cover in 2025 what are people using to treat cancer and to try to give the most balanced view of what we think is is safe or reasonably safe and what we think is either unproven or known to be risky, really to have it be kind of a go-to, like all-in-one, as much information as we have about these really challenging cases. We tried to include, Ann mentioned, you know, specific cancers, and I think when there were specific things to shout out with specific cancers, we really tried to highlight that. Like, "Okay, lots of young patients with cancer have Hodgkin's lymphoma, so what is safe and what is not for that specific case?" Or, "What is safe or what is not when you are thinking about colon cancers?" And we have a shout-out in here about considering checking for DPD deficiencies in patients who are pregnant. And I know it is generally recommended nowadays, but certainly for people who are pregnant, you know, you really want to avoid excess toxicity. So I think just really trying to be attentive to specifics about certain cancers in young patients and what would be valuable for a practicing oncologist and obstetrician to know when you are faced with this situation. Dr. Ann Partridge: Yeah, and I think the other critical thing that is great about this guideline is it's a starting place. And I anticipate that we will be building on this guideline for many years to come. And remember that when first, I was not around then, but probably three or four decades ago, when chemotherapy was just coming out and patients were coming in pregnant, there was a feeling I am sure that was, "We cannot give this to this person because it is purposefully going to destroy cells. And when you destroy cells in a growing fetus, you are going to destroy or harm that fetus." And yet, people did not have great choices. It was get treated or die, especially with things like leukemia early on. And bold patients along with their oncologist said, "Bring it on." And that is how some of this literature has been born. And so moving forward, there will be either purposeful exposures or inadvertent exposures of some of our therapies where we will learn ultimately. And this is a place where we can update these guidelines. That is the beautiful thing about the ASCO guidelines is that they are constantly being thought about to be updated. And then when there is enough of a change in practice, they will be updated such that they will continue to inform how we do this in the years to come for patients who come in pregnant. Dr. Allison Loren: Yeah, and I will say I have been doing this long enough now, we were just talking about a different guideline, the fertility guideline earlier today, and over the 20 years that the fertility guidelines have been out, just the amount of research has really skyrocketed. And you can see as you look at each guideline how much we have learned, what we can say, "Yes, this is working," "No, this is not working." Like, it is stuff that we used to say, "Oh, we do not really know," and now we have answers.  I think I speak for both of us when I say that we are hopeful that this will serve as, as Ann said, as a starting off point and really inspire people to ask the questions and do the research so that we can give better guidance moving forward, really trying to think about, you know, mechanisms and leaning on our colleagues in pharma and in the government who sort of think about safety and efficacy, to sort of make sure that they are contemplating not just non-pregnant patients, but also pregnant patients or as they are thinking about marking the package inserts with safety guidelines around this. Brittany Harvey: Yes, this is a critically important first guideline on the management of cancer during pregnancy, and we will look forward to continuing to build on that. I think as you mentioned, this guideline is far-reaching and has a lot of recommendations in it. And so both the full text of the guideline and those at-a-glance algorithms, figures, and tables will be really useful for clinicians in their clinic. Finally, to wrap us up, we have just been discussing this a little bit, but specifically, what are the outstanding questions on the management of pregnant patients with cancer, and where is this further research needed? Dr. Alison Loren: There are lots and lots and lots of unanswered questions. And I think if you look at the table, most of what we say is, "We are pretty sure this is okay, we are not so sure about this." I am paraphrasing, but we really just are operating in a paucity of what we would normally consider gold-standard evidence. It is hard to imagine, of course, there would ever be, as we mentioned in the beginning, randomized trials. But I think that preclinical data, mechanistic data, trying to think about including as we go through animal data, making sure that we are looking at female animals and pregnant animals so that we can sort of fully understand what the impact may be. And then I think thinking about more localized therapies around sort of radiation, you know, we are now moving into really hyper-focused radiation treatments like protons. Is that better because there is less scatter? Like I think those are real considerations that we just do not know the answer to. What do you think? Dr. Ann Partridge: I think so many unanswered questions, and this is a call to action to continue to and increase the documentation of the experiences and outcomes for patients diagnosed during pregnancy. Dr. Alison Loren: Yeah, and I think the long-term outcomes too are really going to be critical. Brittany Harvey: Yes, we will look forward to learning about more evidence across the spectrum of care to inform future updates to this guideline. So I want to thank you both so much for your work to develop this guideline, to review the extensive amounts of literature that you did, and work to create this guideline. And thank you also for your time today, Dr. Loren and Dr. Partridge. Dr. Alison Loren: Thanks. It was fun. Dr. Ann Partridge: Yeah, thank you. Brittany Harvey: And finally, thank you to all of our listeners for tuning into the ASCO Guidelines Podcast. To read the full guideline, go to www.asco.org/survivorship-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app, which is available in the Apple App Store or the Google Play Store. If you have enjoyed what you have 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. 

