Podcasts about mayo clin proc

This is a capstone presentation from Chief Resident of Mayo Clinic Emergency Medicine, Dr. Taylor Christian.   Teaser: Can we fulfill our oath to “do no harm” if we ignore the harm of racial injustice in medicine? Understanding the historical roots and persistent impact of medical racism isn't just informative; it is a call to action. This presentation is an opportunity to learn, reflect, and act to become better advocates.   CONTACTS X - @AlwaysOnEM; @VenkBellamkonda; @TayMChristian YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch; @drtaylormonet Email - AlwaysOnEM@gmail.com   REFERENCES & LINKS Meisel ZF, Shofer FS, Dolan AR, Goldberg E, Cannuscio CC, Rhodes KV, Perrone J, Hess EP, Rogers M, Bellamkonda V, Bell J, Zyla M, Becker L, McCollum S, Schapira M. Comparing Three Ways to Help Patients with Acute Pain Learn about Opioid Risks — The Life STORRIED Study [Internet]. Washington (DC): Patient-Centered Outcomes Research Institute (PCORI); 2021 Oct. PMID: 39383261. Engel-Rebitzer E, Dolan AR, Aronowitz SV, Shofer FS, Nguemeni Tiako MJ, Schapira MM, Perrone J, Hess EP, Rhodes KV, Bellamkonda VR, Cannuscio CC, Goldberg E, Bell J, Rodgers MA, Zyla M, Becker LB, McCollum S, Meisel ZF. Patient Preference and Risk Assessment in Opioid Prescribing Disparities: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2021 Jul 1;4(7):e2118801. doi: 10.1001/jamanetworkopen.2021.18801. PMID: 34323984; PMCID: PMC8322998. Racic M, Roche-Miranda MI, Fatahi G. Twelve tips for implementing and teaching anti-racism curriculum in medical education. Med Teach. 2023 Aug;45(8):816-821. doi: 10.1080/0142159X.2023.2206534. Epub 2023 May 3. PMID: 37134226. Sahai A, Corley AMS, Lipps L, Lawton R, DeBlasio D, Klein M. A Locally-Focused Structural Racism Curriculum for Pediatric Primary Care Residents. Acad Pediatr. 2023 Nov-Dec;23(8):1510-1512. doi: 10.1016/j.acap.2023.06.012. Epub 2023 Jun 9. PMID: 37302703. Carrera D, Tejeda C, Kakani P, Napolitano J. Addressing Racism in Medical Education: A Longitudinal Antiracism Discussion Curriculum for Medical Students. Med Sci Educ. 2023 Apr 28;33(3):639-643. doi: 10.1007/s40670-023-01788-x. PMID: 37501797; PMCID: PMC10368613. Seegmiller Renner AM, Gross JR, Laughlin-Tommaso SK. Paving a Path to Inclusion, Diversity, Anti-Racism, and Equity: A Curriculum Roadmap. Mayo Clin Proc. 2023 Dec;98(12):1755-1762. doi: 10.1016/j.mayocp.2023.08.026. PMID: 38043992.

Traditional career development frameworks often overlook the importance of well-being. This podcast episode emphasizes why wellness is essential to building a sustainable and fulfilling career. Host Kyle Enfield, MD, FCCM, is joined by Jennifer Duncan, MD, and Raquel Cabral, PhD, CPH, to explore how team members and leaders can integrate personal values, connection, and purpose into career decision-making. Dr. Duncan, director of wellness for graduate medical education (GME), and Dr. Cabral, a staff psychologist for GME, both at Washington University School of Medicine, share insights from their work supporting trainees' personal and professional growth. Together, they explore the nuanced meaning of well-being—not as constant happiness, but as a sense of satisfaction and alignment with a person's values, even amid challenges. The conversation highlights the importance of helping team members identify and live by their personal values as a foundation for career satisfaction. Dr. Cabral distinguishes between goals and values, underscoring that, while goals can be achieved or not, values guide how a person shows up in all aspects of life. She outlines how residents and other early-career professionals can uncover values by reflecting on meaningful or difficult work experiences. These reflections can then guide decisions about clinical rotations, job searches, and leadership opportunities. Dr. Duncan emphasizes how small but intentional adjustments—such as carving out just 20% of one's time for personally meaningful work—can protect against burnout. Both guests discuss the critical role leaders play in supporting well-being, from understanding each team members' values to fostering a strong sense of community. They refer to The Burnout Challenge (Maslach C, Leiter MP. Harvard University Press. 2024), which outlines six workplace drivers of burnout, including mismatches in values. Finally, the episode highlights the work of the Mayo Clinic's Colleagues Meeting to Promote and Sustain Satisfaction (COMPASS) Groups. The COMPASS randomized clinical trial (West CP, et al. Mayo Clin Proc. 2021;96:2606-2614) evaluated a small group established to promote well-being. The group was provided discussion topics without trained facilitators. Protected time was not provided but meal expenses were compensated. This model showed positive outcomes in reducing burnout and strengthening collegial connections. This episode is part of SCCM's Leadership, Empowerment, and Development (LEAD) series and offers actionable insights for anyone invested in building healthier, value-aligned medical careers.

