Podcasts about icus

In this episode of the Healthy, Wealthy, and Smart Podcast, host Dr. Karen Litzy welcomes Campbell Will, an integrative physiotherapist and breathwork educator, to discuss the significant impact of breath on health and performance. Campbell shares his journey from traditional physiotherapy to specializing in breath work, highlighting the role of proper breathing in enhancing performance and reducing stress. He emphasizes the importance of shifting the focus from disease to health and how breath can serve as a powerful tool for achieving balance and well-being. Tune in to discover valuable insights on how breathwork can transform your approach to health and self-regulation. Time Stamps:  [00:02:19] Importance of breath in health. [00:06:13] Defining breathwork and its impact. [00:06:54] Breathwork and nervous system health. [00:10:03] Breathing and emotional state. [00:13:45] Breathing's impact on health. [00:18:01] Dysfunctional breathing effects. [00:20:59] Dysfunctional breathing and posture. [00:26:01] Breathwork and assessment importance. [00:29:47] Breathing as a present anchor. [00:31:41] Nervous system and breathwork. [00:34:18] Nervous system's role in healing. [00:39:15] Breath awareness and self-empowerment. [00:41:40] Awareness as a foundational piece. [00:45:03] Vulnerability in professional practice.   More About Campbell Will: Campbell Will is an integrative physiotherapist with a primary focus on the role of the breath on human health and performance. His experience spans ICUs, neurosurgical wards, elite athletes and private practice. Across this spread of clinical settings he noticed a widely unaddressed commonality; breathing. When done correctly, it elevates and enhances performance. When done poorly, it drives dysfunction.  Campbell utilises his diverse background and experience to help practitioners shift their focus from disease and dysfunction to health, happiness and freedom. His holistic, multidisciplinary approach focuses on restoring balance to body, mind, emotions and energy. Campbell views the breath as a tool accessible to all, providing the foundation for optimal health and well-being. Resources from this Episode: Campbell's Website Campbell on Instagram Free Gift: Fundamentals of Breath : A Self Paced Breath Correction Program (coupon BREATHE20 for 20% off)   Jane Sponsorship Information:   Book a one-on-one demo here Mention the code LITZY1MO for a free month   Follow Dr. Karen Litzy on Social Media: Karen's Twitter Karen's Instagram Karen's LinkedIn Subscribe to Healthy, Wealthy & Smart: YouTube Website Apple Podcast Spotify SoundCloud Stitcher iHeart Radio

Support the show:https://www.paypal.me/Truelifepodcast?locale.x=en_USBuy Grow kit: https://modernmushroomcultivation.com/This Band willl Blow your Mind! Codex Serafini: https://codexserafini.bandcamp.com/album/the-imprecation-of-animaThere are moments in our lives when the veil lifts—when the illusions fall away and what remains is truth, raw and unfiltered. It is in these moments that we are called to choose: to turn back into the shadows of familiarity, or to walk forward into the fire of awakening. Today, you're about to meet two people who have not only walked that path—but have become guides for those ready to burn away what no longer serves and to stand in the flame of their own becoming.Patrick and Michele Fishley are the founders of Soul Reflections, the world's first global online Iboga/Ibogaine community—a sanctuary for practitioners, providers, seekers, and visionaries alike. But their story isn't just digital—it's deeply spiritual, rooted in blood, bone, and ancient tradition. They are Ngangas—healers and seers—initiated into the sacred Bwiti traditions of Gabon, recognized by the elders themselves, not just for their knowledge, but for their courage, their humility, and their relentless commitment to truth.Patrick, known in the Bwiti tradition as DIBADI Mabunza Mukuku a Kandja—the warrior with the Bwete force and flames of truth from his mouth—is a Registered Nurse with over three decades of experience in Emergency Rooms, ICUs, and trauma bays. A Medical Director and lead facilitator, he has guided over 1,500 Iboga journeys with a perfect safety record. His work bridges the primal and the clinical, the ancestral and the modern.Michele, known as Yakéta—Mother of Twins, Mother of All—is a Licensed Practical Nurse and a transformational integration coach with over 18 years of acute care experience. She is a fierce and nurturing presence in the space, initiated into the sacred feminine lineages of the Nyèmbè and Mabundi traditions. Michele brings the power of the mother, the healer, and the spiritual midwife into every ceremony, retreat, and conversation.Together, Patrick and Michele have turned their lives into a living ceremony. They carry the medicine not just in their hands, but in their hearts. Through their annual pilgrimages to Gabon, they continue to deepen their commitment to the Bwiti traditions—honoring the land, the elders, and the sacred fire of Iboga.Their mission is simple yet profound: to weave ancient wisdom with modern healing, to create safe, soul-rooted spaces for transformation, and to remind us that real healing is not a transaction—it is a sacred initiation.So if you're ready to hear from two of the most grounded, experienced, and spiritually aligned voices in the Iboga space… buckle up. This conversation isn't just a discussion—it's a portal.https://soulreflections.net/ Support the show:https://www.paypal.me/Truelifepodcast?locale.x=en_USCheck out our YouTube:https://youtube.com/playlist?list=PLPzfOaFtA1hF8UhnuvOQnTgKcIYPI9Ni9&si=Jgg9ATGwzhzdmjkgGrow your own:https://modernmushroomcultivation.com/This Band Will Blow Your Mind: Codex Serafinihttps://codexserafini.bandcamp.com/album/the-imprecation-of-anima

Our main focus today was on nudging critical care clinicians to consider a more palliative approach to care.  Our guests are all trained in critical care: Kate Courtright, Scott Halpern, and Jaspal Singh.  Kate and Scott have additional training in palliative medicine.  To start. we review: What is a nudge? Also called behavioral interventions, heuristics, and cognitive biases. Prior podcasts on the ethics of nudging, and a different trial conducted by Kate and Scott in which the default for hospitalized seriously ill patients was to receive a palliative care consult. What is sludge?  I'd never heard the term, perhaps outside of Eric's pejorative reference to my coffee after adding copious creamers, flavoring, and sweeteners.  Sludge is apparently when you create barriers or extra work for someone.  For example, putting the healthy food at the back of the grocery store is sludge; making an applicant for health insurance climb the flight of stairs to the office - weeding out those less fit - is also sludge.  Prior-auth forms? Sludge. Examples of nudges, some based in health care, others in coffee.  This specific study, published in JAMA Internal Medicine, was conducted in 17 ICUs in North Carolina. Many were community hospitals.  Participants were critically ill and intubated.  Clinicians were randomized to 4 groups: Usual care Prognosis nudge - EHR prompt asking, do you think your patient will be alive in 6 months? This is called a focusing effect Comfort care nudge - EHR prompt asking if they'd offered comfort-focused care. This is called accountable justification - an appeal to standards of care for critically ill patients endorsed by multiple professional societies. Both the prognosis and comfort care nudge. A few key points of discussion: Is an EHR prompt a nudge or sludge?   The intervention was a negative study for the primary outcome, hospital length of stay.  Why?  The prognosis nudge did nothing.  What to make of that? Would you think an EHR nudge to consider prognosis might move the needle, at least on some outcomes? The nudge toward offering comfort care led to more hospice and early comfort-care orders.  Is this due to chance alone, given the multiplicity of secondary outcomes examined?  Or is it a tantalizing finding that suggests a remarkably low cost EHR based nudge might, on a population level, lead to critical care clinicians offering comfort care and hospice more frequently?  Imagine!    -Alex Smith  

The World Federation of Pediatric Intensive & Critical Care Societies (WFPICCS), in collaboration with OPENPediatrics, recognizes World PICU Awareness Week 2025. This initiative aims to raise global awareness about the importance of PICUs and critical care wards worldwide, emphasizing how healthcare professionals in these units, regardless of resource setting, are driving change. From managing infectious diseases to overcoming infrastructure challenges, this episode explores the resilience and innovation in pediatric intensive care across Sub-Saharan Africa. Hear from frontline experts in Sierra Leone, the Democratic Republic of Congo, and Madagascar as they share their experiences in providing critical care amidst epidemics, conflicts, and climate change. Discover how dedicated healthcare professionals are transforming outcomes for children in some of the most challenging environments. HOST Hans-Joerg Lang, MD, PhD, FRCPCH NGO Alliance for International Medical Action (ALIMA), Dakar Heidelberg Institute of Global Health, Germany GUESTS Archippe Muhandule Birindwa, MD, PhD Medical Director at Cliniques Universitaires de Bukavu Head of Department of Pediatrics at Université Officielle de Bukavu Pediatrics Lecturer at Institut Supérieur de Technique Médicale Democratic Republic of the Congo Diavolana Koecher, MD Professor at the University of Mahajanga Madagascar Marah Issiatu, RN, SCM, MSN Senior Nurse Specialist at JMB-PCE hospital Nursing Officer at JMB-PCE hospital Sierra Leone DATE Initial publication date: May 9, 2025. TRANSCRIPTS English - https://cdn.bfldr.com/D6LGWP8S/at/9p2jw59n8ghrghgpk7m72g/WPAW-25_Africa_Final_English.pdf Spanish - https://cdn.bfldr.com/D6LGWP8S/at/nv25jghz5c99ckcnt9jb4gpr/WPAW-25_Africa_Final_Spanish.pdf French - https://cdn.bfldr.com/D6LGWP8S/at/pm9j5jzbcz6v8jrghhsrp/WPAW-25_Africa_Final_French.pdf Portuguese - https://cdn.bfldr.com/D6LGWP8S/at/fj34b5cj9gjj6q3wgt3g7wrx/WPAW-25_Africa_Final_Portuguese.pdf Italian - https://cdn.bfldr.com/D6LGWP8S/at/35vmps6w6kkcnvhwvzf32wmc/WPAW-25_Africa_Final_Italian.pdf German - https://cdn.bfldr.com/D6LGWP8S/at/bnph8nvgg9k69j753f744jh/WPAW-25_Africa_Final_German.pdf Arabic - https://cdn.bfldr.com/D6LGWP8S/at/wrrm7hfnf43sngsj55bkf4/WPAW-25_Africa_Final_Arabic.pdf Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access, thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

The World Federation of Pediatric Intensive & Critical Care Societies (WFPICCS), in collaboration with OPENPediatrics, recognizes World PICU Awareness Week 2025. This initiative aims to raise global awareness about the importance of PICUs and critical care wards worldwide, emphasizing how healthcare professionals in these units, regardless of resource setting, are driving change. From predictive analytics to AI-driven teamwork, this episode explores how pediatric intensive care units across North America are blending technology and human insight to transform care. Hear experts from leading children's hospitals in the U.S. discuss how innovation, frontline collaboration, and a focus on people, not just machines, are shaping the future of critical care for children. HOST Maya Dewan, MD, MPH Division Director, Division of Critical Care Attending Physician, Pediatric Intensive Care Unit & Associate Professor UC Department of Pediatrics Cincinnati Children's Hospital United States of America GUESTS Matthew Zackoff MD, Med Director, Critical Care Fellowship Program Co-Lead Digital Simulation, Center for Simulation and Research Attending Physician, Pediatric Intensive Care Unit Assistant Professor, UC Department of Pediatrics Cincinnati Children's Hospital United States of America Sanjiv Mehta, MD, MBE Sanjiv D Mehta, MD, MBE, MSCE Assistant Professor of Anesthesiology and Critical Care Medicine, University of Pennsylvania School of Medicine Attending Physician, Division of Pediatric Critical Care Medicine, Children's Hospital of Philadelphia Associate Medical Director for Analytics - ICU United States of America Jean Anne Cieplinski-Robertson, MSN, RN Senior Director of Nursing, Critical Care Children's Hospital of Philadelphia United States of America DATE Initial publication date: May 8, 2025. TRANSCRIPTS English - https://cdn.bfldr.com/D6LGWP8S/at/b73v7gmf79nzjt9bt3vg3w/WPAW-25_North_America_Final_English.pdf Spanish - https://cdn.bfldr.com/D6LGWP8S/at/2xjfmjbwfcw739f6f68tj4q/WPAW-25_North_America_Final_Spanish.pdf French - https://cdn.bfldr.com/D6LGWP8S/at/9b4xsp88j7m3t438rpxrc62t/WPAW-25_North_America_Final_French.pdf Portuguese - https://cdn.bfldr.com/D6LGWP8S/at/5bqn4q6fnw8b5gnr6swvvbx/WPAW-25_North_America_Final_Portuguese.pdf Italian - https://cdn.bfldr.com/D6LGWP8S/at/3n2xjk7tvrqgmtwwhx3mb8nb/WPAW-25_North_America_Final_Italian.pdf German - https://cdn.bfldr.com/D6LGWP8S/at/2q58jgjq7p99nxsgmbqp887/WPAW-25_North_America_Final_German.pdf Arabic - https://cdn.bfldr.com/D6LGWP8S/at/ntsn8qpntsfkm65krzs6hqc/WPAW-25_North_America_Final_Arabic.pdf Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access, thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

The World Federation of Pediatric Intensive & Critical Care Societies (WFPICCS), in collaboration with OPENPediatrics, recognizes World PICU Awareness Week 2025. This initiative aims to raise global awareness about the importance of PICUs and critical care wards worldwide, emphasizing how healthcare professionals in these units, regardless of resource setting, are driving change. From frugal innovations to digital transformation, this episode highlights how pediatric intensive care is evolving across Asia. Hear from experts in Bangladesh, India, and Indonesia as they share how low-cost technologies, telemedicine, and integrated referral systems are improving outcomes for critically ill children even in the most remote settings. Discover how resilience and resourcefulness are driving change across the region. HOST Arun Bansal, MD, FCCM, FRCPCH Professor in Pediatric Critical Care at PGIMER Chandigarh, India and Chairperson of Pediatric Intensive Care Chapter of India GUESTS Mohammod Joyaber Chisti, MBBS, MMed (Paediatrics), PhD Professor of Pediatrics at icddr,b, Bangladesh Renowned for pioneering low-cost respiratory support technologies like bubble CPAP. Jayashree Muralidharan, MBBS MD Pediatrics FIAP FICCM Head of Pediatric Critical Care at PGIMER, Chandigarh, India A leader in intensive care in India. She had helped in developing and integrating digital health systems into PICU workflows using TelePICU. She also helped in developing a PICU Referral App Kurniawan Taufiq Kadafi, Sp.A(K) Chief of Pediatric Emergency Services, Indonesia, An expert on remote and interfacility pediatric transport across Indonesia's archipelago. DATE Initial publication date: May 7, 2025. TRANSCRIPTS English - https://cdn.bfldr.com/D6LGWP8S/at/k7x72vx63hnbvwx6wpwc4xnt/WPAW-25_Asia_Final_English.pdf Spanish - https://cdn.bfldr.com/D6LGWP8S/at/qxkcv5b23xs49tj6z6w6np/WPAW-25_Asia_Final_Spanish.pdf French - https://cdn.bfldr.com/D6LGWP8S/at/v463w7zbhbbpfbbmj8qf8b/WPAW-25_Asia_Final_French.pdf Portuguese - https://cdn.bfldr.com/D6LGWP8S/at/p377fk7m84xmppk9hx6bbq6/WPAW-25_Asia_Final_Portuguese.pdf Italian - https://cdn.bfldr.com/D6LGWP8S/at/gxbshfgg7xcm7rfpx3p5n4vm/WPAW-25_Asia_Final_Italian.pdf German - https://cdn.bfldr.com/D6LGWP8S/at/4px7mgpbf65rbb8n8vv2sjr/WPAW-25_Asia_Final_German.pdf Arabic - https://cdn.bfldr.com/D6LGWP8S/at/64vtqntqj7v99j4ztc2pk5n3/WPAW-25_Asia_Final_Arabic.pdf Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access, thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

The World Federation of Pediatric Intensive & Critical Care Societies (WFPICCS), in collaboration with OPENPediatrics, recognizes World PICU Awareness Week 2025. This initiative aims to raise global awareness about the importance of PICUs and critical care wards worldwide, emphasizing how healthcare professionals in these units, regardless of resource setting, are driving change. From digital twins to AI-driven alarms, this episode explores how innovation, teamwork, and smarter technology are reshaping pediatric intensive care across Europe. Join experts from the UK and the Netherlands as they share how connecting data, patients, families, and care teams is improving outcomes and why breaking down silos is key to the future of pediatric critical care. HOST Diana Ferro, PhD, ABAIM, MS, BS Healthcare Research Officer, Predictive and Preventive Medicine Ospedale Pediatrico Bambino Gesù Board Executive, Italian Society for AI in Medicine Rome, Italy GUESTS Erik Koomen, MD Chief Medical Technology Officer Anesthesiologist and pediatric intensivist Pediatric Intensive Care Department of Pediatrics Wilhelmina's Children Hospital (part of UMC Utrecht) Utrecht, Netherlands Joppe Nijman, MD, PhD Pediatric intensivist Consultant and investigator clinical operations research group Wilhelmina's Children Hospital (part of UMC Utrecht) Utrecht, Netherlands Peter White, RN Chief Nursing Information Officer Alder Hey Children's Hospital Liverpool, England DATE Initial publication date: May 6, 2025. TRANSCRIPTS English - https://cdn.bfldr.com/D6LGWP8S/as/j37fnp56fwg6n8pzmfbppf8r/WPAW-25_Europe_Final_English Spanish - https://cdn.bfldr.com/D6LGWP8S/at/qrjqs79zq4prpnr4km3p79/WPAW-25_Europe_Final_Spanish.pdf French - https://cdn.bfldr.com/D6LGWP8S/at/649tc94vccnhhskbfhppf/WPAW-25_Europe_Final_French.pdf Portuguese - https://cdn.bfldr.com/D6LGWP8S/at/4qrxwztkfxf6sfgq24h83c2m/WPAW-25_Europe_Final_Portuguese.pdf Italian - https://cdn.bfldr.com/D6LGWP8S/at/5vvc7bgbtk7k57kfxt5w694/WPAW-25_Europe_Final_Italian.pdf German - https://cdn.bfldr.com/D6LGWP8S/at/j5szgq6vtng48g4mt8rrx7h/WPAW-25_Europe_Final_German.pdf Arabic - https://cdn.bfldr.com/D6LGWP8S/at/mz5rkq8nf54p8739t9gzftcw/WPAW-25_Europe_Final_Arabic.pdf Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access, thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

The World Federation of Pediatric Intensive & Critical Care Societies (WFPICCS), in collaboration with OPENPediatrics, recognizes World PICU Awareness Week 2025. This initiative aims to raise global awareness about the importance of PICUs and critical care wards worldwide, emphasizing how healthcare professionals in these units, regardless of resource setting, are driving change. From AI-driven sepsis screening to innovative non-invasive ventilation protocols, this episode delves into the transformative impact of technology and collaboration in pediatric intensive care across the Middle East. Join us as we hear from leading experts who are pioneering data-driven approaches and creative solutions to improve patient outcomes in resource-limited settings. Discover how these advancements are shaping the future of pediatric care in the region HOST Manu Somasundaram Sundaram, MBBS, MD (India), FRCPCH, CPHQ, MBA. Consultant PICU and Medical Director Quality, SIDRA Medicine , Doha, Qatar Assistant Professor , Weill Cornell Medicine - Qatar GUESTS Omar Al Dafaei, MD Consultant PICU Royal Hospital Muscat, Oman Kholoud Said, MD, MRCPCH Consultant –Pediatric ICU, Royal Hospital Muscat, Oman AbdulRahman Zayed Saad AlDaithan, MD Senior Specialist, Pediatric Intensive Care Unit Pediatrics Division General Ahmadi Hospital, Kuwait Oil Company (KOC) Al Ahmadi Area, Kuwait DATE Initial publication date: May 5, 2025. TRANSCRIPTS English - https://cdn.bfldr.com/D6LGWP8S/at/rnkk777mrhwhq82w78hm54j4/WPAW-25_Middle_East_Final_English.pages Spanish - https://cdn.bfldr.com/D6LGWP8S/at/q37ww33767cvm527g3t92w5p/WPAW-25_Middle_East_Final_Spanish.pdf French - https://cdn.bfldr.com/D6LGWP8S/at/b58j8mpc4xwpm9mwf537hp/WPAW-25_Middle_East_Final_French.pdf Portuguese - https://cdn.bfldr.com/D6LGWP8S/at/7h4r8xg937364bbzbms9w9/WPAW-25_Middle_East_Final_Portuguese.pdf Italian - https://cdn.bfldr.com/D6LGWP8S/at/fsf97qrks969v9q9spbw9n/WPAW-25_Middle_East_Final_Italian.pdf German - https://cdn.bfldr.com/D6LGWP8S/at/56f5rhgws7ns94r6mgh9z/WPAW-25_Middle_East_Final_German.pdf Arabic - https://cdn.bfldr.com/D6LGWP8S/at/46j3wgv359br2fx6j399xtgk/WPAW-25_Middle_East_Final_Arabic.pdf Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access, thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

In this episode of the NCS Podcast Perspective series, Nicholas Morris, MD, is joined by Immediate Past-President of NCS, Paul Vespa, MD, a professor of neurology and neurosurgery at UCLA. Dr. Vespa shares his path into neurocritical care, as well as his views on the growth of neuro ICUs and advances in continuous EEG monitoring and microdialysis. He discusses the future of AI in EEG, the value of patient stories and the importance of clinician-investigators, mentorship, and teamwork. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.  

The World Federation of Pediatric Intensive & Critical Care Societies (WFPICCS), in collaboration with OPENPediatrics, recognizes World PICU Awareness Week 2025. This initiative aims to raise global awareness about the importance of PICUs and critical care wards worldwide, emphasizing how healthcare professionals in these units, regardless of resource setting, are driving change. Discover how innovation is reshaping pediatric intensive care across Latin America. From telemedicine and AI to regional data networks, leading experts share practical solutions and powerful success stories. HOST Manuel Enrique Soriano Aguilar, MD Pediatric Critical Care Medicine StarMédica Hospital Infantil Privado & Centro Médico ABC Past President of the Mexican Society of Pediatric Critical Care SLACIP (Latin-American Association of Pediatric Critical Care) Representative to the World Federation of Pediatric & Critical Care Societies (WFPICCS) Mexico GUESTS Emmanuelle Dexeus Gabriel Fernández Vera, Paediatric Critical Care Medicine/Big Data in Health Intensive Care Hospital General de Acapulco RENEO and PALS instructor, SLACIP social media spokesperson Mexico Ledis Maria Izquierdo Borrero, MD Paediatrician specialising in Critical Care Medicine and Paediatric Intensive Care. Master in Biomedical Engineering Chief UCIP Hospital Militar Central Associate Professor Universidad Militar Nueva Granada Colombia Alexandra Jimenez Chaves, MD Specialist in Paediatric Intensive Care Mg(c) Artificial Intelligence Support Services Coordinator at Colsubsidio Children's Clinic Teacher Colegio Mayor Nuestra Señora del Rosario Advanced Life Support in Paediatrics Instructor Founding Member Aipocrates (Think Tank Innovation in Health) Colombia Maria del Pilar Arias, MD Specialist in Paediatric Intensive Care - Master in Clinical Effectiveness - Master in Data Science and Knowledge Management Staff physician Intermediate Care Unit. Ricardo Gutierrez Children's Hospital Buenos Aires. Argentina Coordinator of the SATI-Q Quality Benchmarking Program (Argentinean Society of Intensive Care). DATE Initial publication date: May 4, 2025. TRANSCRIPTS English - https://cdn.bfldr.com/D6LGWP8S/as/89x7t8rcm3rbv32vnkxvjh6/WPAW-25_LATAM_Final_English Spanish - https://cdn.bfldr.com/D6LGWP8S/at/px9wtttsw8q68w2h68r8qcpx/WPAW-25_LATAM_Final_Spanish.pdf French - https://cdn.bfldr.com/D6LGWP8S/at/2pn95f94vc9vm9p633zq59/WPAW-25_LATAM_Final_French.pdf Portuguese - https://cdn.bfldr.com/D6LGWP8S/at/z6v47859hk7tpn8vzkvkrbm/WPAW-25_LATAM_Final_Portuguese.pdf Italian - https://cdn.bfldr.com/D6LGWP8S/at/gpqnjkkpth8g7ps84gfgkhr/WPAW-25_LATAM_Final_Italian.pdf German - https://cdn.bfldr.com/D6LGWP8S/at/76n5cr66m6cq9474hwr986tq/WPAW-25_LATAM_Final_German.pdf Arabic - https://cdn.bfldr.com/D6LGWP8S/at/785vh6cqkrsrr8mxf9xwtgkx/WPAW-25_LATAM_Final_Arabic.pdf Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access, thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support or control any related videos in the sidebar; these are placed by YouTube. We apologize for any inconvenience this may cause.

The World Federation of Pediatric Intensive & Critical Care Societies (WFPICCS), in collaboration with OPENPediatrics, recognizes World PICU Awareness Week 2025. This initiative aims to raise global awareness about the importance of PICUs and critical care wards worldwide, emphasizing how healthcare professionals in these units, regardless of resource setting, are driving change. From solar-powered oxygen to virtual mentoring across islands, this episode explores how innovation and collaboration are transforming pediatric intensive care in Oceania. Hear powerful stories from frontline experts overcoming resource limitations to improve outcomes in some of the world's most remote regions. HOST Emma Haisz, RN ECLS Clinical Nurse Consultant Queensland Children's Hospital Brisbane, Australia GUESTS Trevor Duke, MD, FRACP Paediatric intensive care specialist at Melbourne's Royal Children's Hospital Professor of paediatrics at the University of Melbourne Department of Paediatrics Professor of child health at the School of Medicine, University of Papua New Guinea Monica Brook MB BS, FCICM PICU Consultant Starship Children's Hospital Auckland, New Zealand Please visit: www.openpediatrics.org DATE Initial publication date: May 3, 2025. TRANSCRIPTS English - https://cdn.bfldr.com/D6LGWP8S/at/nw8gknpkxp2rq8cpt7fgjgb/WPAW-25_Oceania_Final_English.pdf French - https://cdn.bfldr.com/D6LGWP8S/at/wv5wftfg9z4w58mf8hnjkp/WPAW-25_Oceania_Final_French.pdf German - https://cdn.bfldr.com/D6LGWP8S/at/6j49gthzfrnhj5r7zkmkhbh/WPAW-25_Oceania_Final_German.pdf Spanish - https://cdn.bfldr.com/D6LGWP8S/at/xf46wzqx2rwwjrkqgg33bwq/WPAW-25_Oceania_Final_Spanish.pdf Portuguese - https://cdn.bfldr.com/D6LGWP8S/at/bv7rcpx5jcxj9t6c3w98bjh/WPAW-25_Oceania_Final_Portuguese.pdf Italian - https://cdn.bfldr.com/D6LGWP8S/at/7xxpc4gh5hjvgvvc7c3fcj7/WPAW-25_Oceania_Final_Italian.pdf Arabic - https://cdn.bfldr.com/D6LGWP8S/at/xzvxftsvjzszrfgwh72j5srn/WPAW-25_Oceania_Final_Arabic.pdf Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access, thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support or control any related videos in the sidebar; these are placed by YouTube. We apologize for any inconvenience this may cause.

Summary At some point this medication may show its face on the pain boards.  Whether or not Suzetrigine will appear on the pain boards, all of us need to know about this new class of analgesic. Brought to you by NRAP Academy, home of the PainExam Board Prep Here, Dr. David Rosenblum delivered a comprehensive lecture about a new pain medication called Journavx (Suzetrigine). He discussed its mechanism of action as a NAV 1.8 receptor inhibitor, its clinical applications, contraindications, and dosing guidelines. Dr. Rosenblum emphasized that this non-opioid medication represents a new class of pain management drugs with no addiction potential. He also shared information about upcoming educational events, including ultrasound courses and various pain management conferences. The lecture included detailed information about drug interactions, safety considerations, and clinical trial results comparing Journavx to placebo and hydrocodone-acetaminophen combinations. Key findings from clinical trials showed that Jornavix achieved pain relief in 119 minutes compared to 480 minutes for placebo in abdominoplasty trials, and 240 minutes versus 480 minutes in bunionectomy trials. The recommended dosing is 50mg tablets twice daily, with an initial loading dose of 100mg. While the drug showed promising results for moderate to severe acute pain management, it did not demonstrate superiority over hydrocodone in clinical trials. Important contraindications include CYP3A inhibitors, and special considerations are needed for patients with hepatic impairment or those taking hormonal contraceptives. The medication should be taken on an empty stomach, either one hour before or two hours after food, and patients should avoid grapefruit juice while on this medication. For more infomation.... Chapters Introduction and Upcoming Events Dr. Rosenblum announced several upcoming events, including an ultrasound course in New York City on May 17th, 2025. He mentioned offering ultrasound and IV training for healthcare professionals, particularly nurses, ICUs, PAs, and hospital doctors. He also highlighted upcoming conferences including ASPN, Pain Week, Latin American Pain Society, New York, New Jersey Pain Congress, ASIPP, and EPA. Introduction to Journavx (Suzetrigine) Dr. Rosenblum introduced Suzetrigine (Journavx), a new 50mg tablet medication. He emphasized that this discussion was not sponsored by any pharmaceutical company but rather focused on educating about a new class of pain medication. He noted its potential importance as a future board examination topic. Mechanism of Action Dr. Rosenblum explained that Jornavx works by inhibiting the NAV 1.8 receptor. He detailed how the drug blocks sodium ions from entering pain-sensing neurons, disrupting action potential initiation and propagation. He emphasized that the drug is highly selective, binding over 31,000 times more selectively to NAV 1.8 than other NAV subtypes. Contraindications and Drug Interactions Dr. Rosenblum outlined various contraindications, particularly focusing on CYP3A inhibitors and inducers. He listed specific medications in each category and emphasized the importance of careful monitoring when prescribing Journavx alongside these medications. Clinical Trial Results and Dosing Guidelines Dr. Rosenblum presented clinical trial results showing Journavx's effectiveness in treating moderate to severe acute pain. He detailed the dosing guidelines: 50mg tablets twice daily, with an initial loading dose of 100mg. He emphasized the importance of taking the medication on an empty stomach and avoiding grapefruit juice. Q&A No Q&A session in this lecture

Summary At some point this medication may show its face on the Anesthesia boards.  Whether or not Suzetrigine will appear on the Anesthesiology boards, all of us need to know about this new class of analgesic. Brought to you by NRAP Academy, home of the AnesthesiaExam Board Prep Here, Dr. David Rosenblum delivered a comprehensive lecture about a new pain medication called Journavx (Suzetrigine). He discussed its mechanism of action as a NAV 1.8 receptor inhibitor, its clinical applications, contraindications, and dosing guidelines. Dr. Rosenblum emphasized that this non-opioid medication represents a new class of pain management drugs with no addiction potential. He also shared information about upcoming educational events, including ultrasound courses and various pain management conferences. The lecture included detailed information about drug interactions, safety considerations, and clinical trial results comparing Journavx to placebo and hydrocodone-acetaminophen combinations. Key findings from clinical trials showed that Jornavix achieved pain relief in 119 minutes compared to 480 minutes for placebo in abdominoplasty trials, and 240 minutes versus 480 minutes in bunionectomy trials. The recommended dosing is 50mg tablets twice daily, with an initial loading dose of 100mg. While the drug showed promising results for moderate to severe acute pain management, it did not demonstrate superiority over hydrocodone in clinical trials. Important contraindications include CYP3A inhibitors, and special considerations are needed for patients with hepatic impairment or those taking hormonal contraceptives. The medication should be taken on an empty stomach, either one hour before or two hours after food, and patients should avoid grapefruit juice while on this medication. For more infomation.... Chapters Introduction and Upcoming Events Dr. Rosenblum announced several upcoming events, including an ultrasound course in New York City on May 17th, 2025. He mentioned offering ultrasound and IV training for healthcare professionals, particularly nurses, ICUs, PAs, and hospital doctors. He also highlighted upcoming conferences including ASPN, Pain Week, Latin American Pain Society, New York, New Jersey Pain Congress, ASIPP, and EPA. Introduction to Journavx (Suzetrigine) Dr. Rosenblum introduced Suzetrigine (Journavx), a new 50mg tablet medication. He emphasized that this discussion was not sponsored by any pharmaceutical company but rather focused on educating about a new class of pain medication. He noted its potential importance as a future board examination topic. Mechanism of Action Dr. Rosenblum explained that Jornavx works by inhibiting the NAV 1.8 receptor. He detailed how the drug blocks sodium ions from entering pain-sensing neurons, disrupting action potential initiation and propagation. He emphasized that the drug is highly selective, binding over 31,000 times more selectively to NAV 1.8 than other NAV subtypes. Contraindications and Drug Interactions Dr. Rosenblum outlined various contraindications, particularly focusing on CYP3A inhibitors and inducers. He listed specific medications in each category and emphasized the importance of careful monitoring when prescribing Journavx alongside these medications. Clinical Trial Results and Dosing Guidelines Dr. Rosenblum presented clinical trial results showing Journavx's effectiveness in treating moderate to severe acute pain. He detailed the dosing guidelines: 50mg tablets twice daily, with an initial loading dose of 100mg. He emphasized the importance of taking the medication on an empty stomach and avoiding grapefruit juice. Q&A No Q&A session in this lecture

  Summary At some point this medication may show its face on the Physiatry boards.  Whether or not Suzetrigine will appear on the Physical Medicine and Rehabilitation boards, all of us need to know about this new class of analgesic. Brought to you by NRAP Academy, home of the PMRExam Board Prep Here, Dr. David Rosenblum delivered a comprehensive lecture about a new pain medication called Journavx (Suzetrigine). He discussed its mechanism of action as a NAV 1.8 receptor inhibitor, its clinical applications, contraindications, and dosing guidelines. Dr. Rosenblum emphasized that this non-opioid medication represents a new class of pain management drugs with no addiction potential. He also shared information about upcoming educational events, including ultrasound courses and various pain management conferences. The lecture included detailed information about drug interactions, safety considerations, and clinical trial results comparing Journavx to placebo and hydrocodone-acetaminophen combinations. Key findings from clinical trials showed that Jornavix achieved pain relief in 119 minutes compared to 480 minutes for placebo in abdominoplasty trials, and 240 minutes versus 480 minutes in bunionectomy trials. The recommended dosing is 50mg tablets twice daily, with an initial loading dose of 100mg. While the drug showed promising results for moderate to severe acute pain management, it did not demonstrate superiority over hydrocodone in clinical trials. Important contraindications include CYP3A inhibitors, and special considerations are needed for patients with hepatic impairment or those taking hormonal contraceptives. The medication should be taken on an empty stomach, either one hour before or two hours after food, and patients should avoid grapefruit juice while on this medication. For more infomation.... Chapters Introduction and Upcoming Events Dr. Rosenblum announced several upcoming events, including an ultrasound course in New York City on May 17th, 2025. He mentioned offering ultrasound and IV training for healthcare professionals, particularly nurses, ICUs, PAs, and hospital doctors. He also highlighted upcoming conferences including ASPN, Pain Week, Latin American Pain Society, New York, New Jersey Pain Congress, ASIPP, and EPA. Introduction to Journavx (Suzetrigine) Dr. Rosenblum introduced Suzetrigine (Journavx), a new 50mg tablet medication. He emphasized that this discussion was not sponsored by any pharmaceutical company but rather focused on educating about a new class of pain medication. He noted its potential importance as a future board examination topic. Mechanism of Action Dr. Rosenblum explained that Jornavx works by inhibiting the NAV 1.8 receptor. He detailed how the drug blocks sodium ions from entering pain-sensing neurons, disrupting action potential initiation and propagation. He emphasized that the drug is highly selective, binding over 31,000 times more selectively to NAV 1.8 than other NAV subtypes. Contraindications and Drug Interactions Dr. Rosenblum outlined various contraindications, particularly focusing on CYP3A inhibitors and inducers. He listed specific medications in each category and emphasized the importance of careful monitoring when prescribing Journavx alongside these medications. Clinical Trial Results and Dosing Guidelines Dr. Rosenblum presented clinical trial results showing Journavx's effectiveness in treating moderate to severe acute pain. He detailed the dosing guidelines: 50mg tablets twice daily, with an initial loading dose of 100mg. He emphasized the importance of taking the medication on an empty stomach and avoiding grapefruit juice. Q&A No Q&A session in this lecture

