Podcasts about jama netw open

Featuring perspectives from Dr Joshua K Sabari, including the following topics: Jänne PA et al. Final analysis results and patient-reported outcomes from DESTINY-Lung02 — A dose-blinded, randomized, phase 2 study of trastuzumab deruxtecan in patients with HER2-mutant metastatic NSCLC. J Thorac Oncol 2025;20(12):1814-28. (0:00) Heymach JV et al. Circulating tumor DNA (ctDNA) analysis following zongertinib treatment (tx) in patients (pts) with human epidermal growth factor receptor 2 (HER2)-mutant non-small cell lung cancer (NSCLC): Phase Ia/Ib Beamion LUNG-1 study. ESMO 2025;Abstract 2020P. (8:30) Schram AM et al. Beamion PANTUMOR-1: Rationale and design of a phase II trial of zongertinib in HER2-overexpressed/amplified or HER2-mutant solid tumors. Future Oncol 2026;22(7):795-803. (12:53) Johnson ML et al. Beamion LUNG-2: A phase III randomized controlled trial of zongertinib (BI 1810631) versus standard of care in patients with locally advanced/metastatic non-squamous NSCLC harboring HER2 tyrosine kinase domain (TKD) mutations. ASCO 2024;Abstract TPS8654. (19:40) Le X et al. SOHO-02: Phase III trial of BAY 2927088 in patients with locally advanced or metastatic NSCLC with HER2-activating mutations. ASCO 2025;Abstract TPS8648. (21:41) Li BT et al. Open-label, randomized, multicenter, phase 3 study evaluating trastuzumab deruxtecan (T-DXd) as first-line treatment in patients with unresectable, locally advanced, or metastatic non-small cell lung cancer (NSCLC) harboring HER2 exon 19 or 20 mutations (DESTINY-Lung04). ASCO 2022;Abstract TPS9137. (22:59) Jänne PA et al. Trastuzumab deruxtecan for ERBB2-mutant metastatic NSCLC with or without brain metastases: A secondary analysis of randomized clinical trials. JAMA Netw Open 2025;8(11):e2543107. (24:37) CME information and select publications

Join Jenn Dawson and Mitchell Hanson for some quick-hitting "research hot takes!"Topical Therapies Supporting Links and Articleshttps://nextstepsinderm.com/derm-topics/expanding-the-treatment-landscape-for-atopic-dermatitis-hidradenitis-suppurativa-and-chronic-hand-eczema/https://www.dermatologytimes.com/view/advancing-topical-stewardship-and-expanding-nonsteroidal-optionshttps://www.arcutis.com/arcutis-announces-publication-of-positive-long-term-safety-and-efficacy-data-with-zoryve-roflumilast-cream-0-05-for-treatment-of-mild-to-moderate-atopic-dermatitis-in-children-ages-2-5/Social Unrest Leads to Access Barriers Supporting Links and ArticlesC. L. Presley, J. Meisenheimer VII, C. W. Rundle, S. Maguiness, I. A. Maher, and A. J. M. Anderson, “Social Unrest and Its Implications on the Pediatric Dermatological Patient: Lessons From a Single Center Academic Dermatology Department,” Pediatric Dermatology (2026): 1–2, https://doi.org/10.1111/pde.70260.Mukerjee K, Shah S, Falusi O. State Policies and Access to Care for Immigrant Children—Implications for Pediatric Health Outcomes. JAMA Netw Open. 2025;8(12):e2545833. doi:10.1001/jamanetworkopen.2025.45833Skin of Color in Pediatric Dermatology Supporting Links and ArticlesDondi, A., Ranieri, A., Andreozzi, L., Leuzzi, M., D'Alanno, G., Pierantoni, L., Zama, D., Battelli, E., Calegari, R., Borghesi, A., Lanari, M., & Neri, I. (2026). Skin of Color in Pediatric Dermatology: A Cross-Sectional Retrospective Analysis Addressing Inclusive Diagnosis and Care. Life (Basel, Switzerland), 16(4), 578. https://doi.org/10.3390/life16040578Fagan E, Reagen C, Ituarte B, Shet P, Shaver-Dominguez N, Harter N, Wei EX, Oudenhoven M. Trends in Pediatric Representation Within Skin of Color Dermatology Literature: A Decade-Long Analysis. Pediatr Dermatol. 2026 Jan-Feb;43(1):95-97. doi: 10.1111/pde.16038. Epub 2025 Aug 13. PMID: 41611238.This episode is presented by Disc Medicine. Although Disc Medicine provided funding for this PeDRA Pearls Podcast, the contents of the podcast were developed independently by PeDRA. Learn more about Disc Medicine.

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-494 Overview: Primary care visits offer a valuable opportunity to identify and address excessive screen time—a health concern that can impact adults' physical and mental well-being. This episode brings you current data on adult screen use and its health consequences, helping you recognize and respond to a growing issue in patient populations. Episode resource links: Front Psychiatry. 2022 Dec 22:13:1058572. doi: 10.3389/fpsyt.2022.1058572. eCollection 2022 BMC Med. 2025 Feb 21;23(1):107. JAMA Netw Open. 2025 Mar 3;8(3):e252493. doi: 10.1001/jamanetworkopen.2025.2493 Guest: Robert A. Baldor MD, FAAFP   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-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-494 Overview: Primary care visits offer a valuable opportunity to identify and address excessive screen time—a health concern that can impact adults' physical and mental well-being. This episode brings you current data on adult screen use and its health consequences, helping you recognize and respond to a growing issue in patient populations. Episode resource links: Front Psychiatry. 2022 Dec 22:13:1058572. doi: 10.3389/fpsyt.2022.1058572. eCollection 2022 BMC Med. 2025 Feb 21;23(1):107. JAMA Netw Open. 2025 Mar 3;8(3):e252493. doi: 10.1001/jamanetworkopen.2025.2493 Guest: Robert A. Baldor MD, FAAFP   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-Med.

Antenatal corticosteroids are a MAJOR win in the management of preterm labor. An initial course of antenatal corticosteroids has been shown to reduce morbidity and mortality in patients with preterm prelabor rupture of membranes. For patients who remain undelivered after the initial course of antenatal corticosteroids, it is uncertain whether a booster course of antenatal corticosteroids reduces neonatal morbidity or increases the infection risk. The ACOG, in its current guidance, has concluded that the current evidence is insufficient to make a recommendation. Corticosteroids, especially at the doses given, are also powerful immunosuppressants. When you administer that first course, you accept a minor, calculated risk for a massive, proven benefit. But when you introduce a second course of steroids into a uterine environment that has already been ruptured and exposed to vaginal flora for weeks, you are pouring fuel on the fire. PLUS, the environment for the fetus with prolonged preterm prelabor rupture of membranes is unique. PPPROM, the chronic exposure to ruptured membranes and the resultant oligohydramnios is theorized to trigger a kind of stress response in the fetus- so the baby may make their own endogenous corticosteroid flare. So, rescue steroids after an initial course of steroids in PPROM cases has remained controversial but we have updated data that has provided new insights. In this episode, we will highlight an RCT from 2023 and a more recent systematic review and meta-analysis from May 2026 on this very subject. Listen in for details. 1. Garite TJ, Kurtzman J, Maurel K, Clark R; Obstetrix Collaborative Research Network. Impact of a 'rescue course' of antenatal corticosteroids: a multicenter randomized placebo-controlled trial. Am J Obstet Gynecol. 2009 Mar;200(3):248.e1-9. doi: 10.1016/j.ajog.2009.01.021. Erratum in: Am J Obstet Gynecol. 2009 Oct;201(4):428. PMID: 19254583.2. Tenbrink E, Quain A, Rone V, Harris K, Hadley E, Haas D, Shanks A. Risk of Neonatal Sepsis With Rescue Steroids in Preterm Premature Rupture of Membranes. Cureus. 2023 Apr 6;15(4):e37207. doi: 10.7759/cureus.37207. PMID: 37159785; PMCID: PMC10163895.3. Melamed N, Murphy KE, Pylypjuk C, et al. Timingof Antenatal Corticosteroid Administration and Neonatal Outcomes. JAMA Netw Open. 2025;8(5):e2511315. 4. Porreco R, Garite TJ, Combs CA, Maurel K, Huls CK, Baker S, Fortner KB, Longo SA, Nageotte M, Lewis D, Tran L; Obstetrix Collaborative Research Network. Booster course of antenatal corticosteroids after preterm prelabor rupture of membranes: a double-blind randomized trial. Am J Obstet Gynecol MFM. 2023 May;5(5):100896. doi: 10.1016/j.ajogmf.2023.100896. Epub 2023 Feb 14. PMID: 36796641.5. Da Costa Y, Ramanathan V, Oliveira JA, Brito J, Yousif A. Repeat versus Single Course of Antenatal Corticosteroid in Management of Preterm Premature Rupture of Membranes: A Systematic Review and Meta-analysis. Am J Perinatol. 2026 May;43(7):925-932. doi: 10.1055/a-2708-5314. Epub 2025 Oct 9. PMID: 41067234

Did you know that the average age of puberty onset in girls has been declining for decades, and that early puberty can have lasting psychological, social, and physical consequences? Roshni Patel, a fourth-year medical student at the Medical College of Georgia, and Bianca Forte, WHNP, a Women's Health Nurse Practitioner with a specialty in Pediatric and Adolescent Gynecology at Wellstar MCG Health, to discuss the recognition, evaluation, and management of precocious puberty in girls. Specifically, they will: Review the normal pubertal timeline and define precocious puberty in females Distinguish between premature thelarche, premature adrenarche, and precocious puberty through history and physical exam findings Discuss the initial diagnostic workup, including bone age studies, hormone levels, and the GnRH stimulation test Differentiate central precocious puberty from peripheral precocious puberty and outline appropriate management for each Address the mental health impact of early puberty and how to support young patients during the clinical encounter Identify when to refer patients to Pediatric Endocrinology or Pediatric and Adolescent Gynecology Special thanks to Dr. Rebecca Yang and Dr. Sarah Straka for peer reviewing this episode Free CME Available: Link Coming Soon! References: Aghaee S, Deardorff J, Quesenberry CP, Greenspan LC, Kushi LH, Kubo A. Associations Between Childhood Obesity and Pubertal Timing Stratified by Sex and Race/Ethnicity. Am J Epidemiol. 2022;191(12):2026-2036. doi:10.1093/aje/kwac148 Berberoğlu M. Precocious puberty and normal variant puberty: definition, etiology, diagnosis and current management. J Clin Res Pediatr Endocrinol. 2009;1(4):164-174. doi:10.4274/jcrpe.v1i4.3 Carel JC, Léger J. Clinical practice. Precocious puberty. N Engl J Med. 2008;358(22):2366-2377. doi:10.1056/NEJMcp0800459 Dinkelbach L, Grasemann C, Kiewert C, Leikeim L, Schmidt B, Hirtz R. Central Precocious Puberty and Psychiatric Disorders. JAMA Netw Open. 2025;8(6):e2516679. Published 2025 Jun 2. doi:10.1001/jamanetworkopen.2025.16679 Eckert-Lind C, Busch AS, Petersen JH, et al. Worldwide Secular Trends in Age at Pubertal Onset Assessed by Breast Development Among Girls: A Systematic Review and Meta-analysis. JAMA Pediatr. 2020;174(4):e195881. doi:10.1001/jamapediatrics.2019.5881 Hampl SE, Hassink SG, Skinner AC, et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics. 2023;151(2):e2022060640. doi:10.1542/peds.2022-060640 Joinson C, Heron J, Lewis G, Croudace T, Araya R. Timing of menarche and depressive symptoms in adolescent girls from a UK cohort. Br J Psychiatry. 2011;198(1):17-2. doi:10.1192/bp.110.080861 Kaplowitz PB. For Premature Thelarche and Premature Adrenarche, the Case for Waiting before Testing. Horm Res Paediatr. 2020;93(9-10):573-576. doi:10.1159/000512764 Klein DA, Emerick JE, Sylvester JE, Vogt KS. Disorders of Puberty: An Approach to Diagnosis and Management. Am Fam Physician. 2017;96(9):590-599. Kota AS, Sharma L, Ejaz S. Precocious Puberty. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544313/

