Podcasts about Harborview Medical Center

Join the University of Washington Surgical Palliative Care Team for their final episode of this series — a dual journal review and clinical challenges discussion on assessing medical decision-making capacity. Using Dr. Paul Applebaum's foundational framework, the team outlines the four key criteria for evaluating capacity and brings the topic to life through two contrasting standardized patient scenarios. This episode highlights why capacity assessment is not only relevant but essential for surgeons navigating complex, high-stakes decisions.  Hosts:  Dr. Katie O'Connell (@katmo15) is an associate professor of surgery at the University of Washington. She is a trauma surgeon, palliative care physician, director of surgical palliative care, and founder of the Advance Care Planning for Surgery clinic at Harborview Medical Center, Seattle, WA. Dr. Ali Haruta is an assistant professor of surgery at the University of Washington. She is a trauma and emergency general surgeon and palliative care physician. Ali recently completed fellowships in palliative care at the University of Washington and Trauma and Critical Care at Parkland.  Dr. Lindsay Dickerson (@lindsdickerson1) is a PGY6 general surgery resident at the University of Washington with an interest in surgical oncology.   Dr. Virginia Wang is a PGY3 general surgery resident at the University of Washington. Learning Objectives: 1.        Decipher the distinction between the terms “capacity” and “competence”.   2.        Describe the four criteria for assessing medical decision-making capacity presented in Dr. Paul Applebaum's article “Assessment of Patients' Competence to Consent to Treatment.” 3.        Apply the capacity assessment framework to real-world clinical scenarios in surgical practice.  References: 1.        Applebaum, PS. Assessment of Patients' Competence to Consent to Treatment. New England Journal of Medicine 2007; 357(18):1834-1840. https://pubmed.ncbi.nlm.nih.gov/17978292/ 2.        Special thank you to Mr. Mark Fox for his acting contribution to this episode. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

In our recent episode on global burn surgery with Dr. Barclay Stewart and Dr. Manish Yadav, we discussed several cases at Kirtipur Hospital in Nepal to illustrate the global burden of burns and similarities and differences in treating burns at Harborview Medical Center, a level 1 trauma and ABA verified burn center in Seattle, WA and Kirtipur Hospital (Nepal Cleft and Burn Center) in Kathmandu, Nepal. In this episode Dr. Stewart and Dr. Yadav return for an interview by UW Surgery Resident, Paul Herman, sharing insights on how to get involved in global surgery with an emphasis on sustainable participation. Hosts:  Manish Yadav, Kirtipur Hospital, Nepal Barclay Stewart, UW/Harborview Medical Center Paul Herman, UW/Harborview General Surgery Resident, @paul_herm  Tam Pham, UW/Harborview Medical Center (Editor) Learning Objectives 1.     Approaches to global surgery  a.     Describe historical perspectives on global health and global surgery reviewing biases global surgery inherits from global health due to the history of colonialism, neo-colonialism and systemic inequalities b.     Review a recently published framework and evaluation metrics for sustainable global surgery partnerships (GSPs) as described by Binda et al., in Annals of Surgery in March 2024. c.      Provide examples of this framework from a successful global surgery partnership d.     Define vertical, horizontal and diagonal global surgery approaches e.     Share tips for initial engagement for individuals interested in getting involved in global surgery References 1.     Gosselin, R., Charles, A., Joshipura, M., Mkandawire, N., Mock, C. N. , et. al. 2015. “Surgery and Trauma Care”. In: Disease Control Priorities (third edition): Volume 1, Essential Surgery, edited by H. Debas, P. Donkor, A. Gawande, D. T. Jamison, M. Kruk, C. N. Mock. Washington, DC: World Bank. 2.     Qin R, Alayande B, Okolo I, Khanyola J, Jumbam DT, Koea J, Boatin AA, Lugobe HM, Bump J. Colonisation and its aftermath: reimagining global surgery. BMJ Glob Health. 2024 Jan 4;9(1):e014173. doi: 10.1136/bmjgh-2023-014173. PMID: 38176746; PMCID: PMC10773343. https://pubmed.ncbi.nlm.nih.gov/38176746/ 3.     Binda CJ, Adams J, Livergant R, Lam S, Panchendrabose K, Joharifard S, Haji F, Joos E. Defining a Framework and Evaluation Metrics for Sustainable Global Surgical Partnerships: A Modified Delphi Study. Ann Surg. 2024 Mar 1;279(3):549-553. doi: 10.1097/SLA.0000000000006058. Epub 2023 Aug 4. PMID: 37539584; PMCID: PMC10829902.  https://pubmed.ncbi.nlm.nih.gov/37539584/ 4.     Jedrzejko N, Margolick J, Nguyen JH, Ding M, Kisa P, Ball-Banting E, Hameed M, Joos E. A systematic review of global surgery partnerships and a proposed framework for sustainability. Can J Surg. 2021 Apr 28;64(3):E280-E288. doi: 10.1503/cjs.010719. PMID: 33908733; PMCID: PMC8327986. https://pubmed.ncbi.nlm.nih.gov/33908733/ 5.     Frenk J, Gómez-Dantés O, Knaul FM: The health systems agenda: prospects for the diagonal approach. The handbook of global health policy. 2014 Apr 24; pp. 425–439 6.     Davé DR, Nagarjan N, Canner JK, Kushner AL, Stewart BT; SOSAS4 Research Group. Rethinking burns for low & middle-income countries: Differing patterns of burn epidemiology, care seeking behavior, and outcomes across four countries. Burns. 2018 Aug;44(5):1228-1234. doi: 10.1016/j.burns.2018.01.015. Epub 2018 Feb 21. PMID: 29475744. https://pubmed.ncbi.nlm.nih.gov/29475744/ 7.     Strain, S., Adjei, E., Edelman, D. et al. The current landscape of global international surgical rotations for general surgery residents in the United States: a survey by the Association for Program Directors in Surgery's (APDS) global surgery taskforce. Global Surg Educ 3, 77 (2024). https://doi.org/10.1007/s44186-024-00273-2 8.     Francalancia S, Mehta K, Shrestha R, Phuyal D, Bikash D, Yadav M, Nakarmi K, Rai S, Sharar S, Stewart BT, Fudem G. Consumer focus group testing with stakeholders to generate an enteral resuscitation training flipbook for primary health center and first-level hospital providers in Nepal. Burns. 2024 Jun;50(5):1160-1173. doi: 10.1016/j.burns.2024.02.008. Epub 2024 Feb 15. PMID: 38472005; PMCID: PMC11116054. https://pubmed.ncbi.nlm.nih.gov/38472005/ 9.     Shrestha R, Mehta K, Mesic A, Dahanayake D, Yadav M, Rai S, Nakarmi K, Bista P, Pham T, Stewart BT. Barriers and facilitators to implementing enteral resuscitation for major burn injuries: Reflections from Nepalese care providers. Burns. 2024 Oct 28;51(1):107302. doi: 10.1016/j.burns.2024.107302. Epub ahead of print. PMID: 39577105. https://pubmed.ncbi.nlm.nih.gov/39577105/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Stefan Wheat, MD is an emergency physician and faculty in the Department of Emergency Medicine at the University of Washington, practicing at both Harborview Medical Center and UWMC—Northwest Hospital emergency departments. With the Center for Health and the Global Environment (CHanGE) at the University of Washington, Dr. Wheat works to understand the scope of the health threats posed by climate change, promote healthcare system adaptation and emergency preparedness, and inform policies to keep people safe in a rapidly changing world. He completed a fellowship in Climate & Health Science Policy at the University of Colorado where he worked as a Physician-Fellow at the Department of Health and Human Services in their Office of Climate Change and Health Equity (OCCHE) and as an Associate Research Scientist at Columbia University's Global Consortium on Climate and Health Education.His work has included founding ClimateRx, a seamless tool designed to help health professionals to connect with patients and colleagues on how we can respond to the health risks of climate change, and the development of Climate Resources for Health Education (CRHE), a global health professional-led initiative that aims to provide free, publicly accessible, evidence-based resources to accelerate the incorporation of climate change and planetary health information into educational curricula.Link to ClimateRx:https://www.climaterx.org/Funded Climate and Health Research opportunity for WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) region researchers and community partners:https://deohs.washington.edu/change/implementation-and-evaluation-fellowship-climate-change-and-healthClimate Change and Health Bootcamp (intensive 3-day certificate based course hosted by Columbia University (open to all health professionals):https://www.publichealth.columbia.edu/academics/non-degree-special-programs/professional-non-degree-programs/skills-health-research-professionals-sharp-training/trainings/climate-change-health

Dr. Nathan White (Emergency Medicine; Associate Dean for RGE at Harborview Medical Center; Director, Resuscitation Engineering Science Unit) explains how he brought an idea from his clinical practice to market. Dr. White developed Stasys, a medical device that diagnoses platelet health for trauma care. Start with identifying a need or gap in your clinical work. Then seek out experts across the University to find someone doing related work and collaboratively explore solutions. Finally, partner with UW's CoMotion to complete the steps from prototypes to licensing and commercialization. Throughout the process as additional parties become involved, stay committed to the end application you have envisioned for the product. Learn about Stasys Medical Corp here.Read the episode transcript here.Music by Kevin MacLeod (https://incompetech.com/)

In this episode, Sommer Kleweno Walley, Chief Executive Officer at Harborview Medical Center, shares insights into the unique role of the hospital in Seattle's healthcare system, its financial turnaround, and upcoming plans for growth. She discusses the challenges and opportunities ahead, including a new tower expansion and evolving leadership strategies, while emphasizing the importance of patient-centered care and community partnerships.

Join University of Washington's surgical palliative care team for another engaging role play episode, where we tackle the challenging goals-of-care conversation. Using the VitalTalk REMAP framework, we explore effective communication strategies, highlight common pitfalls, and simulate two real-world scenarios: an on-call surgeon discussing goals of care with a complex patient facing an emergent surgical issue, and a team member facilitating a family meeting about goals of care in the surgical ICU. Hosts:  Dr. Katie O'Connell (@katmo15) is an associate professor of surgery at the University of Washington. She is a trauma surgeon, palliative care physician, director of surgical palliative care, and founder of the Advance Care Planning for Surgery clinic at Harborview Medical Center, Seattle, WA. Dr. Ali Haruta is an assistant professor of surgery at the University of Washington. She is a trauma and emergency general surgeon and palliative care physician. Ali recently completed fellowships in palliative care at the University of Washington and Trauma and Critical Care fellowship at Parkland.  Dr. Lindsay Dickerson (@lindsdickerson1) is a PGY6 general surgery resident at the University of Washington, with an interest in surgical oncology.  Dr. Virginia Wang is a PGY3 general surgery resident at the University of Washington. Learning Objectives: • Identify questions that elicit patients' goals and values, particularly during emotionally charged conversations.   • Name the three categories of patient values in the values triad. • Describe the importance of aligning with patients' and families' values and demonstrate techniques to achieve alignment.   • Develop a treatment plan that reflects patients' stated values.   References: “REMAP.” VitalTalk. Accessed December 2nd. https://www.vitaltalk.org/guides/transitionsgoals-of-care/ ***SPECIALTY TEAM APPLICATION LINK: https://docs.google.com/forms/d/e/1FAIpQLSdX2a_zsiyaz-NwxKuUUa5cUFolWhOw3945ZRFoRcJR1wjZ4w/viewform?usp=sharing

In this episode of Girls with Grafts, we're honored to sit down with Dr. Tam Pham, the Program Director at the University of Washington Medicine Regional Burn Center. Dr. Pham opens up about his personal journey when he sustained a burn as a young child. Rachel and Dr. Pham discuss the topic of imposter syndrome among some burn survivors and caregivers, highlighting that while we may not all have physical scars, we do all carry emotional ones.Dr. Pham also shares the critical role of aftercare and support services in helping survivors reclaim their lives and thrive beyond their injuries. He also reflects on his connection with Grace Athena Flott, a local artist, fellow survivor, and former patient, whose powerful artwork he proudly displays in their burn clinic. This episode is a moving tribute to the resilience of the burn community, the power of support, and the art of turning pain into purpose. Don't miss this inspiring and heartfelt conversation!  ⭐️ Enjoyed the show? Tell us by leaving a 5-star review and sharing on social media using hashtag #GirlswithGrafts and tagging Phoenix Society for Burn Survivors!   Meet Our Guest Dr. Tam Pham is a highly accomplished surgeon specializing in burn and trauma care, with extensive academic and clinical experience. Currently, he is a professor and director of the University of Washington Medicine Regional Burn Center at Harborview Medical Center. A graduate of the University of California, Dr. Pham pursued rigorous postgraduate training, including a General Surgery residency, and fellowships in burn care and surgical critical care at the University of Washington. His academic contributions are significant, with numerous published research papers, including studies on critical care and telemedicine applications in burn care.Dr. Pham has also been honored with numerous awards and is dedicated to advancing burn care. He has volunteered internationally as well as holds board certifications and is a member of many professional organizations, including the American Burn Association. Links Watch Dr. Rob Cartotto's Girls with Grafts podcast episode on YouTube. Watch Grace Athena Flott's Girls with Grafts podcast episode on YouTube.Learn more about Grace's recent selection to create Governor Jay Inslee's official portrait.Learn more about Phoenix SOAR (Survivors Offering Assistance in Recovery).Podcast Sponsor Today's podcast is powered by the National Fire Sprinkler Association! NFSA aims to protect lives and property through the advancement of fire sprinklers. Learn more about fire sprinklers, fire advocacy, and how to get involved by visiting nfsa.org.  Sponsor Girls with Grafts  Interested in becoming a sponsor of the show? Email us at info@phoenix-society.org.  