*Content Warning: sexual assault, sexual abuse, sexual violence, rape, suicidal ideation, and mental illness.Resources:Rape, Abuse, & Incest National Network: RAINN.org1 in 6 Organization: 1in6.org1 in 6 Organization Instagram: http://www.instagram.com/1in6orgNational Sexual Violence Resource Center: https://www.nsvrc.org/find-helpNational Sexual Assault Hotline (1800-656-4763): https://www.rainn.org/resourcesSources:The 1 in 6 Statistic. (n.d.). One in Six Organization. Retrieved June 26, 2024, from https://1in6.org/statistic/Cal Poly Humboldt & North Coast Rape Crisis Team. (n.d.). Supporting Survivors. Sexualized Violence Statistics. Retrieved June 26, 2024, from https://supportingsurvivors.humboldt.edu/statisticChen LP, Murad MH, Paras ML, Colbenson KM, Sattler AL, Goranson EN, Elamin MB, Seime RJ, Shinozaki G, Prokop LJ, Zirakzadeh A. Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clin Proc. 2010 Jul;85(7):618-29. doi: 10.4065/mcp.2009.0583. Epub 2010 May 10. PMID: 20458101; PMCID: PMC2894717. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894717/March 2020 Delayed Disclosure: A Factsheet Based on Cutting-Edge Research on Child Sexual Abuse. (2020). Montana Legislature. Retrieved June 26, 2024, from https://leg.mt.gov/bills/2023/Minutes/Senate/Exhibits/230227JUSa3.pdfT. Muller, R., PhD. (2020, October 15). The Invisible Male Victims of Sexual Trauma. Psychology Today. https://www.psychologytoday.com/us/blog/talking-about-trauma/202010/the-invisible-male-victims-sexual-traumaNational Intimate Partner and Sexual Violence Survey: 2015 Data Brief - Updated Release. (2018). National Center for Injury Prevention and Control Centers for Disease Control and Prevention. Retrieved June 26, 2024, from https://www.nsvrc.org/sites/default/files/2021-04/2015data-brief508.pdfNational Sexual Violence Resource Center. (n.d.). Sexual Assault: Statistics. Retrieved June 26, 2024, from https://www.nsvrc.org/statisticsPetersson, C.C., Plantin, L. Breaking with Norms of Masculinity: Men Making Sense of Their Experience of Sexual Assault. Clin Soc Work J 47, 372–383 (2019). https://doi.org/10.1007/s10615-019-00699-yRape, Abuse, & Incest National Network. (n.d.). Perpetrators of Sexual Violence: Statistics. RAINN. Retrieved June 26, 2024, from https://www.rainn.org/statistics/perpetrators-sexual-violenceRape, Abuse, & Incest National Network. (n.d.-b). Sexual Assault of Men and Boys: Statistics. Retrieved June 26, 2024, from https://www.rainn.org/articles/sexual-assault-men-and-boysU.S. Department of Veterans Affairs. (n.d.). National Center for PTSD: Sexual Assault - Males. https://www.ptsd.va.gov/understand/types/sexual_trauma_male.aspLeRon Barton: LeRon's Instagram: http://www.instagram.com/leronlbarton Leron's Website: https://leronbarton.com/Follow Something Was Wrong:Website: somethingwaswrong.com IG: instagram.com/somethingwaswrongpodcastTikTok: tiktok.com/@somethingwaswrongpodcast Follow Tiffany Reese:Website: tiffanyreese.me IG: instagram.com/lookieboo business@tiffanyreese.me The SWW theme Song is U Think U, by Glad Rags. The S21 cover art is by the Amazing Sara Stewart.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Dr. Pritish Tosh, consultant physician in Infectious Diseases, and Supply Chain Management specialist for Mayo Clinic talks through the relationship between our clinical delivery of care and the strength of our supply chain practices. Our recent experiences with facemasks in the pandemic, the daily threats to medication access, and the events of recent longshoreman strike as well as Hurricane Helene damage to saline production locations has shown us how valuable it is to understand our supply chain. In this chapter, Alex and Venk, get schooled on the importance of this understanding, the basics of how to assess the stability of supply chain, and how to be advocates for a healthy supply chain infrastructure moving forward. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Tosh PK, Schafer JM, Harvieux TP, Hall BL. Medical Supply Shortages - We are part of the problem...and solution. Mayo Clin Proc. 2023 Dec; 98(12):1763-1766Associated Press. (2024, October 1). US port strike: Over 45,000 dockworkers from Maine to Texas hit picket lines. AP News. Retrieved from https://apnews.com/article/port-strike-ila-dockworkers-begins-e5468e760f46a64e4322d1702beb1f72[1](https://apnews.com/article/port-strike-ila-dockworkers-begins-e5468e760f46a64e4322d1702beb1f72). Harris, R. (2018, March 31). Why did sterile salt water become the IV fluid of choice? NPR. Retrieved from https://www.npr.org/sections/health-shots/2018/03/31/597666140/why-did-sterile-salt-water-become-the-iv-fluid-of-choice[1](https://www.mybib.com/tools/apa-citation-generator).   WANT TO WORK AT MAYO? EM Physicians: https://jobs.mayoclinic.org/emergencymedicine EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs   Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

Could we be on the brink of a public healthcare crisis? In this episode, I tackle a pressing issue: while menopause is a universal experience for women, the support systems in place are alarmingly inadequate. I'll explore how the “menopause penalty” affects our health, relationships, finances, and careers, and why this could lead to a shortage of physicians to care for us.Join me as I reveal shocking statistics that highlight the urgent need for better support in our workplaces and communities. My goal is to inspire you to advocate for more resources and create a nurturing environment for women navigating this significant life transition. Tune in to understand the critical need for change and discover how we can work together to build a better future for all womenReferencesWorking Paper - “The Menopause "Penalty" - Institute for Fiscal StudiesImpact of Menopause Symptoms on Women in the Workplace. Mayo Clin Proc. 2023Understanding the Role of Menopause in Work and Careers - Korn FerryThanks for listening. Find more info about Reset Recharge on the website or Instagram.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities. Episodes originally aired from 2016 to 2021. Originally released: November 28, 2019 Peer review prior to publication of medical data dates back to the 9th century CE but has only really gained steam in the past 70 or 80 years. Ideally, peer review would serve as an initial filter for data that enter a permanent public scientific record. But peer review is not without flaws. In the second installment of the BrainWaves segment, “It's not over yet…,” we discuss publication as a potential source of bias and highlight the reasons why it should not be the final step of the peer review process. Produced by James E Siegler. Music courtesy of Cullah, Lee Rosevere, John Bartmann, Kevin McLeod, and Jon Watts. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter (now X) @brainwavesaudio for the latest updates to the podcast. REFERENCES Bingham C, van der Weyden MB. Peer review on the Internet: launching eMJA peer review study 2. Med J Aust 1998;169(5):240-1. PMID 9762058Godlee F, Gale CR, Martyn CN. Effect on the quality of peer review of blinding reviewers and asking them to sign their reports: a randomized controlled trial. JAMA 1998;280(3):237-40. PMID 9676667Haffar S, Bazerbachi F, Murad MH. Peer review bias: a critical review. Mayo Clin Proc 2019;94(4):670-6. PMID 30797567Jefferson T, Alderson P, Wager E, Davidoff F. Effects of editorial peer review: a systematic review. JAMA 2002;287(21):2784-6. PMID 12038911Jefferson T, Rudin M, Brodney Folse S, Davidoff F. Editorial peer review for improving the quality of reports of biomedical studies. Cochrane Database Syst Rev 2007;2007(2):MR000016. PMID 17443635Mandavilli A. Peer review: Trial by Twitter. Nature 2011;469(7330):286-7. PMID 21248816Ware M. Peer review: Benefits, perspectives, and alternatives. Publishing Research Consortium, 2008. We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

