POPULARITY
10 episodes with jama intern med
8 episodes with jama intern med
9 episodes with jama intern med
6 episodes with jama intern med
8 episodes with jama intern med
4 episodes with jama intern med
2 episodes with jama intern med
2 episodes with jama intern med
2 episodes with jama intern med
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-434 Overview: Is butter back on the menu? This episode breaks down a recent study on butter consumption and mortality risk, examines the origins of saturated fat concerns, and offers patient-centered guidance. Gain practical tools to address outdated nutrition beliefs and guide patients toward realistic, heart-healthy dietary choices rooted in the latest evidence. Episode resource links: JAMA Intern Med. Published online March 6, 2025. doi:10.1001/jamainternmed.2025.0205 PLoS One 2016 Jun 29;11(6):e0158118. doi: 10.1371/journal.pone.0158118 Guest: Robert A. Baldor MD, FAAFP Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com
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-434 Overview: Is butter back on the menu? This episode breaks down a recent study on butter consumption and mortality risk, examines the origins of saturated fat concerns, and offers patient-centered guidance. Gain practical tools to address outdated nutrition beliefs and guide patients toward realistic, heart-healthy dietary choices rooted in the latest evidence. Episode resource links: JAMA Intern Med. Published online March 6, 2025. doi:10.1001/jamainternmed.2025.0205 PLoS One 2016 Jun 29;11(6):e0158118. doi: 10.1371/journal.pone.0158118 Guest: Robert A. Baldor MD, FAAFP Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com
Contributor: Geoff Hogan MD Educational Pearls: Penicillin allergies are relatively uncommon despite their frequent reports 10% of the population reports a penicillin allergy but only 5% of these cases are clinically significant 90-95% of patients may tolerate a rechallenge after appropriate allergy evaluation Penicillin Allergy Decision Rule (PEN-FAST) on MD Calc Useful tool to assess patients for penicillin allergies Five years or less since reaction = 2 points (even if unknown) Anaphylaxis or angioedema OR Severe cutaneous reaction = 2 points Treatment required for reaction (e.g. epinephrine) = 1 point (even if unknown) A score of 0 on PEN-FAST indicates a less than 1% risk of a positive penicillin allergy test A score of 1 or 2 indicates a 5% risk of a positive penicillin allergy test A low score on PEN-FAST should prompt clinicians to proceed with the best empiric antibiotic for the patient's infection References Broyles AD, Banerji A, Barmettler S, et al. Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: Specific Drugs [published correction appears in J Allergy Clin Immunol Pract. 2021 Jan;9(1):603. doi: 10.1016/j.jaip.2020.10.025.] [published correction appears in J Allergy Clin Immunol Pract. 2021 Jan;9(1):605. doi: 10.1016/j.jaip.2020.11.036.]. J Allergy Clin Immunol Pract. 2020;8(9S):S16-S116. doi:10.1016/j.jaip.2020.08.006 Piotin A, Godet J, Trubiano JA, et al. Predictive factors of amoxicillin immediate hypersensitivity and validation of PEN-FAST clinical decision rule [published correction appears in Ann Allergy Asthma Immunol. 2022 Jun;128(6):740. doi: 10.1016/j.anai.2022.04.005.]. Ann Allergy Asthma Immunol. 2022;128(1):27-32. doi:10.1016/j.anai.2021.07.005 Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and Management of Penicillin Allergy: A Review. JAMA. 2019;321(2):188-199. doi:10.1001/jama.2018.19283 Trubiano JA, Vogrin S, Chua KYL, et al. Development and Validation of a Penicillin Allergy Clinical Decision Rule. JAMA Intern Med. 2020;180(5):745-752. doi:10.1001/jamainternmed.2020.0403 Summarized & edited by Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/
When you hear about a big drop in the stock market, do you feel uneasy? Do you consider selling your stocks or not investing any more money right now. That you'll wait until the market starts to recover? If that sounds like you, you need to listen to this podcast episode. I want to encourage you to stay invested. When you deviate from your investment plan due to the performance of the stock market, you are actually practicing market timing, which is a fool game. In this episode, I explain why it's so hard to time the market and why it's better to stay invested, and keep investing according to your financial or investment plan. That was true even with the Great Depression. The big market drop came in 1929 but the stock market didn't hit bit bottom until 1932. People who kept investing in 1930 and 1931 and didn't wait until 1932 ended up with a much higher portfolio by 1942. Current life expectancy in the US of 79.4 years is from https://www.macrotrends.net/global-metrics/countries/usa/united-states/life-expectancy The research study that showed that US male physicians were older when they died compared to male lawyers, other male professionals, and men in general is Frank, Erica et al. Mortality rates and causes among U.S. physicians American Journal of Preventive Medicine, Volume 19, Issue 3, 155 – 159. The Jama paper reporting women physicians have a lower life expectancy compared to male physicians is Patel VR, Liu M, Worsham CM, Stanford FC, Ganguli I, Jena AB. Mortality Among US Physicians and Other Health Care Workers. JAMA Intern Med. Published online February 24, 2025.WPlease subscribe and leave a review on your favorite Podcasting platform. If you want to start your path to financial freedom, start with the Financial Freedom Workbook. Download your free copy today at https://www.GrowYourWealthyMindset.com/fiworkbook You can learn more about Elisa at her website or follow her on social media. Website: https://ww.GrowYourWealthyMindset.com Instagram https://www.instagram.com/GrowYourWealthyMindset Facebook https://www.facebook.com/ElisaChiang https://www.facebook.com/GrowYourWealthyMindset YouTube: https://www.youtube.com/c/WealthyMindsetMD Linked In: www.linkedin.com/in/ElisaChiang Disclaimer: The content provided in the Grow Your Wealthy Mindset Podcast is for informational and entertainment only and should not be considered professional investment, legal, or tax advice. Dr Elisa Chiang is not a certified financial planner, attorney, or accountant. The views expressed are the personal opinion of Elisa Chiang and her guests and should not be taken as advice specific to you, the listener of the podcast. P...
JAMA Intern Med 2023;183:407-415Background: As we have previously discussed, trials comparing invasive versus conservative management in patients with non-ST elevation myocardial infarction (NSTEMI) have yielded mixed results. The average age of participants in these studies was in the 60s, and multiple comorbidities were relatively uncommon. However, many NSTEMI patients seen in clinical practice are older and have multiple comorbidities. These patients have worse prognosis and have competing risks for mortality. Whether an invasive strategy provides a benefit for this population remains uncertain.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The MOSCA-FRAIL trial sought to compare invasive vs conservative strategy in older adults with frailty and NSTEMI.Patients: Eligible patients had to have NSTEMI, be 70 years or older, and have frailty defined by 4 points or greater on the Clinical Frailty Scale.Patients were excluded if they were known to have nonrevascularizable coronary artery disease, significant concomitant non-ischemic heart disease, or life expectancy less than 12 months.Baseline characteristics: The trial randomized 167 patients from 13 hospitals in Spain – 84 randomized to invasive strategy and 83 to conservative strategy.The average age of patients was 86 years and 47% were men. Approximately 92% had hypertension, 56% had diabetes, 77% had hyperlipidemia, 31% had prior myocardial infarction, 27% had history of atrial fibrillation, 18% had prior stroke, 44% had chronic kidney disease, and 3% were current smokers.Procedures: Patients were randomly assigned in a 1:1 ratio to undergo invasive or conservative strategy.In the invasive strategy, patients underwent coronary angiogram within 72 hours of admission, and revascularization was performed as appropriate. In the conservative arm, patients were treated with medical therapy alone. A coronary angiogram was permitted for recurrent ischemia during the index admission.Medical treatment was given according to the guidelines at the time. In both arms, dual antiplatelet was recommended for one year. In patients with high bleeding risk or taking an oral anticoagulant, one antiplatelet could be stopped after the first month.Endpoints: The primary end point was the number of days alive and out of the hospital between discharge from the index hospitalization to 1 year. The coprimary end point was the composite of cardiac death, reinfarction, or post-discharge revascularization.Analysis was performed based on the intention-to-treat principle. The estimated sample size to provide 80% power at 5% alpha was 176 patients. This assumed that the number of days for the primary outcome in the conservative arm was 273 days and that an invasive strategy would increase that by 20%, that is 55 days.Results: Due to the COVID pandemic, the trial was terminated early after randomizing 95% of the planned sample size. During the index admission, 98% of the patients in the invasive arm underwent coronary angiogram and 60% underwent revascularization. Among patients in the conservative arm, 9.6% underwent revascularization due to recurrent ischemia during the index admission.The primary outcome (number of days alive and out of the hospital between discharge from the index hospitalization to 1 year) was numerically lower with the invasive arm but this was not statistically significant (mean difference 28 days, 95% CI: -7 – 62; p= 0.12).There was no difference in the coprimary end point - cardiac death, reinfarction, or post-discharge revascularization – absolute values were not provided. The invasive strategy was associated with significantly more bleeding events requiring hospitalization (8 patients vs 1 patient, incidence rate ratio: 14.9, 95% CI: 1.7 – 129.0; p= 0.02) including 4 deaths related to bleeding.Conclusion: In older, frail patients with NSTEMI, an invasive strategy did not significantly reduce the number of days of being alive and out of the hospital at 1-year. It also did not reduce the coprimary end point which was the composite of cardiac death, reinfarction, or post-discharge revascularization. An invasive strategy was associated with more bleeding requiring hospitalization.The trial is small, and its results should be interpreted with caution. Nonetheless, it is an important study that paves the way for future, larger trials in this population. The primary endpoint is both meaningful and relevant to this population. The average age of participants in this trial is approximately 20 years older than those in TACTICS-TIMI 18, RITA 3, and ICTUS. It is important to recognize that older, frail patients with multiple comorbidities are significantly underrepresented in clinical trials and likely derive less benefit or even harm from interventions.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe
Sitzen ist das neue Rauchen. Und überhaupt: Wer rastet, der rostet. Allerdings: In Deutschland haben wir ein Problem mit Übergewicht, mit Herz-Kreislauf-Erkrankungen - unter anderem weil wir uns zu wenig bewegen. Die Weltgesundheitsorganisation empfiehlt Erwachsenen pro Woche mindestens 150 bis 300 Minuten moderate Ausdauerbelastung oder mindestens 75 bis 150 Minuten intensive körperliche Belastung - und mindestens an zwei Tagen pro Woche kräftigende Übungen. Aber wieso ist Sport überhaupt gesund? Was passiert in unserem Körper, wenn wir uns bewegen? Wieviel Sport müssen wir machen, um bestimmten Krankheiten vorzubeugen? Zusammen mit Synapsen-Host Lucie Kluth spricht Wissenschaftsjournalistin Sarah Emminghaus über sogenannte Weekend-Worriors, über die Frage, wie Sport bei Angsterkrankungen helfen kann und warum es hilfreich sein kann, in Sportkleidung ins Bett zu gehen. HINTERGRUNDINFORMATIONEN 1. Studie über die Entdeckung des Myokins IL-6: Pedersen BK, Steensberg A, Fischer C, Keller C, Keller P, Plomgaard P, et al. Searching for the exercise factor: is IL-6 a candidate? J Muscle Res Cell Motil. 2003;24(2-3):113-9. doi:10.1023/a:1026070911202. 2. Studie über das Exerkin BDNF bei Panikpatienten: Ströhle A, Stoy M, Graetz B, Scheel M, Wittmann A, Gallinat J, et al. Acute exercise ameliorates reduced brain-derived neurotrophic factor in patients with panic disorder. Psychoneuroendocrinology. 2010 Apr;35(3):364-8. 3. Studie über das Ausbleiben der Menstruation bei Sportlerinnen: Gimunová M, Paulínyová A, Bernaciková M, Paludo AC. The prevalence of menstrual cycle disorders in female athletes from different sports disciplines: a rapid review. Int J Environ Res Public Health. 2022 Oct 31;19(21):14243. 4. Studie darüber, dass Spaß am Sport eine Rolle für Motivation spielen dürfte: Rhodes RE, Kates A. Can the affective response to exercise predict future motives and physical activity behavior? A systematic review of published evidence. Ann Behav Med. 2015 Oct;49(5):715-31. 5. Studie über das Hormon ANP und seine Rolle bei Angst: Ströhle A, Feller C, Strasburger CJ, Heinz A, Dimeo F. Anxiety modulation by the heart? Aerobic exercise and atrial natriuretic peptide. Psychoneuroendocrinology. 2006 Oct;31(9):1127-30. 6. Studie über den Zusammenhang zwischen Bewegung und Krebs: Moore SC, Lee IM, Weiderpass E, Campbell PT, Sampson JN, Kitahara CM, et al. Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Intern Med. 2016;176(6):816-25. doi:10.1001/jamainternmed.2016.1548. 7. Studie über den Zusammenhang zwischen Bewegung und psychischen Krankheiten: Singh B, Olds T, Curtis R, et al. Effectiveness of physical activity interventions for improving depression, anxiety, and distress: an overview of systematic reviews. Br J Sports Med. 2023;57:1203-9.
