Podcasts about Interventions

In this episode, we explore the intersection of ovarian health, menopause, and AI technology with Kiran, the founder of TimelessBioTech. The conversation delves into the importance of ovarian longevity for women's health, the predictive tools being developed to forecast menopause timing, and the various interventions that can support ovarian health. Kiran shares insights on hormonal balance, the role of lifestyle factors, and the future of personalized health strategies for women. The discussion emphasizes the need for targeted solutions and the potential for AI to revolutionize women's health care.Timeless Biotech WebsiteKiran's email for investors, clinics, and companies looking to invest in or work with Timeless: Kiiran@timelessbiotech.comThis episode is brought to you by OneSkin, the longevity scientists behind the first topical peptide scientifically proven to reverse skin aging—now bringing their expertise to your scalp. If you care about aging well, you can't ignore your hair. The health of your scalp directly impacts the strength, thickness, and lifespan of every strand. That's why OneSkin created their new OS-01 HAIR, the first scalp serum powered by a longevity peptide designed to optimize follicle health, balance the scalp, and extend the healthspan of your hair follicles. In their clinical study, OS-01 HAIR showed significant improvements in hair density, thickness, and overall scalp health—all by targeting follicle aging at the root. I've been using it myself and I'm genuinely impressed. It's lightweight, fragrance-free, and backed by science—not fluff. If you're serious about keeping your hair vibrant and resilient as you age, I highly recommend giving OneSkin's OS-01 HAIR a try. Head to oneskin.co/KAYLA  for 15% off your order. About KiranKiran Kumar is the Founder & CEO of Timeless Biotech, an early-stage ovarian longevity company that has prototyped the first-ever time-to-menopause predictor and ovarian age clock. Kiran is a Biotechnology Bioengineer from UC San Diego, and has contributed to research in ML-powered diagnostics.Kiran has worked in numerous longevity and wellness startups such as FOXO Technologies, OneSkin, and Timeline where she authored. research-backed contentKiran's work sits at the intersection of Physiology, AI, and Longevity.Chapters00:00 Introduction to Ovarian Longevity and AI Solutions02:44 The Importance of Ovarian Health in Longevity05:38 Understanding Menopause and Ovarian Aging08:48 Predictive Tools for Menopause Timing11:32 Interventions for Ovarian Longevity14:31 The Role of Hormones in Ovarian Health17:25 Innovative Approaches to Hormonal Balance20:14 The Future of Ovarian Health Technologies22:58 Personalized Health Strategies for Women25:31 Conclusion and Future Directions

In this episode, recorded live at CCCF 2024, we sit down with Dr. Emilie Belley-Côté, a cardiac intensivist, researcher, and clinical trialist from McMaster University, to unpack cardiogenic shock: the SCAI classification.Whether you're in the ED, cath lab, or ICU, the SCAI (Society for Cardiovascular Angiography and Interventions) stages offer a common language to describe the severity of cardiogenic shock, guide escalation of care, and improve outcomes through structured assessment.Dr. Belley-Côté walks us through:The five SCAI stages (A through E): what they mean and how they're used.How this classification system improves communication between specialties.The importance of recognizing patients in pre-shock (Stage B) before they deteriorate.Real-world application: how SCAI staging intersects with clinical signs, biomarkers, and hemodynamic monitoring.Where the SCAI classification fits in research, including trials evaluating mechanical circulatory support and advanced heart failure therapies.With Dr. Belley-Côté's clear explanations and insights from the front lines of cardiac critical care, this episode is essential listening for anyone managing unstable cardiac patients.

Dr. Nora Fritz, PhD, PT, DPT, NCS, an expert in postural control and fall risk in people with multiple sclerosis, joins host J.J. Mowder-Tinney for a deep dive into reactive balance—why it matters, how it's measured, and what we can do about it. J.J. and Nora explore the latest research around sensory reweighting, backward walking, and compensatory stepping, connecting the science to real-world clinical applications across patient populations. Together, they discuss strategies to support your clients' safety and confidence through tailored interventions and meaningful conversations. Whether you're looking to sharpen your assessment approach or rethink fall prevention strategies, this episode offers insights you won't want to miss.Learning ObjectivesAnalyze the evidence around reactive postural control in persons with MSApply evidence-based, practical strategies to actionably address reactive balance control in persons with MSIncorporate measures of psychological functioning that may impact goal setting for reactive postural control in persons with MSTimestamps(00:00:00) Welcome(00:00:47) Introduction to reactive balance and multiple sclerosis (MS)(00:03:04) Understanding reactive balance mechanisms(00:06:50) Research insights on backward walking(00:11:55) Neural control of reactive balance(00:17:45) Applications across different diagnoses(00:20:57) Practical examples in therapy sessions(00:26:41) Assessing reactive balance in clinical settings(00:29:02) Understanding patient concerns and fear of falling(00:33:04) Interventions for improving reactive balance(00:35:24) Creative approaches to reactive balance training(00:38:44) Key takeaways for clinicians(00:40:34) Case studies and clinical insights(00:42:31) Research and future directions in balance trainingResources Mentioned in EpisodeAcademy of Neurologic Physical Therapy (ANPT) podcast episode that discusses the CAFFE Scale: DD SIG Episode 53: JNPT highlight: Concern About Falling and Fear of Falling in MS with Taylor TaklaBalance AssessmentsMini-BESTestPush and ReleaseABC ScaleFES-ICAFFE ScaleNeuro Navigators is brought to you by Medbridge. If you'd like to earn continuing education credit for listening to this episode and access bonus takeaway handouts, log in to your Medbridge account and navigate to the course where you'll find accreditation details. If applicable, complete the post-course assessment and survey to be eligible for credit. The takeaway handout on Medbridge gives you the key points mentioned in this episode, along with additional resources you can implement into your practice right away.To hear more episodes of Neuro Naviagators, visit ⁠⁠⁠https://www.medbridge.com/neuro-navigators⁠⁠⁠If you'd like to subscribe to Medbridge, visit ⁠⁠⁠https://www.medbridge.com/pricing/⁠⁠⁠IG: https://www.instagram.com/medbridgeteam/

Here's a prep guide for hospital births that will help you feel more confident, and empower you with information that could help you avoid unnecessary procedures that can result in trauma and/or injury.Our guest is HeHe Stewart, a birth doula and founder of The Birth Lounge, a non-judgmental, evidence-based childbirth education online platform known for helping parents navigate birth. HeHe also has her own podcast called the Birth Lounge. Here's some of what we discuss:how to avoid unnecessary C-sectionshow to confidently ask for optionswhat to do if things don't go as expectedcrucial information to prepare you for hospital birthFull show notes: fourthtrimesterpodcast.comConnect with HeHe Stewart Tranquility by HeHe | The Birth Lounge Education PlatformHeHe's Podcast The Birth Lounge PodcastLearn more The 10 Questions Every First-Time Parent Asks | Home Birth As An Alternative To The Hospital | How a Friend or Family Member Can Help You if You Don't Have a Doula (What is a Doula?)Resources HelloGaia Parenting Copilot | FREE DOWNLOAD Customizable Birth Plan | FREE DOWNLOAD Customizable Fourth Trimester Plan | Postpartum Soups and Stews CollectionConnect with Fourth Trimester Facebook | Instagram