Is now the time to refinance your mortgage? Only if you meet certain criteria. Clark breaks it down.  Also - Are you with what Clark calls a Giant Monster Mega Bank? If so, you may be paying fees you don't have to! Clark's overview of the banking industry makes it clear, the regional, super regional and giant banks are not your wallet's friend. Hear how people are migrating their money in a way that's comfortable for them - a method called “soft switching”.  Mortgage Refi Guidelines: Segment 1 Ask Clark: Segment 2 Banish Bank Fees: Segment 3 Ask Clark: Segment 4 Mentioned on the show: How and When To Refinance Your Mortgage: A Step-By-Step Guide Mortgage Refinance Calculator - With Cash Out and Points What Can I Safely Use for Peer-to-Peer Payments? How To Freeze and Unfreeze Your Credit With Experian, Equifax and TransUnion How To Switch Banks in 4 Simple Steps Best Online Banks: Free Checking and High-Interest Savings Accounts Best Cash Management Account: Comparing Vanguard, Fidelity, and Schwab Costco Travel: 5 Things To Know Before You Book When Do You Need a Travel Agent? Clark's Christmas Kids Clark.com resources: Episode transcripts Community.Clark.com  /  Ask Clark 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

Join us for our next webinar: Focus on Guidelines. Panelists will discuss their approaches to a range of difficult cases in multiple areas, including rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis and vasculitis, and discuss how they apply the guidelines in everyday practice. You'll hear different perspectives and practical tips you can use in clinic. Panelists: Audrey Gibson, PA-C Benjamin A. Smith, PA-C Jack Cush, MD Following the discussion, join a live Q & A with the panelists. Register now to reserve your spot!  This is our second Tuesday Night Rheumatology this month as part of our Mission: APP Partners in Care campaign

This episode dives into the complexities of postpartum running, emphasizing the importance of understanding recovery, the phased return to running, and the mental health aspects of postpartum life. The hosts discuss the evolution of exercise guidelines during and after pregnancy, the significance of individualized recovery plans, and the physiological advantages that can be leveraged postpartum. They also highlight the importance of mental health and identity shifts that occur during this period, encouraging listeners to be patient and kind to themselves as they navigate their postpartum journey.

AUA Guidelines: Genitourinary Syndrome of Menopause  Host: Mark L. Gonzalgo, MD, PhD, MBA Guests: Tracey S. Wilson, MD & Una J. Lee, MD Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline (2025) Kaufman MR, Ackerman LA, Amin KA, et al. The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause. J Urol. 0(0). doi:10.1097/JU.0000000000004589. https://www.auajournals.org/doi/10.1097/JU.0000000000004589

This week, how the newly established Minnesota Sustainable Foraging Task Force is making decisions about state-wide foraging rules, plus a conversation with Mille Lacs Band of Ojibwe representatives about the newly named Grand Casino Arena in St. Paul.----- Producers: Xan Holston & Travis Zimmerman Editing: Britt AamodtEditorial support: Emily Krumberger Anchor: Marie Rock Mixing & mastering: Chris Harwood----- For the latest episode drops and updates, follow us on social media. instagram.com/ampersradio/instagram.com/mnnativenews/ Never miss a beat. Sign up for our email list to receive news, updates and content releases from AMPERS. ampers.org/about-ampers/staytuned/ This show is made possible by community support. Due to cuts in federal funding, the community radio you love is at risk. Your support is needed now more than ever. Donate now to power the community programs you love: ampers.org/fund