Sitzen ist das neue Rauchen. Und überhaupt: Wer rastet, der rostet. Allerdings: In Deutschland haben wir ein Problem mit Übergewicht, mit Herz-Kreislauf-Erkrankungen - unter anderem weil wir uns zu wenig bewegen. Die Weltgesundheitsorganisation empfiehlt Erwachsenen pro Woche mindestens 150 bis 300 Minuten moderate Ausdauerbelastung oder mindestens 75 bis 150 Minuten intensive körperliche Belastung - und mindestens an zwei Tagen pro Woche kräftigende Übungen. Aber wieso ist Sport überhaupt gesund? Was passiert in unserem Körper, wenn wir uns bewegen? Wieviel Sport müssen wir machen, um bestimmten Krankheiten vorzubeugen? Zusammen mit Synapsen-Host Lucie Kluth spricht Wissenschaftsjournalistin Sarah Emminghaus über sogenannte Weekend-Worriors, über die Frage, wie Sport bei Angsterkrankungen helfen kann und warum es hilfreich sein kann, in Sportkleidung ins Bett zu gehen. HINTERGRUNDINFORMATIONEN 1. Studie über die Entdeckung des Myokins IL-6: Pedersen BK, Steensberg A, Fischer C, Keller C, Keller P, Plomgaard P, et al. Searching for the exercise factor: is IL-6 a candidate? J Muscle Res Cell Motil. 2003;24(2-3):113-9. doi:10.1023/a:1026070911202. 2. Studie über das Exerkin BDNF bei Panikpatienten: Ströhle A, Stoy M, Graetz B, Scheel M, Wittmann A, Gallinat J, et al. Acute exercise ameliorates reduced brain-derived neurotrophic factor in patients with panic disorder. Psychoneuroendocrinology. 2010 Apr;35(3):364-8. 3. Studie über das Ausbleiben der Menstruation bei Sportlerinnen: Gimunová M, Paulínyová A, Bernaciková M, Paludo AC. The prevalence of menstrual cycle disorders in female athletes from different sports disciplines: a rapid review. Int J Environ Res Public Health. 2022 Oct 31;19(21):14243. 4. Studie darüber, dass Spaß am Sport eine Rolle für Motivation spielen dürfte: Rhodes RE, Kates A. Can the affective response to exercise predict future motives and physical activity behavior? A systematic review of published evidence. Ann Behav Med. 2015 Oct;49(5):715-31. 5. Studie über das Hormon ANP und seine Rolle bei Angst: Ströhle A, Feller C, Strasburger CJ, Heinz A, Dimeo F. Anxiety modulation by the heart? Aerobic exercise and atrial natriuretic peptide. Psychoneuroendocrinology. 2006 Oct;31(9):1127-30. 6. Studie über den Zusammenhang zwischen Bewegung und Krebs: Moore SC, Lee IM, Weiderpass E, Campbell PT, Sampson JN, Kitahara CM, et al. Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Intern Med. 2016;176(6):816-25. doi:10.1001/jamainternmed.2016.1548. 7. Studie über den Zusammenhang zwischen Bewegung und psychischen Krankheiten: Singh B, Olds T, Curtis R, et al. Effectiveness of physical activity interventions for improving depression, anxiety, and distress: an overview of systematic reviews. Br J Sports Med. 2023;57:1203-9.
Send us a textSpannendes Thema diese Woche im HAINS Talk Journal Club - die Arbeit von Homberg et al. aus JAMA Internal Medicine zur Frage nach Abbruchkriterien bei der innerklinischen Reanimation: Holmberg MJ, Granfeldt A, Moskowitz A, et al. Termination of Resuscitation Rules for In-Hospital Cardiac Arrest. JAMA Intern Med. Published online January 27, 2025. doi:https://doi.org/10.1001/jamainternmed.2024.7814Mit im Studio dabei - Michael Ziller, wissenschaftlicher Mitarbeiter der Klinik für Anästhesiologie am UKHD
Un nouvel épisode du Pharmascope est disponible… Et on aborde encore l'andropause et son traitement! Dans cette deuxième partie, Nicolas, Isabelle et Olivier discutent des données d'efficacité et d'innocuité de la testostérone en contexte d'andropause. Les objectifs pour cet épisode sont les suivants: Discuter de la prise en charge pharmacologique de l'andropause Discuter des données d'efficacité de la testostérone en contexte d'andropause Discuter des données d'innocuité de la testostérone en contexte d'andropause Ressources pertinentes en lien avec l'épisode Série documentaire « L'andropause sans tabou ». Disponible sur l'EXTRA d'ICI TOU.TV TTrialsSnyder PJ, et coll.; Testosterone Trials Investigators. Effects of Testosterone Treatment in Older Men. N Engl J Med. 2016 Feb 18;374(7):611-24. Resnick SM, et coll. Testosterone Treatment and Cognitive Function in Older Men With Low Testosterone and Age-Associated Memory Impairment. JAMA. 2017 Feb 21;317(7):717-727. Roy CN, et coll. Association of Testosterone Levels With Anemia in Older Men: A Controlled Clinical Trial. JAMA Intern Med. 2017 Apr 1;177(4):480-490. TRAVERSELincoff AM, et coll; TRAVERSE Study Investigators. Cardiovascular Safety of Testosterone-Replacement Therapy. N Engl J Med. 2023 Jul 13;389(2):107-117. Pencina KM, et coll. Effect of Testosterone Replacement Therapy on Sexual Function and Hypogonadal Symptoms in Men with Hypogonadism. J Clin Endocrinol Metab. 2024 Jan 18;109(2):569-580. Bhasin S, et coll. Depressive Syndromes in Men With Hypogonadism in the TRAVERSE Trial: Response to Testosterone-Replacement Therapy. J Clin Endocrinol Metab. 2024 Jun 17;109(7):1814-1826. Pencina KM, et coll. Efficacy of Testosterone Replacement Therapy in Correcting Anemia in Men With Hypogonadism: A Randomized Clinical Trial. JAMA Netw Open. 2023 Oct 2;6(10):e2340030. Snyder PJ, Bauer DC, Ellenberg SS, Cauley JA, Buhr KA, Bhasin S, Miller MG, Khan NS, Li X, Nissen SE. Testosterone Treatment and Fractures in Men with Hypogonadism. N Engl J Med. 2024 Jan 18;390(3):203-211. Autres référencesLee H, et coll. Testosterone replacement in men with sexual dysfunction. Cochrane Database Syst Rev. 2024 Jan 15;1(1):CD013071. Domes T, et coll. Canadian Urological Association guideline: Erectile dysfunction. Can Urol Assoc J. 2021 Oct;15(10):310-322. Buvat J, et coll. Hypogonadal men nonresponders to the PDE5 inhibitor tadalafil benefit from normalization of testosterone levels with a 1% hydroalcoholic testosterone gel in the treatment of erectile dysfunction (TADTEST study). J Sex Med. 2011 Jan;8(1):284-93. Walther A, Breidenstein J, Miller R. Association of Testosterone Treatment With Alleviation of Depressive Symptoms in Men: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2019 Jan 1;76(1):31-40. Wittert G, et coll. Testosterone treatment to prevent or revert type 2 diabetes in men enrolled in a lifestyle programme (T4DM): a randomised, double-blind, placebo-controlled, 2-year, phase 3b trial. Lancet Diabetes Endocrinol. 2021 Jan;9(1):32-45. Bhasin S, et coll. Effect of Testosterone on Progression From Prediabetes to Diabetes in Men With Hypogonadism: A Substudy of the TRAVERSE Randomized Clinical Trial. JAMA Intern Med. 2024 Apr 1;184(4):353-362.
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-416 Overview: Listen in as we discuss chronic sacroiliac (SI) dysfunction and the role of nonpharmacological therapies, including acupuncture, in managing back pain and improving function. Hear evidence-based considerations for integrating acupuncture into your practice to offer effective, medication-free options for patients with chronic SI pain. Episode resource links: Kim G, Kim D, Moon H, et al. Acupuncture and Acupoints for Low Back Pain: Systematic Review and Meta-Analysis. Am J Chin Med. 2023;51(2):223-247. doi:10.1142/S0192415X23500131 Mu J, Furlan AD, Lam WY, Hsu MY, Ning Z, Lao L. Acupuncture for chronic nonspecific low back pain. Cochrane Database Syst Rev. 2020;12(12):CD013814. Published 2020 Dec 11. doi:10.1002/14651858.CD013814 Tu J-F et al. Acupuncture vs sham acupuncture for chronic sciatica from herniated disk: A randomized clinical trial. JAMA Intern Med 2024 Oct 14; [e-pub]. (https://doi.org/10.1001/jamainternmed.2024.5463) Wu M, Fan C, Liu H, et al. The Effectiveness of Acupuncture for Low Back Pain: An Umbrella Review and Meta-Analysis. Am J Chin Med. 2024;52(4):905-923. doi:10.1142/S0192415X2450037X https://www-dynamed-com.umassmed.idm.oclc.org/condition/sciatica Guest: Susan Feeney, DNP, FNP Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com
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-416 Overview: Listen in as we discuss chronic sacroiliac (SI) dysfunction and the role of nonpharmacological therapies, including acupuncture, in managing back pain and improving function. Hear evidence-based considerations for integrating acupuncture into your practice to offer effective, medication-free options for patients with chronic SI pain. Episode resource links: Kim G, Kim D, Moon H, et al. Acupuncture and Acupoints for Low Back Pain: Systematic Review and Meta-Analysis. Am J Chin Med. 2023;51(2):223-247. doi:10.1142/S0192415X23500131 Mu J, Furlan AD, Lam WY, Hsu MY, Ning Z, Lao L. Acupuncture for chronic nonspecific low back pain. Cochrane Database Syst Rev. 2020;12(12):CD013814. Published 2020 Dec 11. doi:10.1002/14651858.CD013814 Tu J-F et al. Acupuncture vs sham acupuncture for chronic sciatica from herniated disk: A randomized clinical trial. JAMA Intern Med 2024 Oct 14; [e-pub]. (https://doi.org/10.1001/jamainternmed.2024.5463) Wu M, Fan C, Liu H, et al. The Effectiveness of Acupuncture for Low Back Pain: An Umbrella Review and Meta-Analysis. Am J Chin Med. 2024;52(4):905-923. doi:10.1142/S0192415X2450037X https://www-dynamed-com.umassmed.idm.oclc.org/condition/sciatica Guest: Susan Feeney, DNP, FNP Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com
A new year and a new beginning. Special guest co-host Pedro Mendes joins Dr. Chris Labos to answer a viewer question about menopause. Become a supporter of our show today either on Patreon or through PayPal! Thank you! http://www.patreon.com/thebodyofevidence/ https://www.paypal.com/donate?hosted_button_id=9QZET78JZWCZE Email us your questions at thebodyofevidence@gmail.com. Assistant researcher: Aigul Zaripova, MD Editor: Robyn Flynn Theme music: “Fall of the Ocean Queen“ by Joseph Hackl Rod of Asclepius designed by Kamil J. Przybos Chris' book, Does Coffee Cause Cancer?: https://ecwpress.com/products/does-coffee-cause- cancer Obviously, I'm not your doctor (probably). This podcast is not medical advice for you; it is what we call information. References: Geographic variability of menopausal symptoms 1) Nappi RE et al. Global cross-sectional survey of women with vasomotor symptoms associated with menopause: prevalence and quality of life burden. Menopause. 2021 May 24;28(8):875-882. doi: 10.1097/GME.0000000000001793. 2) Nappi RE, et al. Prevalence and quality-of-life burden of vasomotor symptoms associated with menopause: A European cross-sectional survey. Maturitas. 2023 Jan;167:66-74. doi: 10.1016/j.maturitas.2022.09.006. What's the normal duration of symptoms 3) Avis NE, et al. Study of Women's Health Across the Nation. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015 Apr;175(4):531-9. doi: 10.1001/jamainternmed.2014.8063. The Women's Health Initiative (WHI) studies Rossouw JE et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002 Jul 17;288(3):321-33. doi: 10.1001/jama.288.3.321. Anderson GL et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA. 2004 Apr 14;291(14):1701-12. doi: 10.1001/jama.291.14.1701. Decline in HRT after WHI studies Sprague BL, Trentham-Dietz A, Cronin KA. A sustained decline in postmenopausal hormone use: results from the National Health and Nutrition Examination Survey, 1999-2010. Obstet Gynecol. 2012 Sep;120(3):595-603. doi: 10.1097/AOG.0b013e318265df42. Danish Osteoporosis Prevention Study Schierbeck LL metal. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ. 2012 Oct 9;345:e6409. doi: 10.1136/bmj.e6409. Kronos Early Estrogen Prevention Study (KEEPS) Harman SM, et al. Arterial imaging outcomes and cardiovascular risk factors in recently menopausal women: a randomized trial. Ann Intern Med. 2014 Aug 19;161(4):249-60. doi: 10.7326/M14-0353. Kronos Early Estrogen Prevention Study (KEEPS) Hodis HN et al. Vascular Effects of Early versus Late Postmenopausal Treatment with Estradiol. N Engl J Med. 2016 Mar 31;374(13):1221-31. doi: 10.1056/NEJMoa1505241. Stopping hormonal therapy Berman RS et al. Risk factors associated with women's compliance with estrogen replacement therapy. J Womens Health. 1997 Apr;6(2):219-26. doi: 10.1089/jwh.1997.6.219. Grady D, Sawaya GF. Discontinuation of postmenopausal hormone therapy. Am J Med. 2005 Dec 19;118 Suppl 12B:163-5. doi: 10.1016/j.amjmed.2005.09.051. Tapering vs. abrupt stop or hormonal therapy Haimov-Kochman R et al. Gradual discontinuation of hormone therapy does not prevent the reappearance of climacteric symptoms: a randomized prospective study. Menopause. 2006 May-Jun;13(3):370-6. doi: 10.1097/01.gme.0000186663.36211.c0. PMID: 16735933.