Live Q&A Calls with Bill Hartman at http://uhp.networkEpisode Overview In this episode, Chris and Bill scrutinize the “Four Stages of Competence” model — a familiar framework in coaching and skill acquisition that assumes learners progress linearly from ignorance to mastery. This discussion reframes learning as a dynamic reorganization of behavior in response to constraint, not a climb up a competence ladder.Key Topics & Chapter Highlights00:00 – Why We're Talking About “Learning”04:00 – The “Four Stages” Origin Story07:00 – Linearity vs. Complexity10:00 – “Incompetence” Isn't Incompetent14:00 – Coaching Without Context Fails18:00 – Behavioral Recognition Over Labels23:00 – You're Not Coaching a Blank Slate28:00 – The Limits of Cueing32:00 – Adaptive Behavior, Not Error36:00 – Evolving the Model (Again)41:00 – Interventions as Design, Not Correction45:00 – Wrapping Up: The System Solves ItselfKey Takeaways Movement — even if awkward or compensatory — reflects the best available solution to the system's current constraints. That's competence, just not your preferred version. Adaptation doesn't follow steps. It unfolds in response to pressure, structure, and context. That process is inherently non-linear. Labels like “incompetent” blind us to what's actually happening. Watch what people do. Understand what it's solving for.Models Should Breathe Even the quadrant model evolved through testing. If your model isn't helping you see clearly, evolve it — or discard it. LEARN MOREJOIN the UHP Network to learn directly from Bill through articles, videos and courses.http://UHP.network FOLLOW Bill on IG to stay up to date on when his courses are coming out:IG: https://www.instagram.com/bill_hartman_pt/TRAIN WITH BILLInterested in the only training program based on Bill Hartman's Model?Join the rapidly growing community who are reconstructing their bodies at https://www.reconu.co FREE EBOOK by Bill about the guiding principles of training when you fill out your sign-up form. http://www.reconu.co SUBSCRIBE for even more helpful content:YT: https://www.youtube.com/@BillHartmanPTIG: https://www.instagram.com/bill_hartman_pt/FB: https://www.facebook.com/BillHartmanPTWEB: https://billhartmanpt.com/Podcast audio:https://open.spotify.com/show/7cJM6v5S38RLroac6BQjrd?si=eca3b211dafc4202https://podcasts.apple.com/us/podcast/reconsider-with-bill-hartman/id1662268221or download with YT Premium

Join @theradork aka Dr. Ellen Csepe as we discuss the obesity paradox and our role as clinicians in addressing this global health crisis while aligning with new medical Interventions    If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

Epistemic status: This post — the result of a loosely timeboxed ~2-day sprint[1] — is more like “research notes with rough takes” than “report with solid answers.” You should interpret the things we say as best guesses, and not give them much more weight than that.Summary There's been some discussion of what “transformative AI may arrive soon” might mean for animal advocates. After a very shallow review, we've tentatively concluded that radical changes to the animal welfare (AW) field are not yet warranted. In particular: Some ideas in this space seem fairly promising, but in the “maybe a researcher should look into this” stage, rather than “shovel-ready” We're skeptical of the case for most speculative “TAIAW” projects We think the most common version of this argument underrates how radically weird post-“transformative”-AI worlds would be, and how much this harms our ability to predict the longer-run [...] ---Outline:(00:28) Summary(02:17) 1. Paradigm shifts, how they screw up our levers, and the eras we might target(02:26) If advanced AI transforms the world, a lot of our assumptions about the world will soon be broken(04:13) Should we be aiming to improve animal welfare in the long-run future (in transformed eras)?(06:45) A Note on Pascalian Wagers(08:36) Discounting for obsoletion & the value of normal-world-targeting interventions given a coming paradigm shift(11:16) 2. Considering some specific interventions(11:47) 2.1. Interventions that target normal(ish) eras(11:53)

Tous les matins à 7h20, les petits secrets de l'actualité, les infos que vous n'avez pas vues ailleurs. Les journalistes des rédactions de RMC et RMC Sports se mobilisent pour vous raconter les coulisses de l'actualité.

In this special episode, host Chris Patil (VP-Media, BioAge) moderates a live panel discussion at the 25th Bay Area Aging Meeting at UCSF, bringing together six leading voices across the aging research ecosystem to tackle one of the field's most critical challenges: how to move promising discoveries from the laboratory to therapies that can benefit patients.The distinguished panel spans academia, industry, and scientific publishing, featuring Janine Sengstack (CEO, Junevity), Saul Villeda (Professor, UCSF), Jodi Nunnari (Director, Bay Area Institute of Science, Altos Labs), Sebastien Thuault (Chief Editor, Nature Aging), Anne Brunet (Professor, Stanford), and Nir Barzilai (Professor, Albert Einstein College of Medicine). Together, they explore the most promising research directions for clinical impact, the revolutionary tools enabling modern aging research, and the structural challenges that must be overcome to bring longevity therapies to market.Listeners will gain insights into the emerging science of cellular rejuvenation, the importance of systemic factors in aging, how to balance high-risk discovery with practical drug development, and the cultural shifts needed to better prepare the next generation of scientists for translational work. The panel also addresses the regulatory challenges of targeting aging itself as an indication and offers candid advice for young researchers navigating this rapidly evolving field.The Finer Details:Emerging research directions with the greatest clinical potential: cellular senescence, rejuvenation and repair, DNA methylation clocks, and understanding what makes aging biomarkers tickThe revolution in cellular and spatial resolution tools and how single-cell technologies are revealing cell-type-specific aging responsesSystemic factors and the remarkable plasticity remaining in aging organisms that can be unlocked through interventionsThe critical importance of starting with human data and working backward to validate targets and approachesChallenges unique to aging biotech: the need for aging-specific cellular assays, testing in older animal models, and genetic validationCultural and structural barriers between academia and industry, including the shift from mechanism-focused to mission-driven researchBalancing high-risk fundamental discovery with the practical needs of drug development and clinical translationThe regulatory landscape for aging interventions and potential pathways to FDA approval beyond traditional disease indicationsAdvice for young scientists: embracing rejection as part of the process, finding passion, working as teams, and considering diverse career paths in the growing longevity ecosystemQuotes:"Our goal as a company is to increase human health span, and the way I like to frame that more colloquially is we want to increase the number of happy, healthy years each person gets to spend on Earth." - Janine Sengstack"There is an exquisite amount of plasticity left in an aging organism, both within the tissues, within the cells. There is plasticity that we can actually tap into." - Saul Villeda"Burn bright, but don't burn out." - Jodi Nunnari"The challenge that we run into is that there are so many combinations that very quickly it would become intractable to line up enough test tubes to test them all." - Sebastien Thuault, on the complexity of aging interventions"We love our job. If not, we would not be doing it. I would do it again in a heartbeat... you get paid to play, to ask the questions that interest you, the approaches that interest you to play with who you want to—it is a fantastic job." - Saul Villeda"Our life is a life of rejection...and still, we're having fun and making an advance. So don't give up." - Nir Barzilai

Open Discussion!