Is it an allergy or an autoimmune vasculitis, or a little of both? Find out the story of urticarial vasculitis, how this disease was recognized and eventually sorted out from other types of urticaria. ·       Intro 0:12 ·       In this episode 0:21 ·       Case study 1:22 ·       Chronic spontaneous urticaria, hives and nettles 7:57 ·       Dermatographism and witchcraft? 10:15 ·       Causes of urticaria 11:17 ·       Theory of inflammation and histamines 11:40 ·       Urticaria and treatments with histamines 12:09 ·       Types of urticaria 13:02 ·       Mayo Clinic study 13:39 ·       Chronic urticaria as a manifestation of necrotizing venulitis 16:10 ·       Connection between types of urticaria and leukocytoclastic vasculitis 20:02 ·       More case studies 20:38 ·       What do we know about treatments? 22:23 ·       In conclusion 24:15 ·       Coming up in part two 25:08 ·       Thanks for listening 25:47 Disclosures: Brown reports no relevant financial disclosures. We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. References: Czarnetzki BM. Int J Dermatol. 1989;doi:10.1111/j.1365-4362.1989.tb01314.x. Kolkhir P, et al. J Allergy Clin Immunol. 2019;doi:10.1016/j.jaci.2018.09.007. McDuffie FC, et al. Mayo Clin Proc. 1973;48(5):340-8. Natbony SF, et al. J Allergy Clin Immunol. 1983;doi:10.1016/0091-6749(83)90096-9. Soter NA. N Engl J Med. 1977;doi:10.1056/NEJM197706232962505.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: April 26, 2018 Forget what you did 5 minutes ago? What if this happened every 5 minutes...for an entire day? In this week's program, Dr. Laura Mainardi shares her family's experience with a day that will never be forgotten. But never remembered. Produced by James E Siegler and Laura Mainardi-Villarino. Music by Pablo Pavan, Azevedo Silva, Montplaisir, and Kevin McLeod. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision-making. REFERENCES Arena JE, Rabinstein AA. Transient global amnesia. Mayo Clin Proc 2015;90(2):264-72. PMID 25659242Hainselin M, Quinette P, Juskenaite A, et al. Just do it! How performing an action enhances remembering in transient global amnesia. Cortex 2014;50:192-9. PMID 24268322Noël A, Quinette P, Hainselin M, et al. The still enigmatic syndrome of transient global amnesia: interactions between neurological and psychopathological factors. Neuropsychol Rev 2015;25(2):125-33. PMID 25868986Quinette P, Guillery-Girard B, Dayan J, et al. What does transient global amnesia really mean? Review of the literature and thorough study of 142 cases. Brain 2006;129(Pt 7):1640-58. PMID 16670178  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date. 

Joanne e Fred discutem sobre o manejo de medicações no perioperatório, com foco em anti-hipertensivos e antidiabéticos - quando suspender e quando manter? Referências: 1. ESC Scientific Document Group , 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery: Developed by the task force for cardiovascular assessment and management of patients undergoing non-cardiac surgery of the European Society of Cardiology (ESC) Endorsed by the European Society of Anaesthesiology and Intensive Care (ESAIC), European Heart Journal, Volume 43, Issue 39, 14 October 2022, Pages 3826–3924. 2. Gualandro DM, Yu PC, Caramelli B, Marques AC, Calderaro D, Fornari LS, Pinho C, et al. 3ª Diretriz de Avaliação Cardiovascular Perioperatória da Sociedade Brasileira de Cardiologia. Arq. Bras. Cardiol. 2017;109(3 suppl 1):1-104. 3. Himes CP, Ganesh R, Wight EC, Simha V, Liebow M. Perioperative Evaluation and Management of Endocrine Disorders. Mayo Clin Proc. 2020 Dec;95(12):2760-2774.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.Originally released: July 18, 2017With so many disease-modifying therapies out there, how do you decide which drug to use in your patient with multiple sclerosis? BrainWaves makes it simple. In this interview with Dr. Christopher Perrone, we review the US FDA-approved therapies for relapsing-remitting multiple sclerosis, their mechanisms of action, side effects, and benefits. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health-identifying information. The content in this episode was approved and vetted by Salim Chahin.REFERENCESTorkildsen O, Myhr KM, Bo L. Disease-modifying treatments for multiple sclerosis - a review of approved medications. Eur J Neurol 2016;23(Suppl 1):18-27. PMID 26563094Wingerchuk DM, Carter JL. Multiple sclerosis: current and emerging disease-modifying therapies and treatment strategies. Mayo Clin Proc 2014;89(2):225-40. PMID 24485135We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

Les pharmaciens sont fréquemment confrontés à des interactions qui peuvent faire allonger l'intervalle QT et augmenter le risque de torsades de pointe. Quelle conduite privilégier pour prévenir les torsades de pointe d'origine médicamenteuse? Qui sont les patients les plus susceptibles de développer ce type d'arythmie et quels outils sont disponibles pour évaluer le risque? Quand faut-il intervenir? Pour nous guider à travers ces questions, Trait pharmacien reçoit Geneviève Cyr, pharmacienne à l'Institut de cardiologie de Montréal. NOUVEAUTÉ! Les membres de l'A.P.E.S. peuvent réclamer des UFC en réussissant un questionnaire d'évaluation des apprentissages! https://bit.ly/3PaDAuJ Références : Site Web de CredibleMeds : https://crediblemeds.org/ Vandael E et coll. Development of a risk score for QTc-prolongation: the RISQ-PATH study. Int J Clin Pharm 2017;39(2):424-32. Vandael E et coll. A smart algorithm for the prevention and risk management of QTc prolongation based on the optimized RISQ-PATH model. Br J Clin Pharmacol 2018;84(12):2824-35. Tisdale JE et coll. Development and validation of a risk score to predict QT interval prolongation in hospitalized patients. Circ Cardiovasc Qual Outcomes 2013;6(4):479-87. Haugaa KH et coll. Institution-wide QT alert system identifies patients with a high risk of mortality. Mayo Clin Proc 2013;88(4):315-25.