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-412 Overview: Discover how improper arm positioning can lead to inaccurate blood pressure readings and influence hypertension management as we discuss a recent randomized controlled trial. Hear evidence-based techniques to ensure proper arm and cuff positioning, improving hypertension diagnosis in your clinical practice. Episode resource links: JAMA Intern Med. Published online October 7, 2024. doi:10.1001/jamainternmed.2024.5213 Guest: Robert A. Baldor MD, FAAFP Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com
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-412 Overview: Discover how improper arm positioning can lead to inaccurate blood pressure readings and influence hypertension management as we discuss a recent randomized controlled trial. Hear evidence-based techniques to ensure proper arm and cuff positioning, improving hypertension diagnosis in your clinical practice. Episode resource links: JAMA Intern Med. Published online October 7, 2024. doi:10.1001/jamainternmed.2024.5213 Guest: Robert A. Baldor MD, FAAFP Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com
Un nouvel épisode du Pharmascope est maintenant disponible! Dans ce 147e épisode, Nicolas et Olivier discutent de trois études scientifiques récentes. Au menu : cible de tension artérielle chez les diabétiques, sémaglutide en gonarthrose et vitamine K2 pour les crampes nocturnes! Les objectifs pour cet épisode sont les suivants: Discuter des bénéfices et des risques d'une cible intensive de tension artérielle pour la population diabétique. Discuter des bénéfices du sémaglutide pour favoriser la perte de poids et la douleur associée à la gonarthrose. Discuter des bénéfices de la vitamine K pour soulager les crampes musculaires nocturnes. Ressources pertinentes en lien avec l'épisode Bi Y et coll.; BPROAD Research Group. Intensive Blood-Pressure Control in Patients with Type 2 Diabetes. N Engl J Med. 2024 Nov 16. Bliddal H et coll.; STEP 9 Study Group. Once-Weekly Semaglutide in Persons with Obesity and Knee Osteoarthritis. N Engl J Med. 2024 Oct 31;391(17):1573-1583. Tan J et coll. Vitamin K2 in Managing Nocturnal Leg Cramps: A Randomized Clinical Trial. JAMA Intern Med. 2024 Oct 28:e245726. doi: 10.1001/jamainternmed.2024.5726.
In 2022, women in the United States earn 82 cents for every dollar men earn. This has been called the Gener Wage Gap or the Gender Pay Gap. This gap appears to be potentially higher for women physicians, and persists even after controlling for age, experience, specialty and other factors. Over a simulated 40 year career, women physician are estimated to earn $2 million less than male physicians. Women are also more likely to decrease work or give up work in order to take care of children. This puts women at a disadvantage for building wealth compared to men. This episode explores the evidence behind the gender pay gap and talks about things you can start doing now to close the gap for yourself. ReferencesUS Census Bureauhttps://www.gao.gov/products/gao-23-106041 US Census Bureau Diversity in Medicine: Facts and Figures 2019 Figure 12. Percentage of U.S. medical school graduates by sex, academic years 1980-1981 through 2018-2019https://www.aamc.org/data-reports/workforce/data/figure-12-percentage-us-medical-school-graduates-sex-academic-years-1980-1981-through-2018-2019 Jena AB, Olenski AR, Blumenthal DM. Sex Differences in Physician Salary in US Public Medical Schools. JAMA Intern Med. 2016 Sep 1;176(9):1294-304 Miller H, Seckel E, White CL, Sanchez D, Rubesova E, Mueller C, Bianco K. Gender-based salary differences in academic medicine: a retrospective review of data from six public medical centers in the Western USA BMJ Open. 2022 Apr 7;12(4): Whaley CM, Koo T, Arora VM, Ganguli I, Gross N, and Jena AB. Female Physicians Earn An Estimated $2 Million Less Than Male Physicians Over A Simulated 40-Year Career. 2021 Dec;40(12):1856-1864. Harvard Business Review Why Women Volunteer for Tasks that Don't Lead to Promotionshttps://hbr.org/2018/07/why-women-volunteer-for-tasks-that-dont-lead-to-promotions Please subscribe and leave a review on your favorite Podcasting platform. If you want to start your path to financial freedom, start with the Financial Freedom Workbook. Download your free copy today at https://www.GrowYourWealthyMindset.com/fiworkbook You can learn more about Elisa at her website or follow her on social media.Website: https://ww.GrowYourWealthyMindset.comInstagram https://www.instagram.com/GrowYourWealthyMindsetFacebook https://www.facebook.com/ElisaChianghttps://www.facebook.com/GrowYourWealthyMindsetYouTube: https://www.youtube.com/c/WealthyMindsetMDLinked In: www.linkedin.com/in/ElisaChiang Disclaimer: The content provided in the Grow Your Wealthy Mindset Podcast is for informational and entertainment only and should not be considered professional investment, legal, or tax advice. Dr Elisa Chiang is not a certified financial planner, attorney, or accountant. The views expressed are the personal opinion of Elisa Chiang and her guests and should not be taken as advice specific to you, the listener of the podcast. Personal finance is personal and your personal financial decision need to be made based on your personal financial situation and risk tolerance after having completed your own due diligence.
Iaaaaaaaaago Jorge, Marcela Belleza e Nathalie Santana conversam sobre as últimas atualizações no tratamento da obesidade em três partes: o que é obesidade controlada? quais são as drogas novas? quais são os efeitos adversos? Use o cupom TDC2024 para assinar o HITT do Medcof e ganhe um cupom de 6 meses gratuitos do Guia TdC! https://hiit.grupomedcof.com.br Referências: 1. Chuang MH, Chen JY, Wang HY, Jiang ZH, Wu VC. Clinical Outcomes of Tirzepatide or GLP-1 Receptor Agonists in Individuals With Type 2 Diabetes. JAMA Netw Open. 2024;7(8):e2427258. Published 2024 Aug 1. doi:10.1001/jamanetworkopen.2024.27258 2. Coutinho W, Halpern B. Pharmacotherapy for obesity: moving towards efficacy improvement. Diabetol Metab Syndr. 2024;16(1):6. Published 2024 Jan 3. doi:10.1186/s13098-023-01233-4 3. Gudzune KA, Kushner RF. Medications for Obesity: A Review. JAMA. Published online July 22, 2024. doi:10.1001/jama.2024.10816 4. Halpern B, Mancini MC, de Melo ME, et al. Proposal of an obesity classification based on weight history: an official document by the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Society for the Study of 5. Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022;387(3):205-216. doi:10.1056/NEJMoa2206038 6. Jastreboff AM, Kaplan LM, Frías JP, et al. Triple-Hormone-Receptor Agonist Retatrutide for Obesity - A Phase 2 Trial. N Engl J Med. 2023;389(6):514-526. doi:10.1056/NEJMoa2301972 7. Li JR, Cao J, Wei J, Geng W. Case Report: Semaglutide-associated depression: a report of two cases. Front Psychiatry. 2023;14:1238353. Published 2023 Aug 29. doi:10.3389/fpsyt.2023.1238353 8. Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med. 2023;389(24):2221-2232. doi:10.1056/NEJMoa2307563 9. Obesity and Metabolic Syndrome (ABESO). Arch Endocrinol Metab. 2022;66(2):139-151. doi:10.20945/2359-3997000000465 10. Rodriguez PJ, Goodwin Cartwright BM, Gratzl S, et al. Semaglutide vs Tirzepatide for Weight Loss in Adults With Overweight or Obesity. JAMA Intern Med. Published online July 8, 2024. doi:10.1001/jamainternmed.2024.2525 11. Wang W, Volkow ND, Berger NA, Davis PB, Kaelber DC, Xu R. Associations of semaglutide with incidence and recurrence of alcohol use disorder in real-world population [published correction appears in Nat Commun. 2024 Jun 18;15(1):5177. doi: 10.1038/s41467-024-49655-6]. Nat Commun. 2024;15(1):4548. Published 2024 May 28. doi:10.1038/s41467-024-48780-6 12. Wang W, Volkow ND, Berger NA, Davis PB, Kaelber DC, Xu R. Association of semaglutide with risk of suicidal ideation in a real-world cohort. Nat Med. 2024;30(1):168-176. doi:10.1038/s41591-023-02672-2
Did you know that one simple change in your kitchen could transform your health? In today's episode, Miles Hassell, MD, explores the extensive health benefits of extra virgin olive oil (EVOO). Drawing on three lines of evidence, he makes a compelling case for making EVOO your primary kitchen fat. A few takeaways from Miles Hassell, MD: Studies have shown that EVOO supports gut health. A healthy gut can contribute to improved digestion, a stronger immune system, and even better mental health. Regular consumption of EVOO has been associated with a lower incidence of dementia. This connection underscores the importance of incorporating EVOO into your diet as part of a proactive approach to brain health. Research indicates that higher consumption of olive oil is linked to a lower incidence of certain cancers. The powerful antioxidant and anti-inflammatory properties of EVOO play a significant role in reducing cancer risk. One of the most well-documented benefits of EVOO is its ability to lower the risk of heart disease. Unlike other vegetable oils, EVOO has been consistently shown to promote cardiovascular health. Miles Hassell, MD emphasizes that EVOO is not just a cooking ingredient but a therapeutic tool. Its unique composition of monounsaturated fats, antioxidants, and anti-inflammatory compounds makes it a powerhouse for health promotion. While other vegetable oils lack the same level of evidence for health benefits, EVOO stands out for its protective effects. When compared to other oils, EVOO consistently comes out on top. Making the switch to EVOO can be a simple yet powerful change to improve your overall health. So next time you're cooking, reach for the EVOO and enjoy both its flavor and its multitude of health benefits. Join the cause! Support the podcast and be a champion of a future episode by donating here: https://greatmed.org/donate/ For more information and references head to: https://greatmed.org Purchase Good Food Great Medicine Twitter (X): https://x.com/greatmedorg Instagram: @mileshassellmd Facebook: https://www.facebook.com/people/GreatMedorg/61554645308577/ Substack: https://substack.com/@greatmed YouTube: https://www.youtube.com/@greatmedicine email: info@greatmed.org References for Today's Episode: Markellos C, Ourailidou ME, Gavriatopoulou M, Halvatsiotis P, Sergentanis TN, Psaltopoulou T. Olive oil intake and cancer risk: A systematic review and meta-analysis. PLoS One. 2022 Jan 11;17(1):e0261649. doi: 10.1371/journal.pone.0261649. PMID: 35015763; PMCID: PMC8751986. Millman JF, Okamoto S, Teruya T, Uema T, Ikematsu S, Shimabukuro M, Masuzaki H. Extra-virgin olive oil and the gut-brain axis: influence on gut microbiota, mucosal immunity, and cardiometabolic and cognitive health. Nutr Rev. 2021 Nov 10;79(12):1362-1374. doi: 10.1093/nutrit/nuaa148. PMID: 33576418; PMCID: PMC8581649. Guasch-Ferré M, Hruby A, Salas-Salvadó J, Martínez-González MA, Sun Q, Willett WC, Hu FB. Olive oil consumption and risk of type 2 diabetes in US women. Am J Clin Nutr. 2015 Aug;102(2):479-86. doi: 10.3945/ajcn.115.112029. Epub 2015 Jul 8. PMID: 26156740; PMCID: PMC4515873 Valls-Pedret C, Lamuela-Raventós RM, Medina-Remón A, Quintana M, Corella D, Pintó X, Martínez-González MÁ, Estruch R, Ros E. Polyphenol-rich foods in the Mediterranean diet are associated with better cognitive function in elderly subjects at high cardiovascular risk. J Alzheimers Dis. 2012;29(4):773-82. doi: 10.3233/JAD-2012-111799. PMID: 22349682. Moreno-Luna R, Muñoz-Hernandez R, Miranda ML, Costa AF, Jimenez-Jimenez L, Vallejo-Vaz AJ, Muriana FJ, Villar J, Stiefel P. Olive oil polyphenols decrease blood pressure and improve endothelial function in young women with mild hypertension. Am J Hypertens. 2012 Dec;25(12):1299-304. doi: 10.1038/ajh.2012.128. Epub 2012 Aug 23. PMID: 22914255. Cougnard-Grégoire A, Merle BM, Korobelnik JF, Rougier MB, Delyfer MN, Le Goff M, Samieri C, Dartigues JF, Delcourt C. Olive Oil Consumption and Age-Related Macular Degeneration: The Alienor Study. PLoS One. 2016 Jul 28;11(7):e0160240. doi: 10.1371/journal.pone.0160240. PMID: 27467382; PMCID: PMC4965131. Kien CL, Bunn JY, Tompkins CL, Dumas JA, Crain KI, Ebenstein DB, Koves TR, Muoio DM. Substituting dietary monounsaturated fat for saturated fat is associated with increased daily physical activity and resting energy expenditure and with changes in mood. Am J Clin Nutr. 2013 Apr;97(4):689-97. doi: 10.3945/ajcn.112.051730. Epub 2013 Feb 27. Erratum in: Am J Clin Nutr. 2013 Aug;98(2):511. PMID: 23446891; PMCID: PMC3607650. Guasch-Ferré M, Liu G, Li Y, Sampson L, Manson JE, Salas-Salvadó J, Martínez-González MA, Stampfer MJ, Willett WC, Sun Q, Hu FB. Olive Oil Consumption and Cardiovascular Risk in U.S. Adults. J Am Coll Cardiol. 