Dean's Chat hosts, Drs. Jensen and Richey, welcome Dr. Lawrence Ford, currently practicing in Kaiser Permanente Oakland Hospital. Dr. Ford has had an exceptional career in podiatric surgery. He obtained his undergraduate degree in Biology at the University of California, Irvine. He went on to complete his Podiatric Medical School degree with California College of Podiatric Medicine in San Francisco, California. He then went on to do a three-year surgical residency program with Northwest Podiatric Foundation -Swedish Medical Center in Seattle, WA. Join us as we hear about his experience working with Dr. Sigvard T. Hansen at Harborview Medical Center. Listen, as we discuss the history of how relationship building fostered a collaboration between orthopedics and podiatry to progress the field of podiatric surgery for resident education. He discussed how transparency and excellence helped to foster new opportunities and practice with his full scope and capacity. Dr. Ford has served in multiple leadership roles, his most recent contributions as part of the education committee for the AO Basic and Advanced course development, past Residency director for the Kaiser Permanente SF Bay Area foot and Ankle residency program, previous department chair for podiatric surgery, ABFAS oral exam committee and communications committee. He has lectured at multiple ACFAS events and other national meetings in the topics of podiatric surgery, Trauma and reconstruction. Listen as he discusses the importance of research and how it helped impact his career to work with the residents and the residency program and scratch the itch of asking curiosity questions. Dr. Ford focuses his treatment philosophy around, evaluating the root cause from a biomechanical and functional etiology, and then focusing treatment on that cause as he says treating the symptoms without regard for the etiology, leads to frustration. He has a particular interest in mechanical engineering, especially how faulty mechanics can impact muscle imbalance and have progressive development of foot ankle pain. As Dr. Richey's former residency director he had an direct impact on her own career and now as her friend and mentor, she gives some touching remarks about her gratitude to him for both large transformational lessons as well as small but highly impactful moments.  In his time away from the podiatric profession Dr. Ford enjoys seeking time outdoors, including a variety of hiking camping, backpacking, kayaking, and backcountry skiing as well as being an avid Tottenham soccer fan! Enjoy! https://residency-ncal.kaiserpermanente.org/residency/podiatry/bayarea/ https://www.acfas.org/ https://www.abfas.org/residents https://www.aofoundation.org/aona  

On this episode of MedAxiom HeartTalk, host Melanie Lawson, MS, explores the transformative potential of artificial intelligence (AI) for cardiovascular care with guests Effie Andrikopoulou, MD, MBA, FACC, FASE, associate professor at the University of Washington and medical director at Harborview Medical Center, and Denise Busman, MSN, RN, CPHQ, FACC, vice president of Care Transformation Services at MedAxiom. They explore how care teams can integrate AI into everyday practice and consider the current challenges and opportunities to improve patient outcomes. Guest Bios:Effie Andrikopoulou, MD, MBA, FACC, FASE Dr. Andrikopoulou is an associate professor of Medicine at the University of Washington and the medical director of the Echocardiography Lab at Harborview Medical Center. She completed her internal medicine training at Thomas Jefferson University in Philadelphia, cardiology fellowship at the University of Alabama at Birmingham (UAB), and advanced multimodality cardiovascular imaging training at Brigham and Women's Hospital in Boston. Dr. Andrikopoulou also holds an MBA from UAB. She is an expert in cardiovascular imaging, and her clinical niche is cardio-oncology. Dr. Andrikopoulou is a rising leader in the space of artificial intelligence (AI). She is passionate about developing and implementing AI ("collaborative intelligence") algorithms to optimize clinical workflows and ensure delivery of high-quality, equitable care to all patients and communities irrespective their socioeconomic and cultural backgrounds. Her expertise has been recognized with several awards, including the 2016 Rising Stars in Healthcare in Alabama and the 2016 American Heart Association Women in Cardiology Trainee Award for Excellence.Denise Busman, MSN, RN, CPHQ, FACC As Vice President of Care Transformation Services at MedAxiom, Denise brings more than 30 years of experience as a cardiovascular clinician and leader to her role. Her clinical expertise is complemented by a passion for engaging multidisciplinary teams to transform care delivery and enhance clinical quality. Known for her work in program development and change management, Denise is skilled in the implementation of new programs and clinical initiatives. Denise joined MedAxiom from Corewell Health, formerly known as Spectrum Health – a multi-hospital system in Michigan, where she held a variety of positions including critical care educator and cardiology clinical nurse specialist. Most recently, her focus was directed toward clinical improvement and quality for the cardiovascular service line, where she implemented innovative approaches to care and served as a trusted advisor to cardiovascular physicians and team members. Denise holds a bachelor's degree in nursing from Michigan State University and master's degree in nursing from Grand Valley State University. She has been active with the American College of Cardiology (ACC) for many years as a Michigan Chapter board member, cardiovascular team liaison, ACC Scientific Program Committee member and reviewer of scientific abstracts.

Dean's Chat hosts Drs. Jeffrey Jensen and Johanna Richey,  welcome Dr. Ronald Ray DPM, who currently practices in Great Falls Montana. Dr. Ray completed his undergraduate degree at California State University at Long Beach with a Bachelors of Science in Physical Therapy. He worked as a Physical Therapist for several years and ultimately became interested in podiatry from his interest in the mechanics of the lower extremity.   Through his work, he explored podiatric medicine and decided to return for his Doctor of Podiatric Medicine degree obtained from the California College of Podiatric Medicine.  He went on to complete his surgical residency training at one of the top programs in the country at Waldo Podiatric Surgical Residency Program in Seattle Washington (now known as the Swedish residency program). Here he was introduced to many of his mentors. It was through his training he met Dr. Sig Hansen MD with Harborview Medical Center and had the privilege of doing an AO Fellowship with him.   Listen, as we hear his experience of working with Dr. Hanson and the beautiful lessons that he learned watching a master of surgery. Join us as we discuss all things podiatric medicine and surgery as we discuss Dr. Ray's many service opportunities.   Dr. Ray discusses what it means to be involved with professional organizations. As a past president of the American Board of Foot and Ankle Surgery as well as leader in the American College of Foot and Ankle Surgeons (serving on many different committee including: Annual Scientific meeting, Leadership Development Committee and Surgical Skills Committee).  Dr. Ray is no stranger to advancing our profession in the education world. His continued dedication and service are predicated on his passion, which is clear as you hear him speak.  Dr. Ray discusses tricks to elevate speaking in public which our students will surely benefit. Tune in, as he discusses his mentors, Dr. Jeffrey Christensen DPM and Richard Bouche DPM, who helped encourage him to take on lecture opportunities and get engaged in the profession. He provides great wisdom and tips into stretching your comfort zone and being willing to jump in and take the leap into the unknown. His physical therapist framework of learning and developing a skill set-verbalizing, and saying lectures out loud to develop proprioception and muscle memory to improve public speaking are fascinating!  Dr. Ray has been integral in the development of the American College of Foot and Ankle Surgeons collaboration with the AO Foundation to build the curriculum for the Advanced Principles Course for Foot and Ankle Trauma and Surgery. He talks about how this collaborative effort has been a harmonious, but delicate balance of earning trust and maintaining the highest standards to propel our profession forward.   If you are interested in more information about how to join the American College of Foot and Ankle Surgeons or the AO North America https://www.aofoundation.org/aona/engage-with-us/Become-a-member https://www.acfas.org/membership/joinrenew  To find upcoming AO-ACFAS courses:  https://www.aofoundation.org/aona/our-community/DPM/DPM-courses-and-events#sortCriteria=%40startdate%20ascending&f-speciality=DPM https://www.acfas.org/education-professional-development/educationcalendar  

  I wanted to take a moment to express my condolences to the Rice family as I found out just a little bit earlier today that doctor Stephen Rice, who we had on the podcast back in April of 2023, so a little over a year ago, had passed away this past Saturday on September 14th. We have definitely lost a leader in the world of pediatric sports medicine and someone who really was able to help put sports medicine on the map. I'm trying to remember and go back and thinking when I first met Steve. I think it was at our research fellowship meeting that we had during our fellowship year and he was one of the leaders and educators for that and I met Steve I think at that point. May have been earlier at an AAP meeting when I was a resident but I'm pretty sure that was my first interaction with him. If you knew Steve, Steve was someone. If you got near him and he had something on his mind, you would definitely be stuck there for a little bit. He would be someone who would definitely talk with you and certainly express his opinion about things. And love it or not like it, that's that's entirely up to you. I always enjoyed having conversations with Steve. I certainly like to push him a little bit on certain things as well and I think he liked the challenge and pushback as well. I really, really appreciated having the time and opportunity to feature him on the podcast last year. He had had an interesting story. I knew a lot about Steve as a sports medicine physician, but I definitely did not know much about Steve as far as his life before that and really learned a lot about him and his passion for broadcasting and being able to broadcast baseball games And just certainly all the stuff that he had done and people he had an influence on that are are certainly now considered also very pivotal and important people in the world of sports medicine. So I just wanted to put the episode back out there again just so it's fresh in people's minds. In certainly a way, I attribute to him. I'm really just, again, I'm honored and touched that I had the opportunity to speak with him last year before he passed and just to give him an opportunity to to tell a story. I think those stories are important and I was privileged to know him and to consider him a friend and a good colleague and someone who is ever passionate about the world of sports medicine and supporting kids and kids' sports and the health of kids. So we lost a giant in the world of pediatric sports. I don't know any other way to express that, but we will miss you, Steve. And I hope you get to broadcast a Brooklyn Dodgers game up in the sky there. And, I hope you enjoy the episode and enjoy listening to Steve.    Connect with The Host! Subscribe to This Podcast Now!        The ultimate success for every podcaster – is FEEDBACK! Be sure to take just a few minutes to tell the hosts of this podcast what YOU think over at Apple Podcasts! It takes only a few minutes but helps the hosts of this program pave the way to future greatness! Not an Apple Podcasts user? No problem! Be sure to check out any of the other many growing podcast directories online to find this and many other podcasts via The Podcaster Matrix!     Housekeeping -- Get the whole story about Dr. Mark and his launch into this program, by listing to his "101" episode that'll get you educated, caught up and in tune with the Doctor that's in the podcast house! Listen Now! -- Interested in being a Guest on The Pediatric Sports Medicine Podcast? Connect with Mark today!   Links from this Episode: -- Dr. Mark Halstead: On the Web -- On Twitter -- Stephen Rice Receives Honor https://www.app.com/story/getpublished/2017/08/22/stephen-rice-m-d-receives-prestigious-sports-medicine-award/591976001/ -- Harborview Medical Center https://www.uwmedicine.org/locations/harborview-medical-center

What’s Trending: We have a verdict in the case of activist Summer Taylor that was killed on I-5. The Boeing machinists are expected to reject their latest contract offer and go on strike. Neighbors of Seattle’s Belltown community are urging the city to tear down a vacant building that has been taken over by homeless squatters. A shooting in Seattle’s Yesler Terrace neighborhood injured 3 last night. The victims were sent to Harborview Medical Center. // Marjorie Taylor Greene of all people denounced Laura Loomer’s rhetoric about Kamala Harris on social media. Donald Trump declined another debate with Kamala Harris. // Microsoft is making another round of massive layoffs in its XBOX division. Jon Bon Jovi helped a woman off the ledge of a bridge.

Have you ever been confused about the concept of brain death, or struggled to explain brain death to a patient's family or your fellow clinicians? Join the Behind the Knife Surgical Palliative Care team and our special guest, neurologist & neurointensivist Dr. Sarah Wahlster, as we explore the 2023 Pediatric & Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline and what this updated guideline means for our practice in surgical palliative care! Hosts: Dr. Katie O'Connell (@katmo15) is an Associate Professor of Surgery at the University of Washington in the division of Trauma, Burn, and Critical Care Surgery. She is a trauma surgeon, palliative care physician, Director of Surgical Palliative Care, and founder of the Advance Care Planning for Surgery Clinic at Harborview Medical Center in Seattle, WA. Dr. Virginia Wang is a PGY-3 General Surgery resident at the University of Washington. Guest: Dr. Sarah Wahlster (@SWahlster) is an Associate Professor of Neurology at the University of Washington. She is a neurologist, neurointensivist, and Program Director of the Neurocritical Care Fellowship at Harborview Medical Center in Seattle, WA. Learning Objectives: ·      Understand the concept of assent and how it can be helpful in communicating with families of patients who have sustained brain death ·      Explain the main steps required for diagnosis of brain death (prerequisites, clinical exam, apnea testing, ancillary testing) ·      Understand key differences between the 2023 guideline and previous (2010 & 2011) guidelines ·      Be able to name the 3 accepted modalities of ancillary testing for brain death ·      Know basic communication best practices with families of patients who have sustained brain death from the surgical palliative care perspective (consistency of language & messaging; avoidance of phrases such as “life-sustaining treatment”, “comfort-focused measures”) References: 1.     Greer, D. M., Kirschen, M. P., Lewis, A., Gronseth, G. S., Rae-Grant, A., Ashwal, S., Babu, M. A., Bauer, D. F., Billinghurst, L., Corey, A., Partap, S., Rubin, M. A., Shutter, L., Takahashi, C., Tasker, R. C., Varelas, P. N., Wijdicks, E., Bennett, A., Wessels, S. R., & Halperin, J. J. (2023). Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline. Neurology, 101(24), 1112–1132. https://doi.org/10.1212/WNL.0000000000207740 2.     Lewis, A., Kirschen, M. P., & Greer, D. (2023). The 2023 AAN/AAP/CNS/SCCM Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline: A Comparison With the 2010 and 2011 Guidelines. Neurology. Clinical practice, 13(6), e200189. https://doi.org/10.1212/CPJ.0000000000200189 3.     AAN Interactive Brain Death/Death by Neurologic Criteria Evaluation Tool – https://www.aan.com/Guidelines/BDDNC 4.     AAN Brain Death/Death by Neurologic Criteria Checklist – https://www.aan.com/Guidelines/Home/GetGuidelineContent/1101 5.     Kirschen, M. P., Lewis, A., & Greer, D. M. (2024). The 2023 American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society, and Society of Critical Care Medicine Pediatric and Adult Brain Death/Death by Neurologic Criteria Determination Consensus Guidelines: What the Critical Care Team Needs to Know. Critical care medicine, 52(3), 376–386. https://doi.org/10.1097/CCM.0000000000006099 6.     Greer, D. M., Shemie, S. D., Lewis, A., Torrance, S., Varelas, P., Goldenberg, F. D., Bernat, J. L., Souter, M., Topcuoglu, M. A., Alexandrov, A. W., Baldisseri, M., Bleck, T., Citerio, G., Dawson, R., Hoppe, A., Jacobe, S., Manara, A., Nakagawa, T. A., Pope, T. M., Silvester, W., … Sung, G. (2020). Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project. JAMA, 324(11), 1078–1097. https://doi.org/10.1001/jama.2020.11586 7.     Lele, A. V., Brooks, A., Miyagawa, L. A., Tesfalem, A., Lundgren, K., Cano, R. E., Ferro-Gonzalez, N., Wongelemegist, Y., Abdullahi, A., Christianson, J. T., Huong, J. S., Nash, P. L., Wang, W. Y., Fong, C. T., Theard, M. A., Wahlster, S., Jannotta, G. E., & Vavilala, M. S. (2023). Caseworker Cultural Mediator Involvement in Neurocritical Care for Patients and Families With Non-English Language Preference: A Quality Improvement Project. Cureus, 15(4), e37687. https://doi.org/10.7759/cureus.37687 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Date: July 29, 2024 Reference: Connolly SJ et al (ANNEXA-I investigators) Andexanet for Factor Xa Inhibitor–Associated Acute Intracerebral Hemorrhage. NEJM May 2024 Guest Skeptic: Dr. Vasisht Srinivasan is an Emergency Medicine physician and neurointensivist at the University of Washington and Harborview Medical Center in Seattle, WA. He is an assistant professor in Emergency Medicine, Neurology, […] The post SGEM#450: Try Again – Andexanet for Factor Xa Inhibitor–Associated Acute Intracerebral Hemorrhage first appeared on The Skeptics Guide to Emergency Medicine.