Dr. Nayantara Coelho-Prabhu, Mayo Clinic gastroenterologist specializing in the care of patients with gastrointestinal bleeding and endoscopy, talks through many aspects of acute GI bleeding. She helps to clarify the prioritization of medications, when to incorporate imaging, broadens our differentials for upper and lower GI bleeding, gives mindblowing advice on stool guiac testing and SO much more in this over-stuffed (or should we say constipated) chapter of Always on EM. There is also a special cameo from Dr. Luke Wood going over how to insert a Minnesota tube (esophageal balloon tamponade device)!   CONTACTS X - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com   RECOMMENDATION: Dieulafoy lesion video from New England Journal of Medicine: https://youtu.be/tzJQDen1nug?si=zOmywZ1VN3VvA004    REFERENCES: Drescher MJ, Stapleton S, Britstone Z, Fried J, Smally AJ. A call for reconsideration of the use of fecal occult blood testing in emergency medicine. Journal of Emerg Med. 2020. 58(1)54-58 Mathews BK, Ratcliffe T, Sehgal R, Abraham JM, Monash B. Fecal Occult Blood testing in hospitalized patients with upper gastrointestinal bleeding. Journal of Hospital Medicine. 2017. 12(7)567-569 Harewood GC, McConnell JP, Harrington JJ, Mahoney DW, Ahlquist DA. Detection of occult upper gastrointestinal bleeding: performance in fecal occult blood tests. Mayo Clin Proc. 2002 Jan;77(1):23-28 Blatchford O, et al. A risk score to predict need for treatment for upper gastrointestinal haemorrhage. Lancet 2000. Oct 14;356(9238):1318-21 Blatchford O, Davidson LA, Murray WR, Blatchford M, Pell J. Acute upper gastrointestinal haemorrhage in west of scotland: case ascertainment study. BMJ 1997. Aug 30;315(7107):510-4 Chen IC, Hung MS, Chiu TF, Chen JC, Hsiao CT. Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding. Am J Emerg Med. 2007 Sep;25(7):774-9 Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021 May 1;116(5):899-917 Roberts I, Shakur-STill H, Afolabi A, et al. Effects of High-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Lancet 2020. 395(10241):1927-1936 Aziz M, Haghbin H, Gangwani MK, Weissman S, Patel AR, Randhawa MK, Samikanu LB, Alyousif ZA, Lee-Smith W, Kamal F, Nawras A, Howden CW. Erythromycin improves the quality of esophagogastroduodenoscopy in upper gastrointestinal bleeding: a network meta-analysis. Dig Dis Sci 2023. Apr;68(4):1435-1446 Abraham NS, Barkun AN, Sauer BG, et al. American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of anticoagulants and antiplatelets during acute gastrointestinal bleeding and the periendoscopic period. Am J Gastroenterol 2022;00:1-17 Vigano GL, Mannucci PM, Lattuada A, Harris A, Remuzzi G. Subcutaneous desmopressin (DDAVP) shortens the bleeding time in uremia. Am J Hematol 1989. May;31(1):32-5 Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila FL, Soares-Weiser K, Uribe M. Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding. Cochrane Database Syst Rev 2010. Sep 8;2010(9):CD002907 Gao Y, Qian B, Zhang X, Liu H, Han T. Prophylactic antibiotics on patients with cirrhosis and upper gastrointestinal bleeding: A meta-analysis. PLoS One 2022. Dec 22;17(12):e0279496 Steffen R, Knapp J, Hanggi M, Iten M. Use of the REBOA catheter for uncontrollable upper gastrointestinal bleeding with hemorrhagic shock. Anaesthesiologie 2023. May;72(5):332-337 Sato M, Kuriyama A. Countering hemorrhagic shock due to duodenal variceal rupture with resuscitative endovascular balloon occlusion of the aorta. Am J Emerg Med 2023. Feb;64:204.e1-204.e3

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-326 Overview: Alcohol abuse has become more prevalent in the past decade, which means that primary care providers must play a crucial role in treating this preventable disorder. Don't miss this discussion on the current state of alcohol abuse and how to use evidence-based screening tools for prevention. Episode resource links: Esser,M., Leung, G., Sherk, A., Bohm, M., Liu, Y., Lu, H. & Naimi, T.  Estimated Deaths Attributable to Excessive Alcohol Use Among US Adults Aged 20 to 64 Years, 2015 to 2019. JAMA Network Open. 2022;5(11):e2239485. doi:10.1001/jamanetworkopen.2022.39485 National Institute on Drug Abuse Screening and Assessment Tools Resource Chart: https://nida.nih.gov/nidamed-medical-health-professionals/screening-tools-resources/chart-screening-tools Substance Abuse and Mental Health Services Administration (SAMHSA):  National Help Line:  https://www.samhsa.gov/find-help/national-helpline Alcoholics Anonymous:  Find AA near you https://www.aa.org/find-aa Paradis, C., Butt, P., Shield, K., Poole, N., Wells, S., Naimi, T., Sherk, A., & the Low-Risk Alcohol Drinking Guidelines Scientific Expert Panels. (2023). Canada's Guidance on Alcohol and Health: Final Report. Ottawa, Ont.: Canadian Centre on Substance Use and Addiction.  Fairbanks J, Umbreit A, Kolla BP, et al. Evidence-Based Pharmacotherapies for Alcohol Use Disorder: Clinical Pearls. Mayo Clin Proc. 2020;95(9):1964-1977. doi:10.1016/j.mayocp.2020.01.030 Guest: Jill M. Terrien PhD, ANP-BC   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-326 Overview: Alcohol abuse has become more prevalent in the past decade, which means that primary care providers must play a crucial role in treating this preventable disorder. Don't miss this discussion on the current state of alcohol abuse and how to use evidence-based screening tools for prevention. Episode resource links: Esser,M., Leung, G., Sherk, A., Bohm, M., Liu, Y., Lu, H. & Naimi, T.  Estimated Deaths Attributable to Excessive Alcohol Use Among US Adults Aged 20 to 64 Years, 2015 to 2019. JAMA Network Open. 2022;5(11):e2239485. doi:10.1001/jamanetworkopen.2022.39485 National Institute on Drug Abuse Screening and Assessment Tools Resource Chart: https://nida.nih.gov/nidamed-medical-health-professionals/screening-tools-resources/chart-screening-tools Substance Abuse and Mental Health Services Administration (SAMHSA):  National Help Line:  https://www.samhsa.gov/find-help/national-helpline Alcoholics Anonymous:  Find AA near you https://www.aa.org/find-aa Paradis, C., Butt, P., Shield, K., Poole, N., Wells, S., Naimi, T., Sherk, A., & the Low-Risk Alcohol Drinking Guidelines Scientific Expert Panels. (2023). Canada's Guidance on Alcohol and Health: Final Report. Ottawa, Ont.: Canadian Centre on Substance Use and Addiction.  Fairbanks J, Umbreit A, Kolla BP, et al. Evidence-Based Pharmacotherapies for Alcohol Use Disorder: Clinical Pearls. Mayo Clin Proc. 2020;95(9):1964-1977. doi:10.1016/j.mayocp.2020.01.030 Guest: Jill M. Terrien PhD, ANP-BC   Music Credit: Richard Onorato