Join us as we discuss research on mental health and wellbeing in the surgical workforce with Drs. Yang and Collins. The episode explores key findings from recent national surveys showing that nearly one in seven surgeons report suicidal ideation in the past year, with depression, anxiety, and PTSD affecting 15–20% of the surgical population. The conversation highlights protective factors—professional fulfillment, resilience, self-valuation, and connection—while distinguishing between healthy resilience and normalized suffering. Dr. Yang and Dr. Collins discuss systemic barriers including time constraints, out-of-pocket mental health costs, and persistent stigma, alongside actionable institutional interventions: protecting dedicated wellbeing time, establishing peer support and psychological first aid programs, ensuring free mental health access, and expanding research to understand what helps surgeons thrive. The episode emphasizes that self-care is essential to patient safety and invites listeners to become advocates, engage with the literature, and help drive culture change within their institutions. For more information about the AAS wellbeing survey, please email Dr. Yang at CJYANG@MGH.HARVARD.EDU.Host:   Steven Thornton, MD (General Surgery Resident at Duke University) Agnes Premkumar (General Surgery Resident at Creighton) Guests: Jeff Yang, MD (Massachusetts General Hospital) Reagan Collins, MD (University of Pennsylvania) Publications Discussed: Hughes TM, Collins RA, Cunningham CE. Depression and Suicide Among American Surgeons-A Grave Threat to the Surgeon Workforce. JAMA Surg. 2024 Jan 1;159(1):7-8. doi: 10.1001/jamasurg.2023.4658. PMID: 37792380. [https://pubmed.ncbi.nlm.nih.gov/37792380/] Collins RA, Herman T, Snyder RA, Haines KL, Stey A, Arora TK, Geevarghese SK, Phillips JD, Vicente D, Griggs CL, McElroy IE, Wall AE, Hughes TM, Sen S, Valinejad J, Alban A, Swan JS, Mercaldo N, Jalali MS, Chhatwal J, Gazelle GS, Rangel E, Yang CJ, Donelan K, Gold JA, West CP, Cunningham C. Unspoken Truths: Mental Health Among Academic Surgeons. Ann Surg. 2024 Mar 1;279(3):429-436. doi: 10.1097/SLA.0000000000006159. Epub 2023 Nov 23. PMID: 37991182. [https://pubmed.ncbi.nlm.nih.gov/37991182/]  Yaghmour NA, Bynum WE 4th, Hafferty FW, Könings KD, Richter T, Brigham TP, Nasca TJ. Causes of Death Among US Medical Residents. JAMA Netw Open. 2025 May 1;8(5):e259238. doi: 10.1001/jamanetworkopen.2025.9238. Erratum in: JAMA Netw Open. 2025 Jul 1;8(7):e2523489. doi: 10.1001/jamanetworkopen.2025.23489. PMID: 40366660; PMCID: PMC12079293. [https://pubmed.ncbi.nlm.nih.gov/40366660/] Nasca BJ, Hunt ML, Ramirez RT, Eng JS, Li RD, Agarwal G, Bilimoria KY, Hu YY. One is too many: suicidality among general surgery residents. Acad Med. 2025 Dec 24:wvaf105. doi: 10.1093/acamed/wvaf105. Epub ahead of print. PMID: 41819820. [https://pubmed.ncbi.nlm.nih.gov/41819820/] Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Send us Fan MailIn this Journal Club, Ben and Daphna dig into two new papers on PDA management in our smallest patients. First, the SMART-PDA pilot RCT from Souvik Mitra and colleagues, which uses comprehensive hemodynamic screening to selectively treat high-volume shunts in infants born before 26 weeks, and whose striking Bayesian signal for reduced pulmonary hemorrhage and NEC stopped the trial early. Then a companion JAMA Network Open comparative effectiveness study across four pharmacotherapy regimens. Along the way, Ben shares hemodynamics pearls from his Montreal training: why left ventricular output, LA:Ao ratio, and transductal velocity matter more than PDA diameter alone.----Selective early medical treatment of the patent ductus arteriosus in extremely low gestational age infants: a pilot randomised controlled trial (SMART-PDA). Mitra S, Hebert A, Castaldo MP, Disher T, El-Naggar W, Dhillon S, Alhassen Z, Koo J, Katheria AC, Hyderi A, Kumaran K, Ting J, Surak A, Larocque J, Pepper D, Hornberger L, Makoni M, Weisz DE, Jain A, Bacchini F, Cameron-Nola AJJ, Hatfield T, Dorling J, McNamara PJ, Thabane L.Arch Dis Child Fetal Neonatal Ed. 2026 May 18:fetalneonatal-2026-330462. doi: 10.1136/archdischild-2026-330462. Online ahead of print.PMID: 42150872Pharmacologic Therapies for Patent Ductus Arteriosus in Extremely Preterm Infants. Mitra S, Jain A, Ting JY, Ben Fadel N, Drolet C, Abou Mehrem A, Soraisham AS, Jasani B, Louis D, Lapointe A, Dorling J, Khurshid F, Hyderi A, Kumaran K, Toye J, Harabor A, Weisz DE, Stavel M, Morin A, Bhattacharya S, Lalitha R, Afifi J, Augustine S, Castaldo MP, Hatfield T, Su YC, Shah PS; Canadian Neonatal Network Investigators.JAMA Netw Open. 2026 Jun 1;9(6):e2617477. doi: 10.1001/jamanetworkopen.2026.17477.PMID: 42262753 Free PMC article.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

Series Description Disclosure is a three-part podcast series from the Docs with Disabilities Podcast that examines one of the most personal and consequential decisions disabled healthcare providers make: whether, when, and how to disclose a disability. Through the voices of medical students, residents, practicing physicians, psychologists, nurses, researchers, legal scholars, and disability advocates, the series explores disclosure as an ongoing process shaped by identity, institutional culture, ableism, and power. Blending lived experience with research and policy, the series challenges assumptions about disability in healthcare while illuminating pathways toward more inclusive learning, training, and practice environments. Part 2: Medical Culture, Stigma, and What Prevents Disclosure Why does disability disclosure feel so difficult—and for many, unsafe—in healthcare? In the second episode of the Disclosure series, we move beyond individual disclosure decisions to examine the culture of medicine itself. Through the perspectives of physicians, researchers, allied health professionals, disability scholars, and trainees, this episode explores how the hidden curriculum, stigma, institutional practices, and everyday interactions shape whether disabled healthcare professionals feel they belong. Contributors reflect on the burdens of seeking accommodations, the impact of ableist assumptions, the complexities of partial disclosure, and the ways colleagues, mentors, and institutional norms influence identity safety. Together, these stories reveal that disclosure is never simply an individual choice—it is a reflection of the culture in which it occurs and a catalyst for reimagining a more inclusive future for healthcare. Transcript: https://docs.google.com/document/d/103BYwMaTCBRYJB7IZU3UHfp6zMPIvBVF/edit?usp=share_link&ouid=104315301750264632478&rtpof=true&sd=true Keywords Disability disclosure Medical culture Hidden curriculum Ableism in medicine Disability stigma Psychological safety Identity safety Disability accommodations Physicians with disabilities Medical students with disabilities Healthcare workplace culture Health professions education Healthcare inclusion Disability justice Healthcare professionals Production Team Developer, Writer, Executive Producer: Sofia Schlozman Co-Producers: Rylee Betchkal and Lisa Meeks Co-Producer, Sound Selection and Editing: Gabe Abrams Sound Production: Next Day Podcast Digital Media: Katie Sullivan Citations Anderson, H. L. K., Konopasky, A. W., Bullock, J. L., Meeks, L. M., & Jain, N. R. (2025). The Call is Coming from Inside the House: Racism and Ableism in US Medical Education. Teaching and Learning in Medicine, 0(0), 1–19. https://doi.org/10.1080/10401334.2025.2581621 Evans, H. D. (2017). Un/covering: Making Disability Identity Legible. Disability Studies Quarterly, 37(1). https://doi.org/10.18061/dsq.v37i1.5556 Jain, N. R. (2020). Political disclosure: Resisting ableism in medical education. Disability & Society, 35(3), 389–412. https://doi.org/10.1080/09687599.2019.1647149 Graduation Questionnaire (GQ). (n.d.). AAMC. Retrieved July 6, 2026, from https://www.aamc.org/data-reports/students-residents/report/graduation-questionnaire-gq Stergiopoulos E, Fernando O, Martimianakis MA. "Being on Both Sides": Canadian Medical Students' Experiences With Disability, the Hidden Curriculum, and Professional Identity Construction Academic Medicine. 2018;93(10):1550-1559. doi:10.1097/ACM.0000000000002300. Pereira-Lima K, Meeks LM, Ross KET, et al. Barriers to Disclosure of Disability and Request for Accommodations Among First-Year Resident Physicians in the US. JAMA Netw Open.2023;6(5):e239981. doi:10.1001/jamanetworkopen.2023.9981  

Clinical work with clients at high risk for suicide can make providers feel they are on a conveyor belt. One reason for this is that, sadly, so many people are struggling with crises and safety concerns; the demand for services seems never-ending. But another reason is more insidious: the risk of provider burnout. On today's episode, Dr. Erin Frick shares her perspective from working as a clinician and educator in the field of suicide prevention. Listen in as she encourages us to remain hopeful and connected with the “humanness” behind the crises. And if you have thoughts about how to “redefine the ‘wins' “ in this work, share them with us.Erin Frick, Psy.D., is a clinical psychologist and an Associate Director at the Consortium for Defense Psychology (CDP), located at the Uniformed Services University of the Health Sciences.. At CDP, Dr. Frick leads the VA-Safeguard Suicide Prevention Project, where her team works to identify and implement best practices for suicide prevention among special veteran populations by leveraging evidence-based psychotherapies and VA standards of care. She also leads the DoD Child Collaboratory, a team dedicated to researching and implementing training and best practices for utilizing telehealth and digital tools to enhance healthcare and support for military youth and families.Resources mentioned in this episode: Therapeutic Risk Management Tool, available on the Rocky Mountain MIRECC website: https://www.mirecc.va.gov/visn19/trm/The benefits of mindfulness for stress reduction: Ameli R, Sinaii N, West CP, Luna MJ, Panahi S, Zoosman M, Rusch HL, Berger A. Effect of a Brief Mindfulness-Based Program on Stress in Health Care Professionals at a US Biomedical Research Hospital: A Randomized Clinical Trial. JAMA Netw Open. 2020 Aug 3;3(8):e2013424. doi: 10.1001/jamanetworkopen.2020.13424. PMID: 32840621; PMCID: PMC7448827. CDP's CBT for Suicide Prevention workshops: https://cdp.usuhs.edu/training-schedule Calls-to-action: For example: Attend CDP's CBT for Suicide Prevention (CBT-SP) trainingRegularly implement self-careShare your impactful moment in the comments or via https://www.speakpipe.com/cdpp4pSubscribe to the Practical for Your Practice PodcastSubscribe to The Center for Deployment Psychology Monthly Email

Gonadal hormones have a complicated influence on appetite. Estradiol generally suppresses appetite, whereas progesterone opposes estradiol's action such that their combined presence represents a high-risk hormonal milieu for Binge Eating (BE). Testosterone is thought to be associated with increased BE in females but appears protective in males. In some reports, combination oral contraceptive (COC) use has been linked to greater BE-related appetitive processes (e.g., food intake). Now, we have 2 recent, back-to-back publications (June 2026 in JAMA Network Open, and July 2026 in Appetite) that have examined the relationship of hormonal contraception on binge eating behavior. These found seemingly opposing conclusions. Listen in for details. 1. Klump KL, Di Dio AM, Anaya C, et al. Combined Oral Contraceptive Use and Binge Eating. JAMA Netw Open. 2026;9(6):e2619047. doi:10.1001/jamanetworkopen.2026.190472. Katz JM, Yan R, Beltz AM, Gearhardt AN. Associations between reproductive hormonal milieus and binge eating: The roles of sex and hormonal contraceptive use. Appetite. 2026 Jul 1;222:108547. doi: 10.1016/j.appet.2026.108547. Epub 2026 Mar 20. PMID: 41866083.3. Bass L, Prostináková T, Silang KG, Griffiths-Gray A, McQuilliam S, Mahon E, Whitehead A, Johnson KO. Does it hold weight? The perceived effects of contraceptive use on weight status in females: A mixed-methods study. PLoS One. 2025 Dec 29;20(12):e0339323. doi: 10.1371/journal.pone.0339323. PMID: 41460817; PMCID: PMC12747328.

Series Description Disclosure is a three-part podcast series from the Docs with Disabilities Podcast that examines one of the most personal and consequential decisions disabled healthcare providers make: whether, when, and how to disclose a disability. Through the voices of medical students, residents, practicing physicians, psychologists, nurses, researchers, legal scholars, and disability advocates, the series explores disclosure as an ongoing process shaped by identity, institutional culture, ableism, and power. Blending lived experience with research and policy, the series challenges assumptions about disability in healthcare while illuminating pathways toward more inclusive learning, training, and practice environments. Part 1: The Decision to Disclose What does it really mean to disclose a disability in healthcare? In the first episode of the Disclosure series, healthcare providers across the continuum—from students and trainees to practicing clinicians—share the personal, professional, and institutional factors that shape disclosure decisions. Drawing on stories from medical students, residents, physicians, researchers, disability scholars, and legal experts, the episode explores disclosure as more than a pathway to accommodations—it can be an act of identity, advocacy, community-building, and resistance. At the same time, contributors examine the risks of stigma, discrimination, and institutional betrayal that continue to make disclosure a deeply complex and often uncertain decision. Transcript: https://docs.google.com/document/d/1IWxZcow_B9hSIGpvozadJ5pov4-Qmq97/edit?usp=share_link&ouid=104315301750264632478&rtpof=true&sd=true Keywords:  Disability disclosure Medical education Physicians with disabilities Medical students with disabilities Disability accommodations Ableism Disability inclusion Healthcare trainees Stigma Health professions education Production Team:  Developer, Writer, Executive Producer: Sofia Schozman  Co Producers: Rylee Betchkal and Lisa Meeks Co-Producer, Sound Selection and Editing: Gabe Abrams Sound Production: Next Day Podcast Digital Media: Katie Sullivan   Citations:  Anderson, H. L. K., Konopasky, A. W., Bullock, J. L., Meeks, L. M., & Jain, N. R. (2025). The Call is Coming from Inside the House: Racism and Ableism in US Medical Education. Teaching and Learning in Medicine, 0(0), 1–19. https://doi.org/10.1080/10401334.2025.2581621 Evans, H. D. (2017). Un/covering: Making Disability Identity Legible. Disability Studies Quarterly, 37(1). https://doi.org/10.18061/dsq.v37i1.5556 Jain, N. R. (2020). Political disclosure: Resisting ableism in medical education. Disability & Society, 35(3), 389–412. https://doi.org/10.1080/09687599.2019.1647149 Graduation Questionnaire (GQ). (n.d.). AAMC. Retrieved July 6, 2026, from https://www.aamc.org/data-reports/students-residents/report/graduation-questionnaire-gq Stergiopoulos E, Fernando O, Martimianakis MA. "Being on Both Sides": Canadian Medical Students' Experiences With Disability, the Hidden Curriculum, and Professional Identity Construction Academic Medicine. 2018;93(10):1550-1559. doi:10.1097/ACM.0000000000002300. Pereira-Lima K, Meeks LM, Ross KET, et al. Barriers to Disclosure of Disability and Request for Accommodations Among First-Year Resident Physicians in the US. JAMA Netw Open. 2023;6(5):e239981. doi:10.1001/jamanetworkopen.2023.9981  