This episode is brought to you by Barefaced: Barefaced takes the guesswork out of skincare. Founded by Nurse Practitioner Jordan Harper, they pair results-driven products with expert guidance, simplifying your routine and empowering you to achieve the confidence that comes from truly feeling great in your skin. Go to www.barefaced.com and use code VALERIA15 at checkout. Valid through 3/30/25 for both new and existing customers. Starting 3/31/25, valid for new customers only. Offer valid on one-time purchases only. Not applicable to subscription orders. In this episode, Valeria is joined by Jordan Harper, a Board-Certified Nurse Practitioner and Founder/CEO of Barefaced. They delve into Jordan's unique journey from working in pediatric ICUs, to becoming an injector and then establishing her own skincare brand based on her clients' needs. From Botox to Mini Facelifts, Jordan and Valeria discuss the highs and lows of facial augmentation and when and how to know which procedures are right for you. Together they also explore the foundational elements of effective skincare routines, the efficacy of in-office treatments like microneedling and Botox, and the evolving landscape of aesthetic procedures. Additionally, Jordan sheds light on the significance of using the right products based on skin type, Barefaced's mission of “Less is More”, and the broader conversation around aging gracefully while maintaining mental and physical well-being. Follow Jordan: https://www.instagram.com/jordanharper_np/  Follow Barefaced: https://www.instagram.com/barefaced/  Shop my look from this episode: https://shopmy.us/collections/1382416  Follow me: https://www.instagram.com/valerialipovetsky/  What We talked about: 00:39 Meet Jordan Harper: From the ICU to Barefaced 01:22 Navigating the World of Experts 03:40 The Role of Problem Solving in Skincare 05:19 Transitioning to Cosmetic Dermatology 08:14 The Evolution of Injectable Treatments 14:46 The Importance of a Solid Skincare Foundation 17:29 Debunking Skincare Myths and Best Practices 31:51 The Importance of Nighttime Skincare 32:01 Maximizing Collagen Production with Vitamin C 32:42 Daytime Skincare Challenges 33:12 The Right Way to Use Retinoids 35:32 SPF: Myths and Realities 37:48 Exfoliation: Finding the Right Balance 40:59 Navigating Skincare Products and Treatments 45:56 The Role of Botox in Skincare 56:52 Facelifts and Aging Gracefully 59:17 Final Thoughts and Takeaways Learn more about your ad choices. Visit megaphone.fm/adchoices

Nonepileptic events are prevalent and highly disabling, and multiple pathophysiologic mechanisms for these events have been proposed. Multidisciplinary care teams enable the efficient use of individual expertise at different treatment stages to address presentation, risk factors, and comorbidities.   In this episode, Kait Nevel, MD, speaks with Adriana C. Bermeo-Ovalle, MD, an author of the article “A Multidisciplinary Approach to Nonepileptic Events,” in the Continuum® February 2025 Epilepsy issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Bermeo-Ovalle is a professor and vice-chair for Faculty Affairs in the Department of Neurological Sciences at Rush University Medical Center in Chicago, Illinois. Additional Resources Read the article: A Multidisciplinary Approach to Nonepileptic Events 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: @IUneurodocmom Full episode transcript available here 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, which features conversations with Continuum's guest editors and authors 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 and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Nevel: Hello, this is Dr Kait Nevel. Today I'm interviewing Dr Adriana Bermeo about her article on a multidisciplinary approach to nonepileptic events, which she wrote with Dr Victor Petron. This article appears in the February 2025 Continuum issue on epilepsy. Welcome to the podcast, and please introduce yourself to our audience. Dr Bermeo-Ovalle: Hello Dr Neville, it's a pleasure to be here. Thank you very much for inviting me. My name is Adriana Bermeo and I'm an adult epileptologist at Rush University Medical Center in Chicago, and I am also the codirector of the NEST clinic, which is a treatment clinic for patients with nonepileptic seizures within our level four epilepsy center. Dr Nevel: Wonderful. Well, thank you so much for being here, and I can't wait to talk to you about your article and learn a little bit about NEST, maybe, during our conversation, and how you approach things. To start us off talking about your article today, could you share with us what you think is the most important takeaway from your article for the practicing neurologist? Dr Bermeo-Ovalle: Wonderful. There's some messages that I would like people to get from working with patients with functional neurologic disorders in general. The first one is that functional neurologic disorders are very common in presentation in the neurologic clinic, almost no matter what your practice of self-specialty care is. The second is that for people who treat patients primarily with seizures or epilepsy, they account for between 5 to 10% of our patients in the clinic, but about 30% of our patients in our epilepsy monitoring unit because the seizures typically do not respond to anti-seizure medication management. Also, that in order to diagnose them, you don't need to have a neuropsychological stress already be available for the patient or the clinician. And the most important thing is that there are available treatments for these patients and that there are options that we can offer them for them to have less seizures and to be more integrated to whatever activities they want to get integrated. Dr Nevel: Wonderful. What do you think a practicing neurologist might find surprising after reading your article? Dr Bermeo-Ovalle: I think still many neurologists feel very hopeless when they see patients with these conditions. They do not have very good answers right away for the patients, which is frustrating for the neurologist. And they don't think there's too much they can do to help them other than send them somewhere else, which is very difficult for the neurologist and is crushing to the patients to see these doctors that they're hoping to find answers to and then just find that there's not much to do. But what I want neurologists to know is that we are making strides in our understanding of the condition and that there are effective treatments available. And I hope that after reading this and engaging with this conversation, they will feel curious, even hopeful when they see the next patient in the clinic. Dr Nevel: Yeah, absolutely. I find the history of nonepileptic seizures really interesting and I enjoyed that part of your article. How has our understanding of nonepileptic seizures evolved over the centuries, and how does our current understanding of nonepileptic seizures inform the terminology that we use? Dr Bermeo-Ovalle: Yeah. The way we name things and the way we offer treatment goes along to how we understand things. So, the functional seizures and epileptic seizures were understood in ancient times as possession from the spirits or the demons or the gods, and then treatments were offered to those kind of influences and that continues to happen with functional seizures. So, we go through the era when this was thought to be a women-only condition that was stemming from their reproductive organs and then treatments accordingly were presented. And later on with Charcot and then Freud, they evolved to even conversion disorders, which is one understanding the most conversion disorders, which is one of the frameworks where this condition has been treated with psychotherapy, psychoanalytic psychotherapy. And in our current understanding, we understand functional neurologic disorders in general as a more like a connection, communication network disorder, between areas of the brain that modulate emotional processing and movement control. And therefore, our approach these days is much more geared towards rehabilitation. You know, I think that's the evolution of thinking in many different areas. And as we learn more, we will be acquiring more tools to help our patients. Dr Nevel: Yeah, great. Thanks so much for that answer. Just reading the historical information that you have in your article, you can imagine a lot of stigma with this diagnosis too over time, and that- I think that that's lessening. But I was wondering if you could talk about that a little bit. How do we approach that with our patients and loved ones, any stigma that they might feel or perceive from being diagnosed with nonepileptic seizures? Dr Bermeo-Ovalle: Thank you for asking that question. Stigma is actually an important problem even for people living with epilepsy. There's still a lot of misunderstanding of what epilepsy is and how it affects people, and that people living with epilepsy can live normal, healthy lives and do everything they want to do with appropriate treatment. And if a stigma is still a problem with epilepsy, it is a huge problem for patients living with functional neurologic symptoms in general, but particularly with functional seizures or nonepileptic seizures. Because the stigma in this population is even perpetuated by the very people who are supposed to help them: physicians, primary care doctors, emergency room doctors. Unfortunately, the new understanding of this condition has not gotten to everybody. And these patients are often even blamed for their symptoms and for the consequences of their symptoms and of their seizures in their family members, in their job environment, in their community. Living with that is really, really crushing, right? Even people talk about, a lot about malingering. They come back about secondary gain. I can tell you the patients I see with functional seizures gain nothing from having this condition. They lose, often, a lot. They lose employment, they lose ability to drive. They lose their agency and their ability to function normally in society. I do think that the fight- the fighting of stigma is one that we should do starting from within, starting from the healthcare community into our understanding of what these patients go through and what is causing their symptoms and what can we do to help them. So there's a lot of good work to be done. Dr Nevel: Absolutely. And it starts, like you said, with educating everybody more about nonepileptic seizures and why this happens. The neurobiology, neurophysiology of it that you outlined so nicely in your article, I'm going to encourage the listeners to look at Figure 1 and 4 for some really nice visualization of these really complex things that we're learning a lot about now. And so, if you don't mind for our listeners, kind of going over some of the neurobiology and neurophysiology of nonepileptic seizures and what we're learning about it. Dr Bermeo-Ovalle: Our understanding of the pathophysiology of functional neurologic seizure disorder is in its infancy at this point. The neurobiological processes that integrate emotional regulation and our responses to it, both to internal stimuli and to external stimuli and how they affect our ability to have control over our movement---it's actually amazing that we as neurologists know so little about these very complex processes that the brain do, right? And for many of us this is the reason why we're in neurology, right, to be at the forefront of this understanding of our brain. So, this is in that realm. It is interesting what we have learned, but it's amazing all that we have to learn. There is the clear relationship between risk factors. So, we know patients with functional neurologic symptom disorder and with functional seizures, particularly in many different places in the world with many different beliefs, relationship to their body, to their expression of their body, have this condition no matter how different they are. And also, we know that they have commonalities. For example, traumatic experiences that are usually either very strong traumatic experiences or very pervasive traumatic experiences or recurrent over time of different quality. So, we are in the process of understanding how these traumatic experiences actually inform brain connectivity and brain development that result in this lack of connections between brain areas and the expression of them, and that result in this kind of disorder. I wish I can tell you more about it or that I would understand more about it, but I am just grateful for the work that has been done so that we can understand more and therefore have more to offer to these patients and their families and their communities that are support. Dr Nevel: Yeah, absolutely. That's always the key, and just really exciting that we're starting to understand this better so that we can hopefully treat it better and inform our patients better---and ourselves. Can you talk to us a little bit about the multidisciplinary team approach and taking care of patients with nonepileptic seizures? Who's involved, what does best practice model look like? You have a clinic there, obviously; if you could share with us how your clinic runs in the multidisciplinary approach for care of these patients? Dr Bermeo-Ovalle: The usual experience of patients dealing with functional seizures, because this is a condition that has neurological symptoms and psychiatric symptoms, is that they go to the neurologist and the neurologist does not feel sufficiently able to manage all the psychiatric comorbidities of the condition. So, the patient is sent to psychiatry. The psychiatry really finds themselves very hopeless into handling seizures, which is definitely not their area of expertise, and these patients then being- “ping-ponging” from one to the other, or they are eventually sent to psychotherapy and the psychotherapist doesn't know what they're dealing with. So, we have found with- and we didn't come up with this. We had wonderful support from other institutions who have done- been doing this for a longer time. That bringing all of this specialty together and kind of situating ourselves around the patient so that we can communicate our questions and our discrepancies and our decision between who takes care of what without putting that burden on the patient is the best treatment not only for the patient, who finally feels welcome and not burden, but actually for the team. So that the psychiatrist and the neurologist support the psychotherapist who does the psychotherapy, rehabilitation, mind the program. And we also have the support and the involvement of neuropsychology. So, we have a psychiatrist, a neurologist, social worker, psychotherapist and neuropsychology colleagues. And together we look at the patient from everywhere and we support each other in the treatment of the patient, keeping the patient in the middle and the interest of the patient in the middle. And we have found that that approach has helped our patients the best, but more importantly, makes our job sustainable so that none of us is overburdened with one aspect of the care of the patient and we feel supported from the instances that is not our most comfortable area. So that is one model to do it. There's other models how to do it, but definitely the interdisciplinary care is the way to go so far for the care of patients with functional neurologic symptom disorders and with functional seizures or nonepileptic seizures in particular. Dr Nevel: Yeah, I can see that, that everybody brings their unique expertise and then doesn't feel like they're practicing outside their, like you said, comfort zone or scope of practice. In these clinics---or maybe this happens before the patient gets to this multidisciplinary team---when you've established a diagnosis of nonepileptic seizures, what's your personal approach or style in terms of how you communicate that with the patient and their loved ones? Dr Bermeo-Ovalle: It is important to bring this diagnosis in a positive term. You know, unfortunately the terminology question is still out and there's a lot of teams very invested into how to better characterize this condition and how to- being told that you don't have something is maybe not that satisfying for patients. So, we are still working on that, but we do deliver the diagnosis in positive terms. Like, this is what you have. It's a common condition. It's shared by this many other people in the world. It's a neuropsychiatric disorder and that's why we need the joint or collaborative care from neurology and psychiatry. We know the risk factors and these are the risk factors. You don't have to have all of them in order to have this condition. These are the reasons why we think this is the condition you have. There is coexisting epilepsy and functional seizures as well. We will explore that possibility and if we get to that conclusion, we will treat these two conditions independently and we- our team is able to treat both of them. And we give them the numbers of our own clinic and other similar clinics. And with that we hope that they will be able to get the seizures under better control and back to whatever is important to them. I tell my trainees and my patients that my goals of care for patients with functional seizures are the same as my patients with epileptic seizures, meaning less seizures, less disability, less medications, less side effects, less burden of the disease. And when we communicate it in that way, patients are very, very open and receptive. Dr Nevel: Right. What do you think is a mistake to avoid? I don't know if “mistake” is necessarily the right word, but what's something that we should avoid when evaluating or managing patients with nonepileptic seizures? What's something that you see sometimes, maybe, that you think, we should do that differently? Dr Bermeo-Ovalle: I think the opportunity of engaging with these patients is probably the hardest one. Because neurologists have the credibility, they have the relationship, they have- even if they don't have a multi-disciplinary team all sitting in one room, they probably have some of the pieces of this puzzle that they can bring together by collaborating. So, I think that missing the opportunity, telling the patient, this is not what I do or this is not something that belongs to me, you need to go to a mental health provider only, I think is the hardest one and the most disheartening for patients because our patients come to us just like all patients, with hopes and with some information to share with us so that we can help them make sense of it and have a better way forward. We as neurologists know very well that we don't have an answer to all our patients, and we don't offer zero seizures to any of our patients, right? We offer our collaborative work to understand what is going on and a commitment to walk in the right direction so that we are better every day. And I do think wholeheartedly that that is something that we can offer to patients with functional seizures almost in any environment. Dr Nevel: Yeah, absolutely. And using that multidisciplinary approach and being there with your patient, moving forward in a longitudinal fashion, I can see how that's so important. What do you find most challenging and what do you find most rewarding about caring for patients with nonepileptic seizures? Dr Bermeo-Ovalle: The thing that I find more challenging are the systemic barriers that the system still places. We discuss with the patients, what is the right time to go to the emergency room or not? Because the emergency room may be a triggering environment for patients with functional seizures and it may be a place where not everybody is necessarily attuned to have this conversation. Having said that, I never tell any of my patients not to go to the emergency room because I don't know what's happening with them. As a matter of fact, we're getting a lot of information on high mortality rates in patients with functional seizures, and it's not because of suicide and is probably not related to the seizure. Maybe this is---you know, this is speculation on my part---that is because they get to more severe conditions in other things that are not the functional seizures because they just experienced the healthcare system as very hostile because we are very in many instances. So, navigating that is a little bit difficult, and I try to tell them to have the doctors call me so that I can frame it in a different way and still be there for them. But I can tell you this clinic is the most rewarding clinic of all my clinical activities. And I love with all my heart being an epileptologist and seeing my patients with epilepsy. But the number of times my patients with functional seizures say, nobody had ever explained this to me, nobody had ever validated my experience in front of my family so that I'm not- like, feel guilty myself for having this episode, I can't tell you how many times. And obviously patients who come to the nonepileptic seizure clinic already know that they come to the nonepileptic seizure clinic, so that- you can say it's a selection of patients that are already educated in this condition to come to the clinic. But I would love everybody to know managing this population can be enormously, enormously satisfying and rewarding. Dr Nevel: Especially for, I imagine, patients who have been in and out of the ER, in and out of the hospital, or seen multiple providers and make their way to you. And you're able to explain it in a way that makes sense and hopefully reduces some of that stigma maybe that they have been feeling. Dr Bermeo-Ovalle: And along with that, iatrogenic interventions, unnecessary intubations, unnecessary ICUs; like, so much. And I think, I have no superpower to do that other than understanding this condition in a different way. And by I, I mean all the providers, because I'm not alone in this. There's many, many people doing excellent work in this state. And we just need to be more. Dr Nevel: Yeah, sure. Absolutely. So, on that note, what's next in research, or what do you think will be the next big thing? What's on the horizon in this area? Dr Bermeo-Ovalle: I think the community in the functional neurologic disorder community is really hopeful that more understanding into the neurobiology of this condition will bring more people over and more neurologists willing to take it on. There was an invitation from the NIH, I think, about four or five years ago to submit proposals for research in this area in particular. So, all of those studies must be ongoing. I'm much more a clinician than a researcher myself, but I am looking forward to what all of that is going to mean for our patients. And for- I think there's other opportunities in that further understanding of the clinical manifestations of many other conditions, and for our understanding of our relationship with our patients. I feel we are more attuned to align with a disease that, when the experience of the patient- and with a disease like this, a condition like this one, we have to engage with the personal experience of the patient. What I mean by that is that we are more likely to say,  I'm an epileptologist, I'm an MS doctor, you know, and we engage with that condition. This condition, like, just makes us engaging with the symptom and with the experience of the person. And I think that's a different frame that is real and rounded into the relationship with our patients. So, I think there's so much that we can learn that can change practice in the future. Dr Nevel: Yeah. And as your article, you know, outlines, and you've outlined today during our discussion, that- how important this is for the future, that we treat these patients and help them as much as we can, that comes with understanding the condition better, because wow, I was really surprised reading your article. The mortality associated with this, the healthcare costs, how many people it affects, was just very shocking to me. So, I mean, this is a really important topic, obviously, and something that we can continue to do better in. Wonderful. Well, thank you so much. It's been really great talking to you today. Dr Bermeo-Ovalle: Thank you, Katie, I appreciate it too. Dr Nevel: So again, today I've been interviewing Dr Adriana Bermeo about her article on a multidisciplinary approach to nonepileptic events, which she wrote with Dr Victor Petron. This article appears in the most recent issue of Continuum on epilepsy. Be sure to check out Continuum audio episodes from this and other issues. And thank you to our listeners for joining today.  Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

 This week on the Team Lally Real Estate Radio Show, we interview Leigh Loganbill, Founder of Vitaflow Wellness. Leigh dives into the world of wellness, discussing innovative treatments that promote overall health, vitality, and rejuvenation. She also discusses Vitaflow's expansion, her journey into the wellness industry, and key tips for living a healthier life. Adrienne and Attilio share their personal experiences with Vitaflow and the impact of its treatments.We also have our Expert We Trust. Jodie Tanga of Pacific Rim Mortgage talks about their upcoming seminar on thriving in a tough market and explains nontraditional lending—how it differs from traditional loans and its impact on interest rates. Taylor Bramwell of Kilauea Pest Control shares his experience with mysterious attic noises in his new home, revealing what attracted the pests and how his team resolved it. He also highlights three surprising pests they commonly handle. Duke Kimhan of Hawaii Pacific Property Management breaks down wear and tear in rentals, why tenants aren't responsible for it, and what actually counts as damage.Who is Leigh Loganbill?Leigh Loganbill, a registered nurse with over 25 years of experience in ICUs and emergency rooms, moved to Hawaii in 2005 as a travel nurse. After years of witnessing preventable illnesses, she shifted her focus to proactive wellness and self-care. This passion led her to establish Vitaflow Wellness in Kailua, where she offers IV therapy, microneedling, PRP, and advanced aesthetic treatments backed by science, helping clients feel their best while embracing Hawaii's outdoor lifestyle.Vitaflow Wellness is an IV lounge and lifestyle med spa in Kailua, dedicated to enhancing health and well-being through science-backed treatments. They offer IV vitamin drips, esthetic services like XEOMIN and microneedling, PRP therapy, and antioxidant testing to support optimal wellness. By prioritizing hydration, prevention, and nutrient absorption, Vitaflow Wellness helps clients rejuvenate, thrive, and maintain a vibrant, healthy lifestyle.To reach Leigh, you may contact her in the following ways:Phone: (808) 780-7245Email: aloha@vitaflowwellness.comWebsite: Vitaflowwellness.com

 This week on the Team Lally Real Estate Radio Show, we interview Leigh Loganbill, Founder of Vitaflow Wellness. Leigh dives into the world of wellness, discussing innovative treatments that promote overall health, vitality, and rejuvenation. She also discusses Vitaflow's expansion, her journey into the wellness industry, and key tips for living a healthier life. Adrienne and Attilio share their personal experiences with Vitaflow and the impact of its treatments.We also have our Expert We Trust. Jodie Tanga of Pacific Rim Mortgage talks about their upcoming seminar on thriving in a tough market and explains nontraditional lending—how it differs from traditional loans and its impact on interest rates. Taylor Bramwell of Kilauea Pest Control shares his experience with mysterious attic noises in his new home, revealing what attracted the pests and how his team resolved it. He also highlights three surprising pests they commonly handle. Duke Kimhan of Hawaii Pacific Property Management breaks down wear and tear in rentals, why tenants aren't responsible for it, and what actually counts as damage.Who is Leigh Loganbill?Leigh Loganbill, a registered nurse with over 25 years of experience in ICUs and emergency rooms, moved to Hawaii in 2005 as a travel nurse. After years of witnessing preventable illnesses, she shifted her focus to proactive wellness and self-care. This passion led her to establish Vitaflow Wellness in Kailua, where she offers IV therapy, microneedling, PRP, and advanced aesthetic treatments backed by science, helping clients feel their best while embracing Hawaii's outdoor lifestyle.Vitaflow Wellness is an IV lounge and lifestyle med spa in Kailua, dedicated to enhancing health and well-being through science-backed treatments. They offer IV vitamin drips, esthetic services like XEOMIN and microneedling, PRP therapy, and antioxidant testing to support optimal wellness. By prioritizing hydration, prevention, and nutrient absorption, Vitaflow Wellness helps clients rejuvenate, thrive, and maintain a vibrant, healthy lifestyle.To reach Leigh, you may contact her in the following ways:Phone: (808) 780-7245Email: aloha@vitaflowwellness.comWebsite: Vitaflowwellness.com

LEXINGTON, Ky. (March 5, 2025) — It's hard to believe it's been five years since the COVID-19 pandemic officially arrived in the Commonwealth – but on Friday, March 6, 2020, Gov. Andy Beshear confirmed the state's first COVID-19-positive patient and declared a state of emergency in Kentucky. And that first case was tested and diagnosed right here at the University of Kentucky Albert B. Chandler Hospital. That day began a grueling, years-long grind for medical professionals across the state, the country, and the world. Hospital systems struggled to keep up with surges of severely ill patients coming through their doors. Shortages of personal protective equipment, ventilators, ECMO machines, inpatient beds, and even health care providers themselves led to a type of global health crisis not seen in more than a century.   In today's episode of Behind the Blue, you'll hear from eight longtime employees from the medical side of UK's campus, ranging from administrators to frontline health care providers to researchers. We asked them to reflect on those scary, early days of the pandemic, how it impacted their professional and personal lives, and some of the lessons learned from living through such a significant moment in history. Let's meet our guests for this oral history of the COVID-19 pandemic at UK and in the Commonwealth.   Jenn Alonso has been at UK HealthCare for 13 years and has worked in the medicine intensive care unit (MICU) as a registered nurse since 2014. As a MICU nurse, she works alongside a team of physicians, nurses, therapists and other providers to take care of some of the most critically ill patients who come to UK HealthCare. Alonso was working in the MICU the day UK's first COVID-19 patient was admitted and was directly involved in frontline care for the sickest COVID-19 patients day in and day out.   Kim Blanton, D.N.P., is the chief nursing officer for UK Albert B. Chandler Hospital. Blanton began her nursing career at UK in 1998 in the neuro-trauma ICU and worked her way up through several nursing positions, including rapid response nursing, working as a division charge nurse and managing the cardiovascular stepdown unit. After briefly leaving UK to help create and run an ICU at a local rural hospital, she returned in 2011 as a hospital operations administrator before becoming the UK HealthCare enterprise director for Infection Prevention and Control (IPAC) and Quality and Safety. Blanton was serving in her IPAC role when the COVID-19 pandemic began and was instrumental in UK's COVID-19 response: She helped bring home UK students from abroad, called COVID-19 patients to help them navigate their care and quarantine, developed plans and processes for patient surges and PPE needs, and much more.   Kevin Hatton, M.D., Ph.D., is the chief medical officer for UK Albert B. Chandler Hospital. An anesthesiologist by training, he earned both his medical degree and doctorate of philosophydegree from UK. Including his time in residency, Dr. Hatton has worked at UK HealthCare for 21 years, serving in a variety of leadership roles in anesthesiology in critical care medicineprimarily for neurology and cardiovascular ICUs. When the pandemic began, he was serving as senior medical director for critical care services as well as was interim director for ECMO services. Initially, Hatton's role focused on training and preparing the anesthesia critical care team to help provide care for non-COVID ICU patients, as much of the medicine ICU staff's time was spent caring for COVID-positive inpatients. ECMO, the highest form of life support, is a machine that takes over function of a patient's damaged heart and/or lungs by removing a patient's blood, oxygenating it, and returning it into the body. Though ECMO is used on a daily basis at UK HealthCare, its use skyrocketed during the pandemic as patients whose lungs were severely damaged by the virus needed this highest form of life support. As interim director for ECMO services, Hatton and his team had to rapidly develop protocols and processes to use the limited number of ECMO machines to help the most patients possible.   Ashley Montgomery-Yates, M.D., has been physician in the UK Division of Pulmonary, Critical Care and Sleep Medicine since 2013. As a critical care physician, she works primarily in the MICU setting taking care of the sickest patients – people on ventilators, with multi-organ failure, post-operative complications, and more. In 2013, she launched UK HealthCare's ICURecovery Clinic, which helps patients who have been in the ICU navigate the follow-up care and resources they need to recover. At the time, UK HealthCare's ICU Recovery Clinic was just one of three in the nation. Montgomery-Yates is currently the senior vice chair for the Department of Internal Medicine. When the pandemic began, she had recently become the interim chief medical officer for inpatient and emergency services. In this role and as an ICU physician, Montgomery-Yates and her colleagues were heavily involved in the day-to-day care of inpatients with COVID-19. She was part of the team that launched UK's successful Mass Vaccination Clinic out at Kroger Field, and her ICU teams also helped guide the creation of UK HealthCare's brand-new MICU, which opened January 2024.   Meg Pyper is a division charge nurse with the UK Albert B. Chandler Hospital Emergency Department and has been with UK HealthCare Emergency Medicine since 2010. As a charge nurse, her role is like air traffic control for the ED — taking calls from EMS and local hospitals about incoming patients and transfers, determining what services that patient will need upon arrival, and notifying interdisciplinary team members to be prepared when those patients arrive. As a nurse, she was drawn to emergency medicine after seeing her favorite nurse mentors be “the calm in the chaos.” Pyper began in this role just weeks before the pandemic arrived in Kentucky, and she and her team were the first line of care COVID patients received when they arrived at UK Chandler Hospital.   Lindsay Ragsdale, M.D., is the chief medical officer for Kentucky Children's Hospital and chief of the Division of Pediatric Palliative Care. Since arriving at UK in 2013, she has worked to build a robust program that helps seriously ill young patients and their families by caring for them holistically – looking at their physical, mental, emotional and spiritual well-being, and helping them navigate the experience of being severely ill.  Ragsdale became the KCH CMO in 2021, right when the COVID-19 delta variant was beginning to affect children much more than previous variants had. She helped set up both the pediatric monoclonal antibody clinic that provided infusions to help protect high-risk pediatric patients, as well as the successful pediatric vaccine clinic, which provided COVID-19 vaccines for children in a playful, engaging environment.   Rob Sprang is the director of Kentucky TeleCare, a role he's held at UK since 1996. UK first began using telehealth services in 1995. Since then, telehealth has grown by leaps and bounds, but its use skyrocketed during the pandemic. Earlier days of telehealth were usually done facility-to-facility — however, the vastly improved technology and public acceptance of telehealth, along with new, more relaxed regulatory laws around its use has allowed telehealth to explode in popularity. When the pandemic hit Kentucky, Sprang and his team — along with countless ambulatory providers and staff – worked 24/7 for more than a week to get UK HealthCare clinics set up to offer telehealth so that patients could still see their providers without needing to go into the hospital or clinic. Telehealth was a critical element in helping to protect both patients and providers from potential exposure to COVID-19.   Vince Venditto, Ph.D., is an associate professor of pharmaceutical sciences in the UK College of Pharmacy with a background in chemistry, drug delivery, and vaccine development. In the early days of the pandemic, his work in blood analysis – looking for biomarkers for cardiovascular disease in up to 1,500 samples at a time – was adapted to do mass testing for COVID antibodies as a means of diagnosis. After PCR tests became the gold standard for diagnosing the disease, his work shifted again — this time to working with local pharmacies for surveillance of COVID out in Kentucky communities. Post-COVID, this project has evolved to include other infectious diseases and inflammatory conditions, and it focuses on increasing access to health care through Kentucky's network of pharmacies. It also has a new name: Pharmacy-based Recruitment Opportunities To Enhance Community Testing and Surveillance (PROTECTS). Venditto co-directs this project along with Brooke Hudspeth, Pharm.D., an associate professor of pharmacy practice and science. Venditto is also part of The Consortium for Understanding and Reducing Infectious Diseases in Kentucky (CURE-KY), which fosters multidisciplinary collaborations to address the burden of infectious diseases in the Commonwealth and beyond. This consortium was built on the heels of UK's COVID-19 Unified Research Experts (CURE) Alliance, which was quickly assembled in 2020 to support a full range of COVID-related research. -- Behind the Blue is available via a variety of podcast providers, including iTunes and Spotify. Become a subscriber to receive new episodes of “Behind the Blue” each week. UK's latest medical breakthroughs, research, artists and writers will be featured, along with the most important news impacting the university. Behind the Blue is a joint production of the University of Kentucky and UK HealthCare. Transcripts for this or other episodes of Behind the Blue can be downloaded from the show's blog page.  To discover how the University of Kentucky is advancing our Commonwealth, click here.  

Due to advancements in medical and surgical care, the survival of patients with congenital conditions into adulthood has dramatically increased. However, as these individuals transition to adulthood, their unique physiology, chronic complications, and evolving care needs create significant challenges for their management when they are admitted to adult intensive care units (ICUs). This episode will discuss adult congenital disease in the ICU. Dr. Zanotti is joined by Dr. Cameron Dezfulian, a pediatric and adult critical care physician. He is the director of the Adult Congenital Heart Disease Program Development for the Section of Critical Care at Texas Children's Hospital and a faculty member at Cardiothoracic Critical Care at Baylor St. Luke's Medical Center. He is also a Senior Faculty member at Baylor College of Medicine in Houston, Texas. Additional resources: ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease. Circulation 2008: https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.108.190690 Special Considerations in Critical of the Congenital Heart Disease Patient. E Neethling, et al. Can J Cardiol. 2023: https://pubmed.ncbi.nlm.nih.gov/36682483/ Management of the Critically Ill Adult with Congenital Heart Disease. WB Kratzert, et al. J Cardiothorac Vasc Anesth 2018: https://pubmed.ncbi.nlm.nih.gov/29500124/ Adults with childhood-onset chronic conditions admitted to US pediatric and adult intensive care units. J Edwards, et al. J Crit Care 2015: https://pubmed.ncbi.nlm.nih.gov/25466316/ Down Syndrome. MJ Bull. N Eng J Med 2020. https://www.nejm.org/doi/full/10.1056/NEJMra1706537 Books and Music mentioned in this episode: The Bible: https://bit.ly/3EK4LL6

Dr. Zach Bush brings a unique perspective to understanding human emotions and healing, drawing from his 17-year background in academic medicine running ICUs and bone marrow transplant units, combined with his deep study of Chinese medicine, energy healing, and nature's intelligence. After leaving conventional medicine in 2010, he established an integrated medical center where he absorbed extensive knowledge of Chinese herbal medicine and acupuncture. His discovery that emotions are at the root of all diseases, backed by 5,000 years of Chinese medical science, led him to develop innovative approaches to emotional healing. Dr. Bush's current work with Project Biome involves studying nature's patterns and cycles, giving him unprecedented insights into how human emotional patterns mirror larger natural systems.In this powerful episode, you'll learn:The crucial difference between emotions and feelings, and why this distinction matters for healingHow our addiction to emotional patterns keeps us stuck in victim-perpetrator cyclesWhy nature has no purpose, and how this understanding can liberate us from emotional sufferingThe role of beauty in experiencing unconditional love and breaking free from emotional patternsHow unprocessed grief and trauma manifest physically and can be released through feelingWays to move from intellectual understanding to embodied feelingThe importance of being witnessed in our authentic expressionHow natural cycles of death and rebirth apply to emotional healingPractical approaches to feeling more deeply and metabolizing emotions naturallyKey Takeaway: Our addiction to processed emotions - much like processed foods - keeps us disconnected from the natural flow of feeling that exists in nature. By learning to distinguish between conditioned emotional patterns and raw, authentic feelings, we can break free from this addiction. The path forward isn't about managing or controlling emotions, but rather allowing ourselves to feel more deeply and completely, just as nature does. When we can embrace this natural way of being, our emotional struggles begin to metabolize and transform on their own, leading to genuine healing and liberation.Connect with Dr. Bush:Website: https://journeyofintrinsichealth.com/Join Dr Bush's Community: https://journeyofintrinsichealth.com/Instagram: @zachbushmdConnect with Raj:Instagram: @raj_janaiTunes: https://podcasts.apple.com/rs/podcast/stay-grounded-with-raj-jana/id1318038490Spotify: https://open.spotify.com/show/22Hrw6VWfnUSI45lw8LJBPYouTube: https://www.youtube.com/@raj_janaLegal Disclaimer: The information and opinions discussed in this podcast are for educational and entertainment purposes only. The host and guests are not medical or mental health professionals, and their advice should not be a substitute for seeking professional help. Any action taken based on the information presented is strictly at your own risk. The podcast host and their guests shall have neither liability nor responsibility to any person or entity with respect to any loss, damage, or injury caused or alleged to be caused directly or indirectly by information shared in this podcast. Consult your physician before making any changes to your mental health treatment or lifestyle. Hosted on Acast. See acast.com/privacy for more information.