Description: An immersive reading of The Drunkard's Child by Francis Ellen Watkins Harper with reflection on alcohol use disorder, repression, and change. Website:https://anauscultation.wordpress.com/ Work: The Drunkard's Child by Francis Ellen Watkins HarperHe stood beside his dying child,With a dim and bloodshot eye;They'd won him from the haunts of viceTo see his first-born dieHe came with a slow and staggering tread,A vague, unmeaning stare,And, reeling, clasped the clammy hand,So deathly pale and fair.In a dark and gloomy chamber,Life ebbing fast away,On a coarse and wretched pallet,The dying sufferer lay:A smile of recognitionLit up the glazing eye;“I'm very glad,” it seemed to say,“You've come to see me die.”That smile reached to his callous heart,Its sealed fountains stirred;He tried to speak, but on his lipsFaltered and died each word.And burning tears like rainPoured down his bloated face,Where guilt, remorse and shameHad scathed, and left their trace.“My father!” said the dying child,(His voice was faint and low,)“Oh! clasp me closely to your heart,And kiss me ere I goBright angels beckon me away,To the holy city fair—Oh! tell me, Father, ere I go,Say, will you meet me there?”He clasped him to his throbbing heart,“I will! I will!” he said;His pleading ceased—the father heldHis first-born and his dead!The marble brow, with golden curls,Lay lifeless on his breast;Like sunbeams on the distant cloudsWhich line the gorgeous west.References:Frances Ellen Watkins Harper:  https://www.poetryfoundation.org/poets/frances-ellen-watkins-harper The Drunkard's Child: https://play.google.com/books/reader?id=z0vmxcwxlrEC&pg=GBS.PA2&printsec=frontcover&output=reader&hl=en  Driessen E, Hollon SD. Cognitive behavioral therapy for mood disorders: efficacy, moderators and mediators. Psychiatr Clin North Am. 2010;33(3):537-555. Fairbanks J, Umbreit A, Kolla BP, et al. Evidence-Based Pharmacotherapies for Alcohol Use Disorder: Clinical Pearls. Mayo Clin Proc. 2020;95(9):1964-1977.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: August 6, 2020 The electroencephalogram is a nearly 100-year-old neurodiagnostic instrument. And yet, we learn new things from it every day. This week on the BrainWaves podcast, Dr. Tracey Milligan (Mass General Brigham) reviews the indications and utilization of a routine scalp EEG. Also discussed: limitations of scalp EEG, brain surgery, nonepileptic events, and why you should consider becoming an epileptologist. Produced by James E Siegler and Tracey Milligan. Music courtesy of Steve Combs, Lee Roosevere, Siddhartha, Soft and Furious, Patches, and Magic in the Other. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. James Siegler reports having received consulting fees from Ceribell, which produces a bedside scalp EEG with automated seizure detection. However, there is no specific reference to this device or company, nor was this episode sponsored by Ceribell. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Bouma HK, Labos C, Gore GC, Wolfson C, Keezer MR. The diagnostic accuracy of routine electroencephalography after a first unprovoked seizure. Eur J Neurol 2016;23(3):455-63. PMID 26073548 Cascino GD. Clinical indications and diagnostic yield of video-electroencephalographic monitoring in patients with seizures and spells. Mayo Clin Proc 2002;77(10):1111-20. PMID 12374255 Debicki DB. Electroencephalography after a single unprovoked seizure. Seizure 2017;49:69-73. PMID 28532713 Pillai J, Sperling MR. Interictal EEG and the diagnosis of epilepsy. Epilepsia 2006;47 Suppl 1:14-22. PMID 17044820 Wiebe S, Blume WT, Girvin JP, Eliasziw M; Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study Group. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 2001;345(5):311-8. PMID 11484687  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: February 20, 2020 Immune checkpoint inhibitors have revolutionized cancer treatment. Unlike chemotherapy, which essentially includes cellular toxins that can cause widespread and unnecessary tissue damage, checkpoint inhibitors are used to train the body's natural immune system to fight off cancer. And while they are extraordinarily effective options for patients with malignant disease, they are not without risk. Every day, we are learning more and more about the autoimmune side effects of these novel therapies. This week on the BrainWaves Podcast, Dr. Justine Cohen (University of Pennsylvania) shares her experience managing patients with checkpoint inhibitor neurotoxicity. Produced by James E Siegler and Justine Cohen. Music courtesy of Jon Watts, Kai Engel, and Kevin McLeod--as well as a cameo appearance by the Checkpoints. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Bhatia S, Tykodi SS, Thompson JA. Treatment of metastatic melanoma: an overview. Oncology (Williston Park) 2009;23(6):488-96. PMID 19544689 Cohen JV, Buchbinder EI. The evolution of adjuvant therapy for melanoma. Curr Oncol Rep 2019;21(12):106. PMID 31768772 Cohen JV, Wang N, Venur VA, et al. Neurologic complications of melanoma. Cancer 2020;126(3):477-86. PMID 31725902 Graus F, Dalmau J. Paraneoplastic neurological syndromes in the era of immune-checkpoint inhibitors. Nat Rev Clin Oncol 2019;16(9):535-48. PMID 30867573 Hottinger AF. Neurologic complications of immune checkpoint inhibitors. Curr Opin Neurol 2016 ;29(6):806-12. PMID 27653290 Wick W, Hertenstein A, Platten M. Neurological sequelae of cancer immunotherapies and targeted therapies. Lancet Oncol 2016;17(12):e529-41. PMID 27924751 Zekeridou A, Lennon VA. Neurologic autoimmunity in the era of checkpoint inhibitor cancer immunotherapy. Mayo Clin Proc 2019;94(9):1865-78. PMID 31358366 Zubiri L, Allen IM, Taylor MS, et al. Immune-related adverse events in the setting of PD-1/L1 inhibitor combination therapy. Oncologist 2020;25(3):e398-404. PMID 32162817  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