Keri Nasenbeny (CNO, Harborview Medical Center), joins us in this episode to provide advice on how to create high performing teams, especially in interdisciplinary spaces. Start by establishing trust and cohesion with your team, and learn strategies to set those foundations. Learn about how to create a team quickly when needed, and also what to do when a team isn't functioning as well as you hoped. For any team, celebrate the diversity of perspectives, skills, and connections each team member brings, and celebrate wins both big and small. You may read the episode transcript here.Music by Kevin MacLeod (https://incompetech.com/)

When Paige Johnson '15 first started exploring job opportunities for hospital dietitians, she was amazed by the demand for different dietetic specialties and services. Johnson started her career at Seattle Children's Hospital's milk lab, mixing formulas or fortifying a mother's breastmilk, then moved to pediatric oncology. After four and a half years working at Seattle Children's, Johnson recently accepted a new clinical dietitian position at Harborview Medical Center.

In neurocritical care, the initial evaluation is often fast paced, and assessment and management go hand in hand. History, clinical examination, and workup should be obtained while considering therapeutic implications and the need for lifesaving interventions. In this episode, Aaron Berkowitz, MD, PhD FAAN, speaks with Sarah Wahlster, MD, an author of the article “The Neurocritical Care Examination and Workup,” in the Continuum June 2024 Neurocritical Care issue. Dr. Berkowitz is a Continuum® Audio interviewer and professor of neurology at the University of California San Francisco, Department of Neurology and a neurohospitalist, general neurologist, and a clinician educator at the San Francisco VA Medical Center and San Francisco General Hospital in San Francisco, California. Dr. Wahlster is an associate professor of neurology in the departments of neurology, neurological surgery, and anesthesiology and pain medicine at Harborview Medical Center, University of Washington in Seattle, Washington. Additional Resources Read the article: The Neurocritical Care Examination and Workup Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @AaronLBerkowitz Guest: @SWahlster Full Episode Transcript Sarah Wahlster, MD   Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, a companion podcast to the journal. Continuum Audio features conversations with the guest editors and authors of Continuum, who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article by clicking on the link in the Show Notes. Subscribers also have access to exclusive audio content not featured on the podcast. As an ad-free journal entirely supported by subscriptions, if you're not already a subscriber, we encourage you to become one. For more information on subscribing, please visit the link in the Show Notes. AAN members: stay tuned after the episode to hear how you can get CME for listening.  Dr Berkowitz: This is Dr Aaron Berkowitz, and today I'm interviewing Dr Sarah Wahlster about her article on examination and workup of the neurocritical care patient, which is part of the June 2024 Continuum issue on neurocritical care. Welcome to the podcast, Dr Wahlster. Can you please introduce yourself to the audience? Dr Wahlster: Thank you very much, Aaron. I'm Sarah Wahlster. I'm a neurologist and neurontensivist at Harborview Medical Center at the University of Washington. Dr Berkowitz: Well, Sarah and I know each other for many, many years. Sarah was my senior resident at Mass General and Brigham and Women's Hospital. Actually, Sarah was at my interview dinner for that program, and I remember meeting her and thinking, “If such brilliant, kind, talented people are in this program, I should try to see if I can find my way here so I can learn from them.” So, I learned a lot from Sarah as a resident, I learned a lot from this article, and excited for all of us to learn from Sarah, today, talking about this important topic. So, to start off, let's take a common scenario that we see often. We're called to the emergency room because a patient is found down, unresponsive, and neurology is called to see the patient. So, what's running through your mind? And then, walk us through your approach as you're getting to the bedside and as you're at the bedside. Dr Wahlster: Yeah, absolutely. This was a fun topic to write about because I think this initial kind of mystery of a patient and the initial approach is something that is one of the puzzles in neurology. And I think, especially if you're thinking about an emergency, the tricky part is that the evaluation and management go hand in hand. The thinking I've adapted as a neurointensivist is really thinking about “column A” (what is likely?) and “column B” (what are must-not-miss things?). It's actually something I learned from Steve Greenberg, who was a mutual mentor of us - but he always talked me through that. There's always things at the back of your head that you just want to rule out. I do think you evaluate the patient having in mind, “What are time-sensitive, critical interventions that this patient might need?” And so, I think that is usually my approach. Those things are usually anything with elevated intracranial pressure: Is the patient at risk of herniating imminently and would need a neurosurgical intervention, such as an EVD or decompression? Is there a neurovascular emergency, such as an acute ischemic stroke, a large-vessel occlusion, a subarachnoid hemorrhage that needs emergent intervention? And then other things you think about are seizures, convulsive/nonconvulsive status, CNS infection, spinal cord compression. But I think, just thinking about these pathologies somewhere and then really approaching the patient by just, very quickly, trying to gather as much possible information through a combination of exam and history. Dr Berkowitz: Great. So, you're thinking about all these not-to-miss diagnoses that would be life-threatening for the patient and you're getting to the bedside. So, how do you approach the exam? Often, this is a different scenario than usual, where the patient's not going to be able to give us a history or maybe necessarily even participate in the exam, and yet, as you said, the stakes are high to determine if there are neurologic conditions playing into this patient's status. So, how do you approach a patient at the bedside? Dr Wahlster: So, I think first step in an ICU setting (especially if the patient has a breathing tube) is you think about any confounders (especially sedation or metabolic confounders) - you want to remove as soon as possible, if able. I think as you do the exam, you try to kind of incorporate snippets of the history and really try to see - you know, localize the problem. And also kind of see, you know, what is the time course of the deterioration, what is the time course of the presentation. And that is something I actually learned from you. I know you've always had this framework of “what is it, where is it?” But I think in terms of just a clinical exam, I would look at localizing signs. I think, in the absence of being able to do the full head-to-toe neuro exam and interact with the patient, you really try to look at the brainstem findings. I always look at the eyes right away and look at, I think, just things like, you know, the gaze (how is it aligned? is there deviation? is there a skew? what do the pupils look like? [pupillary reactivity]). I think that's usually often a first step - that I just look at the patient's eyes. I think other objective findings, such as brainstem reflexes and motor responses, are also helpful. And then you just look whether there's any kind of focality in terms of - you know, is there any difference in size? But I think those are kind of the imminent things I look at quickly. Dr Berkowitz: Fantastic. Most of the time, this evaluation is happening kind of en route to the CT scanner or maybe a CT has already happened. So, let's say you're seeing a patient who's found down, the CT has either happened or you asked for it to happen somewhat quickly after you've done your exam, and let's say it's not particularly revealing early on. What are the sort things on your exam that would then push you to think about an MRI, a lumbar puncture, an EEG? You and I both spend time in large community hospitals, right, where “found down” is one of the most common chief concerns. In many cases, there isn't something to see on the CT or something obvious in the initial labs, and the question always comes up, “Who gets an MRI? Who gets an LP? Who gets an EEG?” - and I'm not sure I have a great framework for this. Obviously, you see focality on your exam, you know you need to look further. But, any factors in the history or exam that, even with a normal CT, raise your suspicion that you need to go further? Dr Wahlster: It's always a challenge, especially at a community hospital, because some of these patients come in at 1 AM where the EEG is not imminently available. But I think - let's say the CT scan is absolutely normal and doesn't give me a cause, but as an acute concerning deterioration, I think both EEG and LP would cross my mind. MRI I kind of see a little bit as a second-day test. I think there's very rare situation where an acute MRI would inform my imminent management. It's very informative, right, because you can see very small-vessel strokes. We had this patient that actually had this really bad vasculitis and we were able to see the small strokes everywhere on the MRI the day later, or sometimes helps you visualize acute brainstem pathology. But I think, even that - if you rule out a large-vessel occlusion on your CTA, there's brainstem pathology that is not imminently visible on the CT - it's nothing you need to go after. So, I do think the CT is a critical part of that initial eval, and whereas I always admire the neurological subspecialties, such as movements, where you just – like, your exam is everything. I think, to determine these acute time-sensitive interventions, the CT is key. And also, seeing a normal CT makes me a little less worried. You always look at these “four H” (they're big hypodensity, hyperdensity, any shift; is there hydrocephalus or herniation). I think if I don't have an explanation, my mind would imminently jump to seizure or CNS infection, or sometimes both. And I think then I would really kind of - to guide those decisions and whether I want to call in the EEG tech at 2 AM - I would, you know, again, look at the history and exam, see if there's any gaze deviation, tongue biting, incontinence - anything leading up towards seizure. I think, though, even if I didn't have any of those, those would strengthen my suspicion. If I really, absolutely don't have an explanation and the patient off sedation is just absolutely altered, I would still advocate for an EEG and maybe, in the meantime, do a small treatment trial. And I think with CNS infection - obviously, there are patients that are high risk for it - I would try to go back and get history about prodromes and, you know, look at things like the white count, fevers, and all of that. But again, I think if there's such a profound alteration in neurologic exam, there's nothing in the CT, and there's no other explanation, I would tend to do these things up front because, again, you don't want to miss them. Dr Berkowitz: Yeah, perfect. So many pearls in there, but one I just want to highlight because I'm not sure I've heard the mnemonic - can you tell us the four Hs again of sort of neurologic emergencies on CT? Dr Wahlster: Yeah. So, it's funny; for ages - I'm actually not sure where that's coming from, and I learned it from one of my fellows, one of our neurocritical care fellows - he's a fantastic teacher and he would teach our EM and anesthesia residents about it and his approach to CT. But yeah, the four H - he was always kind of like, “Look at the CT. Do you see any acute hypodensities, any hyperdensities?” And hypodensities would be involving infarct or edema; hyperdensities would be, most likely, hemorrhage (sometimes calcification or other things). Then, “Do you see hydrocephalus?” (because that needs an intervention). And, “Look at the midline structures and the ventricles.” And then, “Do you see any signs of herniation?” And he would go through the different types of herniation. But I thought that's a very good framework for looking at the “noncon” and just identifying critical pathology that needs some intervention. Dr Berkowitz: Yeah – so, hypodensity, hyperdensity, herniation, hydrocephalus. That's a good one – the four Hs; fantastic. Okay. So, a point that comes up a few times in your article - which I thought was very helpful to walk through and I'd love to pick your brain about a little bit – is, which patients need to be intubated for a neurologic indication? So, often we do consultations in medical, surgical ICUs; patients are intubated for medical respiratory reasons, but sometimes patients are intubated for neurologic reasons. So, can you walk us through your thinking on how to decide who needs to be intubated for the concern of depressed level of consciousness? Dr. Wahlster: It's an excellent question, and I think I would bet there's a lot of variation in practice and difference in opinion. There was actually the 2020 ESICM guidelines kind of commented on it, and those are great guidelines in terms of just intubation, mechanical ventilation of patients, and just acknowledging how there is a lack of really strong evidence. I would say the typical mantra (“GCS 8, intubate”) has been proposed in the trauma literature. And at some point, I actually dug into this to look behind the evidence, and there's actually not as much evidence as it's been put forth in guidelines and that kind of surprised me - that was just recently. I was like, “Actually, let me look this up.” I would say I didn't find a ton of strong evidence for it. I would say, as neurologist – you know, I'm amazed because GCS, I think is a - in some ways, a good tool to track things because it's so widely used across the board. But I would say, as neurologists, we all know that it sometimes doesn't account for some sort of nuances; you know, if a patient is aphasic, if a patient has an eyelid-opening apraxia - it can always be a little confounded. I'm amazed that GCS is still so widely used, to be frank. But I would say there is some literature - some school of thought - that maybe just blindly going by that mantra could be harmful or could not be ideal. I would say – I mean, I look at the two kind of functional things: oxygenation and ventilation. I think, in a neuro patient, you always think about airway protection or the decreased level of consciousness being a major issue (What is truly airway protection? Probably a mix of things). Then there's the issue of respiratory centers and respiratory drive - I think those are two issues you think about. But ultimately, if it leads to insufficient oxygenation - hypoxia early on is bad and that's been shown in several neurologic acute brain injuries. I think you also want to think about ventilation, especially if the mental status is poor to the point that the PCO2 elevates, that could also augment an ICP or exacerbate an ICP crisis. Or sometimes, I think there's just dysregulation of ventilation and there's hyperventilation to the point that the PCO2 is so low that I worry about cerebral vasoconstriction. So, I worry about these markers. I think, the oxygenation, I usually just kind of initially track on the sats. Sometimes, if the patient is profoundly altered, I do look at an arterial blood gas. And then there are things like breathing sounds (stridor, stertor [the work of breathing]). And I think something that also makes me have a lower threshold to intubate is if I'm worried and I want to scan, and I'm worried that the patient can't tolerate it - I want an imminent scan to just see why the patient is altered, or seizing, or presenting a certain way. Dr Berkowitz: All great pearls for how to think through this. Yeah - it's hard to think of hard and fast rules, and you can get to eight on the GCS in many different ways, as you said, some of which may not involve the respiratory mechanics at all. So, that's a helpful way of thinking about it that involves both the mental state, kind of the tracheal apparatus and how it's being managed by the neurologic system, and also the oxygen and carbon dioxide (sort of, respiratory parameters) – so, linking all those together; that's very helpful. And, related question – so, that's sort of for that patient with central nervous system pathology, who we're thinking about whether they need to be intubated for a primary neurologic indication. What about from the acute neuromuscular perspective (so, patients with Guillain-Barré syndrome or myasthenic crisis); how do you think about when to intubate those patients? Dr Wahlster: Yeah, absolutely - I think that's a really important one. And I think especially in a patient that is rapidly progressing, you always kind of think about that, and you want them in a supervised setting, either the ER or the ICU. I mean, there's some scores - I think there's the EGRIS score; there's some kind of models that predict it. I would say, the factors within that model, and based on my experience, often the pace of progression of reflex motor syndrome. I often see things like, kind of, changes in voice. You know, myasthenia, you look at things like head extension, flexion - those are the kind of factors. I would say there's this “20/30/40 rule” about various measures of, like, NIF and vital capacities, which is great. I would say in practice, I sometimes see that sometimes the participation in how the NIF is obtained is a little bit funky, so I wouldn't always blindly go by these numbers but sometimes it's helpful to track them. If you get a reliable kind of sixty and suddenly it drops to twenty, that makes me very concerned. But I would say, in general, it's really a little bit the work of breathing - looking at how the patient looks like. There's also (at some point) ABG abnormalities, but we always say, once those happen, you're kind of later in the game, so you should really - I think anyone that is in respiratory distress, you should think about it and have a low threshold to do it, and, at a minimum, monitor very closely. Dr Berkowitz: Yeah, we have those numbers, but so often, our patients who are weak, from a neuromuscular perspective, often have facial and other bulbar weakness and can't make a seal on the device that is used to check these numbers, and it can look very concerning when the patient may not, or can be a little bit difficult to interpret. So, I appreciate you giving us sort of the protocol and then the pearls of the caveats of how to interpret them and going sort of back to basics. So, just looking at the patient at the bedside and how hard they are working to breathe, or how difficult it is for them to clear their secretions from bulbar weakness. Moving on to another topic, you have a really wonderful section in your article on detecting clinical deterioration in patients in the neuro ICU. Many patients in the neuro ICU - for example, due to head trauma or large ischemic stroke or intracerebral hemorrhage, subarachnoid hemorrhage, or status epilepticus - they can't communicate with us to tell us something is getting worse, and they can't (in many cases) participate in the examination. They may be intubated, as you said, sedated or maybe even not sedated, and there's not necessarily much to follow on the exam to begin with if the GCS is very low. So, I'd love to hear your thoughts and your pearls, as someone who rounds in the neuro-ICU almost every day. What are you looking for at the bedside to try to detect sort of covert deterioration, if you will, in patients who already have major neurologic deficits, major neurologic injury or disease that we're aware of? I'm trying to see if there is some type of difference at the bedside that would lead you to be concerned for some underlying change and go back to the scanner or repeat EEG, LP, et cetera. Dr Wahlster: Yeah. I think that's an excellent question because that's a lot of what we do in the neuro ICU, right? And when you read your Clans, your residency, like, “Ah, QNR neuro checks, [IG1]  ” right? We often do that in many patients. But I think in the right patient, it can really be life or death a matter, and it is the exam that really then drives a whole cascade of changes in management and detects the need for lifesaving procedure. I would say it depends very much on the process and what you anticipate, right? If you have, for example, someone with a large ischemic stroke, large MCA stroke, especially, right, then there's sometimes conversations about doing a surgical procedure before they herniate. But let's say, kind of watch them and are worried that they will, you do worry about uncal herniation, and you pay attention to the pupil, because often, if the inferior division is infarcted, you know, you can see that kind of temporal tickling the uncus already. And so, I think those are patients that I torture with those NPi checks and checking the pupil very vigilantly. I would say, if it's a cerebellar stroke, for example, right, then you think about, you know, hydrocephalus. And often patients with cerebellar stroke - you know, the beauty of it is that if you detect it early, those patients can do so well, but they can die, and will die if they develop hydrocephalus start swelling. But I think, often something I always like to teach trainees is looking at the eye movements in upgaze and downgaze because, often, as the aqueduct, the third ventricle gets compressed and there's pressure on the colliculi – you kind of see vertical gaze get worse. But I would say I think it's always good to know what the process is and then what deterioration would look like. For example, in subarachnoid hemorrhage, where you talk about vasospasm - it's funny - I think a really good, experienced nurse is actually the best tool in this, but they will sometimes come to you and say, “I see this flavor,” and it's actually a constellation of symptoms, especially in the anterior ACA (ACom) aneurysms. You sometimes see patients suddenly, like, making funky jokes or saying really weird things. And then you see that in combination with, sometimes, a sodium drop, a little bit of subfebrile temperature; blood pressure shoot up sometimes, and that is a way the brain is sometimes regulating. But it's often a constellation of things, and I think it depends a little on the process that you're worried about. Dr Berkowitz: Yeah, that's very helpful. You just gave us some pearls for detecting deterioration related to vasospasm and subarachnoid hemorrhage; some pearls for detecting malignant edema in an MCA stroke or fourth ventricular compression in a large cerebellar stroke. Patients I find often very challenging to get a sense of what's going on and often get scanned over and over and back on EEG, not necessarily find something: patients with large intracerebral hemorrhage (particularly, in my experience, if the thalamus is involved) just can fluctuate a lot, and it's not clear to me actually what the fluctuation is. But you're looking for whether they're developing hydrocephalus from third ventricular compression with a thalamic hemorrhage (probably shouldn't be seizing from the thalamus, but if it's a large hemorrhage and cortical networks are disrupted and it's beyond sort of the subcortical gray matter, or has the hemorrhage expanded or ruptured it into the ventricular system?) And yet, you scan these patients over and over, sometimes, and just see it's the same thalamic hemorrhage and there's some, probably, just fluctuation level of arousal from the thalamic lesion. How do you, as someone who sees a lot of these patients, decide which patients with intracerebral hemorrhage - what are you looking for as far as deterioration? How do you decide who to keep scanning when you're seeing the same fluctuations? I find it so challenging - I'm curious to hear your perspective. Dr Wahlster: Yeah, no - that is a very tricky one. I mean, unfortunately, in patients with deeper hemorrhages or deeper lesions - you know, thalamic or then affecting brainstem - I think those are the ones that ultimately don't have good, consistent airway protection and do end up needing a trach, just because there's so much fluctuation. But I agree - it's so tricky, and I don't think I can give a perfect answer. I would say, a little bit I lean on the imaging. And for example - let's say there's a thalamic hemorrhage. We recently actually had a patient - I was on service last week - we had a thalamic hemorrhage with a fair amount of edema on it that was also kind of pressing on the aqueduct and didn't have a lot of IVH, right? But it was, like, from the outside pushing on it and where we ended up getting more scans. And I have to say, that patient actually just did fine and actually got the drain out and didn't need a shunt or anything, and actually never drained. We put an EVD and actually drained very little. So, I think we're still bad at gauging those. But I think, in general, my index of suspicion or threshold to scan would be lower if there was something, like, you know, a lot of IVH associated, if, you know, just kind of push on the aqueduct. It's very hard to say, I think. Sometimes, as you get to know your patients, you can get a little bit of a flavor of what is within normal fluctuation. I think it's probably true for every patient, right? - that there's always some fluctuation within the realm of like, “that's what he does,” and then there's something more profound. Yeah, sorry - I wish I could give a better answer, but I would say it's very tricky and requires experience and, ideally, you really taking the time to examine the patient yourself (ideally, several times). Sometimes, we see the patient - we get really worried. Or the typical thing we see the ICU is that the neurosurgeons walk around at 5 AM and say, like, “She's altered, she's different, she's changed.” And then the nurse will tell you at 8 AM, like, “No, they woke up and they ate their breakfast.” So, I think really working with your nurse and examining the patient yourself and just getting a flavor for what the realm of fluctuation is. Dr Berkowitz: Yeah - that's helpful to hear how challenging it is, even for a neurocritical care expert. I'm often taking care of these patients when they come out of the ICU and I'm thinking, “Am I scanning these patients too much?” Because I just don't sort of see the initial stage, and then, you know, you realize, “If I'm concerned and this is not fitting, then I should get a CT scan,” and sometimes you can't sort it out of the bedside. So, far from apologizing for your answer, it's reassuring, right, that sometimes you really can't tell at the bedside, as much as we value our exam. And the stakes are quite high if this patient's developed intraventricular hemorrhage or hydrocephalus, and these would change the management. Sometimes you have these patients the first few days in the ICU (for us, when they come out of the ICU) are getting scanned more often than you would like to. But then you get a sense of, “Oh, yeah - these times of day, they're hard to arouse,” or, “They're hard to arouse, but they are arousable this way,” and then, “When they are aroused, this is what they can do, and that's kind of what we saw yesterday.” And yet, as you said, if anyone on the team (the resident, the nurse, the student, our neurosurgery colleague) says, “I don't think this is how they were yesterday,” then, very low threshold to just go back and get a CT and make sure we're not missing something. Dr. Wahlster: Exactly. Yeah. I would say the other thing is also certain time intervals, right? If I'm seeing a patient that may be in vasospasm kind of around the days seven to ten, for the first fourteen day, I would be a little bit more nervous. Or with swelling - acute ischemic stroke says that could peak swelling, when knowing which [IG2]  , I would just be more anxious or have a lower threshold to scan. Yeah. Dr Berkowitz: Yeah - very helpful. Well, thank you so much for joining me today on Continuum Audio. Dr Wahlster: Thank you very much, Aaron. Dr Berkowitz: Again, today we've been interviewing Dr Sarah Wahlster, whose article, “Examination and Workup of the Neurocritical Care Patient” appears in the most recent issue of Continuum, on neurocritical care. Be sure to check out Continuum Audio episodes from this and other issues. And thank you so much to our listeners for joining us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practice. And right now, during our Spring Special, all subscriptions are 15% off. Go to Continpub.com/Spring2024 or use the link in the episode notes to learn more and take advantage of this great discount. This offer ends June 30, 2024. AAN members: go to the link in the episode notes and complete the evaluation to get CME. Thank you for listening to Continuum Audio.