On this episode of the Pretty Powerful Podcast, we sit down with the incredible Morgan Taylor—board-certified pediatric nurse practitioner, Chief Nursing Officer at Archer Review, and a true advocate for nursing education. Morgan shares her journey from working in pediatric ICUs at Duke University Hospital to leading innovative curriculum development for over half a million nursing and NP students. We discuss her mission to bridge critical gaps in nursing education, her passion for fostering a supportive community, and how to empower new nurses to stay in the profession during a time of unprecedented shortages.

“I have been a paratrooper and a medic for an air wing, consistently put my patients, brothers and sisters, and our national interest as my top priority,” Harry Fisher, an EMT since 1997, told Dr. Peter McCullough. “When I spoke out about the horrific things I was witnessing… I was called a terrorist by social media and shunned by many of my peers.” The paramedic says he witnessed “evidence of genocide” in 2020-2024 and shares how the medical system influences the minds of clinicians until they comply. Harry Fisher is a Nationally Registered Paramedic (NRP) with extensive experience in emergency medical services. An EMT since 1997 and paramedic since 2013, Fisher served as an Army and Air Force medic before working on ambulances for many years. During the COVID-19 pandemic, he transitioned to contract work in ERs, ambulances, and ICUs. Fisher is the author of “Safe and Effective, For Profit: A Paramedic's Story Exposing American Genocide” available at https://FishersBook.com. His career has spanned Oklahoma, New York City, North Dakota, and Alaska. Find him at https://x.com/harryfisherEMTP Dr. Kelly Victory MD is the Chief of Disaster and Emergency Medicine at The Wellness Company. A board-certified trauma and emergency specialist with over 30 years of clinical experience, Dr. Kelly served as CMO for Whole Health Management, delivering on-site healthcare services for Fortune 500 companies. She holds a BS from Duke University and her MD from the University of North Carolina. Follow her at https://x.com/DrKellyVictory 「 SUPPORT OUR SPONSORS 」 Find out more about the brands that make this show possible and get special discounts on Dr. Drew's favorite products at https://drdrew.com/sponsors  • FATTY15 – The future of essential fatty acids is here! Strengthen your cells against age-related breakdown with Fatty15. Get 15% off a 90-day Starter Kit Subscription at https://drdrew.com/fatty15 • PALEOVALLEY - "Paleovalley has a wide variety of extraordinary products that are both healthful and delicious,” says Dr. Drew. "I am a huge fan of this brand and know you'll love it too!” Get 15% off your first order at https://drdrew.com/paleovalley • THE WELLNESS COMPANY - Counteract harmful spike proteins with TWC's Signature Series Spike Support Formula containing nattokinase and selenium. Learn more about TWC's supplements at https://twc.health/drew 「 MEDICAL NOTE 」 Portions of this program may examine countervailing views on important medical issues. Always consult your physician before making any decisions about your health. 「 ABOUT THE SHOW 」 Ask Dr. Drew is produced by Kaleb Nation (https://kalebnation.com) and Susan Pinsky (https://twitter.com/firstladyoflove). This show is for entertainment and/or informational purposes only, and is not a substitute for medical advice, diagnosis, or treatment. Learn more about your ad choices. Visit megaphone.fm/adchoices

There's a shortage of specialized nurses who play a critical role in providing care to sexual assault survivors. Particularly in Louisiana, Mississippi, and Alabama. They are called sexual assault nurse examiners — or SANEs.As Drew Hawkins reports for the Gulf States Newsroom, one potential solution is to use telemedicine — but it's currently not available in the Gulf South.College textbooks are expensive. You might already know this if you've been to college, but prices have accelerated just in the last few years. And while tuition hikes and admission practices often create barriers of entry to higher education, sometimes it's that are prohibitively expensive, as they're often not covered by scholarships. As the spring semester gets into swing at schools across Louisiana, we found ourselves interested in efforts LSU is taking to address the accelerating problem of college textbook prices. Allen LeBlanc, Open Scholarship Librarian, at LSU Libraries tells us more about solutions.In June 2024, researchers released a medical study involving one Out Lady of the Lake Regional Medical Center in Baton Rouge. It looked at techniques for intubating patients, the practice putting a tube down your throat to provide ventilation, is something that's generally done when you're in critical condition. The trial involved Our Lady of the Lake Regional Medical Center in Baton Rouge as well as other ERs and ICUs across the nation. They're using a BPAP, a bilevel positive airway pressure machine.Dr. Christopher Thomas is a pulmonary critical care specialist at the hospital. He tells us more about this study, what researchers are hoping to find, and the results of a new airway pressure machine. ___Today's episode of Louisiana Considered was hosted by Adam Vos. Our managing producer is Alana Schrieber. We get production support from Garrett Pittman and our assistant producer Aubry Procell. You can listen to Louisiana Considered Monday through Friday at noon and 7 p.m. It's available on Spotify, the NPR App and wherever you get your podcasts. Louisiana Considered wants to hear from you! Please fill out our pitch line to let us know what kinds of story ideas you have for our show. And while you're at it, fill out our listener survey! We want to keep bringing you the kinds of conversations you'd like to listen to.Louisiana Considered is made possible with support from our listeners. Thank you!

Enterprise Ireland Irish medtech client company Aerogen today announces details of a €300 million transformational scaling and investment plan, which will result in the creation of 725 new jobs in Ireland over the next 10 years. Aerogen is Ireland's largest indigenous medtech company and Enterprise Ireland's largest client company in the sector having firmly established itself as the world leader in acute care aerosol drug delivery. This announcement was made in conjunction with Enterprise Ireland's End of Year Results for 2024, which confirms that total employment at companies supported by the agency increased to a record 234,454 last year, with 15,741 new jobs created. 64% of the new jobs created in these client companies were located outside the Dublin region, with all nine regions recording job growth. Minister for Enterprise, Trade and Employment Peter Burke was on site in Galway to preside over Aerogen's growth announcement and deliver Enterprise Ireland's results. "The government, through Enterprise Ireland, is targeting ambitious scaling of Irish multinationals that will help drive the Irish economy and our competitive advantage forward. Aerogen's announcement today is evidence of that Irish multinational ambition in action, and we are delighted to support them on their patient-focused mission. Commenting on the positive employment growth figures recorded by companies supported by Enterprise Ireland, Minister Burke said, "It is hugely positive to see Enterprise Ireland-supported companies recording job growth for the fourth year in a row. 2024 was a challenging year for some sectors of exporting Irish businesses with high interest rates and international instability impacting business performance, so to record significant employment growth is even more impressive. Today's announcement that Aerogen will implement an ambitious scaling plan, creating high-quality jobs here in the west of Ireland, is very welcome and demonstrates the continued success of Irish companies' performance in export markets. The government stands firm in our commitment to Irish companies competing and growing on a global scale." Aerogen - Transformational Scaling Plan With over 25 years of experience, 300 international patents and over 200 clinical papers, Aerogen technology has been used to treat over 25 million patients in emergency departments, adult and paediatric ICUs, general wards and ambulance services in 75 countries worldwide. Aerogen offers a safe and powerful drug delivery device for the treatment of critical respiratory illness and other non-respiratory illnesses and is the leading manufacturer of high-performance, single-use respiratory nebulisers in the world. The Aerogen Group is headquartered in Dangan, Galway, and the new Irish jobs will be across R&D, manufacturing, science and engineering and located there and at its two manufacturing sites in Parkmore, Galway and in Shannon. The implementation of the transformational scaling plan will enable Aerogen to create up to 725 highly skilled jobs in the West by 2035, increasing its global workforce to over 2,000, of which over 1,100 will be based in Ireland. As part of the ten-year scaling and investment plan, Aerogen aims to accelerate its existing device technology through new product innovation and leveraging of global opportunities. Simultaneously, it will build its emerging biopharmaceutics business with a major breakthrough in treating premature newborns with Infant Respiratory Stress Syndrome. High-quality R&D is crucial to its goal to become a global leader in pulmonary medicine and biopharmaceutical delivery, combined with a true commitment to improving patient care through cutting-edge technologies. Aerogen has been growing at over 20% per annum for the last decade, with annual revenues now over €150 million, and has contributed €130 million to local Irish businesses in that time. Over the next five years Aerogen expects to contribute a further €250 million in income and...

In this episode of the Saving Lives Podcast, we review a nationwide study on cardiogenic shock in general ICUs, recently published in the European Heart Journal: Acute Cardiovascular Care. Discover why non-ischemic heart failure now leads cardiogenic shock admissions, which patient groups face the highest mortality, and how early ICU intervention can improve outcomes. Stay tuned for critical insights into managing this high-risk population. The Vasopressor & Inotrope Handbook I have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. Amazon: ⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠ (Affiliate Link) My Store: ⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠ (Use "podcast" to save 10%) Citation: Citation: Guido T, Giovanni T, Elena G, Anna Z, Michele Z, Stefano F. Cardiogenic shock in general intensive care unit: a nationwide prospective analysis of epidemiology and outcome. Eur Heart J Acute Cardiovasc Care. 2024 Dec 3;13(11):768-778. doi: 10.1093/ehjacc/zuae108. PMID: 39302432.

Minnesota hospitals are seeing a surge in visits. It's mostly flu patients, according to the state, but COVID-19, RSV and norovirus are also spiking. Hospitals says it's putting a strain on ICUs and increasing wait times in emergency departments. And a state senator facing burglary charges is requesting to postpone a jury trial until May — after the Minnesota legislative session comes to a close. Those stories and more in today's evening update from MPR News. Hosted by Emily Reese. Music by Gary Meister.

Meet again Joe Sherman. Joe grew up in a family being the youngest of seven siblings. His parents who had not gone to college wanted their children to do better than they in part by getting a college education. Joe pretty much always wanted to go into medicine, but first obtained a bachelor's degree in engineering. As he said, in case what he really wanted to do didn't pan out he had something to fall back on.   Joe, however, did go on and obtain his MD and chose Pediatrics. He has been in the field for 35 years.   This time with Joe we talk a lot about the state of the medical industry. One of Joe's main efforts is to educate the medical profession and, in fact the rest of us, about burnout among medical personnel. Joe tells us why burnout is so high and we discuss what to do about it. Joe talks about how the medical profession needs to change to keep up with the many challenges faced by doctors and staff and he offers interesting and thought-provoking ideas. Again, I hope you will find my discussion with Joe Sherman beneficial, productive and helpful to you, especially if you are a doctor.       About the Guest:   Dr. Joe Sherman helps health professionals transform their relationship with the unrelenting demands of their jobs and discover a path toward meaning, professional fulfillment, and career longevity. He believes the key to personal and professional success lies in bringing “soul to role” in your medical practice.   Dr. Sherman is a pediatrician, coach and consultant to physicians and healthcare organizations in the areas of cross-cultural medicine, leadership, and provider well-being.  He is a facilitator with the Center for Courage & Renewal and a Master Certified Physician Development Coach with the Physician Coaching Institute.   Dr. Sherman has been in pediatric practice for over 35 years concentrating on healthcare delivery to underserved and medically complex children in the District of Columbia, Tacoma, Seattle, Uganda, and Bolivia.  He has held numerous faculty positions and is currently Clinical Associate Professor of Pediatrics at the University of Washington.   Ways to connect with Dr.Joe:   My website is: https://joeshermanmd.com/   LinkedIn: www.linkedin.com/in/joeshermanmd   Direct email connection: joe@joeshermanmd.com       About the Host:   Michael Hingson is a New York Times best-selling author, international lecturer, and Chief Vision Officer for accessiBe. Michael, blind since birth, survived the 9/11 attacks with the help of his guide dog Roselle. This story is the subject of his best-selling book, Thunder Dog.   Michael gives over 100 presentations around the world each year speaking to influential groups such as Exxon Mobile, AT&T, Federal Express, Scripps College, Rutgers University, Children's Hospital, and the American Red Cross just to name a few. He is Ambassador for the National Braille Literacy Campaign for the National Federation of the Blind and also serves as Ambassador for the American Humane Association's 2012 Hero Dog Awards.   https://michaelhingson.com https://www.facebook.com/michael.hingson.author.speaker/ https://twitter.com/mhingson https://www.youtube.com/user/mhingson https://www.linkedin.com/in/michaelhingson/   accessiBe Links https://accessibe.com/ https://www.youtube.com/c/accessiBe https://www.linkedin.com/company/accessibe/mycompany/   https://www.facebook.com/accessibe/       Thanks for listening!   Thanks so much for listening to our podcast! If you enjoyed this episode and think that others could benefit from listening, please share it using the social media buttons on this page. Do you have some feedback or questions about this episode? Leave a comment in the section below!   Subscribe to the podcast   If you would like to get automatic updates of new podcast episodes, you can subscribe to the podcast on Apple Podcasts or Stitcher. You can subscribe in your favorite podcast app. You can also support our podcast through our tip jar https://tips.pinecast.com/jar/unstoppable-mindset .   Leave us an Apple Podcasts review   Ratings and reviews from our listeners are extremely valuable to us and greatly appreciated. They help our podcast rank higher on Apple Podcasts, which exposes our show to more awesome listeners like you. If you have a minute, please leave an honest review on Apple Podcasts.       Transcription Notes:   Michael Hingson ** 00:00 Access Cast and accessiBe Initiative presents Unstoppable Mindset. The podcast where inclusion, diversity and the unexpected meet. Hi, I'm Michael Hingson, Chief Vision Officer for accessiBe and the author of the number one New York Times bestselling book, Thunder dog, the story of a blind man, his guide dog and the triumph of trust. Thanks for joining me on my podcast as we explore our own blinding fears of inclusion unacceptance and our resistance to change. We will discover the idea that no matter the situation, or the people we encounter, our own fears, and prejudices often are our strongest barriers to moving forward. The unstoppable mindset podcast is sponsored by accessiBe, that's a c c e s s i capital B e. Visit www.accessibe.com to learn how you can make your website accessible for persons with disabilities. And to help make the internet fully inclusive by the year 2025. Glad you dropped by we're happy to meet you and to have you here with us.   Michael Hingson ** 01:21 Well, hi all. This is your host, Mike hingson, and welcome to another episode of unstoppable mindset. And today we are meeting once again with Dr Joe Sherman. And if you remember our last show, Dr Sherman is a board certified pediatrician and master certified physician development coach, and I won't give any more away, because it's more fun to talk to him about all of that. But we had such an interesting discussion, it just seemed like what we ought to do is to have a continued discussion, because we didn't get to cover everything that he provided to us last time, and and I know we've probably got lots more that we can add to the discussion. So, Joe, welcome to unstoppable mindset. We're glad you're here   Dr. Joe Sherman ** 02:10 again. Thanks so much for having me. Michael, it's good to be back.   Michael Hingson ** 02:13 Well, glad you're here and all that. Do you want to start by kind of, maybe refreshing people about you a little bit life and all that, any anything that you want to give us just to start the process? Sure,   Dr. Joe Sherman ** 02:25 I currently live in Seattle, Washington with my wife. We have a few grown children that are in their early 20s, and I am a pediatrician, and now am a physician professional development coach, and I facilitate retreats for health professionals, medical teams, and most of my focus is on trying to bring who we are to what we do kind of being more authentically who we are in our workplace, trying to come to our work with a more balanced mindset, and trying to work A little bit more collegially as medical teams in today's ever changing health care environment. So now, I have practiced for about 35 years in pediatrics, and am now devoting all of my time to coaching and facilitation. You   Michael Hingson ** 03:37 know, gosh, there's so many, so many things that would be interesting to discuss, and I do want to stay away from the whole idea of politics, but at the same time, what do you think about the whole way the medical profession, you know, of course, one of the things that comes to mind is just everything that happened during COVID. But what do you think about the way the medical profession and some of the things that the profession is trying to do is being treated by politicians, and a lot of times it seems like people don't take it seriously, or it just doesn't fit into their agenda. Does that make sense?   Dr. Joe Sherman ** 04:15 You mean, as far as so as a pandemic was concerned? Well, the   Michael Hingson ** 04:20 pandemic, or, you know, there were some discussions about end of life or life discussions, and some people poo pooed, having that kind of thing and saying that isn't something that doctors should be doing. Oh,   Dr. Joe Sherman ** 04:33 I think, right now, I think that politics and healthcare are intricately entwined. Especially after the pandemic, and I think right now, the idea of the politics getting in the way of a kind of. The doctor patient relationship is, is challenging. It's challenging for healthcare workers. I think where we desperately need political courage is in trying to develop a healthcare system that works for everybody in the country. So I think that that's where the focus should be.   Michael Hingson ** 05:21 What do you think about? And I've had a number of people tell me, single pay healthcare system wouldn't be a good thing. It's too socialistic, and we'll leave that out of it just wouldn't be a good thing. It seems to me that it has been very successful in a number of places, but the kinds of arguments that people give are well, but by having competition, we have been a lot better at producing new and innovative technologies that wouldn't be produced or wouldn't be provided if we had just a single pay kind of system. I don't know whether that makes sense or I'm expressing it the best way, but it just seems like there's an interesting debate there. I   Dr. Joe Sherman ** 06:03 think there is debate because I do think there is some truth in the statement that our health care system has enabled development of technology and research in ways, perhaps that other countries have not. On the other hand, our health outcomes and our health access for people who live in this country is not very good, especially given the degree of wealth that our country has. So I used to joke, although it's not that funny, but one clinic where I worked that was a low income clinic, I used to joke that if one of our patients were to come out of their apartment To cross the street to come to the clinic. They may be turned away at the door because they don't have any insurance, or they don't have the proper insurance, or they can't pay but if they happen to be get run over by a car in the street on their way across the street, there would be no questions asked. The ambulance come pick them up. They'd be taken to the emergency room, given the best treatment to try to save their lives, admitted to the ICU and incur a huge medical bill with the greatest of technology, but they would not have been able to have gotten that primary care appointment to be in with. Yeah. So we are very kind of high tech, high intensity, high specialized in our approach to health care, whereas other countries focus much more on primary care.   Michael Hingson ** 07:54 I know in 2014 in January, my wife became ill. Started out as bronchitis, and it kept getting worse, and she didn't want to go to the hospital, but, and she was always in a wheelchair, so she she found that they didn't really know how to deal with can Well, she was congenital or always paralyzed from basically t3 from the breast down, and she so she didn't like to go, but finally, we compelled her to go to the hospital. And was on a Saturday, and the next day, the bronchitis morphed into double pneumonia and ARDS, and her lungs ended up being 90% occluded, so she had to even to get air into her lungs, they had to use a ventilator, and she had a peeps level of 39 just to get air into her lungs. Yeah, you know what that that means. And it was, it was pretty amazing. People came from all over the hospital just to watch the gages, but she had literally, just about turned 65 and we were very blessed that we didn't get any bill because Medicare, I Guess, absorbed the entire thing, and we we, we didn't know whether, whether we would get anything or not, and we didn't. And she did recover from that, although she felt that she had coded a couple times, and then her brain wasn't quite as good as it had been, but, but she did well, and so we got incredible care from Kaiser Terra Linda up in the San Rafael area, and it all went well. Of course, I we had gotten the pneumonia shots, and I complained to our physician to talk about joking. I complained to our primary care physician. I. Well, you say that these shots are supposed to keep it from happening, but we both had the shots and and, and she got double pneumonia anyway. Of course, the unfortunate thing was that that the doctor had an answer. She said, Yeah, but it would have been worse if he hadn't gotten the shot. Darn. She shot me down, but it was fun to joke.   Dr. Joe Sherman ** 10:18 Well, I'm sorry that that happened to you that that's, that's a unfortunate situation, it   Michael Hingson ** 10:26 was, but you know, things, things do happen and and we did get over it. And out of that, we ended up moving down to Southern California to be closer to to family. So it worked out okay. But we we love the and really support the medical system in any way that we can. We see both of us did, and I still, you know, and wherever she is, she must see the value of of what's done. And it just is so frustrating anytime people say doctors are crazy people. They don't, they don't really look out for people's interest, and just so many different things. It, it's unfortunate, because, you know, I can tell you from personal experiences. I just said what we saw,   Dr. Joe Sherman ** 11:16 yeah, I think that what is happening in our healthcare system now is this epidemic of burnout amongst professionals, especially amongst physicians and nurses, but and a lot of that has to do with the amount of administrative tasks and the amount of pressure that's put on physicians and other health care providers in trying to see as many patients as they can in the shortest amount of time as possible, and this is because of our system of fee for service reimbursement for medical care, the way that that health systems stay afloat is by trying to see as many patients as possible, and this unfortunately, combined with the amount of administrative work that needs to be done for each of those visits, plus the amount of communication that comes in from patients, as well as referral sources and requests for prescription refills, all of that comes in constantly through the computer of any physician that's trying to work as an outpatient or inpatient doctor, and it just becomes overwhelming,   Michael Hingson ** 12:43 yeah, how do we fix that? That's a good loaded, general question, isn't   Dr. Joe Sherman ** 12:50 it? It is it is a good question. And I I think it's a multi pronged approach. I do think that one thing that has happened is that the technology of healthcare and the business of healthcare has changed dramatically during the time that I've been a physician, a pediatrician, and the culture of healthcare, kind of, the way we do things, really hasn't changed. So that means that the business and the technology has placed more demands on us, and at the same time, we're kind of doing things pretty much the same way we've always done them, because of these extra demands that are placed on physicians and other health professionals, what's needed are experts that are in those areas of billing, administrative, administration, technology, it all of those things that now all feed into seeing patients in the office or in the hospital. So you need all of those professionals working together side by side along with the physician, allow the physician to do the work that she's been taught to do, which is actually deal with the patient and take care of the patient, and then let other people do the data entry, do the billing, take care of all of the messages and other things that are coming in around that that that provider. Do   Michael Hingson ** 14:23 you think that the same level of burnout exists in other countries that exists here?   Dr. Joe Sherman ** 14:29 You know it does. I do think that burnout exists everywhere in healthcare. I do think that it is less in low income countries, which seems kind of strange, but I've worked for many years in my life in low income countries in Africa as well as South America. And it's a different culture. It's a different culture. Culture of health care there is, there are different expectations of doctors, I think, in other countries, especially countries that are used to seeing a lot of disease and mortality, the pressure on saving lives and the pressure on having to be perfect and always get it right and knowing everything to do it each time that a patient comes in is not quite as intense as it is here. So I do think that it is different in other places. However, I will say that I have spoken to physicians in definitely in the more developed, higher income world, parts of the world that this epidemic of burnout is pretty universal   Michael Hingson ** 15:57 now, It seems to me that I've been seeing in recent years more what they're called physician assistants. Is that a growing population, or is it always been there, and I just haven't noticed it? And does that help?   Dr. Joe Sherman ** 16:14 I do think that in our country, here in the US, the future, will see many more physicians assistants and nurse practitioners, what we call Advanced Practice clinicians, or advanced practice practitioners, providers. We're going to see many more of them doing primary care, and a model that I think would would probably work very well is a team based model where the MD, who is kind of trained at a much higher level for many more years, leads a team of other providers made up of physicians assistants and nurse practitioners to do primary care, to take care of a group of patients, and perhaps that MD is there to consult, to be back up and to care for the more complex patients, while the nurse practitioners and PAs Are are getting the primary care, delivering the primary care.   Michael Hingson ** 17:23 Well, I know that the PAs that I have dealt with through the years, it seems to me, have, especially in the last 10 years, but have been very, very competent, very qualified. And I I don't, I don't know that, where I would say that they're less rushed, but I've had the opportunity to have some good conversations with them sometimes when, when the doctor just doesn't have the time. So it that's one of the reasons that prompted the question. It just seems to me that the more of that that we can do, and as you said, the more that that takes off. Perhaps some of the load from the physician itself may, over time, help the burnout issue.   Dr. Joe Sherman ** 18:10 I do think so. But I also feel like there's tremendous pressure right now on those pas and nurse practitioners, because they're under a lot of pressure too, too, and there aren't enough of them. Reduce and yes, so actually, right now, there's a movement within the the federal government to expand the number of positions in training programs for nurse practitioners and PAs. We have far too few, especially Physician Assistant schools. We don't have nearly as many as we need in this country. And if you look at the numbers, I think it's more competitive to get into PA school than it is to medical school,   18:54 really. Yeah,   Dr. Joe Sherman ** 18:58 I, you know, I that's been my experience of what I've seen from people just, you know, the number of applicants toward compared to the number of accepted, hey,   Michael Hingson ** 19:09 they wouldn't let you into a PA school, huh?   19:11 Exactly? Yeah.   Michael Hingson ** 19:15 No, I know. Well, it's, it is interesting. I know we read a few years ago that University of California Riverside actually started a program specifically, I'm trying to remember whether it was for training doctors. It was something that was supposed to be an accelerated program. Oh, some of the hospitals sponsored it. And the agreement would be, if you went to the school, you'd get the education, you wouldn't pay and at the end, and you would go to work for those hospitals like, I think Kaiser was one of the major sponsors of it. And again, it was all about trying to bring more people into the profession. Which certainly is admirable by any standard.   Dr. Joe Sherman ** 20:04 Yes, I think there are. Now, there are a few medical schools, and they're expanding the numbers that have free tuition, and they some of those schools, such as NYU Medical School has a generous donor who is given a tremendous amount of money as a donation and as an endowment. It pays for all the education of the students that go there. And there are some other schools that have the same arrangement. I think, I think if I were to be boss of the country, I would make all medical education free in in return, people would have to work in an underserved area for a certain number of years, maybe a few years, and then after that, they would be free to practice debt free, in any specialty and anywhere they would like.   Michael Hingson ** 21:10 Well, we need to do something to deal with the issue, because more and more people are going to urgent cares and other places with with different issues. I have someone who helps me a little bit. She's our housekeeper, and she also comes over once a week for dinner, and she has some sort of allergy. She just her face and her neck swelled up yesterday and had all sorts of red spots and everything. It's the second time she took not Benadryl, but something else that made it go away the first time, but it was back, and several of us insisted that she go to urgent care, and she went, and while she was there, she heard somebody say that they had been waiting four hours. So she left, you know, and which doesn't help at all. So I don't know actually whether she went back, because I talked with her later and said, Go back. So I don't know whether she did, but the waiting time is oftentimes very long, which is unfortunate. And I don't know whether more people are getting sick, or they think they're getting sick, or they're just taking ailments that are less too urgent care, but there are definitely long waiting times.   Dr. Joe Sherman ** 22:25 Yes, people, the people do not have a medical home. Many, many people don't have a medical home, a true medical home, that early in my practice pediatrician, as a general pediatrician, if there was a child that was in our practice and at night time or over a weekend, somebody would be on call. If that parent was concerned about a child in any way, they call the emergency line for the practice, the on call line, and that operator would page whoever the doctor was on call, and I would, as the doctor covering call that parent and talk directly at home, give advice over the phone, say what to do, make a decision of whether that child needed to go to the emergency room or not, or in the vast majority of cases, could give advice over the phone about what to do and then follow up when the office was open the next day or on the next week. Yeah, but nowadays, people aren't connected to offices like that. Yeah. We have call centers nurse advice lines of people that don't have access to medical records or have very strict protocols about what type of advice to give and the bottom line and the safest thing is go to the emergency room or go to urgent care. So that's unfortunately why some of the highest burnout rates are in emergency room doctors, and some of the biggest problems with understaffing are in emergency rooms right now. And   Michael Hingson ** 24:16 I can understand that, and makes perfect sense to hear that, and it's unfortunate but true. So yeah, but yeah, you're right. So many people don't really have a home. We've been blessed Karen, my now late wife, of course, was always a patient of Kaiser, and was a strong advocate for the way they did most of all of what they did. And so I eventually, when we got married and we were in a Kaiser area, then I did the same thing. And mostly I think it worked out well. I think. Kaiser is a little bit more conservative than some when it comes to perhaps some of the the newer procedures or newer sorts of things like they, you know, we see ads on TV now for the Inspire way of dealing with sleep apnea, as opposed to CPAP machines. And I don't know whether Kaiser has finally embraced that, but they didn't for the longest time. At least our doctor said that it wasn't really great to have to undergo surgery to deal with it, and the CPAP machines work fine, but I think overall it to to use your your words, definitely, if you're in that kind of an environment, it is a little bit more of a home, and you have definite places to go, which I think is valuable. And I think that more people really ought to try to figure out a way to find a home if they can.   Dr. Joe Sherman ** 26:00 Yeah, I do think that it is in the amount just society has advanced so so rapidly and so much in in how communication is instantaneous these days, through texting and through internet and through instant messaging, all these different ways that everything is sped up so people are looking for answers right away. Yeah, and it's, it's that's often puts too much pressure on the people that are trying to manage all of the patients that and all of their inquiries that they have. So I think, I think we need to make some serious changes in the way that we, that we staff hospitals, the way we staff clinics, and look and see what are the specific duties that need to be done, the specific activities and responsibilities in attending to a patient and specifically target personnel that are skilled in that activity, instead of having a physician who you know, is not the greatest typist, or is not the greatest at trying to figure out a code of billing for insurance or how to look at 100 messages that came in while she was attending to, you know, 25 patients in A clinic. It's just too much. It's overwhelming. And I mean, I now facilitate a group. It's a support group for physicians through physicians anonymous, where physicians are suffering from anxiety, depression, addiction. Suicide, ideation, and it's it's really at at scary levels right now, and I do think that the healthcare systems are starting to be aware of it. Think patients need to be aware of it, and the reason why, when you call, you're on hold forever or you never do get to speak to a real person, where it takes months to get in to see a doctor, it's because nobody's home. Yeah, everybody is many, many people have, have quit.   Michael Hingson ** 28:39 Yeah, there's such a shortage. I know at least we see ads oftentimes for nurses and encouraging people to go into the field, because there's such a shortage of nurses, just like there's a shortage of teachers. But we don't do as much with the conversation of, there's an incredible shortage of physicians. I think it's probably done in some ways, but not as publicly as like nurses and some other types of physicians.   Dr. Joe Sherman ** 29:13 Yes, I think right now, the I always feel like, I mean, this has been always true that on hospital floors, because the profit margin for hospitals is very narrow, there are only certain services that hospitals truly make profit on. So usually the staffing levels are kept to the very bare minimum, and now that just puts too much pressure on those that are remaining. And so now we're seeing many more hospitals have nurses that go out on strike or or decide to slow down, or. Or do other measures to try to get the attention of how dangerous it is to have understaffing in the hospital.   Michael Hingson ** 30:08 Have we learned anything, because of all the stuff that happened with COVID Now that we're in this somewhat post COVID world, have we have we learned a lot or any or anything, or is anything changing, and is there really ever going to be a true post COVID world? For that matter? That's a fair question.   Dr. Joe Sherman ** 30:29 That is a fair question. And I do think recent changes in policy by the CDC of of treating COVID As if it were influenza, or RSV or other type of respiratory viruses is there are many physicians that disagree with that policy, because COVID, this COVID, 19 that We've been dealing with, causes many more complications for those that have complex medical conditions, and this long COVID situation is something that we really don't have a grasp on at this point, but I believe one innovation I would see or expansion that has come about is the whole telehealth movement, now that there are many, many more video visits, I do think that's a good thing. I also believe that it can provide more flexibility for healthcare providers, which will help to decrease burnout, if providers are able to perhaps do their telehealth visits from home, or be able to spend time doing telehealth visits as opposed to having to see patients in person. I think what happens now is we need to get better organized as far as which types of visits are should be telehealth, and which types should be seen in person, so that one provider is not going back and forth from, you know, computer screen to seeing somebody in person, back and and so that gets too disorganized. Yeah, I think at times, other things, I think we learned a lot about infectious disease. I think that the general public learned a lot more about infections and infection control. I think that's all good. I think one thing that we did not learn, unfortunately, is how desperately we desperately we need to do something to try to stem the tide of burnout, because it just accelerated during COVID and then has continued to accelerate because of the economic crunch that healthcare systems find themselves in now.   Michael Hingson ** 33:10 Well, and what is, to me, a little bit scary, is all it takes is one COVID mutation that we don't expect or encounter, and we're almost in back where we were, at least for a while. And I hope the day will come when, rather than using the the mRNA type vaccine that we use now that we truly will have a vaccine like an influenza vaccine, that can really kill the virus and that we can then take, even if it's yearly, but that will truly build up the immune system in the same sort of way. Although I have no problem with the current vaccine, in fact, I'm going in for my next vaccine vaccination a week from tomorrow. And what cracks me up is I've been there a number of times, and some people talk about the conspiracies of all they're doing is injecting you with all these little things that are going to track you wherever you go. And I'm sitting there going, Fine, let them. Then if there's a problem, they're going to know about it, and they'll come and get me, you know, but what I really love to do is a nurse will come over, she'll give me the the vaccination, and she pulls the needle away, and then I reach over with my one hand and slap my hand right over where she did the shot. And I said, Wait a minute. One just got out. I had to get it, you know. And, and she says, you know, there aren't really any trackers. I said, No, I'm just messing with you, but, but you know, it will be nice when that kind of a vaccination comes, and I'm sure. Or someday it will.   Dr. Joe Sherman ** 35:02 Well, I think the vaccines it this specific, these types of respiratory viruses do mutate quite a bit. There's all kinds of variants, and they change every year. So I think no matter what kind of vaccine we get, we're still with with infections such as influenza or COVID, we're still going to end up needing to get annual vaccines, most likely, yeah,   Michael Hingson ** 35:34 and that is the issue, that even with influenza, we do get lots of variants, and I know a couple of years, as I understand it, they kind of predict what strains to immunize for based on like, when Australia gets in our middle of the year and things like that. But sometimes it doesn't work. That is they they guessed wrong when it gets to us, or it's mutated again, and it's unfortunate, but it is, it is what we have to deal with. So for me, as far as I'm concerned, anything that we can do is going to help. And I really have found the current vaccines that we do get for COVID, at least, whether it will totally keep you from getting it or not, which I gather it won't necessarily, at least it will mitigate to a large degree what could happen if you didn't take the vaccination.   Dr. Joe Sherman ** 36:34 Yes, yes, that's correct. We We are. We're seeing much less deaths as a result of COVID infection. However, in the peak of the winter time in the clients that I was that I've been coaching, who work in in hospitals and in ICUs, they were seeing still a large number of patients that were there. It's just that we've now developed better treatment and management for it and so, so then less people are dying of it. But it is, you know, we have, again, the amount of research, medical research and development that has developed these vaccines has prevented so much infection that what doctors are called on to do now and what they're called on to treat and manage has shifted much more into areas of behavioral health and lifestyle change than it is treating infections. That's dramatically different experience through my pediatric training than what type of training that a pediatrician these days gets   Michael Hingson ** 38:01 and there again, that means that the physicians have to spend the time learning a lot of that that they didn't learn before, which also takes a toll, because they can't be in front of patients while they're learning or while They're studying.   Dr. Joe Sherman ** 38:18 Yes, yeah, it's what the medical students and residents now are being called on to manage in the hospital are very, very complex, specialized conditions and very serious conditions. My experience as a resident was much more. The vast majority of people I took care of as a pediatric resident were normal, healthy children who happen to get sick, mostly with infection and sometimes very seriously sick, come in the hospital, receive treatment, and walk out as a child, a normal, healthy child again, we don't see that as often as pediatric residents, just speaking from pediatricians point of view, and I think that that has a an emotional toll on the resident physicians. I got a tremendous amount of reward from caring for patients with serious infections that received antibiotics and got completely better than patients who already have complex chronic conditions that just get worse or a complication, and they come In and the resident helps to manage them a little bit, and then sends them on their way. But really doesn't feel like they cured them contributed in the same way and that that was they don't have that same type of reward, that rewarding feeling, I think, are   Michael Hingson ** 39:59 we seeing? More of that kind of patient, significantly more than we used to in the hospital. Absolutely. Why is that? Is there really are more or   Dr. Joe Sherman ** 40:11 or what? Well, there aren't. We've taken care of most of the serious bacterial infections that used to be treated in the hospital with antibiotics, we've taken care of them with vaccines, and then we've also advanced the the quality and and variety of conditions that we can treat as an outpatient now, so that people that used to come into the hospital all the time for conditions, simple, basic things, are now treated as outpatients. And that's a good because you don't want to be in the hospital any longer than you absolutely have to. No,   Michael Hingson ** 40:58 I had, well, my father, I don't remember how old I was. It must have been in the we 1960 sometime he had to have a his gallbladder out. So it was a pretty significant operation at the time, because they he was in the hospital a couple days, and came home with a nice scar and all that. And then my brother later had the same thing. And then in 2015 suddenly I had this, really on a Thursday night, horrible stomachache. And I figured there is something going on. I hadn't had my appendix out, but this wasn't right where my appendix was, but we went to the local hospital. We called Kaiser, and they there isn't a hospital, a Kaiser hospital up here, so they sent us to another place, and they took x rays, and then we ended up going down. They they took me by ambulance on down to Kaiser, and it was a gallbladder issue. So I guess all the men in my family had it. But what happened was that when they did the surgery, and by the time we got down to Kaiser, the there was a gallstone and it passed. So I didn't want to do the surgery immediately, only because I had the following Sunday an engagement. So we did it, like a week later, the doctor thought I was crazy, waiting. And then later he said, Well, you were right. But anyway, when I had the operation, there were three little band aids, and it was almost, I guess you call it outpatient, because I went home two hours later. Wow, I was I was blessed. So they it was almost like, and I've had colonoscopies before. I didn't spend any more time doing the gallbladder operation than I did, really, with all that I spent in the hospital doing a colonoscopy, it was pretty good,   Dr. Joe Sherman ** 42:58 right? I do think that there's been again, major advances in endoscopic surgeries and robotic surgeries and minimally invasive procedures to be able to to treat patients. I mean, again, I have to say that our ability now to treat stroke and and heart attacks, myocardial infarction, our abilities to our ability to treat those acutely, do something to try to improve the outcome, has improved dramatically just recently, I would say, especially stroke management. So what we have is amazing, dramatic changes in in reducing the morbidity and mortality from stroke now, and I think that it's remarkable. Even as a physician, I didn't even realize until a recent trip I took to Bolivia with a group of neurosurgeons how stroke is treated now, and it's, it's, it's phenomenal that before you have a stroke, and it's just kind of like, well, you hope for the best. You support hope that some blood flow returns to that part of the brain. Now, if you have a stroke, and people are taught to recognize it and immediately get to the hospital, they can give a medication to melt the clot, or actually go in there with the catheter and extract the clot out of the vessel and restore you back to full function and   Michael Hingson ** 44:56 remarkable, and have a glass of red wine while you're at it. Yeah. Uh, or, or, do we still say that TPA helps some of those things a little bit? You   Dr. Joe Sherman ** 45:07 know, it's interesting. It's, you know, as far as as I think I've never seen so many articles written about the consumption of alcohol coffee, going back and forth and back and forth. You know what's helpful? What's not? Everything in moderation, I would say this point,   Michael Hingson ** 45:28 yeah, I I would not be a good poster child for the alcohol industry. I have tea every morning for well, with breakfast. And the reason I do is that I decided that that would be my hot drink of choice. I've never been a coffee drinker. The caffeine doesn't do anything for me, so it's more the tea and then a little milk in it. It is a hot drink. Ever since being in the World Trade Center, I do tend to clear my throat and cough more, so the tea helps that, and that's the reason that I drink tea. But I remember seeing old commercials about red wine. Can can help you. So if I have a choice in wine, I'll oftentimes get red just because I've heard that those commercials, and I don't know how how true it is anymore, but hey, it's as good a reason as any to have a glass of wine every other week. And that's about what it usually is.   Dr. Joe Sherman ** 46:26 Yeah, sounds like. Sounds like a good, a good plan. Yeah,   Michael Hingson ** 46:31 works. Well, it's, it's now kept me around for a while, and we'll keep doing it. It works. So what is it that healthcare workers and physicians do to kind of restore their love for what they do and work toward burnout? What can individuals do?   Dr. Joe Sherman ** 46:54 I think we're at a point now where in in approaching the issue of burnout and approaching the issue of overwhelm with the amount of work that physicians are called on to do these days is a combination of personal Changes to mindset and approach to our work, as well as structural and organizational changes to facilitate our work. And I think that the organizational structural changes, again, have to do with trying to improve specific staffing to match the activities and responsibilities that are that are called on in the medical setting, and being able to do more in the in the formation of medical teams and in teamwork And in people having a common mission, working together, appreciating what each other does, and hospital administrations and and those folks that run the business of the hospital truly value and enlist The engagement of frontline workers in policy and procedures. So those are kind of structural changes right on the personal side, yeah, I was that's I just a lot of it has to do with being more realistic. And I'm speaking to myself too. We can't do everything for everyone all the time we are human. We often have been taught that we are super human, but we're not. And if, if we try to do too much and try to do it perfectly, then our bodies will rebel and we'll get sick. So I think we need to set boundaries for ourselves. We need to be able to say, these are the hours that I'm working. I can't work any more than that. We need to say that you can't reach me three different ways, 24 hours a day, all the time, and have me respond to all of those inquiries, we have to set limits, and we have to really look at what it is that we love about medicine, what it is we love to do within medicine, and really try the best we can, I Think, with the help of coaches and other types of mentors and folks that can help us to create the types of jobs and the types of positions that help us maximize that experience of fulfillment, that experience of of. Feeling like we truly are contributing to the health and well being of our patients. Do   Michael Hingson ** 50:07 you think overall that the kind of work you do, and then others are doing to address the issue of burnout is is really helping? Are we are we making more progress, or are we still losing more than we gain.   Dr. Joe Sherman ** 50:23 I think we're making progress on an individual basis, on people that do seek help. But we need also to change the mindset of ourselves as physicians, to be willing to seek help. We need to seek help and be admit that we need that type of support, but until we get organizational commitment to trying to change the structures and the systems that we work under, then we will continue to have more physicians lost to burnout, depression and suicide.   Michael Hingson ** 51:05 Are healthcare institutions recognizing more the whole issue of burnout, and are they? Are they really starting to do more about it?   Dr. Joe Sherman ** 51:17 Some, I think some are. I think organizations are recognizing it. Associations of physicians are recognizing it. But when it comes to surviving as a health organization, healthcare institution, the bottom line is, what runs a show, and the way you make income is through billing, and the billing occurs as a result of a health care provider providing and billing for what they Do. So if there's an economic crunch, the first thing to go is anything that doesn't generate income and supports for the well being of staff does not generate direct income. What it does, though, is that it retains staff. It it results in a happier staff, a more higher professional satisfaction, and in the long run, is going to save you money,   Michael Hingson ** 52:33 yeah, which, which is another way of making some more money.   Dr. Joe Sherman ** 52:39 Yeah. I mean the total cost, the average cost for replacing a physician who has decided to quit is anywhere from about 600,000 to $2 million depending on the specialty of the physician. Yeah,   Michael Hingson ** 52:57 and then getting people to necessarily see that is, of course, a challenge, but it still is what what needs to happen, because it would seem to me that those costs are just so high, and that has to account for something that is still a fair chunk of money. Yeah, it   Dr. Joe Sherman ** 53:16 is. It's a great deal of money. And, you know, our again, our system of health care, we were headed in the right direction. And I think eventually we have to get there to population based health in looking at health outcomes and trying to look at overall health of of our our citizens and and those who live here in our country in trying to, instead of having a fee for service model, have a model that looks at reimbursement for health care based on the total health of The patient, and that is contributed to by nurses, doctors, technicians, receptionists, community health workers, all those types of health professionals.   Michael Hingson ** 54:12 What can we do to get the wider society to become more aware of all of these issues and maybe to advocate for change.   Dr. Joe Sherman ** 54:25 I think, I think avenues like this, these   Michael Hingson ** 54:29 podcasts, this podcast is one.   Dr. Joe Sherman ** 54:32 I also believe that look at your real life, lived experience of trying to access healthcare today compared to how it was 20 years ago, and are you having more trouble? Are you having is it more expensive? Are you having more challenges? This is direct result of a. System that's not functioning well.   Michael Hingson ** 55:02 Did the whole process of what we now call Obamacare, did that help in the medical process in any way? I   Dr. Joe Sherman ** 55:11 think what happened with Obamacare was well, and the bottom line answer is yes, it has helped. And the way it has helped is that more people have access to health insurance, less people are completely uninsured than ever before. So I think from that perspective, that's been helpful, but there were so many compromises, oh yeah, to insurance companies and two different lobbyists that were all looking out for their interests, that what ended up happening was a much more watered down version of what was initially proposed, but step in the right direction, And if we continue to work toward that, and we have some contribution of government sponsored health insurance, then we're going to be better off as a nation,   Michael Hingson ** 56:14 yeah, well, and anytime we can make a step forward, it does help, which is, of course, a good thing. So if there's one thing you want listeners to take away or watchers, because we are on YouTube, if there's one thing you want people to take away from this, what would it be?   Dr. Joe Sherman ** 56:33 It would be, pay attention to your own personal experience with healthcare. Pay attention to your own health and observe what's going on in the clinics, in the offices and in the hospitals where you receive your medical care. If somebody is treating you well with respect and compassion, point it out. Make it known. Thank them. Yeah, make it known that you know that they're under tremendous stress and pressure, and that anytime that they can be kind, then that means that they are very dedicated to to treating you, treating patients. And if you're finding that where you're going to receive your health care seems to be understaffed, and say something about it. If you have a health care provider who is a bit snappy, is not patient with you, doesn't seem to be listening to you, it's not because they don't want to. Yeah, they desperately want to. It's just that the conditions are such that they're not able to   Michael Hingson ** 57:44 and and it would probably be good to at least engage them in a little dialog and say, hey, hey, I'm not trying to yank your chain here and kind of try to help warm them up. I've been a firm believer that in a lot of places where I go, like in the in the airline world, the TSA people and so on, I love to do my best to make them laugh. So like when I go up to the kiosk and the TSA agent says, I need to see your ID, especially when I'm wearing a mask, I'll say, Well, what do you want to see it for? You can't tell who it is behind this mask, right? And I've had a couple people who didn't expect anything like that, but they usually laugh at it. Then the other one I love to use is they ask for my idea. I say, Well, what's wrong with yours? Did you lose yours? And I just love to try to make them laugh where I can, because I know it's a thankless job, and I know that what doctors and medical people deal with is a pretty thankless job, too. So it's fun to try to make them laugh whenever I can and get them to smile.   Dr. Joe Sherman ** 58:47 Yep, they all could use a little bit more humor. Yeah, there's always that. So   Michael Hingson ** 58:51 if people want to learn more about you and reach out and learn about your work and so on, how do they do that? Where do they find you, online or any of those things? Sure,   Dr. Joe Sherman ** 59:00 I have a website that you can go to. It's Joe Sherman md.com and you can reach me by email. Joe at Joe Sherman md.com also on LinkedIn, so you can find me there. Too Cool. Well,   Michael Hingson ** 59:20 once again, I want to thank you for being here. This has been a lot of fun and very enjoyable and in a lot of ways, but certainly educational, and I've learned a lot, and we got through all the questions this time that we didn't get through last time, which is always a good thing. So see, it was worth doing it twice.   Dr. Joe Sherman ** 59:39 Great. Thank you so much. Well, it was   Michael Hingson ** 59:42 fun, and of course, for you listening out there, reach out to Joe, and I want to hear from you. I want to hear what you think of today. So please email me. Michael, h i at accessibe, A, C, C, E, S, S, I, B, e.com, or go to our podcast page, www, dot. Michael hingson.com/podcast and Michael Hinkson is m, I, C, H, A, E, L, H, I N, G, s, O n.com/podcast, would really appreciate a five star review from you, wherever you are listening to us. We like those reviews if you can, if you know anyone that you think ought to be a good guest on unstoppable mindset. And Joe you as well. We'd love to hear from you or provide us introductions. Always looking for more folks to to meet and to chat with, and love the incredible diversity and subjects that we get to talk about. So that makes it a lot of fun, but I do want to just once more. Joe, thank you for being here. This has been enjoyable, and I really appreciate it. Thanks   Dr. Joe Sherman ** 1:00:40 so much, Michael, I enjoyed the conversation.   Michael Hingson ** 1:00:48 You have been listening to the Unstoppable Mindset podcast. Thanks for dropping by. I hope that you'll join us again next week, and in future weeks for upcoming episodes. To subscribe to our podcast and to learn about upcoming episodes, please visit www dot Michael hingson.com slash podcast. Michael Hingson is spelled m i c h a e l h i n g s o n. While you're on the site., please use the form there to recommend people who we ought to interview in upcoming editions of the show. And also, we ask you and urge you to invite your friends to join us in the future. If you know of any one or any organization needing a speaker for an event, please email me at speaker at Michael hingson.com. I appreciate it very much. To learn more about the concept of blinded by fear, please visit www dot Michael hingson.com forward slash blinded by fear and while you're there, feel free to pick up a copy of my free eBook entitled blinded by fear. The unstoppable mindset podcast is provided by access cast an initiative of accessiBe and is sponsored by accessiBe. Please visit www.accessibe.com . AccessiBe is spelled a c c e s s i b e. There you can learn all about how you can make your website inclusive for all persons with disabilities and how you can help make the internet fully inclusive by 2025. Thanks again for Listening. Please come back and visit us again next week.