Join EIQ priority list here. 00:00 Morning Routines and Personal Updates02:52 Exploring Seduction and Personality Types05:37 Parenting Challenges and Body Image08:38 Bikini Competitions and Body Confidence10:29 The Impact of Hernias and Body Trauma11:27 Exploring GLP-1s and Weight Loss Interventions13:08 The Nuances of Disordered Eating and Weight Loss15:33 Understanding the Role of GLP-1s in Eating Behaviors18:17 The Importance of Exercise in Weight Management21:13 Weight Stigma and Its Societal Implications23:36 The Changing Landscape of Weight Stigma27:12 The Intersection of Wealth, Beauty, and Body Image30:00 Curiosity in Health and Body Goals

Why is society polarised when it comes to the topic of child and teen discipline and particularly on the matter of corporal punishment? Is there perhaps a middle ground to be reached so that errant children don’t fall deeper into criminal tendencies or should we be taking an either / or approach? Lester Kiewit speaks to Frank Elgar, a full professor in the Department of Equity, Ethics and Policy in the School of Population and Global Health at McGill University, and he has looked at the topic of corporal punishment as part of his research into social patterns on child and youth health, economic inequality, food insecurity and school violence in various political and economic contexts. Good Morning Cape Town with Lester Kiewit is a podcast of the CapeTalk breakfast show. This programme is your authentic Cape Town wake-up call. Good Morning Cape Town with Lester Kiewit is informative, enlightening and accessible. The team’s ability to spot & share relevant and unusual stories make the programme inclusive and thought-provoking. Don’t miss the popular World View feature at 7:45am daily. Listen out for #LesterInYourLounge which is an outside broadcast – from the home of a listener in a different part of Cape Town - on the first Wednesday of every month. This show introduces you to interesting Capetonians as well as their favourite communities, habits, local personalities and neighbourhood news. Thank you for listening to a podcast from Good Morning Cape Town with Lester Kiewit. Listen live on Primedia+ weekdays between 06:00 and 09:00 (SA Time) to Good Morning CapeTalk with Lester Kiewit broadcast on CapeTalk https://buff.ly/NnFM3Nk For more from the show go to https://buff.ly/xGkqLbT or find all the catch-up podcasts here https://buff.ly/f9Eeb7i Subscribe to the CapeTalk Daily and Weekly Newsletters https://buff.ly/sbvVZD5 Follow us on social media CapeTalk on Facebook: https://www.facebook.com/CapeTalk CapeTalk on TikTok: https://www.tiktok.com/@capetalk CapeTalk on Instagram: https://www.instagram.com/ CapeTalk on X: https://x.com/CapeTalk CapeTalk on YouTube: https://www.youtube.com/@CapeTalk567See omnystudio.com/listener for privacy information.

In this episode of JACC This Week, Editor-in-Chief Dr. Harlan Krumholz summarizes key studies from the July 15 issue, focused on cardiovascular interventions. Topics include new insights on plaque vulnerability in acute coronary syndromes, virtual flow reserve after PCI, long-term data on FFR-guided revascularization, and stent thrombosis risk. This issue delivers high-impact, practice-relevant research for interventionalists, imaging specialists, and general cardiologists alike.

Max Keiser, Bitcoin OG and Sr. BTC Advisor to Presiden Bukele, is forecasting significant governmental intervention as Bitcoin approaches a valuation of $400,000. “At $400,000 Bitcoin, the global hash wars will be so intense the US invokes national security and seizes publicly traded companies like $MSTR $COIN $MARA $RIOT.” Learn more about your ad choices. Visit megaphone.fm/adchoices

Shannon and Mary chat with Dr. Katie Pace-Miles about MTSS and RTI, sharing practical tips for delivering effective reading interventions, choosing quality resources, and running efficient team meetings to support struggling readers.   Whether you're a classroom teacher trying to support struggling readers, a specialist designing intervention programs, or a parent advocating for your child, this conversation provides clear, actionable guidance for making literacy interventions both manageable and truly impactful.LINKS FOR RESOURCES MENTIONED IN THE EPISODE:Easy CBMMaking Words Stick by Katie Pace Miles and Molly Ness *Amazon affiliate link*our episode with Molly Ness from Season 6overview of MTSS/RTI from understood.orgmeeting normsFCRR Fast PhrasesWrights LawCaregiver Guide from Katie Pace MilesLetter Knowledge Guide from Katie Pace MilesThe Reading Institute websiteThe Reading Institute on IGThe Reading Institute (LinkedIn)The Reading Institute (Facebook)Katie Pace Miles' websiteConnect with Katie through LinkedInFind Katie on IGMcGraw Hill Science of Literacy Library:A free resource hub containing blogs, videos, research reports, and more— designed to connect teachers with practical classroom resources and Professional Learning tips.Bonus Episodes access through your podcast appBonus episodes access through PatreonFree Rubrics Guide created by usFinding Good Books Guide created by usSupport the showGet Literacy Support through our Patreon

JOIN THE MONEY MISSION:https://moneymissionja.comGet the Money Mission Workbook: https://amzn.to/4567eL2Support us on Patreon: https://www.patreon.com/moneymediajaOn this episode of Taking Stock…Money Media is FIVE years old! And we want to celebrate YOU with some awesome giveaways. Plus, the analysts weigh in on the latest market developments…The Organisation for Economic Co-operation and Development just released its midyear economic outlook. How does it affect you and your money.And the IMF thinks the BOJ should loosen its reins on the forex market.We'll discuss.******************OUR SEGMENTS: 0:00- Intro1:42 - What's Hot in Business12:40 - Economic Update35:17 - Market Recap42:39 - The Analysts- BOJ and IMF Forex 54:20- The Analysts- Stock Market Rebound?1:04:08 - The Analysts- JPS Contract Not Being Renewed*******************SUBSCRIBE TO OUR NEWSLETTER: getmoneynews.comJOIN THE MONEY MISSION:https://moneymissionja.com******************

In which stage of lymphedema will elevation of an extremity MOST particularly help reduce swelling? Find it all out in the podcast!  Be prepared for the NPTE so that you can pass with flying colors! Check out www.ptfinalexam.com/podcast for more information and to stay up-to-date with our latest courses and projects.  #Npte #PT #ptboards #crushtheNPTE #study #studygram #spt #ptstudent #ptlife #sptprobs #physicaltherapystudent #physicaltherapy #physio #physiotherapist #ptlife #ptstudentstudy

How can we make mental health support more accessible and effective for children and adolescents? In this episode of Mind the Kids, host Clara Faria sits down with Professor Maria Loades to explore the promise of single session interventions—a cutting-edge approach designed to deliver immediate, evidence-based help in just one session. Is it really a case of ‘One and done?'. Together, they unpack the barriers that keep many young people from seeking support, from stigma to logistical hurdles, and discuss how culturally sensitive, age-appropriate, and trustworthy resources can break down these walls. The conversation highlights the importance of listening to young people's voices in shaping mental health services, the need for thoughtful consent processes for those under 16, and the potential for digital, on-demand interventions to serve as both a first step and a bridge to further care.  Whether you're a practitioner, parent, or advocate, this episode offers fresh insights into how single session interventions could transform youth mental health access and outcomes