Please visit answersincme.com/RTS860 to participate, download slides and supporting materials, complete the post test, and get a certificate. In this activity, a pediatrician and a pediatric dermatologist discuss strategies for optimizing biologic treatment for moderate to severe atopic dermatitis (AD). Upon completion of this activity, participants should be better able to: Recognize when treatment escalation to systemic therapy is warranted in pediatric patients with atopic dermatitis (AD); Select the optimal biologic for a given pediatric patient with moderate to severe AD; and Outline strategies to optimize biologic treatment in pediatric patients with moderate to severe AD. This activity is intended for US healthcare professionals only.

Today we're kicking off another segment in our Guidelines Series, and doing a deep dive into the 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Over a series of episodes we'll talk about the most recent updates … Continue reading →

Send us a textThe hardest part of digital parenting isn't picking the right app or filter—it's building a home where conversation is constant and boundaries make sense. We walk through the simple guardrails that protected our kids and explain how relationship-first parenting can coexist with firm, clear rules that kids actually respect.Support the showKEEPING KIDS SAFE ONLINEConnect with us...www.nextTalk.orgFacebookInstagramContact Us...admin@nextTalk.orgP.O. BOX 160111 San Antonio, TX 78280

Enid Martinez, MD is a Senior Associate in Critical Care at Boston Children's Hospital, and an Assistant Professor of Anaesthesia at Harvard Medical School. She is the Director of the Pediatric Critical Care Nutrition Program in the Division of Critical Care Medicine and Principal Investigator for a clinical-translational research program on gastrointestinal function and nutrition in pediatric critical illness.Learning Objectives:By the end of this podcast, listeners should be able to:Recognize the impact of nutritional status on outcomes of critically-ill children.Describe the key aspects of the metabolic stress response in critical illness.Discuss a clinical approach to accurately estimating and prescribing nutrition in critically-ill children.Reflect on an expert's approach to managing aspects of nutrition in critically-ill children where there may not be high-quality evidence. Selected references:Mehta et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2017 Jul;41(5):706-742. doi: 10.1177/0148607117711387. Epub 2017 Jun 2. PMID: 28686844. Fivez et al. Early versus Late Parenteral Nutrition in Critically Ill Children. N Engl J Med. 2016 Mar 24;374(12):1111-22. doi: 10.1056/NEJMoa1514762. Epub 2016 Mar 15. PMID: 26975590.Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

In this timely and eye-opening interview, host Mark Alyn sits down with Kevin Busque, Head of Gusto 401(k) powered by Guideline, to break down what California small-business owners urgently need to know about the state's retirement savings mandate—and why waiting could be a costly mistake. With the December 31, 2025 compliance deadline rapidly approaching, California employers with as few as one W-2 employee are legally required to offer a retirement savings option. Business owners must either enroll employees in the state-run CalSavers IRA program or implement a qualified private retirement plan, such as a 401(k). Yet, according to recent research shared in the interview, nearly 75% of small-business owners are unaware of CalSavers, and 65% don't realize they could face fines of up to $750 per employee for missing deadlines. Kevin clearly explains the penalty structure, which begins with $250 per eligible employee after 90 days of noncompliance and escalates to an additional $500 per employee after 180 days. But this conversation goes far beyond warnings—it's about smart, strategic action. Kevin outlines how today's modern 401(k) plans are far more affordable, flexible, and tax-advantaged than many business owners realize. With new federal tax credits and simplified administration, retirement plans are no longer just for big corporations. Mark and Kevin also explore how offering a quality retirement benefit can do more than satisfy a mandate—it can boost recruitment, strengthen employee loyalty, enhance your employer brand, and align with long-term business growth. Kevin's entrepreneurial background and leadership at Guideline and Gusto add practical insight into how small companies can implement powerful benefits without overwhelming cost or complexity. This interview is a must-watch for any California business owner who wants to avoid penalties, stay compliant, and turn a regulatory requirement into a competitive advantage. #CaliforniaBusiness #SmallBusinessOwners #RetirementPlanning #CalSavers #401kPlans #EmployeeBenefits #BusinessCompliance #MarkAlyn #Gusto401k #GuidelineRetirement #Entrepreneurship #HRCompliance #WorkplaceBenefitsBecome a supporter of this podcast: https://www.spreaker.com/podcast/late-night-health-radio--2804369/support.

