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Delaying diagnosis of parkinsonism can mean delaying care. In a study recently published in JAMA Neurology, David Vaillancourt, PhD, and colleagues tested the ability of an AI model to differentiate between Parkinson disease and other neurodegenerative disorders when paired with MRI. He joins JAMA and JAMA+ AI Associate Editor Yulin Hswen, ScD, MPH to discuss. Related Content: A Large Proportion of Parkinson Disease Diagnoses Are Wrong—Here's How AI Could Help Automated Imaging Differentiation for Parkinsonism
Interview with Alexander Chern, MD, author of Over-the-Counter Hearing Aid–Enabled Earbuds—Merging Hearing Health and Technology. Hosted by Paul C. Bryson, MD, MBA. Related Content: Over-the-Counter Hearing Aid–Enabled Earbuds—Merging Hearing Health and Technology
LISTENER DISCRETION IS ADVISED. References: Buxton. Sustained Monomorphic VT: Clinical Manifestations, Diagnosis, and Evaluation. Up-to-Date. Farré J, Rubio JM, Sternick EB. Confounding factors leading to misdiagnosing ventricular tachycardia as supraventricular in the emergency room. Indian Pacing Electrophysiol J. 2023;23(1):1-13. doi:10.1016/j.ipej.2022.11.002 Kashou AH, Evenson CM, Noseworthy PA, et al. Differentiating wide complex tachycardias: A historical perspective. Indian Heart J. 2021;73(1):7-13. doi:10.1016/j.ihj.2020.09.006 Salim Rezaie, "SVT With Aberrancy Versus VT", REBEL EM blog, November 22, 2013. Available at: https://rebelem.com/svt-aberrancy-versus-vt/. Steinman RT, Herrera C, Schuger CD, Lehmann MH. Wide QRS tachycardia in the conscious adult. Ventricular tachycardia is the most frequent cause. JAMA. 1989 Feb 17;261(7):1013-6. PMID: 2915409. Vereckei A. Current algorithms for the diagnosis of wide QRS complex tachycardias. Curr Cardiol Rev. 2014 Aug;10(3):262-76. doi: 10.2174/1573403x10666140514103309. PMID: 24827795; PMCID: PMC4040878.
With all the attention focused on Alzheimer's biomarkers and amyloid antibodies, it's easy to forget that comprehensive dementia care is more than blood draws and infusions. On today's podcast, we buck this trend and dive into the complexities and challenges of comprehensive dementia care with the authors of two pivotal articles recently published in JAMA. We've invited David Reuben and Greg Sachs to talk about their two respective trials, published in JAMA — D-CARE and IN-PEACE — aimed at improving the evidence for care models supporting individuals diagnosed with dementia. D-CARE tested the comparative effectiveness of health system-based dementia care, a community-based program, and usual care, while IN-PEACE assessed the addition of palliative care to dementia care programs for individuals with moderate to severe dementia. Despite their pragmatic trial designs and high expectations, both studies' primary outcomes were negative, although there were some intriguing positive secondary outcomes. We discuss how some critical questions about the integration of these findings into practice, and how they fit in with previous research that did show benefits (see this past podcast on using health navigators to improve dementia care). If you want to learn more about comprehensive dementia care, check out these past podcasts: Our previous podcast on comprehensive dementia care with Lee Jennings and Chris Callahan Our podcast on the GUIDE Model with Malaz Boustani and Diane Ty Our podcast on Transforming the Culture of Dementia Care with Anne Basting, Ab Desai, Susan McFadden, and Judy Long Lastly, here is the link to Greg Sachs' NEJM article that describes his maternal grandmother decline from Alzheimer's disease.
Send us a Text Message (please include your email so we can respond!)Episode 72! We continue talking about the articles from the CCR25 conference with UK-ROX or "Conservative Oxygen Therapy in Mechanically Ventilated Critically Ill Adult Patients" published in JAMA 2025 by Martin et al and TARGET-Protein or "Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit" by Jaber et al in Lancet 2018.UK-ROX: https://pubmed.ncbi.nlm.nih.gov/40501321/UK-ROX (JAMA): https://jamanetwork.com/journals/jama/article-abstract/2835384TARGET-Protein: https://pubmed.ncbi.nlm.nih.gov/40495743/TARGET-Protein (JAMA): https://jamanetwork.com/journals/jama/article-abstract/2835302If you enjoy the show be sure to like and subscribe, leave that 5 star review! Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!
In this World Shared Practice Forum Podcast, Dr. Padmanabhan Ramnarayan discusses the findings of the clinical trial comparing high-flow nasal cannula (HFNC) therapy to continuous positive airway pressure (CPAP) therapy in pediatric critical care. The trial, which was published in JAMA, explores the effectiveness of HFNC as a non-inferior alternative to CPAP for respiratory support in acutely ill children. Dr. Ramnarayan reviews the trial's design, key outcomes, and implications for clinical practice, providing valuable insights for healthcare professionals involved in pediatric respiratory care. LEARNING OBJECTIVES - Understand the design and methodology of the clinical trial comparing HFNC and CPAP in pediatric critical care - Identify the primary and secondary outcomes of the trial and their significance - Discuss the implications of the trial findings for clinical practice and future research in pediatric respiratory care AUTHORS Padmanabhan "Ram" Ramnarayan, MBBS, MD, FRCPCH, FFICM Professor of Paediatric Critical Care Imperial College London Jeffrey Burns, MD, MPH Emeritus Chief Division of Critical Care Medicine Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital Professor of Anesthesia Harvard Medical School DATE Initial publication date: August 26, 2025. ARTICLES REFERENCED Ramnarayan P, Richards-Belle A, Drikite L, et al. Effect of High-Flow Nasal Cannula Therapy vs Continuous Positive Airway Pressure Therapy on Liberation From Respiratory Support in Acutely Ill Children Admitted to Pediatric Critical Care Units: A Randomized Clinical Trial. JAMA. 2022;328(2):162-172. doi:10.1001/jama.2022.9615 RENOVATE Investigators and the BRICNet Authors, Maia IS, Kawano-Dourado L, et al. High-Flow Nasal Oxygen vs Noninvasive Ventilation in Patients With Acute Respiratory Failure: The RENOVATE Randomized Clinical Trial. JAMA. 2025;333(10):875-890. doi:10.1001/jama.2024.26244 Pelletier JH, Maholtz DE, Hanson CM, et al. Respiratory Support Practices for Bronchiolitis in the Pediatric Intensive Care Unit. JAMA Netw Open. 2024;7(5):e2410746. Published 2024 May 1. doi:10.1001/jamanetworkopen.2024.10746 TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/as/whctgh753rgnhc7rxn7w3mn/20250712_WSP_Ramnarayan_Transcript Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Ramnarayan P, O'Hara JE, Burns JP. High-Flow Nasal Cannula vs CPAP in Acutely Ill Children. 08/2025. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/high-flow-nasal-cannula-vs-cpap-in-acutely-ill-children-by-p-ramnarayan-openpediatrics
Quick summaries of articles 51-60. Enjoy! 51. Fun Activities and Recovery Acuff, S. F., et al. A brief measure of non-drug reinforcement: Association with treatment outcomes during initial substance use recovery. Drug and Alcohol Dependence, 256, 111092. 52. Buprenorphine-precipitated Fentanyl Withdrawal Thakrar AP, et al. Buprenorphine-Precipitated Withdrawal Among Hospitalized Patients Using Fentanyl. JAMA Netw Open. 2024 Sep 3;7(9):e2435895. 53. Methadone Vs. Buprenorphine Nosyk B, Et al. Buprenorphine/Naloxone vs Methadone for the Treatment of Opioid Use Disorder. JAMA. 2024 Oct 17. 54. High Daily Doses of Buprenorphine Axeen S, et al. Association of Daily Doses of Buprenorphine With Urgent Health Care Utilization. JAMA Netw Open. 2024 Sep 3;7(9):e2435478. 55. How Buprenorphine Works in Pregnancy Caritis, Steve N. MD; et al. A Pharmacologic Evaluation of Buprenorphine in Pregnancy and the Postpartum Period. Journal of Addiction Medicine ():10.1097/ADM.0000000000001380, September 2, 2024. 56. How Many Quite Attempts Does It Take? Fontes RM, et al. Beyond the first try: How many quit attempts are necessary to achieve substance use cessation? Drug Alcohol Depend. 2024 Dec 8;267:112525. 57. What is Recovery? Zemore SE, et al. Understanding the Shared Meaning of Recovery From Substance Use Disorders: New Findings From the What is Recovery? Study. Subst Abuse. 2023 Sep 15;17:11782218231199372. 58. Semaglutide for Alcohol Use Disorder (The RCT) Hendershot CS, et al. Once-Weekly Semaglutide in Adults With Alcohol Use Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2025 Feb 12:e244789. 