2020 Apr 21;75(15):1729-1739. doi: 10.1016/j.jacc.2020.02.036. Epub 2020 Mar 5. PMID: 32147453; PMCID: PMC7233327. Ferrara LA, Raimondi AS, d'Episcopo L, Guida L, Dello Russo A, Marotta T. Olive oil and reduced need for antihypertensive medications. Arch Intern Med. 2000 Mar 27;160(6):837-42. doi: 10.1001/archinte.160.6.837. PMID: 10737284. Priore P, Cavallo A, Gnoni A, Damiano F, Gnoni GV, Siculella L. Modulation of hepatic lipid metabolism by olive oil and its phenols in nonalcoholic fatty liver disease. IUBMB Life. 2015 Jan;67(1):9-17. doi: 10.1002/iub.1340. Epub 2015 Jan 28. PMID: 25631376. Gutiérrez-Repiso C, Soriguer F, Rojo-Martínez G, García-Fuentes E, Valdés S, Goday A, Calle-Pascual A, López-Alba A, Castell C, Menéndez E, Bordiú E, Delgado E, Ortega E, Pascual-Manich G, Urrutia I, Mora-Peces I, Vendrell J, Vázquez JA, Franch J, Girbés J, Castaño L, Serrano-Ríos M, Martínez-Larrad MT, Catalá M, Carmena R, Gomis R, Casamitjana R, Gaztambide S. Variable patterns of obesity and cardiometabolic phenotypes and their association with lifestyle factors in the Di@bet.es study. Nutr Metab Cardiovasc Dis. 2014 Sep;24(9):947-55. doi: 10.1016/j.numecd.2014.04.019. Epub 2014 Jun 9. PMID: 24984822. Ramsden CE, Zamora D, Leelarthaepin B, Majchrzak-Hong SF, Faurot KR, Suchindran CM, Ringel A, Davis JM, Hibbeln JR. Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. BMJ. 2013 Feb 4;346:e8707. doi: 10.1136/bmj.e8707. Erratum in: BMJ. 2013;346:f903. PMID: 23386268; PMCID: Juul F, Vaidean G, Lin Y, Deierlein AL, Parekh N. Ultra-Processed Foods and Incident Cardiovascular Disease in the Framingham Offspring Study. J Am Coll Cardiol. 2021 Mar 30;77(12):1520-1531. doi: 10.1016/j.jacc.2021.01.047. PMID: 33766258. Schnabel L, Kesse-Guyot E, Allès B, Touvier M, Srour B, Hercberg S, Buscail C, Julia C. Association Between Ultraprocessed Food Consumption and Risk of Mortality Among Middle-aged Adults in France. JAMA Intern Med. 2019 Apr 1;179(4):490-498. doi: 10.1001/jamainternmed.2018.7289. PMID: 30742202; PMCID: PMC6450295. Lane MM, Gamage E, Du S, Ashtree DN, McGuinness AJ, Gauci S, Baker P, Lawrence M, Rebholz CM, Srour B, Touvier M, Jacka FN, O'Neil A, Segasby T, Marx W. Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. BMJ. 2024 Feb 28;384:e077310. doi: 10.1136/bmj-2023-077310. PMID: 38418082; PMCID: PMC10899807. Alonso-Pedrero L, Ojeda-Rodríguez A, Martínez-González MA, Zalba G, Bes-Rastrollo M, Marti A. Ultra-processed food consumption and the risk of short telomeres in an elderly population of the Seguimiento Universidad de Navarra (SUN) Project. Am J Clin Nutr. 2020 Jun 1;111(6):1259-1266. doi: 10.1093/ajcn/nqaa075. PMID: 32330232. Taneri PE, Wehrli F, Roa-Díaz ZM, Itodo OA, Salvador D, Raeisi-Dehkordi H, Bally L, Minder B, Kiefte-de Jong JC, Laine JE, Bano A, Glisic M, Muka T. Association Between Ultra-Processed Food Intake and All-Cause Mortality: A Systematic Review and Meta-Analysis. Am J Epidemiol. 2022 Jun 27;191(7):1323-1335. doi: 10.1093/aje/kwac039. PMID: 35231930.
Contributor: Aaron Lessem MD Educational Pearls: Oseltamivir (Tamiflu) is an antiviral medication used commonly to treat influenza Trials show that the medication reduces the duration of illness by less than 1 day (~16 hours in one systematic review) Benefit only occurs if taken within 48 hours of symptom onset Must be taken for 5 days A 2024 meta-analysis reviewed 15 randomized-controlled trials for the risk of hospitalization No reduction in hospitalizations with oseltamivir in patients over the age of 12 No difference in high-risk patients over the age of 65 or those with comorbidities The authors note that the confidence interval in these populations is wide, indicating a need for subsequent studies in high-risk populations Oseltamivir is associated with adverse effects including nausea, vomiting, and neurologic symptoms The risk of adverse effects may outweigh the benefits of a small reduction in the duration of illness References 1. Hanula R, Bortolussi-Courval É, Mendel A, Ward BJ, Lee TC, McDonald EG. Evaluation of Oseltamivir Used to Prevent Hospitalization in Outpatients with Influenza: A Systematic Review and Meta-Analysis. JAMA Intern Med. 2024;184(1):18-27. doi:10.1001/jamainternmed.2023.0699 2. Jefferson T, Jones M, Doshi P, Spencer EA, Onakpoya I, Heneghan CJ. Oseltamivir for influenza in adults and children: Systematic review of clinical study reports and summary of regulatory comments. BMJ. 2014;348(April):1-18. doi:10.1136/bmj.g2545 Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit
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-381 Overview: While the aerosol in e-cigarettes does contain toxicants and carcinogens, since it is not burned like combustible tobacco cigarettes, vaping exposes the user to fewer toxicants and chemicals. Many consider using e-cigarettes for smoking cessation, but evidence has been conflicting. Tune in as we discuss a recent review examining the efficacy of e-cigarettes in aiding smoking cessation and explore potential adverse effects associated with their usage. Episode resource links: Lin, H. X., Liu, Z., Hajek, P., Zhang, W. T., Wu, Y., Zhu, B. C., Liu, H. H., Xiang, Q., Zhang, Y., Li, S. B., Pesola, F., & Wang, Y. Y. (2024). Efficacy of Electronic Cigarettes vs Varenicline and Nicotine Chewing Gum as an Aid to Stop Smoking: A Randomized Clinical Trial. JAMA internal medicine, 10.1001/jamainternmed.2023.7846. Advance online publication. https://doi.org/10.1001/jamainternmed.2023.7846 Lindson, N., Butler, A. R., McRobbie, H., Bullen, C., Hajek, P., Begh, R., Theodoulou, A., Notley, C., Rigotti, N. A., Turner, T., Livingstone-Banks, J., Morris, T., & Hartmann-Boyce, J. (2024). Electronic cigarettes for smoking cessation. The Cochrane database of systematic reviews, 1(1), CD010216. https://doi.org/10.1002/14651858.CD010216.pub8 Sanford BT, Brownstein NC, Baker NL, et al. Shift From Smoking Cigarettes to Vaping Nicotine in Young Adults. JAMA Intern Med. Published online November 13, 2023. doi:10.1001/jamainternmed.2023.5239 Guest: Susan Feeney, DNP, FNP-BC, NP-C Music Credit: Richard Onorato
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-381 Overview: While the aerosol in e-cigarettes does contain toxicants and carcinogens, since it is not burned like combustible tobacco cigarettes, vaping exposes the user to fewer toxicants and chemicals. Many consider using e-cigarettes for smoking cessation, but evidence has been conflicting. Tune in as we discuss a recent review examining the efficacy of e-cigarettes in aiding smoking cessation and explore potential adverse effects associated with their usage. Episode resource links: Lin, H. X., Liu, Z., Hajek, P., Zhang, W. T., Wu, Y., Zhu, B. C., Liu, H. H., Xiang, Q., Zhang, Y., Li, S. B., Pesola, F., & Wang, Y. Y. (2024). Efficacy of Electronic Cigarettes vs Varenicline and Nicotine Chewing Gum as an Aid to Stop Smoking: A Randomized Clinical Trial. JAMA internal medicine, 10.1001/jamainternmed.2023.7846. Advance online publication. https://doi.org/10.1001/jamainternmed.2023.7846 Lindson, N., Butler, A. R., McRobbie, H., Bullen, C., Hajek, P., Begh, R., Theodoulou, A., Notley, C., Rigotti, N. A., Turner, T., Livingstone-Banks, J., Morris, T., & Hartmann-Boyce, J. (2024). Electronic cigarettes for smoking cessation. The Cochrane database of systematic reviews, 1(1), CD010216. https://doi.org/10.1002/14651858.CD010216.pub8 Sanford BT, Brownstein NC, Baker NL, et al. Shift From Smoking Cigarettes to Vaping Nicotine in Young Adults. JAMA Intern Med. Published online November 13, 2023. doi:10.1001/jamainternmed.2023.5239 Guest: Susan Feeney, DNP, FNP-BC, NP-C Music Credit: Richard Onorato
It can be hard to make healthy changes. And there's no shortage of advice on what to change and how to change. In this episode, we dig into why change can be hard and how to make the process a bit easier. We'll talk about the nuances of external and internal motivators in behavior change, distinguishing between external (extrinsic) motivators, which stem from outside forces, and internal (intrinsic) motivators, which arise from our personal desires or values. The short story is that external motivators can be effective in the short term, especially for routine or necessity-driven tasks, but they often fall short in fostering lasting behavioral changes that contribute to wellbeing. We'll share some insights into human biology, including our evolutionary drives and the principle of homeostasis, while also touching on the significance of self-acceptance and self-compassion in nurturing internal motivation. Joy Lab and Natural Mental Health are community-supported. When you buy through the links below, we may earn a commission. That support helps keeps the Joy Lab podcast free for all! Sources & Notes: Joy Lab Program: Take the next leap in your wellbeing journey with step-by-step practices to help you build and maintain the elements of joy in your life. Your Joy Lab membership also includes our NMH Community! NMH Community: Access lots of extra resilience-boosting resources (like our Sleeping Well Workshop) AND you'll join a group of inspiring folks who play an integral role in keeping this podcast going... which means powerful resources stay accessible to everyone. Free Resilience Quiz & free Mini-Course: Based on decades of clinical experience, we've created a model of resilience that is both helpful and practical. True to our approach at Natural Mental Health, we start with strengths. You'll identify these strengths in your Resilience Type. Your Resilience Type highlights your unique strengths, what fuels your joy, what keeps you in balance, and the lifestyle practices that most nourish you. After you find your Resilience Type, sign up for your free mini-course to receive tailored lifestyle practices that can support your mood, resilience, and overall wellbeing. Ladapo, J. A., Orstad, S. L., Wali, S., et al. (2023). Effectiveness of Goal-Directed and Outcome-Based Financial Incentives for Weight Loss in Primary Care Patients With Obesity Living in Socioeconomically Disadvantaged Neighborhoods: A Randomized Clinical Trial. JAMA Intern Med, 183(1), 61–69. Access. Murayama, K., Kitagami, S., Tanaka, A. and Raw, J. (2016). People's naiveté about how extrinsic rewards influence intrinsic motivation. Motivation Science, 2 (3), 138-142. Access. Volpp, K. G., John, L. K., Troxel, A. B., Norton, L., Fassbender, J., Loewenstein, G. (2008). Financial Incentive–Based Approaches for Weight Loss: A Randomized Trial. JAMA, 300(22), 2631–2637. Access. Where to shop: Our partner store at Fullscript: Find high-quality supplements and wellness products. Except for our CBD Gummies, any product links mentioned in the show notes below will require an account. Sign up for your free Fullscript account. Resilient Remedies: This is where you can find our line of trusted, high-quality CBD gummies. Subscribe to our Newsletter: Join us for exclusive emails, updates, and additional strategies. Our favorite resilience-boosting reads at Bookshop.org Full transcript available here. Please remember that this content is for informational and educational purposes only. It is not intended to provide medical advice and is not a replacement for advice and treatment from a medical professional. Please consult your doctor or other qualified health professional before beginning any diet change, supplement, or lifestyle program. Please see our terms for more information. If you or someone you know is struggling or in crisis, help is available. Call the NAMI HelpLine: 1-800-950-6264 available Monday through Friday, 10 a.m. – 10 p.m., ET. OR text "HelpLine" to 62640 or email NAMI at helpline@nami.org. Visit NAMI for more. You can also call or text SAMHSA at 988 or chat 988lifeline.org.