Contributor: Travis Barlock, MD Educational Pearls:   First-pass success is critical to limit complications from apnea, hypoxia, and airway trauma.  Complication rate for patients intubated on the first pass is 14% Complication rates increase to 47% after two attempts, 64% after three, and 71% after the fourth attempt   How to improve likelihood of first-pass success: Use Video laryngoscopy (VL). VL increases chance of first-pass success to 85% from 71% Use a bougie, especially in patients with anatomically difficult or otherwise obstructed airways. The BEAM study cites a success rate in these patients of 96% with a bougie, compared to 82% without Use a Checklist mnemonic (SOAPME) Suction – On, ready, and within reach Oxygen – Patient is preoxygenated Adjuncts – Oral/nasal adjuncts and BVM ready Positioning - Patient positioned properly; consider obesity, using semi-Fowler/head-up positioning Medications – Rapid sequence intubation (RSI), sedation, vasopressor, and other medications prepared as necessary Equipment – Laryngoscope (blade), tube, bougie/stylet, syringe, scalpel/cric kit, others ready as necessary References Sakles, J.C., Chiu, S., Mosier, J., Walker, C. and Stolz, U. (2013), The Importance of First Pass Success When Performing Orotracheal Intubation in the Emergency Department. Acad Emerg Med, 20: 71-78. https://doi.org/10.1111/acem.12055 Prekker ME, Driver BE, Trent SA, et al. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. New England Journal of Medicine. 2023;389(5). doi:https://doi.org/10.1056/nejmoa2301601 Driver BE, Prekker ME, Klein LR, et al. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA. 2018;319(21):2179–2189. doi:10.1001/jama.2018.6496 ‌Turner JS, Bucca AW, Propst SL, et al. Association of Checklist Use in Endotracheal Intubation With Clinically Important Outcomes: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(7):e209278. doi:10.1001/jamanetworkopen.2020.9278 Turner, Joseph S et al. "Feasibility of  upright patient positioning and intubation success rates At two academic EDs." The American journal of emergency medicine vol. 35,7 (2017): 986-992. doi:10.1016/j.ajem.2017.02.011   Summarized by Sam Pahl | Edited by Sam Pahl & Ahmed Abdel-Hafiz, NREMT-P   Donate: https://emergencymedicalminute.org/donate/   Join our mailing list: http://eepurl.com/c9ouHf  

Welche Nahrungsergänzung wirkt wirklich – und was ist nur teurer Urin?Am Ende dieser Folge hast Du den Überblick. Du weißt, welche 5 Supplements wissenschaftlich am besten dastehen, woran Du echte Qualität erkennst und wann Du Dir das Geld sparen kannst. Garantiert frei von Superlativen, dafür mit den Gedanken unseres medizinischen Beirats, des Sport- und Ernährungsmediziners Niels Schulz-Ruhtenberg.Du erfährst:warum dasselbe Supplement bei dem einen wie Magie wirkt und beim anderen nichts bringtwelche 5 sich lohnen (von Vitamin D bis Kreatin)was die neue COSMOS-Studie aus Harvard über Multivitamine zeigt (und warum Du sie trotzdem nüchtern einordnen solltest)wie Du sinnvolle Präparate von teurer Geldverbrennung unterscheidest

Send us Fan MailIn this Journal Club episode, Ben and Daphna review a nationwide Swedish cohort study examining the association between phototherapy duration and neonatal outcomes in very preterm infants (22 to 31 weeks). The study's primary outcome, late neonatal mortality on days 8 to 27, was not significantly associated with phototherapy duration. However, longer phototherapy exposure was associated with increased odds of severe neonatal morbidity, including IVH and BPD, in infants born at 26 to 31 weeks. The findings prompt an important conversation about the near-universal use of phototherapy in preterm neonates and whether current practice warrants reassessment.----Phototherapy, Morbidity, and Mortality in Very Preterm Newborns. Deschmann E, Håkansson S, Söderling J, Norman M.JAMA Netw Open. 2026 May 1;9(5):e2614107. doi: 10.1001/jamanetworkopen.2026.14107.PMID: 42166159 Free PMC article.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

Un nouvel épisode du Pharmascope est disponible! Dans ce 178e épisode, Nicolas, Olivier et Amélie tentent de pondre des réponses un tant soi peu intelligentes à vos excellentes questions. Nous discutons d'ajustement de lévothyroxine, du suivi des IECA/ARA, du rôle de la cariprazine et de l'impact des inhibiteurs du SGLT-2 sur le magnésium.   Les objectifs pour cet épisode sont les suivants: Discuter des modalités d'ajustement de la lévothyroxine et de la déprescription potentielle de celle-ci Discuter des suivis de laboratoire suivant l'initiation d'un ARA ou d'un IECA Discuter des évidences portant sur l'utilisation de la cariprazine Discuter de l'impact des  inhibiteurs du SGLT-2 sur le magnésium Ressources pertinentes en lien avec l'épisode Jonklaas J, et coll; American Thyroid Association Task Force on Thyroid Hormone Replacement. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014 Dec;24(12):1670-751. Van Uytfanghe K, et coll. Thyroid Stimulating Hormone and Thyroid Hormones (Triiodothyronine and Thyroxine): An American Thyroid Association-Commissioned Review of Current Clinical and Laboratory Status. Thyroid. 2023 Sep;33(9):1013-1028. Ravensberg J, et coll. Discontinuation of Levothyroxine in Adults Aged 60 Years or Older. JAMA. 2026 Apr 6;335(17):1491–8. RPE de néphrologie de l'APES. Place des IECA et des ARA dans le traitement de la maladie rénale chronique. Septembre 2025. Bhandari S, et coll; STOP ACEi Trial Investigators. Renin-Angiotensin System Inhibition in Advanced Chronic Kidney Disease. N Engl J Med. 2022 Dec 1;387(22):2021-2032. Clase CM, et coll. Acute change in glomerular filtration rate with inhibition of the renin-angiotensin system does not predict subsequent renal and cardiovascular outcomes. Kidney Int 2017;91:683-90. Garlo KG, et coll. Association of changes in creatinine and potassium levels after initiation of renin angiotensin aldosterone system inhibitors with emergency department visits, hospitalizations, and mortality in individuals with chronic kidney disease. JAMA Netw Open 2018;1:e183874. Monographie de produit, Abbvie. VRAYLAR (cariprazine). Canada, 6 mars 2024. Barabassy A, et coll. Transdiagnostic Efficacy of Cariprazine: A Systematic Review and Meta-Analysis of Efficacy Across Ten Symptom Domains. Pharmaceuticals (Basel). 2025 Jul 2;18(7):995. Németh G, et coll. Cariprazine versus risperidone monotherapy for treatment of predominant negative symptoms in patients with schizophrenia: a randomised, double-blind, controlled trial. Lancet. 2017 Mar 18;389(10074):1103-1113. Fava M, et coll. Efficacy of adjunctive low-dose cariprazine in major depressive disorder: a randomized, double-blind, placebo-controlled trial. Int Clin Psychopharmacol. 2018 Nov;33(6):312-321. Durgam S, et coll. Efficacy and safety of adjunctive cariprazine in inadequate responders to antidepressants: a randomized, double-blind, placebo-controlled study in adult patients with major depressive disorder. J Clin Psychiatry. 2016 Mar;77(3):371-8. Barabassy A, Csehi R, Dombi ZB, Szatmári B, Brevig T, Németh G. Transdiagnostic Efficacy of Cariprazine: A Systematic Review and Meta-Analysis of Efficacy Across Ten Symptom Domains. Pharmaceuticals (Basel). 2025 Jul 2;18(7):995. Zhang J, et coll. Comparative Effects of Sodium-Glucose Cotransporter 2 Inhibitors on Serum Electrolyte Levels in Patients with Type 2 Diabetes: A Pairwise and Network Meta-Analysis of Randomized Controlled Trials. Kidney360. 2022 Jan 19;3(3):477-487. Toto RD, et coll. Correction of hypomagnesemia by dapagliflozin in patients with type 2 diabetes: A post hoc analysis of 10 randomized, placebo-controlled trials. J Diabetes Complications. 2019 Oct;33(10):107402.

Back in June 2024, we highlighted surprising data from JAMA Network Open regarding adolescent care in the ED. Because many adolescents use the ED as their primary care provider, it's a good opportunity for them to have contraception addressed regardless of why they presented. But that's not what was happening. That publication from two years ago showed significant gaps in addressing contraception in the ED to pregnancy vulnerable young women, mainly teens. We covered those results back then and said that that would be a wonderful QI project for any resident or medical students to work with their hospital ED to improve that. Well, now a similar publication, looking at a different target- STI empiric treatment among pregnant women in the ED, has been published with that same vibe. Yep, there are BIG discrepancies in what pregnant women are given- or in this case, NOT GIVEN, in the ED compared to their nonpregnant peers. This was published in mid-April 2026. Two big questions remain unanswered in this data. Listen in for details. 1. Gottlieb M, Moyer E, Slocum GW, et al. Sexually Transmitted Infection Treatment Rates Among Pregnant vs Nonpregnant Patients in Emergency Departments. JAMA Network Open. 2026. 2. Canter H, Reed J, Palmer C, et al. Contraception Use and Pregnancy Risk Among Adolescents in Pediatric Emergency Departments. JAMA Netw Open. 2024;7(6):e2418213. doi:10.1001/jamanetworkopen.2024.18213

Contributor: Aaron Lessen, MD Educational Pearls:  Back pain is a common presenting complaint in the emergency department. Challenges arise when tailoring care to elderly populations using standard medical therapy: Muscle relaxants carry the risk of CNS depression or anticholinergic effects such as urinary retention and confusion. Pain medications such as opiates have side effects including constipation, respiratory depression, and hypotension. NSAIDs carry a risk of GI bleeding and worsening kidney function with chronic use. A randomized clinical trial assessing the effects of acupuncture on low back pain took 800 adults aged 65 and older with chronic low back pain and placed them into one of three treatment arms: Usual medical care Standard acupuncture consisting of 8–15 treatment sessions over 12 weeks, plus usual medical care Standard acupuncture consisting of 8–15 treatment sessions over 12 weeks, plus 4-6 maintenance sessions during the next 12 weeks, plus usual medical care Using the Roland-Morris Disability Questionnaire (RMDQ) score, they assessed disability at 6 months and 12 months. The study found that those who had undergone treatment with acupuncture had significantly greater improvements in disability related to low back pain compared to the group that was only treated with usual medical care. Acupuncture is not used in the ER, but could represent a relatively safe adjunctive therapy for patients who are not responding to standard medical therapy alone.   References:  American College of Surgeons Committee on Trauma. Best practices guidelines: geriatric trauma management. American College of Surgeons; 2023. Accessed May 27, 2026. https://www.facs.org/media/ubyj2ubl/best-practices-guidelines-geriatric-trauma.pdf DeBar LL, Wellman RD, Justice M, et al. Acupuncture for chronic low back pain in older adults: a randomized clinical trial. JAMA Netw Open. 2025;8(9):e2531348. doi:10.1001/jamanetworkopen.2025.31348 Summarized by Ashley Lyons, OMS3 | Edited by Ashley Lyons & Ahmed Abdel-Hafiz, NREMT-P

Small hospitals bring unique stewardship challenges, but also unique opportunities. Dr. Tina Khadem and Dr. Ashley Cubillos join host Dr. Whitney Buckel to discuss the realities of antimicrobial stewardship in small and critical access hospitals. From navigating competing priorities and limited resources, to building strong provider relationships in close-knit communities, we have you covered! Join us as we unpack real-world strategies, challenge common perceptions, and highlight the practical pearls you can apply in your own setting. References: Implementation of Core Elements at Small and Critical Access Hospitals: https://www.cdc.gov/antibiotic-use/media/pdfs/core-elements-small-critical-508.pdf Stenehjem E, Hyun DY, Septimus E, Yu KC, Meyer M, Raj D, Srinivasan A. Antibiotic Stewardship in Small Hospitals: Barriers and Potential Solutions. Clin Infect Dis. 2017 Aug 15;65(4):691-696. Veillette JJ, May SS, Gabrellas AD, Gelman SS, Albritton J, Lyons MD, Stenehjem EA, Webb BJ, Dalto JD, Throneberry SK, Stanfield V, Grisel NA, Vento TJ. A Fully Integrated Infectious Diseases and Antimicrobial Stewardship Telehealth Service Improves Staphylococcus aureus Bacteremia Bundle Adherence and Outcomes in 16 Small Community Hospitals. Open Forum Infect Dis. 2022 Oct 14;9(11):ofac549. Cubillos AL, Fortier K, Hoang A. P-920. Impact of Positive Blood Culture Antimicrobial Stewardship on Staphylococcus aureus Bloodstream Infection Management across Critical Access, Small, and Medium Community Hospitals. Open Forum Infect Dis. 2026 Jan 11;13(Suppl 1):ofaf695.1126. Smith LM, Ahern JW. Establishing Antibiotic Stewardship Programs in Rural Hospitals to Decrease Fluoroquinolone Prescribing: The Vermont Experience. Infect Prev Pract. 2021 Jan 21;3(1):100121. Kassamali-Escobar Z, et al. Antimicrob Steward Healthc Epidemiol 2024. doi: 10.1017/ash.2024.458. Imlay H, Ciarkowski CE, Bryson-Cahn C, et al Infect Control Hosp Epidemiol 2025. 46: 150–155, doi: 10.1017/ice.2024.206 Ciarkowski CE, Imlay HN, Bryson-Cahn C, et al. Infect Control Hosp Epidemiol 2025. 46: 143–149, doi: 10.1017/ice.2024.171 Stenehjem E, et al. JAMA Netw Open. 2023;6(5):e2313011. doi:10.1001/jamanetworkopen.2023.13011 Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) or @breakpointspodcast_sidp (https://www.instagram.com/breakpointspodcast_sidp/)https://www.instagram.com/breakpointspodcast_sidp/?hl=en Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/ SIDP welcomes pharmacists and non-pharmacist members with an interest in infectious diseases, learn how to join here: https://sidp.org/Become-a-Member Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, Stitcher, Google Play, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/