59. Low-Dose Buprenorphine Initiation (Micro-induction) Suen LW, et al. Outpatient Low-Dose Initiation of Buprenorphine for People Using Fentanyl. JAMA Netw Open. 2025 Jan 2;8(1):e2456253. 60. Lisdexamfetamine for methamphetamine use disorder Ezard N, et al LiMA Investigator Group. Lisdexamfetamine in the treatment of methamphetamine dependence: A randomised, placebo-controlled trial. Addiction. 2024 Dec 19. --- This podcast offers category 1 and MATE-ACT CME credits through MI CARES and Michigan State University. To get credit for this episode and others, go to this link to make your account, take a brief quiz, and claim your credit. To learn more about opportunities in addiction medicine, visit MI CARES. CME: https://micaresed.org/courses/podcast-addiction-medicine-journal-club/ --- Original theme music: composed and performed by Benjamin Kennedy Audio editing: Michael Bonanno Executive producer: Dr. Patrick Beeman A podcast from Ars Longa Media --- This is Addiction Medicine Journal Club with Dr. Sonya Del Tredici and Dr. John Keenan. We practice addiction medicine and primary care, and we believe that addiction is a disease that can be treated. This podcast reviews current articles to help you stay up to date with research that you can use in your addiction medicine practice. The best part of any journal club is the conversation. Send us your comments on social media or join our Facebook group. --- Email: addictionmedicinejournalclub@gmail.com Facebook: @AddictionMedJC Facebook Group: Addiction Medicine Journal Club Instagram: @AddictionMedJC Threads: @AddictionMedJC YouTube: addictionmedicinejournalclub Twitter/X: @AddictionMedJC --- Addiction Medicine Journal Club is intended for educational purposes only and should not be considered medical advice. The views expressed here are our own and do not necessarily reflect those of our employers or the authors of the articles we review. All patient information has been modified to protect their identities. Learn more about your ad choices. Visit megaphone.fm/adchoices
Drs. Whitney Hartlage (@whithartlage11) and Sam Windham join Dr. Ryan Moenster to discuss updates in the diagnosis and management of community-acquire pneumonia. Hear from our guests on the role of rapid diagnostic tests such as multiplex PCR and urinary antigen tests in the inpatient and outpatient setting, considerations for initiating steroids and withholding macrolides, and when to use short antibiotic durations. Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/. Visit our website! https://breakpoints-sidp.org/ References: Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, Cooley LA, Dean NC, Fine MJ, Flanders SA, Griffin MR, Metersky ML, Musher DM, Restrepo MI, Whitney CG. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67. doi: 10.1164/rccm.201908-1581ST. PMID: 31573350; PMCID: PMC6812437. Chaudhuri D, Nei AM, Rochwerg B, Balk RA, Asehnoune K, Cadena R, Carcillo JA, Correa R, Drover K, Esper AM, Gershengorn HB, Hammond NE, Jayaprakash N, Menon K, Nazer L, Pitre T, Qasim ZA, Russell JA, Santos AP, Sarwal A, Spencer-Segal J, Tilouche N, Annane D, Pastores SM. 2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia. Crit Care Med. 2024 May 1;52(5):e219-e233. doi: 10.1097/CCM.0000000000006172. Epub 2024 Jan 19. PMID: 38240492. Odeyemi Y, Tekin A, Schanz C, Schreier D, Cole K, Gajic O, Barreto E. Comparative effectiveness of azithromycin versus doxycycline in hospitalized patients with community acquired pneumonia treated with beta-lactams: A multicenter matched cohort study. Clin Infect Dis. 2025 May 16:ciaf252. doi: 10.1093/cid/ciaf252. Epub ahead of print. PMID: 40378193. Butler AM, Nickel KB, Olsen MA, Sahrmann JM, Colvin R, Neuner E, O'Neil CA, Fraser VJ, Durkin MJ. Comparative safety of different antibiotic regimens for the treatment of outpatient community-acquired pneumonia among otherwise healthy adults. Clin Infect Dis. 2024 Oct 23:ciae519. doi: 10.1093/cid/ciae519. Epub ahead of print. PMID: 39442057; PMCID: PMC12355227. Furukawa Y, Luo Y, Funada S, Onishi A, Ostinelli E, Hamza T, Furukawa TA, Kataoka Y. Optimal duration of antibiotic treatment for community-acquired pneumonia in adults: a systematic review and duration-effect meta-analysis. BMJ Open. 2023 Mar 22;13(3):e061023. doi: 10.1136/bmjopen-2022-061023. PMID: 36948555; PMCID: PMC10040075 Schober T, Wong K, DeLisle G, et al. Clinical outcomes of rapid respiratory virus testing in emergency departments. JAMA Intern Med. 2024;184(5):528-536. Clark T, Lindsley K, Wigmosta T, et al. Rapid multiplex PCR for respiratory viruses reduces time to result and improves clinical care: results of a systematic review and meta-analysis. J Infect. 2023;86(5):462-475. May L, Robbins EM, Canchola JA, Chugh K, Tran NK. A study to assess the impact of the cobas point-of-care RT-PCR assay (SARS-CoV-2 and Influenza A/B) on patient clinical management in the emergency department of the University of California at David Medical Center. J Clin Virol. 2023:168:105597. Cartuliares MB, Rosenvinge FS, Mogensen CB, Skovsted TA, Andersen SL, Østergaard C, et al. Evaluation of point-of-care multiplex polymerase chain reaction in guiding antibiotic treatment of patients acutely admitted with suspected community-acquired pneumonia in Denmark: a multicentre randomised controlled trial. PLoS Med. 2023;20:e1004314. doi: 10.1371/ journal.pmed.1004314. Vaughn VM, Dickson RP, Horowitz JK, Flanders SA. Community-acquired pneumonia: a review. JAMA. 2024;332(15):1282-1295. Davis MR, McCreary EK, Trzebucki AM. Things we do for no reason – ordering Streptococcus pneumoniae urinary antigen in patients with community-acquired pneumonia. Open Forum Infect Dis. 2024;11(3):ofae089. Centers for Disease Control and Prevention. Laboratory Testing for Legionella. Updated June 9, 2025. Accessed July 13, 2025. https://www.cdc.gov/legionella/php/laboratories/index.html. Jain S, Self WH, Wunderink RG. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015;373(5):415-427. Kamat IS, Ramachandram V, Eswaran H, Guffey D, Musher DM. Procalcitonin to distinguish viral from bacterial pneumonia: a systematic review and meta-analysis. Clin Infect Dis. 2020;70(3):538-542. Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single blinded intervention trial. Lancet. 2004;363:600–7. doi: 10.1016/S0140- 6736(04)15591-8. Schuetz P, Christ-Crain M, Thomann R, Falconnier C, Wolbers M, Widmer I, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA. 2009;302:1059–66. Schuetz P, Muller B, Christ-Crain M, Stolz D, Tamm M, Bouadma L, et al. Procalci- € tonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Datab System Rev. 2017;10(10):CD007498. doi: 10.1002/14651858. cd007498.pub2. Huang DT, Yealy DM, Filbin MR, Brown AM, Chang C-CH, Doi Y, et al. Procalcitonin-guided use of antibiotics for lower Respiratory tract infection. New Engl J Med. 2018;379:236–49. doi: 10.1056/NEJMoa1802670. Dequin PF, Meziani F, Quenot JP, et al. Hydrocortisone in severe community-acquired pneumonia. N Engl J Med. 2023;389(19):1623-1634. doi:10.1056/NEJMoa2215145. Gupta AB, Flanders SA, Petty LA, et al. Inappropriate diagnosis of pneumonia among hospitalized adults. JAMA Intern Med. 2024;184(5):548-556. Jones BE, Chapman AB, Ying J, et al. Diagnostic Discordance, Uncertainty, and Treatment Ambiguity in Community-Acquired Pneumonia: A National Cohort Study of 115 U.S. Veterans Affairs Hospitals. Ann Intern Med. 2024;177(9):1179-1189. doi:10.7326/M23-2505. Hartlage W, Imlay H, Spivak ES. The role of empiric atypical antibiotic coverage in non-severe community-acquired pneumonia. Antimicrob Steward Healthc Epidemiol. 2024;4(1):e214. doi:10.1017/ash.2024.453. Dinh A, Barbier F, Bedos JP, et al. Update of guidelines for management of community acquired pneumonia in adults by the French Infectious Disease Society (SPILF) and the French-Speaking Society of Respiratory Diseases (SPLF). Endorsed by the French Infectious Disease Society (SPILF) and the French-Speaking Society of Respiratory Diseases (SPLF); endorsed by the French Intensive Care Society (SRLF), the French Microbiology Society (SFM), the French Radiology Society (SFR), and the French Emergency Society (SFMU). Respir Med and Res. 2025. El Moussaoui R, de Borgie CAJM, van den Broek P, et al. Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate-severe community acquired pneumonia: randomised, double blind study. BMJ. 2006;332(7554):1355. doi:10.1136/bmj.332.7554.1355. Dinh A, Ropers J, Duran C, et al. Discontinuing β-lactam treatment after 3 days for patients with community-acquired pneumonia: a randomized, non-inferiority trial. Lancet. 2021;397(10280):1195-1203.
Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief, and Preeti Malani, MD, MSJ, Deputy Editor of JAMA, the Journal of the American Medical Association, for articles published from August 16-22 2025.
A new JAMA study found that 84% of abortion prescriptions from Aid Access went to patients in states with bans, enabled by “shield laws” protecting telehealth providers across state lines. Provision rates were highest in underserved Southern and Midwestern counties, highlighting telemedicine's role in maintaining access. A Scientific Reports study showed that large language models for clinical use can be manipulated into giving unsafe answers through subtle “adversarial hallucination attacks,” with success rates over 95%. Finally, JAMA Ophthalmology reported GLP-1 agonists may slightly increase risk of sudden vision loss, though benefits still outweigh risks.
Ênio Macedo e Joanne Alves convidam Eduarda Guedes e Mariana Tourinho, R2 CM do HCMFMUSP, para discutir sobre 7 armadilhas na Doença arterial periférica (DAP), antiga DAOP.1. Não reconhecer manifestações clínicas iniciais 2. Valorizar somente o exame físico e não realizar o ITB 3. Solicitar exame de imagem no diagnóstico4. Focar apenas no tratamento farmacológico5. Não usar os tratamentos farmacológicos disponíveis6. Não reconhecer o momento de indicar revascularização7. Não reconhecer isquemia de membro agudaReferências: 1. https://www.tadeclinicagem.com.br/guia/324/doenca-arterial-obstrutiva-periferica-diretriz-ahaacc-2024/2. Gornik, Heather L et al. “2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.” Circulation vol. 149,24 (2024): e1313-e1410. doi:10.1161/CIR.00000000000012513. Khan, Nadia A et al. “Does the clinical examination predict lower extremity peripheral arterial disease?.” JAMA vol. 295,5 (2006): 536-46. doi:10.1001/jama.295.5.5364. Londero, Louise S et al. “Pulse palpation is an effective method for population-based screening to exclude peripheral arterial disease.” Journal of vascular surgery vol. 63,5 (2016): 1305-10. doi:10.1016/j.jvs.2015.11.044
Send us a textWhy are U.S. health care costs so high—and what does that mean for you and your family? In this episode, I dive into the real reasons behind America's staggering health care bills.We start with a story that hits close to home—a $189,000 outpatient cancer surgery bill followed by $12,000-a-month immunotherapy—and I unpack how even with Medicare coverage, the pricing dynamics can feel shocking. Using my experience as a physician and health policy researcher, I explain why these massive charges happen and where the system is breaking down.At the national level, we now spend over $5 trillion a year on health care—roughly 18% of our GDP—and this number is growing far faster than inflation. This growth threatens the solvency of key programs like Medicare, which is projected to run out of funds by 2033 (Health Affairs). Employers are also feeling the pinch, with average family coverage costs now topping $25,500 annually (WSJ). Individuals, especially those using ACA exchanges, face rising premiums—some increasing by 20–30% next year (Axios)—and deductibles between $3,000 and $5,000 are now typical.Despite all this spending, our health outcomes are among the worst in the developed world. The U.S. ranks 33rd in infant mortality and 32nd in life expectancy out of 38 OECD countries, even though we spend about $12,000 per person annually—nearly three times the OECD average (America's Health Rankings).So, what drives these costs? It boils down to three factors: high prices, high utilization, and high administrative overhead. Prices for common procedures are far above international norms—a CT scan in the U.S. costs around $900 compared to $279 in the Netherlands and just $97 in Canada (Health Imaging). U.S. physicians, nurses, and hospital executives also earn significantly more, contributing to overall spending (Medscape; JAMA).On the utilization front, studies estimate that around 25% of all care may be unnecessary, driven by defensive medicine, patient expectations, and incentive structures that reward more procedures—not necessarily better outcomes (PGPF; Choosing Wisely).Even administrative overhead plays a massive role: nearly 25% of U.S. health care spending goes to bureaucracy—four times what's typical in simpler, single-payer systems (Health System Tracker; Health Affairs%20of%20US%20GDP)).If you're wondering why your doctor spends just 17 minutes with you or why your premiums feel like a second mortgage, this episode offers the context—and data—to help you understand what's really going on.Takeaways: Start asking about cash prices—especially if you're still in your deductible phase. Preventive steps like regular exercise may offer the highest return on investment when compared to costly downstream care. And above all, consider your plan carefully during open enrollment.For deeper insights, links to all the studies mentioned, and access to my newslet
In this special episode on Obstructive Sleep Apnea our host, Dr. Neil Skolnik will discuss treatment of OSA. In Part 1 we discussed and overview of OSA, in Part 2 we discussed making the diagnosis will, and Part 4 will look at cases. This special episode is supported by an independent educational grant from Lilly. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health Dr. Sanjay Patel, M.D, Professor of Medicine, Epidemiology, & Clinical and Translational Science, and Director of the Center for Sleep and Cardiovascular Outcomes Research; Medical Director of the Comprehensive Sleep Disorders Program, University of Pittsburgh Medical Center Selected references: Diagnosis and Management of Obstructive Sleep Apnea - A Review. JAMA. 2020;323(14):1389-1400 Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity. N Engl J Med 2024;391:1193-1205
There's a lot of fear and misinformation around HRT, and one of the biggest myths is that HT is a highly significant cause of breast cancer. That is not the case. This is a remnant concept from 2002, with MANY caveats. Calls for the removal of the black box warning on hormone replacement therapy (HRT) stems primarily from the outdated and limited nature of the data from the Women's Health Initiative (WHI) study published in 2002. The WHI, while groundbreaking at the time, focused predominantly on a specific formulation of conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA) in older, postmenopausal women, leading to concerns about its generalizability to the broader population of women considering HRT. This is why on July 17, 2025, the FDA met with a panel of experts, in open forum, to hear the petition of removing the black box warning on hormone replacement therapy. Listen in for details. 1. Writing Group for the Women's Health Initiative Investigators. Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results From the Women's Health Initiative Randomized Controlled Trial. JAMA.2002;288(3):321–333. doi:10.1001/jama.288.3.3212. Manson JE, Crandall CJ, Rossouw JE, Chlebowski RT, Anderson GL, Stefanick ML, Aragaki AK, Cauley JA, Wells GL, LaCroix AZ, Thomson CA, Neuhouser ML, Van Horn L, Kooperberg C, Howard BV, Tinker LF, Wactawski-Wende J, Shumaker SA, Prentice RL. The Women's Health Initiative Randomized Trials and Clinical Practice: A Review. JAMA. 2024 May 28;331(20):1748-1760. doi: 10.1001/jama.2024.6542. PMID: 38691368.3. NAMS: The 2022 hormone therapy position statement of The North American Menopause Society (Menopause)
Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief, and Preeti Malani, MD, MSJ, Deputy Editor of JAMA, the Journal of the American Medical Association, for articles published from August 9-15, 2025.