I've spent some time reflecting back on all my years practicing in hospitals, often not sleeping for extended periods, sometimes days, covering hospitals floors and ICUs, resuscitating people who experienced cardiac arrests, taking them to the cath lab to open arteries, but also witnessing people with all sorts of other health conditions: cancers, wound infections, sepsis, delirium, the various stages of dementia, and hundreds of other debilitating disease. I now recognize that, looking back, so many health conditions can be better understood in light of the contribution of the microbiome, i.e., the trillions of microbes occupying the gastrointestinal tract from mouth to anus, the nasal sinuses, the airways, the brain, the prostate, the vagina and uterus, the skin—virtually every part of the human body. We all know about acute bacterial infections. But I'm talking about something different. While microbes exert effects via a number of different routes—think the gut-brain axis, the gut-skin axis, the gut-muscle axis, effects exerted via hormones, inflammatory mediating proteins, and bacterial breakdown products. But beyond this, there is a curious phenomenon in which bacteria and fungi themselves, by a number of means, travel through the body to take up residence and cause trouble. But the “trouble” is not an infection in the conventional sense, but something different, less acute, less urgent, less dramatic, but nonetheless playing a big role in your health. This is the fascinating and scary phenomenon called “translocation,” the topic for this episode of the Defiant Health podcast. _______________________________________________________________________________For BiotiQuest probiotics including Sugar Shift, go here.A 15% discount is available for Defiant Health podcast listeners by entering discount code UNDOC15 (case-sensitive) at checkout.*_________________________________________________________________________________Get your 15% Paleovalley discount on fermented grass-fed beef sticks, Bone Broth Collagen, low-carb snack bars and other high-quality organic foods here.* For 12% off every order of grass-fed and pasture-raised meats from Wild Pastures, go here._____________________________________________________________________________MyReuteri and Gut to Glow can be found here: oxiceutics.comSupport the showBooks: Super Gut: The 4-Week Plan to Reprogram Your Microbiome, Restore Health, and Lose Weight Wheat Belly: Lose the Wheat, Lose the Weight and Find Your Path Back to Health; revised & expanded ed

TWiM explains how ticagrelor alters the membrane of S. aureus and enhances the activity of vancomycin and daptomycin without eliciting cross-resistance, and the development of a novel continuous disinfectant technology that decreases healthcare-associated infections in ICUs by 70%. Hosts: Vincent Racaniello, Michael Schmidt, and Michele Swanson. Become a patron of TWiM. Links for this episode Ticagrelor and S. aureus (mBio) Novel disinfectant technology (Am J Inf Control) UVC-LED to inactivate foodborne pathogens (Appl Envir Micro) UV disinfection systems (ACS Photonics) High-touch surfaces in specialized patient care area (CDC) Take the TWiM Listener survey! Send your microbiology questions and comments (email or recorded audio) to twim@microbe.tv  