Tu veux découvrir un univers où l'énergie invisible transforme ta vie et ta maison ? Dans cet épisode captivant avec Hervé Pondevie, tu plonges au cœur d'une vérité souvent oubliée : tout ce qui nous entoure vibre et ces vibrations influencent ton quotidien bien plus que tu ne le crois. Hervé, expert en géobiologie et en énergies, partage ses expériences uniques, ses anecdotes surprenantes et ses secrets pour capter les signes que l'univers t'envoie, des signes que tu ne remarques même pas ! Tu vas comprendre pourquoi Rome, avec son histoire et ses bâtiments millénaires, est bien plus qu'une ville musée, c'est un concentré d'énergie puissante qui parle directement à ton âme. Hervé t'invite à écouter tes sensations profondes, à décoder les vibrations des œuvres d'art, des lieux et même des panneaux dans la rue. Le tout pour te reconnecter à ta propre énergie et à celle des autres, et transformer ta vie. Si tu es prêt à ouvrir les yeux sur ce qui se cache derrière le visible, cet épisode est fait pour toi. 5 points forts qui vont te faire vibrer :

Justin Aunger, PhD, and Kay Por Yip MBChB, PhD, join CHEST® Journal Podcast Moderator, Gretchen Winter, MD, to discuss their research into interventions for improving adherence to clinical guidelines for the management and follow-up of pulmonary nodules.  DOI: 10.1016/j.chest.2025.02.031  Disclaimer: The purpose of this activity is to expand the reach of CHEST content through awareness, critique, and discussion. All articles have undergone peer review for methodologic rigor and audience relevance. Any views asserted are those of the speakers and are not endorsed by CHEST. Listeners should be aware that speakers' opinions may vary and are advised to read the full corresponding journal article(s) for complete context. This content should not be used as a basis for medical advice or treatment, nor should it substitute the judgment used by clinicians in the practice of evidence-based medicine.     

Jamie Hartmann-Boyce and Nicola Lindson interview Lauren McMillan, University of Stirling about her project evaluating the effectiveness of an e-cigarette intervention for smoking cessation at centres for people experiencing or at risk of homelessness. Associate Professor Jamie Hartmann-Boyce and Associate Professor Nicola Lindson discuss the new evidence in e-cigarette research and interview Lauren McMillan from the Institute for Social Marketing and Health (ISMH) at the University of Stirling. In the June podcast Lauren discusses Project SCeTCH - a cluster RCT that evaluates the effectiveness of an e-cigarette intervention vs usual care at centres for people experiencing or at risk of homelessness. The study measures smoking abstinence over a 6 month follow-up period and includes embedded process and economic evaluations. If effective, the results will be used to inform the larger-scale implementation of offering e-cigarettes throughout centres for people experiencing or at risk of homelessness to aid smoking cessation. Lauren is part of the research team, led by Dr Allison Ford at the University of Stirling, that conducted the process evaluation of the SCeTCH trial . The main SCeTCH trial was led by Professor Lynne Dawkins (London Southbank University) and Dr Sharon Cox (University College London). This podcast is a companion to the electronic cigarettes Cochrane living systematic review and Interventions for quitting vaping review and shares the evidence from the monthly searches. Our search for the EC for smoking cessation review carried out on 1st June 2025 found 1 ongoing study: https://clinicaltrials.gov/study/NCT06948058 Our search for our interventions for quitting vaping review up to 1st June 2025 found 2 new (DOI 10.1093/ntr/ntaf112; 10.1016/j.amepre.2025.107664) and 2 linked papers (DOI: 10.2196/72002; 10.1016/j.cct.2025.107958) For further details see our webpage under 'Monthly search findings': https://www.cebm.ox.ac.uk/research/electronic-cigarettes-for-smoking-cessation-cochrane-living-systematic-review-1 For more information on the full Cochrane review of E-cigarettes for smoking cessation updated in January 2025 see: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub9/full For more information on the full Cochrane review of Interventions for quitting vaping published in January 2025 see: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD016058.pub2/full This podcast is supported by Cancer Research UK.

Host Sotirios Evangelou, MD, FSCCT is joined by Vlasis Ninios, MD to explore the indispensable role of cardiac CT in transcatheter structural heart interventions. From planning TAVI and TMVR to assessing tricuspid valve therapies, they highlight how CT imaging guides prosthesis sizing, vascular access, and risk assessment. Together, they discuss emerging technologies, evolving indications, and how cardiac CT is shaping the future of structural heart disease treatment. 

We catch up with Professor Petrus De Vries!Coaching of PWLE in LMIC with behavioral interventions: What are the key components of effective coaching programs for people with lived experience in low- and middle-income countries, particularly those focusing on behavioral interventions?Another brilliant interview with researchers from EACD / IAACD 2025 at Heidelberg Germany!

Dr Jo Morrissey joins Paul to discuss her research into wellbeing challenges faced by forensic practitioners worldwide. As Workforce Strategy Lead at the Forensic Capability Network, Dr Morrissey is conducting a comprehensive study examining mental health impacts across all forensic disciplines - from digital forensics to crime scene investigation, DNA analysis, and fingerprint examination. They explore the unique psychological pressures forensic practitioners face, including exposure to traumatic material, working in isolation, and the barriers that prevent many from seeking help. Dr Morrissey discusses how stigma around help-seeking behavior and fears about career prospects continue to affect practitioners, and why evidence-based national guidelines are urgently needed. Take part in the research: Dr Morrissey is seeking responses from current and former forensic practitioners worldwide across all disciplines and sectors. The survey examines well-being challenges, available interventions, and their effectiveness. Your participation could help shape future well-being support for the forensic community. Survey closes Friday 4th July 2025. Survey link: https://forms.office.com/e/GXPMwnpyMi #ForensicScience #MentalHealth #Wellbeing #DigitalForensics 00:00 Introduction to Dr. Jo Morrissey 01:31 Overview of the Wellbeing Study 03:34 Challenges Faced by Forensic Practitioners 08:25 Survey Specifics and Goals 14:57 Barriers and Stigma in Wellbeing 18:49 Ethical Considerations and Future Research 20:09 Open Access to Research Report 20:38 National Guidelines for Wellbeing 22:00 Challenges in Implementing Guidelines 25:07 Importance of Survey Participation 27:02 Potential for Funding and Further Research 28:06 Exploring Differences in Wellbeing 30:51 Impact of Experience and Culture on Wellbeing 33:39 Resilience and Adverse Childhood Experiences 37:05 Closing Remarks and Future Research

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Join pioneering LGBTQ+ activist Daniel C. Tsang for a special conversation reflecting on his 50 years of activism, including his groundbreaking 1975 article Gay Awareness in Bridge Magazine, one of the first to address LGBTQ+ issues in the Asian American community. Tsang will discuss the evolution of LGBTQ+ rights, his personal journey, and the ongoing challenges facing the community. Moderated by the Museum of Chinese in America's Chief Curator Herb Tam, the event will conclude with a Q and A session for audience engagement.