Send us Fan MailBen kicks things off with a major career update before we dive into a critical study from JAMA Network Open. We explore the predictive value of the five minute Apgar score when combined with umbilical artery pH in very preterm infants. While the Apgar score was originally designed for term babies, this analysis of the EPICE cohort reveals its enduring utility even in the smallest patients. We discuss how these two measures interact, which one "wins" when they conflict, and why the clinician assessment remains a powerful predictor of mortality and severe morbidity in the NICU.----Apgar Score Plus Umbilical Artery pH and Adverse Neonatal Outcomes in Very Preterm Infants. Ehrhardt H, Behboodi S, Maier RF, Aubert AM, Ådén U, Staude B, Draper ES, Gudmundsdottir A, Siljehav V, Varendi H, Weber T, Zemlin M, Zeitlin J; EPICE/SHIPS Research Group.JAMA Netw Open. 2026 Feb 2;9(2):e2557913.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

In this episode of SoundPractice, host Mike Sacopulos speaks with two physician-researchers whose landmark study is sounding an early warning about the long-term consequences of state abortion restrictions on the U.S. physician workforce. Anisha Ganguly, MD, MPH, assistant professor of medicine at the University of North Carolina at Chapel Hill, and Anna Morenz, MD, MPH, assistant clinical professor of internal medicine at the University of Arizona, discuss their study published in JAMA Network Open in March 2026. Their study analyzed nearly 24.2 million residency applications submitted to more than 4,300 programs across all medical specialties between the 2018–2019 and 2022–2023 application cycles. Using an interrupted time-series causal methodology developed in collaboration with health economist Anirban Basu, PhD, MS, at the University of Washington, the team found that applications to programs in states enacting new abortion restrictions after Dobbs dropped significantly — among both male and female applicants. Among the conversation's most striking moments: Ganguly reveals that the decline among men applicants was larger than expected — and larger than they had originally hypothesized. She and Morenz discuss why this makes Dobbs an “all of us” problem, not just a women's issue, and what it signals about the broader reproductive climate of restricted states. The episode also covers the pipeline problem: because more than half of physicians ultimately practice in the state where they trained, sustained declines in application volume could worsen existing physician shortages in primary care and emergency medicine in restricted states for years to come. Morenz shares a timely update: in the most recent March 2026 match cycle, two OB-GYN residency programs — both in Texas — failed to fill all their slots. Study Reference: Ganguly AP, Basu A, Morenz AM. State-Level Disparities in Residency Applications After Dobbs v Jackson Women's Health Organization. JAMA Netw Open. 2026;9(3):e260286. doi:10.1001/jamanetworkopen.2026.0286 Learn more about the American Association for Physician Leadership at www.physicianleaders.org.

Send us Fan MailIn this episode of Journal Club, Ben and Daphna dive into the results of the NIRTURE trial, recently published in JAMA Network Open. Building on the lessons of SafeBoosC 3 , the NIRTURE investigators aimed to reduce the burden of cerebral hypoxia and hyperoxia in extremely preterm infants using a standardized NIRS guided treatment protocol. While the study showed a dramatic improvement in maintaining cerebral normoxia, driven largely by a reduction in hyperoxia , the clinical outcomes before discharge remained neutral. Join us as we discuss whether regional oximetry is a must have bedside tool or just another data point in search of a clear clinical benefit.  ----Cerebral Oximetry-Guided Treatment and Cerebral Oxygenation in Extremely Preterm Infants: A Randomized Clinical Trial. Jani PR, Goyen TA, Balegar KK, Maheshwari R, Saito-Benz M, Schindler T, Moore J, Merhi M, Cruz M, Song Y, McDonagh H, Luig M, Tracy M, D'Cruz D, Perdomo A, Morakeas S, Dasireddy V, Culcer M, Shingde V, Bennington K, Michalowski J, Fucek A, Querim J, Stevens S, Santanelli J, Elhindi J, Gloss B, Halliday R, Shah D, Popat H.JAMA Netw Open. 2026 Feb 2;9(2):e2557620. Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

Based on data from 2023-24, roughly 23% of New Yorkers aged 21 or older reported cannabis use in the past 12 months. Although men generally have a higher prevalence of use than women, recent studies show a narrowing gap as female consumption rises. Despite this trend, research is sorely lacking on the impact of cannabis use on pregnancy, birth outcomes and overall health. Many advisory panels and organizations advise against the use of cannabis during pregnancy, but there are numerous reasons pregnant people choose to use. On today's episode, we'll talk through the evidence and provide best practices for caring for pregnant persons who use cannabis.  Related Content:  New York State Department of Health Clinical Guidelines Program Therapeutic Use of Medical Cannabis in New York State (October 2025): https://www.suguidelinesnys.org/guideline/med-cannabis/?mytab=tab_6/#pregnancy New York State Department of Health Office of Cannabis Management Cannabis Considerations for Pregnant and Breastfeeding/Chest Feeding Individuals (2022): https://cannabis.ny.gov/system/files/documents/2022/07/cannabis-considerations-for-pregnant-and-breastfeeding-chestfeeding-individuals-fact-sheet_v2.pdf New York State Behavioral Risk Factor Surveillance System Brief (November 2024-05): https://www.health.ny.gov/statistics/brfss/reports/docs/2024-05_brfss_cannabis_use.pdf New York State Office of Cannabis Management Cannabis Education Library: https://cannabis.ny.gov/education Zolotov Y, Mendoza Temple L, Isralowitz R, et al. Developing Medical Cannabis Competencies: A Consensus Statement. JAMA Netw Open. 2025;8(10):e2535049. doi:10.1001/jamanetworkopen.2025.35049 Raz M, Gupta-Kagan J, & Asnes A. THC Ingestions and Child Protective Services: Guidelines for Practitioners. J Addict Med. 2025 July-Aug;19(4):350-52. doi:10/1097/ADM.0000000000001441 Data to Action: Cannabis consumption during the perinatal period and clinicians' screening and advising, New York State outside of New York City, 2017-2018 and 2021-2022: https://apps.health.ny.gov/public/tabvis/PHIG_Public/prams/publications/Cannabis_consumption_during_the_perinatal_period.pdf Project CBD: http://projectcbd.com/ American College of Gynecologists and Obstetrics Clinical Consensus on Cannabis Use during Pregnancy and Lactation (October 2025): https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2025/10/cannabis-use-during-pregnancy-and-lactation CEI Training, Clinical Approaches to Medical Cannabis: https://ceitraining.org/courses/1589 CEI Clinical Consultation Line 1-866-637-2342 A toll-free service for NYS clinicians offering real-time clinical consultations with specialists on HIV, sexual health, hepatitis C, and drug user health. https://ceitraining.org/  

Send us Fan MailIn this Journal Club episode, Ben reviews a secondary analysis of the CALI trial, published in JAMA Network Open, examining two-year neurodevelopmental and pulmonary outcomes in preterm infants who received early caffeine combined with LISA versus caffeine and CPAP alone. Building on the original CALI trial's finding that early caffeine prior to LISA reduced intubation rates and BPD, this follow-up asks the next logical question: does that early advantage translate into better long-term outcomes? Ben walks through the Bayley scores, gross motor function, ASQ-3, M-CHAT, and pulmonary outcomes — and delivers a reassuring if not statistically significant picture. Tune in for a deep dive into the evidence behind one of neonatology's most debated respiratory strategies!----Two-Year Outcomes of Less Invasive Surfactant Administration Among Preterm Neonates: A Secondary Analysis of a Randomized Clinical Trial. Dorner RA, Morales A, Banerji A, Uy C, Ines F, Finer N, Vaucher Y, Katheria AC.JAMA Netw Open. 2026 Mar 2;9(3):e263852. doi: 10.1001/jamanetworkopen.2026.3852.PMID: 41915392Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

Parents and clinicians are often faced with an important question: is anesthesia safe for young children? In this episode, medical student Kaavya Gudapati is joined by Dr. Maria Valeria Carrasquero and Dr. Ana Mavarez to review the current evidence on anesthesia exposure and the developing brain, and to provide practical guidance for clinical decision-making and family counseling. Specifically, they will: Review the FDA warning regarding repeated or prolonged anesthesia exposure in children under 3 years of age Compare key findings from animal studies and human clinical trials Summarize major studies including PANDA, MASK, and GAS Discuss strategies for counseling families and addressing parental concerns Identify considerations for timing of elective versus urgent procedures Review approaches to minimize exposure and explore potential neuroprotective strategies Special thanks to Dr. Heather Byrd and Dr. Rebecca Yang for peer reviewing this episode. CME available free with sign up: Link coming soon! References: 1. Vinson AE, Houck CS. Neurotoxicity of Anesthesia in Children: Prevention and Treatment. Curr Treat Options Neurol 2018; 20:1–10. https://doi.org/10.1007/S11940-018-0536-Z/TABLES/1. 2. Hansen TG. Anesthesia-related neurotoxicity and the developing animal brain is not a significant problem in children. Pediatric Anesthesia 2015; 25:65–72. https://doi.org/10.1111/PAN.12548. 3. O'Leary JD. Human Studies of Anesthesia-Related Neurotoxicity in Children: A Narrative Review of Recent Additions to the Clinical Literature. Clin Perinatol 2019; 46:637–45. https://doi.org/10.1016/j.clp.2019.08.001. 4. FDA Drug Safety Communication: FDA review results in new warnings about using general anesthetics and sedation drugs in young children and pregnant women | FDA n.d. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-review-results-new-warnings-about-using-general-anesthetics-and (accessed August 28, 2025). 5. FDA Drug Safety Communication: FDA approves label changes for use of general anesthetic and sedation drugs in young children | FDA n.d. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-approves-label-changes-use-general-anesthetic-and-sedation-drugs (accessed August 28, 2025). 6. SmartTots. SmartTots consensus statement on the use of anesthetic and sedative drugs in infants and toddlers.Published 2015. Updated 2017. Accessed September 17, 2025. https://smarttots.org 7. Sun LS, Li G, Miller TLK, Salorio C, Byrne MW, Bellinger DC, et al. Association between a single general anesthesia exposure before age 36 months and neurocognitive outcomes in later childhood. JAMA - Journal of the American Medical Association 2016; 315:2312–20. https://doi.org/10.1001/JAMA.2016.6967. 8. Warner DO, Zaccariello MJ, Katusic SK, Schroeder DR, Hanson AC, Schulte PJ, et al. Neuropsychological and behavioral outcomes after exposure of young children to procedures requiring general anesthesia: The mayo anesthesia safety in kids (MASK) study. Anesthesiology 2018; 129:89–105. https://doi.org/10.1097/ALN.0000000000002232. 9. McCann ME, Berde C, Soriano S, Marmor J, Bellinger D, de Graaff JC, et al. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicenter, randomised controlled equivalence trial. Lancet 2019; 393:664. https://doi.org/10.1016/S0140-6736(18)32485-1. 10. Davidson AJ, Disma N, de Graaff JC, Withington DE, Dorris L, Bell G, et al. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): An international multicentre, randomised controlled trial. The Lancet 2016; 387:239–50. https://doi.org/10.1016/S0140-6736(15)00608-X. 11. Reighard C, Junaid S, Jackson WM, Arif A, Waddington H, Whitehouse AJO, et al. Anesthetic Exposure During Childhood and Neurodevelopmental Outcomes: A Systematic Review and Meta-analysis. JAMA Netw Open 2022;5: e2217427. https://doi.org/10.1001/JAMANETWORKOPEN.2022.17427. 12. Jadhav U, Bhanushali J, Sindhu A, Shiv Kiran Reddy B, Toshniwal A, Rashmika M. A Comprehensive Review of Pediatric Obstructive Sleep Apnea: From Assessment to Intervention 2025. https://doi.org/10.7759/cureus.78051. 13. Andropoulos DB. Neuroprotective strategies in anesthesia-induced neurotoxicity. Best Pract Res Clin Anaesthesiol 2023; 37:52–62. https://doi.org/10.1016/J.BPA.2022.11.005. 14. Ji F, Sun J, Sun L, et al. Effects of Dexmedetomidine and Remifentanil on Neurodevelopmental Outcomes After Sevoflurane Anesthesia in Infants: A Randomized Clinical Trial. Anesthesiology. 2025. 143(4), 827–834. https://doi.org/10.1097/ALN.0000000000005634 15. Saynhalath, R, Disma, N, Taverner, FJ et al. on behalf of the TREX (Trial Remifentanil DEXmedetomidine) Consortium. Short-term Outcomes in Infants after General Anesthesia with Low-dose Sevoflurane/Dexmedetomidine/Remifentanil versus Standard-dose Sevoflurane (the TREX Trial). Anesthesiology 141(6): p 1075-1085, December 2024. | DOI: 10.1097/ALN.0000000000005232 16. Ing C, Warner DO, Sun LS, Flick RP, Davidson AJ, Vutskits L, McCann ME, O'Leary J, Bellinger DC, Rauh V, Orser BA, Suresh S, Andropoulos DB. Anesthesia and Developing Brains: Unanswered Questions and Proposed Paths Forward. Anesthesiology. 2022 Mar 1;136(3):500-512. doi: 10.1097/ALN.0000000000004116. PMID: 35015802.