This week, I'm excited to welcome Dr Jack Kruse. Dr Kruse is a board certified neurosurgeon, health educator, and proponent of unconventional health and wellness practices. Dr. Kruse's philosophy often challenges conventional medical approaches, emphasizing the importance of natural living and reconnecting with ancestral health principles. In this episode, Dr Kruse explains the current state of play around decentralised medicine. View all episodes at www.thehealthsessions.com.au Learn more about Dr Jack Kruse at https://jackkruse.com Episode Transcript: Stuart Cooke (00:01.252) Hey guys, this is Stu from the Health Sessions and I am delighted to welcome Dr. Jack Cruz to the podcast. Dr. Cruz, how are you? Yeah, I'm very well, very well indeed. Very excited to have this conversation. But first up for all of our listeners that may not be familiar with you or your work, I'd love it you could just share a little about yourself, please. Dr Jack Kruse (00:08.76) Pretty good, how about you? Dr Jack Kruse (00:21.976) Yeah, I'm a board certified neurosurgeon in the United States. I have been living in El Salvador for the last four years. When COVID hit, I began to question a lot of the things that were present, and I decided to unretire, go back and do trauma call to see if they were lying to us or not. And I found out that they were. So then I decided to do something about it. and I wound up presenting to the Bukele administration in El Salvador and they shared some of their country-wide data with me and things that they were facing. And they asked me, what did I think was the solution? And I told them, I think you need to have a constitutional amendment put into your constitution so this would never happen again. And I think you need to re-educate some of the people in your health ministry, I think. You need to educate the doctors. You need to tell people the truth. You need to have freedom of the press. You need to embrace freedom. And this was an easy message for Bukele because he gave his people freedom almost as soon as he got elected the first time in 2019, 2020 made Bitcoin legal tender. And that basically returns freedom back to people and their, and their money. So since he did that first, and then he cleaned up the crime problem in the country, fixing the next problem actually was pretty easy. The real hard part, since you're Australian, I can imagine you know this because it's still going on in your country, that you can't get even people to admit that there was a problem with COVID. And if you can't admit there's a problem, you can't solve for X. And that's kind of where we're going. And then after me helping President Bukele, then... Stuart Cooke (01:59.77) Mm-hmm. Dr Jack Kruse (02:16.854) that information started to bleed into Bobby Kennedy's vice presidential candidate, Nicole Shanahan. And then Bobby called me about the law and then they started to use the law in their campaign. And then next year, know, this summer he joins forces with Donald Trump and then Donald Trump has got the message now too. So I would consider myself more of a lethal pathogen for probably the COVID narrative than most other people that you could probably have on. Stuart Cooke (02:45.957) Fantastic, wow, that is quite an introduction. And very interesting times ahead. Let's see what happens. mean, game on. Everything that we've been speaking about in the counterculture world of health, wellness and human performance is about to take centre stage. So really, really interested. So coming from a traditional medicine background into being one of the... one of the leaders in the biohacking and wellness space now. How do you look at traditional medicine right now? Dr Jack Kruse (03:16.664) Traditional medicine is like a sweet on the Titanic. They would like to renovate it and I would like the boat to sink. Why? Because we've gone past the point, you know, it's like a patient with metastatic cancer in just about every Oregon. You know, the time to fix it was to do the prevention earlier, but you have to realize that Stuart Cooke (03:26.829) Right. Dr Jack Kruse (03:42.636) The people that control big pharma really are the bankers. It's a, it's a very big story. And when I mean big, complicated because it's a Leviathan to know where all the missing pieces and parts are, you know, it take a lot longer time than you have allocated to talk to me. But in the last, I would say six months in the United States, I have been doing a ton of podcasts. Why? Because people in the United States, unlike probably Australia, unlike Canada, unlike Europe, they're ready for this discussion about really what happened. And I think, you know, the people in the States voted that way on November 5th, that they were sick and tired of being lied to. And we didn't go down the path that, you know, Canada went, you guys went, Europe went, or even places like South America went. We decided that we're still for the freedom of speech. Stuart Cooke (04:16.12) Hmm. Dr Jack Kruse (04:42.456) And we're still fighting for the truth. We're not going to have digital IDs or we're saying right now that we're not going to have central bank digital coins. But I don't know if that's going to be true or not. I think there may be a path to that because the people that truly control the United States, which are the bankers and the industrial military complex, may have different designs because effectively, you know, what Trump and Bobby Kennedy are bringing to the table right now, really is the vaccine for Big Pharma. It's really the vaccine for the bankers. It's quite a lot to swallow. And like I said, one of my good friends in this story, Kevin McKiernan, who's the person that found SV40 in the jabs, said it's kind of like expecting Trunk and Bobby to go into the Death Star and somehow make Darth Vader nice. I don't know if that's really possible. But I certainly think that it's worth an opportunity to do it. I think other places in the world have actually got collateral effects from COVID. And that's actually what the people who were doing this, the Agenda 201 people, the WEF people, I know there's a lot of people in Australia that are now really fighting hard against this. But you guys already got digital ID. You guys are. are headed towards a CBDC. you know, basically they're interested in making us economic slaves on the plantation. And it's kind of the way in which they've done it is, I'm going to tell you, it's brilliant. It's a brilliant plan. It's been crafted over 120 years and they've done small little changes, insidious changes that you're like, come on, this isn't that bad. But when you add the whole collection up, you know, it's not a good situation. And they've used medical tyranny to pull it off. They've also used financialization, you know, through rehypothecation of money. That's actually the base problem for every country, including my own. And it's actually the base problem that was here in El Salvador. But El Salvador was the one country who started to reverse this trend because during their civil war, Dr Jack Kruse (07:09.292) that the United States CIA effectively started, you know, 30 years ago, they lost their fiat currency called the Cologne and they started to use, you know, U.S. dollars as their economy. So they're completely, you know, dollarized and that creates, you know, a huge problem. when Bukele got in and broke the cycle of corruption that was down here, the first thing he did was, I'm going to give my people a parallel monetary system. that's not tied to the Federal Reserve. And I don't think people like all over the world realize how big a thing that was. And believe it or not, that's actually what got me to come to El Salvador because I realized that this type of maneuver was like what George Washington did for the United States where was, but Kelly was like George Washington on steroids. Why? Most people don't know the history. of the United States well enough, especially you guys, since you're a commonwealth. Thomas Jefferson and James Madison wrote in Federalist Papers before our founding documents were done. They actually had fights with each other and a guy named Alexander Hamilton, which you probably heard. And Jefferson was ardent that the biggest problem with the Bank of England was that their level of usury. and also the way the bank handled business. And he said that no government will ever be successful if you allow the bankers to have this level of control. And Alexander Hamilton took the other side and said, well, that's all well and good, but if you're to create a country like we're trying to do here in the United States, you still have to have a monetary system. right now, going back to the Magna Carta, the Britons have done a pretty good job for about 1,000 years. Why don't we just roll with that until something comes up? And we didn't have a better form of money, you know, at that time. But the funniest part of the story is when Jefferson becomes president after George Washington, his vice president, Aaron Burr, kills Alexander Hamilton in a duel. Like this problem has not gone away in the United States. And I would say to you, it went all the way up into the Bitcoin Nashville event in Dr Jack Kruse (09:29.816) You know, July this year, when you had both Trump and Bobby, when they were both running for president, both of them said that they were about making Bitcoin a reserve currency to back the US dollar, you know, to make it affect how it used to be prior to 1971 when it was backed up by gold. And that's a good step. You know, for me as a Bitcoin maximus, it's not what I want to see. But is that a really positive step? you know, for the United States, yes. If it's a positive stuff for the United States, when we do something, everybody else usually follows. The interesting part is, I don't think Britain is gonna be doing that now because what did they do in their election? They voted for a version of Kamala Harris with a penis. That's called pure scarmor. And generally what the UK does, that's what Canada does, that's what Australia does. And a lot of times the same thing is true with Europe. But this is the first time I can tell you, think, maybe since World War I, when the United States and Britain have gone two different paths. Trump is radically different than King Charles. And in a good way, King Charles is trying to bring the UK and the Commonwealth back to the Dark Ages, medievalism, feudalism, you know, some, I think you guys call it Fabianism, because it's a version of you know, communism, but that's good for a monarchy. And, you know, I'm perfectly fine if the people of Australia, Canada, and the UK are cool with that because, you let's face it, you guys lived with it for a really long time. But that version of bullshit doesn't follow in the United States. Remember, we are the misfits that told the king to kiss our ass in 1774. So I can tell you that I am the latest iteration of that asshole. in 2024 because I don't want any part of what England's doing. I don't want any part of what Australia is doing. I don't want any part of what Canada is doing. I like our founding documents. And this was the case that I made to Bukele in his basement. I actually had to teach him the story that Jefferson went through with a guy named Benjamin Rush. The only remnants that you'll ever hear about Benjamin Rush from anybody else, he was a Dr Jack Kruse (11:57.706) a doctor and a politician who is originally British. You know, he was born in the States, but he had lots of ties to England because remember, we're effectively British just like you guys are in the States. And what Benjamin said that we needed to put a constitutional amendment in our founding documents and the founding fathers who are writing these papers, they went back for 5,000 years and couldn't find anything in human history where Medical Tierney was the attack vector to take a government down and apart. And Jefferson told him, he says, look, I think it's a good idea, but I just don't think that we can do this and do it well because it's going to slow our process down. And there was a lot of different things that went back and forth if you read the Federalist Papers. But I told Bukele the story, and that's when Bukele said to me, so you think that's the best plan of attack? I said, yeah, it is. Because if you try to use lawfare, like having lawyers go after Pfizer, Moderna, AstraZeneca. That's gonna be a giant shit show, especially in the United States. And the reason why is most people don't know this, and I know you guys are just waking up to this, but who is the distributor of the jab? It's the Department of Defense in the United States government. It wasn't Big Pharma. Big Pharma acted like the local street dealers that sell cocaine on the streets. The guy who is the big cartel in Columbia selling the jab is the Department of Defense. This came directly from a bio weapons program that I laid out on some of the podcasts that I had told you about earlier. The specific one is the Danny Jones podcast where I really let it all hang out. And when you find out that the original SV-40 problem showed up in 1951 through 1957 in the polio jabs by Salk, And now we have proof positive that they're present in the jab. 75 years later, you gotta ask yourself a question unless you're completely brain dead. How does, how does SV 40 wind up in the first generation of the polio vaccine and now in these brand new, supposedly cutting edge vaccines? Well, the reason why is because the program isn't what it was designed to be. It was a bio weapon that they decided to use at Dr Jack Kruse (14:24.704) a specific time to actually try to slow Trump down and get him out of office. And it was successful. And in the United States, the real big issue that happened was not only did they get Trump out, they were trying to manufacture, you know, falsified election. That's what January 6th, you know, 2020 was all about. Everybody thought that these people were trying to overthrow the government, but it was actually the opposite. The government certified a falsified election. And we now know that. If I would have told you that three or four years ago, I probably would have the FBI and CIA knocking on my door. But now we now know that things were falsified in Arizona. We know that they were falsified in Pennsylvania. We know that it were falsified here and there. But it's four years later. You can't change history once the government certifies the election on January 6th. They try to pin this insurrection on Trump, which was an absolute joke, but believe it or not, they've thrown a lot of Americans in jail over this issue. Like I know you guys in Australia, Europe, and Canada, you guys actually really bought the story hook, line, and sinker that these people were truly crazy and they were trying to overthrow their government. They were let in by the government. This was a government PsyOps. And it fits now with the narrative that we see with the aftermarket data for the four years of COVID. We are the people for the rest of the world now overturning and putting Windex on all your glass eyes just how bad this really was. So I told people early on, this is before the jabs even were coming out, I looked at the patents of Moderna and Pfizer and I noticed something very interesting, that there was two legal definitions in the Pfizer patent, one for BioNTech and another one for Pfizer. And I just looked at it and I said, this doesn't make sense to me. My initial gut feeling was that they were going to present one to the FDA and then they were going to use one that they were going to mass produce. So that way the FDA wouldn't have all the true data. And since vaccines are protected in this 1986 law, that's horrible that we have, they could unleash this as a giant experiment. Dr Jack Kruse (16:47.5) to get the jab out. I told people, I did a documentary with Robert Malone and Robert McCullough, who are two doctors here in the States that you probably have heard of. And that had to be behind a paywall because you can imagine at that time, the things that we were saying were pretty controversial. Now I was the least controversial person in the movie. Why? Because I didn't really talk too much about medicine. I talked about these two legal definitions at length. And why was I doing that? Because I knew the story in detail more than anybody knew that I knew. Now people know it because I unleashed that story on the Danny Jones podcast. And I felt that they were going to put SV40 in one of the jabs. Why? Because their development team at Pfizer wasn't as advanced as Moderna. Moderna was using an E. coli vector, which I could see in the patents. made sense to me. you know what they were doing. I still thought it was a bad idea because it didn't have any proper safety testing. But I didn't have as big a problem with Moderna as I did with the Pfizer thing. And that's what I said in the documentary. So here we go till 2022 and all of a sudden, this guy, Kevin McKiernan, for those of you in Australia who don't know him, you need to know him. In fact, he just came out on the Danny Jones podcast because I hooked him up with Danny Jones to get his end of the story down because the aftermarket data we have now is even more devastating, probably even more devastating than you know in Australia because something just got published that he did, which we'll talk a little bit about. Kevin got two vials of Pfizer jabs from two lots, tested them in 2022 and found out that the SV40 promoter was in it. He published that information on Twitter. And of course you can only imagine what happened on Twitter at that time. everything exploded, everybody that was on the opposite side, the Biden and Kamala Harris side, the Operation Warp Speed people, the big pharma, they're like, this guy's full of shit, we don't believe him. It got so bad that one of the molecular virologists who is part of the evil empire, or the dark star as we talked about before, he said, I'm gonna prove him wrong, I'm gonna do the test myself. His name's Philip Buchholz, he's at the University of South Carolina, very accomplished. Dr Jack Kruse (19:16.856) virologist who works and has lots of grants with the federal government. Lo and behold, guess what he found? He didn't prove Kevin wrong, he proved Kevin right. And to his credit, to his credit, I have to give him a lot of credit here, he immediately went to the state Senate in South Carolina and actually told the senators that this is a huge problem. Why? Because now we have to start to question other things that potentially could be going on. Because at that time, The initial pulse in the aftermarket data is that I think everybody everywhere in the world knew about the myocarditis story. We knew about the clotting story, but we had just started to see there were several people with several locks that were getting cancers who had no history of cancer at all. And they were getting not minor cancers. These were stage three and stage four cancers in very young fit people. Remember, we were all told the lie that all the fatties were going to die. And it turned out that also was a lie early on. The fatties weren't the ones dying even in the hospital. The people who are dying are the people who getting Tony Fauci's drugs and the people who got intubated. It actually was the hospital algorithmic medicine treatment, you know, that the people in big tech and what we call HARPA, which is a version of DARPA, those are the people that are Silicon Valley connected healthcare folks. came up with these algorithms to treat people with and it became obvious something was going on. So you remember when we started this podcast, I told you I was effectively retired. And when I started hearing all this story, you can only imagine Uncle Jack said, I'm going to check into this bullshit big time. So what did I do? I go back and start volunteering to do a week of trauma call and I'm spending time in the ERs and spending time in the ICUs because that's what neurosurgeons do. So I got to see the sickest of the sick. Stuart Cooke (20:55.641) Mm. Dr Jack Kruse (21:15.352) And lo and behold, what did I find over two years between actually two and a half years, 2021 through 2024? I was averaging 13 clots and at least eight to 10 cancers in a week that would show up in the hospital. And most of those were in vaccinated people. The most amazing part of my observations is that there was no unvaccinated people. that were afflicted by these problems. Like people who just had regular COVID, this truly was like the cold or the flu. And these people never sought care in the ICUs. They came to the ERs, but the ERs would send them out. They wouldn't do anything with them. The people that got admitted, they got put on these algorithms that the hospitals did. And it turned out the hospitals were incentivized by CMS is the government version of healthcare that pays for things and the government would pay for things that they wanted done. They wouldn't pay for the things that shouldn't get done. That's where you heard nobody would let us use hydroxychloroquine, ivermectin. They wouldn't let us use methylene blue. They wouldn't let us use vitamin D. And it turned out all those things for the people that were in the ER that went home, they did really well. In fact, that's actually what Bukele found. Bukele found within two months of doing the jobs, they started to notice a problem. So what did he do? Even through his own Twitter feed, started telling people, we're going to give you little bags of goodies in it that had a lot of these off-label medications. And they didn't have a huge problem. It turned out the people that got admitted and wound up having to go into the ICU who were getting drugs they shouldn't have gotten and got intubated, those are the people that died. And the story continued to get worse. Why? Because we started to see the pulse of the serious stuff, meaning these turbo cancers, the spike in the data went straight up. And for you guys in Australia who don't know this, there's a guy on Twitter that you should follow. His name is the Ethical Skeptic, at Ethical Skeptic. And he is a former Navy intelligence officer in the United States. What did he start doing? Dr Jack Kruse (23:40.856) He's good with numbers. So he started to post many different things and to show how the CDC, the FDA, and everybody was lying through these numbers. And when I saw this, plus I had my observations of being in the hospital, that's part of the reason when Bukele tapped me in 2023 to write this law. I said, you can't fix this problem in the United States with lawfare. And that's when I found out that El Salvador had assigned these special agreements with the drug manufacturers because guess what? El Salvador doesn't have a 1996 vaccine protection law. Turns out Australia doesn't either. Neither does Europe. Neither does Canada. So guess what? This should tell all of you in those countries that the politicians who were in charge at that time, they signed those documents with them. That means they're all technically a path, a legal path in your country to actually go after them soon. But this is only if the politicians aren't crooked. And it turns out in Australia, we found out they're as crooked as all get out. know, the chick that was in charge of New South Wales, she was being paid off by Fisler. We know that. So, and we also know how serious the lockdown effect was, you know, in Canada and Australia. I think you guys probably had it way worse than we did because remember, as Americans, we didn't put up with too much. And I can tell you what I did. I closed my clinic in Louisiana and moved to Florida where DeSantis was. It was business as usual. I was on the beach the whole time, you know, during COVID. And we didn't give a shit. We actually laughed at you guys. And here I was getting on planes and going to states where the COVID situation was bad. And I was actually able to go see what was happening in different areas. And of course, then I started talking to other doctors in the United States to see what their experience was. And what I found out is the zip code of where people were linked to the ideology and the politics of a specific policy. And it was much worse when you were around people who were, how shall we say, left-wing progressives, where they were taking freedom away much faster, kind of like King Charles. Dr Jack Kruse (26:02.316) you know, has advocated through his, you know, good friendship with Klaus Schott. Like, you know, his famous saying is, you'll own nothing but yet be happy about it kind of stance. You know, that's kind of what the Mararkey was all about for a long period of time. And I noticed that the states that had politicians that are in power like that had the worst outcomes. And it turned out places that should have been bad, like for example, One of the things that I did very early is I started to look at data in Africa. Nobody in Africa was getting any problems from this, even though the vaccines were given to them just about for free. But nobody took them because nobody got sick. And it turned out the ethical skeptic started showing that there was a lot of people in Equatorial Africa that were already immune to the virus. Why? Because that was proof positive the virus had gotten out earlier than anybody said. That's when I realized that we were in a giant PsyOps. This was a bioweapons program gone wrong through a lab leak in Wuhan. And we knew the link in the States because we know the story of Fauci. We know why he had to go offshore because of 9-11, because of the Patriot Act. The Patriot Act has a provision in it that we're not allowed to do gain-of-function study in the United States. If you do, it's punishable by treason. So why did the Department of Defense decide to give Anthony Fauci a 67 % raise a long time ago? Because he moved the bioweapons lab to both Wuhan and the Ukraine. Maybe that'll tell you why we have a Ukraine war going on as well, because we're protecting something that we don't want anybody else to know about. And all of this stuff starts to come free through Freedom of Information Acts. And we start to find out that his links are to this cat in a place called EcoHealth Alliance. That's the guy that basically creates all the gain and function studies that get shipped over to the bioweapons lab. Then all of a sudden the story makes sense. The aftermarket data continues in 23 and 24. And it's very clear now when you look at it that we have huge problems not only with clotting and that's with certain jabs. Like all the jabs have different Dr Jack Kruse (28:26.55) diseases associated with them. And we now know through Kevin McKiernan's work, because he's kept on this, when the turbo cancer data came up, he went to Germany and found someone who got four injections, four jabs, patient got colon cancer, the patient decided to have a biopsy done. Kevin was able to sequence the first tumor, then he did another biopsy a week later. and then he did a postmortem biopsy. And what he was looking for was the sequence in the spike protein, the sequence in the cancer, was there intercalation of the plasmid from, you know, Pfizer in the tumor itself? In other words, are you a GMO person if you took this jab? And it turned out without a doubt you are. So that proved what Philip Buchholz was really concerned about when he went to talk to the centers in South Carolina. because frame shift mutations are one cause of cancer. But the other big one is could these little plasmids that are in these jabs also show up? This made Kevin go look further. And then he found out that every single jab you get, there's 60 billion copies of DNA plasmids in each one. That's common to all the messenger RNA. See, SV40 is only in the Pfizer one. But it turns out, is there another nuclear bomb? with the other Jabs and it is, it's that there's DNA plasmids all in there. How did many of the manufacturers hide the level of plasmids in there? They made sure that they put aluminum in their Jabs. Why? Because it turns out aluminum, they'll tell you it's an adjuvant, but it's really an agglutination effect that decreases the number of plasmids so you can get it through, you know, a regulator, which in our country is the FDA and I know in your country has a different name. And I know they're under fire right now too. for some of the stuff that's going on in Australia. But this is how it went down. And this is exactly how they got the Gardasil vaccine approved in the United States as well. It was through this aluminum effect. So the question immediately came up, you know, for guys like me and Kevin, who started to communicate and also communicate with the ethical skeptic and many other researchers in the world. We're talking about Jay Badachari, Martin Kulldorf. We've all started chatting. Dr Jack Kruse (30:52.652) you know, and had our private conversations because we put this together better than the FDA, CDC, and the people in Washington, DC. We figured out the scam very, very quickly. And we started to say, these are the things that we need to start testing and looking for. We now know that in the spike protein of these German cancer patients who had colon cancer, there's sequences in there. that are not attributable to the Pfizer vaccine. So you know what that means? It means one of two things. That means this came from somewhere else, another vector, like it's out there running around, or it came from the people who manufactured the vaccine in there, meaning that this can go through jump conduction. That's a really big problem because that means that now we have a new problem to worry about. This is the latest data I'm bringing to you. It's only two weeks old. Okay, no one's talking about this. Like in the gain of function world, nobody knows what I'm telling you right now. I know nobody in Australia knows this. I imagine when you put this out, people's heads are gonna explode. But I can tell you that Kevin McKiernan just talked about this live on Danny Jones, which is the reason why I told Danny Jones to get Kevin on. podcast because this is information that you're never going to get from the Department of Defense. You're never going to get from the CDC. You're never going to get it from the FDA. Why? Because this directly exposes the fraud and the problems that were present. And not only that, this now takes this vaccine story to a true next level. This means people who took the jab, not only they potentially genetically modified humans, but they may be the source of many future pandemics down the road. And the diseases they get, this is the thing we don't know. This is the next level testing. We need to test every lot in every jab to see what the effect is because what we believe now is that people are gonna get. Dr Jack Kruse (33:16.562) certain diseases from different companies and different lots within those companies. So this is the reason why in the United States we see certain lots associated with turbo cancers. This is why we see certain lots associated with clotting. This is why we see certain lots associated with myocarditis. And this is the reason why we see people getting rhabdomyolysis. And we're starting to see another pulse now with people getting really nasty diseases. called prion diseases, those are diseases neurosurgeons deal with, that's diseases like Jakob-Kreutzfeld disease or amyloidosis, okay? And autoimmune conditions. And the autoimmune conditions have really spiked up. We're starting to see a lot of cases of very unusual type one diabetes in people who shouldn't have it. And we're also starting to see some very unusual. cases of neuroendocrine tumors and guts that normally we wouldn't see that are usually associated with people that have bad diabetes over a period of time. And we're also starting to see neurodegeneration happen at very rapid rates, meaning generally when someone gets diagnosed with a dementia, whether it's frontal temporal dysplasia, Alzheimer's, Parkinson's, any disease like that usually has a prodrome that takes, you know, a couple of decades to go. These people are getting going from like mild cognitive delay to serious neurodegeneration. Many of the stories that you you hear in Australia, Canada, Europe, where people call it long COVID, it doesn't stay long COVID forever. Certain people get it, certain people don't. Our belief right now has to do with the changes in the lots that are there. So that means we need to start testing every single lot that's out there. Do you think that that kind of issue is gonna happen in the United States where big pharma sits at the Cantillon effect? The answer is no. In fact, here's the real joke of the situation. Big pharma, those medicines haven't even withdrawn from the market here yet. At least, you know, the crown got rid of the AstraZeneca one. There was enough for NHS to say, okay, enough of this shit. Dr Jack Kruse (35:38.672) And Johnson & Johnson in the United States was really smart because they pulled their drug off the market themselves. I think they realized that this is a can of worms that nobody really wants to go through. And Johnson & Johnson has a very different vaccine than everybody else. They used an adenovector virus. They're not polluted with a lot of the same things that Pfizer and Moderna are. But Pfizer's risk right now, in my opinion, off the chain. I really think that while we may not be able to get them by lawfare in the United States, even by some of the things that Bobby Kennedy will probably do in HHS, because of the vaccine law, because of the Dole Buy Act, which you may not know about, but that allowed guys like Fauci to profit off of taxpayer funded research, that's actually the incentive that dictate the outcome why Fauci Stuart Cooke (36:15.822) Hmm. Dr Jack Kruse (36:37.794) you know, was so incentivized to work with gain-of-function people and move it offshore because he made a lot of money. And we now know about a year ago, we found out that he got $440 million in royalties through the NIH and CDC. That money was then redeployed to other scientists that supported his criminality. So you can see that this is a giant conspiracy and we have a law that actually Bobby Kennedy's father was important in writing. It's called the RICO statute. And when Bobby Kennedy Sr. was our attorney general when his brother was president before the government killed him, he's the one that came up with the RICO statute. It turns out, even with this 1986 law that's on the books in the states with the Bayh-Dole Act, there's no protection for these people from a RICO case. So guess what may happen? What may happen? And I think this is where Bobby's going to go in HHS. And this is the reason why I think he's going to have a really tough confirmation process in the United States, even though the Senate is now, you know, weighted to the Republicans. You have to realize in the United States, there's a uniparty problem, meaning the DNC and the RNC has a lot of people that are being paid off by Big Pharma, kind of like what I told you happened in New South Wales. And I'm sure there's many people. and many politicians in Australia, Canada, and Europe, who often has been paid off. We'll find out about this eventually, but that's not my current focus. My current focus really is what can we do to help these people that have been harmed by the vaccine? And that's really my focus, you know, in the future, because I'm the guy that understands the interplay between the nuclear genome and the mitochondrial genome. And that's what decentralized medicine really focuses in on. And you have to realize Stuart that the system that you have in Australia, the system they have in Canada and the system in the UK and in the United States is centralized, meaning that no one will ever get to the point that these people are going to need who've been harmed by this bio weapon. And while I would love to jump into the fray on the medical legal side of things, that's not Uncle Jack's expertise. My expertise is understanding how do we keep Dr Jack Kruse (39:04.098) the genetically modified people in the world, how do we silence that DNA? There's no way we're gonna be able to get it out of our DNA. Like a lot of people are gonna tell you you can detox from it. That is absolute pure insanity. That's the kind of thinking that comes from not understanding truly the science behind it. That's what Kevin McKiernan is really good at explaining. So my goal is to teach people the science that I've been developing over 20 years so we can help people. Now, do I think we're going to come up with new treatments down the road? Yes. So what would I like to maybe end this so you can ask me your next question? It's this is going to be much like the AIDS virus. When AIDS came out, it was a death sentence for everybody who got it. And then magically, slowly over time, We did come up with something called protease inhibitors that actually has now made, you know, AIDS almost a non-issue for most people. But the problem is we had 20 years, 25 years of people dying from it before we came up with the answer. I think that we have a duty as decentralized clinicians to help the people in that 25 year span that's gonna happen between now and then. So that really is my focus. And I think The focus that I brought to the table, at least in the United States, the last 12 months is I went from being apolitical to political. Why? Because I believe this story needs to get out. I believe people like you in Australia, the people in the UK and the people in Canada need to know the truth from the United States because guess what? We made you sick and you bought our bullshit story, hook line and sinker. So I believe that my government has a duty to all of you to tell you the truth. And since my government is not telling you the truth, I'm going to come on podcasts and I'm going to fucking light their house on fire. Stuart Cooke (41:08.482) Boy boy boy. So much to unpack and I think we'll get lots of people scrabbling for the show notes as well to cut and paste names into browsers and to follow this path a little bit further. I just want to share a little bit of a story that happened to me last night in as much as I have had internet problems at home and I'm looking for a new internet service provider and I actually signed up with the same one again but for a faster plan and I had to go through and enter credit card details and give them all of my details. And right at the very end of the conversation with the agent on the phone, she said, I'm gonna send you a link and this link will be for you just to finalise your digital ID. And I said, I'm not sure what you mean. I was expecting to give you my bank. my bank details and my personal details, et cetera. And she said, no, no, you need to take a picture of yourself on your mobile phone. You need to scan some documents, your driver's license, your Medicare number, and that will play a part of your digital ID. And I said, well, no, I'm not very comfortable with that. I don't want to do it. So I think I'll just end. I'll end this. Don't worry about that at all. And she rushed off and went to her manager and came back and said, Well, you don't actually have to give us your digital ID right now. You can go into the store afterwards. And I said, well, I don't want to go into the store afterwards. I'm not very comfortable with me giving you my details and building up a digital profile. I'm not going to do that. Does that mean I won't be able to access the service? And she said, no, no. You will be able to access the service. Perhaps you can do it in the future if you like. So hence, I have my new internet plan, at least I will do at the end of the week. I don't have a digital ID. But that's just an example of a curveball that's thrown out perhaps to me as an unsuspecting and law-abiding citizen as part of the plan that I'm sure will develop into something much bigger down the line. So my question to you is that if we've been following the advice of the government and all the powers that be, and we're guided to what we put in our mouths, which typically will be... Stuart Cooke (43:15.713) a low-fat diet, lots of healthy whole grains. We go out into the sunshine. We're taught in Australia to slip, slap, slop, so hatch, sunscreen, avoid the sun at all costs. And now we seem to be in a little bit of a mess where we are getting sicker, we're getting fatter, children have diabetes, obesity, every autoimmune condition. Dr Jack Kruse (43:38.456) You also have the highest skin cancer rate in the world, just so you know that. No, it's not bizarre to me. It makes total sense to me. It's bizarre to you guys. Turns out the sun doesn't give you cancer. It's all the artificial light around you that does. Stuart Cooke (43:42.357) It's bizarre, isn't it? Stuart Cooke (43:49.72) But what if... Stuart Cooke (43:54.446) Well, I'm a British citizen, so I've lived for 21 years of my life under doom and gloom. So there was no sun. You may get a week in the summer, of which we called our heat wave. But now living in Australia, And I've been in this health and wellness sphere for best part of a decade and a half, doing the complete opposite of what I've been told, in terms of what I'm eating and how I'm exposing myself to the sun. I'm drawn to it like a magnet every day and we get plenty of it. No burns, nothing of any of that sort. I've managed to dodge the medical system for best part of 25 years. I've only been into the doctors to get tests that I've wanted to, bloods and things like that. So my question to you is, It seems almost impossible for Joe Public to be able to even conceptualise doing the right thing because they think they're doing the right thing, because they're following all the roles that we are told that the science and the doctors and the powers that they tell us to do. So where do we go? Dr Jack Kruse (44:58.25) everything they say you do the opposite. If you go and look at my Twitter, what does it say in the little circle? Do not comply. And I got news for you. Every, I famously said this to Rick Rubin and Andrew Uberman on a Tetragrammaton podcast that 99.9 % of things that I learned in medical school and residency are pretty much wrong. And there's a lot of reasons why they're wrong. Stuart Cooke (45:00.279) Yeah. Yeah. Stuart Cooke (45:06.202) Yeah. Stuart Cooke (45:15.673) Hmm. Dr Jack Kruse (45:28.002) But you have to realize that incentives dictate outcomes. The reason why you're told to do many of these things, like I've said this in the United States, I haven't said it too much in Australia, but I'll say it to you. Ask yourself this question, why do Bill Gates, ophthalmologist and dermatologist all want to block the sun? Because it's a great business model for them to be profitable. That's exactly the answer. And it turns out if you are not a dumbass Australian, Stuart Cooke (45:51.416) Yeah. Dr Jack Kruse (45:56.554) and you go out to the bush and you see, you know, the kangaroos running around and you see the birds out there. Notice they don't have sunglasses and sunscreen on, right? They go under a tree. mean, the kangaroos really smart. They actually lick their arms to cool themselves off. But they don't, they don't run away from the sun. And the interesting thing is even when you're under a tree, you still have all the light around you. problem is most people in Australia now they go inside under these fake lights and you don't realize it turns out there's no light controls in any of the dermatologist studies. Like for example, when a dermatologist tells you that UV light causes cancer, you're actually allowed to believe that. You know why? You have a duty that the doctor didn't tell you that the study was done with UV light by itself. Let me ask you this question. Does UV light ever show up from the sun by itself? Or does it have six other colors with it? Turns out it's got six other colors. And you told me you're a British guy, so you know the whole famous story about Newton and the prism, right? He's the guy that created the Pink Floyd album cover so that everybody knows there's seven colors from the sun. Well, it turns out, if you take UV light by itself, yeah, that's a problem. That's what the dermatologists hitched their wagon to. But here's the thing. They didn't tell you that red light is the antidote to purple and to blue. Stuart Cooke (47:08.216) That's right. Dr Jack Kruse (47:22.488) And here's the funny part. Anytime the sun's up, anytime the sun sets, red light's always present. And guess what? It's the most dominant part of the solar spectrum, of terrestrial sunlight. 43 % is infrared A or near infrared light. So when you begin to realize that nature has got the antidote for you and you have a government or a doctor or Bill Gates telling you... No, no, no, we want to geoengineer our skies, want to geoengineer your eyes, and we want to geoengineer your skin. It shouldn't be shocking to you why they're telling you to do it. But I would fully agree with you. When I've been to Australia, I look at them and I think they are the dumbest asses in the world to not figure this out. Why? Because even in the dermatologist's literature that's published in Australia, it shows people that have all the skin cancers have the lowest vitamin D level. If they dermatologists are right, it should be exactly the opposite. People that have the highest vitamin D levels, because you can only make vitamin D from UVB light, right? You know that. They should be the ones that have all the skin cancer. And it turns out every single paper that looks at this shows the lower your vitamin D is, the worse your skin cancer is. How do you like that? So when you think about that and you're wearing sunglasses and slip slather and... Stuart Cooke (48:27.812) Mm-hmm. Stuart Cooke (48:41.262) Yeah. Dr Jack Kruse (48:45.91) all that other bullshit's on the side of your buses. It's no shock to me, actually the reason why you guys have that, but it's also the reason why you were very compliant with the government. Because guess what? What's the part of the story that no one in Australia has heard yet? It's what I talked to Danny Jones about. Turns out when you block the sun, you change the orbital frontal gyrus in your brain, dopamine levels drop, and you become more suggestible. That is a program that started back in the United States, but really started in Nazi Germany called MKUltra. Then MKUltra was graduated to the Stanford Research Institute. Then it was graduated to the Brain Health Initiative. In other words, this is how the bioweapons program in DARPA, part of the DOD that also made the jab, how this all links together. And when you begin to realize that these ideas that you have in Australian medicine actually link to why you guys all rolled up your sleeves and took the visor jab, then you begin to understand why Uncle Jack, know, 20, 25 years ago, everybody thought I was a crazy sob on the internet. I got news to you. It's amazing to me how less crazy I've gotten and how brilliant everybody thinks I am in the last four years because guess what? Just about everything I told people was coming, came and it happened. And right now, Uncle Jack's not just talking to Stuart. Cook on the internet. He's talking to Bukele. He's talking to Nicole Shanahan. He's talking to Bobby Kennedy. And he's talking to Donald Trump. I'm also talking to people in different states about taking this law and putting on the books. Why? Because through the lawfare that's happened with Big Pharma, we've created a big mess in the United States. And as I told you before about going into the Death Star in the Pentagon or Washington, DC, I don't believe that Trump and Bobby are going to be able to fix all the problems. Like, I know that most of you guys in the free world now are hoping that Trump and Bobby can do a lot so that that tsunami wave will come to Australia, come to UK, come to Europe and come to Canada to try to help you. I'm going to be, I'm probably going to be the bearer of bad news to you, my friend. I don't think that's going to happen. And I think Bobby is going to be hamstrung by Dr Jack Kruse (51:14.258) some of the powers that be that are linked to the bankers and Big Pharma. And we probably don't have a long enough podcast for me to explain how all these things link, but I can promise you that Big Pharma was the reason why the First Amendment was destroyed in the United States. Why? Because the money that they were able to use, were, Obama changed the law in the United States. It used to be against the law to actually have Big Pharma ads on TV. He changed that. It's called the month act and it was changed I believe in 2008. Soon as they were able to do that, what did that do? Pharma started paying for all the ads on news media and that means the news media was incentivized to tell the propaganda story of Big Pharma on there. And if they didn't, they would just defund them and not pay him. So it turns out all the news anchors and everybody on those places, they all became shills for Big Pharma. In other words, they were just like the drug dealers on the street for the Colombian drug cartel. That's exactly what happened. And this slowly happened from 2008 to 2024. So now when you put on like Fox News or ABC or NBC in United States, all you see is stuff for this drug, that drug, the other drug, you don't see like, you know, advertisements for kiddie food, because kiddie food can't pay their salaries. Okay. But Big Pharma can. And this is why I don't think you guys, you know, across the pond. Stuart Cooke (52:34.593) You Dr Jack Kruse (52:42.124) really understood how important Elon Musk was for the political process in the United States. Why? Because when he bought Twitter from Jack Dorsey, that actually, remember the first thing he did, he got rid of advertising, right? The advertisers all boycotted him. That was the biggest mistake ever because then Twitter or X, however you want to call it, became truly the town square in the United States. That's where people who were canceled under the previous regime, actually got a voice back. And unfortunately, I've told people this and I don't think you know this and probably the people in Australia do. I was one of the few doctors that weren't canceled on Twitter. Why? Because Jack Dorsey was one of my friends and one of my patients. He followed all of my stiff. Why? Because he was a big technologist. You know that he owned Twitter from the beginning and he got sick from his own tech and he came to me to get better. This is the reason why he lives now in a place with a lot of sun. and he does many of the things that Stuart, you do, and you understand the reason why, but what most of you don't understand in Australia and I think UK and Canada, and this is important for you here, this is gonna be a tough swallow for you. If you go look at the last Jason Bourne movie that was made in 2016, do you know why that Hollywood, the Harvey Weinstein and his friends made that movie? That was a direct threat. to Jack Dorsey and Mark Zuckerberg, either you're gonna play ball with us or we're gonna kill you. So guess what? Go look at the storyline. I'm telling you, I knew that. And how can I tell you that I knew? At the Bitcoin Miami event in 2021, Dorsey came to meet with some of my VIPs and told us then that he was gonna sell Twitter. Why? Because at that time he was getting called up in front of Congress all the time and they were talking about section 230 and all this and that. And he said, look, I'm done playing ball with these assholes. you look at just what happened in the United States, did you hear Jack Dorsey say anything about Kamala or Trump? No, he was totally out the mix. He washed his hands of all that. But guess what? Elon Musk knew everything directly from Dorsey. See, many people think Jack's a bad dude. He wasn't a bad dude. Remember, he's 100 % Bitcoin maxi. He's just like what I told you about Boo Kelly in the beginning of this. Dr Jack Kruse (55:07.532) He believes in freedom of money and he realized that Twitter was a bad experiment gone wrong because his board was filled with all those assholes from Silicon Valley that I told you were behind the jab. Those were all the bankers that were tied to this. Like A16Z, these guys are the worst of America. Like we create really amazing products, but you have to realize there's a dystopian side of this side of business. Stuart Cooke (55:20.185) Hmm. Dr Jack Kruse (55:37.66) And this was really why I give Elon a lot of credit, because there's a lot of things about Elon I don't like. I don't like Neuralink. I don't like Starlink. I don't like being controlled from above, because I think DARPA is going to use that technology to do that to all of us eventually. They just haven't got to that point in the game yet. But what Elon did is he gave Americans that had different ideas the opportunity to speak. And I can tell you that's the reason why the election went the way it went. I got news for you guys in Australia think that this was a landslide. I think it was even bigger than that. Why? Because we know that the Democrats did a ton of cheating and even with their cheating they couldn't overcome this because guess what? Americans are truly fed up with what went on. Like you guys think you're a little bit mad? Dude, you have no idea how pissed off. people are here because we understand the scale. And most people are waking up to the stuff that I shared with you here about SV40 and the DNA plasmids and the 60 billion per shot. Dude, that's not even why Trump really won. He won because of all the shit with inflation, the open borders, and the global socialism that the people who are behind the jab, the people in the Department of Defense, they're all in cahoots with each other. That's the stuff that you're dealing with right now with the world economic forum and the people that are in charge in Australia. All of these people got their marching orders from King Charles. Remember, King Charles has been, when he was the prince, he was up Klaus Schwab's ass from almost 50 years ago. And who was their best friend in the United States? Henry Kissinger. He's another guy that's tied to the Council of Foreign Relations. How far does this go back? mean, look, you're a UK guy. You remember the whole story about the Pilgrim Society and the Rhodes Scholars. This all was stuff that came out after Queen Victoria died and the new monarch came in, which was King George, who was Queen Elizabeth's grandfather. His brother, you know this story very well. His brother, Edward VIII, abdicated because everybody wanted to talk about Wallace Simpson. No, he abdicated because the royal family Dr Jack Kruse (58:02.156) was part of propping up Hitler with their bankers, the Rothschilds. And we now know that. It's very obvious. And that's the reason why the king really had to step down. It got so bad in World War I that the king had to change their name from Saxe, Coburn, Gotha to Windsor. They took it off a castle. Wasn't even, you know, didn't even think about it good. And why did they do that? They had to do that because one of the guys from Russia, who took over their land, shot and killed the Romanovs, which was the cousin of the king in England, also the cousin of Wilhelm in Germany. Well, they didn't plan on that. They didn't plan on killing him. But we now know that the Rothschild bankers at the time were the ones with the king that wanted the Romanovs put in jail in Siberia. Why? Because people always forget this. This Bolshevik revolution happens in the middle of World War I. It's the craziest thing ever that you can have a revolution in a royal family and they were worried. But it turned out one of the guys of the three in Russia, that's Trotsky. Trotsky is the one that made the decision to kill the Romanovs. Guess what? Lenin and Stalin didn't want that to happen. They knew that that was going to create a huge problem down the road. When you think about this as a Briton now, now I'm talking to you as a Brit and not as an Australian. Remember what the British Empire is all about. They're all about that imperialism and you are part of the Commonwealth. Well, in one stroke, you lost Russia. You lost the United States in 1774. So what was really World War II all about? It was about setting up a bad deal for the Germans in the Treaty of Versailles so you can guarantee a second world war. That's really what happens. Why? Because the king wanted to bring the United States and Russia back into a war so they could regain a loyal title. And let me just tell you something. There's one thing you're going to learn about the royal family from this midfit who came from you in England, is that the royal family and their bankers Dr Jack Kruse (01:00:23.82) have screwed up the 20th and 21st century more than you can ever imagine. Most of the things that we're all dealing with now are because they want to recapture the lands that they lost and bring them back under British rule. And it turns out the one thing they've done, they've infiltrated a lot of the United States government with people who are still loyal. That's what the Council of Foreign Relations is. And who is the main group in the United States that the Royal Family and the Rothschilds partner with. It's the Rockefellers. Rockefellers were richer than the Rothschilds and the Royal Family. So guess what? They brought them in. And then, magically, we got the Council of Foreign Relations. They're tied to Tavistock. They're tied to the Committee of 300. You got this whole story. And then, magically, we get the Federal Reserve, which is basically all of the families that were in Europe, now the big ones in the United States, who are also all ex-Britain. Now they're all in bed together and go, hey, let's start this process in the United States to see if we can get back to the Middle Ages where everybody's on a feudal plantation and they're working for us and they're happy about it. That's just the marketing slogan that changed from the 1920s to 1973 and 71 when Kissinger and Schwab start the world economic forum. The process for the last 50 years, slow incremental changes to get us back. to the one world government idea. That's all the stuff that we're talking about, all the health stuff, all the COVID stuff. That is the true metastatic cancer that sits at the base of this shit sandwich. Stuart Cooke (01:02:13.032) I think you're like the modern day magnum PI on steroids. What is it we don't know? Dr Jack Kruse (01:02:18.956) Well, just think, well, Stuart, this is what I will say to you, and hopefully this resonates with you and resonates with the audience. There's two type of people in the world, those that believe the government and then those that know the history. And it turns out when you know the history, you have to have one caveat. The victors write the history books, but it turns out the real history is still discoverable if you know what rocks to look under. And when Stuart Cooke (01:02:46.328) Yeah. Dr Jack Kruse (01:02:48.286) I started this whole process because people have asked me, how did you figure a lot of this stuff out? Well, it turned out my mentor in this whole thing, which is Robert O. Becker, who's a doctor in the United States who was canceled by the Industrial Military Complex over the effect of non-native EMF. Turned out when I saw how he was canceled, it was tied to the same story. And when he got canceled in 1977, I met with him in 2007. He had 30 years to figure out who really did him wrong. And let me tell you something, if you think Uncle Jack is salty, you should have met this cat. He was truly pissed off. This guy was twice nominated for the Nobel Prize. So when I sat down with him and we shared notes, he casually warned me. He said, don't do anything crazy like I did and go on 60 minutes and try to tell the world the truth. because the world will never believe the truth because they're in a propaganda of lies. And those lies were set up by the architects that I just told you about, the bankers, Big Pharma, all the corporations, all the people that BlackRock own in the United States, those are all the people that you guys are affected by too. BlackRock affects Australia, UK, everybody else. And the idea of BlackRock... is you only have to have 5 % ownership in a company. Everybody else has fractional ownership. So effectively, this is the same idea that the Rothschilds used in 1812 at the Battle of Waterloo when they took over the banking situation. You they had better information than anything else. You don't have to own a company 100 % or 51 % to control it. If you control the finances, you control the country. And that's actually what Thomas Jefferson warned. are people about in 1774. This is the reason why Thomas Jefferson was absolutely adamant that the Bank of England was filled with a bunch of criminals. And he was right. I mean, I hate to tell you this, but this problem has now persisted on for 250 years in United States. And I would love to tell you that we were smarter than the Britons, but we weren't. We use their system. And now the system is so broken. Dr Jack Kruse (01:05:09.622) and it's so slated to them, they're going, they think we're complete idiots. So they're trying to, you know, completely go back to the way it used to be. And that makes King Charles very happy. Makes the Rothschilds happy, makes the Rockefellers happy. Why? Because they're able to recapture everything. If they can get the United States, they believe they can eventually get Russia back. That should make you realize truly what's going on with NATO, the Ukraine and Putin right now. It completely gives you a different spin on things when you look at what's happened in European, you know, world history here lately. And I just want to be the guy to tell you that I think if you focus on the history here, you'll understand more of the biology and why decentralized medicine is really important for you to follow from this point forward. Like the story that you told me about the digital ID. I really appreciate it because it definitely ties into the story. I think every resident of the UK, every resident of Australia needs to follow your model. think what you said and that you weren't going to comply with this level of intrusion and surveillance is absolutely it. mean, look, we got a guy in the United States right now, Edward Snowden, who warned us about this and he's sitting in in Russia being protected. If you don't think that this story resonates with people in the United States, you're crazy. And look, you guys have a guy that just got out of jail for WikiLeaks. And you forget what WikiLeaks was about. It was about turning all the state's evidence through WikiLeaks of all these connections that I'm telling you about now. And the crazy thing is they treated D platform, right? Through the bank. They got rid of his bank accounts through the Bank of England and all the banks in Australia. Stuart Cooke (01:06:37.123) Yeah. Stuart Cooke (01:07:03.097) Hmm. Dr Jack Kruse (01:07:06.808) So what did he do to continue to do it? He used Bitcoin. Bitcoin actually allowed us to realize that John Podesta, the Clintons, Jeffrey Epstein, all these people were all linked together. This is how a lot of this story started to come out, Stuart, so that the regular folk on the people in Main Street could start talking about it on Twitter. That people like Matt Taibbi, you know, dropped the Twitter files and everybody in the world was like, holy shit, Snowden was right. You know. Julian Assange was right. Like this is no more, this is not a mystery Stuart. You know what the mystery is? Is that people all over the world are too busy watching Netflix, rugby games, soccer games, and doing Circus Maximus. It's the same story that we were told in Plato's Allegory of the Cave, that even when the slave is shown the truth, they're like, I'm gonna go back in the cave, just put my cuffs back on and I'm good. Most of you probably won't like to hear, Stuart Cooke (01:08:02.956) Yeah Dr Jack Kruse (01:08:06.038) of just how much disdain I have for you. But that's the truth. I told the people the same thing in the United States before the election. I said, if you vote for Kamala Harris, you are the slave that's going back in the cave. And I'm not telling you that Trump's any prize package, but he's got less warts than the other person. And I think it's going to take a while for us to really get rid of this metastatic cancer. Organ by organ, we have to change it. But I'm hoping by doing a podcast like this with you, Stuart Cooke (01:08:17.401) Hmm. Stuart Cooke (01:08:23.501) Yeah. Dr Jack Kruse (01:08:36.29) that you can really understand how decentralized finance and decentralized health are linked together. This story is just like the medical caduceus that you look at. The two snakes are intertwined. And it's our job as the patient not to comply with fiat money, with bullshit CBDCs, when any kind of things are controlled, whether it's the internet company or your bank. Take all your money out of the bank. Don't leave it in the bank. And I would tell everybody, I think

Send us a textMahatma Gandhi, Martin Luther King Jr., Rosa Parks, and Kali Dayton. Kali Dayton is an ICU nurse practitioner and like Gandhi, MLK Jr., and Parks, Kali is peacefully protesting the way ICU patients are cared for. Similar to the civil rights advocates before her, Kali fights for the rights of ICU patients. She believes they have the right to limited sedation, early mobilization, open communication, and family participation. Kali was born as a baby nurse into an Awake and Walking ICU in which ventilated patients received little to no sedation, were out of bed walking while intubated, and communicating through whiteboards, all with the crucial support of their families. Then she began traveling to ICUs across the country and found her patients automatically sedated if intubated, enduring long periods of immobilization, and if they were lucky enough to avoid death in the ICU, they were discharged to suffer PTSD and face long periods of rehabilitation.Kali is a self-described ICU revolutionist and is dedicated to educating both clinicians and families through her podcasts, "Walking Home from the ICU" for clinicians, and "Walking You Through the ICU", which is directed toward patients and families. Through her consulting business, Dayton ICU Consulting, she travels the country visiting ICUs helping them to become awake and walking ICUs. The revolution has begun.In the five-minute snippet: did someone say free time? For Kali's bio, visit my website (link below).InstagramKali's bookstoreICU DeliriumContact The Conversing Nurse podcastInstagram: https://www.instagram.com/theconversingnursepodcast/Website: https://theconversingnursepodcast.comYour review is so important to this Indie podcaster! You can leave one here! https://theconversingnursepodcast.com/leave-me-a-reviewWould you like to be a guest on my podcast? Pitch me! https://theconversingnursepodcast.com/intake-formCheck out my guests' book recommendations! https://bookshop.org/shop/theconversingnursepodcast Email: theconversingnursepodcast@gmail.comThank you and I'll talk with you soon!