PODCASTER SENIOR: Silvia Colnaghi; PODCASTER JUNIOR Gaia Fanella; Video: Video 1_Head Impulse.mov - Google DriveVideo 2_Nistagmo.mov - Google DriveVideo 3_Test of Skew.mov - Google Drive;Razionale: La vertigine è un sintomo particolarmente rilevante per la neurologia d'urgenza sia per la sua frequenza sia per la gravità delle malattie delle quali può essere il sintomo. Quanto a frequenza, la vertigine motiva dal 10 al 20% degli accessi in PS e nel 25% di questi casi è il sintomo di un ictus, diagnosi che viene mancata in fase acuta nel 35% dei casi. In particolare, la vertigine è tra i più comuni sintomi di esordio degli ictus del circolo posteriore e solo il 27% di questi pazienti presenta anche dei segni neurologici focali, pertanto stabilire dei criteri per poter valutare se una vertigine acuta, non associata ad altri segni, è ‘centrale' è di grande importanza.Bibliografia: Newman-Toker DE, Hsieh YH, Camargo CA Jr, Pelletier AJ, Butchy GT, Edlow JA. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc. 2008 Jul;83(7):765-75. doi: 10.4065/83.7.765. PMID: 18613993; PMCID: PMC353647 Newman-Toker DE, Peterson SM, Badihian S, Hassoon A, Nassery N, Parizadeh D, Wilson LM, Jia Y, Omron R, Tharmarajah S, Guerin L, Bastani PB, Fracica EA, Kotwal S, Robinson KA. Diagnostic Errors in the Emergency Department: A Systematic Review. Rockville (MD): Agency for Healthcare Research and Quality (US); 2022 Dec. Report No.: 22(23)-EHC043. PMID: 36574484. Kothari RU, Pancioli A, Liu T, Brott T, Broderick J. Cincinnati Prehospital Stroke Scale: reproducibility and validity. Ann Emerg Med. 1999 Apr;33(4):373-8. doi: 10.1016/s0196-0644(99)70299-4. PMID: 10092713. Aroor S, Singh R, Goldstein LB. BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): Reducing the Proportion of Strokes Missed Using the FAST Mnemonic. Stroke. 2017 Feb;48(2):479-481. doi: 10.1161/STROKEAHA.116.015169. Epub 2017 Jan 12. PMID: 28082668.Saber Tehrani AS, Kattah JC, Mantokoudis G, Pula JH, Nair D, Blitz A, Ying S, Hanley DF, Zee DS, Newman-Toker DE. Small strokes causing severe vertigo: frequency of false-negative MRIs and nonlacunar mechanisms. Neurology. 2014 Jul 8;83(2):169-73. doi: 10.1212/WNL.0000000000000573. Epub 2014 Jun 11. PMID: 24920847; PMCID: PMC4117176. Newman-Toker DE, Edlow JA. TiTrATE: A Novel, Evidence-Based Approach to Diagnosing Acute Dizziness and Vertigo. Neurol Clin. 2015 Aug;33(3):577-99, viii. doi: 10.1016/j.ncl.2015.04.011. PMID: 26231273; PMCID: PMC4522574. Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009 Nov;40(11):3504-10. doi: 10.1161/STROKEAHA.109.551234. Epub 2009 Sep 17. PMID: 19762709; PMCID: PMC4593511. Kim JS, Newman-Toker DE, Kerber KA, Jahn K, Bertholon P, Waterston J, Lee H, Bisdorff A, Strupp M. Vascular vertigo and dizziness: Diagnostic criteria. J Vestib Res. 2022;32(3):205-222. doi: 10.3233/VES-210169. PMID: 35367974; PMCID: PMC9249306. Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J, Bisdorff A, Versino M, Evers S, Kheradmand A, Newman-Toker D. Vestibular migraine: Diagnostic criteria1. J Vestib Res. 2022;32(1):1-6. doi: 10.3233/VES-201644. PMID: 34719447; PMCID: PMC9249276. Cnyrim CD, Newman-Toker D, Karch C, Brandt T, Strupp M. Bedside differentiation of vestibular neuritis from central "vestibular pseudoneuritis". J Neurol Neurosurg Psychiatry. 2008 Apr;79(4):458-60. doi: 10.1136/jnnp.2007.123596. PMID: 18344397.

A discussion of vaccine information, hesitancy and uptake among multiple populations and how we can improve uptake in our daily practices Show References McElfish PA, Willis DE, Shah SK, Bryant-Moore K, Rojo MO, Selig JP. Sociodemographic Determinants of COVID-19 Vaccine Hesitancy, Fear of Infection, and Protection Self-Efficacy. J Prim Care Community Health. Jan-Dec 2021;12:21501327211040746. doi:10.1177/21501327211040746  MacDonald NE, Hesitancy SWGoV. Vaccine hesitancy: Definition, scope and determinants. Vaccine. Aug 14 2015;33(34):4161-4. doi:10.1016/j.vaccine.2015.04.036  Nguyen LH, Joshi AD, Drew DA, et al. Racial and ethnic differences in COVID-19 vaccine hesitancy and uptake. medRxiv. Feb 28 2021;doi:10.1101/2021.02.25.21252402  Wong LP, Alias H, Danaee M, et al. COVID-19 vaccination intention and vaccine characteristics influencing vaccination acceptance: a global survey of 17 countries. Infect Dis Poverty. Oct 7 2021;10(1):122. doi:10.1186/s40249-021-00900-w  Jacobson RM, St Sauver JL, Finney Rutten LJ. Vaccine Hesitancy. Mayo Clin Proc. Nov 2015;90(11):1562-8. doi:10.1016/j.mayocp.2015.09.006  S. B. Omer, D. A. Salmon, W. A. Orenstein, M. P. deHart and N. Halsey. Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases. NEJM 2009 Vol. 360 Issue 19 Pages 1981-1988  Lila J. Finney Rutten, Xuan Zhu, Aaron L. Leppin, Jennifer L. Ridgeway, Melanie D. Swift, Joan M. Griffin, Jennifer L. St Sauver, Abinash Virk, Robert M. Jacobson. Evidence-Based Strategies for Clinical Organizations to Address COVID-19 Vaccine Hesitancy. Mayo Clinic Proceedings. Volume 96, Issue 3. 2021. Pages 699-707.  Raymond John D Vergara, Philip Joseph D Sarmiento, James Darwin N Lagman, Building public trust: a response to COVID-19 vaccine hesitancy predicament, Journal of Public Health, Volume 43, Issue 2, June 2021, Pages e291–e292, https://doi.org/10.1093/pubmed/fdaa282  Corbie-Smith G. Vaccine Hesitancy Is a Scapegoat for Structural Racism. JAMA Health Forum. 2021;2(3):e210434. doi:10.1001/jamahealthforum.2021.0434 The 'successful failures' of Apollo 13 and Covid-19 vaccination - STAT (statnews.com)