It's The Ranch It Up Radio Show! Join Jeff Tigger Erhardt, Rebecca Wanner AKA BEC and their crew as they hear how feeding Farmatan to bred cows now can help prevent scours this upcoming calving season.  Plus news, markets, updates, bred cow prices and lots more on this all-new episode of The Ranch It Up Radio Show.  Be sure to subscribe on your favorite podcasting app or on the Ranch It Up Radio Show YouTube Channel. How To Prevent Calf Scours: Feed Farmatan   Feed Farmatan To Prevent Scours This Upcoming Calving Season Calving season is getting ready to start for many producers and for some others it is still a ways away yet.  Regardless, we need to get a jump on scours and make sure each and every calf that hits the ground has the best chance of survival.  A simple solution… FARMATAN from Imogene Ingredients.   WHAT CAUSES SCOURS IN BEEF CATTLE/CALVES Clostridia-Enterotoxemia The most common form of Clostridium in cattle is caused by Clostridia perfringens. The gram-positive bacteria are a challenge due to its ability to form spores and lay dormant for long-periods of time. The bacteria reproduce by releasing spores into its environment (soil, feed, manure). The spores can even lay dormant in the animal's intestine until opportunity presents itself. Infection takes place either through ingestion of spores or through an open wound. The most severe cases happen within the first month of a calf's life, and can result in sudden death. Clinical Signs Diarrhea - Bloody, Mucus Present, Bubbly Dehydrated Bloat Blindness Prevention/Treatment: Prevention can be difficult due to the Clostridia spores being extremely durable and present almost everywhere. Complete cleanout and disinfection between calves is helpful, but not always effective. A good vaccination program will reduce clinical disease. The best method is to develop good gut health and the immune system of the calf. Farmatan has been shown to strengthen the intestinal wall, helping to prevent infection from taking hold. Coccidiosis Cattle are host to numerous species of Coccidia, a single-celled protozoal parasite. Infection and clinical symptoms can happen any time during a calf's life, with the most severe reaction usually occurring between 3-6 weeks of age. The life-cycle of coccidia requires time to infect the intestine causing destruction of the mucosal and epithelial lining. The oocytes mature outside the host in warm, moist environments before being consumed, causing infection of a new host. Clinical Signs Diarrhea - Watery, Bloody Depression Weight Loss Prevention/Treatment: Prevention of Coccidiosis is possible by keeping young calves separate from older animals, providing clean water and feed, and dry conditions. Isolation of infected animals is key to preventing transmission. Keeping the pen dry is the most important step a farmer/rancher can take in preventing Coccidiosis. Treatment can have a good impact on reducing secondary disease, and speeding up recovery time. Farmatan has been shown to disrupt the reproductive cycle of Coccidia; and may help strengthen the intestinal wall to prevent infection, in both the cow and calf. Coronavirus Bovine Coronavirus is a ubiquitous, envelope-viral disease, causing respiratory and enteric infection. There are many serotypes for this virus, making it difficult to test for, and create a vaccine. Coronavirus can present as either diarrhea and/or respiratory illness; transmitted through nasal discharge and/or feces. Animal reservoirs continue to spread the disease, and make eradication almost impossible. Clinical disease will likely occur between days 10-14, and present for up to 4 days. Clinical Signs Diarrhea - Watery Nasal Discharge Coughing Prevention/Treatment: Prevention is difficult due to wild animals transmitting the disease. Keeping wild animals out of animal enclosures is essential. Isolation of infected animals is critical to preventing the spread of Coronavirus. Adequate colostrum intake, along with a good vaccination program will help prevent clinical disease. Learn more about the positive effects of Farmtan's active ingredient on Coronavirus HERE. Cryptosporidium Cryptosporidium Parvum is a single-celled parasite responsible for causing infection in young calves. The infection takes place within the first four weeks of a calves' life, afterwards immunity has developed within the calf. The parasite is either passed from the cow or spread through infected water sources. Clinical Signs Diarrhea - Watery, Bloody, Mucus present Colic Depression Prevention/Treatment: Good sanitary conditions, especially clean water is essential in preventing transmission of cryptosporidium. Isolation of sick calves will help reduce the effect on the overall herd. There is some good effect of calves given adequate colostrum, however this is likely helping by reducing other pathogenic loads rather than a direct effect on Cryptosporidium, itself. Farmatan fed prior to calving