On Legal Docket, Supreme Court rules on treatment for gender transition; on Moneybeat, the Middle East risk; and on History Book, the start of the Korean War. Plus, the Monday morning newsSupport The World and Everything in It today at wng.org/donateAdditional support comes from WatersEdge Kingdom Investments — personal investments that build churches. 5.05% APY on a three-month term. WatersEdge.com/investWatersEdge Kingdom Investments - WatersEdge securities are subject to certain risk factors as described in our Offering Circular and are not FDIC or SIPC insured. This is not an offer to sell or solicit securities. WatersEdge offers and sells securities only where authorized; this offering is made solely by our Offering Circular.

Flex Diet Certification Enrollment Deadline  (click here) & Optimal Weight Loss StrategiesIn this episode of the Flex Diet Podcast, Dr. Mike Nelson discusses the closing of the Flex Diet Certification enrollment, emphasizing its comprehensive program for improving body composition, muscle gain, and performance through nutrition and recovery. Dr. Nelson provides a key tip for weight loss. Listen in for more.00:24 Flex Diet Certification Enrollment01:50 Expert Interviews and Course Content03:41 Tip of the Week05:01 Prioritizing 2 Interventions 07:03 Exercise and Caloric Deficit11:04 Cardio and Activity Recommendations14:40 Upcoming Events

This lecture discusses key ideas from the 20th Century American science-fiction short story writer and novelist, Philip K. Dick's novel Ubik It focuses specifically on the many points in the novel, after the surprise attack on Glen Runciter, Joe Chip, and the entire team of the inertials, where a seemingly dead and in cold-pac Runciter breaks through into the "reality" of those who think themselves survivors. At first this happens through strange written interventions, like a matchbook cover, graffiti, and notes, and through Runciter appearing on currency. As time goes on, the manifestations extend to video and even a meeting between Joe Chip and Glen Runciter. To support my ongoing work, go to my Patreon site - www.patreon.com/sadler If you'd like to make a direct contribution, you can do so here - www.paypal.me/ReasonIO - or at BuyMeACoffee - www.buymeacoffee.com/A4quYdWoM You can find over 3000 philosophy videos in my main YouTube channel - www.youtube.com/user/gbisadler You can get a copy of Ubik here - https://amzn.to/4k8i348

Dr. Halley Alexander and Dr. Serena Yin discuss the effectiveness of an electronic medical record best practice alert in preventing iatrogenic interventions for patients with a diagnosis of PNES. Show references:  https://www.neurology.org/doi/10.1212/CPJ.0000000000200457 

Send us a textAdd this episode to your Helpful file. Have you been in rooms like David uncomfortably endured in a recent Great Clips  experience? His skilled hair-stylist lacked read-the-room-awareness or a voice that didn't make his skin crawl. Intervention was needed. So we unpacked it. And we probed how new grandpa David's son gently corrected his clumsy baby-holding skills. Intervention well done.

Dr. Josh Mitteldorf summarizes his #research perspective #published in Volume 17, Issue 5 of Aging (Aging-US), titled “Methylation clocks for evaluation of anti-aging interventions.” DOI - https://doi.org/10.18632/aging.206245 Corresponding author - Josh Mitteldorf - aging.advice@gmail.com Author interview - https://www.youtube.com/watch?v=efgNvr5ezTk Video short - https://www.youtube.com/watch?v=YjUvpqMzCGc Abstract Methylation clocks have found their way into the community of aging research as a way to test anti-aging interventions without having to wait for mortality statistics. But methylation is a primary means of epigenetic control, and presumably has evolved under strong selection. Hence, if methylation patterns change consistently at late ages it must mean one of two things. Either (1) the body is evolved to destroy itself (with inflammation, autoimmunity, etc.), and the observed methylation changes are a means to this end; or (2) the body detects accumulated damage, and is ramping up repair mechanisms in a campaign to rescue itself. My thesis herein is that both Type 1 and Type 2 changes are occurring, but that only Type 1 changes are useful in constructing methylation clocks to evaluate anti-aging interventions. This is because a therapy that sets back Type 1 changes to an earlier age state has stopped the body from destroying itself; but a therapy that sets back Type 2 changes has stopped the body from repairing itself. Thus, a major challenge before the community of epigenetic clock developers is to distinguish Type 2 from Type 1. The existence of Type 1 epigenetic changes is in conflict with conventional Darwinian thinking, and this has prompted some researchers to explore the possibility that Type 1 changes might be a form of stochastic epigenetic drift. I argue herein that what seems like directed epigenetic change really is directed epigenetic change. Of five recent articles on “stochastic methylation clocks,” only one (from the Conboy lab) is based on truly stochastic changes. Using the Conboy methodology and a methylation database, I construct a measure of true methylation drift, and show that its correlation with age is too low to be useful. Sign up for free Altmetric alerts about this article - https://aging.altmetric.com/details/email_updates?id=10.18632%2Faging.206245 Subscribe for free publication alerts from Aging - https://www.aging-us.com/subscribe-to-toc-alerts Keywords - aging, methylation, stochastic, entropy, programmed aging, aging clock, epigenetic clock To learn more about the journal, please visit our website at https://www.Aging-US.com​​ and connect with us on social media at: Facebook - https://www.facebook.com/AgingUS/ X - https://twitter.com/AgingJrnl Instagram - https://www.instagram.com/agingjrnl/ YouTube - https://www.youtube.com/@AgingJournal LinkedIn - https://www.linkedin.com/company/aging/ Bluesky - https://bsky.app/profile/aging-us.bsky.social Pinterest - https://www.pinterest.com/AgingUS/ Spotify - https://open.spotify.com/show/1X4HQQgegjReaf6Mozn6Mc MEDIA@IMPACTJOURNALS.COM

CutTheClutter: Iraq,Libya to Afghanistan:What regime changes & US interventions say about Israel ‘end goal' in Iran