In this episode, Dr. Sergio Zanotti discusses ECPR–Extracorporeal Cardiopulmonary Resuscitation. ECPR is still be considered a niche therapy, but its relevance and availability are increasing. He is joined by Dr. Adam Green, a practicing intensivist at Cooper University Health Care and an Associate Professor of Medicine at Cooper Medical School of Rowan University (CMSRU). Dr. Green is the director of research for the division of Critical Care and has authored over 50 peer-reviewed publications. He has been part of the ECMO team at Cooper since its inception. Additional resources: Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest. The Lancet Respiratory Medicine 2025: https://www.sciencedirect.com/science/article/pii/S2213260025001225 Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest. JAMA 2022: https://jamanetwork.com/journals/jama/fullarticle/2789313 Association between increasing institutional experience with ECPR and outcomes in patients with out-of-hospital cardiac arrest: A nationwide multicenter observational study in Japan (the JAAM–OHCA registry) RESUSCITATION 2025: https://www.resuscitationjournal.com/article/S0300-9572(24)00862-1/fulltext Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest. N Eng J of Med 2023: https://www.nejm.org/doi/full/10.1056/NEJMoa2204511 Books mentioned in this episode: The Perfect Predator: A Scientist's Race to Save Her Husband from a Deadly Superbug. By S. Strathdee and T Patterson: https://amzn.to/3Hxjmez
Interview with Nyssa Fox Farrell, MD, and Lara W. Crock, MD, PhD, MSCI, authors of Stellate Ganglion Block for the Treatment of COVID-19−Induced Parosmia: A Randomized Clinical Trial. Hosted by Paul C. Bryson, MD, MBA. Related Content: Stellate Ganglion Block for the Treatment of COVID-19−Induced Parosmia
Some conversations change lives. Others change the way we think about how we have them.In this episode, I share the lesson I took from Dr. Rahul Jandial, world-renowned brain surgeon, neuroscientist, and author, about the quiet power of the pause.Rahul has delivered some of the hardest news anyone can hear. And what he's learned is that it's not just the words that matter, it's what happens after them. In those seconds of silence, people begin to process, to find their footing, to summon the courage for what comes next.It's a habit we can all use. At work when we're giving feedback. At home in tough conversations. In moments with friends when they trust us enough to share what's really going on.In this episode, we explore:How silence builds trust faster than reassuranceThe neuroscience behind giving people space to thinkWhy the pause can change the way we lead, comfort, and connectHow to practice it in your everyday lifeIf you've ever wanted to show up better in the conversations that matter most, this one's for you.Here is more information on the studies referenced: Physician–Patient Communication: The Relationship With Malpractice Claims (Wendy Levinson et al., JAMA 1997)How to Stop Saying “Um,” “Ah,” and “You Know” Harvard Business ReviewListen to the full episode with Dr. Rahul Jandial: https://pod.fo/e/251425
A recent paper published in JAMA shows that Idaho has lost approximately 35 percent of doctors specializing in obstetrics and gynecology, leaving many counties without any maternal or reproductive health care providers at all. That comes after the state passed one of the most restrictive abortion bans in the country after the U.S. Supreme Court overturned Roe v. Wade in 2022. Amber Nelson, executive director of the Idaho Coalition for Safe Healthcare, says 85% of these practicing specialists work in just seven of the state’s urban counties. Dr. Amelia Huntsberger was a practicing OBGYN in Idaho for many years before the ban. But after the ban, the emotional strain of navigating patient care amid the possibility of prosecution, led to the painful decision to uproot her family and move out of state. Huntsberger now practices in Eugene, but she says her family still deals with the grief that transition brought. We talk with her and Nelson about the larger trends and what they mean in the lives of women seeking reproductive and material care.
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-445 Overview: Managing knee osteoarthritis (OA) in patients with obesity can be challenging, especially when standard treatments fall short. In this episode, we discuss emerging evidence on the use of metformin to reduce knee pain in patients without diabetes and explore how this option could expand your approach to OA management. Episode resource links: Pan F, Wang Y, Lim YZ, et al. Metformin for Knee Osteoarthritis in Patients With Overweight or Obesity: A Randomized Clinical Trial. JAMA. 2025;333(20):1804-1812. Guest: Alan M. Ehrlich, MD, FAAFP Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com
Send us a textIn this episode of Causes or Cures, Dr. Eeks chats with Dr. Jerry Avorn, a Professor of Medicine at Harvard Medical School, drug safety watchdog, and author of Rethinking Medications: Truth, Power, and the Drugs You Take. If you've ever felt uneasy about the rising cost of prescription drugs, the process or speed by which new meds are approved, or why the side effects list is longer than your grocery receipt, this episode is for you.Dr. Avorn pulls no punches. We talk about:How our current system rewards speed over evidence, and why “accelerated approval” may sound good but can lead to disaster.The rise of drugs approved with weak or surrogate endpoints, yet priced like gold (yep, you still pay full price for half-baked science).Shocking case studies, like the Vioxx heart attack debacle and the controversial Alzheimer's drug Aduhelm.The FDA's evolution from watchdog to lapdog (in some cases).Conflicts of interest.Public funding, private profits: how taxpayer money fuels breakthroughs that we can't afford. (WTF!)And, yes, we talk about the “Do Your Own Research” crowd.Dr. Avorn's mission? Help patients and doctors actually understand what they're taking or prescribing, and what forces are shaping those decisions.Why listen?Because behind every pill is a story, and it's not always the one you're told in the ad with the beach scene and happy jazz flute.Links:Grab the book: Rethinking Medications: Truth, Power, and the Drugs You Take (Simon & Schuster, 2025)Jerry Avorn, MD, is a professor of medicine at Harvard Medical School and a senior internist in the Mass General Brigham health-care system. He built a leading research center at Harvard to study medication use, outcomes, costs, and policies and developed the educational approach of “academic detailing” to provide evidence-based information about medications to prescribers. One of the nation's most highly cited researchers, Dr. Avorn is the author of Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs, and he has written or cowritten over six hundred papers in the medical literature as well as commentaries in the New York Times, The Washington Post, JAMA, and The New England Journal of Medicine.You can contact Dr. Eeks at bloomingwellness.com.Follow Eeks on Instagram here.Or Facebook here.Or X.On Youtube.Or TikTok.SUBSCRIBE to her monthly newsletter here! (Now featuring interviews with top experts on health you care about!)Support the show
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-445 Overview: Managing knee osteoarthritis (OA) in patients with obesity can be challenging, especially when standard treatments fall short. In this episode, we discuss emerging evidence on the use of metformin to reduce knee pain in patients without diabetes and explore how this option could expand your approach to OA management. Episode resource links: Pan F, Wang Y, Lim YZ, et al. Metformin for Knee Osteoarthritis in Patients With Overweight or Obesity: A Randomized Clinical Trial. JAMA. 2025;333(20):1804-1812. Guest: Alan M. Ehrlich, MD, FAAFP Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com