In this podcast, Dr. Chris Solie, an emergency physician, along with Jason Hicks, Fred DeMeuse, Greta Sowels (physician assistants), working for Emergency Medicine Physicians and Consultants (EMPAC) who review journals and papers around emergency medicine. *Disclosure note: None of the speakers or planners for this education activity have relevant financial relationships to disclose with any inelgible company - who's primary business is producing marketing, selling, re-selling, or distributin healthcare products used by or on patients. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Identify emergency medicine journal articles that may be potentially practice changing. Differentiate between using a HEAR score versus a HEART score when assessing patients coming into the ED with chest pain. Restate whether vaccination during pregnancy could reduce the burden of respiratory syncytial virus (RSV) - associated lower respiratory tract illness in newborns and infants. Discuss the rate of wound infection from suturing with sterile gloves, dressings, drapes, etc. versus non-sterile gloves, dressings in emergency department. Discuss the risk-benefit of using tranexamic acid (TXA) in the treatment of gastrointestional bleeds. Identify interventions designed to reduce fatigue among emergency department physicians. Determine whether a direct oral penicillin challenge is noninferior to the standard of care of penicillin skin testing followed by an oral challenge in patients with a low-risk pencillin allergy. This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.) DISCLOSURE ANNOUNCEMENT The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview. Any re-reproduction of any of the materials presented would be infringement of copyright laws. It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. None of Ridgeview's CME planning committee members have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. All of the relevant financial relationships for the individuals listed above have been mitigated. RESOURCES Article 1: O'Rielly, C.M., Andruchow, J.E., McRae, A.D. et al. External validation of a low HEAR score to identify emergency department chest pain patients at very low risk of major adverse cardiac events without troponin testing. Can J Emerg Med 24, 68–74 (2022). https://doi.org/10.1007/s43678-021-00159-y Article 2: Kampmann B, Madhi SA, Munjal I, et al. Bivalent Prefusion F Vaccine in Pregnancy to Prevent RSV Illness in Infants. N Engl J Med. 2023;388(16):1451-1464. doi:10.1056/NEJMoa2216480 Article 3: Zwaans JJM, Raven W, Rosendaal AV, et al. Non-sterile gloves and dressing versus sterile gloves, dressings and drapes for suturing of traumatic wounds in the emergency department: a non-inferiority multicentre randomised controlled trial. Emerg Med J. 2022;39(9):650-654. doi:10.1136/emermed-2021-211540 Article 4: HALT-IT Trial Collaborators. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Lancet. 2020;395(10241):1927-1936. doi:10.1016/S0140-6736(20)30848-5 Article 5: Fowler LA, Hirsh EL, Klinefelter Z, Sulzbach M, Britt TW. Objective assessment of sleep and fatigue risk in emergency medicine physicians. Acad Emerg Med. 2023;30(3):166-171. doi:10.1111/acem.14606 Article 6: Copaescu AM, Vogrin S, James F, et al. Efficacy of a Clinical Decision Rule to Enable Direct Oral Challenge in Patients With Low-Risk Penicillin Allergy: The PALACE Randomized Clinical Trial. JAMA Intern Med. 2023;183(9):944-952. doi:10.1001/jamainternmed.2023.2986 Thank-you for listening to the podcast. Thanks to Dr. Chris Solie, Jason Hicks, Fred DeMeuse and Greta Sowels for their expert knowledge and contribution to this podcast.
After the bumper double paper review episode, we fit two months of blog content into one episode. Iain and Simon discuss the management of the patient with chronic liver disease who has an acute decompensation, global health connections, whether mechanical CPR is more effective than human CPR and the potential effects on elderly patients staying in the ED overnight. References Conor Crowley, Justin Salciccioli, Wei Wang, Tomoyoshi Tamura, Edy Y. Kim, Ari Moskowitz, The association between mechanical CPR and outcomes from in-hospital cardiac arrest: An observational cohort study, Resuscitation, 2024, 110142, ISSN 0300-9572, https://doi.org/10.1016/j.resuscitation.2024.110142. Roussel M, Teissandier D, Yordanov Y, Balen F, Noizet M, Tazarourte K, Bloom B, Catoire P, Berard L, Cachanado M, Simon T, Laribi S, Freund Y; FHU IMPEC-IRU SFMU Collaborators; FHU IMPEC−IRU SFMU Collaborators. Overnight Stay in the Emergency Department and Mortality in Older Patients. JAMA Intern Med. 2023 Dec 1;183(12):1378-1385. doi: 10.1001/jamainternmed.2023.5961. PMID: 37930696; PMCID: PMC10628833. Recommended Conferences Premier Conference - 11th-12th June 2024, Winchester Tactical Trauma 24 - 7th-9th October, Sundsvall, Sweden RCEM Annual Scientific Conference
In this episode of Medmastery's Cardiology Digest, we bridge the gap between academic research and clinical practice, exploring three cardiology studies that provide important insights, some of which may even challenge what you think you know. STUDY #1: First, we explore a study from JAMA Internal Medicine that sheds light on the intricate relationship between chronic inflammation and cardiovascular health in patients with rheumatoid arthritis (RA). The big question is whether there's a link between RA and the development of aortic stenosis, and if so, what does it mean for the future of patient care? Johnson TM et al. Aortic stenosis risk in rheumatoid arthritis. JAMA Intern Med 2023 Jul 31; [e-pub]. (https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2807944) STUDY #2: Next, we tackle a meta-analysis from the British Journal of Sports Medicine that reveals practical insights about the best form of exercise to reduce blood pressure. The conclusion may surprise you, offering a fresh perspective on exercise regimens and their role in combating hypertension. But to grasp the full scope of these revelations, you'll have to tune in. Edwards JJ et al. Exercise training and resting blood pressure: A large-scale pairwise and network meta-analysis of randomized controlled trials. Br J Sports Med 2023 Jul 25; [e-pub]. (https://bjsm.bmj.com/content/57/20/1317) STUDY #3: Lastly, we discuss a study that assesses the risks associated with subsequent pregnancies in women who have experienced peripartum cardiomyopathy (PPCM). We find out the magnitude of the potential for adverse events, including death. Pachariyanon P et al. Long-term outcomes of women with peripartum cardiomyopathy having subsequent pregnancies. J Am Coll Cardiol 2023 Jul 4; 82:16. (https://www.jacc.org/doi/10.1016/j.jacc.2023.04.043) Each of these studies offers a piece of the larger puzzle of cardiovascular health, challenging us to rethink strategies for prevention, monitoring, and treatment. Don't miss this episode, where curiosity meets clinical expertise, unlocking new horizons in cardiology. For show notes, visit us at https://www.medmastery.com/podcasts/cardiology-podcast. Learn more with these courses: Hypertension Mini: https://www.medmastery.com/courses/hypertension-mini Cardiac MRI Essentials: https://www.medmastery.com/courses/cardiac-mri-essentials Echo Masterclass—The Valves: https://www.medmastery.com/courses/echo-masterclass-valves Show notes: Visit us at https://www.medmastery.com/podcasts/cardiology-podcast.