In this insightful podcast, nurse manager Allison Zelikoff explores the history and importance of occupational health, its partnership with infection prevention, and how she found her calling in this field. Find out more about the critical role of occupational health in promoting workplace safety and the challenges this discipline faces including administrative and financial barriers. Listen in to understand the future of occupational health and the crucial connection it maintains with infection prevention. Hosted by: Lerenza Howard, MHA, CIC, LSSGB and Kelly Holmes, MS, CIC About our Guest: Allison Zelikoff, RN, MSN, Nurse Manager, Occupational Health, Fred Hutchinson Cancer Center Allison Zelikoff is the Nurse Manager for Occupational Health at Fred Hutch, a cancer and infectious disease research institute and patient care center in Seattle, Washington. In her role, Allison manages a program that provides direct care to employees following workplace injury, response to bloodborne and respiratory pathogen exposure, large-scale vaccination programs, as well as interdisciplinary collaboration and data analysis aimed at preventing injury and illness among employees in the workplace. Her professional background includes direct patient care serving vulnerable populations in the community setting and at Harborview Medical Center, the region's level 1 trauma center.

  Join us as we speak with Dr. Niten Singh, a respected vascular surgeon and director at the University of Washington, who shares his remarkable journey from the child of immigrants to a distinguished figure in military medicine. Listen in as Dr. Singh reflects on the influence of his late father's values and the pragmatic benefits of attending the Uniformed Services University. His anecdotes from serving as an aviation brigade surgeon in Korea provide a compelling narrative of the challenges he faced balancing medical duties with military hierarchy.     In our conversation, Dr. Singh recounts the evolution of vascular surgery from open to endovascular techniques, drawing on his own experiences during his fellowship and while deployed in Baghdad. He gives us a candid look at the emotional weight carried by military surgeons, discussing the lasting impressions of trauma cases from his deployment. Dr. Singh's insights offer invaluable advice for those embarking on a military medical career and highlight the importance of specialized training in building confidence and skill in the operating room.    The episode rounds out with Dr. Singh detailing his transition from military to civilian practice and the culture of camaraderie that extends from the battlefield to the operating room. Hear about his leadership role at Harborview and his involvement in fostering the growth of the Pacific Northwest Endovascular Conference, which has become a premier event for the vascular surgery community. Dr. Singh's personal stories of memorable surgical cases and the lessons learned throughout his career underscore the importance of teamwork, mentorship, and maintaining balance in both personal and professional life. Tune in for an enriching discussion filled with heart, humor, and a wealth of knowledge from a leader in military and vascular surgery.   Chapters: (00:04) Military Medicine Career and Insights (13:10) Combat Hospital Vascular Surgery Experience (18:19) Military Surgery and Academic Success (26:21) Transition and Growth in Vascular Surgery (36:28) Lessons From Military and Medical Leadership (40:29) Memorable Surgical Cases in Military   Chapter Summaries: (00:04) Military Medicine Career and Insights Dr. Niten Singh shares his journey from child of immigrants to renowned vascular surgeon, reflecting on military service and transitioning to civilian practice.   (13:10) Combat Hospital Vascular Surgery Experience Transition from open to endovascular techniques, impact of specialized training, and emotional aspects of military medicine.   (18:19) Military Surgery and Academic Success Marine Corps camaraderie, advancements in military medical tools, and the importance of academic productivity and mentorship in vascular surgery.   (26:21) Transition and Growth in Vascular Surgery Transitioning from military to civilian life, humorous middle name mix-up, and growth of PNEC as a premier vascular surgery conference.   (36:28) Lessons From Military and Medical Leadership Military service, residency, and civilian life are discussed, along with building a successful residency program and the importance of teamwork and mentorship.   (40:29) Memorable Surgical Cases in Military Surgical cases, military career, and life lessons learned are discussed in this chapter.   Take Home Messages: Overcoming Challenges of Immigrant Heritage: The episode highlights the importance of hard work and dedication, as instilled by immigrant family values, in achieving success in demanding fields such as military and vascular surgery. Military Service Shapes Medical Proficiency: The episode emphasizes the unique learning opportunities provided by military service, which can significantly enhance a surgeon's confidence and technical skills, particularly through specialized training and frontline experiences. Advancements in Surgical Techniques: The podcast delves into the evolution of vascular surgery, detailing the transition from open surgeries to endovascular techniques and how these innovations have transformed patient care, even within the constraints of a combat hospital setting. Mentorship and Academic Contributions: The importance of mentorship, academic productivity, and continuous education in surgery is underscored, showcasing the guest's commitment to fostering growth in the field through conferences and the development of residency programs. The Power of Camaraderie in Medicine: Stories from the episode convey the deep sense of camaraderie and support within the military and medical communities, illustrating how these bonds can aid in navigating the challenges of both military service and civilian medical practice. Episode Keywords: Dr. Niten Singh, Vascular Surgeon, Military Medicine, Immigrant Roots, Uniformed Services University, Aviation Brigade Surgeon, Endovascular Techniques, Trauma Cases, Civilian Practice Transition, Cultural Camaraderie, Harborview Medical Center, Pacific Northwest Endovascular Conference, Medical Mentorship, Surgical Teamwork, Deployment Experiences, Academic Productivity in Military Hashtags: #wardocs #military #medicine #podcast #MilMed #MedEd, #MilitaryMedicine #VascularSurgeon #ImmigrantStory #MilitarySurgeon #SurgicalInnovation #VascularVictories #CombatHospital #SurgeonLife #EndovascularTechniques #MedicalMentorship   Honoring the Legacy and Preserving the History of Military Medicine   The WarDocs Mission is to honor the legacy, preserve the oral history, and showcase career opportunities, unique expeditionary experiences, and achievements of Military Medicine. We foster patriotism and pride in Who we are, What we do, and, most importantly, How we serve Our Patients, the DoD, and Our Nation.   Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/our-guests Subscribe and Like our Videos on our YouTube Channel: https://www.youtube.com/@wardocspodcast Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you.   WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms.     Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast YouTube Channel: https://www.youtube.com/@wardocspodcast

Interview with Dr. Noelle Van Rysselberghe from Harborview Medical Center in Seattle, Washington discussing her paper in the February 2024 Journal of Orthopaedic Trauma entitled “Retrograde Intramedullary Nailing Versus Locked Plating for Extreme Distal Periprosthetic Femur Fractures: A Multicenter Retrospective Cohort Study”.