has been shown to disrupt the life-cycle and reduce transmission from the cow. The direct action of Farmatan on the parasite makes it an excellent choice for treating calves. Learn more about the positive effect of Farmatan's active ingredient HERE. E-Coli Escherichia Coli is a bacterial infection that affects calves within the first week of their life. The bacteria colonize in the lower intestine and produce a toxin. The toxin causes excessive secretion of fluids. The zoonotic disease has special importance in food safety and human health. Colostrum and natural immunity are often not sufficient in preventing infection in cases of high bacterial concentrations. Clinical Signs Diarrhea - Creamy, Yellow Abdominal Pains Fever Vomiting Prevention/Treatment: The best prevention methods for E. Coli include: clean water, dry bedding/environment, isolation of infected animals, and vaccination. Treatment with antibiotics and oral fluids have great benefits in reducing clinical symptoms of the disease. Farmatan has been shown to reduce bacterial load and help prevent infection. Learn more about the positive effects of Farmatan's active ingredient HERE. Rotavirus Rotavirus in calves is caused by a virus belonging to the Reoviridae family, as a non-envelope RNA virus. Rotavirus is thought to be the most common cause of neonatal diarrhea in calves. The virus tends to affect calves between the age of 1-day-old up to a month, with most cases presenting within the first week of life. Shedding and reinfection can happen in older calves and cows. Clinical symptoms are rarely present after the first month of life; older animals tend to either be carriers or asymptomatic. The majority of herds have some level present, with transmission likely happening during or shortly after birth. Clinical Signs Diarrhea - Pale Yellow, Bloody Dehydrated Dull calves Reluctant to drink Prevention/Treatment: The ideal scenario is to prevent infection through, sanitary facilities (calving barn), outdoor calf housing, and a good vaccination program. Colostrum will provide much needed antibodies, protecting the calf before their immune system is fully developed to combat the disease. Farmatan fed prior to calving can help reduce the pathogen load of the cow, reducing the likelihood of transmission. Farmatan supplemented in the milk has been shown to decrease the virus' ability to cause infection and clinical disease. The best treatment for calves already presenting clinical disease is to administer oral fluids/electrolytes to rehydrate the calf. Learn more about the positive effect of Farmatan's active ingredient HERE. Salmonella Salmonella infection of cattle is caused by a variety of species within the family. While the disease is uncommon in cattle with little effect on calf health, it has massive implications for human health and food safety. The bacteria spreads through direct contact or contaminated feed & water. This disease is highly regulated by the USDA. The most severe cases of salmonella affect calves between the ages of 7-10 days old. Clinical Signs Diarrhea - Bloody (flakes of slough tissue), Watery, Mucus present Lethargic Fever Prevention/Treatment: Prevention is always the best option: provide clean water, feed, and bedding. Isolate infected animals, ensure adequate colostrum intake, and develop a vaccination program with your veterinarian. Treatment with antibiotics and fluids (oral or intravenous) greatly increases the survival rate of calves infected with Salmonella. Farmatan has been shown to help reduce the likelihood of infection by protecting the gut, and reduce recovery time of infected animals.  LEARN MORE ABOUT IMOGENE INGREDIENTS  PRODUCTS Paul Mitchell & Paul Martin on RFD TV Rural America Live!  WATCH: https://vimeo.com/759549430/bd063fcc1f Beef Industry News Possible Slow Beef Trend in 2026 According To Rabobank Beef production by major global producers is expected to remain sluggish next year, according to analysts at the Dutch financial services cooperative Rabobank. The recent contraction in beef production is expected to affect major producers in Brazil, Canada and the United States, with New Zealand being likely to see the sharpest percentage drop in beef production, the Rabobank report predicted. Several issues are contributing to the 2025 decline and the expected drop next year, especially in light of limited cattle herds ready for slaughter in both the United States and Brazil, the report added. The long-term contraction of available cattle is being blamed for significant price hikes for retail beef in the last few years, Rabobank noted. Canada is experiencing a tighter pattern that has resulted in a decline of 41,000 metric tons of beef available for export in 2025 versus levels in 2024, according to the report. Canadian beef output in 2026 is expected to be “more limited” compared with this year for reasons also being experienced south of the Canadian border in