In this episode of Dark Mode, John Coyle is joined by comedians Ben Gleib, Danny Jolles, and Lisa Wallen for a fun-filled conversation that mixes comedy and business. The comedians brainstorm ad ideas for products like Liquid Death, weed stash box, and Apple watch bands. Join the crew for a lively and unpredictable discussion filled with creative marketing concepts, behind-the-scenes stories from their comedy careers, and plenty of laughs along the way. Don't miss out on this new episode of Dark Mode with John Coyle — Ad Pitches: Liquid Death, Weed Stash, and Apple Watch Bands with Lisa Wallen, Danny Jolles, and Ben Gleib Key Points: 00:00 Introduction. 06:24 Lisa's partnership with Wally Park. 07:15 Ad pitches for Liquid Death. 09:32 Liquid Death should use more dead billionaires. 10:03 Liquid Death videos on ICUs. 13:51 Liquid Death and waterboarding. 15:57 Elon Musk's robot presentation. 17:29 Ad pitches for a weed stash box. 20:08 Targeting the cigar market. 21:02 Smoking weed on a Frisbee. 23:46 A hand-carved Legend of Zelda stash box. 31:37 Make weed boxes bigger. 32:41 Ben almost got caught with weed. 35:09 TSA jobs and one-armed people. 37:14 Ad pitches for Apple watch bands. 38:51 Ben's broke man's Apple watch. 43:36 Lisa's $800 Devil May Cry statue. 45:50 Should you wear a watch?? 47:12 Lisa talks about her tattoos as “murder trophies.” 50:25 A hot porny KFC commercial. 51:58 Lisa's viral beer commercial story. 60:14 Enemy vs friendship bracelets. ———————————————————————————————— Connect with Lisa Wallen: Instagram: https://www.instagram.com/wisalallen/ Facebook: https://web.facebook.com/lisamariewallen Twitter: https://x.com/wisalallen TikTok: https://www.tiktok.com/@wisalallen Connect with Danny Jolles: Instagram: https://www.instagram.com/dannyjolles/ Facebook: https://web.facebook.com/DannyJolles/?_rdc=1&_rdr Twitter: https://x.com/DannyJolles TikTok: https://www.tiktok.com/@djolles Connect with Ben Gleib: Facebook: https://web.facebook.com/gleib Instagram: https://www.instagram.com/bengleib/ Twitter: https://x.com/bengleib TikTok: https://www.tiktok.com/@bengleib #ComedyPodcast #BusinessHumor #EntrepreneurLife Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Jay Anders, Chief Medical Officer of Medicomp Systems, shares his career transition from an internist to a leader in healthcare IT, emphasizing the importance of usable technology for clinicians. He discusses Medicomp's mission to enhance clinicians' efficiency and patient care through advanced tools. Dr. Anders also explores the challenges of incorporating AI in healthcare, the disparity of healthcare access in rural areas, and the rewarding experience of international medical missions. He highlights the importance of change management in reducing physician burnout and aims to teach coping mechanisms for managing constant healthcare changes.   Guest links: www.medicomp.com | https://www.linkedin.com/in/jayandersmd/ Charity supported: Feeding America Interested in being a guest on the show or have feedback to share? Email us at podcast@velentium.com.  PRODUCTION CREDITS Host: Lindsey Dinneen Editing: Marketing Wise Producer: Velentium   EPISODE TRANSCRIPT Episode 042 - Dr. Jay Anders [00:00:00] Lindsey Dinneen: Hi, I'm Lindsey and I'm talking with MedTech industry leaders on how they change lives for a better world. [00:00:09] Diane Bouis: The inventions and technologies are fascinating and so are the people who work with them. [00:00:15] Frank Jaskulke: There was a period of time where I realized, fundamentally, my job was to go hang out with really smart people that are saving lives and then do work that would help them save more lives. [00:00:28] Diane Bouis: I got into the business to save lives and it is incredibly motivating to work with people who are in that same business, saving or improving lives. [00:00:38] Duane Mancini: What better industry than where I get to wake up every day and just save people's lives. [00:00:42] Lindsey Dinneen: These are extraordinary people doing extraordinary work, and this is The Leading Difference. Hello, and welcome back to The Leading Difference podcast. I'm your host, Lindsey, and I am so excited to introduce you to my guest today, Dr. Jay Anders. As Chief Medical Officer of Medicomp Systems, Dr. Anders supports product development, serving as a representative and voice for the physician and healthcare community. He is a fervent advocate for finding ways to make technology an enabler for clinicians rather than a hindrance. Dr. Anders spearheads Medicomp's knowledge based team and clinical advisory board, working closely with doctors and nurses to ensure that all Medicomp products are developed based on user needs and preferences to enhance usability. As the host of a popular, award winning Healthcare NOW radio podcast, "Tell Me Where IT Hurts," Dr. Anders has discussed the topics of physician burnout, EHR clinical usability, healthcare data interoperability, and the evolving role of technology in healthcare with a variety of industry experts and pundits. Well, hello, Jay. Thank you so much for joining me today. I'm so excited you're here. [00:01:53] Jay Anders: I'm very glad to be here. [00:01:54] Lindsey Dinneen: Excellent. Well, I would love if you wouldn't mind starting off by telling us just a little bit about who you are and your background and maybe what led you into MedTech. [00:02:06] Jay Anders: Well, I am an internist by training, and after practicing medicine in a large multi specialty group practice for almost 20 years, I decided to have a little career shift, and the reason I shifted careers was I had a little computer science background, so I said, "Let's see if we can put that to work." And about that time is 2004, I'll date myself. We started getting into electronic health records, and when they first started to come out, they were just these read only, do nothings, electronic versions of paper. And I thought, "Well, this is not going to work out really well. Let's see what we can do about that." So my big clinic decided we'd be one of the first to hop in the pool. So we did with a company called Integrate. And when we got that all installed and rolled out and everybody using it, they came to me and said, we really need a physician to really help lead what do physicians want or need in healthcare IT. So I said, "Well, we'll just part time." Well, that lasted about six months. And I said, "I can't be in two places at once. I can't practice full time medicine and do this at the same time." So I switched careers and one of the biggest questions I get asked all the time is "Why in the world you do that?" I mean, I saw, you know, five, six thousand patients a year, big practice. And they said, "Why'd you get out of practice?" And I said, "Well, think about it for a minute. So I can see those five or six thousand patients and affect their lives and help their health get better, or in this industry, I can make the lives of hundreds of thousands of patients better. And not only them, the providers that actually take care of them." So to make a really long pathway short, that company got purchased by another company, which got purchased by a company, probably everybody knows called McKesson. And I worked in the big corporate medicine world for a while. I got kind of tired of that. And I wound up with working with Medicomp. We use some of their products and the Integrate product that we had. So I've known him for quite some time and he always told me, he said, "When you're ready to make a change, let me know." So I was ready to make a change and I joined Medicomp. It's now been 11 years working at that particular organization. Love it. It's great. And it's got the right mission. So I was looking for where can I really make a difference? And this company really makes a difference. [00:04:36] Lindsey Dinneen: That's incredible. Thank you for sharing a little bit about your background. And I'd really love to dive into exactly what you ended with because I think that mission is such a key aspect of maybe a lot of things, and probably opinions vary, but I have found that it is really helpful to have something that drives you so that on the difficult days you go, "Yes, but I am here for this reason." So I'm curious, can you expand a little bit about your current company and how it is so missionally driven? [00:05:08] Jay Anders: Well, Medicomp has a single purpose that has multi facts blended into it. How can I say that a little bit better? It's just, it's got a lot of tentacles, but it does one thing. It was started to actually assist the providers at the point of care to actually take care of their patients. It started out 46 years ago. We're one of the oldest healthcare IT companies out there. We're older than Epic. I love to say that. So we started out to how do you really assist clinicians to, to do what they do. And through multiple iterations and years of development and things like that, we have come up with a set of tools that I think really puts the joy back in the practice of medicine for the providers that have to do it. It also has a mechanism to get the patients involved. So my goal when I first started this is, when I first started looking at electronic health records, I said, "This is not going to work," like I said before. And that's what we're doing now. We're making it work. And it's interesting to see the acceptance or push back, however you want to talk about it. But we have but one mission: is to make the lives of the clinicians that use electronic healthcare work for them. [00:06:29] Lindsey Dinneen: Yeah, absolutely. My mind immediately goes to perhaps some of the challenges that the company faces with these electronic records, things like cybersecurity and HIPAA. And I'm so curious to know how you have been able to navigate that and adapt and evolve because, oh dear, those are hot topics. [00:06:51] Jay Anders: Well, yeah, in healthcare, it's probably one of the most regulated things on the planet at least in the United States. And it just got a little bit more complex because the Office of the National Coordinator keeps rolling out more regulations which we have to comply with. It's interesting how Some of these regulations have morphed throughout the process. I'll take HIPAA as an example. You brought it up. The privacy act had a very simple mission is to protect people's medical records from being shared with the wrong people. It went completely over the falls, meaning you can't share anything. And it's really tough to get permissions and all of that. One of the problems we've had that my company helps solve because we're in the exchange information business is being able to share that medical information when it's needed and where it's needed and in a format that's usable. So when people say, "I don't want my medical record shared," it's interesting because if you really ask patients, they say, "Oh yeah, if my doctor who is in the next town needs what I have, wrong with me, send it. I don't want to have to fill it out again." And one of the biggest bugaboos that I've seen with patients, including myself, is that every time you go to the doctor now, they ask you the same set of questions over and over again. Has that information changed? Probably not all that much. So it spends a lot of time going through machinations of making sure everything is okay and shareable and all of that. I have noticed that lately things are starting to loosen up a little bit along those lines. So people are not so scared that their information is going to get in the right hands or wrong hands, needs to be in the right hands. So I see that kind of fading in, in the United States. And what's interesting is our company is international. So we have installations in Thailand and Indonesia and other places. And over there, there's no problem with sharing information, which is a big plus when it comes to really taking care of patients, and that's why we're in this business as a clinician, either on the healthcare IT side like I am now or on the other side before. It's all about taking care of the patient. [00:09:10] Lindsey Dinneen: Yeah. Yes, absolutely. Yeah, and it's cool to think how you have been one of the first providers of such a service because that must have been, I feel like a barrier of entry would have been challenging. What kind of pain points did you have to solve for, especially clinicians who might have been hesitant to adopt the technology? [00:09:31] Jay Anders: Good question. One of the biggest challenges was the breadth of medicine itself. If you think about all the different conditions that a human can have, you have to have support for all of it. Well, getting to the all of it has taken 46 years. So it's not as if it happened yesterday. So the challenge was actually making it work every time, all the time, for the breadth of medicine. Now, one of the things about physicians especially, nursing not so much, but physicians particularly. We all know that we know everything on the planet and we are the absolute arbiter of everything you have as a patient, and we don't need any help at all. We can handle it. We're trained that way, which is really not true. Even in the old days, I would dismiss myself from a patient's room because I knew I had to go look something up. My knowledge is a little diminished in that area, so I have to go look it up. Well now, medicine's expanded so much that there's no way on the earth you can keep track of it all in your head. So, what can keep track of vast amounts of information, both patient information as well as medical information, pretty easily? A computer! So how can we make that computer act and think like a clinician. And that's what we've done at Medicomp. We've actually done that process. So when you walk in with diabetes or whatever condition, I can give you on a screen everything you need to ask and answer about that particular condition and make it easy for you to take care of that patient and document what you need to document and get all the information you need and sort it out. So computers can do that. It's gotten better through time, and now we have the world of AI we have to deal with in healthcare, which is also a little scary, but it does have a great potential. [00:11:34] Lindsey Dinneen: Well, and to that point, to explore it a little further, what is your opinion of incorporating it? How do you feel that the safety or ethical implications of it, I think there's always a lot of great uses for AI, but I'm curious about how do you feel that maybe it would be best utilized for situations like yours or for companies like yours? [00:11:57] Jay Anders: Well, AI is nothing more than a large program that's trying to predict what the next word will be in any given text. That's what it does, basically, down to the ground. The issues with AI is it's not trained as a clinician. You can read it every medical text on the planet, but it still does not really think like a physician thinks. So, along those lines, it's a great augmentation, easy retrieval of data, easy refreshing your memory about something if it's a little esoteric. It's great at that. It's also great at picking up synonymy, which is picking up every different medical term that you try to use in a particular situation. It can do that very well. The issue is it's not trained medically and it really doesn't have the intuition of a well trained physician So I'll tell you a little bit about myself again. When I started as an intern, I had a white coat with every conceivable little pocket manual I could stuff in it, including my stethoscope and tongue depressors and lights and things like that. I passed all my boards. I knew medical text. I knew all that. But it came down, I have to take care of patients now. A little different. And the experience that I developed over 20 years of doing that is something that you really can't stick into a computer. So, I think AI is going to be great about summarizing different sets of information, filtering it, presenting it, doing things like that. I don't think it's going to be used a whole lot to actually diagnose patients. I've seen people try to do that. It scares me a little bit. The other issue is, who's responsible? If a computer makes a diagnosis, who in the world is responsible? It's not the computer, it didn't care less. It's not the programmer who programmed the computer because they didn't know anything about what you were doing. So who's going to be responsible? So there's that one one step. So it can take you so far. It can really help you to get there, but you have to take the training the intuition, all of the knowledge over time, and apply it. So I think it's going to be a good augmentation, not ever a replacement. I just don't see that happening, at least in my lifetime. [00:14:28] Lindsey Dinneen: Yes, we'll see where it goes, but I, yes, that, that makes a lot of sense, and it's a great tool. I think that's a good way of thinking about it, not as a replacement, but just add it to your arsenal, so to speak, and yeah. Now you are a fellow podcaster and I would love if you would share a little bit about your podcast and how that all came about. [00:14:50] Jay Anders: Well, it's been, oh, it's been three years now. Wow. We were thinking about other ways that we could get the word out about what we do as a company, because my podcast is sponsored by the company I work for. But I also have a little bit of thespian in me. I was in plays in college and high school and all that nonsense. That kind of thing really didn't bother me. He says, "Well, let's give it a shot. What would it be like?" And he said, "Okay." So we had our first guest, second guest, things are kind of coming along. You get into a flow, really enjoy doing it, and the conversations are so stimulating. And then I had my conversation with Mickey Tripathi, who's the National Coordinator of Healthcare IT, and I wound up winning a Power Press Award for that particular interview. [00:15:39] Lindsey Dinneen: Congrats. [00:15:40] Jay Anders: It's been a lot of fun. It's engaging. And the feedback I get from it is that they like the conversation. Everybody likes to talk at you, not with you. And I've really tried to get out of that mode of just talking at somebody, but let's have a conversation about a topic. And I've learned a lot. I hope my listeners have learned a lot and it's been a great deal of fun. [00:16:08] Lindsey Dinneen: Yes, that's great. And I also recognize that you are a featured speaker on healthcare IT. And was that, well, you said you have this background in theater. So was public speaking something that came easily to you? Was it something you developed over time? [00:16:28] Jay Anders: It came pretty easily to me, I think. One of the things I did back three companies ago is I got to introduce a keynote speaker and talk about a keynote speaker in front of an M. G. M. A. Conference, and there had to be 6000 people in that audience. It was huge. But I walked out there and I said, "Okay, they're gonna listen to what I'm gonna have to say, and that's gonna be it. It's not gonna affect me." And it was a lot of fun, too. But so big crowds like that, it really doesn't affect me if I'm well prepped. If I'm passionate about talking about, it kind of rolls out of me naturally. So I don't have any problem with it. It's a lot of fun as well. [00:17:12] Lindsey Dinneen: Good. Yeah. Yeah. Just another opportunity to continue spreading that message. You know, I very much enjoyed looking at your LinkedIn profile and learning a little bit about you. And I wondered if you could share a little bit about, I saw that you do or have done in the past, some medical mission work to various countries. I would love if you would share a little bit about that and your heart for that. [00:17:38] Jay Anders: Well, in the past, I've not done it a lot recently, but I have taken several trips to Asia with a medical team and it had to be one of the most rewarding things I think I've ever done. And we were in the country of Kazakhstan, and we were seeing people who really don't have access to healthcare. And what healthcare they have over there was really not all that good. But we went over with a team of five. Had a physical therapist, a nurse, and probably 15 bags full of medications of which all went through customs without a hitch, which I was very surprised. But I got up in the morning, got there right at daybreak, and I would see 250 people a day and work till the sun went down. And there were still people to see. They were so appreciative of any kind of information, any kind of healthcare, any way you could help them. All done just, it was, like I said, one of the most rewarding things that I think I've ever done. And one of the best parts about that trip is I went and went to an orphanage that had, the kids needed health screenings. And there were about 200 kids. So we started early in the morning and I saw child after child after child after child ' till we finally got through the whole thing. And at the end of the day, it's now hanging in our kitchen. One of the little boys came up and said, "I want to give this to you, doctor." And it was a wooden plaque of an, with an urt on it, a camel and a little star. And in that part of the world, that's how they live is these urts, these very unique, tent like structures. And I just broke down. I couldn't, I, it was one of those things where that is going to me, to the nursing home because of that experience. But I highly recommend if anybody in healthcare and I'm not part of Doctors Without Borders, but I support them. If you have a chance to do that, do it. And you can do it as a non medical person because you always need support people. So if you think you want to do it, get yourself involved. It's great to do. It's massively rewarding and an experience that will last you a lifetime. [00:19:59] Lindsey Dinneen: Yeah, life changing. Yeah. Thank you for sharing about that. I thought that was really neat to see that's something that you've done in the past and you're passionate about. And speaking of passions, I know kind of a similar thing, but I think perhaps even in the US, this is something that you advocate for is, something that seems to bother you is the disparity of access to healthcare in more rural settings. And this is something that I feel like, on occasion, maybe some Americans don't realize that even in the United States, there is this disparity. And I was wondering if you could talk a little bit about that and your passion for that. [00:20:37] Jay Anders: Oh, absolutely. I grew up in a town of 20, 000 in the middle of Illinois. And I'll just give you a little progression. So in the town I grew up in, when I was a little boy at six, seven, we had two hospitals, nice size hospitals in that community. Roll ahead to 2024. One is a derelict building that looks horrifying. It's about to fall down. The other has merged with a larger system, which is about 40 miles away. It's coned down in size. They still do a lot of work there, but it's a lot of the major cases get shipped out to the mothership, which is in an adjacent city. But this plays out across rural areas all over the country. Hospitals are closing, they're under pressure, both cost of care as well as reimbursement for that care. Specialists in certain areas are very hard to come by. And when you look about the delivery of care, this is one of the things that bothers me the most. The people who get better in the hospital the quickest are the people who have support groups around them. They have parents, they have children, somebody to come and visit them and be with them, give them a reason to get better. When you move some of these rural hospitals and put them out of business or reduce them to the point they're just an aid station and you ship that patient to a medical center that's 50, 100 miles away, that support group goes away. It's very hard for that to even exist. So if you take into consideration the lack of real reimbursement at that level, at those types of hospitals, the lack of specialty care, which is still needed, and really the lack of primary care, things are headed downhill with that as well. It really is a disparate way of delivering healthcare in the United States. Not everybody can go to a Cleveland Clinic or a Mayo to get their healthcare. I live here in Western Pennsylvania. We have two massive institutions, both of which are wonderful, but not everybody can come here. People that are out in the Northern Pennsylvania, in the middle of the state, they got to travel because their hospitals are closing. And that I think is a travesty of the system. It's something that needs governmental intervention and it needs intervention in several different modes, meaning increased reimbursement, training physicians that want to practice in that type of environment. There are programs out there that are to start to do that, but it needs attention because people out there are not getting the same healthcare as I can get 15 miles up the road in the city of Pittsburgh. [00:23:28] Lindsey Dinneen: Yeah. Yeah. Thank you for sharing a little bit about that, and even some suggestions for ways that this can be helped. I know it's a long road, but I appreciate that you are bringing light to it and helping to start those conversations that will hopefully lead to change down the road. So. [00:23:49] Jay Anders: And technology does have a place to play in doing that as well. Telehealth, distance, ICUs, things like that. There are ways that technology can augment that medical care, but it's expensive. There has to be some type of support for it, both at the state and federal levels. [00:24:09] Lindsey Dinneen: Absolutely. So I'm curious on your path and your journey so far, and obviously you've had a really interesting career path 'cause you've done a few different things over your career and you continue to, I'm sure, learn and grow. But are there any moments that stand out to you as really affirming that, "You know what, I am in the right industry at the right time, at the right time? I'm doing what I was meant to do." [00:24:36] Jay Anders: Boy, that's a great question. One of the things that really drew me to working at the company I'm working at now at Medicomp was the fact that they truly had the physicians and the providers of healthcare's best interest in mind. Foremost, everything we do, and I mean, everything we do, is geared to make their lives better, more effective, and deliver better care. That's what we do. So in my pathway, which came kind of went around in different ways and different companies, different sizes through acquisition and other things, I really wound up in a place where we're not a large company, but we're all of one mind. And that is an absolutely fabulous place to work when you're all pulling the rope in the same direction. And it's all for a great purpose. And when I have providers come up and tell me, "Well, we installed this or we're using this, and it really did help what I'm doing." I had nurses come up to me and at one of our installations that say, "I've got 50 percent more time to spend with my patients. I'm not spending it in an inefficient electronic health record. That's been fixed." And when people say that it's like, "Okay, I'm in the right place at the right time." [00:26:04] Lindsey Dinneen: Yeah, that's incredible. What great testimonies too. Oh my word. Thank you for sharing that. So pivoting the conversation just for fun. Imagine that you were to be offered the opportunity to teach a masterclass on anything you want. It can be in your industry, but it doesn't have to be. And you'll get a million dollars for it. What would you choose to teach? [00:26:30] Jay Anders: I would teach physicians and other clinicians change management theory and how to manage change. That's what I would teach. I've had the luxury in my career of having a professional coach for two years, professional training and leadership. It's been a great thing to have, but not everybody has that. I would love to be able to teach clinicians how they can manage all the change that comes at them every day. It's patience, it's technology, it's knowledge base, all of that. It's changing all the time. You got to have a method. You got to have some skills. You got to have some coping mechanisms to go through that. It can't overwhelm you every time you go to work. And I think that's part of our burnout problem is that there's the skill set of managing change just isn't there to the degree it ought to. And physicians throw their hands up. I'm going, "I'm retiring. I'm going somewhere. I can't do this anymore." And I think that's wrong. So, that's what I do. I would teach coping skills around change in healthcare. [00:27:46] Lindsey Dinneen: I love that. Excellent. And then, how do you wish to be remembered after you leave this world? [00:27:53] Jay Anders: I want to be remembered as somebody who made a difference. You know, a lot of people get into the healthcare IT business because they want to revolutionize this or revolutionize that. I don't want to revolutionize anything. I want to make a difference. And if I can make a difference, I've pretty much done what I went into this profession to do was make a difference with patients, make a difference in my colleagues, and in the industry I'm in now. That's what I want to be remembered as. [00:28:23] Lindsey Dinneen: Yeah. Yeah, I love that. And then, final question. What is one thing that makes you smile every time you see or think about it? [00:28:33] Jay Anders: I'm going to go back to my story in Kazakhstan. Every time I think of that little boy coming up, grabbing my coat, jerking on it, to hand me that little plaque, that gives me a smile every time I think about it. It actually gives my wife a smile, too. Because we'll look up at that plaque in the kitchen and go, "I know where that came from. That was a good time." That makes me smile almost every time. [00:28:59] Lindsey Dinneen: Yeah. What a powerful memory and just such great motivation, something to come back to on the difficult days and then you look at that and go, "Yeah. Okay. I can make a difference here. I did make a difference here." [00:29:14] Jay Anders: I did. [00:29:15] Lindsey Dinneen: I love that so much. Well, this has been an amazing conversation. I am so grateful to you for spending some time with me and just telling me about your background and the amazing work that you're doing, that your company is doing. And we are honored to be making a donation on your behalf as a thank you for your time today to Feeding America, which works to end hunger in the United States by partnering with food banks, food pantries, and local food programs to bring food to people facing hunger, and they also advocate for policies that create long term solutions to hunger. So thank you for choosing that organization to support. And we just wish you the best continued success as you work to change lives for a better world. [00:30:00] Jay Anders: Thank you. It's been a pleasure. [00:30:02] Lindsey Dinneen: Absolutely. And thank you also so much to our listeners for tuning in. And if you're feeling as inspired as I am right now, I'd love it if you would share this episode with a colleague or two, and we will catch you next time. [00:30:16] Ben Trombold: The Leading Difference is brought to you by Velentium. Velentium is a full-service CDMO with 100% in-house capability to design, develop, and manufacture medical devices from class two wearables to class three active implantable medical devices. Velentium specializes in active implantables, leads, programmers, and accessories across a wide range of indications, such as neuromodulation, deep brain stimulation, cardiac management, and diabetes management. Velentium's core competencies include electrical, firmware, and mechanical design, mobile apps, embedded cybersecurity, human factors and usability, automated test systems, systems engineering, and contract manufacturing. Velentium works with clients worldwide, from startups seeking funding to established Fortune 100 companies. Visit velentium.com to explore your next step in medical device development.

In this episode, we have a discussion about the intersection of health design/architecture and surgery with Dr. Andrew Ibrahim, a trained architect and practicing general surgeon and health services researcher. We discuss how hospitals, ICUs, operating rooms, and trauma bays are designed and the evidence behind them.  Host: Cody Mullens, general surgery resident at the University of Michigan, current Behind the Knife Surgery Education Fellow. (@Cody_Mullens) Guest: Dr. Andrew Ibrahim. Associate Professor of Surgery at the University of Michigan, Maud T. Lane Research Professor, Co-Director for the Center for Healthcare Outcomes and Policy. (@AndrewMIbrahim) Guide to hospital design on Dr. Ibrahim's website: https://www.surgeryredesign.com/resources Paper on measuring hospital design and quality of care using clinical data: https://shmpublications.onlinelibrary.wiley.com/doi/full/10.1002/jhm.12987 Science paper: https://www.science.org/doi/10.1126/science.6143402 CHEST paper: https://secure.jbs.elsevierhealth.com/action/getSharedSiteSession?redirect=https%3A%2F%2Fjournal.chestnet.org%2Farticle%2FS0012-3692%2810%2960225-5%2Ffulltext&rc=0 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

On this week's Let It Rip Friday, we're actually sharing an interview with JuJu Chang before the release of the "20/20" episode.  They are now doing a special episode this Friday on the Menendez brothers. JuJu Chang is the correspondent at 9et/8ct on ABC! Juju Chang is a multiple Emmy Award-winning co-anchor of ABC News' “Nightline.” She also reports regularly for “Good Morning America” and “20/20.” Chang's decades of reporting converged in two hour-long prime time specials in 2021. She co-anchored an ABC News Live special “Stop The Hate: The Rise In Violence Against Asian Americans.” And after the mass shooting at three Asian-themed spas, Chang co-anchored and reported from the scene for an “ABC News 20/20” breaking news special “Murder In Atlanta”, which won a Front Page award in 2022. Chang has been recognized for her in-depth personal narratives set against the backdrop of pressing national and international news: from natural disasters to terrorism and racial equity. Her long-form storytelling includes a critical examination of the controversial “Remain in Mexico” immigration policy, told through the eyes of one pregnant woman and her family among the 60,000 asylum seekers camped for months along the Rio Grande. Chang's award-winning report “Trans and Targeted” on violence against transgender women of color across the country caps a series of her stories on LGBTQ+ issues. Chang won a GLAAD award for her story about Matthew Shepard's murder and the legacy his parents built in his honor.   Chang has covered major breaking news for decades for ABC News including extensive coverage of the COVID-19 pandemic: the science, the economic fallout, the racial disparities, the impact on hospital ICUs and essential workers. Chang has covered mass shootings and the myriad issues raised by shootings at the Pulse nightclub in Orlando, at the concert in Las Vegas and at the Sandy Hook school in Newtown, Conn. She's reported on global climate issues including a trip through Guatemala examining the “dry corridor” impact on climate refugees profiling a desperate farming family faced with the stark choice of starvation or migration. Chang has consistently covered gender-based violence through Central Africa on the front lines against Boko Haram and #bringbackourgirls. She traveled to Honduras for “Femicide: the Untold War,” an eye-opening look at rampant violence against women. Chang has profiled newsmakers like Joe Biden and Oprah Winfrey as well as high-profile celebrities including Jamie Lynn Spears, Matt Damon and Ben Affleck. Her extensive feature reporting covers mental illness, opioid addictions and parenting dilemmas. A former news anchor for “Good Morning America,” Chang joined ABC News just after college as an entry-level desk assistant in 1987 and rose to become a producer for “World News Tonight.” After reporting for KGO-TV in San Francisco and the ABC News affiliate service NewsOne in Washington, she co-anchored the overnight show “World News Now.” Chang's work has been recognized with numerous awards, including multiple Emmys, Gracies, a DuPont, a Murrow and Peabody Awards. Born in Seoul, South Korea, and raised in Northern California, Chang graduated with honors from Stanford University with a Bachelor of Arts in political science and communication. She is married to WNET president and CEO Neal Shapiro and, together, they have three sons. Chang is a member of the Council on Foreign Relations and a founding board member of the Korean American Community Foundation.   Connect with JuJu: https://www.instagram.com/jujuchangabc/?hl=en https://x.com/jujuchangabc?lang=en https://www.facebook.com/jujuchang/   How you can stay in touch with Linda: Website Facebook Twitter Instagram Pinterest YouTube SoundCloud   "Proud Sponsors of the Sisterhood of S.W.E.A.T" Essential Formulas

We discuss the practical barriers to implementing the A-F ICU liberation bundle, with Kali Dayton, ACNP-BC (@daytonicu), host of the Walking Home from the ICU podcast, and consultant to ICUs working on these issues. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here!