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-376 Overview: While GLP-1 agents are center stage in the medical and lay press, drugs in the class of sodium-glucose cotransporter 2 inhibitors (SGLT2is) are also quite remarkable at improving a variety of health endpoints. This episode provides an overview of studies supporting the use of SGLT2is to improve patient outcomes. Episode resource links: DM/HF: Age Ageing 2024 Jan 2;53(1):afad254. doi: 10.1093/ageing/afad254 Kidney stones: JAMA Intern Med. 2024 Jan 29:e237660. doi: 10.1001/jamainternmed.2023.7660 Guest: Susan Feeney, DNP, FNP-BC, NP-C Music Credit: Richard Onorato
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-376 Overview: While GLP-1 agents are center stage in the medical and lay press, drugs in the class of sodium-glucose cotransporter 2 inhibitors (SGLT2is) are also quite remarkable at improving a variety of health endpoints. This episode provides an overview of studies supporting the use of SGLT2is to improve patient outcomes. Episode resource links: DM/HF: Age Ageing 2024 Jan 2;53(1):afad254. doi: 10.1093/ageing/afad254 Kidney stones: JAMA Intern Med. 2024 Jan 29:e237660. doi: 10.1001/jamainternmed.2023.7660 Guest: Susan Feeney, DNP, FNP-BC, NP-C Music Credit: Richard Onorato
Today we dive into three cardiology papers with important insights for cardiac care. STUDY #1: We explore an analysis that compares Coronary CT Angiography (CCTA) with stress modalities like SPECT-MPI. We see if CCTA has the potential to reduce the need for invasive angiography, and how it stacks up against other testing strategies. Zito, A, Galli, M, Biondi-Zoccai, G, et al. 2023. Diagnostic strategies for the assessment of suspected stable coronary artery disease: A systematic review and meta-analysis. Ann Intern Med. 6: 817–826. (https://www.acpjournals.org/doi/10.7326/M23-0231) STUDY #2: We discuss the approval of a dual-chamber leadless pacemaker system by the FDA. Although this study supports the efficacy of this innovative approach in certain scenarios, it also raises important concerns. Knops, RE, Reddy, VY, Ip, JE, et al. 2023. A dual-chamber leadless pacemaker. N Engl J Med. 25: 2360–2370. (https://www.nejm.org/doi/10.1056/NEJMoa2300080) STUDY #3: We look at a comprehensive retrospective study that evaluates aggressive management of hypertension in hospitalized adults. What are the ramifications of minimizing the use of BP-lowering agents, particularly intravenous ones, in certain inpatient scenarios? Anderson, TS, Herzig, SJ, Jing, B, et al. 2023. Clinical outcomes of intensive inpatient blood pressure management in hospitalized older adults. JAMA Intern Med. 7: 715–723. (https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2805021) Join us as we dissect these studies, unpacking their methodologies, outcomes, and the intriguing questions they raise. For show notes, visit us at https://www.medmastery.com/podcasts/cardiology-podcast Learn more with these courses: Pacemaker Essentials: https://www.medmastery.com/courses/pacemaker-essentials Pacemaker Essentials Workshop: https://www.medmastery.com/workshops/pacemaker-essentials-workshop Coronary Angiography Essentials: https://www.medmastery.com/courses/coronary-angiography-essentials
Episode Summary: Do you feel confused and mislead by all the information out there that claims to be backed by research but falls flat? In this episode, our irreverent host Aimee interviews Victoria LaFont to discuss the challenges of navigating biased content in the health and wellness industry. Victoria shares her journey of becoming more aware of her own biases and offers tips for listeners to become more discerning consumers of health advice. They emphasize the importance of looking for evidence that matches the claims made, questioning key aspects that are hidden in the literature, and seeking out diverse perspectives. By becoming more critical thinkers, listeners can make better-informed decisions about their health.About the Guest(s):Victoria LaFont is an opera singer turned nutritionist turned marketing expert. She is the founder of The LaFont Agency, a marketing agency that helps clinicians with medically-focused marketing copy, strategy, and clinical research support. Victoria is also involved in teaching and curriculum design for the Nutritional Therapy Association and the University of Western States. With her background in nutrition and marketing, Victoria is passionate about promoting evidence-based information and helping clinicians produce effective content that accounts for bias and seeks to counter it.Key Takeaways:Recognize your own biases and be open to challenging them in order to seek accurate information.Be cautious of business-driven marketing in the health and wellness industry and look for evidence-based content.Understand the difference between relative risk and absolute risk when evaluating research findings.Engage with primary literature and reach out to authors for clarification or additional information.Strive for balance and avoid extreme positions when it comes to health and wellness recommendations.Notable Quotes:"The more we can stay open to what we don't know or try to understand things more deeply, the better we're going to be at understanding what's actually happening." - Victoria LaFont"Accuracy is the ticket. Pretending something is happening when it's not actually happening is useful for our ego, and that's it." - Victoria LaFontResources:Photography by: Dai Ross Photography Podcast Cover Art: Lilly Kate Creative Blasphemous Nutrition on SubstackWork with AimeeThe LaFont Agency - WebsiteThe Statin Study Victoria references - Byrne P, Demasi M, Jones M, Smith SM, O'Brien KK, DuBroff R. Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment: A Systematic Review and Meta-analysis. JAMA Intern Med. 2022;182(5):474–481. doi:10.1001/jamainternmed.2022.0134
This the first episode in our three part series on infertility, pregnancy and breastfeeding as an Emergency Physician. In this installment, we shine a light on the often unspoken struggles of infertility among physicians, specifically focusing on the emergency medicine community. Join us and expert, Dr. Melissa Parsons, as we delve into the personal experiences, professional challenges, and nuanced perspectives of emergency physicians navigating the complex journey of infertility. In part two, we'll explore what it's like to be a pregnant as an EM physician, and in our final episode of the series, we'll talk about some of the challenges surrounding breastfeeding and pumping in the ED. Do you have questions about fertility as an EM Physician? Or want to share your own experience? Hit us up on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Dr. Melissa Parsons, Associate Professor of Emergency Medicine and Associate Residency Program Director at University of Florida College of Medicine in Jacksonville, FL Resources: Physicians should talk about the F word: fertility. Melissa E. Parsons, MD Physician March 3, 2019. KevinMD.com Levy MS, Kelly AG, Mueller C, et al. Psychosocial Burdens Associated With Family Building Among Physicians and Medical Students. JAMA Intern Med. 2023 Sep 1;183(9):1018-1021. doi: 10.1001/jamainternmed.2023.2570. PMID: 37486671; PMCID: PMC10366942. Parsons M, Mannix A, Gore K, et al. The current landscape of emergency medicine resident scheduling. AEM Educ Train. 2024 Jan 16;8(1):e10926. doi: 10.1002/aet2.10926. PMID: 38235394; PMCID: PMC10790185.. Pfennig CL, Wilson CA, Britt TW, et al. A comparative analysis on fertility success among physician specialties. Acad Emerg Med. 2022 Jun;29(6):792-794. doi: 10.1111/acem.14463. Epub 2022 Feb 27. PMID: 35178827; PMCID: PMC9305146. ***** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.
The JournalFeed podcast for the week of Feb 26 – March 1, 2024.These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Monday Spoon Feed:This systematic review and meta-analysis concluded, with moderate certainty evidence, that oseltamivir has little to no effect on hospitalization but does increase nausea and vomiting. Source:Evaluation of Oseltamivir Used to Prevent Hospitalization in Outpatients With Influenza. JAMA Intern Med. 2024 Jan 1;184(1):18-27. doi: 10.1001/jamainternmed.2023.0699. Erratum in: JAMA Intern Med. 2023 Nov 20;: PMID: 37306992; PMCID: PMC10262060.Tuesday Spoon FeedThis survey of US physicians found taking more than 3 weeks of vacation per year was associated with lower rates of burnout, while spending 30 minutes or more per vacation day on patient-related work was associated with increased burnout. Source:Vacation Days Taken, Work During Vacation, and Burnout Among US Physicians. JAMA Netw Open. 2024 Jan 2;7(1):e2351635. doi: 10.1001/jamanetworkopen.2023.51635.
Contributor: Aaron Lessen MD Educational Pearls: Does the size of a blood pressure (BP) cuff matter? A recent randomized crossover trial revealed that, indeed, cuff size can affect blood pressure readings Design 195 adults with varying mid-upper arm circumferences were randomized to the order of BP cuff application: Appropriate Too small Too large Individuals had their mid-upper arm circumference measured to determine the appropriate cuff size Participants underwent 4 sets of triplicate blood pressure measurements, the last of which was always with the appropriately sized cuff Results In individuals requiring a small cuff, the use of a regular cuff resulted in blood pressure readings 3.6 mm Hg lower than with the small cuff In individuals requiring large cuffs, the use of a regular cuff resulted in pressures 4.8 mm Hg higher than with the large cuffs In individuals requiring extra-large cuffs, the use of a regular cuff resulted in pressures 19.5 mm Hg higher than with extra-large cuffs Conclusion Miscuffing results in significantly inaccurate blood pressure measurements It is important to emphasize individualized BP cuff selection References 1. Ishigami J, Charleston J, Miller ER, Matsushita K, Appel LJ, Brady TM. Effects of Cuff Size on the Accuracy of Blood Pressure Readings: The Cuff(SZ) Randomized Crossover Trial. JAMA Intern Med. 2023;183(10):1061-1068. doi:10.1001/jamainternmed.2023.3264 Summarized by Jorge Chalit, OMSII | Edited by Jorge Chalit
Reference: Roussel et al. Overnight stay in the emergency department and mortality in older patients, JAMA Intern Med 2023 Date: December 18, 2023 Guest Skeptic: Dr. Chris Carpenter, Vice Chair of Emergency Medicine at Mayo Clinic. Case: An 85-year-old patient (Ms. McG) presents to your emergency department (ED) after being found by family on the […] The post SGEM#424: Ooh-Ooh, I Can't Wait – To Be Admitted to Hospital first appeared on The Skeptics Guide to Emergency Medicine.
In this episode of the Health Edge I review a recent meta-analysis examining the magnitude of cardiovascular benefit from taking statins for elevated LDL in both primary and secondary prevention.JAMA Intern Med. 2022;182(5):474-481. doi:10.1001/jamainternmed.2022.0134 Published online March 14, 2022. https://pubmed.ncbi.nlm.nih.gov/35285...
Dr. Mark Oldham, Associate Professor of Psychiatry at University of Rochester Medical Center, President-Elect of the American Delirium Society, and Deputy Editor of the Journal of the Academy of Consultation-Liaison Psychiatry, takes us through a deep dive on delirium. This episode covers an enormous amount of material. Contrast encephalopathy and delirium before diving into the dangerousness of delirium and prevention strategies. Explore the neurobiology of delirium and tie it to validated assessment tools and treatment approaches. We also discuss areas for future research, and learn to appreciate the evolutionary function that delirium serves.This episode also deserves some references! (3:38) Lipowski ZJ. Delirium: Acute Brain Failure in Man. Springfield, IL: Charles C Thomas, 1980. (7:55) Slooter AJC, Otte WM, Devlin JW, et al. Updated nomenclature of delirium and acute encephalopathy: statement of ten Societies. Intensive Care Med. 2020;46(5):1020-1022. (21:46) Marcantonio ER, Ngo LH, O'Connor M, et al. 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study [published correction appears in Ann Intern Med. 2014 Nov 18;161(10):764]. Ann Intern Med. 2014;161(8):554-561. (29:50) Kunicki ZJ, Ngo LH, Marcantonio ER, et al. Six-Year Cognitive Trajectory in Older Adults Following Major Surgery and Delirium. JAMA Intern Med. 2023;183(5):442-450. (41:40) Mews MR, Tauch D, Erdur H, Quante A. Comparing consultation-liaison psychiatrist's and neurologist's approaches to delirium - A retrospective analysis. Int J Psychiatry Med. 2016;51(3):284-301. = (1:08:08) Girard TD, Exline MC, Carson SS, et al. Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness. N Engl J Med. 2018;379(26):2506-2516. (1:09:33) Hui D, Frisbee-Hume S, Wilson A, et al. Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care: A Randomized Clinical Trial. JAMA. 2017;318(11):1047-1056. (1:31:36) By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. (1:33:54) Burton JK, Craig LE, Yong SQ, et al. Non-pharmacological interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev. 2021;7(7):CD013307. Published 2021 Jul 19. (1:35:41) Skrobik Y, Duprey MS, Hill NS, Devlin JW. Low-Dose Nocturnal Dexmedetomidine Prevents ICU Delirium. A Randomized, Placebo-controlled Trial. Am J Respir Crit Care Med. 2018;197(9):1147-1156. (1:36:00) Subramaniam B, Shankar P, Shaefi S, et al. Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial [published correction appears in JAMA. 2019 Jul 16;322(3):276]. JAMA. 2019;321(7):686-696.
Hypertensive urgency - asymptomatic patients with elevated blood pressure - is frequently treated in the hospital and outpatient setting. Join host, Geoff Wall, as he critically examines the evidence to assess risk over benefit. The GameChangerTreatment of asymptomatic hypertension has not been shown to improve clinical outcomes. Recent data highlights the risk with increased mortality through aggressive management. HostGeoff Wall, PharmD, BCPS, FCCP, BCGPProfessor of Pharmacy Practice, Drake UniversityInternal Medicine/Critical Care, UnityPoint Health ReferenceAnderson TS, Herzig SJ, Jing B, et al. Clinical Outcomes of Intensive Inpatient Blood Pressure Management in Hospitalized Older Adults. JAMA Intern Med. 2023;183(7):715–723. doi:10.1001/jamainternmed.2023.1667https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2805021 Pharmacist Members, REDEEM YOUR CPE HERE! Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)CPE Information Learning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Explain the difference between hypertensive urgency and emergency2. Discuss recent data about the possible harms of treating asymptomatic hypertension in the hospital setting0.05 CEU/0.5 HrUAN: 0107-0000-23-330-H01-PInitial release date: 10/23/2023Expiration date: 10/23/2024Additional CPE details can be found here.Follow CEimpact on Social Media:LinkedInInstagramDownload the CEimpact App for Free Continuing Education + so much more!