Your patient was in a terrible car crash and is currently intubated with multiple traumatic injuries that will need surgery. Family has just arrived and all they've heard is that he has a broken leg. How do you share this serious news with family? What do you do when they become angry, cry or bombard you with questions that you don't have answers to? Join the surgical palliative care team from the University of Washington as we role play a difficult conversation with a standardized patient. We will identify common challenges that arise and discuss key skills to navigate these situations. Hosts:  Dr. Katie O'Connell (@katmo15) is an assistant professor of surgery at the University of Washington. She is a trauma surgeon, palliative care physician, director of surgical palliative care, and founder of the Advance Care Planning for Surgery clinic at Harborview Medical Center, Seattle, WA. Dr. Ali Haruta is a PGY7 current palliative care fellow at the University of Washington, formerly a UW general surgery resident and Parkland trauma/critical care fellow.  Dr. Lindsay Dickerson (@lindsdickerson1) is a PGY5 general surgery resident and current surgical oncology research fellow at the University of Washington. Dr. Virginia Wang is a PGY2 general surgery resident at the University of Washington. Learning Objectives: ·      Identify common pitfalls encountered during difficult conversations ·      Learn how to synthesize complex medical information and construct a succinct headline statement to deliver a digestible take-home message ·      Develop skills to respond to emotional cues using empathetic statements References: ·      “Responding to Emotion.” Vitaltalk. Accessed March 4, 2024. https://www.vitaltalk.org/guides/responding-to-emotion-respecting/ ·      “Serious News.” Vitaltalk. Accessed March 4, 2024. https://www.vitaltalk.org/guides/serious-news/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

How are we doing?? Click ⁠⁠⁠⁠⁠here⁠⁠⁠⁠⁠ to complete a brief, 2-minute survey. Dr. Jennifer Yu shares insights from her trauma experience at Harborview Medical Center -- a level 1 Trauma center serving 5 states. Dr. Jennifer Yu is a comprehensive ophthalmologist in Seattle, Washington. Dr. Yu received her bachelor's degree at the University of Michigan and her MD and PhD from Washington University School of Medicine, where she also completed ophthalmology residency. Dr. Yu currently serves as the Director of Trauma and Consult Services for ophthalmology at Harborview Medical Center. She is passionate about resident education and is a board member for the American Society of Ophthalmic Trauma. *Interested in joining our team? Click ⁠here⁠* References: More Than a Pickle: Fastest-Growing U.S. Sport May Pose Ocular Injury Risks Moe et al. "International Olympic Committee (IOC) consensus paper on sports-related ophthalmology issues in elite sports" - doi: 10.1136/bmjsem-2023-001644

Reference: Albers GW et al. TIMELESS Investigators. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. NEJM Feb 2024 Date: April 12, 2024 Guest Skeptic: Dr. Vasisht Srinivasan is an Emergency Medicine physician and neurointensivist at the University of Washington and Harborview Medical Center in Seattle, WA. He is an assistant professor in Emergency […] The post SGEM#436: For the Longest Time – To Give TNK for an Acute Ischemic Stroke first appeared on The Skeptics Guide to Emergency Medicine.

Dr. Jacques Hacquebord is  Chief of Hand and Upper Extremity Surgery at NYU Langone Health. He also serves as the co-chief of the Hand Surgery service at Bellevue Hospital (a Level 1 trauma and regional replant center) and co-chief of the Center for Amputation Reconstruction. He did his surgical residency in orthopedic surgery at the University of Washington and the world-renowned trauma center Harborview Medical Center and did his fellowship in Hand/Microsurgery at the University of California at Irvine with Dr Neil Jones. He then completed two traveling fellowships in reconstructive microsurgery and brachial plexus surgery with the first in China and then the second at Ganga Hospital in India. His principal clinical interest and passion within hand and orthoplastic surgery is the primary management and secondary reconstruction of the traumatized upper extremity. This includes replantation surgery, reconstruction of bone and soft tissues deficits in the upper extremity, and complex nerve reconstruction surgery.  The discussion in Part 2 included the following items: other types of clinicians who provide treatment for patients who need hand surgery; influence of artificial intelligence (AI) on hand surgery; complications that could arise during hand surgery and how to mitigate them; management of post-operative pain; dealing with pre-operative anxiety experienced by patients; quality of patient information on the Internet about hand health problems; advice on how to prevent health problems regarding the hands; personal lessons learned that have implications for improving patient care; and research involvement at NYU Langone Health.  

Dr. Jacques Hacquebord is  Chief of Hand and Upper Extremity Surgery at NYU Langone Health. He also serves as the co-chief of the Hand Surgery service at Bellevue Hospital (a Level 1 trauma and regional replant center) and co-chief of the Center for Amputation Reconstruction. He did his surgical residency in orthopedic surgery at the University of Washington and the world-renowned trauma center Harborview Medical Center and did his fellowship in Hand/Microsurgery at the University of California at Irvine with Dr Neil Jones. He then completed two traveling fellowships in reconstructive microsurgery and brachial plexus surgery with the first in China and then the second at Ganga Hospital in India. His principal clinical interest and passion within hand and orthoplastic surgery is the primary management and secondary reconstruction of the traumatized upper extremity. This includes replantation surgery, reconstruction of bone and soft tissues deficits in the upper extremity, and complex nerve reconstruction surgery.  The discussion in Part 1 included the following items: reason for deciding to practice in hand surgery; common health problems that result in patients undergoing hand surgery, influence of gender on the onset of health problems, kinds of health problems children experience, patient expectations of what will result from hand surgery, use of wide-awake local anesthesia no tourniquet surgery (WALANT), and patients' level of cooperation in achieving positive surgical outcomes.    

2023 was an exciting year for Surgical Palliative Care research! Join Drs. Katie O'Connell, Ali Haruta, Lindsay Dickerson, and Virginia Wang from the University of Washington to discuss two seminal randomized controlled trials in the Surgical Palliative Care space. Hosts: ·    Dr. Katie O'Connell (@katmo15) is an Assistant Professor of Surgery at the University of Washington. She is a trauma surgeon, palliative care physician, Director of Surgical Palliative Care, and founder of the Advance Care Planning for Surgery clinic at Harborview Medical Center, Seattle, WA. ·    Dr. Ali Haruta is a PGY7 Hospice & Palliative Care fellow at the University of Washington, formerly a UW General Surgery resident and Parkland Trauma/Critical Care fellow.  ·    Dr. Lindsay Dickerson (@lindsdickerson1) is a PGY5 General Surgery resident and current Surgical Oncology fellow at the University of Washington. ·    Dr. Virginia Wang is a PGY2 General Surgery resident at the University of Washington. Learning Objectives: ·    Discuss the current state of the RCT literature in Palliative Care & Surgical Palliative Care ·    Understand the primary outcomes of the Shinall and Aslakson trials as related to perioperative specialty palliative care intervention ·    Identify limitations in existing surgical palliative care RCTs & further opportunities for study ·    Identify underlying differences between medical oncology and surgical oncology patient populations References: 1.  Shinall MC, Martin SF, Karlekar M, et al. Effects of Specialist Palliative Care for Patients Undergoing Major Abdominal Surgery for Cancer: A Randomized Clinical Trial. JAMA Surg. 2023;158(7):747–755. doi:10.1001/jamasurg.2023.1396 https://pubmed.ncbi.nlm.nih.gov/37163249/ 2.  Aslakson RA, Rickerson E, Fahy B, et al. Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(5):e2314660. doi:10.1001/jamanetworkopen.2023.14660 https://pubmed.ncbi.nlm.nih.gov/37256623/ 3.  Ingersoll LT, Alexander SC, Priest J, et al. Racial/ethnic differences in prognosis communication during initial inpatient palliative care consultations among people with advanced cancer. Patient Educ Couns. 2019;102(6):1098-1103. doi:10.1016/j.pec.2019.01.002 https://pubmed.ncbi.nlm.nih.gov/30642715/ 4.  Bakitas M, Lyons KD, Hegel MT, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA. 2009;302(7):741-749. doi:10.1001/jama.2009.1198 https://pubmed.ncbi.nlm.nih.gov/19690306/ 5.  Corn BW, Feldman DB, Hull JG, O'Rourke MA, Bakitas MA. Dispositional hope as a potential outcome parameter among patients with advanced malignancy: An analysis of the ENABLE database. Cancer. 2022;128(2):401-409. doi:10.1002/cncr.33907 https://pubmed.ncbi.nlm.nih.gov/34613617/ 6.  El-Jawahri A, LeBlanc TW, Kavanaugh A, et al. Effectiveness of Integrated Palliative and Oncology Care for Patients With Acute Myeloid Leukemia: A Randomized Clinical Trial. JAMA Oncol. 2021;7(2):238-245. doi:10.1001/jamaoncol.2020.6343 https://pubmed.ncbi.nlm.nih.gov/33331857/ 7.  More about the metrics from both the Shinall and Aslakson studies: a.     FACT-G – https://www.facit.org/measures/fact-g b.     FACIT-Pal – https://www.facit.org/measures/facit-pal c.     PROMIS-29 – https://heartbeat-med.com/resources/promis-29/ d.     PROPr (PROMIS-Preference) score – https://www.proprscore.com/ ***Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9*** Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other surgical palliative care episodes here: https://app.behindtheknife.org/podcast-category/palliative-care

In this episode, the Medical Director of ACS Trauma Quality Programs—Avery B. Nathens, MD, PhD, FACS—talks with two of his trauma colleagues—Anne G. Rizzo, MD, FACS, and Bryce Robinson, MD, MS, FACS—about the recent successful Trauma Quality Improvement Program (TQIP) meeting in Louisville, Kentucky. In addition to the key insights and lessons learned from TQIP, they also discuss a new guidance document on traumatic brain injury and what to expect from the ACS Trauma Programs in 2024. HOST Avery B. Nathens, MD, PhD, FACS, Medical Director of ACS Trauma Quality Programs, Chief of Surgery at Sunnybrook Health Sciences Center in Toronto, Canada, and Professor of Surgery at the University of Toronto. GUESTS Anne G. Rizzo, MD, FACS, System Surgical Chair at The Guthrie Clinic, as well as President of Surgical Services and Professor of Surgery at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, Virginia Commonwealth University in Richmond, and Geisinger Commonwealth School of Medicine in Pennsylvania. Bryce Robinson, MD, MS, FACS, Professor of Surgery at the University of Washington and Associate Medical Director of Critical Care at Harborview Medical Center, both in Seattle. Talk about the podcast on social media using the hashtag #HouseofSurgery

Episode 123 This conversation was recorded at the Sinai and Synapses alumni gathering in November 2023. In it, we talk with Dr. Muhammad Aurangzeb Ahmad about the ethics of AI in Islam, the future of human-computer interaction, and the ethics of bringing a form of consciousness back to life.  Muhammad Aurangzeb Ahmad is a Research Scientist at University of Washington's Harborview Medical Center and an Affiliate Assistant Professor in the Department of Computer Science at University of Washington Bothell. His research focuses on algorithmic nudging at scale, simulation modeling for machine learning, Responsible AI, and personality emulation. He has had academic appointments at University of Washington, Center for Cognitive Science at University of Minnesota, Minnesota Population Center, and the Indian Institute of Technology at Kanpur. Muhammad also has worked in applied AI in industry for several startups and advisor to various governmental bodies. He has a PhD in Computer Science from the University of Minnesota.    Support this podcast on Patreon at https://www.patreon.com/DowntheWormholepodcast   More information at https://www.downthewormhole.com/   produced by Zack Jackson music by Zack Jackson and Barton Willis 

The percent surface area burn for which half of patients survive, known as lethal area 50, or LA50 depends on where in the world the injury occurs. Calling all surgeons and trainees with an interest in providing more equitable delivery of global injury care - Join our Burn Surgery team as we welcome Dr. Manish Yadav, Plastic and Burn Surgeon at Kirtipur Hospital in Kathmandu, Nepal to discuss several recent challenging cases. We'll discuss the global burden of burn injuries, how emergency burn care systems reduce preventable morbidity and mortality, innovations in resuscitation of burn shock, use of checklists for critical care and safe early excision, and application of palliative care in different cultural contexts. (Co-hosts: Dr. Barclay Stewart, Burn and Trauma Surgeon at Harborview Medical Center and Paul Herman, UWMC/HMC Surgery Resident) Hosts: (affiliation and SM handles) 1.     Manish Yadav, Kirtipur Hospital, Nepal 2.     Barclay Stewart, Harborview Medical Center 3.     Paul Herman, UW/Harborview General Surgery Resident, @paul_herm  4.     Tam Pham, Harborview Medical Center (Editor) Learning Objectives 1.     Describe the global epidemiology of burn injury, disparities in burn injury and care, and highlight efforts to improve burn care in low and middle-income countries 2.     Discuss two cases at a burn center in Kirtipur, Nepal, highlighting challenges in burn care in LMICs and innovations to address these challenges and provide high level care a.     Highlight enteral resuscitation as an innovative strategy with advantages for treating burn shock in low resource settings b.     Discuss the key burn concept of early excision and steps to ensure safe application in low resource settings 1.     References a.     Gosselin, R., Charles, A., Joshipura, M., Mkandawire, N., Mock, C. N. , et. al. 2015. “Surgery and Trauma Care”. In: Disease Control Priorities (third edition): Volume 1, Essential Surgery, edited by H. Debas, P. Donkor, A. Gawande, D. T. Jamison, M. Kruk, C. N. Mock. Washington, DC: World Bank. b.     Stewart BT, Nsaful K, Allorto N, Man Rai S. Burn Care in Low-Resource and Austere Settings. Surg Clin North Am. 2023 Jun;103(3):551-563. doi: 10.1016/j.suc.2023.01.014. Epub 2023 Apr 4. PMID: 37149390. https://pubmed.ncbi.nlm.nih.gov/37149390/ c.      Davé DR, Nagarjan N, Canner JK, Kushner AL, Stewart BT; SOSAS4 Research Group. Rethinking burns for low & middle-income countries: Differing patterns of burn epidemiology, care seeking behavior, and outcomes across four countries. Burns. 2018 Aug;44(5):1228-1234. doi: 10.1016/j.burns.2018.01.015. Epub 2018 Feb 21. PMID: 29475744. https://pubmed.ncbi.nlm.nih.gov/29475744/ d.     Hebron C, Mehta K, Stewart B, Price P, Potokar T. Implementation of the World Health Organization Global Burn Registry: Lessons Learned. Annals of Global Health. 2022; 88(1): 34, 1–10. DOI: https://doi. Org/10.5334/aogh.3669 https://pubmed.ncbi.nlm.nih.gov/35646613/ e.     Jordan KC, Di Gennaro JL, von Saint André-von Arnim A and Stewart BT (2022) Global trends in pediatric burn injuries and care capacity from the World Health Organization Global Burn Registry. Front. Pediatr. 10:954995. doi: 10.3389/fped.2022.954995 https://pubmed.ncbi.nlm.nih.gov/35928690/ f.      Mehta K, Thrikutam N, Hoyte-Williams PE, Falk H, Nakarmi K, Stewart B. Epidemiology and Outcomes of Cooking- and Cookstove-Related Burn Injuries: A World Health Organization Global Burn Registry Report. J Burn Care Res. 2023 May 2;44(3):508-516. doi: 10.1093/jbcr/irab166. PMID: 34850021; PMCID: PMC10413420. https://pubmed.ncbi.nlm.nih.gov/34850021/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here https://behindtheknife.org/listen/

Being a person who cares for loved ones can be most stressful at the holidays. In this Caring For Caregivers Conversation, George Dicks returns to chat with our state director Marguerite Ro. George leads geriatric psychiatry services at Harborview Medical Center and so he's very familiar with seasonal challenges in caregiving. He has some tips and reflections on navigating this time of year. He also recently served as a caregiver for his brother in his final days so he shares his personal journey of caregiving. It wasn't quite what he expected. You can get resources on family caregiving in WA at aarp.org/caregiverswa

Support the Northwest Regional SCI System by donating at http://www.acceleratemed.org/SCI. After conducting a feasibility trial, Amy Starosta PhD, a rehabilitation psychologist, discusses her new randomized control trial of hypnotic cognitive therapy for pain. This is a 3-year study taking place on the inpatient rehabilitation unit at Harborview Medical Center. Feasibility Paper: https://pubmed.ncbi.nlm.nih.gov/37364685/ Case Study Paper: https://pubmed.ncbi.nlm.nih.gov/37445573/

Support the Northwest Regional SCI System by donating at http://www.acceleratemed.org/SCI. We are joined by Deborah Crane MD, a spinal cord injury physician, to hear about her study looking at the feasibility of short, but high intensity exercise program for people with new SCI. This 2-year study will be conducted on the inpatient unit at Harborview Medical Center.