In this episode of the Autism Little Learners Podcast, I sit down with Alex Lamoreaux—a mom of three, including two autistic boys—to talk about her personal and powerful journey with autism. From receiving a late diagnosis herself to navigating complex medical advice, Alex shares how she shifted from fear to confidence in parenting.  We dive into what it really means to trust your gut as a parent and honor the unique needs of each child. This heartfelt conversation explores the emotional ups and downs of advocating for autistic kids and highlights the power of intuition, self-advocacy, and community. You won't want to miss Alex's inspiring and relatable story. Bio Alex Lamoreaux is a late-diagnosed neurodivergent mom of three young boys and a Licensed Clinical Social Worker with a background in addiction recovery and trauma treatment. After two of her sons were diagnosed with autism, she dove into learning—and unlearning—what it really means to support autistic children. Now in the thick of parenting and advocacy, Alex shares practical, real-life insights with honesty and heart, hoping to spark connection and offer support to fellow parents on similar journeys. Alex's TikTok Account https://www.tiktok.com/@alex.lamx?_t=ZT-8xBXQBH46la&_r=1 Takeaways Late diagnosis can provide clarity and reduce shame over past differences. Parents often feel overwhelmed by the amount of information available. Shifting from panic to empowerment is crucial in parenting. Each autistic child is unique and requires different interventions. There is no one-size-fits-all approach to autism. Trusting parental instincts is essential for effective parenting. You do not have to fill your child's day with therapy. Trust your gut feelings about your child's needs. Parents often know their children best, despite professional opinions. Medical professionals may not always have the latest information on autism. Advocating for your child can be challenging, but it is essential. Bringing a list to meetings can help parents stay focused. Cognitive dissonance is common when navigating medical advice. Parents should feel empowered to change providers if necessary. Finding clarity amidst overwhelming information is crucial for parents. You may also be interested in these supports Visual Support Starter Set  Visual Supports Facebook Group Autism Little Learners on Instagram Autism Little Learners on Facebook  

Step inside the evolving world of fetal therapy where precision, teamwork, and full-spectrum care matter most. In this episode of the BackTable OBGYN Podcast, Dr. Anthony Shanks, Vice Chair of Education in the OB department at Indiana University School of Medicine, interviews Dr. Hiba Mustafa, a distinguished maternal-fetal medicine specialist and fetal interventionalist at Riley Children's Hospital. They discuss Dr. Mustafa's expertise in fetal diagnosis and therapy, her training journey through various fellowships, and her role in directing multiple fetal medicine programs. --- SYNPOSIS Dr. Mustafa elaborates on the intricacies of fetal interventions, including procedures for complications in monochorionic twins, spina bifida repair, and new emerging therapies. They also touch on research methodologies like the Delphi consensus technique and summarize key findings from recent studies on conditions such as hemolytic disease, gastroschisis, lower urinary tract obstructions, and preterm birth in twin pregnancies. Dr. Mustafa shares insights on how to stay sharp in the field, the importance of teamwork in surgical procedures, and advice for those aspiring to enter the field of fetal therapy. --- TIMESTAMPS 00:00 - Introduction02:45 - The Role of a Fetal Interventionalist04:00 - Dr. Mustafa's Training Journey07:42 - Fetal Surgery Fellowships16:43 - Conditions Treated by Fetal Interventionalists21:17 - Monitoring and Referrals for Monochorionic Twins30:04 - Understanding Percutaneous Procedures31:10 - Navigating the Equator in Fetal Surgery32:31 - Laser Surgery Techniques and Outcomes33:18 - The Importance of Placenta Delivery33:47 - In Utero Spina Bifida Repair36:19 - Minimally Invasive Techniques for Spina Bifida38:28 - Maintaining Skills in Fetal Interventions42:11 - Delphi Consensus Technique in Medical Research46:19 - Key Takeaways from Recent Research51:55 - Future of Fetal Therapy and Personal Insights

Dr. Halley Alexander talks with Dr. Serena Yin about the effectiveness of an electronic medical record best practice alert in preventing iatrogenic interventions for patients with a diagnosis of psychogenic nonepileptic seizures. Read the related article in Neurology® Clinical Practice.  Disclosures can be found at Neurology.org. 

durée : 00:58:03 - Le 13/14 - par : Bruno Duvic - Maxime Prud'homme 23 ans et Tangui Mosin 22 ans étaient pompiers volontaires. Ils sont morts lundi dernier en combattant un incendie dans le centre-ville de Laon. Un drame qui interroge sur les risques que prennent les pompiers lors de ces interventions, au cœur des centres villes vétustes.

In this episode of Copeland's Corner, Brian welcomes Tony Camin, Cathy Ladman & Mike Larsen as they check in from the SoCal area to discuss the current situation in the U.S. regarding the militarization and federal response to protests, specifically anti-ICE demonstrations. The group reflects on media portrayal differences, the implications of sending Marines for crowd control, and the historical context of federal government intervention in state matters. They also touch on the role of Gavin Newsom as a figure of resistance, the use of military force against American citizens, and the political landscape under Trump. Additionally, they discuss the potential ramifications on freedom of speech, particularly in the stand-up comedy community, in light of recent incidents in Brazil and historical examples from the U.S. Furthermore, they delve into themes regarding authoritarianism, the influence of the Trump administration on different sectors, including higher education and the arts, and the broader social implications of current policies.--Connect with our Guests...Tony Camin - Website: TonyCamin.com  and on Instagram @Tony.CaminCathy Ladman- Website  and @CathyLadman1 on Instagram  Mike Larsen - @WriteMikeLarsen on Instagram --For more from Brian...Visit his website: www.BrianCopeland.comFollow on Social Media: Instagram - @CopelandsCorner & @BrianCopieEmail: BrianCopelandShow@Gmail.com --Copeland's Corner is Created, Hosted, & Executive Produced by Brian Copeland. This Show is Recorded & Mixed by Charlene Goto with Go-To Productions. Visit Go-To Productions for all your Podcast & Media needs.Our Booking Producer is Tom Sawyer. For any show inquiries, please email CopelandsCornerPodcast@gmail.com

On this episode of Big Rich, TD, and Fletch, the glam gauntlet is thrown down in Top of the Rock — who ruled harder: Motley Crue or Poison? Then the guys get real about grade school bullying and the moments that still sting (or make us laugh) decades later. Plus, Big Rich shares his no-BS tips for breaking up with your phone and reclaiming your time from the social media vortex.

Developmental relationship-based interventions have been around for many years, but have not received the level of attention that intervention approaches based on applied behavior analysis have received. Drs. Josh Feder and Andrea Davis, along with a number of colleagues, including Barry, are currently involved in collaborative efforts to bring greater awareness and funding to DRBI interventions. They discuss the justification and research basis for the work currently being undertaken to provide families with greater options for supporting their children's development.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Emmanuel Amiesen is lead author of “Circuit Tracing: Revealing Computational Graphs in Language Models” (https://transformer-circuits.pub/2025/attribution-graphs/methods.html ), which is part of a duo of MechInterp papers that Anthropic published in March (alongside https://transformer-circuits.pub/2025/attribution-graphs/biology.html ). We recorded the initial conversation a month ago, but then held off publishing until the open source tooling for the graph generation discussed in this work was released last week: https://www.anthropic.com/research/open-source-circuit-tracing This is a 2 part episode - an intro covering the open source release, then a deeper dive into the paper — with guest host Vibhu Sapra (https://x.com/vibhuuuus ) and Mochi the MechInterp Pomsky (https://x.com/mochipomsky ). Thanks to Vibhu for making this episode happen! While the original blogpost contained some fantastic guided visualizations (which we discuss at the end of this pod!), with the notebook and Neuronpedia visualization (https://www.neuronpedia.org/gemma-2-2b/graph ) released this week, you can now explore on your own with Neuronpedia, as we show you in the video version of this pod. Chapters 00:00 Intro & Guest Introductions 01:00 Anthropic's Circuit Tracing Release 06:11 Exploring Circuit Tracing Tools & Demos 13:01 Model Behaviors and User Experiments 17:02 Behind the Research: Team and Community 24:19 Main Episode Start: Mech Interp Backgrounds 25:56 Getting Into Mech Interp Research 31:52 History and Foundations of Mech Interp 37:05 Core Concepts: Superposition & Features 39:54 Applications & Interventions in Models 45:59 Challenges & Open Questions in Interpretability 57:15 Understanding Model Mechanisms: Circuits & Reasoning 01:04:24 Model Planning, Reasoning, and Attribution Graphs 01:30:52 Faithfulness, Deception, and Parallel Circuits 01:40:16 Publishing Risks, Open Research, and Visualization 01:49:33 Barriers, Vision, and Call to Action