Dr. Merry Jennifer Markham and ASCO CMO Dr. Julie Gralow discuss the shortage of IV fluids and other challenges that have emerged from Hurricane Helene as high-risk areas brace for impact from another storm, Hurricane Milton. In a conversation with Dr. John Sweetenham, they highlight resources for oncologists and patients and stress the importance of crisis preparedness at cancer centers. TRANSCRIPT Dr. John Sweetenham: Hello, I'm Dr. John Sweetenham, the host of the ASCO Daily News Podcast. Hurricane Helene made landfall on September 26th in Florida and raged over parts of Georgia, North Carolina, Tennessee, and Virginia. The disaster has claimed over 230 lives. Many people are still missing, and many thousands are homeless. The hurricane has exacerbated the nation's IV fluid shortage, and some health care facilities have begun implementing conservation strategies. Meanwhile, Hurricane Milton, another powerful hurricane, is expected to wreak havoc as Florida braces for back-to-back hurricanes in parts of the state. On today's episode, we'll be discussing the impact of these events on cancer care, including the shortage of IV fluids. Joining me for this discussion is Dr. Merry Jennifer Markham, a professor and research lead for the University of Florida Health Cancer Center's Gynecologic Cancer Disease Site Group. I'm also delighted to welcome Dr. Julie Gralow, the chief medical officer at ASCO. Our full disclosures are available in the transcript of this episode. Merry Jennifer and Julie, many thanks for joining us for the podcast today. Dr. Julie Gralow: Thanks for having us, John. Dr. Merry Jennifer Markham: Yes, thank you. Dr. John Sweetenham: Merry Jennifer, can you tell us your exact location today and how your patients and institution have been impacted by Hurricane Helene so far? Dr. Merry Jennifer Markham: I am in the north-central part of Florida. I'm in Gainesville, Florida, which is the home of the University of Florida, where I practice medicine. And we are physically about two hours north of Tampa, two hours north of Orlando, and about an hour and a half southwest of Jacksonville. So right in the middle. And we are currently in the track for the next storm. Helene was a really a devastating storm and what our area felt was primarily what we tend to get in most storms here in the center part of the state, which is a lot of rain, a high risk for tornadoes and a lot of power outages. And one of the challenges that my center in particular faces, and some of the local cancer centers and cancer care providers around in our region, is our patients live in a very rural population. So for those patients who are not in downtown Tampa, downtown Orlando, for example, the rest of the state, especially in the northern part, tends to be quite rural. And so many of our patients had loss of power and a lot also in those regions are on well water. And so when the power goes out, it's not just a matter of losing air conditioning and losing access to Wi-Fi, but it's also losing access to fresh, clean water. Dr. John Sweetenham: Wow, it sounds very challenging. And of course, there are growing concerns at the moment about the IV fluid shortage that's being caused by Hurricane Helene and some hospitals have already begun conserving IV fluid supplies. Can you tell us a little bit about your experience with IV fluid shortages so far and whether you are anticipating other medical supplies to be affected by these shortages in the days or weeks ahead? Dr. Merry Jennifer Markham: Well, the IV fluid shortage has definitely impacted us. I happened to be on service last week and this week, and, working in the inpatient setting right now on our oncology inpatient service, we are having to conserve all IV fluid, and the entire hospital has been directed to find workarounds. And it's not always easy to find workarounds. It has definitely impacted our ability to safely discharge patients and to sometimes adequately give people the hydration, for example, that they need. A lot of the cancer therapies, we also use intravenous fluids to pre-hydrate or post-hydrate, and it's a challenge when we also need to conserve those IV fluids for other critical needs in the hospital setting. And for me, the shortage is really being felt in that inpatient setting right now. I think that other centers are still going through. And what we learned from the pandemic is that when there is a shortage, and it's not just actually the pandemic that we learned this from, but from any of the supply chain issues that we've had is then centers start buying it up, right? And so there's a bit of a panic in the healthcare field where if we're short on IV fluids, then well, now everybody is buying up the remaining IV fluids. And I think that does impact, unfortunately, everyone in a negative way. Dr. John Sweetenham: Yeah, I was reading some news reports earlier today actually about stockpiling and the efforts that some of the companies are going to control their outward going supplies to hopefully prevent some of that stockpiling. As if life for you and your patients wasn't difficult enough, you now have the prospect of another major storm, Hurricane Milton, which is headed your way and predicted to be among the most destructive hurricanes ever on record in central Florida. What are your major concerns in the days ahead and for what this might mean for the longer-term impact on cancer care? Dr. Merry Jennifer Markham: It's concerning. We are definitely in the path and the hospital is currently in sort of crisis preparedness mode. My concerns are always for the patients and for the teams caring for them, especially in my current work in the inpatient setting, these last two weeks. Our patients, because they come from such rural areas, are going to lose power. We will probably lose power, but we have generators at the hospital system, so we're a bit protected. But in many of these areas around us, there will be high winds, there will be flooding for those along the coast, and just the access to a clean, safe living environment is going be in jeopardy during and after the storm. What concerns me about our patients in particular with cancer are the ones who are undergoing treatments and who may have complications and may not be able to reach the help that they need during the storm or in the days following. I have patients that I have been caring for in the last week who still haven't recuperated, still haven't recovered their power from Helene. And so this is just adding insult to injury. I think that the impact on medical supplies is still to be seen. The challenge is always when a storm wipes out the major manufacturer of a particular product, I think we'll probably continue to have the IV fluid shortages. And I think it's just going to be a matter of preparing for a worst-case scenario but being prepared. Dr. John Sweetenham: Absolutely, yes. I think you've already alluded to the fact that as each of these successive disasters affect the country, we sort of learn a little bit more each time. And ASCO has provided resources on its website for disaster assistance. We'll share a link in the transcript of this episode to connect providers and patients to the Hurricane Helene-specific resources, government agencies, and also to patient and caregiver groups. Julie, as ASCO's chief medical officer, you've been speaking to stakeholders across the oncology community, as well as many groups that are responding to the crisis. What's your message to ASCO members and patients and caregivers today? Dr. Julie Gralow: Our main message at ASCO to our members, our immediate outreach was, ‘We're thinking of you, we're here for you, let us know how we can help you.' As you've already said, we've learned from past natural disasters. We had Katrina way back when, specifically for the IV drug shortages. We had a shortage back in 2014 due to a problem in Norway, but in 2017 we had another hurricane, Maria, which impacted Puerto Rico and majorly impacted IV fluids. So we have knowledge that we've gained, we as the whole medical community have gained on how to adapt and where we can hydrate orally or, you know, give electrolytes and where we can reserve things. I think one of our main messages at ASCO is that while our members are those who treat patients with cancer, we use IV fluid everywhere in the hospital, the operating room, the emergency room, the ICUs. We are all in this together, and so, while we have some specific things related to oncology where we can probably save fluid and conserve, etc., we need to work as a whole team, a whole body to protect each other. So, if you're developing an incident management team at your institution or whatever, it needs to be multidisciplinary. We all need to be protecting each other's patients as well. Dr. John Sweetenham: Yeah, absolutely. Just briefly on the subject of IV fluids, do you think it will be necessary to mitigate the IV fluid issue by bringing IV fluids in from other countries? Dr. Julie Gralow: I think the full impact, how long this is going to be, how much we can ramp up domestically, is really yet to be seen. all looking at this. So Baxter, which supplies about 60% of hospital IV fluids and peritoneal dialysis solutions, it was flooded essentially at their big plant in North Carolina. They have several other plants in the US and some internationally too. So the question will be, did those other plants also make IV fluids? Can they be ramped up? There are another at least two companies in the U.S. that make IV fluid. What will be their ability to ramp up? we already do. Baxter says they've already; I think Merry Jennifer alluded to this, they've already instituted a mitigation strategy where they're placing products on a protective allocation. So they are really trying to protect against stockpiling, et cetera. The FDA has come out and said it will consider reviewing potential temporary imports. It also is looking at expediting reviews once the manufacturing lines are up and going again, it will expedite those as well. And they're looking at alternative providers. IV drugs are officially on the FDA's drug shortages list, and that allows certain flexibilities, I am told, in terms of, for example, being able to make sterile IV fluids at a local site if it's on the FDA drug shortage list. And there are some other things that go along with it. It's really hard to find on the FDA drug shortage site. You have to use the right keyword. You have to look it up under sodium chloride for injection. You can't look up saline on it. But it is now there. I think it just got placed in the last 24 hours or so. And so that does allow some additional flexibilities. Dr. John Sweetenham: Okay, great. Thank you. So a question for both of you. A couple of years ago, we covered the consequences of Hurricane Ian on this podcast. And Helene and Milton will presumably not be the last storms which are going to disrupt cancer care and undoubtedly cause a great deal of hardship to many people, both our patients and our caregivers, those who are giving care. Climate change probably predicts that this is going to be an ongoing event. You know, these events have undoubtedly tested the disaster preparedness plans of cancer centers in the region. I wonder how you would assess the readiness of cancer centers to respond to these big disasters, which are undoubtedly in our future, and what areas of care do you think would need more attention? Merry Jennifer, maybe I'll start with you for that question. Dr. Merry Jennifer Markham: I think cancer centers, working within their health system, really should have a disaster preparedness plan in place. Here in Florida, I am very used to the preparedness plans that my system has developed really for every hurricane season. And because hurricane season is from June to the end of November, we are fully aware of this plan and can start taking action. And a lot of that deals with when do we close particular clinics? What areas do we need to prioritize? How do we make sure we've got proper staffing? I think that is the type of thing that cancer centers should have really in a written protocol – here's what we do when this news is coming out of the weather center or something along those lines. One of the challenges that we face, and I think probably this is, I guess I'm going to speak for all of the Southeast who is in the, you know, a hurricane, you know, risk area is disaster fatigue. And I think that is a problem. I don't know if it's unrecognized. I fully recognize it because I feel it. think earlier when we were talking, you mentioned Hurricane Ian and I don't even remember, Ian, because we have so many of these hurricanes. Every year there's a new one or multiple, and they all seem to bring the same kind of disasters. Usually on a local scale; I think what we've seen with Helene has just been so massive across multiple states. But the fatigue, that disaster fatigue, I think can lead people to become a little lax. And there is a risk. If we think of all of us as caregivers for all of our patients and for the physicians and teams practicing, it's easy to become numb and tired and worn out of preparing for these disasters. So, I think it's very important that this stays top of mind and that centers are preparing and also cognizant of the fact that fatigue is also a real potential issue. Dr. John Sweetenham: Right, thanks. Julie. Dr. Julie Gralow: We learn from each event and the events have come closer and closer, at least the hurricanes have. I totally agree with Merry Jennifer that we can't have disaster fatigue. Each one does have its unique component. For example, Helene, while we could see the path and it didn't stray that far from its path, did we really expect that this region, this Appalachian region would be the one most impacted? They're nowhere near a coast, you know, it was a bunch of flooding and dams breaking, so each one is different. From ASCO's perspective, we've learned and we've developed both a domestic crisis response team and plan, as well as an international one. And it's, besides hurricanes and major storms, you know, we've had fires and earthquakes and for our international crisis response team, we've been dealing with conflict and getting cancer care delivery in regions of conflict. So by having a team formed, by learning from each event, and then quickly communicating with members when we can get ahold of them on the ground as to what the real situation is and how we can help, I think we've gotten stronger over the years. It's still, with each one, it's horrible for the people on the ground and our job really is to best support our members and their patients as they're trying to get their lives back together. Dr. John Sweetenham: Thank you. So, I think that winds up most of the issues we wanted to cover today. And I wanted to thank you both Dr. Markham and Dr. Gralow for being on the podcast today and sharing your insights on what is, of course, an extremely challenging situation. I should remind listeners that they will find links to disaster resources for providers and patients on the ASCO website at asco.org. You can also follow Dr. Markham on X. Her tag is at @DrMarkham, where she has been sharing key information and resources. And Dr. Julie Gralow will continue to share resources on X. You can find her @jrgralow. We want to wish you, Merry Jennifer, and our many colleagues in the affected regions, all the best during what we know are very challenging times. Dr. Merry Jennifer Markham: Thank you. And thanks to you, Dr. Gralow, for sharing your insights and thoughts with us today as well. Dr. Julie Gralow: Thanks for having us, John. Dr. John Sweetenham: And thank you to our listeners for your time today. If you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review and subscribe wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and inform. It is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. The guests on this podcast express their own opinions, experience, and conclusions. Guest statements do not necessarily reflect the opinions of ASCO. Mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  Find out more about today's guests: Dr. Merry Jennifer Markham @DrMarkham Dr. Julie Gralow @jrgralow Follow ASCO on social media:  @ASCO on Twitter ASCO on Facebook ASCO on LinkedIn Disclosures: Dr. John Sweetenham No relationships to disclose Dr. Merry Jennifer Markham: Stock and Other Ownership Interests (Immediate Family Member): Pfizer Research Funding (Inst.): AstraZeneca, Merck Dr. Julie Gralow: No relationships to disclose

This week, we kick off a new series focusing on myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). In this first episode, we discuss the alphabet soup of premalignant hematologic conditions including CHIP, CCUS, and ICUS, before moving onto MDS and AML in future episodes.Episode contents: - What is CHIP vs. CCUS vs. ICUS?- What is the mechanism of hematopoiesis? - What is clonality? - What is a variant allele frequency? ****Have some time and want to make some extra money? Get paid to participate in market research surveys: https://affiliatepanel.members-only.online/FOC_24?utm_campaign=FOC&utm_source=email&utm_medium=email** Want to review the show notes for this episode and others? Check out our website: https://www.thefellowoncall.com/our-episodesLove what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

Today on  Equity, Devin Coldeway kicked off our Deals of the Week rundown with Piramidal, a startup which offers a foundational model for analyzing brain scan data that just raised $6 million, as his deal of the week. The premise behind the company is a fascinating one in that its technology aims to help complement the work of nurses and doctors in neural ICUs by helping identify signs of things like an epileptic episode, or a stroke.Mary Ann Azevedo wanted to talk about Comun, a neobank serving Latino immigrants in the U.S. with financial services and banking products. The fintech just raised $21.5 million a round led by Redpoint Ventures, not that long after closing its seed round. It's seeing fast growth — as well as a higher valuation.Rebecca Bellan dug into a scoop she had about Fluid Truck and recent drama there. The startup, which was founded to disrupt the commercial vehicle rental industry, has apparently ousted its sibling co-founders — CEO James Eberhard and chief legal counsel Jenifer Snyder — in what is being described as a hostile takeover.We then moved into the arrest of Telegram founder Pavel Durov, and whether or not tech executives can, and should, be held responsible for what happens on their platforms. And lastly, we dug into what's going at Inflection after Microsoft poached its co-founders. That move has drawn attention from antitrust regulators in the U.S. and U.K., who are now investigating whether Microsoft was anticompetitive. The Equity crew discussed whether or not companies are using acqui-hires to get around antitrust regulation.Honestly, we had so much fun we could've gone on for a whole other episode. Give it a listen!Equity is TechCrunch's flagship podcast, produced by Theresa Loconsolo, and posts every Wednesday and Friday. Subscribe to us on Apple Podcasts, Overcast, Spotify and all the casts. You also can follow Equity on X and Threads, at @EquityPod. For the full episode transcript, for those who prefer reading over listening, check out our full archive of episodes over at Simplecast. Credits: Equity is produced by Theresa Loconsolo with editing by Kell. Bryce Durbin is our Illustrator. We'd also like to thank the audience development team and Henry Pickavet, who manages TechCrunch audio products.

Have you ever felt stuck when you were trying to work through something?  Saul Enriquez, a teacher to our future nurses at Rio Grande Valley Nursing School, has over 26 years of experience in caring for people with a multitude of health issues. During his work providing critical care at ICUs, trauma units, and emergency departments, he's seen patients recover from extensive injuries. All of them had one thing in common: persistence. He now teaches future nurses to have patience with their patients. Even when facing tremendous obstacles, survivors found ways to make improvement, even if it seemed insignificant at the time. Future nurses will learn with those baby steps, patients will eventually find themselves further along their path of recovery. So if you feel stuck, remember that any action is better than inaction. Keep going!Support the Show.New episodes drop every Thursday everywhere you listen to podcasts. - Give us some feedback, tell us what bindwaves has meant for you by emailing us at bindwaves@thebind.org- Leave us a rating or review on Apple Podcasts or Spotify- Follow bindwaves on Instagram, Facebook, and YouTube!- Share episodes with your friends!- Make a monthly or one time donation- Learn more about the Brain Injury Network at www.thebind.org

“I received a 911 call… as a “full arrest” meaning someone not breathing, no pulse,” Harry Fisher, a paramedic, revealed to Dr. Peter McCullough. “Upon arrival to the scene I realized it was a Pfizer vaccination line.” “The Patient was there for her ‘second dose of Pfizer and suddenly collapsed.' … While continuing life saving efforts the nurse on scene stated “this is the second one in two weeks.” ” Later, the patient died. “I have been a paratrooper and a medic for an air wing, consistently put my patients, brothers and sisters, and our national interest as my top priority,” Fisher continued. “When I spoke out about the horrific things I was witnessing… I was called a terrorist by social media and shunned by many of my peers.” Harry Fisher is a Nationally Registered Paramedic (NRP) with extensive experience in emergency medical services. An EMT since 1997 and paramedic since 2013, Fisher served as an Army and Air Force medic before working on ambulances for many years. During the COVID-19 pandemic, he transitioned to contract work in ERs, ambulances, and ICUs. Fisher authored “Safe and Effective, For Profit: A Paramedic's Story Exposing American Genocide.” His career has spanned Oklahoma, New York City, North Dakota, and Alaska. Find him at https://x.com/harryfisherEMPT Dr. Kelly Victory MD is the Chief of Disaster and Emergency Medicine at The Wellness Company. A board-certified trauma and emergency specialist with over 30 years of clinical experience, Dr. Kelly served as CMO for Whole Health Management, delivering on-site healthcare services for Fortune 500 companies. She holds a BS from Duke University and her MD from the University of North Carolina. Follow her at https://x.com/DrKellyVictory 「 SUPPORT OUR SPONSORS 」 Find out more about the brands that make this show possible and get special discounts on Dr. Drew's favorite products at https://drdrew.com/sponsors  • FATTY15 – The future of essential fatty acids is here! Strengthen your cells against age-related breakdown with Fatty15. Get 15% off a 90-day Starter Kit Subscription at https://drdrew.com/fatty15 • CAPSADYN - Get pain relief with the power of capsaicin from chili peppers – without the burning! Capsadyn's proprietary formulation for joint & muscle pain contains no NSAIDs, opioids, anesthetics, or steroids. Try it for 15% off at https://drdrew.com/capsadyn • PALEOVALLEY - "Paleovalley has a wide variety of extraordinary products that are both healthful and delicious,” says Dr. Drew. "I am a huge fan of this brand and know you'll love it too!” Get 15% off your first order at https://drdrew.com/paleovalley • TRU NIAGEN - For almost a decade, Dr. Drew has been taking a healthy-aging supplement called Tru Niagen, which uses a patented form of Nicotinamide Riboside to boost NAD levels. Use code DREW for 20% off at https://drdrew.com/truniagen • THE WELLNESS COMPANY - Counteract harmful spike proteins with TWC's Signature Series Spike Support Formula containing nattokinase and selenium. Learn more about TWC's supplements at https://twc.health/drew 「 MEDICAL NOTE 」 Portions of this program may examine countervailing views on important medical issues. Always consult your physician before making any decisions about your health. 「 ABOUT THE SHOW 」 Ask Dr. Drew is produced by Kaleb Nation (https://kalebnation.com) and Susan Pinsky (https://twitter.com/firstladyoflove). This show is for entertainment and/or informational purposes only, and is not a substitute for medical advice, diagnosis, or treatment. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Julie Brauer // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult lead faculty Julie Brauer discusses the ins & outs of daily life as an acute care physical therapist. Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION JULIE BRAUERWelcome to the PT on ICE Show brought to you by the Institute of Clinical Excellence. My name is Julie. I am a member of the older adult division. Thank you for spending some time on your Wednesday morning with me. Let's dive right in. So one of the most common questions that I receive from students and clinicians is is asking me about acute care. Should I go into acute care? Should I choose home health over acute care? And I'm having a lot of conversations with folks about pros and cons. and sharing my reflections from having been in acute care and home health and inpatient rehab and outpatient and private and home with older adults. So I figured I would do a podcast and bring all these thoughts that I've been having in these individual discussions to all of you. Okay, so what I'm going to do is I'm gonna go through a list of five to seven things that I believe are the most important characteristics of acute care and will help you decide if acute care is the right setting for you and if you are going to thrive in that setting. Okay, so number one, this is what I believe is the most important characteristic that sets acute care apart and will be the biggest factor in helping you determine if you are going to thrive in this setting. All right, number one is that in acute care you have complete autonomy over your day. You have complete autonomy over your schedule. This ended up being The reason why I feel like I thrived the most in acute care is because I wanted full autonomy over how I structured my day. So let me explain what that means. So when I was working in the hospital, I would walk into work, you clock in, and you are more than likely going to be given a list of patients. It is then up to you to decide which of those patients you're going to see. Are they appropriate to be seen? So you're doing some triaging there and you have autonomy to make that choice. And then you get to decide, most importantly, what your day looks like. When do you go see those patients? And this was so key for me. I don't like to be in a box. I don't like to be back to back all day. I like to create my own day. And so I would look at my list and depending on how intense or complex the patients were, depending on my energy levels for the day, I would decide, like, okay, I'm going to knock out a bunch of my patients in the morning. Back to back to back, get it done, and then go eat lunch, and then in the afternoon when my energy stores are down, that's when I do the majority of my documentation. So my afternoon, I wouldn't really have to see any patients, maybe one, and the majority of it was documenting. Or if sitting around and documenting for a long time is something that fatigues you, you can do a system where you go see a patient, then you document. You see a patient, then you document. So if you are someone who really needs that energy reset after pouring into a human, typically one that's very sick and there's lots of complexities and you need a little bit of a break and a breather, you can set your day up so that you get that break after every single patient or perhaps after two patients. So you really have a lot of flexibility there. I remember I was the type of person who I would love to knock everyone out in the morning. I would go find a quiet room or a room that was near some natural light. I would put my music on and I would just sit there and document. So you have full flexibility there. When you look at other settings like inpatient rehab, you are back to back to back to back. It's one of the things that I liked the least about the setting is that I did not feel like I had autonomy over my day. And I realized that that was professionally a big core value of mine. And then if we think about home health, you do have a lot of flexibility. You schedule all of your patients yourself. However, I learned my experience was that that was a big burden for me and I never really knew what I was walking into. I didn't get the choice of who was on my schedule. Scheduling patients was typically fairly time-consuming and frustrating when you're trying to reach out to all these people and they may not be answering and you're trying to very efficiently, Tetris them into your schedule so that you're not driving all around your region. Trying to schedule patients became just this extra task that really stole a lot of my energy. So after having been in multiple settings, I think that was the biggest plus to acute care. And if you are someone who likes to have that flexibility and you feel you can be efficient and effective and productive by making your own schedule, then acute care may be the setting for you over other settings. Okay, that's the biggest one. Number two, When you work in acute care, you learn how to be a master of scale. You have to learn how to come up with unique and creative loading strategies because you are in an environment where you don't have weights. You are in an environment where maybe you are just stationed to the edge of the bed because your patient is, they have tons of lines and tubes attached to them. So you have to figure out how to do a lot with a little. And that skill right there has become, it became my superpower going forward into every other setting. I never encounter a time where I'm with a challenging patient, they're complex, or we are in a less than ideal setting, for example, someone's home, and I have never felt I'm stumped. I don't know how to bring a fitness forward approach to this person. I can't come up with an idea. I don't have weights, and so I just don't know what to do. That has never happened. And the reason for that is because over several years, I learned how to get incredibly creative. So in the acute care setting, that could be as easy. I carry around dumbbells in my backpack. and I'm like rucking through the hospital, I bring my own equipment. We paused, we paused, we're back. That could also look like the, this is my favorite hack, the toiletry buckets that are typically filled with shampoos and soaps. I dump those out, roll up towels, soak them in water, put them in the toiletry bucket, and now that becomes a little bit of load, I would have folks deadlift that toiletry bucket, press it over their head. That was one of my favorites. I would use the tray table for a sled push. I would turn the hospital bed into a total gym and put it at an incline and have them reach at the bar above their head and they're doing pull-ups or I'm having them basically do a leg press with the hospital bed. I just was able to always find a way to bring that fitness forward approach and the acute care setting really forces you to get creative. And that was just such an amazing skill that has carried me through every single setting with every single patient that I've had throughout my career. So that's number two. Okay, number three. You do not, for the most part, have to take any work home with you. Yes. How nice does that sound? So for a lot of you who are in other settings and you typically at night, you get home from work, you maybe go to the gym, you eat your dinner and then you're like, well, here's my glass of wine and I'm going to sit down and I have one to two hours of documentation to do. That is not something that is typically happening when you are in acute care. Now in the very beginning as a new grad, a hundred percent, I was taking documentation home for me. But the vast majority after that learning curve, you know, after I got through that steep learning curve, I was not taking any work home from me. With me. You actually get to leave work at work. The administrative burden is very, very low. The EMR is very easy. It's a very low, low, low documentation burden. Something that I didn't know and I learned when I went into home health is that my god, documentation burden was enough for me to, was a big reason why I quit home health. I truly was so frustrated and cognitively overloaded by how extensive the documentation was that I could not even be present or enjoy the time with my patients. And for me, that was enough to say this setting is absolutely not for me. So if you are someone who you're really trying to create a barrier of when I'm at work, I do my work and I do a fantastic job. And then when I'm out, I'm off, I'm done. You go home and your energy stores go to your partner, they go to your friends, they go to your family. Acute care is definitely a setting where you can more easily create those boundaries. Okay, documentation burden low, that's number three. Number four, you are gonna do a lot of things in acute care that don't look like traditional therapy. Okay, so what I mean by this is that your role beyond improving someone's mobility and getting those sick patients, those, you know, individuals who need to get out of that bed and trying to start to get them stronger. Beyond that, I would say The majority of my time was actually spent being a fierce patient advocate, a fierce patient advocate. That is truly what my role became. And I actually evolved to loving that part of the role even more sometimes than going in and doing the functional mobility strengthening stuff. I thought it was such a beautiful opportunity to be able to advocate hard for my patients. So in MMOA, we call that significance over sexiness. You're not always going to get this patient doing squats or deadlifts or bringing in weights, but what you can do is you can fight to the end so that your patient can get over to inpatient rehab. I will never forget one of my first patients that I experienced working on the trauma floor was an individual who had a spinal cord injury. He fell down the stairs, ended up in the hospital. He did not have insurance. And he worked hard every single day with us. I worked with him for months. But because he didn't have insurance, acute rehab was saying, no, no, no, we're not going to take him. Even though everything else made him the perfect candidate to go to rehab. And we know that his outcomes were going to be so much better if he was able to go over and get that intensive rehab. So me and my colleagues were able to just hammer on that goal and we brought it up to the physicians and we got them to do an appeal and face-to-face peer review and we worked closely with case management and we were able to get him over to rehab because we went after that so hard. and that was more beneficial than probably anything we could have done in a more traditional therapy sense. So you have this awesome ability to really dictate the outcome of these folks and it doesn't look anything like PT. Another example is if you have an interest in working in the ICU you have an amazing role there to advocate. Meaning you're going around with the physicians and case management and the nurse manager and sometimes higher up execs in the hospital and you're looking at these folks who are on sedation and on the vent and you know that you want to get that sedation down so you can get these people up and start that early mobility. and you get to look at their settings and look at what's going on and say, look, can we get this person off Propofol and put them on Propofol? Or sorry, the opposite, take them off Propofol and put them on Procedix so that we can try and decrease the sedation burden that's going on with our patients and get them mobilizing faster. That is so cool. I thought that was amazing. I loved feeling like I was like this mama bear trying to protect all of my patients and get them to the next best. setting and really improve their outcomes. And much of that did not look like teaching them how to do sit to stands or deadlifts. So if that's something that you feel you would love to do, acute care is a really wonderful setting for that. Conversely, if you are an individual who, you know, I talk to a lot of clinicians and students who love the fitness part, like their core values when it comes to their professional career are that They want to be able to work with someone when they are in the stage of being able to load them up. That's what brings them value. They want to work more from a sports performance perspective. And they want them to be at a level where they're able to do all the exercise. Like that's what you love to treat. And so I give them the, you know, I let them know, acute care may not be the setting for you. You really may belong more in outpatient instead. So something to think about just the how dynamic of the role can be in acute care. Okay next you learn how to communicate and you learn how to be on a team. All right you will hear all the time that in acute care you have to have really solid interprofessional communication. 100%, you've heard that word over and over again. But what does interprofessional collaboration actually mean? You learn very quickly that the world does not revolve around you and your therapy plans. These patients are so complex. They have so much going on with them. You are one small piece of the puzzle that actually helps them move on to the next level of care, or helps them get home and be safe. You learn it really quick. You cannot operate in a silo. You start to learn what the nurse's roles are, what the nurse tech's role are, truly what your OT partners and your speech partners can do. And you learn how to work with case management. You learn how to have conversations with physicians. They're all right there, and you have to figure out You have your patient's health and mobility, and you want them to get stronger. That's the forefront of your mind. But you've got to deal with all of these other individuals who have their own priorities when it comes to the patient. the physicians or the surgeons, like I'm trying to keep the lungs and the heart alive, or I'm just trying to keep that brain alive. Like that's what their focus is. You know, the nurses are, Hey, I got to get these meds into my patients and they're overloaded. And you start to learn to have grace for people when maybe they're not fitting the idea of what you think should be done for the patient because you're thinking about your bias of mobilization and strengthening. So you start to understand, how to create allies with individuals who have various priorities when it comes to your patient case. You learn how to argue, you learn how to be direct, but you learn how to respect everyone else's role and everyone else's time. And that can become a really beautiful collaborative effort where you can work together and move people forward. And you just don't get that opportunity in other settings. When I went into home health, I really missed the fact that I could easily collaborate with my OT partners or my speech partners, or I could easily, you know, talk to a physician. In home health, a lot of the time it feels a lot more siloed and My goodness, if I was able to get even just a PA on the phone to tell them about a concern I had with a patient, that was a big win. So if you are someone who values and loves the fact that you're surrounded by a team constantly, acute care may be the setting for you there. Okay, only a few more, I promise. Let's do two more. Okay, next, the emotional toll slash connection is very high in acute care. Now, every single setting you are going to be emotionally connected to your patients, right? You could be in very vulnerable situations with the patient. However, I do believe acute care has the highest amount of emotional connection and along with that emotional toll because you are with folks that are dying, that have been through catastrophic accidents, that are, you know, I will never forget the day where I was working in trauma and a patient came in, terrible car accident. That individual lived, but her spouse died. And you are pouring into this human, they don't even know that their spouse is dead yet. I mean, you are going to face these situations so often, especially if you work more in the ICUs. You are surrounded by death quite frequently, and you're surrounded by a lot of sadness and loss and grief. And that can take a significant toll on you. I think it's beautiful that you are able to be someone who can support your patient, your patient's family during an incredibly tough time. But that can also be something if you are, um, if you are an empathetic person to a fault, sometimes like I am, that you can take on a lot of that grief and that can end up being incredibly heavy for you. So something to consider if you love to be in those vulnerable positions with your patient and you want to help them through dying and sickness and grief and loss, it may be a great setting for you. And that's not to say you don't experience intense joy as well. You can. see folks who were minimally conscious after a stroke or traumatic brain injury, and you can see them, you know, spontaneously start to recover. And that's absolutely incredible as well. But the emotional roller coaster is incredibly high. So if you are prone to taking on a lot of energy and emotion, and that's something that you know is not necessarily a positive for you, then maybe acute care isn't the place for you. Okay, last one here, last one. you do not get to see the sexy outcome. You do not get to see the sexy outcome. In acute care, you truly have to be okay with being the person who sees this person once, you plant a seed and you hope that that grows and that ends up changing this person's trajectory. But you don't get to see that outcome most of the time. And that's really hard for individuals. Many clinicians, they want to build that relationship and go along that journey with someone and see discharge day, see how far they've come from the amount of effort and work and progress that you've been making together. That longer term relationship is so important. This is one of the, um, this is definitely one thing that I didn't like about acute care as much is that I didn't have the ability to see this see this outcome. On the flip side of that, I definitely adopted the perspective that, hey, I've got maybe one or two chances to work with this patient. I'm going to do everything possible to set them down the right path. I'm going to pour into this human 200% to try and make sure that I can hand off the baton to the next person and it's a fitness forward individual and I can continue to keep them in that lane. And I was okay with that. I loved knowing that as a fitness forward professional, when I walked in those doors of my patients' hospital rooms, I knew, I just felt that their outcome was going to be different because I was coming into their room. And I loved being able, I loved being able to have that impact with them, even if it's for a very short amount of time. If that is something that you feel like you can get on board with and you can really learn to value and you can be okay with planting the seed and not seeing the outcome, acute care could be a really wonderful setting for you. If you are someone who knows that they want to go along the journey over a long period of time, they want to see discharge day and know what those efforts look like at the end and what the outcome was, probably not the setting for you. Okay, all, that's my list. It's not an exhaustive list by any means. I would love for you all to add to this list to kind of let more folks know some pros, some cons, some other considerations. Please add to this. Put it in the comments. Send me a message. I'd love to post other thoughts about all the things that go into acute care and whether it is going to be the right setting for you. Okay. So I will end with talking to you all about what we have coming up in the older adult division. So in August we, Oh, first let's talk about July. My goodness. So this coming weekend, we, uh, the whole team is in Littleton, Colorado. And then once we go into August, we are in California, Salt Lake city. in Alaska, as well as our Level 1 online course, that starts August 14th as well. PTINice.com, that's where you can find all of that info. If you're not on the app already, make sure you get on there and get into our community. We're on the app so much more now, so if you have questions or comments, find us in there. All right, team, have a wonderful rest of your Wednesday. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. 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In this episode, Gordon Smith, MD, FAAN speaks with Casey S.W. Albin, MD, author of the article “Neuromuscular Emergencies,” in the Continuum® June 2024 Neurocritical Care issue. Dr. Smith is a Continuum® Audio interviewer and professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. Albin is an assistant professor of neurology and neurosurgery in the departments of neurology and neurosurgery, division of neurocritical care at Emory University School of Medicine in Atlanta, Georgia. Additional Resources Read the article: Neuromuscular Emergencies Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @gordonsmithMD Guest: @caseyalbin Transcript  Full transcript available here  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 visiting 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 Smith: Hi. This is Dr Gordon Smith. I'm super excited today to be able to have the opportunity to talk to Dr Casey Albin, who will introduce herself in a second. She's well known to Continuum Nation as the Associate Editor for Media Engagement for Continuum. She's also a Neurointensivist at Emory University and wrote a really outstanding article for the neurocritical care issue of Continuum on neuromuscular emergencies. Casey, thanks for joining us. Tell us about yourself. Dr Albin: Sure. Thank you so much, Dr Smith. So, yes, I'm Casey Albin. I am a Neurointensivist. I practice at Emory. We have a really busy and diverse care that we provide at the Emory neuro ICUs. Just at the Clifton campus, there's over forty beds. So, although neuromuscular emergencies certainly do not make up the bread and butter of our practice - I mean, like many intensivists, I spend most of my time primarily caring for patients with cerebrovascular disease - this is a really interesting and just kind of a fun group of patients to take care of because of the ability we have to improve their outcomes and that some of these patients really do get better. And that's a really exciting thing to bear witness to. Dr Smith: I love finding neurointensivists that are interested in neuromuscular medicine because I share your interest in these patients and the fact that there's a lot that we can do for them. You know, how did you get interested in neurocritical care, Casey? Dr Albin: You know, I was always interested in critical care. It was really actually the neurology part that I came late to the party. I was actually, like, gearing up to apply into emergency medicine and was doing my emergency medicine sub-I (like, that was the route I was going to take), and during that sub-I, I just kept encountering patients with neurologic emergencies - so, you know, leptomeningeal carcinomatosis and obstructive hydrocephalus, and then a patient with stroke - and I realized I was just gravitating towards the neuroemergencies more so than just any general emergencies. And I had really enjoyed my neurology rotation. I did not foresee that as the path I was going to take, but after kind of spending some time and taking care of so many neurologic emergencies from the lens of an emergency department, sort of realized, like, "You know, I should go back and do a neurology sub-I.” And so, kind of, actually, late in the game is when I did that rotation and, like, dramatically changed my whole life trajectory. So, I have known since sort of that fourth year of medical school that I really wanted to focus on neurocritical care and neurologic emergencies, and I love the blend of critical care medicine and the procedural aspect of my job while doing it with the most interesting of all the organ systems. So, it's really a great blend of medicine. Dr Smith: Did you ever think about neuromuscular medicine? Dr Albin: Uh, no. Dr Smith: I had to ask. I had to ask. Dr Albin: No, I mean, I do really love neuromuscular emergencies, but I've known for forever that like, really wanted to be in an acute care setting. Dr Smith: You know, I think it's such a great story, Casey, and I know you're an educator, too, right? And, um, we hear this from learners all the time about how they come to neurology relatively late in medical school, and it's been really great to see the trajectory in terms of fellowship determination dates and giving our students opportunities to make their choice, you know, later during their medical school career. And I wonder whether your journey is an example of what we're seeing now (which is more and more students going into neurology because we're giving them the free space to do that), and then also in terms of fellowship decisions as well (which was what I was alluding to earlier)? Dr Albin: Yeah, absolutely. I think having more exposure to neurology and getting a chance to be in that clinical environment - you know, when you are doing the “brain and behaviors” (or whatever your medical school calls the neurology curriculum) - it is so hard and it's so dense, and I think that that's really overwhelming for students. And then you get into the clinical aspect of neurology, and sure, you have to know neurolocalization - and that is fundamentally important to everything we do - but the clinical application is just so beautiful and so much fun and it's so challenging, but in a good way. So, I totally agree. I think that more students need more exposure. Dr Smith: Well, I mean, that's a perfect segue to something I wanted to talk to you about, which is you brought up the beauty of neurology - which is, I think, you know, neurologic formulation, really – and we talk a lot about the elegance of the neurologic examination. But one of the things I really liked about your article was its old-school formulation – you talk about the importance of history, examination, localization, pattern recognition – I wonder if, maybe, you could give us some pearls from that approach and how you think about acute neuromuscular problems and the ICU? Dr Albin: Absolutely. I really do think that this is the cornerstone of making a good diagnosis, right? I will tell you what's really challenging about some of these patients when they are admitted to the ICU is that we are often faced with sort of a confounded exam. The patient may have been rapidly deteriorating, and they may not be able to provide a good history. They may be intubated by the time that we meet them. And so not only are they not able to provide a history themselves, but their exam may be confounded by the fact that they're on a little bit of sedation, or they were aspirating and now they have a little bit of pneumonia. I mean, it can be really challenging to get a good neurologic exam in these patients. But I do think the history and the physical are really where the money is in terms of being able to send the appropriate test. And so, when I think about these patients who get admitted to the neuro ICU, the first thing that we have to have is someone who can provide a really good collateral history, because so much of what we're trying to determine is, "Is this the first presentation, and this is a de novo (new) neuromuscular problem?” or “Had the patient actually had sort of a subacute or chronic (even) decline and they've been undiagnosed for something that was maybe a little bit more indolent, but (you know, they had an abrupt decline because, you know, they got pneumonia, or they have bloodstream infection, or whatever it was allowing them to sort of compensate) they have no longer been able to compensate?”. And so, I really do think that that's key. And when I am hearing the story the first time, that's really one of the focuses of my history – is, "Was this truly a new problem?”. And then, when we think about, you know, "Where do we localize this within the nervous system?”, it's actually quite challenging because, you know, patients with acute spinal cord pathology may also not present with the upper motor neuron findings that are classic for spinal cord pathology. And so I think, again, it's a little bit recognizing that you can be confounded and we have to keep a broad differential, but I am sort of examining for whether or not there's proximal versus distal (like, the gradient of where they're weakest), is there symmetry or asymmetry, and then, are there other, sort of, features that go along with helping us localize to something to the nerves (such as sensory symptoms or autonomic symptoms)? So when I think about, you know, where we're putting this, you can put anything in sort of the anterior horn cells or to the nerves themselves, to the neuromuscular junction, and then to the muscles. And teasing that out, I put in some figures and tables within the article to help kind of help the reader think about what are features of my patient's exam, my patient's history, that might help me to put it into one of those four categories. Dr Smith: Yeah, I was actually going to comment on the figures in your article, Casey. They're really fantastic, and I encourage all of our listeners to check it out. There's, you know, figures showing muscle group involvement and different diseases and different muscle disorders and different forms of Guillain-Barré syndrome - it's a really beautiful way of visualizing things. I wonder if we could go back, though, because I wanted to delve down a little bit in this concept of patients who have chronic neuromuscular diseases presenting into the ICU. I mean, this happens surprisingly frequently with ALS patients or, like, myotonic dystrophy. I've seen this a number of times where folks are, just, they're not diagnosed and they're kind of slowly progressing and they tipped over the edge. Can you tell us more about how you recognize this? You talked a little bit about collateral history - other words of wisdom there? Dr Albin: I would say this is one of the hardest things that we encounter in critical care medicine, because quite frequently - and I see this more with ALS than myotonic dystrophies - but, I would say, like, I don't know, once every six months, we have a patient who's undiagnosed ALS present. And I think it can be extremely difficult to tease this out because there's something that's tipped them over the edge. And as an intensivist, you were always focused on resuscitating the patient and saving them from that life-threatening thing that pushed them over the edge, and then trying to tease out, “Well, were they hypercarbic and did they have respiratory failure because, you know, they've got a little bit of COPD, and is that what's going on here?” or, "Have they been declining and has there been sort of this increase in inability to ventilate actually because of diaphragmatic weakness and because of neuromuscular weakness?” Again, the collateral history is really important. One of the things that I think we are challenged by is how difficult - and I'm sure you can comment on this, as someone who is a neuromuscular guy - is how difficult it is to get a good EMG and nerve conduction study in the ICU in patients who may have been there for a little bit, you know? I think about this, sort of, the electrical interference, the fact that the patient's body temperature has fluctuated, the fact that they are, usually, by this time, like, they're a little volume overloaded – they're puffy. You know, it can be very frustrating. I think, actually, you probably would know more about, like, what it's like to do that exam on our ICU patients. Dr Smith: Sometimes, it's really challenging, I agree. And it's the whole list of things that you raised - and I think it goes back to the first question, really. You put a premium on old-school formulation, pattern recognition, localization, and taking a good history - you know, thinking of that ALS patient, right? I mean, one of the challenges, of course, that you have to deal with in that situation is prognostication and decisions regarding intubation, right? And that's very different from (I'll give another scenario that sometimes we run into, which is the other extreme) a patient with myasthenia gravis who, maybe we expect to be able to get off a ventilator very quickly, but sometimes they're reluctant to be ventilated because of their age or advanced directives and whatnot. I wonder if you could talk a little bit about how you approach counseling patients regarding prognosis related to their underlying neuromuscular disease and the need for intubation in a period of mechanical ventilation? Dr Albin: Just like you said, it really ranges from what the underlying diagnosis is. So, one of the things that, you know, like you said, myasthenia - these patients, when they're coming in in crisis, we know that there is a good chance that they're going to respond pretty quickly to immunotherapy. I mean, I think we've all seen these patients get plasma exchange, and within a day or two, they are so much stronger (they're lifting their head off the bed, they're clearing their secretions), and every now and then, we're able to temporize those patients with just noninvasive ventilation. You know, when we're having a discussion about that with the patient and with the care team, we really have to look at the amount of secretions and how well they're clearing them, because, again, we certainly don't want them to aspirate - that really sets people back. But, you know, I think, often in those cases, we can kind of use shared decision-making of, you know, “Can we help you get through this with noninvasive?” or, you know, "Looking at you, would you be all right with a short term of intubation?” Knowing that, usually, these patients stabilize not all the time, but quite frequently, with plasma exchange, which we use preferentially. The middle of that is, then, Guillain-Barré - those patients, because of the neuropathy features (the fact that it's going to take their nerves quite some time to heal, you know) - when those patients need to be intubated, a good 70% or more are going to require longer-term ventilation. And, so, again, it's working with a family, it's working with a patient to let them know, "We suspect that you're going to need to be on the ventilator for a long time. And we suspect, actually, you would probably benefit from early tracheostomy”. And there was a really nice guidance that was just presented in the Journal of Neurocritical Care about prognosticating in patients with specifically Guillain-Barré (so that's helpful). And then, we get to the, really, very difficult (I would say the most difficult thing that we deal with in neuromuscular emergencies) - is the patient who we think might have ALS (we are not positive), and then we are faced with this diagnosis of, “Would you like to be intubated, knowing that we very likely will never extubate you?” - and that, I think, is a very difficult conversation, especially given that there is a lot of uncertainty often in the diagnosis. I would say, even more frequently, what happens is they have been intubated at an outside hospital and then transferred to us for failure to wean from the ventilator and, "Can you work it up and say whether or not this is ALS?” – and that, I think, is one of the most difficult conundrums that we face in the ICU. Dr Smith: Yeah. I mean, that's often very, very difficult. And even when the patient wants to be intubated and ultimately receive a tracheostomy, getting them out of the hospital can sometimes be a real challenge. There's so much I want to talk to you about, and, you know, you talked about prognostication - really great discussion about tools to prognosticate in GBS, both strengths of things like EGRIS and the modified EGOS, and so forth – but, I wonder (given that I'm told time is limited for us) if you could talk a little bit about bedside guidance in terms of assessing when patients need to be intubated? You provide really great definitions of different respiratory parameters and the 20/30/40 rule that I'll refer listeners to, but I wonder if you could share, what's your favorite, kind of, bedside test - or couple of bedside tests - that we can use to assess the need for ventilatory support? And this could be particularly helpful in patients who have, let's say, bifacial weakness and can't get a good seal. So, what do you recommend? Is it breath count? Is it cough? Something else? Dr Albin: I think for me, anecdotally (and I really looked for is there any evidence to support this), but for me, anecdotally - and knowing that there is not really good evidence to support this - whether or not the patient could lift their head off the bed, to me, is a very good marker of their diaphragmatic strength. You know, if they've got good neck flexion, I feel a lot better about it. The single breath count test is another thing that I kind of went down a rabbit hole of, like, "Where did this come from?” because I think, you know, it was one of the first things I was taught in residency - like, “Oh, patient with neuromuscular weakness, have them take a deep breath and count for as many breaths as they can.” We have probably all done that bedside test. It's really important to recognize that the initial literature about it was done in myasthenia patients who were in clinic (so, these were not patients who are, like, abruptly going to need intubation), and it does correlate fairly well with their forced vital capacity (meaning how much they're able to exhale on bedside perimetry), but it is not perfect. And I put that nice graph in the article, and you can see, there's a lot of patients who are able to count quite high but actually have a very low FVC, and patients who count only to ten but have a very good FVC. So, I do like the test and I continue to use it, but I, you know, put an asterisk by it. It's also really important - and I would encourage any sort of neurology trainees, or trainees in any specialty - if you're taking care of these patients, watch the respiratory therapist come and do these at the bedside with them. You'll get a much greater sense of (a) what they're doing, but (b) how well the patient tried. And it is really, I mean, we have to interpret this number in the context of, "Did they give a really good effort?” So, I'll often go to the bedside with the RT and be the one coaching the patient - saying, like, you know, “Try again”, “Practice taking this”, “Do the best you can”, “Go, go, go! Go, go, go!” (you know, like, really coaching the patient) - and you would be surprised at how much better that makes their number. And when you're really appropriately counseling them, that we actually get numbers that are much better predicting what they're doing. Then, you also have a gestalt just from being at the bedside of what they looked like during this. Dr Smith: Yeah. I used to work with a neuromuscular nurse who was truly outstanding who was the loudest and most successful vital capacity coach ever. But, you know, she'd be doing it in one room, and you'd be in the next room with a patient. They'd be like, “What are they doing next door?” She was shouting and exhorting the patient to go harder and breathe better. So, it was always, “Wow, that sounds exciting over there”. All right, this is all in a prelude. What I really want to ask you, Casey, is, you know, whenever we do Continuum Audio interviews, we, like, look up people, and it's not hard to look you up because you're everywhere on the Internet. And come to find out, you're a fully credential neuro Twitter star - and that's the term I saw, a star. So, what's it like being a Twitter star? I guess it's an X star. I don't even know what we call it anymore. Dr Albin: I guess it's that. I don't know. I don't know, either. It's so funny, um, that that has become so much of my, like, academic work. I got on Twitter, or X (whatever it is) during the pandemic because, really, my interest is in, you know, innovatives and medical education, and I really had been trained to do simulation. So, I really wanted to develop simulation curriculum. I love doing sims with our medical students to our fellows. So, I was, like, developing this whole curriculum, and then the pandemic came along, and the sim lab at Emory was like, “Mm, yeah, we're not going to let people go in the sim lab. Like, that's not exposure that we want (people in a room together)”. So one of our fellows at the time was doing a lot on Twitter and he was like, "You would love this. You have cases that you want to teach about. You should really get on board”. And I, sort of, reluctantly agreed and have found the NeuroTwitter community to be, like, just a fantastic exchange of, you know, cases, wisdom, new studies - I mean, it's the way that I keep up with what is being published in the many fields that are adjacent to neurocritical care. So, it's very funny that that has ended up being sort of something that is a really big part of my academic time. But now that we're talking about it, I will give a plug for any of the listeners who are not on X. Dr Jones and I post cases, usually twice a week, that come directly from the Continuum articles or from our files (because, you know, sometimes we can spin them a little bit), but it's an amazing, sort of case-based, way to do some, like, microteaching from all of the beautiful Continuum articles, all the cases - and because there are free articles released from the issue, you know we'll link directly to those. So, for any of the listeners who have not, kind of, joined X for all the reasons that many people cite of not joining, I would say that there's so much learning that happens - but Dr Jones and I are people to follow because of our involvement with Continuum and the great cases that we're able to showcase on that platform. Dr Smith: I think that's a great point. And, you know, there are certainly organizations that are questioning their engagement with X, and I'm on a board of an organization that's talked about not actually participating, and I brought up this point that I think the NeuroTwitter (NeuroX) community is really amazing. You'll have to give me some tips, though, I'm at, like, 498 followers or something like that. Do you know how many followers you have? I looked it up yesterday. I've got it for you if you don't know. Dr Albin: I don't know recently. Dr Smith: Yeah, 18,200 as of yesterday. That's amazing! Dr Albin: Yeah, it's worldwide. We're spreading knowledge of Continuum across the globe. It's fantastic. Dr Smith: That's crazy. Yeah, that's great work. It's really great to see the academic, kind of, productivity that comes of that. And I agree with you - Continuum has a really great presence there, and it's a great example of why you're the Associate Editor for Media Engagement. I think we're going to have to, I guess, gamify would be the right thing? Maybe we should, uh, see what the Las Vegas book is on the number of followers between you and Lyell Jones, I think. Dr Albin: Totally. Dr Smith: Yeah. Hey, Casey, this has been awesome. I've been so excited to talk to you - and I could keep talking to you for hours about your NeuroTwitter stardom – but in particular, neuromuscular weakness. I really encourage all of our listeners to check out the article. It's really, really, really, great - really enjoyed it. I learned a lot, and it reminded me a lot of things that I had forgotten. So thank you for the great article, and thanks for a really fun discussion. Dr Albin: Thank you, Dr Smith. It was truly a pleasure.   Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, please consider subscribing to the journal. There's a link in the episode notes. We'd also appreciate you following the podcast and rating or reviewing it. AAN members, go to the link in the episode notes and complete the evaluation to get CME for this article. Thank you for listening to Continuum Audio.