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-480 Overview: Tune in as we discuss nonsurgical options for managing knee osteoarthritis in primary care. This episode reviews current guidelines and highlights new research on yoga as an effective alternative to traditional strengthening exercises. Gain practical insights to help patients reduce pain, improve function, and delay surgery—all while expanding your integrative treatment toolkit. Episode resource links: Abafita BJ, Singh A, Aitken D, et al. Yoga or strengthening exercise for knee osteoarthritis: a randomized clinical trial. JAMA Netw Open. 2025;8(4):e253698. doi:10.1001/jamanetworkopen.2025.3698 Brophy, Robert H. MD; Fillingham, Yale A. MD. AAOS Clinical Practice Guideline Summary: Management of Osteoarthritis of the Knee (Nonarthroplasty), Third Edition. Journal of the American Academy of Orthopaedic Surgeons 30(9):p e721-e729, May 1, 2022. | DOI: 10.5435/JAAOS-D-21-01233 Guest: Jillian Joseph, MPAS, PA-C Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-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-480 Overview: Tune in as we discuss nonsurgical options for managing knee osteoarthritis in primary care. This episode reviews current guidelines and highlights new research on yoga as an effective alternative to traditional strengthening exercises. Gain practical insights to help patients reduce pain, improve function, and delay surgery—all while expanding your integrative treatment toolkit. Episode resource links: Abafita BJ, Singh A, Aitken D, et al. Yoga or strengthening exercise for knee osteoarthritis: a randomized clinical trial. JAMA Netw Open. 2025;8(4):e253698. doi:10.1001/jamanetworkopen.2025.3698 Brophy, Robert H. MD; Fillingham, Yale A. MD. AAOS Clinical Practice Guideline Summary: Management of Osteoarthritis of the Knee (Nonarthroplasty), Third Edition. Journal of the American Academy of Orthopaedic Surgeons 30(9):p e721-e729, May 1, 2022. | DOI: 10.5435/JAAOS-D-21-01233 Guest: Jillian Joseph, MPAS, PA-C Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-Med.

We interview Katherine Rizzolo about her work with Lilia Cervantes on implementing policies to provide dialysis care in the undocumented immigrant population. We talk about how the experience of undocumented immigrants differs from those with citizenship without insurance, tools she used from implementation science in this work, the path to policy change in Colorado, and the role of implementation science in policy change. Ah, implementation science: making common sense and decency incredibly rigorous. Mentioned on today's show: Cervantes L, Rizzolo K, Tummalapalli SL, Wainstein M, Glasgow RE, Jolles MP. Use of a Context- and Equity-Focused Implementation Science Framework to Aid the Design of Clinical Trials. J Am Soc Nephrol. 2025 Jun 1;36(6):1197-1200. doi: 10.1681/ASN.0000000633. Epub 2025 Jan 17. PMID: 39823190; PMCID: PMC12147963. Cervantes L. Dialysis in the Undocumented: Driving Policy Change with Data. J Hosp Med. 2020 Aug;15(8):502-504. doi: 10.12788/jhm.3319. PMID: 31891561; PMCID: PMC7518140. Nilsen, P. Making sense of implementation theories, models and frameworks. Implementation Sci 10, 53 (2015). https://doi.org/10.1186/s13012-015-0242-0 Proctor EK, Powell BJ, Baumann AA, Hamilton AM, Santens RL. Writing implementation research grant proposals: ten key ingredients. Implement Sci. 2012 Oct 12;7:96. doi: 10.1186/1748-5908-7-96. PMID: 23062065; PMCID: PMC3541090. Rizzolo K, Ressalam J, Robledo K, et al. Participant Experiences in a Kidney Failure Care Intervention in the Navigate-Kidney Study. JAMA Netw Open. 2025;8(11):e2548506. doi:10.1001/jamanetworkopen.2025.48506

Send us Fan MailIn this Journal Club episode, Ben and Daphna review a systematic review and meta-analysis from JAMA Network Open questioning the clinical value of predischarge car seat tolerance screening (CSTS). Driven by data suggesting that testing does not reduce 30-day mortality or hospital readmissions, they discuss the high failure rates, varying definitions of bradycardia and desaturation, and the unintended consequence of prolonged NICU stays. They also highlight the practical reality of CSTS in ensuring parents actually have an appropriate car seat at discharge. Tune in for a critical look at whether this 1991 AAP recommendation still holds up today!----Predischarge Car Seat Tolerance Screening in Preterm and At-Risk Full-Term Infants: A Systematic Review and Meta-Analysis. King BC, Dalvie N, Hay S, Jensen EA, Zupancic JAF.JAMA Netw Open. 2026 Feb 2;9(2):e2558197. doi:0.1001/jamanetworkopen.2025.58197.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

Send us Fan MailIn this Daily Journal Club episode, Ben and Daphna review a massive Swedish national cohort study from JAMA Network Open examining early prophylactic hydrocortisone in extremely preterm infants. They discuss the targeted regimens used, differences in gestational age outcomes, and whether a blanket prophylactic approach is truly effective for preventing BPD. With impressive data covering 98% of all NICU admissions in Sweden, the hosts debate the nuances of targeting 24 to 25-weekers versus older preemies and the potential confounding impact of chorioamnionitis. Tune in for your daily snack of evidence-based medicine and insights into optimizing NICU steroid protocols!----Early Prophylactic Hydrocortisone and Bronchopulmonary Dysplasia-Free Survival in Extremely Preterm Infants. Smedbäck V, Björklund LJ, Flisberg A, Wróblewska J, Baud O, Wejryd E, Ådén U.JAMA Netw Open. 2026 Feb 2;9(2):e2560146. doi:10.1001/jamanetworkopen.2025.60146.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

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-477 Overview: With rising administrative demands, many clinicians are considering artificial intelligence (AI) scribes—this episode unpacks what you need to know before incorporating this technology. We explore key benefits like reduced burnout and improved workflow, along with ethical, legal, and safety considerations to help you make informed decisions about integrating AI scribing into your practice. Episode resource links: Cohen IG, Ritzman J, Cahill RF. Ambient Listening—Legal and Ethical Issues. JAMA Netw Open.2025;8(2):e2460642. doi:10.1001/jamanetworkopen.2024.60642 Olson KD, Meeker D, Troup M, et al. Use of Ambient AI Scribes to Reduce Administrative Burden and Professional Burnout. JAMA Netw Open. 2025;8(10):e2534976. doi:10.1001/jamanetworkopen.2025.34976 https://www.healio.com/news/dermatology/20251210/ai-scribes-hold-transformative-potential-for-improving-physician-burden-patient-care Guest: Jillian Joseph, MPAS, PA-C   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-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-477 Overview: With rising administrative demands, many clinicians are considering artificial intelligence (AI) scribes—this episode unpacks what you need to know before incorporating this technology. We explore key benefits like reduced burnout and improved workflow, along with ethical, legal, and safety considerations to help you make informed decisions about integrating AI scribing into your practice. Episode resource links: Cohen IG, Ritzman J, Cahill RF. Ambient Listening—Legal and Ethical Issues. JAMA Netw Open.2025;8(2):e2460642. doi:10.1001/jamanetworkopen.2024.60642 Olson KD, Meeker D, Troup M, et al. Use of Ambient AI Scribes to Reduce Administrative Burden and Professional Burnout. JAMA Netw Open. 2025;8(10):e2534976. doi:10.1001/jamanetworkopen.2025.34976 https://www.healio.com/news/dermatology/20251210/ai-scribes-hold-transformative-potential-for-improving-physician-burden-patient-care Guest: Jillian Joseph, MPAS, PA-C   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-Med.

Episode 216: Fibromyalgia Overview Reitta Wyllie and Tejasvi Ayaggari (medical students) discuss with Dr. Arreaza the presentation, diagnosis and management of fibromyalgia, a commonly unrecognized disease that may impact patient's quality of life if left untreated.   Written by Reitta Nash, MSIV, American University of the Caribbean. Additional commentary provided by Dr. Tejasvi Ayyagari.  Edits and comments by Hector Arreaza, MD. You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice. Introduction Fibromyalgia is a chronic pain condition that affects millions of people worldwide, yet it remains one of the most misunderstood disorders in medicine. Patients often experience widespread pain, fatigue, sleep disturbances, cognitive difficulties, and a host of other symptoms that significantly impact daily functioning and quality of life.  TJ: It's common, but I feel it is mostly misunderstood and sometimes goes undiagnosed. Reitta: Yes, despite its prevalence, fibromyalgia has historically been met with skepticism, delayed diagnosis, and stigma. Today, we'll break down what fibromyalgia is, what we know about its underlying mechanisms, how it's diagnosed, and how it's managed using evidence-based approaches. What is fibromyalgia? Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal pain, accompanied by symptoms such as fatigue, non-restorative sleep, cognitive dysfunction often referred to as “fibro/brain fog,” and mood disturbances. TJ: Unlike inflammatory or autoimmune diseases, fibromyalgia does not cause structural damage to joints or muscles, nor does it produce objective findings on imaging or routine laboratory testing. Instead, it is considered a centralized pain disorder, meaning pain processing within the central nervous system is altered. Arreaza: Many years ago, I had a patient who had fibromyalgia in Germany. He shared how hard it was for him to get diagnosed and treated because many countries fail to recognize fibromyalgia as a disease. However, Germany is not one of them. The German Association of the Medical Scientific Societies (AWMF) has established specific diagnostic criteria for fibromyalgia syndrome (FMS). Also, the World Health Organization recognizes fibromyalgia as a chronic condition, and it is included in the International Classification of Diseases 10th edition (ICD-10). Reitta: The American College of Rheumatology (ACR) recognizes fibromyalgia as a distinct clinical diagnosis, affecting approximately 2–4% of the population, with a higher prevalence in women, though it can affect individuals of any sex or age. Historical Perspective Fibromyalgia was once referred to by terms such as fibrositis, a name that implied inflammation of connective tissue. However, as research failed to demonstrate inflammatory changes, the terminology evolved. In 1990, the American College of Rheumatology introduced the first formal diagnostic criteria, which focused heavily on tender point examination. Over time, these criteria were revised as understanding of the condition improved. Modern diagnostic criteria no longer rely on tender points and instead emphasize symptom severity and widespread pain distribution, reflecting a more patient-centered and clinically practical approach. What causes fibromyalgia? The exact cause of fibromyalgia is not fully understood, but current evidence supports a multifactorial, neurobiological model. The American Academy of Family Physicians identifies a spectrum of chronic overlapping pain conditions that frequently coexist with fibromyalgia, including IBS, TMJ pain, vulvodynia, Chronic fatigue syndrome, interstitial cystitis, endometriosis, chronic tension headaches, migraine, and chronic low back pain. These functional somatic conditions may represent a single disorder manifesting as pain in different body regions at different times over the life span. _____________________ References: Aaron RV, Ravyts SG, Carnahan ND,et al. Prevalence of depression and anxiety among adults with chronic pain: a systematic review and metaanalysis‑analysis. JAMA Netw Open. 2025;8(3):e250268. doi:10.1001/jamanetworkopen.2025.0268. PMID: 40053352. Bradley LA. Pathophysiologic mechanisms of fibromyalgia and its related disorders. J Clin Psychiatry. 2008;69(Suppl 2):6‑14. PMID: 19962493. doi:10.4088/JCP.v69s02102. Häuser W, Ablin J, Fitzcharles MA, et al. Fibromyalgia. Am Fam Physician. 2023;107(2):158‑166. Häuser W, Fitzcharles MA. Facts and myths pertaining to fibromyalgia. Nat Rev Rheumatol. 2018;14(9):525‑535. PMID: 38607678; doi:10.1038/s41584‑018‑0084‑4. Kleykamp BA, Ferguson MC, McNicol E, et al.The prevalence of psychiatric and chronic pain comorbidities in fibromyalgia: An ACTION systematic review. Semin Arthritis Rheum. 2021;51(1):166‑174. PMID: 33383293. doi:10.1016/j.semarthrit.2020.10.006. Magen E, Tolkin L, Aamar S, et al.Endocrine comorbidities in fibromyalgia. Clin Endocrinol (Oxf). 2025;[Epub ahead of print]. doi:10.xxxx/clinend.2025.xxxxx. Mohabbat AB, Wilkinson JM. Central sensitization: When it is not “all in your head.” Am Fam Physician. 2023;107(1):92‑96. Moscati A, Faucon AB, ArnaizYépez‑Yépez C, et al.Life is pain: Fibromyalgia as a nexus of multiple liability distributions. Am J Med Genet B Neuropsychiatr Genet. 2023;192(2):134‑148. doi:10.1002/ajmg.b.32911. Rivera FA, Munipalli B, Allman ME, et al.A retrospective analysis of the prevalence and impact of associated comorbidities on fibromyalgia outcomes in a tertiary care center. Front Med (Lausanne). 2023;10:1184734. doi:10.3389/fmed.2023.1184734. Sleurs D, Tebeka S, Scognamiglio C, Dubertret C, Le Strat Y. Comorbidities of selfreported fibromyalgia in United States adults: A ‑reported fibromyalgia in United States adults: A crosssectional‑sectional study from the NESARC‑III. Eur J Pain. 2020;24(9):1687‑1698. doi:10.1002/ejp.1619. Winslow BT, Vandal C, Dang L. Fibromyalgia: Diagnosis and management. Am Fam Physician. 2023;107(2):158‑166. PMID: 36791450. Wolfe F, Clauw DJ, Fitzcharles MA, et al. Revisions to the American College of Rheumatology fibromyalgia diagnostic criteria. Arthritis Care Res (Hoboken). 2023;75(12):2029‑2039. PMID: 41097025. doi:10.1002/acr.24963. Wolfe F, Clauw DJ, Fitzcharles MA, et al.Revisions to the American College of Rheumatology fibromyalgia diagnostic criteria. Arthritis Care Res (Hoboken). 2023;75(12):2029‑2039. PMID: 41097025. doi:10.1002/acr.24963. Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