In this episode of the PFC Podcast, host Dennis engages with Andy Fisher to discuss the controversial topic of needle decompression in Individual First Aid Kits (IFACs). They explore the historical context of IFAC contents, the effectiveness of needle decompression, and the challenges in identifying tension pneumothorax in the pre-hospital setting. The conversation also delves into the training and decision-making processes in combat medicine, assessment techniques for pneumothorax, and potential alternatives to needle decompression. In this conversation, the speakers delve into the evolving perspectives on thoracostomy and its application in pre-hospital settings, particularly in combat medicine. They discuss the implications of tension physiology in hemothorax and the prevalence of massive hemothorax in recent years. The conversation also revisits treatment protocols for chest injuries, emphasizing the need for a shift towards simple thoracostomy over needle decompression. Finally, they evaluate the use of pigtail catheters versus traditional chest tubes, weighing the pros and cons of each in emergency situations.TakeawaysNeedle decompression is debated in the context of IFACs.Historical context shows that needle decompression was not originally included in official DOD lists.Hemorrhage is the leading cause of mortality in trauma cases.Tension pneumothorax is rare, occurring in only 1.1% of cases.Identifying tension pneumothorax in pre-hospital settings is challenging.Medics should rely on objective data for decision-making.Training often prioritizes speed over thorough assessment.Prophylactic interventions for tension pneumothorax may not be effective.Chest tubes are not always life-saving interventions.Exploring alternatives like finger thoracostomy may be beneficial. Evolving views on thoracostomy emphasize its selective use.Needle decompression may be overused in practice.Tension physiology can occur with blood accumulation in the chest.Massive hemothorax is increasingly recognized in trauma cases.Up to 49% of combat casualties require chest tubes.Simple thoracostomy should be prioritized over needle decompression.Patient monitoring is crucial in pre-hospital settings.Pigtail catheters may not be suitable for pre-hospital use.Chest tubes are preferred for their reliability in emergencies.Comfort for the patient is important but should not compromise urgent care.Chapters00:00 Introduction to the Podcast and Guest01:01 Debate on Needle Decompression in IFACs03:20 Historical Context of IFAC Contents06:40 Effectiveness of Needle Decompression09:09 Challenges in Identifying Tension Pneumothorax12:00 Training and Decision-Making in Combat Medicine16:21 Assessment Techniques for Pneumothorax21:29 Interventions for Tension Pneumothorax25:19 Exploring Alternatives to Needle Decompression25:50 Evolving Perspectives on Thoracostomy31:38 Understanding Tension Physiology in Hemothorax36:41 Revisiting Treatment Protocols for Chest Injuries43:12 Evaluating Pigtail Catheters vs. Chest TubesThank you to Delta Development Team for in part, sponsoring this podcast.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠⁠

Brent Minchew is Co-Founder, Executive Director, and Chief Scientist at Arête Glacier Initiative, a new nonprofit launched to close the gap between frontier glaciology research and actionable sea-level forecasts—and to probe whether “brake-tapping” inside Antarctic glaciers can slow their slide into the sea. Brent explains why current models still span 1–6 feet of rise by 2100—even if Paris targets are met—and how melting glaciers, especially Antarctica's so-called “Doomsday Glacier,” drive that uncertainty. He details why glaciology remains drastically underfunded, how sea-level changes already threaten coastal economies via insurance markets, and where Arête's first $5 million in philanthropic capital is going. He also walks through early-stage solutions—from thermo-siphons that passively refreeze ice to pumping sub-glacial water—that could “hit the brakes” on glacier flow and buy humanity time for deep decarbonization.In this episode, we cover: [03:45] Launching Arête to bridge glacier science and solutions[05:38] Inside the “doomsday glacier” and its global risk[07:18] Why Thwaites may collapse even if we hit climate goals[09:51] Sea level rise: Millions displaced per inch[12:41] The silent crisis of glacial melt[13:28] Economic ripple effects of rising seas[15:53] What Larsen B's collapse taught us[20:04] Arête's model: Philanthropy + global research[22:51] Advancing glacier tech through TRL stages[25:45] How Antarctica is governed[35:28] Refreezing glaciers with thermo-siphons[45:00] Drilling costs vs. seawalls: Where's the value?Episode recorded on May 14, 2025 (Published on June 2, 2025) Enjoyed this episode? Please leave us a review! Share feedback or suggest future topics and guests at info@mcj.vc.Connect with MCJ:Cody Simms on LinkedInVisit mcj.vcSubscribe to the MCJ Newsletter*Editing and post-production work for this episode was provided by The Podcast Consultant

In this episode of the Pacey Performance Podcast, Tyler Lesher, head athletic trainer for UCLA men's basketball, discusses the current state of athletic training in the US, the importance of gut health in recovery, and the challenges faced by athletic trainers. He emphasizes the need for a balance between research and clinical practice, the gut-brain connection, and practical interventions for improving gut health. Tyler also shares insights on assessing gut health and the significance of testing for athletes. Main talking points: • Athletic training jobs are declining due to various factors. • Gut health is crucial for overall recovery and performance. • Research can often be biased and not applicable to real-world scenarios. • Chronic inflammation can hinder recovery processes. • Fasting and cold water immersion can improve gut health. • The gut-brain axis significantly affects mental health. • Personalized testing is essential for understanding individual gut health. • Athletes should keep a food and symptom journal to identify triggers. • Interventions for gut health should be tailored to the individual. • Communication with athletes about nutrition is vital for their performance.