In this enlightening episode of Finding Frequency, we are honored to have Dr. Susan Frampton, President Emeritus of Planetree International, join us. Dr. Frampton is a renowned medical anthropologist and an influential advocate for person-centered care. She has significantly contributed to transforming healthcare environments by focusing on patients' holistic well-being and fostering compassionate care.  Join us as we delve into Dr. Frampton's extensive experience and insights on the impact of healthcare environments on patient outcomes, her role in developing global health policies, and the stories behind successful and struggling care environments. Whether you're a healthcare professional, designer, or someone interested in creating spaces that enhance well-being, this episode offers valuable perspectives on the profound connection between our surroundings and health. In this episode, you will hear: Dr. Frampton's advocacy and her work with families dealing with sickle cell disease Overview of the Planetree model (human interactions, access to information, and social support in healthcare) The importance of physical environments in hospitals (ex., family-centered ICUs and healing gardens) Innovative design changes in healthcare settings to enhance patient comfort and emotional well-being The role of safety and quality of life in designing aging-in-place environments Resources from this Episode To learn more about Planetree: https://www.planetree.org/ Planetree's upcoming Person-Centered Care Forum: https://web.cvent.com/event/e32a1821-00a0-4bde-b05f-63deb3fa4d77/summary  Reach out directly to Dr.Frampton at Sframpton@planetree.org  Find out more about Frequency: https://frequencyspaces.com/  Subscribe to the Frequency Newsletter:  https://frequencyspaces.com/subscribe  Podcast Disclosure:  https://frequencyspaces.com/podcast-disclosure  Follow and Review: We'd love for you to follow us if you haven't yet. Click that purple '+' in the top right corner of your Apple Podcasts app. We'd love it even more if you could drop a review or 5-star rating over on Apple Podcasts. Simply select “Ratings and Reviews” and “Write a Review” then a quick line with your favorite part of the episode. It only takes a second and it helps spread the word about the podcast. Episode Credits If you like this podcast and are thinking of creating your own, consider talking to my producer, Emerald City Productions. They helped me grow and produce the podcast you are listening to right now. Find out more at https://emeraldcitypro.com Let them know we sent you.

Despite validated models, predicting outcomes after traumatic brain injury remains challenging, requiring prognostic humility and a model of shared decision making with surrogate decision makers to establish care goals. In this episode, Lyell Jones, MD, FAAN, speaks with Jamie E. Podell, MD, an author of the article “Traumatic Brain Injury and Traumatic Spinal Cord Injury,” in the Continuum June 2024 Neurocritical Care issue. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Podell is an assistant professor in the department of neurology, program in trauma at the University of Maryland School of Medicine in Baltimore, Maryland. Additional Resources Read the article: Traumatic Brain Injury and Traumatic Spinal Cord Injury 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 Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Guest: @jepodell Transcript Full transcript available here 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 visiting 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 Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today, I'm interviewing Dr Jamie Podell, who has recently authored an article on traumatic brain injury and traumatic spinal cord injury in the latest issue of Continuum on neurocritical care. Dr Podell, welcome. Thank you for joining us today. Why don't you introduce yourself to our audience and tell us a little bit about yourself?   Dr Podell: Thanks, Dr Jones. It's great to be here. As you mentioned, I'm Dr Podell. I'm neurocritical care faculty at University of Maryland Shock Trauma. I have a primary interest in traumatic brain injury, both from a research and clinical perspective. I previously have more of a cognitive neuroscience background, but I think it kind of ties into how I think about TBI and outcomes from traumatic brain injury. But what I really like doing is managing acutely ill patients in the ICU, and I think TBI really affords those kinds of interventions, and it's a really rewarding kind of setting to take care of patients. Dr Jones: Yeah, and I really can't wait to talk to you about your article here, which is fantastic. For our listeners who might be new to Continuum, Continuum is a journal dedicated to helping clinicians deliver the best possible neurologic care to their patients, just like Dr Podell was talking about. We do that with high quality and current clinical reviews, and Dr Podell's article - it's a massive topic - traumatic brain injury and traumatic spinal cord injury. And, you know, as we start off here, Dr Podell, we have the attention now of a massive audience of neurologists. If you had one most important practice change that you would like to see in the care of these patients who have trauma, what would that practice change be? And, I think, maybe, we'll give you two answers, because you cover TBI and you cover spinal cord injury. What would be the most important practice changes you'd like to see?   Dr Podell: So, this isn't that specific, but I think it's really important. I think we need more neurologists, and specifically neurointensivists, managing these patients. I think there's a lot of variability across institutions and how acute severe TBI and spinal cord injury patients are managed. They're often in surgical ICUs, and neurology may be involved in consultation but not in the day-to-day management. But I think what we're seeing is that, you know, there's a lot of multisystem organ dysfunction that happens in these patients, and that has a really strong interplay with neurologic recovery and brain function. And I think, you know, neurointensivists are very well equipped to think about the whole body and how we can kind of manipulate and really aggressively support the body to help heal the brain with special attention to, kind of, the nuance of any individual patient's brain injury. Because TBI is extremely heterogeneous and there's not just a cookie-cutter script for how these patients can be managed, I think, you know, people like neurologists, neurointensivists who have a lot of attention to the nuance - that's really helpful in their management.   Dr Jones: I'm so glad you said that, and not just because I'm a neurologist who's a fan of neurologists, but I do think there are some corners of neuroscience care where neurologists could be a little more present - and trauma definitely seems like one of those, doesn't it?   Dr Podell: Yeah, I think it's tough, because some patients with severe TBI and spinal cord injury can have a lot of multisystemic trauma with, you know, pulmonary contusions, intraabdominal pathology - you need to go to the OR for their other injuries, and so I think it really makes sense to have kind of a collaborative multidisciplinary approach to these patients, but I think neurologists should play a very big role in that approach, however that's done (there are lots of different ways that it's done). But I think having a primary neurology-trained neurointensivist – I know I'm biased, but I think that's where I'd like to see the field moving.   Dr Jones: And, obviously, neurocritical care is an intuitive place for neurological trauma care to start, and even with the sequelae of downstream things, I think neurologists could be more engaged. I wonder if neurology hasn't historically been as involved because it's sort of gravitated to surgical specialists. And I think part of it is, you know, trauma is not usually a diagnostic mystery, right? The neurologist can't pretend to be Sherlock Holmes and try to figure out what's going on when it was pretty clear what the event was, right?   Dr Podell: Right. Yeah, I agree with both of those points. I think, for one, I think postacute care is also a big area where neurologists can be involved more - and patients kind of fall through the cracks. A lot of times, these patients will just follow up with a neurosurgeon and get a repeat head CT and it'll look stable. We started implementing post-TBI neural recovery clinics, which I think other places are starting to do as well, and I think that's kind of a good model for getting neurologists involved - but also, rehab specialists are involved in that. But in terms of, yeah, the diagnostic mysteries and stuff, I think there still can be some, though, with TBI. Yes, obviously, the initial primary insult is obvious, but the secondary pathology that can happen in patients is really nuanced, and it is so variable, and, sometimes, it does take that detective eye to see, “Oh, this patient has one cerebrovascular injury, their risk of stroke to this territory? How are we going to manage it? and thinking about all the kind of sources of secondary decline that are possible. I think it takes that neurology detective sometimes to think about, too.   Dr Jones: Yeah. We never stop pretending to be detectives, right?   Dr Podell: Yeah.   Dr Jones: And on a related note, you know, in your article, you mentioned some of the novel serum and electrophysiologic and imaging biomarkers that are being used to care for these patients. How are you using those in your practice, Dr Podell?   Dr Podell: That's a good question. I think, unfortunately, as with a lot of clinical care, the clinical care does kind of lag behind the research and what we know what we can learn about these patients and their outcomes through retrospective studies. So, to be completely honest, you know, even the serum studies that I mentioned in the article (like GFAP, UCH-L1) - those kind of things, that's not clinically available at our institution. We don't use those. I think a lot of the imaging biomarkers that we see, some of them are coming from more advanced imaging – like, we're talking about FMRI - that requires a lot of post processing (so, again, we're not necessarily using that clinically). But what I would say is that we use imaging to kind of try to predict what complications patients might be at risk of and to try to predict their clinical course. And I think it comes down to trying to break down the heterogeneity of these patients and to try to kind of lump them into different bins of, “What's this patient at risk for?”, “What's their trajectory going to be like?”, “When can I start peeling back how aggressive I am with this patient?”. And, so far, I don't think any of the markers that we have are really clear black-white prescriptive indicators of what to do (I don't think we're quite there yet). So, again, I think we just kind of use all of the data in combination to come up with a management plan for these patients. I think some of the markers, (like some of the electrophysiologic markers), looking at EEG for things like background can provide prognostic information, especially in patients who are comatose that you're wondering about if they're going to wake up (so a lot of this can inform family discussions). But, you know, we used to think that grade three diffuse axonal injury on MRI portended a very poor prognosis (and in the past, some surgeons and ICUs might use that to limit care in patients), but more and more, we're finding that even that is quite nuanced and we're detecting more and more diffuse axonal injury on images in patients who then wake up, or have already woken up and they have the MRI later, and you're like, “Hmm, they had DAI. It's a good thing you didn't get the MRI early and decide not to move forward with aggressive care”. But, I think, in a patient who's comatose and you don't have a good explanation, sometimes, looking for those additional biomarkers to explain what kind of injury pathology you have can just provide more information for families.   Dr Jones: Yeah, and that's a great point that comes up in a lot of our articles and interviews (that the biomarkers really do have to be in a clinical context). So, if I understand you correctly, really, no individual biomarker that has emerged as a precise predictor or prognosticator for outcomes - but you do talk a lot about recent advances in the care of these patients. What would you want to point out to our listeners that's come up recently in the care of trauma?   Dr Podell: Yeah. I think the evidence basis for severe TBI is limited because, again, there's so much heterogeneity and different things going on with different patients, but some of the evidence that has come out more recently involves, kind of, indications for surgical procedures and the timing of those procedures. Some of that is still kind of expert consensus-based. But, for example, doing a secondary decompression for elevated ICP with the DECRA and RESCUEicp trials. We do have better high-quality evidence that doing a secondary decompression for more refractory, elevated ICP can improve both mortality and functional outcomes in patients, so that has kind of become more standard of care. Additionally, I think timing for spinal cord injury, neurosurgical procedures - that's been a topic that's been studied in more evidence-based to perform earlier decompressive surgeries. And then, I think, you know, more and more is emerging just about the pathophysiology of secondary injury - and some of those things haven't necessarily translated to what to do about it - but we've learned about things like cortical spreading depolarizations being associated with worse outcomes in traumatic brain injury, and we've also identified that ketamine or memantine can both actually stop those cortical spreading depolarizations. But the overall impact of managing them is still unknown, and the way that we detect those, it requires an invasive electrocorticography monitor which not all centers have. So, I think, one of the important things as we move forward in TBI care is, as we get this better mechanistic understanding of some of the pathophysiology that's happening in these TBI patients, figuring out a way to be able to translate that across all clinical settings where you can actually do the monitoring invasively - that's also an issue we see. Even intracranial pressure monitoring is pretty standard of care, but not all centers do that, and we have to be able to apply practice recommendations to centers where there isn't necessarily access to the same things that we have at large academic trauma centers.    Dr Jones: Got it. Obviously, there's a lot of research in this area, a lot of clinical research, and I'm glad you mentioned the secondary injury - things that are happening at the tissue level are important for us to think about. As the care of patients with trauma has evolved (and I'm thinking now of patients with spinal cord injury), we still see patients who receive high-dose corticosteroids in the setting of acute spinal cord injury - and obviously, that's something that's evolved. Can you tell our listeners a little bit more about what they should be doing when they're seeing a patient with a traumatic spinal cord injury?   Dr Podell: Yes. So, the steroids story for spinal cord injury is kind of interesting. There were a series of trials called the NASCIS trials that looked at corticosteroids and spinal cord injury, and they were initially interpreted that high-dose steroids had a beneficial effect on spinal cord injury recovery - but then, kind of in relooking at the data and recognizing that these were kind of unplanned subgroup analyses that showed benefit, and then looking at kind of pooled reanalysis and meta-analysis of all the data out there, it was determined that there actually was no clear benefit from steroids and that there was a clear incidence of more complications from high-dose steroids. So, in general, corticosteroids are not recommended for spinal cord injury. Same for traumatic brain injury, too (even though some people will still give steroids for that) - there was a CRASH study that looked at corticosteroids in TBI and found worse outcomes in TBI (so there actually is high-level evidence not to use steroids in that case). That's not to say that there's not an inflammatory process that's going on that could be causing secondary injury - I think that's still, really, you know, an area of active research is to try to figure out what is the balance between potential adaptive mechanisms of inflammation that are happening versus more maladaptive sources of secondary injury from inflammation and how and when do we target that inflammation to improve outcomes. So, there's still, I think, more to come on that.   Dr Jones: And, you know, we are guided by evidence, obviously, but also, we learn from our experience as clinicians. You work in the neurocritical care unit. You take care of all patients with critical neurologic problems. When it comes to TBI and spinal cord injury, what kind of management tips or tricks have you learned that would be good for our audience to hear?   Dr Podell: I think the way that I would sum it up is that you should be very aggressive - supportive care early on, and then thoughtfully pull back and let the brain and spinal cord heal itself. And, you know, the patients come in with TBI (for example) very sympathetically aroused. They do need sedation, they need blood pressure support, they need mechanical ventilation - they need help kind of maintaining homeostasis. And other autonomic effects with spinal cord injury happen, too - you get neurogenic shock (you need very aggressive management of blood pressure, volume assessments), you know, in both cases in trauma patients, managing things like coagulopathy - but, you know, over time, usually, these things start to, kind of, heal themselves to some degree. And then, kind of thoughtfully figuring out when you can peel back on the different measures that you're doing to support them through their acute injuries. Different protocols have been developed, and the Brain Trauma Foundation has developed evidence-based guidelines that have improved (just having a protocol, we know, improves) trauma outcomes overall at centers - but I think those protocols are just guidelines, and you really have to pay attention to the individual patient in front of you. For TBI, for example, our guideline will say to aggressively manage fever within the first seven days with surface cooling. But in a patient that, for example, developed kind of a stroke or progressive cerebral edema even on day five (or something) you're looking at them, and on day seven, they're still having a lot of swelling in their brain, I'm not going to peel off the temperature management. So, there is nuance - you can't just kind follow a rule book in these patients.   Dr Jones: Got it. And I think that point about aggressive support early is a good takeaway for any listeners who might be engaged in the care of these patients. You know, I imagine working in that setting and taking care of patients who are in the midst of a devastating injury - I imagine that can be pretty challenging, but I imagine it could be pretty rewarding as well. What drew you to this particular area of interest, Dr Podell, and what do you find most exciting about it?   Dr Podell: A lot kind of converged for me in this area. I went into neurology thinking I would be a cognitive neurologist. I had more of a neuroimaging background and an interest in neural network pathology that certainly happens to patients with TBI (and patients with TBI often will have neuropsychiatric and neurocognitive problems after injury). But then, during residency, I found myself. My personality clicked in the ICU, and I just liked managing sick patients - I liked the pace of it, I also really liked it. It's kind of a team sport in the ICU with multiple people involved - the bedside nurses, respiratory therapists, neurosurgeons, trauma surgeons - all working together to figure out the best management plan for these patients, so you don't feel alone in managing them. And not all outcomes are good, obviously, but you can see people get better even during their course of their ICU stay - and that's really, really rewarding. And I think what we're seeing even in the literature following patients out longer and longer, the recovery trajectory for TBI is different than what we see in other neurologic injuries (like stroke, where the longer you go - up to ten, twenty years, even - people are still improving). I think the idea that you can keep hope alive for a lot of these patients and try to combat any kind of nihilism - obviously, there's a time and place for that after a really devastating injury, but I've seen a lot of patients who are really, really sick, needing therapeutic hypothermia, barbiturate coma, decompression, still then recovering and being able to come back into the ICU and talk to us.   Dr Jones: We might have some junior listeners who are thinking about behavioral neurology or neurocritical care, and it's probably - I don't know if it's reassuring, or maybe concerning, to them to know that they might swing completely to the other end of the spectrum of acuity, which is kind of what you did.   Dr Podell: Yeah, and what I'm trying to do now is, I'm very interested in autonomic dysfunction that happens in these patients. It's related a lot to multisystem organ dysfunction and, I think, may contribute to secondary injury, too, with changes in cerebral perfusion, especially in patients who have storming or even just the early autonomic dysregulation that happens early on. I think it's induced by neural network dysfunction from the brain injury, kind of similar to the way that there are other phenotypes that would be induced by neural network dysfunction (like coma).  So, we're trying to look at MRIs of acute TBI patients and trying to identify what structural imaging pathology then gives rise to these different kinds of clinical phenotypes - trying to bring it back to this neuroscience focus.   Dr Jones: Well, that gives us and our listeners something to look forward to, Dr Podell. And again, I just want to thank you for joining us, and thank you for such a great discussion on the care of patients with TBI, and spinal cord disorders and thank you for such a wonderful article.   Dr Podell: Thank you very much. It is my pleasure.   Dr Jones: Again, we've been speaking with Dr Jamie Podell, author of an article on traumatic brain injury and traumatic spinal cord injury in Continuum's latest issue on neurocritical care. Please check it out. And thank you to our listeners for joining today.   Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, please consider subscribing to the journal. There's a link in the episode notes. We'd also appreciate you following the podcast and rating or reviewing it. AAN members, go to the link in the episode notes and complete the evaluation to get CME for this article. Thank you for listening to Continuum Audio.  

Trial of the Week: PROWESS-SHOCK Special Guest: Paul Szumita, PharmD, FCCM, FASHP, BCCCP, BCPS @paulszumita   03:30 – Background studies/Setting the scene 30:25 – PROWESS-SHOCK discussion/Where are we now   Paul Szumita joins to highlight a June Trial of the Week “Drotrecogin alfa (activated) in adults with septic shock” published in the New England Journal of Medicine in 2012. To fully understand the discussion regarding drotrecogin alfa, Paul and I review the mechanism of action and its proposed action in the treatment of sepsis. Then we review earlier studies and the controversy behind the FDA approval process. Finally, we go into detail on what Clinical Pharmacists were tasked with doing at the time based on treatment protocols or hospital restrictions. Then we dive into the Trial of the Week, discussing the study design and results. What was the mood in ICUs and Pharmacy Departments after this publication? How much did our sepsis care improve from PROWESS to PROWESS-SHOCK? What lessons did we learn with the Xigris FDA approval process? Is there a patient population that could still benefit from drotrecogin alfa treatment? Plus, trial fun facts, issues with calculating APACHE II scores, and so much more. Reference list: https://pharmacytodose.com/wp-content/uploads/2024/06/prowess-shock-trial-of-the-week-references.pdf   PharmacyToDose.Com @PharmacyToDose PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Louise Phipps Senft is a force of nature! She has excelled at the highest levels as an attorney, an author, a professor, fellow podcaster, and following her son Archer's 2015 spinal cord injury, an amazing advocate for individuals with SCI and their families. After having spent many months in ICUs and around her son's hospital bed, Louise realized that most hospitals in the US do not have Spinal Cord Injury expertise, most families do not have mediation skills which are essential for navigating complicated health care, and most doctors are not trauma informed. So, as she has done her whole life, Louise rose to the occasion! She founded the 501(c)(3) non-profit, the Integrative Center for Trauma Healing, Advocacy, and Transformation, IC THAT, d/b/a Blink of an Eye™, in 2021 to fill the gap for more relational and trauma informed responses for SCI families in crisis bringing them cutting edge SCI medical expertise as well as hope, emotional and spiritual support, and navigation how to's. Blink of an Eye™ is training medical teams from the inside out through the families served. Blink of an Eye™ public charity exists for those who know how life can change in the blink of an eye. Their mission is to transform the spinal cord injury experience for families and medical teams into an Extraordinary Experience, despite the devastation, in the first days and months of injury. Louise and I had a wide-ranging and candid conversation last week. I believe this episode will make you think long and hard about your life, and that of your loved ones and friends, because as we all know, it can change in the blink of an eye!

Dr. Pierre Kory is the president emeritus of the Front Line Covid-19 Critical Care Alliance, which he co-founded with Dr. Paul Marik. Dr. Kory also runs the Leading Edge Clinic that specializes in treatment plans for SARS-2 infections, symptoms of long Covid and vaccine injuries. He is regarded as an international pioneer in ultrasound diagnostics for critically ill patients, therapeutic hypothermia and the use of intravenous vitamin C for treating septic shock. Dr. Kory developed the first national medical educational programs in ultrasonography for critical care medicine.  Earlier he was the chief of critical care services and the medical director of trauma and life support at the University of Wisconsin. He has earned many teaching awards in hospitals throughout the country. During the height of the Covid pandemic, Pierre helped lead ICUs to deal with the viral surges and was one of the early advocates for intravenous vitamin C and the repurposed drug ivermectin. He is the author of "War on Ivermectin: The Medicine that Saved Millions and Could Have Ended the Pandemic" -- largely a personal account about his crusade and the harsh opposition he faced to bring a safe, cheap and highly effective generic medication to public attention, and the catastrophic results due to medical establishment and mainstream media to push solely the vaccines and novel experimental drugs. The Front Line Covid-19 Critical Care Alliance's website is Covid19CriticalCare.com. The site also includes vital information for effectively treating SARS-2 infections, reversing long-Covid symptoms, and how to detox following an mRNA Covid vaccination. 

Spain, Ireland and Norway to recognize a Palestinian state on May 28. Biden releasing 1 million barrels of gasoline from Northeast reserve in bid to lower prices at pump. The rise of super commuting. 1 dead, 20 in ICUs after deadly turbulence on Singapore Airlines flight. Trump says he is open to restrictions on contraception before backing away from the statement. Woke Wednesday. Fast food price wars. Elvis's granddaughter Riley Keough files lawsuit to stop Graceland foreclosure sale. 9/11 video alleges ‘secret' new evidence in landmark case against Saudi hijackers.