Welcome to the Choosing Wisely Campaign series! This is the fourth episode of a 5-part series exploring the ABIM Foundation's Choosing Wisely Lists. This campaign aims to promote conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures. Our third case-based episode presents a child with fever and cough. After a clear discussion of the case and thoughtful consideration of the etiology and treatment strategies, we use the AAP's Choosing Wisely Hospital Medicine and Infectious Diseases lists to create a resource-conscious care plan that is safe and patient-centered. In the coming episodes, we'll explore the pediatric lists and apply our knowledge to cases of common presentations seen in primary and acute care pediatrics. Series Learning Objectives: Introduction to the Choosing Wisely Campaign: Understand the origins, historical precedent, and primary goals of the campaign. Case-Based Applications: Explore five common presentations in primary and acute care pediatrics, applying concepts from various Choosing Wisely lists to guide management and resource stewardship. Effective Communication: Learn strategies for engaging in tough conversations with parents and colleagues to create allies and ensure evidence-based practices are followed. Modified rMETRIQ Score: 14/15 Competencies: AACN Essentials: 1: 1.1 g; 1.2 f; 1.3 d, e 2: 2.1 d, e; 2.2 g; 2.4 f, g; 2.5 h, i, j, k 7: 7.2 g, h, k 9: 9.1i, j; 9.2 i, j; 9.3 i, k NONPF NP Core Competencies: 1: NP 1.1h; NP 1.2 k, m; NP 1.3 f, j, h 2: NP 2.1 j, g; NP 2.2 k, n; NP 2.4 h, i; NP 2.5 k, l, m, n, o 7: NP 7.2 m 9: NP 9.1 m, n; NP 9.2 n; NP 9.3 p References ABIM Foundation. (2019). Communicating about overuse with vulnerable populations. Retrieved from https://www.choosingwisely.org/files/Communicating-About-Overuse-to-Vulnerable-Population_Final2.pdf American Academy of Pediatrics [AAP] Committee on Infectious Diseases & Pediatric Infectious Diseases Society. (2018). Five things physicians and patients should question. Retrieved from https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWInfectiousDisease.pdf de Benedictis, F. M., Kerem, E., Chang, A. B., Colin, A. A., Zar, H. J., & Bush, A. (2020). Complicated pneumonia in children. Lancet (London, England), 396(10253), 786–798. https://doi.org/10.1016/S0140-6736(20)31550-6 Kato, H. (2024) Antibiotic therapy for bacterial pneumonia. J Pharm Health Care Sci 10, 45. https://doi.org/10.1186/s40780-024-00367-5 Schlapbach, L. J., Watson, R. S., Sorce, L. R., Argent, A. C., Menon, K., Hall, M. W., Akech, S., Albers, D. J., Alpern, E. R., Balamuth, F., Bembea, M., Biban, P., Carrol, E. D., Chiotos, K., Chisti, M. J., DeWitt, P. E., Evans, I., Flauzino de Oliveira, C., Horvat, C. M., Inwald, D., … Society of Critical Care Medicine Pediatric Sepsis Definition Task Force (2024). International Consensus Criteria for Pediatric Sepsis and Septic Shock. JAMA, 331(8), 665–674. https://doi.org/10.1001/jama.2024.0179 Smith, D. K., Kuckel, D. P., & Recidoro, A. M. (2021). Community-Acquired Pneumonia in Children: Rapid Evidence Review. American family physician, 104(6), 618–625. Society of Hospital Medicine, AAP, & Academic Pediatric Association. (2021). Five things physicians and patients should question. Retrieved from https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWHospitalmedicine.pdf Yun K. W. (2024). Community-acquired pneumonia in children: updated perspectives on its etiology, diagnosis, and treatment. Clinical and experimental pediatrics, 67(2), 80–89. https://doi.org/10.3345/cep.2022.01452
...we enter the 18th year of the "Risin' " sessions - and amongst the nu-choon pressure, I begin the broken beats and nu-jazz section with a little tribute to the late Harold Matthews, Jr., aka Blak Beat Niks...2 hours of soulful, deep and broken pleasure is right here - enjoy!!Track-listing: Jazzanova feat. Clara Hill - No Use (Crackazat Remix)Luther Johnson - Backdoor Man (Yoruba Soul Mix)Louis Baker - Keep On (Philippa's Don't Lose The Fire Mix)Thierry Tomas - Life's GreatRochelle Jordan - Through The Wall (Extended Mix)Arnold Jarvis - Love Is Beautiful (Franke Estevez FUZION ClubMixed Alt Vox)Josh Milan - Starlight (Honeycomb Club Dub Mix)Rochelle Fleming - Balls 2 Bounce (Terry Hunter Main Mix)Babs Presents - A Unique Party (Unique Rhythm Soulful Mix)DJ Umbi & Jama feat. Peter Anguria - I See The Light (Original Mix)Blak Beat Niks - Celebration (Midnight Jazz Mix)Jill Scott – Golden MoneyD'Moov feat. Nicole Henry - For The Love Of You (Doruk Ozlen Reprise)Rednose Distrikt feat. Raffaela Herbert & Andy Bereboot – FlyButti 49 feat. Emo – FlyingRednose Distrikt feat. Lady Alma – Gotta Make A Move (DJ Spinna & Mark De Clive-Lowe Remix)Conway Kasey - MyrrrMERLIN BOBB - N UR EYES (Vocal Remix)Luis Radio & Fabrizio Monaco - Much More (Original Mix)Kyra, Cash Only & China Charmeleon - Holy Water (Extended Mix) …and here's the download link: https://www.sendspace.com/file/v3c1it…as always, thanks to all who locked on…
Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief, and Preeti Malani, MD, MSJ, Deputy Editor of JAMA, the Journal of the American Medical Association, for articles published from August 2-8, 2025.
REDIFF - Le chanteur iconique Bob Marley est décédé il y a un peu plus de 40 ans. Après avoir vendu 77 millions d'albums, sa voix continue de résonner partout dans le monde. Il a permis à la musique reggae d'être connue partout, mais il est surtout devenu un prophète pour les Jamaïcains. Un statut qui lui aura presque coûté la vie. Que se cache-t-il vraiment derrière la légende Bob Marley ? Confidentiel lève le voile sur un mythe pas comme les autres. Pour en parler, Ophélie Meunier reçoit un invité exceptionnel : Ziggy Marley, fils de Bob Marley et producteur du biopic "Bob Marley: One Love".Hébergé par Audiomeans. Visitez audiomeans.fr/politique-de-confidentialite pour plus d'informations.
Dr. Ed Livingston, renowned surgeon, educator, and researcher, who was a former deputy editor at JAMA, found himself out of a job after a JAMA podcast he hosted with Dr. Mitch Katz that discussed, among other items, structural racism as a contributor to the high mortality in minorities from COVID. This incident led to a series of lawsuits, some of which were highly publicized. Ed shares behind the scenes events, incidents, and what transpired in 2021, and how the AMA handled the situation. In this episode, Ed shares his background, career path, passion for education and medicine, and his disappointment at how everything was handled by the AMA. This is a rare discussion with some information being shared for the first time ever with listeners and viewers. The AMA declined the request to comment and provide their side of the story. Superior court ruling Livingston v AMA (AMA declares that physicians not entitled to due process, rules that the AMA committed libel and defamation): https://rulings.law/rulings/judge-curtis-a-kin/22stcv09441-2022-10-13.html Unanimous Appellate decision regarding libel and defamation by the AMA, Adds an additional finding of false light and invasion of privacy https://www4.courts.ca.gov/opinions/nonpub/B324638.PDF X post summarizing the Appellate decision (the court refers to the AMA as disingenuous): https://x.com/ehlJAMA/status/1852551140799291817 Article summarizing the Appellate decision (““[d]rawing all reasonable inferences in his favor, Livingston has made a prima facie case that the gist or sting of the accusation in statement [that the podcast ‘denied the existence of structural racism in medicine,' was not true.”): http://www.metnews.com/articles/2024/defamation_11042024.htm Court orders Livingston to pay $110,000 to AMA despite his prevailing on the key allegations: https://rulings.law/rulings/judge-joseph-lipner/22stcv09441-2025-04-08.html Article from the lawyer representing the AMA declaring that the process the AMA used against Livingston is abused “the widely abused anti-SLAPP statute.”: https://www.law.com/therecorder/2019/06/03/calif-high-court-ruling-good-news-for-defamation-plaintiffs/?slreturn=20250722074004 X post with links to the various rulings: https://x.com/ehlJAMA/status/1913584194405425374 Check out Chadi's website for all Healthcare Unfiltered episodes and other content. www.chadinabhan.com/ Watch all Healthcare Unfiltered episodes on YouTube. www.youtube.com/channel/UCjiJPTpIJdIiukcq0UaMFsA
Interview with Sameer Jauhar, PhD, author of Incidence and Nature of Antidepressant Discontinuation Symptoms: A Systematic Review and Meta-Analysis. Hosted by John Torous, MD. Related Content: Incidence and Nature of Antidepressant Discontinuation Symptoms
Send us a textDescription: An immersive reading of The Roses by Seth Peterson with reflection on boundaries, aging and decline. Website:https://anauscultation.wordpress.comWork:Peterson S. The Roses. JAMA. 2025;333(16):1461. https://jamanetwork.com/journals/jama/article-abstract/2832004 Seth Peterson: Bluesky: @drsethPTX: @sethpeterson.bsky.social
As the Trump administration works to reimagine public health, a new study paints a stark picture of the challenges facing the nation’s kids. American children’s health has significantly worsened across several key indicators since 2007, according to a recent study published in JAMA. Ali Rogin speaks with Dr. Christopher Forrest, a pediatrician and one of the study’s lead authors, for more. PBS News is supported by - https://www.pbs.org/newshour/about/funders
As the Trump administration works to reimagine public health, a new study paints a stark picture of the challenges facing the nation’s kids. American children’s health has significantly worsened across several key indicators since 2007, according to a recent study published in JAMA. Ali Rogin speaks with Dr. Christopher Forrest, a pediatrician and one of the study’s lead authors, for more. PBS News is supported by - https://www.pbs.org/newshour/about/funders
Editor's Summary by Linda Brubaker, MD, and Preeti Malani, MD, MSJ, Deputy Editors of JAMA, the Journal of the American Medical Association, for articles published from July 26-August 1, 2025.