Today, I am delighted to connect with James Kimmel Jr., a Yale psychiatry lecturer, a lawyer, and the founder and co-director of the Yale Collaborative for Motive Control Studies.  In our conversation, we explore the science of revenge, examining how it affects the brain and identifying risk factors that could contribute to extremes in revenge activity. James shares his journey from childhood to law and academia and offers his perspective on the intersection of justice, neuroscience, and human behavior. We talk about forgiveness, exploring how it reshapes the brain, counteracts revenge addiction, and serves as a tool for healing. We also cover specific interventions, including the non-justice system and the warning signs for extremes in addictive behaviors. This invaluable and insightful conversation with James Kimmel Jr. is an incredible resource for moms everywhere. IN THIS EPISODE YOU WILL LEARN: How revenge impacts the brain How psychological harm can lead to revenge cravings The link between addiction and revenge-seeking Why some individuals are more at risk for revenge-seeking than others Some common forms of revenge-driven behavior What does a revenge attack look like? James shares how revenge motivated his choice to become a lawyer and how he came to do the work he does now The benefits of forgiveness as an antidote to revenge cravings How social media platforms exploit the addictive process of revenge-seeking Interventions and support systems for managing revenge addiction Connect with Cynthia Thurlow   Follow on ⁠X⁠ ⁠Instagram⁠ ⁠LinkedIn⁠ Check out Cynthia's ⁠website⁠ Submit your questions to ⁠support@cynthiathurlow.com⁠ Connect with James Kimmel Jr. On his⁠ website⁠ Buy a copy of James' latest book,⁠ The Science of Revenge⁠ ⁠SavingCain.org⁠: Preventing Murd

Dr. Barbara Moscicki discusses the critical role of HPV in women's health, particularly its association with various cancers, including cervical cancer. She explains the dual nature of HPV as both a commensal organism and a pathogen, emphasizing the importance of understanding its oncogenic potential. The conversation also covers the significance of screening methods, such as Pap smears, in detecting precancerous changes and the complexities surrounding the treatment of different cervical intraepithelial neoplasia (CIN) stages. This conversation delves into the complexities of cancer screening methods, particularly focusing on cervical and anal cancer. Dr. Barbara Moscicki discusses the importance of understanding various screening guidelines, the role of HPV vaccination in preventing cancers, and the need for clear communication between clinicians and patients regarding these topics. The discussion highlights the evolving nature of cancer screening practices and the importance of patient education in navigating these changes.About Our Guest:Dr. Moscicki is a Pediatrician, Board Certified in Adolescent Medicine. She is the current Division Chief of Adolescent and Young Adult Medicine with clinical expertise in reproductive health care for menstrual irregularities, sexual health, and sexually transmitted diseases. Dr. Moscicki has expertise in HPV -related disease including diagnosis of cervical dysplasia and treatment. She also offers medical care for women with eating disorders.Resources & Links:This episode was supported by the Patient Centered Outcomes Research Institute (PCORI) and features the PCORI research study here: https://pubmed.ncbi.nlm.nih.gov/33632649/ ‘Effect of 2 Interventions on Cervical Cancer Screening Guideline Adherence'Chapter Codes00:00 Introduction to HPV and Women's Health03:00 Understanding HPV's Role in Cancer06:01 The Dual Nature of HPV: Commensal vs Pathogenic08:57 Oncogenes and Their Impact on Cellular Regulation12:09 The Intersection of HPV and Screening Methods14:58 Cervical Cancer Screening and Pap Smears20:30 Understanding Cancer Screening Methods23:17 Guidelines for Cervical and Anal Cancer Screening31:02 The Importance of HPV Vaccination39:35 Key Messages for Clinicians and PatientsTakeaways- Dr. Moscicki specializes in adolescent and young adult medicine.- HPV is linked to multiple cancers beyond cervical cancer.- The understanding of HPV's role in cancer has evolved significantly.- E6 and E7 proteins from HPV disrupt normal cell regulation.- CIN3 is considered a true pre-cancer that requires treatment.- Liquid cytology has improved the accuracy of Pap smears.- CIN1 is often self-resolving and does not require treatment.- CIN2 presents a diagnostic dilemma due to variability in interpretation.- Women have options regarding the management of CIN2 lesions.Connect with Us:Enjoyed this episode? Make sure to subscribe, rate, and review! Follow us on Instagram, Facebook, or Linkedin @mantacares and visit our website at mantacares.com for more episodes and updates.Listen Elsewhere: Website: https://mantacares.com/pages/podcast?srsltid=AfmBOopEP5GJ-Wd2nL-HYAInrw YouTube: https://www.youtube.com/@mantacares Spotify: https://open.spotify.com/episode/3TR1lFLtf6em5YyKtlWy2L?si=6ma-9g_w Apple: https://podcasts.apple.com/us/podcast/navigating-cervical-cancer-screening-surger Disclaimer:All content and information provided in connection with Manta Cares is solely intended for informational and educational purposes only. This content and information is not intended to be a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.This episode was supported by an award from the Patient-Centered Outcomes Research Institute.

A patient with ascites is most likely to develop which of the following complications? Find it all out in the podcast!  Be prepared for the NPTE so that you can pass with flying colors! Check out www.ptfinalexam.com/podcast for more information and to stay up-to-date with our latest courses and projects.  #Npte #PT #ptboards #crushtheNPTE #study #studygram #spt #ptstudent #ptlife #sptprobs #physicaltherapystudent #physicaltherapy #physio #physiotherapist #ptlife #ptstudentstudy

On this episode, we discuss chronic coronary syndrome (CCS) and describe its clinical presentation, underlying pathophysiology, and progression. We review current guidelines and evidence-based treatment strategies for managing CCS, including both pharmacological and non-pharmacological interventions. Our primary pharmacotherapy focus was on comparing and contrasting antianginal therapies, but we also touch on antiplatelet agents, and risk factor modification strategies. Cole and I are happy to share that our listeners can claim ACPE-accredited continuing education for listening to this podcast episode! We have continued to partner with freeCE.com to provide listeners with the opportunity to claim 1-hour of continuing education credit for select episodes. For existing Unlimited (Gold) freeCE members, this CE option is included in your membership benefits at no additional cost! A password, which will be given at some point during this episode, is required to access the post-activity test. To earn credit for this episode, visit the following link below to go to freeCE's website: https://www.freece.com/ If you're not currently a freeCE member, we definitely suggest you explore all the benefits of their Unlimited Membership on their website and earn CE for listening to this podcast. Thanks for listening! If you want to support the podcast, check out our Patreon account. Subscribers will have access to all previous and new pharmacotherapy lectures as well as downloadable PowerPoint slides for each lecture. If you purchase an annual membership, you'll also get a free digital copy of High-Powered Medicine 3rd edition by Dr. Alex Poppen, PharmD. HPM is a book/website database of summaries for over 150 landmark clinical trials.You can visit our Patreon page at the website below:  www.patreon.com/corconsultrx We want to give a big thanks to Dr. Alex Poppen, PharmD and High-Powered Medicine for sponsoring the podcast..  You can get a copy of HPM at the links below:  Purchase a subscription or PDF copy - https://highpoweredmedicine.com/ Purchase the paperback and hardcover - Barnes and Noble website We want to say thank you to our sponsor, Pyrls. Try out their drug information app today. Visit the website below for a free trial: www.pyrls.com/corconsultrx We also want to thank our sponsor Freed AI. Freed is an AI scribe that listens, prepares your SOAP notes, and writes patient instructions. Charting is done before your patient walks out of the room. You can try 10 notes for free and after that it only costs $99/month. Visit the website below for more information: https://www.getfreed.ai/  If you have any questions for Cole or me, reach out to us via e-mail: Mike - mcorvino@corconsultrx.com Cole - cswanson@corconsultrx.com