Clayton Lewis has over three decades of experience launching and scaling early-stage companies. His impressive track record includes leading two companies, Onvia and HouseValues, to public offerings and serving as a general partner at Maveron. He co-founded Arivale in 2014, and served as its CEO. He currently advises CEOs and is a member of the Board of Trustees for Harborview Medical Center. Clayton is recognized for his expertise guiding purpose-driven leaders toward creating audacious economic value while staying true to their purpose.  You'll hear Lindsay and Clayton discuss: Clayton's focus shifted from passion-driven pursuits in his 20s, to prioritizing financial success imid career. Launching Arivale allowed him to reconnect with his passion for health and wellness, marking a transformative stage in his career. Use joy as a filter to evaluate your daily activities and interactions. This shift allowed Clayton to find balance and fulfillment in both his personal and professional life. Passion can be both an asset and a liability. While passion fueled Arivale's vision, it also led to challenges, such as losing perspective and overlooking critical business considerations. Leaders need to balance passion with objectivity to maintain a holistic perspective, especially in assessing product-market fit and strategic direction. Clayton outlines the practicality of a North Star in guiding day-to-day decisions. He emphasizes the importance of aligning the team with a shared vision, defining success at various intervals, fostering a learning culture, and integrating the North Star into the company's values. Clayton shares how Arivale brought its North Star to life culturally. This includes storytelling sessions about impactful client experiences, recognizing team members living company values, and creating a culture of continuous learning and improvement. As an advisor to CEOs, Clayton encourages setting audacious goals, fostering relationships, and maintaining a positive attitude. He emphasizes the role of a North Star in guiding business decisions and aligning teams toward a common purpose. Clayton uses his North Star as a filter when selecting companies to work with or invest in. He listens for passion, clarity of purpose, and the willingness of entrepreneurs to articulate and refine their goals. Various terms can be used to describe the guiding purpose, such as mission, vision, values, and brand strategy. Clayton remains flexible with the language, focusing on the essence of a clear and motivating direction. Sustaining leadership energy involves setting audacious goals, building strong relationships, and maintaining a positive outlook. Resources Clayton Lewis on LinkedIn

Welcome to the first in a series of new podcast episodes from the pages of Gastroenterology, the flagship journal of the American Gastroenterological Association and the most prominent journal in the field of gastrointestinal disease. This podcast series covers articles in the journal's “Gastro Grand Rounds” section, which features discussions among multidisciplinary teams of experts on the management of complex clinical cases. Gastro Grand Rounds: Managing Diverticulitis Dr. G.S. Raju, editor of the Gastro Grand Rounds section in Gastroenterology, is joined by Dr. Lisa Strate to discuss her article, “Recurrent Lower Abdominal Pain, Altered Bowel Habits, and Malaise: Conservative or Surgical Approach to a Common Disorder.” https://www.gastrojournal.org/article/S0016-5085(23)00042-2/fulltext Dr. Strate is a professor of medicine at the University of Washington School of Medicine and is the section head of gastroenterology at Harborview Medical Center. Dr. Strate's research has examined risk factors for the development of diverticular disease. Her work has informed the development of guidelines, dietary recommendations, and measurements for the prevention of diverticulitis. She has investigated the role of chronic inflammation and the gut microbiome in diverticulitis. She is a fellow of AGA. [0:27] Introduction of the author. [2:20] The utility of CT in evaluating diverticulitis. [5:49] Managing a patient with uncomplicated diverticulitis. [11:00] Take-home instructions for the patient. [14:12] Preparing the patient colonoscopy, strategies used during the procedure, and documenting findings. [19:11] Utility of a barium enema. [20:22] The patient returns and has left lower quadrant pain. What are the next steps? [24:30] Laying out the pros and cons of continued medical management compared with surgery for a patient who has recurrent episodes of uncomplicated diverticulitis. [28:00] Does the author's institution have a support group for patients? [28:55] What is the longest period of antibiotics the author has given to a patient who does not want surgery? [30:34] Take-home messages for fellows and residents. Thank you for listening. Find this and other articles on our website at https://www.gastrojournal.org. We welcome your feedback. Please email us at gastro@gastro.org. This discussion was recorded on Sept. 5, 2023, and reflects medical knowledge at that time. The views and opinions expressed in this podcast are those of the individual speakers only and do not necessarily represent those of the American Gastroenterological Association. The content of this podcast is provided for general information purposes only and does not offer medical or any other type of professional advice.

Surgeons are trained to, well…do surgery, but is that always the right treatment for the patient? Not offering surgery can be a challenge, especially when you're consulted about a sick patient in the middle of the night and the clinical momentum is moving toward the OR. Join Drs. Katie O'Connell, Ali Haruta, Lindsay Dickerson, and Virginia Wang from the University of Washington as we discuss how to recognize when a surgery is potentially not beneficial and communicate serious news with the patient and consulting team. Hosts: Dr. Katie O'Connell (@katmo15) is an assistant professor of surgery at the University of Washington. She is a trauma surgeon, palliative care physician, director of surgical palliative care, and founder of the Advance Care Planning for Surgery clinic at Harborview Medical Center, Seattle, WA. Dr. Ali Haruta is a PGY7 current palliative care fellow at the University of Washington, formerly a UW general surgery resident and Parkland trauma/critical care fellow.  Dr. Lindsay Dickerson (@lindsdickerson1) is a PGY5 general surgery resident and current surgical oncology fellow at the University of Washington. Dr. Virginia Wang is a PGY2 general surgery resident at the University of Washington. Learning Objectives: Identify when a patient's disease course is unlikely reversible by surgery  Learn to avoid defaulting to offering potentially non-beneficial surgical treatment for patients at the end-of-life Learn to recommend comfort-focused treatments for patients at the end-of-life Develop the communication skill of delivering serious news References: 1. Cooper Z, Courtwright A, Karlage A, Gawande A, Block S. Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: description of the problem and elements of a solution. Ann Surg. Dec 2014;260(6):949-57. doi:10.1097/SLA.0000000000000721 2. VitalTalk. One page Guides. https://www.vitaltalk.org/guides/  3. VitalTalk. Using Ask-Tell-Ask to Make a Recommendation.  https://www.vitaltalk.org/using-ask-tell-ask-to-make-a-recommendation/ 4. VitalTalk. What's a Headline? https://www.vitaltalk.org/whats-a-headline/ 5. Zaza SI, Zimmermann CJ, Taylor LJ, Kalbfell EL, Stalter L, Brasel K, Arnold RM, Cooper Z, Schwarze ML. Factors Associated With Provision of Nonbeneficial Surgery: A National Survey of Surgeons. Ann Surg. 2023 Mar 1;277(3):405-411. doi: 10.1097/SLA.0000000000005765. Epub 2022 Nov 24. PMID: 36538626; PMCID: PMC9905263. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other surgical palliative care episodes here: https://behindtheknife.org/podcast-category/palliative-care/

How often are you drawn into your most ridiculous, joyful, vibrant, SINGING self? Do you include Taylor Swift music and the Barbie movie as part of your spiritual practice? This Methodist chaplain does! Meet Melissa Bortnick, mother of three, clinical spiritual expert, and pastor in training. Currently a chaplain fellow with the VA Puget Sound Health Care System, Melissa just finished a year of chaplaincy at Harborview Medical Center. (fun fact: this is the hospital in downtown Seattle that inspired the fictional Grey's Anatomy medical center.) Melissa also happens to be a girlhood friend of mine, who I haven't seen in decades! It's funny how some things (and people) never change. We're the same girls as always :-) Join us for a fun and meaningful conversation about how to take special care of your own spirit. Book Recommendations: Here are Melissa's top five! Strong and Weak: Embracing a Life of Love, Risk and True Flourishing Paperback February 12, 2016 by Andy Crouch    The Back Side of the Cross: An Atonement Theology for the Abused and Abandoned by Diane Leclerc , Brent Peterson, et al. | Jun 29, 2022 Holy Envy: Finding God in the Faith of Others by Barbara Brown Taylor  | Mar 24, 2020  Dare to Lead: Brave Work. Tough Conversations. Whole Hearts. Hardcover – October 9, 2018by Brené Brown Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others Paperback – May 4, 2009by Laura van Dernoot Lipsky (Author), Connie Burk   OUTLINE of this Episode Introduction Melissa Bortnick is a Clinical Spiritual Chaplain. She works with patients, families, and medical staff to provide spiritual care. Spiritual care is not limited to religious beliefs, but rather focuses on the whole person's well-being. Melissa believes that everyone has a spirit that needs to be cared for, regardless of their religious beliefs.   The Work of a Clinical Spiritual Resident Melissa's work as a chaplain is very diverse. She may be called to the bedside of a patient who is dying, to provide comfort and support to a family member who has just lost a loved one, or to simply sit with a patient who is feeling scared or alone. She also works with staff members who are dealing with the emotional and psychological stress of working in a hospital setting. Where Melissa works, spiritual care is integrated into the clinical support of each patient. They take a holistic view of  the patient's health and well-being. She says that it can help patients to feel more connected to themselves, to their loved ones, and to something larger than themselves. Spiritual care can help patients to cope with difficult emotions such as fear, anger, and grief.   Grief, Loss, Death...and the Importance of Finding Joy Melissa's work is challenging but also very rewarding. She is grateful for the opportunity to help people in their darkest moments. She also says that she is constantly learning and growing in her role as a chaplain. The episode ends with Melissa talking about the importance of finding joy in life, even after experiencing loss, and we talk a little bit about Internal Family Systems, a kind of therapy that acknowledges all of the different inner selves of each individual. She says that she finds joy in spending time with her family and friends, in doing things that she loves, in music (Taylor Swift concerts!) and in helping others. "That is the entire purpose of why we are here on Earth in the first place-- to constantly be moving towards being the fullest, most joyful, most exuberant and lively version of ourselves we can be." -Chaplain Melissa Bortnick   Please follow me on Instagram and TikTok @book_of_lifeyness Music Credit: William Claeson, "Song for a New Beginning"    

Ever wondered who's ultimately responsible for the homeless encampments cropping up on the steep terrains of Washington State's Department of Transportation land? Brace yourselves as we unravel the baffling bureaucracy that leaves city workers in a quandary over this gnarly issue. Drawing upon the firsthand account of Jeremy Harris- the reporter who brought to light the disturbing incident of an explosion at a homeless encampment sandwiched between Interstate 5 and Harborview Medical Center, we delve into the grim realities of the encampment lifestyle, marred by drug feuds and lethal explosions. Interesting to note, these fire-scorched encampments are being resurrected by the very residents that were victimized, leaving us to question the state's plan of action.As you join us in this riveting conversation, you'll gain insights into the state's stance on the issue and the viability of their proposed solutions. We spotlight a recent encampment fire, an incident that further cements the urgency for additional housing solutions. You'll be amazed at how the homeless and drug addicts have ingeniously established these encampments on a terrain as challenging as the steep slopes of the DOT land. So, tune in for an enlightening discussion that takes a hard, unfiltered look at the complex issue of homeless encampments and the pressing need for a robust resolution.Support the show

Picture a targeted attack, an explosion unfolding just steps away from a bustling hospital, right in the heart of Seattle. The scene: a homeless encampment, believed to be the battleground of a raging drug turf war. This is not the plot of a blockbuster movie, but the grim reality we're diving into today. We discuss the disturbing implications of this event, which happened on state property and shockingly close to Harborview Medical Center, and the concerning lack of urgency in the city and state's response.As we dissect the aftermath and the city's struggle to clear the encampment, we question the accountability of authorities and the desperate need for immediate action. We're bringing you exclusive on-the-ground accounts of the alarming return of tents, gas cans, propane tanks, and even a surveillance camera to the site. This episode serves as a stark reminder of the urban chaos lurking beneath the surface of our cities, and the resilience of those caught in the crossfire. Tune in as we shine a light on this unsettling story of city life, a powerful wake-up call for all of us.Support the show

David Boze in for Bryan Suits! There was an explosion at a homeless encampment near Harborview Medical Center, there has been significant criminal activity reported coming from this encampment. Seattle Police were met with resistance when responding to an illegal street race, people were jumping on police cars and throwing metal items at officers. // There are people rallying for Hunter Biden saying that this is not an important issue to be pursuing, President Joe Biden is caught in the middle. Hunter Biden's plea deal was put on hold, Hunter thought this plea deal would make him immune to potential future charges. Hunter Biden has now pleaded not guilty after going back on the proposed plea deal.  See omnystudio.com/listener for privacy information.