Today, we're diving into a condition that's as fascinating as it is complex: Achalasia—where the esophagus stops playing nice, and swallowing becomes a daily challenge. We're breaking down the latest evidence, comparing POEM, pneumatic dilation, and Heller myotomy, and digging into what actually matters when deciding how to treat each achalasia subtype. Join show hosts Drs. Jake Greenberg, Dana Portenier, Zach Weitzner, and Joey Lew as they discuss the past, present, and future of Achalasia management. Whether you're a medical student or a seasoned attending, this episode will arm you with the tools to think critically about diagnosis, tailor your treatment strategy, and stay ahead of the curve on the future of achalasia care. Hosts: · Jacob Greenberg, MD, EdM, MIS Division Chief and Vice Chair for Education, Duke University · Dana Portenier, MD, MIS Fellowship Director, Duke University · Zachary Weitzner, MD, Minimally Invasive and Bariatric Surgery Fellow, Duke University, @ZachWeitznerMD · Joey Lew, MD, MFA, Surgical resident PGY-3, Duke University, @lew__actually Learning Goals: By the end of this episode, listeners will be able to: · Describe the pathophysiology and key diagnostic criteria for achalasia, including the role of manometry, EGD, and esophagram. · Differentiate between the three subtypes of achalasia based on the Chicago Classification and understand the clinical significance of each. · Compare treatment options for achalasia—pneumatic dilation, Lap Heller myotomy, and POEM—including indications, efficacy, and long-term outcomes. · Interpret landmark studies (e.g., European Achalasia Trial, JAMA POEM trial) and their impact on treatment decision-making. · Recognize patient-specific factors (age, comorbidities, achalasia subtype) that influence the choice of therapy. · Discuss evolving technologies and future directions in achalasia management, including endoluminal robotics, ARMS, and combined anti-reflux strategies. · Outline a basic treatment algorithm for newly diagnosed achalasia, incorporating diagnostic steps and tailored interventions. · Appreciate the multidisciplinary approach to achalasia care, including the roles of MIS surgeons, gastroenterologists, and emerging procedural skillsets. References: · Boeckxstaens G, Elsen S, Belmans A, Annese V, Bredenoord AJ, Busch OR, Costantini M, Fumagalli U, Smout AJPM, Tack J, Vanuytsel T, Zaninotto G, Salvador R; European Achalasia Trial Investigators. 10‑year follow-up results of the European Achalasia Trial: a multicentre randomised controlled trial comparing pneumatic dilation with laparoscopic Heller myotomy. Gut. 2024 Mar;73(4):582‑589. doi: 10.1136/gutjnl‑2023‑331374. PMID: 38050085 https://pubmed.ncbi.nlm.nih.gov/38050085/ · He J, Yin Y, Tang W, Jiang J, Gu L, Yi J, Yan L, Chen S, Wu Y, Liu X. Objective Outcomes of an Extended Anti‑reflux Mucosectomy in the Treatment of PPI‑Dependent Gastroesophageal Reflux Disease (with Video). J Gastrointest Surg. 2022 Aug;26(8):1566–1574. doi:10.1007/s11605‑022‑05396‑9. PMID: 35776296 https://pubmed.ncbi.nlm.nih.gov/35776296/ · Modayil RJ, Zhang X, Rothberg B, et al. Peroral endoscopic myotomy: 10-year outcomes from a large, single-center U.S. series with high follow-up completion and comprehensive analysis of long-term efficacy, safety, objective GERD, and endoscopic functional luminal assessment. Gastrointest Endosc. 2021;94(5):930-942. doi:10.1016/j.gie.2021.05.014. PMID: 33989646. https://pubmed.ncbi.nlm.nih.gov/33989646/ · Ponds FA, Fockens P, Lei A, Neuhaus H, Beyna T, Kandler J, Frieling T, Chiu PWY, Wu JCY, Wong VWY, Costamagna G, Familiari P, Kahrilas PJ, Pandolfino JE, Smout AJPM, Bredenoord AJ. Effect of peroral endoscopic myotomy vs pneumatic dilation on symptom severity and treatment outcomes among treatment-naive patients with achalasia: a randomized clinical trial. JAMA. 2019 Jul 9;322(2):134–144. doi:10.1001/jama.2019.8859. PMID: 31287522. https://pubmed.ncbi.nlm.nih.gov/31287522/ · Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT; ACG Clinical Guidelines Committee. ACG clinical guidelines: Diagnosis and management of achalasia. Am J Gastroenterol. 2020 Sep;115(9):1393–1411. doi:10.14309/ajg.0000000000000731. PMID: 32773454; PMCID: PMC9896940 https://pubmed.ncbi.nlm.nih.gov/32773454/ · West RL, Hirsch DP, Bartelsman JF, de Borst J, Ferwerda G, Tytgat GN, Boeckxstaens GE. Long term results of pneumatic dilation in achalasia followed for more than 5 years. Am J Gastroenterol. 2002;97(6):1346-1351. doi:10.1111/j.1572-0241.2002.05771.x. PMID:12094848. https://pubmed.ncbi.nlm.nih.gov/12094848/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Interview with Jennifer M. Johnson, MD, PhD and Adam J. Luginbuhl, MD authors of A Pathologic Treatment Effect and Survival in HPV-Negative HNSCC Following Neoadjuvant Nivolumab. Hosted by Paul C. Bryson, MD MBA. Related Content: Pathologic Treatment Effect and Survival in HPV-Negative HNSCC Following Neoadjuvant Nivolumab Emerging Role of Pathologic Response in Head and Neck Squamous Cell Carcinoma Immunotherapy
A new NEJM trial found methotrexate offers similar lung function improvements as prednisone in pulmonary sarcoidosis, but with fewer side effects—suggesting it could be a safer first-line option for some patients. A JAMA study revealed that patients trust physicians less when AI is mentioned in care ads, highlighting the importance of framing AI as a tool that supports—not replaces—clinical judgment. Another NEJM trial showed that giving take-home ondansetron to children after ED visits for gastroenteritis significantly reduced vomiting and return visits, with no added risks. Together, these studies support a shift toward individualized care, better patient communication, and practical interventions to improve outcomes.
Send us a Text Message (please include your email so we can respond!)Episode 70! In this episode we have a special guest, Wes Ely, join us to talk about A2B or "Dexmedetomidine- or Clonidine-Based Sedation Compared With Propofol in Critically Ill Patients" by Walsh et al published in JAMA May of 2025. A long discussion but a good one, don't miss this one!Pubmed: https://pubmed.ncbi.nlm.nih.gov/40388916/JAMA: https://jamanetwork.com/journals/jama/article-abstract/2834276Editorial: https://jamanetwork.com/journals/jama/article-abstract/2834277If you enjoy the show be sure to like and subscribe, leave that 5 star review! Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!
Contributor: Taylor Lynch, MD Educational Pearls: Dilutional Hyponatremia: Occurs when there is an excess of free water relative to sodium in the body. Causes a falsely low sodium concentration without a true change in total body sodium. Commonly seen in DKA: Hyperglycemia raises plasma osmolality. Water shifts from the intracellular to extracellular space. This dilutes serum sodium, creating apparent hyponatremia. Corrected sodium calculation: Use tools like MDCALC, or apply this formula: Add 1.6 mEq/L to the measured sodium for every 100 mg/dL increase in glucose above 100. Clinical relevance: Considering corrected sodium in DKA is crucial, as the lab value may not be reflective of actual sodium depletion. True severe hyponatremia can lead to complications like seizures May require treatment with hypertonic saline. References: Fulop M. Acid–base problems in diabetic ketoacidosis. Am J Med Sci. 2008;336(4):274-276. doi:10.1097/MAJ.0b013e318180f478 Palmer BF, Clegg DJ. Electrolyte and Acid–Base Disturbances in Patients with Diabetes Mellitus. N Engl J Med. 2015;373(6):548-559. doi:10.1056/NEJMra1503102 Spasovski G, Vanholder R, Allolio B, et al. Diagnosis and management of hyponatremia: a review. JAMA. 2014;312(24):2640–2650. doi:10.1001/jama.2014.13773 Summarized by Ashley Lyons, OMS3 | Edited by Ashley Lyons & Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/
In this episode, we focus on the history of researchers discovering the clinical applicability of the IL 23/17 axis, with a particular emphasis on psoriasis, psoriatic arthritis and axial SpA · Intro 0:01 · In this episode 0:12 · Leonard Calabrese, DO, is listening! 0:54 · Recap of last episode 3:09 · Putting the pieces together 5:12 · Quick overview of this science heavy episode 6:11 · What is psoriasis? 7:26 · Immunosuppressants for psoriasis/ Throwing meds at people and seeing what happens 10:10 · In the modern world of 1986 – olive oil placebo trial 11:36 · A quick aside into fungi 12:35 · What kind of T-cells are involved here? 16:41 · The TH-1 hypothesis 18:20 · IL-23 and IL-17 are doing something 19:34 · Going back to the drawing board in 2004 20:00 · p40 + p19 = IL-23 21:00 · IL-23 via minicircle DNA in mice 23:05 · Brand new and shiny TH-17 25:23 · The family of IL-17 26:36 · What do we know about IL-17 and psoriasis? 27:10 · IL-17A vs IL-17F in mouse studies 27:35 · Finding the difference between IL-17A and IL-17F in humans 28:23 · What exactly is IL-17 doing? 29:30 · The articular manifestations of psoriatic arthritis 30:57 · Spondylarthritis and the IL 23/17 axis 33:56 · T-cells we haven't talked about 35:40 · Summary of this episode 39:08 · Thanks for listening 41:34 We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. References: Bashyam H. J Exp Med. 2007;doi:10.1084/jem.2042fta Bjerke R J. Acta Derm Venereol. 1982;PMID:6179355 Cargill M, et al. Am J Hum Genet. 2007;doi:10.1086/511051 Chan J R, et al. J Exp Med. 2006;doi:10.1084/jem.20060244 Cuthbert R J, et al. Ann Rheum Dis. 2019;doi:10.1136/annrheumdis-2019-215210 Ellis C N, et al. JAMA. 1986;doi:10.1001/jama.1986 Ettehadi P, et al. Clin Exp Immunol. 1994;doi:10.1111/j.1365-2249.1994.tb06244.x Furue M, et al. Int J Mol Sci. 2020;doi:10.3390/ijms21041275 Gooderham M J, et al. J Eur Acad Dermatol Venereol. 2018;doi:10.1111/jdv.14868 Lee E, et al. J Exp Med. 2004;doi:10.1084/jem.20030451 Leonardi C L, et al. Lancet. 2008;doi:10.1016/S0140-6736(08)60725-4 Mease P J, et al. Lancet. 2000;doi:10.1016/S0140-6736(00)02530-7 Menon B, et al. Arthritis Rheumatol. 2014;doi:10.1002/art.38376 Moos S, et al. J Invest Dermatol. 2019;doi:10.1016/j.jid.2019.01.006 Muelle W, et al. N Engl J Med. 1979;doi:10.1056/NEJM197909063011016 Papp K A, et al. Lancet. 2008;doi:10.1016/S0140-6736(08)60726-6 Reinhardt A, et al. Arthritis Rheumatol. 2016;doi:10.1002/art.39732 Sherlock J P, et al. Nat Med. 2012;doi:10.1038/nm.2817 Tribe H T. Mycologist. 1998;doi:10.1016/S0269-915X(98)80100-6 Yawalkar N, et al. J Invest Dermatol. 1998;doi:10.1046/j.1523-1747.1998.00446.x Zaba L C, et al. J Allergy Clin Immunol. 2009;doi:10.1016/j.jaci.2009.08.046 Disclosures: Brown reports no relevant financial disclosures.