Description: An immersive reading of excerpts from Death's End by Cixin Liu translated by Ken Liu with reflection on wording, healthcare decision making, family and finances. Website:https://anauscultation.wordpress.com/ Work:excerpts from Death's End by Cixin Liu translated by Ken LiuA fit of coughing forced him to put down the newspaper and try to get some sleep.The next day, the TV also showed some interviews and reports about the euthanasia law, but there didn't seem to be a lot of public interest.Tianming had trouble sleeping that night: He coughed; he struggled to breathe: he felt weak and nauseous from the chemo. The patient who had the bed next to his sat on the edge of Tianming's bed and held the oxygen tube for him. His surname was Li, and everyone called him "Lao Li," Old Li.Lao Li looked around to be sure that the other two patients who shared the room with them were asleep, and then said, "Tianming, I'm going to leave early.""You've been discharged?""No. It's that law."Tianming sat up. "But why? Your children are so solicitous and caring-""That is exactly why I've decided to do this. If this drags out much longer, they'd have to sell their houses. What for? In the end, there's no cure. I have to be responsible for my children and their children."Lao Li sighed, lightly patted Tianming's arm, and returned to his own bed.Staring at the shadows cast against the window curtain by swaying trees, Tianming gradually fell asleep. For the first time since his illness, he had a peaceful dream. […]It took a great deal of internal discussion before the news outlets settled on the verb "to conduct." "To execute" was clearly inappropriate; "to carry out" sounded wrong as well; "to complete" seemed to suggest that death was already certain, which was not exactly accurate, either. […]None of Lao Li's family members were present for the procedure. He had kept his decision from them and requested that the city's Civil Affairs Bureau-not the hospital- inform his family after the procedure was complete. The new law permitted him to conduct his affairs in this manner.References:Death's End (book 3): https://www.tatteredcover.com/book/9780765386632 The Three-Body Problem (book 1): https://www.tatteredcover.com/book/9780765382030 NB: Tattered Cover is a local Denver bookstore  Cixin Liu: https://paper-republic.org/pers/liu-cixin/ Koch T. A Sceptics Report: Canada's Five Years Experience with Medical Termination (MAiD) [published online ahead of print, 2022 Feb 12].Virtual Mentor. 2007;9(1):188-192.Oregon Public Health. Oregon's Death with Dignity Act 2014. Salem, OR: Oregon Public Health; 2015. Available from: www.oregon.gov/oha/ph/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf. Accessed 2015 Nov 27. Siddiqui M, Rajkumar SV. The high cost of cancer drugs and what we can do about it. Mayo Clin Proc. 2012;87(10):935-943.Hao Yu, Universal health insurance coverage for 1.3 billion people: What accounts for China's success?, Health Policy, Volume 119, Issue 9, 2015, Pages 1145-1152, https://doi.org/10.1016/j.healthpol.2015.07.008.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 18, 2017 In this week's episode of Teaching through Clinical Cases, Dr. Michael Rubenstein (episode #17, "The FAME clinic in Tanzania") leads a discussion on the evaluation of a young patient with a rapidly progressive gait difficulty with numbness and paresthesias. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health-identifying information. This episode was vetted and approved by Michael Rubenstein. REFERENCES Goodman BP. Metabolic and toxic causes of myelopathy. Continuum (Minneap Minn) 2015;21(1 Spinal Cord Disorders):84-99. PMID 25651219 Kriegstein AR, Shungu DC, Millar WS, et al. Leukoencephalopathy and raised brain lactate from heroin vapor inhalation ("chasing the dragon"). Neurology 1999;53(8):1765-73. PMID 10563626 Kumar N, Elliott MA, Hoyer JD, Harper CM Jr, Ahlskog JE, Phyliky RL. "Myelodysplasia," myeloneuropathy, and copper deficiency. Mayo Clin Proc 2005;80(7):943-6. PMID 16007901 Pema PJ, Horak HA, Wyatt RH. Myelopathy caused by nitrous oxide toxicity. AJNR Am J Neuroradiol 1998;19(5):894-6. PMID 9613506 Stabler SP. Vitamin B12 deficiency. N Engl J Med 2013;368(21):2041-2. PMID 23697526  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date. 

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: April 18, 2019 In medicine, less is more. Sometimes. In this week's program, Dr. Igor Rybinnik of the Rutgers Robert Wood Johnson Medical School shares what he's learned when it comes to overtreating patients. Produced by James E Siegler and Igor Ribynnik. Music courtesy of Chris Zabriskie, Kevin McLeod, Mystery Mammal, Hyson, Fabian Measures, and Scott Holmes. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Coysh T, Breen DP. A nationwide analysis of successful litigation claims in neurological practice. JRSM Open 2014;5(3):2042533313518914. PMID 25057378 DesRoches CM, Rao SR, Fromson JA, et al. Physicians' perceptions, preparedness for reporting, and experiences related to impaired and incompetent colleagues. JAMA 2010;304(2):187-93. PMID 20628132 Klaas PB, Berge KH, Klaas KM, Klaas JP, Larson AN. When patients are harmed, but are not wronged: ethics, law, and history. Mayo Clin Proc 2014;89(9):1279-86. PMID 24993860 Mohr JC. American medical malpractice litigation in historical perspective. JAMA 2000;283(13):1731-7. PMID 10755500 Silveira MJ, Kim SY, Langa KM. Advance directives and outcomes of surrogate decision making before death. N Engl J Med 2010;362(13):1211-8. PMID 20357283  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

Paging all urine experts, all urine experts please report to the Pain Pod! Actually, if you believe that you could benefit from a thorough discussion on the complexities of urine drug screening and testing, then “you're in” luck! Everyone gets a cup! Everyone fills a cup! But then what? Shouldn't a practitioner know what cross-reactants could create possible false-positives? Are there methods to “beat the system” and outsmart urine drug screenings and testings? Join us for a lively discussion on the most useful strategies for incorporating urine drug screenings, or preferably testings, into your own practice. If “you're in” over your head, then this episode is for you! In this episode of the Pain Pod, Mark “Pain Guy” Garofoli chats through the multiple nuances of all thing's urine in respect to patient care. Come one, come all, to the Pain Pod!!! Episode References • Urine Drug Monitoring Overview of Screening and Testing o Moeller, K, et. al. Urine Drug Screenings: Practical Guide for Clinicians. Mayo Clin Proc. 2008;83(1)66-76. • Urine Drug Screenings Incorrect 1/3rd of the time o https://www.painnewsnetwork.org/stories/2015/4/11/urine-drug-test-often-gives-false-results • Urine Drug Screening False Positive Cross Reactants o https://www.uspharmacist.com/article/urine-drug-screening-minimizing-false-positives-and-false-negatives-to-optimize-patient-care • Synthetic Urine Recipes o https://www.synbioproject.org/how-to-make-synthetic-urine/ • Whizzinator o https://whizzinator.com/ • Mike Tyson's Podcast Whizzinator Explanation o https://www.mmamania.com/2020/11/8/21555388/mike-tyson-admits-to-using-whizzinator-fake-penis-to-pass-drug-tests-i-put-my-babys-urine-in-it • APhA Webinar's o https://www.pharmacist.com/Education/eLearning