On this episode, Kash and Pete are joined by Marc Swiontkowski, editor of the JBJS and legend of orthopaedics!0:00 intro5:22 Chip Routt14:20 Marc's Residency17:30 Common Operations During Residency 22:05 Problem Factors24:35 Memorable Operations26:30 JBJS48:15 Pay to Publish53:00 What do you value?56:00 Delivering Trials59:00 Predictions 1:09:50 Rehab 1:11:01 Mohit Bhandari1:13:20 Leadership 1:20:00 Mentors 1:22:00 What's Next?Dr. Swiontkowski is a professor in the Department of Orthopedic Surgery. He specialises in trauma, fractures, non-unions, malunions, children's fractures, osteomyelitis, and leg length inequality.Dr. Swiontkowski received his medical degree from the University of Southern California School of Medicine. He completed his internship and residency training at the University of Washington, then went to Davos, Switzerland where he completed a research fellowship at the Laboratory for Experimental Surgery.He began his work as Associate Professor at the Vanderbilt University where he helped establish the state of Tennesee's first level one trauma centre. Dr. Swiontkowski then moved to the University of Washington as Professor of Orthopaedic Surgery and Chief of Orthopaedic Surgery, Harborview Medical Center in Seattle, Washington from 1988-1997. From September 1997 through October 2007, he held the position of Professor and Chairman of the Department of Orthopaedic Surgery at the University of Minnesota.Since then, Dr. Swiontkowski has held the position of Professor in the Department of Orthopaedic Surgery at the University of Minnesota and was CEO of TRIA Orthopaedic Center in Bloomington, MN from 2007- 2015. He now holds the roles of Editor-in-Chief of the Journal of Bone and Joint Surgery (JBJS) and continues as a Professor at the University of Minnesota.He has received many honours nationally and internationally throughout his celebrated career, especially for his research and clinical achievements. Some of these include:Board of Directors Mid America Orthopaedic AssociationPast president of the American Orthopaedic Association and Orthopaedic Trauma AssociationDirector Emeritus of the American Board of Orthopaedic Surgery and American Board of Medical SpecialtiesEditor-in-Chief of the Journal of Bone and Joint SurgeryThis is a very informative and enjoyable podcast for all who are fans of Marc's work, as well as for those who are discovering him for the first time.Be sure to follow orthohub on all social media platforms:https://orthohub.xyz/https://www.facebook.com/orthohub.xyzhttps://www.instagram.com/orthohubxyz/https://www.linkedin.com/company/orthohub/https://twitter.com/OrthohubXYZ#orthopaedicsurgeons #orthopedics #health #orthopedic

GUEST: Dr. Susan Collins--a licensed clinical psychologist and Associate Professor at Washington State University. She's co-directer of the Harm Reduction Research and Treatment Center at UW Medicine

Thurston County Sheriff Derek Sanders is back on the job after being airlifted to Harborview Medical Center on April 2nd in the wake of serious collision; Police in Des Moines have arrested a man they accuse of vandalizing several businesses and homes Thursday morning; Tacoma police have announced several arrests linked to multiple armed robberies and assaults across the Puget Sound region // Phillies' Fans Throw Hot Dogs & Trash at Each Other During Dollar Dog Night at Citizen's Bank Park // Property taxes could be going up significantly under a last-minute bill introduced yesterday in Olympia // Biden admin grants $350K in taxpayer money to translate the "Homosaurus" into Spanish; Lars Larson joins John to discuss the details // The federal judge who ruled against Joe Kennedy - - the Bremerton "praying coach" - - says he was "delighted" when the U-S Supreme Court reversed his decision; Washington's ban on the sale of AR-15s and 59 other guns will likely be tested in the U-S Supreme Court: That's what a recently retired federal judge from our state is saying // Fed up by LA pothole, Arnold Schwarzenegger fills it himself // Climate change is affecting baseball home runs, study says - Steve Moore joins John to discuss the details // Asian Americans are the best educated and highest income racial group in the U.S., yet increasingly, they're not treated like other minorities. This week on Full Measure. Sharyl Attkisson joins John to discuss // Randy Pepple joins John to discuss the latest going on in the legislative session // Lower-income renters have less residual income than ever before // Mary Quant, the Sixties fashion trailblazer and miniskirt maverick, dies aged 93; Why People Are Fleeing Blue Cities for Red States // Sen. Tim Scott Announces First Step Of 2024 Presidential Run

Kimmy Siebens understands what it takes to be a nurse and the sacrifices one must go through in order to do her job. But, going above and beyond her work responsibilities, Siebens strives to make sure everyone, housed or unhoused, has access to the care they need. Her work is helping save lives and she is speaking up on behalf of those who can't. See omnystudio.com/listener for privacy information.

In the evening of October 19th, a series of gunshots startled the residents of the 1100 block of Martin Luther King Jr. Way. When police arrived shortly after, D'Vonne Pickett Jr. was lying on the ground with multiple gunshot wounds. He was rushed to Harborview Medical Center, where he later died of his injuries. D'Vonne Pickett Jr. and his wife Keanna are familiar faces throughout the Central District community. When the USPS closed its office in the CD, the two founded The Postman, a shipping and mailing business. In a statement, Mayor Bruce Harrell said that D'Vonne was known for his kindness, determination, and passion for uplifting the Seattle community.

On this episode of Through the Human Geography Lens, hosts Gwyneth Holt and Eric Rasmussen talk with Clare Jones, Chief Commercial Officer at What3Words. What3Words is an alternative geospatial coordinate system based on a remarkable bit of computational wizardry. Using a supercomputer and a clever algorithm, W3W has divided the entire surface of the planet into 3 meter x 3 meter squares and named each square using 3 common words. For example, atomic.chairs.talent identifies the walk-in door into the Emergency Department at Harborview Medical Center in Seattle. The app is free for personal use. More information is available at https://what3words.com/ 00:50 What is What3Words and why is a new coordinate system important? 03:00 How can ordinary people use W3W? 04:15 The appearance of physical signs displaying W3W addresses on walls. 04:30 How does W3W handle languages? 06:05 How is W3W used by emergency services? 08:45 Many words sound similar (e.g. copy and coffee), and a plural "s" is easy to miss. How does W3W handle that potential confusion? 09:35 Mongolia, with a nomadic population, chose to use W3W as their national addressing system. How has that gone? 11:15 Discussing the human security aspect of W3W coordinate simplification, including saving lives in Afghanistan during the evacuation. 14:15 The use of W3W in slums, in rural medical care, in refugee camps, and in disaster response. 15:25 The use of W3W on a small island within Kwajalein Atoll in the remote Pacific. 17:15 What are the objections to W3W? 19:30 What do you see for the future of W3W? 20:05 W3W wants to solve describing coordinates in the vertical dimension: How can W3W describe height? 22:00 W3W business model: Free for individuals and NGOs, and fee-for-service or a subscription model for businesses. Disclaimer: Opinions expressed on this podcast do not necessarily reflect the views of the WWHGD sponsors and should not be construed as an endorsement. --- Send in a voice message: https://anchor.fm/wwhgd-support/message

Harborview Medical Center is turning away all non-urgent patients, and has been for more than a week. The hospital is at 130 percent of its capacity. One big reason: staffing, both at the hospital and in other parts of the healthcare system.Dr. Steve Mitchell, medical director of Harborview's emergency department, explains what's going on and how the hospital is adapting. We also hear from nurse Nicole Johnson on burnout among frontline healthcare workers. We want to hear from you! Follow us on Instagram at SeattleNowPod, or leave us feedback online: https://www.kuow.org/feedback

Good Monday everyone, this is Garrison Hardie with your CrossPolitic Daily News Brief for Monday, August 15th, 2022. FLF Conference Plug: Folks, our upcoming Fight Laugh Feast Conference is just 2-months away from happening in Knoxville TN, October 6-8! Don't miss beer & psalms, our amazing lineup of speakers which includes George Gilder, Jared Longshore, Pastor Wilson, Dr. Ben Merkle, Pastor Toby, and we can’t say yet…also dont miss our awesome vendors, meeting new friends, and stuff for the kids too…like jumpy castles and accidental infant baptisms! Also, did you know, you can save money, by signing up for a Club Membership. So, go to FightLaughFeast.com and sign up for a club membership and then register for the conference with that club discount. We can’t wait to fellowship, sing Psalms, and celebrate God’s goodness in Knoxville October 6-8. Now, here’s what you may have missed over the weekend: https://www.foxnews.com/politics/idaho-supreme-court-abortion-bans-will-be-allowed-challenges Idaho Supreme Court: Abortion bans will be allowed to take effect amid challenges The Idaho Supreme Court ruled Friday that strict abortion bans will be allowed to take effect. The ruling comes as legal challenges over the laws continue and the court sped up the timeline for lawsuits to be decided. Two justices agreed with expediting the cases, but noted that they felt laws should not be enforced until the legal process has been completed. A doctor and a regional Planned Parenthood sued Idaho over three anti-abortion laws. The Justice Department is also suing Idaho in federal court over a near-total abortion ban; the judge has not yet ruled in that case. The state Supreme Court's ruling means that potential relatives of an embryo or fetus can now sue abortion providers over procedures done after six weeks of gestation and another stricter ban criminalizing all abortions is slated for later in August. Potential relatives can sue for up to $20,000 within four years of an abortion. On Aug. 25, per the Idaho Supreme Court's decision, a near-total criminalizing of all abortions – still allowing doctors to defend themselves at trial by claiming the abortion was done to save the pregnant person’s life – will take effect. Planned Parenthood has also sued over a third ban that criminalizes abortions done after six weeks of gestation except in cases where it was needed to save a pregnant person’s life or done because of rape or incest. That law was written to take effect on Aug. 19. The Supreme Court said the plaintiffs both failed to show that allowing enforcement of the laws would cause "irreparable harm" and that there was not enough evidence that they had a "clear right" to a remedy. This ruling comes as other states face similar challenges following the U.S. Supreme Court's decision to overturn Roe v. Wade. In nearby Wyoming, a judge blocked the state's near-total ban on Wednesday. The Louisiana Supreme Court on Friday denied an appeal filed by plaintiffs, allowing the ban there to stay in effect. In Kansas, the elections director said the state would go along with a request for a hand recount of votes from every county after last week's decisive statewide vote affirming abortion rights. https://hotair.com/karen-townsend/2022/08/13/monkeypox-is-getting-a-new-name-because-the-who-says-the-name-is-racist-n489435 Monkeypox is getting a new name because the WHO says the name is racist Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, met with scientists this week to discuss best naming practices for diseases. The focus is to avoid offending any “ethnic, social, or professional groups and minimize harm to trade, travel, tourism, or animals.” Monkeypox is at the top of the agenda to receive a new name. Two clades (variants) of the disease have already been given new names. The WHO released a statement on Friday announcing the new names of two variants of monkeypox. Using Roman numerals instead of geographic areas, the Congo Basin variant is now Clade one or 1 and the West Africa clade is Clade two or II. This is to avoid stigmatization. Is all of this political correctness run amok? It looks like it. Who are they afraid of offending? Monkeys? Africans from the Congo or West Africa? Other diseases are named using geographic locations and they aren’t being renamed. It’s like the coronavirus that came from Wuhan, China. No one was supposed to call it the Wuhan virus because it might offend Communist Chinese leaders. Monkeypox has been around since 1958. The world’s population has managed to live with that name since then. It was a commonsense name at the time – research monkeys in Denmark were observed to have a pox-like disease. Monkeys are not thought to be the animal reservoir. Now that it is spreading globally and health experts are beginning to panic, calling it a health emergency, suddenly the virus needs a new name. The WHO declared the disease an international emergency in July. The U.S. declared its epidemic a national emergency this month. Before that, back in May, Sleepy Joe was pushing the panic button and telling Americans that “everybody” should be concerned about monkeypox. The first human case of monkeypox was reported in the Democratic Republic of the Congo in 1970, thus the name of that variant. The WHO is now reporting that it held an open forum to discuss a name change for the disease after a group of 30 scientists from Africa warned of an “urgent need” to change the name. It has a stigmatizing potential, they said. The virus has been reported in several other African countries and abroad. The Western outbreak began in May in the U.K., Portugal, and Spain. It has spread to the U.S., Canada, France, and Germany. Scientists are concerned about racist connotations and also stigma for the LGBTQ community. There have also been attacks on and poisoning of monkeys. I think there is an urgent need to alert gay men of how monkeypox spreads. Outside of Africa, 98% of cases are men who have sex with men. There is a limited global supply of vaccines. Health officials are rushing to stop monkeypox from becoming entrenched as a new disease. There’s been a lot of tippy-toeing around that fact out of fear of offending gay men. It isn’t exclusively gay men, it’s also bisexual men who have sex with women. Anyone can get it. Even children can get monkeypox from skin-to-skin contact. It is, however, stoppable. Scientists know how it is spread and how to stop it. If Team Biden has declared monkeypox a national emergency, why hasn’t he ramped up vaccine production. There’s a shortage. The longer the virus hangs around and spreads, the more likely it produces variants, like what happened during the coronavirus pandemic. It gets more contagious. The Biden administration continues to prove how inept it is in dealing with emergencies. Where are the public service announcements targeting the communities most at risk? Biden seems to be asleep at the wheel once again. Call the virus anything they want, more education and outreach is needed. Treat it like other STDs. Don’t ignore it and hope it goes away. Name changes are just window dressing, politically correct window dressing. Boniface Woodworking LLC: Boniface Woodworking exists for those who enjoy shopping with integrity; who want to buy handmade wooden furniture, gifts, and heirloom items that will last for generations. From dining tables and church pulpits to cigar humidors and everything in between; quality pieces that you can give your children’s children, tie them to their roots, and transcend the basic function of whatever they are! So, start voting with your dollars, and stop buying cheap crap from people who hate you! Visit www.bonifacewoodworking.com to see our gallery, learn our story, and submit your order for heirloom quality wood items. https://thepostmillennial.com/seattle-hospital-over-130-percent-capacity-no-longer-admitting-non-emergency-patients?utm_campaign=64487 Seattle hospital over 130 percent capacity, no longer admitting non-emergency patients Harborview Medical Center in Seattle announced Thursday that the facility is over capacity by approximately 150 patients, and will have to temporarily stop admitting patients with less acute conditions, diverting people to other facilities for treatment. The hospital’s licensed capacity is 413 but has more than 560 inpatients, meaning that capacity is over 130 percent. Other area hospitals report ready and willing to work with the medical center which all said they could "surge" to accommodate additional patients. According to a release from the hospital, there are also over 100 patients who are waiting to be discharged. Harborview CEO Sommer Kleweno Walley said, "Given the unique position Harborview has in the community as the level 1 trauma center, as the disaster center, and here for all critical illness, we had to make a very difficult decision today - one that has been weighing on our minds as UW Medicine leadership." "In order to ensure that we maintain our critical capacity for any type of trauma that is needed in our region and for any type of critical illness, we have moved to going on what we call 'basic life support divert.' Patients not in need of more urgent care will be needed to be taken care of and brought by ambulances to other hospitals surrounding Harborview in the area. Harborview for this time period will no longer be able to take care of the less acute patients in order to maintain our capacity." "In order to ensure that we maintain our critical capacity for any type of trauma that is needed in our region and for any type of critical illness, we have moved to going on what we call basic life support divert," Walley said. Dr. Steve Mitchell, acting medical director of Harborview Medical Center, said "What has been happening is that when ambulances arrive at Emergency Departments, they are unable to offload patients into beds inside the Emergency Department and they're having to wait for longer and longer periods of time, sometimes for hours, which is then impacting their ability to serve their communities for emergencies when they occur." According to an internal email obtained by the Postmillenial: "Harborview is currently at 130% capacity. Factors include the lack of staffing at nursing/rehab facilities that would normally receive patients needing that level of care. That is creating a backlog of patients in the emergency department, impacting Harborview’s ability to receive additional non-critical patients." Medical facilities in Washington state have been suffering from a staffing crisis following a Covid vaccine mandate that was enacted by Democrat Governor Jay Inslee for state and hospital workers. Earlier this week, the Yakima Board of Health sent a letter to Inslee asking him to rescind the vaccine mandate. County Commissioner Amanda McKinney criticized Proclamation 21-14.5, which requires employees, volunteers, and contractors for state agencies, schools, and health care organizations to be vaccinated against the coronavirus. Last Friday, Inslee removed the requirement for boosters but left the vaccine mandate in place following negotiations with labor unions. According to a survey conducted by the Washington State Hospital Association this year, hospitals in the state suffered a net loss of about $929 million in the first three months of 2022, due in part to high inflation and labor shortages, which have resulted in labor, drug and supply cost increasing faster than payment rates. https://nypost.com/2022/08/12/fernando-tatis-jr-suspended-80-games-for-violating-mlb-ped-policy/ Fernando Tatis Jr. suspended 80 games for violating MLB PED policy The Padres will be without Fernando Tatis Jr. for the rest of the season. Tatis Jr. tested positive for Clostebol, and will be suspended for 80 games. The news of the suspension was first reported by ESPN’s Jeff Passan. “I’ve been informed by Major League Baseball that a test sample I submitted returned a positive result for Clostebol, a banned substance,” Tatis Jr. said in a statement, through the MLBPA. “It turns out that I inadvertently took a medication to treat ringworm that contained Clostebol. I should have used the resources available to me in order to ensure that no banned substances were in what I took. I failed to do so. “I want to apologize to Peter, AJ, the entire Padres organization, my teammates, Major League Baseball, and fans everywhere for my mistake. I have no excuse for my error, and I would never do anything to cheat or disrespect the game I love.” The 23-year-old phenom had missed the entire season due to a fractured wrist but had been expected to return soon. This is a blow to the Padres, who went all in trading a haul of highly-ranked prospects to the Nationals for superstar outfielder Juan Soto and formidable first baseman Josh Bell. The Padres are 63-51. While they trail the Dodgers by 16 games in the NL West, they would qualify for the postseason as a Wild Card team if the playoffs started today. Tatis Jr. signed a 14-year, $340 million contract with the Padres last February. This has been your CrossPolitic Daily News Brief. If you liked the show, hit that share button down below. If you wanted to sign up for our conference, sign up for a club membership, or sign up for a magazine subscription, you can do all of that at fightlaughfeast.com. And as always, if you’d like to send me a news story, ask about our conference, or become a corporate partner of CrossPolitic, email me, at garrison@fightlaughfeast.com. For CrossPolitic News, I’m Garrison Hardie. Have a great day, and Lord bless.