Episode Notes Complicated UTIs just got a whole lot less complicated—or did they? Dr. Dana Bowers and Kyle Molina (@kcmolinaID) join Dr. Whitney Buckel to break down what's new, what's controversial, and what this means for your day‑to‑day antimicrobial decisions. Join us as we dig into the biggest updates, the evidence behind them, and the clinical pearls you won't want to miss. References: Nelson Z, Aslan AT, Beahm NP, et al. Guidelines for the Prevention, Diagnosis, and Management of Urinary Tract Infections in Pediatrics and Adults: A WikiGuidelines Group Consensus Statement. JAMA Netw Open. 2024 Nov 4;7(11):e2444495. Trautner BW, Cortes-Penfield NW, Gupta K, et al. Complicated Urinary Tract Infections (cUTI): Clinical Guidelines for Treatment and Management. Published July 17, 2025. https://www.idsociety.org/practice-guideline/complicated-urinary-tract-infections/ Kadry N, Natarajan M, Bein E, Kim P, Farley J. Discordant Clinical and Microbiological Outcomes Are Associated With Late Clinical Relapse in Clinical Trials for Complicated Urinary Tract Infections. Clin Infect Dis 2023;76(10:1768-1775. https://academic.oup.com/cid/article/76/10/1768/6980780 USCAST Oral cephalosporin STIC against S. aureus and E. coli meeting recording. https://www.youtube.com/watch?v=HieaVFAC08s MacDougall C. A Cloudy Crystal Ball: Critically Assessing and Rethinking the Antibiogram. Clin Infect Dis. 2023;77(11):1501-1503. doi:10.1093/cid/ciad468 Koehl J, Spolsdoff D, Negaard B, et al. Cephalosporins for Outpatient Pyelonephritis in the Emergency Department: COPY-ED Study. Ann Emerg Med. 2025;85(3):240-248. doi:10.1016/j.annemergmed.2024.10.013 Dunne MW, Aronin SI, Das AF, et al. Sulopenem for the Treatment of Complicated Urinary Tract Infections Including Pyelonephritis: A Phase 3, Randomized Trial. Clin Infect Dis. 2023;76(1):78-88. doi:10.1093/cid/ciac704 Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) or @breakpointspodcast_sidp (https://www.instagram.com/breakpointspodcast_sidp/)https://www.instagram.com/breakpointspodcast_sidp/?hl=en Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/ SIDP welcomes pharmacists and non-pharmacist members with an interest in infectious diseases, learn how to join here: https://sidp.org/Become-a-Member Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, Stitcher, Google Play, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/

Send a textIn this Journal Club episode, Ben and Daphna review the eye-opening results of the NeoDry Trial recently published in JAMA Network Open. They explore the clinical rationale of whether drying very preterm infants before applying a plastic wrap in the delivery room improves rates of normothermia upon NICU admission. While the intervention did not significantly improve temperatures, it unexpectedly revealed an alarming increased mortality risk for the smallest neonates. Tune in as they break down the study's design, discuss the potential causes for this stark safety signal, and highlight the ongoing challenge of maintaining thermoregulation for our most vulnerable preemies!----Drying Very Preterm Infants Before Plastic Wrapping at Birth: A Randomized Clinical Trial. Cavallin F, Doglioni N, Risso FM, Monari CB, Aversa S, Troiani S, Battajon N, Moschella S, Villani PE, Vedovato S, Maiorca D, Frezza S, Lista G, Laforgia N, Mondello I, Sibona I, Staffler A, Pratesi S, Paviotti G, De Bernardo G, Lama S, Miselli F, Bua J, Gitto E, Pesce S, Baraldi E, Trevisanuto D; NEODRY Trial Group.JAMA Netw Open. 2026 Mar 2;9(3):e2556902. doi: 10.1001/jamanetworkopen.2025.56902.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

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-475 Overview: A prescribing cascade occurs when adverse effects of a medication are mistaken for a new condition and treated with additional drugs. Older adults experiencing polypharmacy are most at risk. The impact of prescribing cascades can be substantial, leading to falls, organ injury, unnecessary imaging and tests, and more. Join us as we explore how to recognize and prevent these harmful cascades in your patients. Episode resource links: Adrien  O, Mohammad  AK, Hugtenburg  JG,  et al.  Prescribing cascades with recommendations to prevent or reverse them: a systematic review.   Drugs Aging. 2023;40(12):1085-1100. doi:10.1007/s40266-023-01072-yPubMedGoogle ScholarCrossref   Brath  H, Mehta  N, Savage  RD,  et al.  What is known about preventing, detecting, and reversing prescribing cascades: a scoping review.   J Am Geriatr Soc. 2018;66(11):2079-2085. doi:10.1111/jgs.15543PubMedGoogle ScholarCrossref   Daunt R, McGettigan S, Kelly L, Curtin D, O'Mahony D. Detection of Potential Prescribing Cascades in Multimorbid Older Patients Hospitalised with Acute Illness-An Observational Prospective Prevalence Study. Drugs Aging. 2025;42(6):535-546. doi:10.1007/s40266-025-01201-9   Growdon ME, Tjota N, Campbell R, et al. Decision-Making and Downstream Outcomes of the Gabapentinoid-Diuretic Prescribing Cascade. JAMA Netw Open. 2025;8(12):e2545274. doi:10.1001/jamanetworkopen.2025.45274   McCarthy  LM, Savage  R, Dalton  K,  et al.  ThinkCascades: a tool for identifying clinically important prescribing cascades affecting older people.   Drugs Aging. 2022;39(10):829-840. doi:10.1007/s40266-022-00964-9PubMedGoogle ScholarCrossref   O'Mahony, D., Cherubini, A., Guiteras, A.R. et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med 14, 625–632 (2023). https://doi.org/10.1007/s41999-023-00777-y   Rochon, P.A., O'Mahony, D., Cherubini, A. et al. International expert panel's potentially inappropriate prescribing cascades (PIPC) list. Eur Geriatr Med 16, 1573–1584 (2025). https://doi.org/10.1007/s41999-025-01215-x   Young EH, Pan S, Yap AG, Reveles KR, Bhakta K. Polypharmacy prevalence in older adults seen in United States physician offices from 2009 to 2016. PLoS One. 2021;16(8):e0255642. Published 2021 Aug 3. doi:10.1371/journal.pone.0255642 Guest: Susan Feeney, DNP, FNP-BC, NP-C   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-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-475 Overview: A prescribing cascade occurs when adverse effects of a medication are mistaken for a new condition and treated with additional drugs. Older adults experiencing polypharmacy are most at risk. The impact of prescribing cascades can be substantial, leading to falls, organ injury, unnecessary imaging and tests, and more. Join us as we explore how to recognize and prevent these harmful cascades in your patients. Episode resource links: Adrien  O, Mohammad  AK, Hugtenburg  JG,  et al.  Prescribing cascades with recommendations to prevent or reverse them: a systematic review.   Drugs Aging. 2023;40(12):1085-1100. doi:10.1007/s40266-023-01072-yPubMedGoogle ScholarCrossref   Brath  H, Mehta  N, Savage  RD,  et al.  What is known about preventing, detecting, and reversing prescribing cascades: a scoping review.   J Am Geriatr Soc. 2018;66(11):2079-2085. doi:10.1111/jgs.15543PubMedGoogle ScholarCrossref   Daunt R, McGettigan S, Kelly L, Curtin D, O'Mahony D. Detection of Potential Prescribing Cascades in Multimorbid Older Patients Hospitalised with Acute Illness-An Observational Prospective Prevalence Study. Drugs Aging. 2025;42(6):535-546. doi:10.1007/s40266-025-01201-9   Growdon ME, Tjota N, Campbell R, et al. Decision-Making and Downstream Outcomes of the Gabapentinoid-Diuretic Prescribing Cascade. JAMA Netw Open. 2025;8(12):e2545274. doi:10.1001/jamanetworkopen.2025.45274   McCarthy  LM, Savage  R, Dalton  K,  et al.  ThinkCascades: a tool for identifying clinically important prescribing cascades affecting older people.   Drugs Aging. 2022;39(10):829-840. doi:10.1007/s40266-022-00964-9PubMedGoogle ScholarCrossref   O'Mahony, D., Cherubini, A., Guiteras, A.R. et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med 14, 625–632 (2023). https://doi.org/10.1007/s41999-023-00777-y   Rochon, P.A., O'Mahony, D., Cherubini, A. et al. International expert panel's potentially inappropriate prescribing cascades (PIPC) list. Eur Geriatr Med 16, 1573–1584 (2025). https://doi.org/10.1007/s41999-025-01215-x   Young EH, Pan S, Yap AG, Reveles KR, Bhakta K. Polypharmacy prevalence in older adults seen in United States physician offices from 2009 to 2016. PLoS One. 2021;16(8):e0255642. Published 2021 Aug 3. doi:10.1371/journal.pone.0255642 Guest: Susan Feeney, DNP, FNP-BC, NP-C   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-Med.

Contributor: Travis Barlock, MD Educational Pearls:  Foul-smelling urine and cloudy urine are commonly misinterpreted as indicators of a UTI. However, these findings alone are not diagnostic. Criteria for UTI: Presence of localized urinary symptoms: Suprapubic pain Dysuria Hesitancy Urgency Urinalysis with WBC > 10 Urine culture with > 100,000 CFU/mL Colonization differs from infection - many patients harbor asymptomatic bacteria but do not have a true infection. Consequences of overtreatment One review showed 45% of patients treated with antibiotics for a presumed UTI actually had asymptomatic bacteriuria and were incorrectly treated. Unnecessary antibiotic treatment can have deleterious effects on the gut microbiome, increasing the risk of multidrug-resistant infections. Another problem with overdiagnosing UTI is missing the real diagnosis by explaining symptoms away as "just a UTI." Be mindful of the risk of overtesting versus not testing at all. Clinicians must navigate a balance between moving patients efficiently through the ER and testing appropriately when a UTI is truly suspected. References: Baghdadi JD, Korenstein D, Pineles L, et al. Exploration of primary care clinician attitudes and cognitive characteristics associated with prescribing antibiotics for asymptomatic bacteriuria. JAMA Netw Open. 2022;5(5):e2214268. doi:10.1001/jamanetworkopen.2022.14268 Colgan R, Williams M. Acute uncomplicated urinary tract infections in adults. Am Fam Physician. 2024;109(2):167-174. Accessed February 21, 2026. https://www.aafp.org/pubs/afp/issues/2024/0200/acute-uncomplicated-utis-adults.html#afp20240200p167-ta1 Summarized by Ashley Lyons OMS3 | Edited by Ashley Lyons & Jorge Chalit OMS4 Donate: https://emergencymedicalminute.org/donate/ Join our mailing list: http://eepurl.com/c9ouHf

There has been a shift in cervical cancer screening from primary cytology based to HPV based. Even HPV screening has had its evolution from physician collected samples to patient self-collection, either in a clinical setting or at home with an approved collection system. In May 2025, the FDA cleared the first at-home self-collection kit for HPV screening, specifically the Teal Wand by Teal Health. Now, we are seeing the advent of POSSIBLY another avenue for cervical HPV testing- although it is a bit awkward: the use of menstrual blood as an HPV screening test. In this episode we will review a new cross-sectional, population-based study from China which compared testing menstrual blood for human papillomavirus during cervical cancer screening to clinician-collected cervical samples for human papillomavirus (HPV). This concept, and these results, are not new at all! And there are important limitations to consider at this time. Listen in for details.1. Testing menstrual blood for human papillomavirus during cervical cancer screening in China: cross sectional population based study. BMJ 2026; 392 doi: https://doi.org/10.1136/bmj-2025-084831 (Published 04 February 2026)BMJ 2026;392:e084831https://www.bmj.com/content/392/bmj-2025-0848312. Naseri S, Young S, Cruz G, Blumenthal PD. Screening for High-Risk Human Papillomavirus Using Passive, Self-Collected Menstrual Blood. Obstet Gynecol. 2022 Sep 1;140(3):470-476. doi: 10.1097/AOG.0000000000004904. Epub 2022 Aug 3. PMID: 35926207; PMCID: PMC9377370.3. Fokom Domgue J, Chandra M, Oladoyin O, Desai M, Yu R, Shete S. Women's Preferences for Home-Based Self-Sampling or Clinic-Based Testing for Cervical Cancer Screening. JAMA Netw Open. 2026;9(2):e2558841. doi:10.1001/jamanetworkopen.2025.58841