terms of the available cattle herd. References: https://meatingplace.com/slower-beef-production-trend-to-continue-in-2026-rabobank/?utm_source=omeda&utm_medium=email&utm_cid=1103020073&utm_campaign=MTGMCD251201004&utm_date=20251201-1300 New World Screwworm Website Tracks Parasite There's a new way for producers and other stakeholders to track the fight against the New World Screwworm — a parasite that threatens live cattle herds. The USDA has launched a dedicated website with up-to-date information on the spread of the screwworm, which so far has been confined to cattle in several Mexican states near the U.S. border. The site includes resources for livestock producers, veterinarians, animal-health officials, wildlife experts, healthcare providers, pet owners, researchers, drug manufacturers, and the general public. Reports of the pest in Mexican cattle prompted the U.S. to halt cattle imports from Mexico back in May. USDA also committed $21 million to boost sterile fly production in Mexico as part of its response. The new website pulls together information from multiple federal partners, including the FDA, the Department of Energy, Homeland Security, the EPA, and the State Department.  Reference: https://www.aphis.usda.gov/livestock-poultry-disease/stop-screwworm Nightshade In Corn Residue Could Be Toxic Have you noticed any black nightshade in your corn stalks that you are grazing or plan to graze? If these fields have too much black nightshade, be careful — it might be toxic. Black nightshade is common in many corn fields in the fall, especially those that had hail damage in the summer or any situation where the corn canopy became thin or open. It usually isn't a problem, but if the density of nightshade is very high, there is the potential that it could poison livestock. Almost all livestock, including cattle, sheep, swine, horses and poultry are susceptible.   Black nightshade plants average about two feet in height and have simple alternating leaves. In the fall, berries are green and become black as the plant matures. All plant parts contain some of the toxin and the concentration increases as plants mature, except in the berries. Freezing temperatures will not reduce the toxicity. It is very difficult to determine exactly how much black nightshade is risky. Guidelines say that a cow would need to consume three to four pounds of fresh black nightshade to be at risk of being poisoned. These guidelines, though, are considered conservative since there is little data on the actual toxicity of nightshade plants. Fortunately, even though nightshade plants remain green fairly late into the fall, cattle usually don't appear to seek out nightshade plants to graze. However, green plants of nightshade might become tempting toward the end of a field's grazing period when there is less grain, husks or leaves to consume.  References: https://www.nationalbeefwire.com/nightshade-in-corn-residue-grazing-could-be-toxic Featured Experts in the Cattle Industry Paul Mitchell – Imogene Ingredients https://www.imogeneingredients.com/ Follow on Facebook: @FarmatanUSA Kirk Donsbach – Financial Analyst at StoneX https://www.stonex.com/ Follow on Facebook: @StoneXGroupInc Shaye Wanner – Host of Casual Cattle Conversation https://www.casualcattleconversations.com/ Follow on Facebook: @cattleconvos Contact Us with Questions or Concerns Have questions or feedback? Feel free to reach out via: Call/Text: 707-RANCH20 or 707-726-2420 Email: RanchItUpShow@gmail.com Follow us: Facebook/Instagram: @RanchItUpShow YouTube: Subscribe to Ranch It Up Channel: https://www.youtube.com/c/RanchItUp Catch all episodes of the Ranch It Up Podcast available on all major podcasting platforms. Discover the Heart of Rural America with Tigger & BEC Ranching, farming, and the Western lifestyle are at the heart of everything we do. Tigger & BEC bring you exclusive insights from the world of working ranches, cattle farming, and sustainable beef production. Learn more about Jeff 'Tigger' Erhardt & Rebecca Wanner (BEC) and their mission to promote the Western way of life at Tigger and BEC. https://tiggerandbec.com/ Industry References, Partners and Resources For additional information on industry trends, products, and services, check out these trusted resources: Allied Genetic Resources: https://alliedgeneticresources.com/ American Gelbvieh Association: https://gelbvieh.org/ Axiota Animal Health: https://axiota.com/multimin-campaign-landing-page/ Imogene Ingredients: https://www.imogeneingredients.com/ Jorgensen Land & Cattle: https://jorgensenfarms.com/#/?ranchchannel=view Medora Boot: https://medoraboot.com/ RFD-TV: https://www.rfdtv.com/ Rural Radio Network: https://www.ruralradio147.com/ Superior Livestock Auctions: https://superiorlivestock.com/ Transova Genetics: https://transova.com/ Westway Feed Products: https://westwayfeed.com/ Wrangler: https://www.wrangler.com/ Wulf Cattle: https://www.wulfcattle.com/