In a Nutshell: The Plant-Based Health Professionals UK Podcast
In episode seven, Daisy and Clare chat about all things related to fish - from where to obtain those all important essential omega 3 fatty acids, to whether fishing really is sustainable and what you can eat as an alternative on a plant based diet if you decide to leave fish alone. Further references are linked below: https://www.cambridge.org/core/journals/public-health-nutrition/article/are-we-running-out-of-fish-fish-health-and-sustainability/3D836148DDB47B8F1D2E790872533B90 Li N, et al. Fish consumption and multiple health outcomes: Umbrella review. Trends in Food Science and Technology 2020. doi:10.1016/j.tifs.2020.02.033 Song M,et al. Association of animal and plant protein intake with all-cause and cause-specific mortality. JAMA Intern Med 2016. doi10.1001/jamainternmed.2016.4182 Jayedi A, Shab-Bidar S. Fish Consumption and the Risk or Chronic Disease: An Umbrella Review of Meta-Analyses of Prospective Cohort Studies. Advances in Nutrition 2020; 11:. Burns-Whitmore B, Froyen E, Heskey C, Parker T, Pablo GS. Alpha-linolenic and linolenic fatty acids in the vegan diet: Do they require dietary reference intake/ adequate intake special considerations? Nutrients 2019; 11:. Statement on the benefits of fish/seafood consumption compared to the risks of methlymercury in fish/seafood. EFSA J 2015. doi:10.2903/j.efsa2015.3982 Update on the monitoring of levels of dioxins and PCB's in food and feed. EFSA J 2012. doi:10.2903/j.efsa.2012.2832 Xue B, et al. Underestimated Microplastics Pollution Derived from Fishery Activities and ‘Hidden' in Deep Sediment. Environ Sci Technol 2020. doi:10.1021/acs.est.9b04850 Cohen L, Jefferies A. Environmental Exposure and Cancer. Using the Precautionary Principle. Ecancermedicalscience 2019. doi:10.3332/ecancer.2019.ed91 Chen J, et al. Antibiotics and Food Safety in Aquaculture. J Agric Food Chem 2002.doi:10.1021/es011287i Courtenay M, et al. Tackling antimicrobial resistance 2019-2024- The UK's five year national action plan. J Hosp Infec 2019. doi:10.1016/j.jhin.2019.02.019 Manyi-Loh C, Mamphweli S, Meyer E, Okoh A. Antibiotic use in agriculture and its consequential resistance in environmental sources: Potential public health implications. Molecules 2018; 23(4):795,doi:10.3390/molecules23040795 Milanovic V, Osimani A, Aquilanti L, et al Occurrence of antibiotic resistant genres in the faecal DNA of healthy omnivores, ovo-lacto vegetarians and vegans. Mol Nutr Food Res 2017; 61(9) doi:10.1002/mnfr.201601098 The Gospel of the Eels - book by Patrik Svensson https://www.bbc.co.uk/news/science-environment-64814781 https://marine-conservation.org/wp-content/uploads/2021/08/Sala-et-al_Nature_2021.pdf Financial Times articles (behind a pay wall) Missing ice and bleached coral: the sudden warming of the oceans | Financial Times 7/8/23 Use of horseshoe crabs' blue blood puts pharma groups under scrutiny | Financial Times (ft.com) 23/8/23 Seagrass beds | WWT https://www.vegansociety.com/resources/nutrition-and-health/nutrients/omega-3-and-omega-6-fats?gad_source=1&gclid=CjwKCAjw38SoBhB6EiwA8EQVLr47EqsO8r6_-9XuzhPk1rWVqZm4V1FtXDUD_FWKiTxINNDBNTM4RxoCWRwQAvD_BwE
Jason selects an important paper on Physician burnout and how concerns have reached a strident pitch Authors: Panagioti, et al,. Publication details: Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction A Systematic Review and Meta-analysis JAMA Intern Med. 2018;178(10):1317-1330.
Contributor: Aaron Lessen MD Educational Pearls: 33 Medical residents and 91 nurses at Massachusetts General Hospital were randomized into two groups: Intervention group: 15 PGY-1 residents assigned to the same medical service floor for a 16-week period (12 weeks after adjustment for COVID-19 restrictions) alongside 43 nurses. Control group: 18 PGY-1 residents assigned to the usual 4-week block rotations across 6 medical floors. At 6 months, there were no differences in teamwork performance metrics including advanced medical simulations and nurse presence at rounds. The 12-month assessment demonstrated improvement in performance metrics. Increased time together allows individuals to get to know each other better and therefore improve performance metrics that rely on communication. References 1. Iyasere CA, Wing J, Martel JN, Healy MG, Park YS, Finn KM. Effect of Increased Interprofessional Familiarity on Team Performance, Communication, and Psychological Safety on Inpatient Medical Teams: A Randomized Clinical Trial. JAMA Intern Med. 2022;182(11):1190-1198. doi:10.1001/jamainternmed.2022.4373 Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit, OMSII
Show notes Walking is a powerful way to connect to ourselves and the environment. But do we really need to get 10,000 steps every day? In today's episode, I answer that big question! I talk about the current exercise guidelines and research on exercise and walking. I share some specific recommendations around walking, aerobic work, strength training and HIIT training to help you plan your training. I also talk about my walking practice and how I plan my training. What you will discover My take on walking and why I walk every day What the current exercise guidelines say for health and longevity The research behind walking 10,000 steps a day How many steps we should be walking Clear guidelines for you to follow when it comes to walking, zone 2, strength training and HIIT Recommendations to help you plan your training Featured on the show About Warrior School https://warriorschool.co Apply for Warrior School https://docs.google.com/forms/d/e/1FAIpQLSdS7OVobSu60FFc1pyIQVySKasuwjWvWnttTJOMRrgj6MLEPw/viewform Download my FREE bodyweight strength program https://amykatebowe.ck.page/9925443715 Australian Exercise Guidelines https://www.health.gov.au/topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians/for-adults-18-to-64-years Referenced research studies Saint-Maurice PF, Troiano RP, Bassett DR, et al. Association of Daily Step Count and Step Intensity With Mortality Among US Adults. JAMA. 2020;323(12):1151–1160. doi:10.1001/jama.2020.1382 Lee IM, Shiroma EJ, Kamada M, Bassett DR, Matthews CE, Buring JE. Association of Step Volume and Intensity With All-Cause Mortality in Older Women. JAMA Intern Med. 2019 Aug 1;179(8):1105-1112. doi: 10.1001/jamainternmed.2019.0899. PMID: 31141585; PMCID: PMC6547157. Peter Attia https://peterattiamd.com
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-332 Overview: In this episode, we take a look at the dynamic landscape of hyperlipidemia management, discussing current guidelines for hyperlipidemia treatment and the interplay between evidence-based recommendations and expert opinions. Tune in to gain a broader understanding of hyperlipidemia management and unlock fresh perspectives to enhance patient care. Episode resource links: JAMA Intern Med. March 14, 2022. doi:10.1001/jamainternmed.2022.0134 JAMA. Published online March 6, 2023. doi:10.1001/jama.2023.2487 Guest: Robert A. Baldor MD, FAAFP Music Credit: Richard Onorato
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-332 Overview: In this episode, we take a look at the dynamic landscape of hyperlipidemia management, discussing current guidelines for hyperlipidemia treatment and the interplay between evidence-based recommendations and expert opinions. Tune in to gain a broader understanding of hyperlipidemia management and unlock fresh perspectives to enhance patient care. Episode resource links: JAMA Intern Med. March 14, 2022. doi:10.1001/jamainternmed.2022.0134 JAMA. Published online March 6, 2023. doi:10.1001/jama.2023.2487 Guest: Robert A. Baldor MD, FAAFP Music Credit: Richard Onorato
What about oral?? Lewis GD et al. Effect of oral iron repletion on exercise capacity in patients with heart failure with reduced ejection fraction and iron deficiency: The IRONOUT HF randomized clinical trial. JAMA 2017 May 16; 317:1958. (http://dx.doi.org/10.1001/jama.2017.5427. opens in new tab) randomized, 225 patients with symptomatic systolic HF for 16-weeks to either oral iron polysaccharide 150 mg twice daily and placebo in 225 patients with symptomatic systolic HF (median left ventricular ejection fraction, 25%) At 16 weeks, the groups did not differ on the primary endpoint of peak oxygen consumption (VO2) or on secondary endpoints, including 6-minute walk distance and quality of life as measured with the Kansas City Cardiomyopathy Questionnaire. Thus as you mentioned not only is it not well tolerated it also doesn't appear to work which might be a better reason to not give it.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0279166Vitamin D2 supplementation was associated with a 48.8% reduction in suicide/self-harm risks, and vitamin D3 with a 44.8% reduction, both highly significant (P < .001). this sounds great but it is purely relative reduction not absolute because the absolute numbers wereUnadjusted suicide attempt/intentional self-harm rates in the D2 sample were 0.27% for those treated versus 0.52% for those untreated. The corresponding percentages for D3 were 0.20% versus 0.36%, respectively.Which equals a NNT of roughly 400 and 625 over 8 yrs, respectfully.IF this was true then that actually isn't too bad (not good or great but not terrible) but this was a retrospective observational trial so they just looked at a lot of people and said what can we find and publish.So what are other reasons that someone would not commit suicide??My first thought is ‘you only get put on vit d if you go to the doctor” (which is true)And typically the people that go to the doctor for their health care a little more about their health than someone who commits suicideClearly this isn't a universal answer but possibleAnother thought isthe vet that goes to the doctor and gets prescribed vit d feels like someone “cares for him/her” so maybe it has nothing to do with the vit d but just the sense of reassurance that someone cares about them?? Based on this I still wouldn't/wont write for vitamin d unless you need cheap placebo since we cant actually write for placeboD'Andrea E et al. Comparing effectiveness and safety of SGLT2 inhibitors vs DPP-4 inhibitors in patients with type 2 diabetes and varying baseline HbA1c levels. JAMA Intern Med 2023 Feb 6; [e-pub]. Sodium–glucose cotransporter-2 (SGLT-2) inhibitors are used to manage type 2 diabetes but also have protective cardiovascular and renal effects. Do these benefits and adverse effects vary according to baseline level of hyperglycemia SGLT-2 inhibitors were compared with propensity-score–matched patients who initiated dipeptidyl peptidase-4 (DPP-4) inhibitors, within three categories of HbA1c: 9%. After mean follow-up of 8 months, initiation of SGLT-2 inhibitors was associated with significantly lower risks for major adverse cardiovascular events and hospitalization for heart failure, DUH we know this works in people that don't have diabetes why is it a surprise that it works in those with uncontrolled or controlled diabetes. To me this points to the problem that A1C is a number, it is not the problem, a bad A1C says there could be a problem in the future but in itself the A1C is a number!Buelt, Andrew | Apr 19, 2023, 3:25 PM | | to meTreat-to-Target or High-Intensity Statin in Patients With Coronary Artery Disease: A Randomized Clinical Trial | Cardiology | JAMA | JAMA Network JAMA. 2023;329(13):1078-1087. doi:10.1001/jama.2023.2487 randomized noninferiority trial 4400 patients Question Is treatment to a goal low-density lipoprotein cholesterol (LDL-C) level between 50 and 70 mg/dL noninferior to a strategy using high-intensity statin therapy among patients with coronary artery disease? To assess whether a treat-to-target strategy is noninferior to a strategy of high-intensity statins for long-term clinical outcomes in patients with coronary artery disease.Patients were randomly assigned to receive either the LDL-C target strategy, with an LDL-C level between 50 and 70 mg/dL as the target, or high-intensity statin treatment, which consisted of rosuvastatin, 20 mg, or atorvastatin, 40 mg. Which isn't HIGH in my book that that is fine. Primary end point was a 3-year composite of death, myocardial infarction, stroke, or coronary revascularization with a noninferiority margin of 3.0 percentage points. The primary end point occurred in (8.1%) in the treat-to-target group and (8.7%) in the high-intensity statin group Worst conclusion ever“Conclusions and Relevance Among patients with coronary artery disease, a treat-to-target LDL-C strategy of 50 to 70 mg/dL as the goal was noninferior to a high-intensity statin therapy for the 3-year composite of death, myocardial infarction, stroke, or coronary revascularization. These findings provide additional evidence supporting the suitability of a treat-to-target strategy that may allow a tailored approach with consideration for individual variability in drug response to statin therapy.” Let's see if something that's much more difficult and costly and more blood draws and more work and more office appointments is non inferior to something that's easier such as take this medication and that it………………………………... Then why it is, we recommend the much more difficult thing. Treat-to-Target or High-Intensity Statin in Patients With Coronary Artery Disease: A Randomized Clinical Trial | Cardiology | JAMA | JAMA Network JAMA. 2023;329(13):1078-1087. doi:10.1001/jama.2023.2487 randomized noninferiority trial 4400 patients Question Is treatment to a goal low-density lipoprotein cholesterol (LDL-C) level between 50 and 70 mg/dL noninferior to a strategy using high-intensity statin therapy among patients with coronary artery disease? To assess whether a treat-to-target strategy is noninferior to a strategy of high-intensity statins for long-term clinical outcomes in patients with coronary artery disease.Patients were randomly assigned to receive either the LDL-C target strategy, with an LDL-C level between 50 and 70 mg/dL as the target, or high-intensity statin treatment, which consisted of rosuvastatin, 20 mg, or atorvastatin, 40 mg. Which isn't HIGH in my book that that is fine. Primary end point was a 3-year composite of death, myocardial infarction, stroke, or coronary revascularization with a noninferiority margin of 3.0 percentage points. The primary end point occurred in (8.1%) in the treat-to-target group and (8.7%) in the high-intensity statin group Worst conclusion ever“Conclusions and Relevance Among patients with coronary artery disease, a treat-to-target LDL-C strategy of 50 to 70 mg/dL as the goal was noninferior to a high-intensity statin therapy for the 3-year composite of death, myocardial infarction, stroke, or coronary revascularization. These findings provide additional evidence supporting the suitability of a treat-to-target strategy that may allow a tailored approach with consideration for individual variability in drug response to statin therapy.” Let's see if something that's much more difficult and costly and more blood draws and more work and more office appointments is non inferior to something that's easier such as take this medication and that it………………………………... Then why it is, we recommend the much more difficult thing. Hydrochlorothiazide and Prevention of Kidney-Stone Recurrence | NEJMN Engl J Med 2023; 388:781-791 Thiazide diuretic agents are widely used for prevention of the recurrence of kidney stones, but data regarding the efficacy of such agents as compared with placebo are limited. double-blind RCT patients with recurrent calcium-containing kidney stones were randomized to hctz 12.5 mg, 25 mg, or 50 mg once daily or placebo once daily. primary end point, a composite of symptomatic or radiologic recurrence of kidney stones. Symptomatic= The visible passage of a stone and radiologic =Appearance of new stones on CT 416 patients were randomized and followed for almost 3yrs primary end-point event occurred in (59%) in the placebo group (59%) in the 12.5-mg hydrochlorothiazide group (56%) in the 25-mg group(49%) in the 50-mg group (rate ratio, 0.92; 95% CI, 0.63 to 1.36) No difference in any of the subgroups that was looked at there was no difference in the stone composition if it was calcium oxalate or calcium phosphate there was no difference Some women and people of race were underrepresented in this study but when you have a well done study that is the best we have the burden of proof now falls on you to prove there is benefit… for me this goes against board questions and what I thought was true and will lead me to stopping HCTZ if I am using it for prevention of kidney stones.
Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum. Ayers JW, Poliak A, Dredze M, et al. JAMA Intern Med. Published Ahead of Print. doi:10.1001/jamainternmed.2023.1838 Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. Brought to you by CSMi – https://www.humacnorm.com/ptinquest Learn more about/Buy Erik's courses – The Science PT Support us on the Patreons! Music for PT Inquest: “The Science of Selling Yourself Short” by Less Than Jake Used by Permission Other Music by Kevin MacLeod – incompetech.com: MidRoll Promo – Mining by Moonlight
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-328 Overview: Are you tired of sifting through conflicting information about nutrition and mortality? Look no further than this podcast episode, where we dive deep into the latest dietary research. With so much conjecture and small data sets out there, it can be challenging to know what advice to give. Tune in to this discussion to gain valuable insights and to make informed recommendations about healthy eating habits for your patients. Episode resource links: JAMA Intern Med. doi:10.1001/jamainternmed.2022.6117 Nutrients 2021 Jul 9;13(7):2342. doi: 10.3390/nu13072342. Guest: Robert A. Baldor MD, FAAFP Music Credit: Richard Onorato
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-328 Overview: Are you tired of sifting through conflicting information about nutrition and mortality? Look no further than this podcast episode, where we dive deep into the latest dietary research. With so much conjecture and small data sets out there, it can be challenging to know what advice to give. Tune in to this discussion to gain valuable insights and to make informed recommendations about healthy eating habits for your patients. Episode resource links: JAMA Intern Med. doi:10.1001/jamainternmed.2022.6117 Nutrients 2021 Jul 9;13(7):2342. doi: 10.3390/nu13072342. Guest: Robert A. Baldor MD, FAAFP Music Credit: Richard Onorato
In this episode of Culture by Design, Tim and Junior discuss the importance of psychological safety in healthcare. They highlight the significant issue of medical errors in the industry and propose creating a culture of rewarded vulnerability to overcome the fear of speaking up. They also discuss the barriers to psychological safety in healthcare and the ultimate impact of psychological safety, which is to improve patient outcomes and reduce preventable medical errors, ultimately saving lives. The 4 Stages of Psychological Safety offer strategies for measuring and improving the fear of speaking up at all levels of the organization. By prioritizing psychological safety, healthcare leaders can create a better work environment and improve the quality of care for patients.Important Links and ReferencesWorld Health Organization. (2017). Global Priorities for Patient Safety Research. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/258881/WHO-IER-PSP-2017.11-eng.pdf?sequence=1Institute of Medicine. (1999). To Err is Human: Building a Safer Health System. Washington, DC: National Academies Press. Retrieved from https://www.nap.edu/catalog/9728/to-err-is-human-building-a-safer-health-systemAchieving Physical Safety Through Psychological Safetyhttps://www.leaderfactor.com/podcast/achieving-physical-safety-through-psychological-safetyMagill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370(13):1198-1208. doi:10.1056/NEJMoa1306801Allegranzi, B., Bagheri Nejad, S., Combescure, C., Graafmans, W., Attar, H., Donaldson, L., & Pittet, D. (2011). Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. The Lancet, 377(9761), 228-241. doi:10.1016/S0140-6736(10)61458-4Zimlichman E, Henderson D, Tamir O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med. 2013;173(22):2039-2046. doi:10.1001/jamainternmed.2013.9763
Jenny shares the radiology journey she went on that ultimately led to the ACR incidental thyroid nodule white paper guidelines. A list of references is included below. Radiopaedia 2023 Virtual Conference ► https://radiopaedia.org/courses/radiopaedia-2023-virtual-conference Become a supporter ► https://radiopaedia.org/supporters Get an All-Access Pass ► https://radiopaedia.org/courses/all-access-course-pass Andrew's Twitter ► https://twitter.com/drandrewdixon Frank's Twitter ► https://twitter.com/frankgaillard Ideas and Feedback ► podcast@radiopaedia.org Hoang JK, Langer JE, Middleton WD, Wu CC, Hammers LW, Cronan JJ, Tessler FN, Grant EG, Berland LL. Managing incidental thyroid nodules detected on imaging: white paper of the ACR Incidental Thyroid Findings Committee. J Am Coll Radiol. 2015 Feb;12(2):143-50. doi: 10.1016/j.jacr.2014.09.038. Epub 2014 Nov 1. PMID: 25456025. Smith-Bindman R, Lebda P, Feldstein VA, Sellami D, Goldstein RB, Brasic N, Jin C, Kornak J. Risk of thyroid cancer based on thyroid ultrasound imaging characteristics: results of a population-based study. JAMA Intern Med. 2013 Oct 28;173(19):1788-96. doi: 10.1001/jamainternmed.2013.9245. PMID: 23978950; PMCID: PMC3936789. Nguyen XV, Choudhury KR, Eastwood JD, Lyman GH, Esclamado RM, Werner JD, Hoang JK. Incidental thyroid nodules on CT: evaluation of 2 risk-categorization methods for work-up of nodules. AJNR Am J Neuroradiol. 2013 Sep;34(9):1812-7. doi: 10.3174/ajnr.A3487. Epub 2013 Apr 4. PMID: 23557957; PMCID: PMC7965620. Nguyen XV, Roy Choudhury K, Tessler FN, Hoang JK. Effect of Tumor Size on Risk of Metastatic Disease and Survival for Thyroid Cancer: Implications for Biopsy Guidelines. Thyroid. 2018 Mar;28(3):295-300. doi: 10.1089/thy.2017.0526. Epub 2018 Feb 22. PMID: 29373949. Drake T, Gravely A, Ensrud K, Billington CJ. Reporting of Incidental Thyroid Nodules on Chest Computed Tomography and the Impact on Nodule Evaluation: A Retrospective Cohort Study. Thyroid. 2022 Dec;32(12):1529-1534. doi: 10.1089/thy.2022.0349. Epub 2022 Oct 31. PMID: 36128846. Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg. 2014 Apr;140(4):317-22. doi: 10.1001/jamaoto.2014.1. PMID: 24557566. The Reading Room is a radiology podcast intended primarily for radiologists, radiology registrars and residents.
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-315 Overview: A recent publication shows that being a “weekend warrior” exerciser provides the same benefit to mortality risk as spreading the physical activity out across the week. Listen to this podcast to hear the data from this study and to optimally counsel your patients on how to lower their mortality risk through physical activity. Episode resource links: Physical Activity Guidelines for Americans, 2nd Edition.; 2018. https://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf. dos Santos M, Ferrari G, Lee DH, et al. Association of the “Weekend Warrior” and Other Leisure-time Physical Activity Patterns With All-Cause and Cause-Specific Mortality: A Nationwide Cohort Study. JAMA Intern Med.2022;182(8):840–848. doi:10.1001/jamainternmed.2022.2488 Guest: Jillian Joseph, MPAS, PA-C Music Credit: Richard Onorato
Efficacy and Safety of Intensive Versus Nonintensive Supplemental Insulin With a Basal-Bolus Insulin Regimen in Hospitalized Patients With Type 2 Diabetes: A Randomized Clinical Study | Diabetes Care | American Diabetes Association (diabetesjournals.org) randomized noninferiority study from Emory University, 224 hospitalized patients with longstanding type 2 diabetes Both groups received basal/bolus insulin; both the starting dose and subsequent changes were specified by the study protocol. Additional premeal SSI was added to scheduled premeal bolus doses.randomized to either intensive SSI (at BG >140 mg/dL) or nonintensive SSI (at BG >260 mg/dL) before meals and at bedtime. Mean baseline glycosylated hemoglobin (HbA1c) was 9%, and 60% of patients were using insulin at home. Patients with a presenting glucose level of >400 mg/dL or diabetic ketoacidosis were excluded. Outcome---Mean daily BG level, hypoglycemia, severe hyperglycemia, percent of BGs in the target range (70–180 mg/dL), and the amount of total, basal, or prandial insulin used did not differ between groups. However, significantly fewer patients in the nonintensive group than in the intensive group received SSI (34% vs. 91%). COMMENTAlthough this is a single-center study, its results are persuasive and suggest that a less-intense SSI regimen can achieve similar glucose outcomes in hospitalized patients with type 2 diabetes who are receiving basal/bolus insulin. It also could decrease nursing treatment burden. As we move slowly toward more continuous glucose monitoring in hospitals, reducing use of SSI is another opportunity to achieve similar results with less staff burden and more patient comfort. Comparative Effectiveness and Safety Between Apixaban, Dabigatran, Edoxaban, and Rivaroxaban Among Patients With Atrial Fibrillation: A Multinational Population-Based Cohort Study: Annals of Internal Medicine: Vol 175, No 11 (acpjournals.org) In a retrospective study, investigators accessed five electronic health databases from Europe and the U.S. to compare >500,000 new DOAC users with newly diagnosed atrial fibrillation. Follow up varied from 1.5 to 4.5 years. In propensity score–adjusted analyses, patients who received apixaban had significantly less gastrointestinal (GI) bleeding did those who received any of the other three drugs (hazard ratios, 0.7–0.8). This result was consistent among older patients and those with chronic kidney disease (CKD). Risk for stroke or other systemic embolism, intracranial hemorrhage, and all-cause mortality did not differ significantly among DOACs. COMMENTThis is the largest comparison of individual DOACs, and it demonstrates similar efficacy among all agents. Although apixaban was associated with less GI bleeding, absolute percentages of GI bleeds ranged from ≈2% to ≈3.5% for all DOACs; therefore, apixaban's statistically significant safety benefit might amount to marginal clinical benefit for any individual patient. I might turn to apixaban for patients at high risk for GI bleeding (and those with CKD), but all DOACs remain reasonable options for preventing thromboembolism in most patients with atrial fibrillation. Ellenbogen MI et al. Safety and effectiveness of apixaban versus warfarin for acute venous thromboembolism in patients with end-stage kidney disease: A national cohort study. J Hosp Med 2022 Oct; 17:809. (https://doi.org/10.1002/jhm.12926. opens in new tab) . In an industry-funded retrospective study, investigators used a national database (years, 2014–2018) and propensity score–adjusted analysis to compare outcomes among >11,500 patients with ESRD and newly diagnosed VTE who received either apixaban or warfarin.Only 2% of patients received apixaban in 2014, but 47% received apixaban in 2018.during the 6 months following initiation of therapy, apixaban — compared with warfarin associated with significantly lower incidence of major bleeding (10% vs. 14%), including intracranial bleeding (1.8% vs. 2.5%) and gastrointestinal bleeding (8.6% vs. 10.4%). Recurrent VTE and all-cause mortality were similar in the two groups. VTE and creatine clearence less than 30 then I think apixaban is the drug of choice—I would like to see this study don't with afib and done with exclusively
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