This week’s Pulm PEEPs Pearls episode is all about spontaneous breathing trials (SBTs). SBTs are a standard part of the daily practice in the intensive care unit, but the exact methods vary across ICUs and institutions. Listen in to hear about the most common methods of SBTs, the physiology of each method, and what the evidence says. Contributors This episode was prepared with research by Pulm PEEPs Associate Editor George Doumat. Dustin Latimer, another Pulm PEEPs Associate Editor, assisted with audio and video editing. Key Learning Points What an SBT is really testing An SBT is a stress test for post-extubation work of breathing, not just a ventilator check. The goal is to balance sensitivity and specificity: Too hard → unnecessary failures and delayed extubation Too easy → false positives and higher risk of reintubation Common SBT modalities and how they compare T-piece No inspiratory support and no PEEP Highest work of breathing Most “physiologic” but often too strict Pressure support (PS) + PEEP (e.g., 5/5 or 8/5) Offsets ETT resistance and provides modest assistance Easier to pass than T-piece CPAP (0/5) No inspiratory help, but provides PEEP to counter ETT resistance Sits between PS and T-piece in difficulty Evidence favors pressure-supported SBTs for most patients Large meta-analysis (~6,000 patients, >40 RCTs): Pressure-supported SBTs increase successful extubation (~7% absolute benefit) No increase in reintubation rates Trials (e.g., FAST trial): Patients pass SBTs earlier Leads to earlier extubation and fewer ventilator-associated risks Bottom line: A 30-minute PS 5/5 SBT is evidence-based and appropriate for most stable ICU patients When a T-piece still makes sense T-piece SBTs are useful when: Cost of reintubation is high Difficult airway Prior failed extubation Pretest probability of success is low Prolonged or difficult weaning Tracheostomy vs extubation decisions Need to mimic physiology without positive pressure In LV dysfunction or pulmonary edema even small amounts PEEP may significantly improve physiology Some centers use a hybrid approach: PS SBT → short confirmatory T-piece before extubation CPAP as a middle ground Rationale: Allows full patient effort while compensating for ETT resistance Evidence: Fewer and smaller trials Possible modest improvement in extubation success No clear mortality or LOS benefit Reasonable option based on patient physiology, institutional protocols, and clinician comfort No single “perfect” SBT mode Across PS, T-piece, CPAP, and newer methods (e.g., high-flow via ETT) there are no consistent differences in mortality or length of stay What matters most: Daily protocolized screening Thoughtful bedside clinical judgment Matching SBT difficulty to patient-specific risk Institutional variation is normal—and acceptable Examples: PS 10/5 in postoperative surgical ICU patients PS 5/0 as an intermediate difficulty option Key question clinicians should ask: What does passing or failing this specific SBT tell me about this patient's likelihood of post-extubation success? Take-home pearls SBTs are stress tests of post-extubation physiology. PS 5/5 for 30 minutes is a strong default for most ICU patients. T-piece trials are valuable when false positives are costly or physiology demands it. CPAP is reasonable but supported by less robust data. Consistency, daily screening, and judgment matter more than the exact mode. References and Further Reading Burns KEA, Khan J, Phoophiboon V, Trivedi V, Gomez-Builes JC, Giammarioli B, Lewis K, Chaudhuri D, Desai K, Friedrich JO. Spontaneous Breathing Trial Techniques for Extubating Adults and Children Who Are Critically Ill: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2024 Feb 5;7(2):e2356794. doi: 10.1001/jamanetworkopen.2023.56794. PMID: 38393729; PMCID: PMC10891471. Burns KEA, Sadeghirad B, Ghadimi M, Khan J, Phoophiboon V, Trivedi V, Gomez Builes C, Giammarioli B, Lewis K, Chaudhuri D, Desai K, Friedrich JO. Comparative effectiveness of alternative spontaneous breathing trial techniques: a systematic review and network meta-analysis of randomized trials. Crit Care. 2024 Jun 8;28(1):194. doi: 10.1186/s13054-024-04958-4. PMID: 38849936; PMCID: PMC11162018. Subirà C, Hernández G, Vázquez A, Rodríguez-García R, González-Castro A, García C, Rubio O, Ventura L, López A, de la Torre MC, Keough E, Arauzo V, Hermosa C, Sánchez C, Tizón A, Tenza E, Laborda C, Cabañes S, Lacueva V, Del Mar Fernández M, Arnau A, Fernández R. Effect of Pressure Support vs T-Piece Ventilation Strategies During Spontaneous Breathing Trials on Successful Extubation Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial. JAMA. 2019 Jun 11;321(22):2175-2182. doi: 10.1001/jama.2019.7234. Erratum in: JAMA. 2019 Aug 20;322(7):696. doi: 10.1001/jama.2019.11119. PMID: 31184740; PMCID: PMC6563557. Burns KEA, Wong J, Rizvi L, Lafreniere-Roula M, Thorpe K, Devlin JW, Cook DJ, Seely A, Dodek PM, Tanios M, Piraino T, Gouskos A, Kiedrowski KC, Kay P, Mitchell S, Merner GW, Mayette M, D’Aragon F, Lamontagne F, Rochwerg B, Turgeon A, Sia YT, Charbonney E, Aslanian P, Criner GJ, Hyzy RC, Beitler JR, Kassis EB, Kutsogiannis DJ, Meade MO, Liebler J, Iyer-Kumar S, Tsang J, Cirone R, Shanholtz C, Hill NS; Canadian Critical Care Trials Group. Frequency of Screening and Spontaneous Breathing Trial Techniques: A Randomized Clinical Trial. JAMA. 2024 Dec 3;332(21):1808-1821. doi: 10.1001/jama.2024.20631. PMID: 39382222; PMCID: PMC11581551. Mahul M, Jung B, Galia F, Molinari N, de Jong A, Coisel Y, Vaschetto R, Matecki S, Chanques G, Brochard L, Jaber S. Spontaneous breathing trial and post-extubation work of breathing in morbidly obese critically ill patients. Crit Care. 2016 Oct 27;20(1):346. doi: 10.1186/s13054-016-1457-4. PMID: 27784322; PMCID: PMC5081985. Yi LJ, Tian X, Chen M, Lei JM, Xiao N, Jiménez-Herrera MF. Comparative Efficacy and Safety of Four Different Spontaneous Breathing Trials for Weaning From Mechanical Ventilation: A Systematic Review and Network Meta-Analysis. Front Med (Lausanne). 2021 Nov 22;8:731196. doi: 10.3389/fmed.2021.731196. PMID: 34881255; PMCID: PMC8647911.​

This week, Marianna sits down with Chris Bositis and Cara McAnaney from the National Clinician Consultation Center (NCCC) to talk all about lower-barrier substance use and HIV prevention and treatment. Tune in to learn how direct-to-inject ties into that and why it matters for you as an HIV care provider. -- Resources: Waters RC, Hoog J, Bell C, Toland P, Valley J, Hurtado L, Kallsen MA, Johnson T, Gerard A, Fockele CE, Klein JW. Injectable-Only Overlapping Buprenorphine Starting Protocol in a Low-Threshold Setting. JAMA Netw Open. 2025 Aug 1;8(8):e2527016. doi: 10.1001/jamanetworkopen.2025.27016. PMID: 40815514; PMCID: PMC12357186.Rosenwohl-Mack S, Suen LW, Logan AA, Peterson D, Snyder HR. Outpatient Initiation of 7-Day Injectable Buprenorphine: A Direct-to-Inject Case Series. Subst Use Addctn J. 2025 Oct;46(4):1064-1069. doi: 10.1177/29767342251330412. Epub 2025 Apr 4. PMID: 40183345; PMCID: PMC12353995.D'Onofrio G, Herring AA, Perrone J, Hawk K, Samuels EA, Cowan E, Anderson E, McCormack R, Huntley K, Owens P, Martel S, Schactman M, Lofwall MR, Walsh SL, Dziura J, Fiellin DA. Extended-Release 7-Day Injectable Buprenorphine for Patients With Minimal to Mild Opioid Withdrawal. JAMA Netw Open. 2024 Jul 1;7(7):e2420702. doi: 10.1001/jamanetworkopen.2024.20702. PMID: 38976265; PMCID: PMC11231806. Help us track the number of listeners our episode gets by filling out this brief form! (https://www.e2NECA.org/?r=AQX7941)--Want to chat? Email us at podcast@necaaetc.org with comments or ideas for new episodes. --Check out our free online courses: www.necaaetc.org/rise-courses--Download our HIV mobile apps:Google Play Store: https://play.google.com/store/apps/developer?id=John+Faragon&hl=en_US&gl=USApple App Store: https://apps.apple.com/us/developer/virologyed-consultants-llc/id1216837691

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-470 Overview: Social media use is nearly ubiquitous among adolescents, raising concern about its role in rising rates of depression, anxiety, insomnia, and suicidality. Although prior evidence has been mixed, emerging studies offer new insights on the relationship between social media use and adolescent mental health. Join us as we review current literature and discuss potential strategies to mitigate negative impacts and improve outcomes. Episode resource links: Calvert E, Cipriani M, Dwyer B, et al. Social Media Detox and Youth Mental Health. JAMA Netw Open. 2025;8(11):e2545245. doi:10.1001/jamanetworkopen.2025.45245 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2840489   Clayborne ZM, Capaldi CA, Mehra VM. Associations between digital media use behaviours, screen time and positive mental health in youth: results from the 2019 Canadian Health Survey on Children and Youth. BMC Public Health. 2025;25(1):2303. Published 2025 Jul 3. doi:10.1186/s12889-025-22874-2 Grøntved A, Singhammer J, Froberg K, et al. A prospective study of screen time in adolescence and depression symptoms in young adulthood. Prev Med. 2015;81:108-113. doi:10.1016/j.ypmed.2015.08.009 Nagata JM, Memon Z, Talebloo J, et al. Prevalence and Patterns of Social Media Use in Early Adolescents. Acad Pediatr. 2025;25(4):102784. doi:10.1016/j.acap.2025.102784 Oberle E, Ji XR, Kerai S, Guhn M, Schonert-Reichl KA, Gadermann AM. Screen time and extracurricular activities as risk and protective factors for mental health in adolescence: A population-level study. Prev Med. 2020;141:106291. doi:10.1016/j.ypmed.2020.106291 Pieh C, Humer E, Hoenigl A, et al. Smartphone screen time reduction improves mental health: a randomized controlled trial. BMC Med. 2025;23(1):107. Published 2025 Feb 21. doi:10.1186/s12916-025-03944-z Riehm KE, Feder KA, Tormohlen KN, et al. Associations Between Time Spent Using Social Media and Internalizing and Externalizing Problems Among US Youth. JAMA Psychiatry. 2019;76(12):1266–1273. doi:10.1001/jamapsychiatry.2019.2325 Varona MN, Muela A, Machimbarrena JM. Problematic use or addiction? A scoping review on conceptual and operational definitions of negative social networking sites use in adolescents. Addict Behav. 2022;134:107400. doi:10.1016/j.addbeh.2022.107400 Woolf SH. The Youth Mental Health Crisis in the United States: Epidemiology, Contributors, and Potential Solutions. Pediatrics. 2025;156(5):e2025070849. doi:10.1542/peds.2025-070849 Xiang AH, Martinez MP, Chow T, et al. Depression and Anxiety Among US Children and Young Adults. JAMA Netw Open. 2024;7(10):e2436906. doi:10.1001/jamanetworkopen.2024.36906 BBC: Australia has banned social media for kids under 16. How will it work? https://www.bbc.com/news/articles/cwyp9d3ddqyo Guest: Susan Feeney, DNP, FNP-BC, NP-C   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-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-470 Overview: Social media use is nearly ubiquitous among adolescents, raising concern about its role in rising rates of depression, anxiety, insomnia, and suicidality. Although prior evidence has been mixed, emerging studies offer new insights on the relationship between social media use and adolescent mental health. Join us as we review current literature and discuss potential strategies to mitigate negative impacts and improve outcomes. Episode resource links: Calvert E, Cipriani M, Dwyer B, et al. Social Media Detox and Youth Mental Health. JAMA Netw Open. 2025;8(11):e2545245. doi:10.1001/jamanetworkopen.2025.45245 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2840489   Clayborne ZM, Capaldi CA, Mehra VM. Associations between digital media use behaviours, screen time and positive mental health in youth: results from the 2019 Canadian Health Survey on Children and Youth. BMC Public Health. 2025;25(1):2303. Published 2025 Jul 3. doi:10.1186/s12889-025-22874-2 Grøntved A, Singhammer J, Froberg K, et al. A prospective study of screen time in adolescence and depression symptoms in young adulthood. Prev Med. 2015;81:108-113. doi:10.1016/j.ypmed.2015.08.009 Nagata JM, Memon Z, Talebloo J, et al. Prevalence and Patterns of Social Media Use in Early Adolescents. Acad Pediatr. 2025;25(4):102784. doi:10.1016/j.acap.2025.102784 Oberle E, Ji XR, Kerai S, Guhn M, Schonert-Reichl KA, Gadermann AM. Screen time and extracurricular activities as risk and protective factors for mental health in adolescence: A population-level study. Prev Med. 2020;141:106291. doi:10.1016/j.ypmed.2020.106291 Pieh C, Humer E, Hoenigl A, et al. Smartphone screen time reduction improves mental health: a randomized controlled trial. BMC Med. 2025;23(1):107. Published 2025 Feb 21. doi:10.1186/s12916-025-03944-z Riehm KE, Feder KA, Tormohlen KN, et al. Associations Between Time Spent Using Social Media and Internalizing and Externalizing Problems Among US Youth. JAMA Psychiatry. 2019;76(12):1266–1273. doi:10.1001/jamapsychiatry.2019.2325 Varona MN, Muela A, Machimbarrena JM. Problematic use or addiction? A scoping review on conceptual and operational definitions of negative social networking sites use in adolescents. Addict Behav. 2022;134:107400. doi:10.1016/j.addbeh.2022.107400 Woolf SH. The Youth Mental Health Crisis in the United States: Epidemiology, Contributors, and Potential Solutions. Pediatrics. 2025;156(5):e2025070849. doi:10.1542/peds.2025-070849 Xiang AH, Martinez MP, Chow T, et al. Depression and Anxiety Among US Children and Young Adults. JAMA Netw Open. 2024;7(10):e2436906. doi:10.1001/jamanetworkopen.2024.36906 BBC: Australia has banned social media for kids under 16. How will it work? https://www.bbc.com/news/articles/cwyp9d3ddqyo Guest: Susan Feeney, DNP, FNP-BC, NP-C   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-Med.