Interview with Dennis J. Rivet II, MD, author of GLP-1 Receptor Agonists in Idiopathic Intracranial Hypertension. Hosted by Cynthia E. Armand, MD. Related Content: GLP-1 Receptor Agonists in Idiopathic Intracranial Hypertension
The incidence of early onset colorectal cancer (EOCRC) has been rising prompting the change in change in screening guidelines to 45 years of age for average risk patients. Join us for an in-depth discussion with guest speakers Dr. Andrea Cercek and Dr. Nancy You, where we provide a comprehensive look at the growing challenge of EOCRC. Hosts: - Dr. Janet Alvarez - General Surgery Resident at New York Medical College/Metropolitan Hospital Center - Dr. Wini Zambare – General Surgery Resident at Weill Cornell Medical Center/New York Presbyterian - Dr. Phil Bauer, Graduating Colorectal Surgical Oncology Fellow at Memorial Sloan Kettering Cancer Center - Dr. J. Joshua Smith MD, PhD, Chair, Department of Colon and Rectal Surgery at MD Anderson Cancer Center - Dr. Andrea Cercek - Gastrointestinal Medical Oncologist at Memorial Sloan Kettering Cancer Center - Dr. Y. Nancy You, MD MHSc - Professor, Department of Colon and Rectal Surgery at MD Anderson Cancer Center Learning objectives: - Describe trends in incidence of colorectal cancer, with emphasis on the rise of EOCRC. - Identify age groups and demographics most affected by EOCRC. - Summarize USPSTF recommendations for colorectal cancer screening. - Distinguish between screening methods (e.g., colonoscopy, FIT-DNA) and their sensitivity. - Understand treatment approaches for colon and rectal cancer (CRC) - Understand the role of mismatch repair (MMR) status in guiding treatment. - Outline the importance of genetic counseling and testing in young patients. - Discuss racial, ethnic, and socioeconomic disparities in CRC incidence and outcomes. - Describe the impact of cancer treatment on fertility and sexual health. - Review fertility preservation options. - Identify the value of integrated care teams for young CRC patients. References: 1. Siegel, R. L. et al. Colorectal Cancer Incidence Patterns in the United States, 1974–2013. JNCI J. Natl. Cancer Inst. 109, djw322 (2017). https://pubmed.ncbi.nlm.nih.gov/28376186/ 2. Abboud, Y. et al. Rising Incidence and Mortality of Early-Onset Colorectal Cancer in Young Cohorts Associated with Delayed Diagnosis. Cancers 17, 1500 (2025). https://pubmed.ncbi.nlm.nih.gov/40361427/ 3. Phang, R. et al. Is the Incidence of Early-Onset Adenocarcinomas in Aotearoa New Zealand Increasing? Asia Pac. J. Clin. Oncol.https://pubmed.ncbi.nlm.nih.gov/40384533/ 4. Vitaloni, M. et al. Clinical challenges and patient experiences in early-onset colorectal cancer: insights from seven European countries. BMC Gastroenterol. 25, 378 (2025). https://pubmed.ncbi.nlm.nih.gov/40375142/ 5. Siegel, R. L. et al. Global patterns and trends in colorectal cancer incidence in young adults. (2019) doi:10.1136/gutjnl-2019-319511. https://pubmed.ncbi.nlm.nih.gov/31488504/ 6. Cercek, A. et al. A Comprehensive Comparison of Early-Onset and Average-Onset Colorectal Cancers. J. Natl. Cancer Inst. 113, 1683–1692 (2021). https://pubmed.ncbi.nlm.nih.gov/34405229/ 7. Zheng, X. et al. Comprehensive Assessment of Diet Quality and Risk of Precursors of Early-Onset Colorectal Cancer. JNCI J. Natl. Cancer Inst. 113, 543–552 (2021). https://pubmed.ncbi.nlm.nih.gov/33136160/ 8. Standl, E. & Schnell, O. Increased Risk of Cancer—An Integral Component of the Cardio–Renal–Metabolic Disease Cluster and Its Management. Cells 14, 564 (2025). https://pubmed.ncbi.nlm.nih.gov/40277890/ 9. Muller, C., Ihionkhan, E., Stoffel, E. M. & Kupfer, S. S. Disparities in Early-Onset Colorectal Cancer. Cells 10, 1018 (2021). https://pubmed.ncbi.nlm.nih.gov/33925893/ 10. US Preventive Services Task Force. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 325, 1965–1977 (2021). https://pubmed.ncbi.nlm.nih.gov/34003218/ 11. Fwelo, P. et al. Differential Colorectal Cancer Mortality Across Racial and Ethnic Groups: Impact of Socioeconomic Status, Clinicopathology, and Treatment-Related Factors. Cancer Med. 14, e70612 (2025). https://pubmed.ncbi.nlm.nih.gov/40040375/ 12. Lansdorp-Vogelaar, I. et al. Contribution of Screening and Survival Differences to Racial Disparities in Colorectal Cancer Rates. Cancer Epidemiol. Biomarkers Prev. 21, 728–736 (2012). https://pubmed.ncbi.nlm.nih.gov/22514249/ 13. Ko, T. M. et al. Low neighborhood socioeconomic status is associated with poor outcomes in young adults with colorectal cancer. Surgery 176, 626–632 (2024). https://pubmed.ncbi.nlm.nih.gov/38972769/ 14. Siegel, R. L., Wagle, N. S., Cercek, A., Smith, R. A. & Jemal, A. Colorectal cancer statistics, 2023. CA. Cancer J. Clin. 73, 233–254 (2023). https://pubmed.ncbi.nlm.nih.gov/36856579/ 15. Jain, S., Maque, J., Galoosian, A., Osuna-Garcia, A. & May, F. P. Optimal Strategies for Colorectal Cancer Screening. Curr. Treat. Options Oncol. 23, 474–493 (2022). https://pubmed.ncbi.nlm.nih.gov/35316477/ 16. Zauber, A. G. The Impact of Screening on Colorectal Cancer Mortality and Incidence: Has It Really Made a Difference? Dig. Dis. Sci. 60, 681–691 (2015). https://pubmed.ncbi.nlm.nih.gov/25740556/ 17. Edwards, B. K. et al. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 116, 544–573 (2010). https://pubmed.ncbi.nlm.nih.gov/19998273/ 18. Cercek, A. et al. Nonoperative Management of Mismatch Repair–Deficient Tumors. New England Journal of Medicine 392, 2297–2308 (2025). https://pubmed.ncbi.nlm.nih.gov/40293177/ 19. Monge, C., Waldrup, B., Carranza, F. G. & Velazquez-Villarreal, E. Molecular Heterogeneity in Early-Onset Colorectal Cancer: Pathway-Specific Insights in High-Risk Populations. Cancers 17, 1325 (2025). https://pubmed.ncbi.nlm.nih.gov/40282501/ 20. Monge, C., Waldrup, B., Carranza, F. G. & Velazquez-Villarreal, E. Ethnicity-Specific Molecular Alterations in MAPK and JAK/STAT Pathways in Early-Onset Colorectal Cancer. Cancers 17, 1093 (2025). https://pubmed.ncbi.nlm.nih.gov/40227607/ 21. Benson, A. B. et al. Colon Cancer, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J. Natl. Compr. Cancer Netw. JNCCN 19, 329–359 (2021). https://pubmed.ncbi.nlm.nih.gov/33724754/ 22. Christenson, E. S. et al. Nivolumab and Relatlimab for the treatment of patients with unresectable or metastatic mismatch repair proficient colorectal cancer. https://pubmed.ncbi.nlm.nih.gov/40388545/ 23. Dasari, A. et al. Fruquintinib versus placebo in patients with refractory metastatic colorectal cancer (FRESCO-2): an international, multicentre, randomised, double-blind, phase 3 study. The Lancet 402, 41–53 (2023). https://pubmed.ncbi.nlm.nih.gov/37331369/ 24. Strickler, J. H. et al. Tucatinib plus trastuzumab for chemotherapy-refractory, HER2-positive, RAS wild-type unresectable or metastatic colorectal cancer (MOUNTAINEER): a multicentre, open-label, phase 2 study. Lancet Oncol. 