Record cold temperatures are impacting parts of the U.S. and the frigid conditions are expected to persist through the weekend. Tom Hanson has more, and Rob Marciano gives the latest forecast. The American Cancer Society is suggesting a change to cervical cancer screening guidelines so women have the option for self-collection of samples. CBS News medical contributor Dr. Céline Gounder explains. A 19-year-old college student said she was on her way home to Texas to surprise her family for Thanksgiving when ICE detained her at Boston Logan International Airport. She was then deported to Honduras despite a judge's order. Jericka Duncan reports. Cincinnati Bengals cornerback Marco Wilson's passion for painting is making a mark. He became the first active player in the NFL to be featured in its Artist Replay program. Wilson sits down with Natalie Morales to talk about art's impact on his life. Amy Allen, who is up for four Grammys, including songwriter of the year, sits down with Anthony Mason to talk about how she went from a nursing student to writing Grammy-nominated hits for Sabrina Carpenter and other pop stars. To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

The Jeffrey Epstein scandal has exposed in brutal clarity the fact that the elite play by a completely different set of rules than ordinary people. Epstein and the powerful circle surrounding him — billionaires, politicians, executives, royalty, intelligence-connected figures — operated in a world where consequences simply didn't apply. While everyday people's lives are governed by strict accountability, surveillance, and rigid legal systems, Epstein's network existed in a realm of private islands, private jets, sealed court files, and protections purchased through money, influence, and institutional loyalty. Even after Epstein was first arrested in 2006, he received a secret sweetheart plea deal that was deliberately hidden from the victims themselves — something that would never even be imagined for a regular person. It wasn't justice; it was a privilege machine shielding the powerful from the rules everyone else is expected to follow.Even after his death, that dual system has remained plainly visible. Documents are released slowly or heavily redacted, names are shielded, grand juries remain sealed, and institutions scramble to protect reputations rather than tell the full truth. Meanwhile, the public watches as banks escape criminal charges with fines small enough to be considered a business expense, universities refuse to return Epstein-linked donations, and high-profile associates deny everything with straight faces despite overwhelming evidence. For ordinary people, accountability is immediate and merciless. For the elite, accountability is optional — managed by high-priced lawyers and PR teams until the outrage subsides. The Epstein saga is not just a crime story; it is a window into the two-tiered system that defines modern power: one law for the wealthy and connected, and another for everyone else.to contact me:bobbycapucci@protonmail.comBecome a supporter of this podcast: https://www.spreaker.com/podcast/the-epstein-chronicles--5003294/support.