Recent randomized controlled trials have shown that routine perioperative palliative care does not improve outcomes for patients undergoing curative-intent cancer surgery. No, that wasn't a typo. Regardless of how the data were analyzed, the findings remained consistent: perioperative palliative care DID NOT improve outcomes in the only two randomized controlled trials conducted in this area—the SCOPE and PERIOP-PC trials. Null trials like these often receive less attention in academic and clinical settings, but they can be profoundly practice-changing. Consider the Shannon Carson study on palliative care for chronically critically ill patients. While some have argued it "wasn't a palliative care study," I've always regarded it as one of the most significant studies for understanding not what works—but what doesn't—for palliative care in specific patient populations. The same holds true for the SCOPE and PERIOP-PC trials. Both were null, but their findings are deeply relevant to clinical practice. That's why we invited the lead authors, Rebecca Aslakson (PERIOP-PC) and Myrick "Ricky" Shinall (SCOPE), to share insights into what they did in their studies and why they think they got the results that they did. One key takeaway for me from this discussion was the idea that patients undergoing curative-intent surgery might simply be too early in their cancer trajectory to derive meaningful benefits from palliative care, and maybe the focus should be more on geriatrics. I especially appreciated the closing discussion about the future of research in this area: if routine perioperative palliative care doesn't improve outcomes, what should the next generation of studies focus on? Eric Widera   Studies we talk about during the podcast Aslakson et al. Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer: A Randomized Clinical Trial. JAMA Netw Open. 2023 Shinall et al. Effects of Specialist Palliative Care for Patients Undergoing Major Abdominal Surgery for Cancer: A Randomized Clinical Trial. JAMA Surg. 2023 Carson et al. Effect of Palliative Care–Led Meetings for Families of Patients With Chronic Critical Illness: A Randomized Clinical Trial. JAMA. 2016 Holdsworth et al. Patient Experiences of Specialty Palliative Care in the Perioperative Period for Cancer Surgery. JPSM. 2024 Williams et al. Patient Perceptions of Specialist Palliative Care Intervention in Surgical Oncology Care. Am J Hosp Palliat Care. 2025  Yefimova et al. Palliative Care and End-of-Life Outcomes Following High-risk Surgery. JAMA Surg. 2020   

In this episode, we review the clinical presentation, diagnosis, and treatment of uncomplicated urinary tract infections. Key Concepts Uncomplicated urinary tract infections (UTI) are defined as an infection localized to the bladder without any systemic signs or symptoms of infection in someone who is not immunocompromised, pregnant, catheterized, and has normal urologic anatomy. UTIs are most commonly seen in younger women. E. coli is by far the most common urinary pathogen. Symptoms alone drive most of the diagnosis of UTI; however, urinalysis and urine culture can be helpful in some circumstances. Nitrofurantoin (Macrobid) is recommended for men and women for first-line therapy in most patients. Fosfomycin, Bactrim, pivmecillinam, and certain B-lactams can be considered in certain circumstances. Women are usually treated for 3-5 days and men 5-7 days. Some evidence suggests inferior clinical outcomes for B-lactam; however, the amount of data in general is lacking for B-lactams. Recommended B-lactams (aside from pivmecillinam) include amoxicillin/clavulanate, cephalexin, cefadroxil, cefpodoxime, and cefdinir. References Nelson Z, Aslan AT, Beahm NP, et al. Guidelines for the Prevention, Diagnosis, and Management of Urinary Tract Infections in Pediatrics and Adults: A WikiGuidelines Group Consensus Statement. JAMA Netw Open. 2024;7(11):e2444495. Published 2024 Nov 4. doi:10.1001/jamanetworkopen.2024.44495 Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-e120. doi:10.1093/cid/ciq257 Kurotschka PK, Gágyor I, Ebell MH. Acute Uncomplicated UTIs in Adults: Rapid Evidence Review. Am Fam Physician. 2024;109(2):167-174. https://www.wikiguidelines.org/

In this episode, Dr. Andy Cutler and Dr. Jeff Strawn unpack common misconceptions that complicate real-world use of antidepressants. They review evidence on efficacy, suicidality risk, mechanisms, and early side effects, and discuss how to navigate hesitancy and misinformation. The conversation also addresses when to start medication, how to balance caution with timely intervention in youth, and practical ways to strengthen trust and therapeutic alliance.  Jeffrey R. Strawn, MD, FAACAP, is a Professor of Psychiatry, Pediatrics, and Clinical & Translational Pharmacology at the University of Cincinnati (UC) in Cincinnati, Ohio. He is the Director of the UC Anxiety Disorders Research Program and the Associate Vice Chair of Research in the Department of Psychiatry & Behavioral Neuroscience at UC.   Andrew J. Cutler, MD, is a distinguished psychiatrist and researcher with extensive experience in clinical trials and psychopharmacology. He currently serves as the Chief Medical Officer of Neuroscience Education Institute and EMA Wellness. He is a Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University in Syracuse, New York.  Resources  Zhang K et al. Functional connectivity predicting transdiagnostic treatment outcomes in internalizing psychopathologies. JAMA Netw Open 2025;8(9):e2530008. doi: 10.1001/jamanetworkopen.2025.30008  Lagerberg T et al. Selective serotonin reuptake inhibitors and suicidal behaviour: a population-based cohort study. Neuropsychopharmacology 2022;47(4):817-23. doi: 10.1038/s41386-021-01179-z  Never miss an episode!

Send us a textIn this Journal Club episode, Ben and Daphna review a salient study from JAMA Network Open examining outcomes of infants born at 21 weeks' gestation at the University of Iowa. They walk through resuscitation practices, early physiologic challenges, survival trends, and short-term developmental outcomes, while placing the data in the broader context of shifting limits of viability. The discussion highlights both cautious optimism and the many unanswered questions that remain as neonatology continues to push the boundaries of what is possible.----Outcomes of Infants Born at 21 Weeks' Gestational Age. Hyland RM, Mat HD, Boly TJ, Thomas BJ, Stanford AH, Harmon HM, Bermick JR, Davila RC, Colaizy TT, Dagle JM, Klein JM, Greiner AL, Bell EF, McNamara PJ; University of Iowa Neonatology Program.JAMA Netw Open. 2025 Dec 1;8(12):e2548211. doi:10.1001/jamanetworkopen.2025.48211.PMID: 41385227 Free PMC article.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textMaternal Psychological Distress Before and After Childbirth and Neurodevelopmental Delay in Toddlers.Matsumura K, Tanaka T, Kuroda M, Tsuchida A, Hatakeyama T, Kasamatsu H, Inadera H; Japan Environment and Children's Study Group.JAMA Netw Open. 2025 Oct 1;8(10):e2540907. doi: 10.1001/jamanetworkopen.2025.40907.PMID: 41171271 Free PMC article.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

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-463 Overview: Listen in as we discuss how integrating behavioral therapies into the management of chronic back pain can improve function, reduce opioid use, and empower patients. Boost your clinical toolkit with evidence-based strategies that enhance outcomes while aligning with evolving guidelines for safer, multimodal approaches to chronic pain care. Episode resource links: Zgierska AE, Edwards RR, Barrett B, et al. Mindfulness vs Cognitive Behavioral Therapy for Chronic Low Back Pain Treated With Opioids: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(4):e253204. doi:10.1001/jamanetworkopen.2025.3204 Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022. MMWR Recomm Rep. 2022 Nov 4;71(3):1-95. doi: 10.15585/mmwr.rr7103a1. PMID: 36327391; PMCID: PMC9639433. Guest: Jillian Joseph, MPAS, PA-C Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  

In this solo episode, Darin reframes one of the most misunderstood forces in life — stress. Instead of seeing it as the enemy, he explores how stress is actually a messenger, guiding you back to alignment, safety, and awareness. Through science, spirituality, and lived experience, Darin breaks down how stress shows us where we're trying to control, where we're disconnected, and where our nervous system is calling for attention. He unpacks the layers of modern stress — from trauma and environment to community and purpose — and offers practical, embodied tools to restore calm, clarity, and resilience.     What You'll Learn 00:00:00 – Welcome to Super Life: Solutions for a Healthier Life and Better World 00:00:32 – Sponsor Spotlight: TheraSauna - Natural Healing Technologies (15% off with code Darrandai) 00:02:10 – The Super Life Podcast: Finding Contentment, Happiness, and Purpose 00:02:51 – Today's Topic: Stress - Reframing Stress as an Ally and Dashboard Light 00:04:54 – The "No Choice" Universe: Reconnecting to Infinite Possibilities 00:05:16 – The Reality of Stress: Statistics and the Impact of Chronic Stress 00:06:21 – Stress is Layered: Beyond a Single Cause, Addressing Chronic Stress 00:08:29 – Solutions for a Super Life: Safety over Calm and the Vagal Response 00:09:38 – The Inner Dialogue Layer: Trauma, Unconsciousness, and Spiritual Bypassing 00:11:47 – The Social Field Layer: Relationships, Community, and Finding Your Way Home 00:14:20 – Sponsor Spotlight: Bite Toothpaste - Sustainable, Non-Toxic Tabs (20% off with code Darin20) 00:16:35 – Creating Your Own Vision: Setting Boundaries with Media and Social Algorithms 00:17:29 – Finding Your Purpose: From Raising Children to Healing Injuries 00:18:35 – Environmental and Existential Stress Layers: Clutter, Noise, and Service 00:19:26 – Stress Load and Resiliency: Why Small Triggers Cause Blow-Ups 00:20:02 – Understanding the Dashboard Light: Acknowledging Unwillingness 00:20:35 – Safety as the Signal: Body Relaxation and Providing Inner Security 00:23:44 – Reframing Trauma: Was it the Protector You Needed at the Time? 00:25:00 – Releasing Trauma: Techniques, The Healing Code, and Waking the Tiger 00:26:06 – Finishing the Survival Response: Shaking, Crying, Screaming, and Stretching 00:26:38 – Stress as a Multiplier: Impact on Immune System, Heart, and Aging 00:28:10 – Stress Slows Repair: Inflammation, Cardiovascular Risk, and Cellular Aging 00:29:48 – The Integrative Approach: Changing Your Environments to Support Anti-Stress 00:30:07 – Actionable Stress Solutions: Circadian Rhythm, Nature, and Noise Reduction 00:30:44 – Actionable Stress Solutions: Gratitude, Conscious Breath, and Movement 00:31:32 – Energy Drains to Eliminate: Conflict, Clutter, Scrolling, and Late Caffeine 00:32:17 – Connecting to Greater Purpose: The Super Life Patreon Platform 00:32:54 – Morning/Night Questions: Letting Go, Creating, and Contributing 00:33:17 – Final Toolkit: Slow Breathing, Movement, Nature, Sauna, and Sleep 00:34:25 – The Invitation: Digging into all Layers of a Super Life on Patreon   Thank You to Our Sponsors Therasage: Go to www.therasage.com and use code DARIN at checkout for 15% off Bite Toothpaste: Go to trybite.com/DARIN20 or use code DARIN20 for 20% off your first order. Find More from Darin Olien: Instagram: @darinolien Podcast: SuperLife Podcast Website: superlife.com Book: Fatal Conveniences   Key Takeaway "Stress isn't your enemy — it's your compass. Every wave of tension points you back to what's asking for care, attention, and love. When you stop fighting stress and start listening to it, you don't just survive — you evolve."       Bibliography (selected, peer-reviewed) Sources: Gallup Global Emotions (2024); Gallup U.S. polling (2024); APA Stress in America (2023); Natarajan et al., Lancet Digital Health (2020); Orini et al., UK Biobank (2023); Martinez et al. (2022); Leiden University (2025). Cohen S, Tyrrell DA, Smith AP. Psychological stress and susceptibility to the common cold. N Engl J Med.1991;325(9):606–612. New England Journal of Medicine Cohen S, et al. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proc Natl Acad Sci USA. 2012;109(16):5995–5999. PNAS Kiecolt-Glaser JK, et al. Slowing of wound healing by psychological stress. Lancet. 1995;346(8984):1194–1196. The Lancet Kiecolt-Glaser JK, et al. Hostile marital interactions, proinflammatory cytokine production, and wound healing.Arch Gen Psychiatry. 2005;62(12):1377–1384. JAMA Network Tawakol A, et al. Relation between resting amygdalar activity and cardiovascular events. Lancet.2017;389(10071):834–845. The Lancet Epel ES, et al. Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci USA.2004;101(49):17312–17315. PNAS McEwen BS, Stellar E. Stress and the individual: mechanisms leading to disease. Arch Intern Med.1993;153(18):2093–2101. PubMed McEwen BS, Wingfield JC. Allostasis and allostatic load. Ann N Y Acad Sci. 1998;840:33–44. PubMed Felitti VJ, et al. Relationship of childhood abuse and household dysfunction to many leading causes of death in adults (ACE Study). Am J Prev Med. 1998;14(4):245–258. AJP Mon Online Edmondson D, et al. PTSD and cardiovascular disease. Ann Behav Med. 2017;51(3):316–327. PMC Afari N, et al. Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis.Psychosom Med. 2014;76(1):2–11. PMC Goyal M, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014;174(3):357–368. PMC Qiu Q, et al. Forest therapy: effects on blood pressure and salivary cortisol—a meta-analysis. Int J Environ Res Public Health. 2022;20(1):458. PMC Laukkanen T, et al. Sauna bathing and reduced fatal CVD and all-cause mortality. JAMA Intern Med.2015;175(4):542–548. JAMA Network Zureigat H, et al. Physical activity lowers CVD risk by reducing stress-related neural activity. J Am Coll Cardiol.2024;83(16):1532–1546. PMC Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med.2010;7(7):e1000316. PMC Chen Y-R, Hung K-W. EMDR for PTSD: meta-analysis of RCTs. PLoS One. 2014;9(8):e103676. PLOS Hoppen TH, et al. Network/pairwise meta-analysis of PTSD psychotherapies—TF-CBT highest efficacy overall.Psychol Med. 2023;53(14):6360–6374. PubMed van der Kolk BA, et al. Yoga as an adjunctive treatment for PTSD: RCT. J Clin Psychiatry. 2014;75(6):e559–e565. PubMed Kelly U, et al. Trauma-center trauma-sensitive yoga vs CPT in women veterans: RCT. JAMA Netw Open.2023;6(11):e2342214. JAMA Network Bentley TGK, et al. Breathing practices for stress and anxiety reduction: components that matter. Behav Sci (Basel). 2023;13(9):756.