24, 496–508 (2023). https://pubmed.ncbi.nlm.nih.gov/37142372/ 25. Sauer, R. et al. Preoperative versus Postoperative Chemoradiotherapy for Rectal Cancer. N. Engl. J. Med. 351, 1731–1740 (2004). https://pubmed.ncbi.nlm.nih.gov/15496622/ 26. Cercek, A. et al. Adoption of Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer. JAMA Oncol. 4, e180071 (2018). https://pubmed.ncbi.nlm.nih.gov/29566109/ 27. Garcia-Aguilar, J. et al. Organ Preservation in Patients With Rectal Adenocarcinoma Treated With Total Neoadjuvant Therapy. J. Clin. Oncol. 40, 2546–2556 (2022). https://pubmed.ncbi.nlm.nih.gov/35483010/ 28. Schrag, D. et al. Preoperative Treatment of Locally Advanced Rectal Cancer. N. Engl. J. Med. 389, 322–334 (2023). https://pubmed.ncbi.nlm.nih.gov/37272534/ 29. Kunkler, I. H., Williams, L. J., Jack, W. J. L., Cameron, D. A. & Dixon, J. M. Breast-Conserving Surgery with or without Irradiation in Early Breast Cancer. N. Engl. J. Med. 388, 585–594 (2023). https://pubmed.ncbi.nlm.nih.gov/36791159/ 30. Jacobsen, R. L., Macpherson, C. F., Pflugeisen, B. M. & Johnson, R. H. Care Experience, by Site of Care, for Adolescents and Young Adults With Cancer. JCO Oncol. Pract. (2021) doi:10.1200/OP.20.00840. https://pubmed.ncbi.nlm.nih.gov/33566700/ 31. Ruddy, K. J. et al. Prospective Study of Fertility Concerns and Preservation Strategies in Young Women With Breast Cancer. J. Clin. Oncol. (2014) doi:10.1200/JCO.2013.52.8877. https://pubmed.ncbi.nlm.nih.gov/24567428/ 32. Su, H. I. et al. Fertility Preservation in People With Cancer: ASCO Guideline Update. J. Clin. Oncol. 43, 1488–1515 (2025). https://pubmed.ncbi.nlm.nih.gov/40106739/ 33. Smith, K. L., Gracia, C., Sokalska, A. & Moore, H. Advances in Fertility Preservation for Young Women With Cancer. Am. Soc. Clin. Oncol. Educ. Book 27–37 (2018) doi:10.1200/EDBK_208301. https://pubmed.ncbi.nlm.nih.gov/30231357/ 34. Blumenfeld, Z. How to Preserve Fertility in Young Women Exposed to Chemotherapy? The Role of GnRH Agonist Cotreatment in Addition to Cryopreservation of Embrya, Oocytes, or Ovaries. The Oncologist 12, 1044–1054 (2007). 35. Bhagavath, B. The current and future state of surgery in reproductive endocrinology. Curr. Opin. Obstet. Gynecol. 34, 164 (2022). 36. Ribeiro, R. et al. Uterine transposition: technique and a case report. Fertil. Steril. 108, 320-324.e1 (2017). 37. Yazdani, A., Sweterlitsch, K. M., Kim, H., Flyckt, R. L. & Christianson, M. S. Surgical Innovations to Protect Fertility from Oncologic Pelvic Radiation Therapy: Ovarian Transposition and Uterine Fixation. J. Clin. Med. 13, 5577 (2024). 38. Holowatyj, A. N., Eng, C. & Lewis, M. A. Incorporating Reproductive Health in the Clinical Management of Early-Onset Colorectal Cancer. JCO Oncol. Pract. 18, 169–172 (2022). ***Behind the Knife Colorectal Surgery Oral Board Audio Review: https://app.behindtheknife.org/course-details/colorectal-surgery-oral-board-audio-review Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-442 Overview: Listen in as we review the USPSTF's recently proposed recommendations for screening women who are at risk for developing osteoporosis. Gain confidence to navigate these changes and engage patients in shared decision-making to ensure timely, evidence-based preventive care. Episode resource links: JAMA. 2025;333(6):498–508. doi:10.1001/jama.2024.27154 Guest: Robert A. Baldor MD, FAAFP Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com
Send us a textExtended Caffeine for Apnea in Moderately Preterm Infants: The MoCHA Randomized Clinical Trial.Carlo WA, Eichenwald EC, Carper BA, Bell EF, Keszler M, Patel RM, Sánchez PJ, Goldberg RN, D'Angio CT, Van Meurs KP, Hibbs AM, Ambalavanan N, Cosby SS, Newman NS, Vohr BR, Walsh MC, Das A, Ohls RK, Fuller J, Rysavy MA, Ghavam S, Brion LP, Puopolo KM, Moore R, Baack ML, Colaizy TT, Baserga M, Osman AF, Merhar SL, Poindexter BB, DeMauro SB, Kumar V, Cotten CM; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.JAMA. 2025 Jun 24;333(24):2154-2163. doi: 10.1001/jama.2025.5791.PMID: 40294395 Clinical Trial.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Guest host Jefferey Jaxen is joined by Dr. Pete Chambers, John Chase Taylor, and disaster recovery expert Steve Slepcevic to unpack the catastrophic flooding in Central Texas. Geoengineering researcher Jim Lee weighs in on the controversial debate around weather modification.The Jaxen Report dives into Congress's vaccine injury hearings, a new JAMA study showing a rise in chronic childhood illness, RFK Jr.'s defunding of GAVI, the FDA's mixed messaging on myocarditis and Moderna approval for kids, and growing concerns over fluoride, PFAS, and other hidden toxic exposures.Investigative journalist Alex Newman closes out the show with a deep dive into the rapid advance of AI, the transhumanist agenda, and the global control systems driving this digital transformation.Guests: Dr. Pete Chambers, Steve Slepcevic, John Chase Taylor, Jim Lee, Alex NewmanBecome a supporter of this podcast: https://www.spreaker.com/podcast/the-highwire-with-del-bigtree--3620606/support.
Summary In this episode of Armed American Radio, host Mark Walters discusses the ongoing fight for Second Amendment rights, focusing on the increasing involvement of medical professionals and associations in gun control debates. The conversation highlights personal experiences with doctors regarding firearms, the financial implications of gun violence, and recent changes in Florida's gun laws. The episode emphasizes the importance of being informed about one's rights and the political landscape surrounding gun ownership. Takeaways The fight for Second Amendment rights is ongoing and multifaceted. Medical associations are increasingly involved in gun control discussions. Personal experiences with doctors can vary significantly regarding firearms. Financial motivations may underlie some medical professionals' anti-gun rhetoric. Florida has made significant changes to its gun laws recently. It's essential to know your doctor's stance on firearms. The NRA plays a crucial role in advocating for gun rights. Legislation can have a direct impact on gun ownership and rights. Understanding the data behind gun violence is critical for informed discussions. Engagement in political processes is necessary to protect Second Amendment rights. Keywords Second Amendment, gun rights, Armed American Radio, medical associations, Florida gun laws, gun violence, NRA, conservative politics, firearms, legislation
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