Good Monday everyone, this is Garrison Hardie with your CrossPolitic Daily News Brief for Monday, August 15th, 2022. FLF Conference Plug: Folks, our upcoming Fight Laugh Feast Conference is just 2-months away from happening in Knoxville TN, October 6-8! Don't miss beer & psalms, our amazing lineup of speakers which includes George Gilder, Jared Longshore, Pastor Wilson, Dr. Ben Merkle, Pastor Toby, and we can’t say yet…also dont miss our awesome vendors, meeting new friends, and stuff for the kids too…like jumpy castles and accidental infant baptisms! Also, did you know, you can save money, by signing up for a Club Membership. So, go to FightLaughFeast.com and sign up for a club membership and then register for the conference with that club discount. We can’t wait to fellowship, sing Psalms, and celebrate God’s goodness in Knoxville October 6-8. Now, here’s what you may have missed over the weekend: https://www.foxnews.com/politics/idaho-supreme-court-abortion-bans-will-be-allowed-challenges Idaho Supreme Court: Abortion bans will be allowed to take effect amid challenges The Idaho Supreme Court ruled Friday that strict abortion bans will be allowed to take effect. The ruling comes as legal challenges over the laws continue and the court sped up the timeline for lawsuits to be decided. Two justices agreed with expediting the cases, but noted that they felt laws should not be enforced until the legal process has been completed. A doctor and a regional Planned Parenthood sued Idaho over three anti-abortion laws. The Justice Department is also suing Idaho in federal court over a near-total abortion ban; the judge has not yet ruled in that case. The state Supreme Court's ruling means that potential relatives of an embryo or fetus can now sue abortion providers over procedures done after six weeks of gestation and another stricter ban criminalizing all abortions is slated for later in August. Potential relatives can sue for up to $20,000 within four years of an abortion. On Aug. 25, per the Idaho Supreme Court's decision, a near-total criminalizing of all abortions – still allowing doctors to defend themselves at trial by claiming the abortion was done to save the pregnant person’s life – will take effect. Planned Parenthood has also sued over a third ban that criminalizes abortions done after six weeks of gestation except in cases where it was needed to save a pregnant person’s life or done because of rape or incest. That law was written to take effect on Aug. 19. The Supreme Court said the plaintiffs both failed to show that allowing enforcement of the laws would cause "irreparable harm" and that there was not enough evidence that they had a "clear right" to a remedy. This ruling comes as other states face similar challenges following the U.S. Supreme Court's decision to overturn Roe v. Wade. In nearby Wyoming, a judge blocked the state's near-total ban on Wednesday. The Louisiana Supreme Court on Friday denied an appeal filed by plaintiffs, allowing the ban there to stay in effect. In Kansas, the elections director said the state would go along with a request for a hand recount of votes from every county after last week's decisive statewide vote affirming abortion rights. https://hotair.com/karen-townsend/2022/08/13/monkeypox-is-getting-a-new-name-because-the-who-says-the-name-is-racist-n489435 Monkeypox is getting a new name because the WHO says the name is racist Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, met with scientists this week to discuss best naming practices for diseases. The focus is to avoid offending any “ethnic, social, or professional groups and minimize harm to trade, travel, tourism, or animals.” Monkeypox is at the top of the agenda to receive a new name. Two clades (variants) of the disease have already been given new names. The WHO released a statement on Friday announcing the new names of two variants of monkeypox. Using Roman numerals instead of geographic areas, the Congo Basin variant is now Clade one or 1 and the West Africa clade is Clade two or II. This is to avoid stigmatization. Is all of this political correctness run amok? It looks like it. Who are they afraid of offending? Monkeys? Africans from the Congo or West Africa? Other diseases are named using geographic locations and they aren’t being renamed. It’s like the coronavirus that came from Wuhan, China. No one was supposed to call it the Wuhan virus because it might offend Communist Chinese leaders. Monkeypox has been around since 1958. The world’s population has managed to live with that name since then. It was a commonsense name at the time – research monkeys in Denmark were observed to have a pox-like disease. Monkeys are not thought to be the animal reservoir. Now that it is spreading globally and health experts are beginning to panic, calling it a health emergency, suddenly the virus needs a new name. The WHO declared the disease an international emergency in July. The U.S. declared its epidemic a national emergency this month. Before that, back in May, Sleepy Joe was pushing the panic button and telling Americans that “everybody” should be concerned about monkeypox. The first human case of monkeypox was reported in the Democratic Republic of the Congo in 1970, thus the name of that variant. The WHO is now reporting that it held an open forum to discuss a name change for the disease after a group of 30 scientists from Africa warned of an “urgent need” to change the name. It has a stigmatizing potential, they said. The virus has been reported in several other African countries and abroad. The Western outbreak began in May in the U.K., Portugal, and Spain. It has spread to the U.S., Canada, France, and Germany. Scientists are concerned about racist connotations and also stigma for the LGBTQ community. There have also been attacks on and poisoning of monkeys. I think there is an urgent need to alert gay men of how monkeypox spreads. Outside of Africa, 98% of cases are men who have sex with men. There is a limited global supply of vaccines. Health officials are rushing to stop monkeypox from becoming entrenched as a new disease. There’s been a lot of tippy-toeing around that fact out of fear of offending gay men. It isn’t exclusively gay men, it’s also bisexual men who have sex with women. Anyone can get it. Even children can get monkeypox from skin-to-skin contact. It is, however, stoppable. Scientists know how it is spread and how to stop it. If Team Biden has declared monkeypox a national emergency, why hasn’t he ramped up vaccine production. There’s a shortage. The longer the virus hangs around and spreads, the more likely it produces variants, like what happened during the coronavirus pandemic. It gets more contagious. The Biden administration continues to prove how inept it is in dealing with emergencies. Where are the public service announcements targeting the communities most at risk? Biden seems to be asleep at the wheel once again. Call the virus anything they want, more education and outreach is needed. Treat it like other STDs. Don’t ignore it and hope it goes away. Name changes are just window dressing, politically correct window dressing. Boniface Woodworking LLC: Boniface Woodworking exists for those who enjoy shopping with integrity; who want to buy handmade wooden furniture, gifts, and heirloom items that will last for generations. From dining tables and church pulpits to cigar humidors and everything in between; quality pieces that you can give your children’s children, tie them to their roots, and transcend the basic function of whatever they are! So, start voting with your dollars, and stop buying cheap crap from people who hate you! Visit www.bonifacewoodworking.com to see our gallery, learn our story, and submit your order for heirloom quality wood items. https://thepostmillennial.com/seattle-hospital-over-130-percent-capacity-no-longer-admitting-non-emergency-patients?utm_campaign=64487 Seattle hospital over 130 percent capacity, no longer admitting non-emergency patients Harborview Medical Center in Seattle announced Thursday that the facility is over capacity by approximately 150 patients, and will have to temporarily stop admitting patients with less acute conditions, diverting people to other facilities for treatment. The hospital’s licensed capacity is 413 but has more than 560 inpatients, meaning that capacity is over 130 percent. Other area hospitals report ready and willing to work with the medical center which all said they could "surge" to accommodate additional patients. According to a release from the hospital, there are also over 100 patients who are waiting to be discharged. Harborview CEO Sommer Kleweno Walley said, "Given the unique position Harborview has in the community as the level 1 trauma center, as the disaster center, and here for all critical illness, we had to make a very difficult decision today - one that has been weighing on our minds as UW Medicine leadership." "In order to ensure that we maintain our critical capacity for any type of trauma that is needed in our region and for any type of critical illness, we have moved to going on what we call 'basic life support divert.' Patients not in need of more urgent care will be needed to be taken care of and brought by ambulances to other hospitals surrounding Harborview in the area. Harborview for this time period will no longer be able to take care of the less acute patients in order to maintain our capacity." "In order to ensure that we maintain our critical capacity for any type of trauma that is needed in our region and for any type of critical illness, we have moved to going on what we call basic life support divert," Walley said. Dr. Steve Mitchell, acting medical director of Harborview Medical Center, said "What has been happening is that when ambulances arrive at Emergency Departments, they are unable to offload patients into beds inside the Emergency Department and they're having to wait for longer and longer periods of time, sometimes for hours, which is then impacting their ability to serve their communities for emergencies when they occur." According to an internal email obtained by the Postmillenial: "Harborview is currently at 130% capacity. Factors include the lack of staffing at nursing/rehab facilities that would normally receive patients needing that level of care. That is creating a backlog of patients in the emergency department, impacting Harborview’s ability to receive additional non-critical patients." Medical facilities in Washington state have been suffering from a staffing crisis following a Covid vaccine mandate that was enacted by Democrat Governor Jay Inslee for state and hospital workers. Earlier this week, the Yakima Board of Health sent a letter to Inslee asking him to rescind the vaccine mandate. County Commissioner Amanda McKinney criticized Proclamation 21-14.5, which requires employees, volunteers, and contractors for state agencies, schools, and health care organizations to be vaccinated against the coronavirus. Last Friday, Inslee removed the requirement for boosters but left the vaccine mandate in place following negotiations with labor unions. According to a survey conducted by the Washington State Hospital Association this year, hospitals in the state suffered a net loss of about $929 million in the first three months of 2022, due in part to high inflation and labor shortages, which have resulted in labor, drug and supply cost increasing faster than payment rates. https://nypost.com/2022/08/12/fernando-tatis-jr-suspended-80-games-for-violating-mlb-ped-policy/ Fernando Tatis Jr. suspended 80 games for violating MLB PED policy The Padres will be without Fernando Tatis Jr. for the rest of the season. Tatis Jr. tested positive for Clostebol, and will be suspended for 80 games. The news of the suspension was first reported by ESPN’s Jeff Passan. “I’ve been informed by Major League Baseball that a test sample I submitted returned a positive result for Clostebol, a banned substance,” Tatis Jr. said in a statement, through the MLBPA. “It turns out that I inadvertently took a medication to treat ringworm that contained Clostebol. I should have used the resources available to me in order to ensure that no banned substances were in what I took. I failed to do so. “I want to apologize to Peter, AJ, the entire Padres organization, my teammates, Major League Baseball, and fans everywhere for my mistake. I have no excuse for my error, and I would never do anything to cheat or disrespect the game I love.” The 23-year-old phenom had missed the entire season due to a fractured wrist but had been expected to return soon. This is a blow to the Padres, who went all in trading a haul of highly-ranked prospects to the Nationals for superstar outfielder Juan Soto and formidable first baseman Josh Bell. The Padres are 63-51. While they trail the Dodgers by 16 games in the NL West, they would qualify for the postseason as a Wild Card team if the playoffs started today. Tatis Jr. signed a 14-year, $340 million contract with the Padres last February. This has been your CrossPolitic Daily News Brief. If you liked the show, hit that share button down below. If you wanted to sign up for our conference, sign up for a club membership, or sign up for a magazine subscription, you can do all of that at fightlaughfeast.com. And as always, if you’d like to send me a news story, ask about our conference, or become a corporate partner of CrossPolitic, email me, at garrison@fightlaughfeast.com. For CrossPolitic News, I’m Garrison Hardie. Have a great day, and Lord bless.

Ever wonder what happens to your blood once you donate? Well, as Bloodworks 101 producer John Yeager found out, sometimes it goes to the front line where seconds count in the battle between life and death.Today, in the first of a special two-part series about Transfusions in the Field, you'll meet Dr. Michael Sayre from Seattle's Harborview Medical Center who plays a crucial role in making sure your blood get to where it needs to be.