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.Originally released: February 4, 2018A little fever can go a long way. In this installment of the Teaching through Clinical Cases series, Dr. Kathleen Murphy (infectious Disease) manages a healthy young man who presents with fever and his first seizure of life.Produced by James E Siegler and Kathleen Murphy. Music by Hyson, Jahzzar, and Josh Woodward. Voiceovers by Erika Mejia and Isa Smrstik. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making.REFERENCESHaktanir A. MR imaging in novel influenza A(H1N1)-associated meningoencephalitis. AJNR Am J Neuroradiol 2010;31(3):394-5. PMID: 20150309Iijima H, Wakasugi K, Ayabe M, Shoji H, Abe T. A case of adult influenza A virus-associated encephalitis: magnetic resonance imaging findings. J Neuroimaging 2002;12(3):273-5. PMID: 12116748Sampathkumar P. West Nile virus: epidemiology, clinical presentation, diagnosis, and prevention. Mayo Clin Proc 2003;78(9):1137-43; quiz 1144. PMID: 12962168Takanashi J, Barkovich AJ, Yamaguchi K, Kohno Y. Influenza-associated encephalitis/encephalopathy with a reversible lesion in the splenium of the corpus callosum: a case report and literature review. AJNR Am J Neuroradiol 2004;25(5):798-802. PMID: 15140723Thigpen MC, Whitney CG, Messonnier NE, et al. Bacterial meningitis in the United States, 1998-2007. N Engl J Med 2011;364(21):2016-25. PMID 21612470We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

In this episode we talk about the indoctrination all of us went through during our medical training.  In the next episode we will discuss learned helplessness, unlearning, and re-learning agency and self-efficacy. References and resources mentioned in this podcast References 1. Greenawald MH MD, FAAFP, Pipas CF MD, MPH, FAAFP.  The Power Of Coaching: Supercharge Your Personal and Professional Well-being.   Fam Pract Manag. 2022 Sep-Oct;29(5):12-16. 2. Shanafelt TD, West CP, Dyrbye LN, Trockel M, Tutty M, Wang H, Carlasare LE, Sinsky C. Changes in Burnout and Satisfaction With Work-Life Integration in Physicians During the First 2 Years of the COVID-19 Pandemic.  Mayo Clin Proc. 2022 Sep 14;S0025-6196(22)00515-8. Empowering Women Physicians resources for you Sign up for the EWP Coaching Program Waitlist The Ultimate Coaching Guide for Women Physicians Books We Love Guide References (RCT & academic journal articles on physician coaching) Dr. Katrina Ubell session inside EWP Dr. Katrina Ubell's book

What does the PAPA spectrum disorder teach us about SAPHO? Is SAPHO an autoinflammatory condition or part of the SpA spectrum? Why have antibiotics been used to treat this condition? Find out in this episode! Intro :01 Welcome to another exciting episode of Rheuminations :11 About today's episode :17 A summary of SAPHO Part 1 :24 What to expect in this episode 1:28 Earlier long-term data 2:27 A more recent paper from Italy 6:47 Therapeutics in detail 12:17 Summary so far 21:39 IL-1 inhibition in SAPHO 22:32 Monogenic pediatric conditions 33:58 Why can't we check the genes in SAPHO? 40:00 Episode summary 41:55 We went through a lot in this paper 45:29 Thanks for listening 43:53 Disclosure: Brown reports no relevant financial disclosures. We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum and be sure to check out Rheum + Boards – your destination for rheumatology education and quizzes! References: Agak GW, et al. J Invest Dermatol. 2014;134:366-373. Aksentijevich I, et al. N Engl J Med. 2009;360:2426-2437. Assmann G, Simon P. Best Pract Res Clin Rheumatol. 2011;25:423-434. Boursier G, et al. J Invest Dermatol. 2021;141:1141-1147. Cai R, et al. Front Cell Dev Biol. 2021;doi:10.3389/fcell.2021.643644. Colina M, et al. Arthritis Rheum. 2009;61:813-821. Daoussis D, et al. Semin Arthritis Rheum. 2019;48:618-625. Eun IS, et al. J Clin Neurosci. 2021;92:153-158. Ferguson PJ, El-Shanti H. Biomolecules. 2021;11:367. Grosse J, et al. Blood. 2006;107:3350-3358. Guignard S, et al. Joint Bone Spine. 2002;69:392-396. Hayem G, et al. Semin Arthritis Rheum. 1999;29:159-171. Holzinger D, Roth J. Curr Opin Rheumatol. 2016;28:550-559. Hurtado-Nedelec M, et al. J Rheumatol. 2010;37:401-409. Liao HJ, et al. Rheumatology (Oxford). 2015;54:1317-1326. Lindor NM, et al. Mayo Clin Proc. 1997;72:611-615. Nguyen MT, et al. Semin Arthritis Rheum. 2012;42:254-265. Trimble BS, et al. Agents Actions. 1987;21:281-283. Yeon HB, et al. Am J Hum Genet. 2000;66:1443-1448. You H, et al. J Clin Immunol. 2021;41:565-575.

Shampo MA, Kyle RA, Steensma DP. Albert Sabin--conqueror of poliomyelitis. Mayo Clin Proc. 2011 Jul;86(7):e44. doi: 10.4065/mcp.2011.0345. PMID: 21719614; PMCID: PMC3127575. --- Send in a voice message: https://anchor.fm/las-poderosas-celulas-nk/message

Bienvenue dans un nouvel épisode de podcast sur un sujet que vous nous avez souvent demandé de traiter : le burn out. Qu'est-ce que c'est ? Est-ce un trouble reconnu et que l'on sait prendre en charge ? Quels en sont les symptômes et quelles sont les personnes qui sont susceptibles d'en souffrir ? Catherine va répondre à mes questions en utilisant son expérience et les articles scientifiques qu'elle a épluché pour l'occasion. Pour vous abonner gratuitement à notre Lettre Psy contenant 3 articles sur la psychologie toutes les deux semaines ou découvrir le contenu que nous proposons sur Youtube ou les réseaux sociaux, rendez-vous sur catherinelapsy.com. Sources : Amanullah S, Ramesh Shankar R. The Impact of COVID-19 on Physician Burnout Globally: A Review. Healthcare (Basel). 2020 Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry. 2016 Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S, Mata DA. Prevalence of Burnout Among Physicians: A Systematic Review. JAMA. 2018 Arnsten AFT, Shanafelt T. Physician Distress and Burnout: The Neurobiological Perspective. Mayo Clin Proc. 2021 Denning M, Goh ET, Tan B, Kanneganti A, Almonte M, Scott A, Martin G, Clarke J, Sounderajah V, Markar S, Przybylowicz J, Chan YH, Sia CH, Chua YX, Sim K, Lim L, Tan L, Tan M, Sharma V, Ooi S, Winter Beatty J, Flott K, Mason S, Chidambaram S, Yalamanchili S, Zbikowska G, Fedorowski J, Dykowska G, Wells M, Purkayastha S, Kinross J. Determinants of burnout and other aspects of psychological well-being in healthcare workers during the Covid-19 pandemic: A multinational cross-sectional study. PLoS One. 2021 Apr 16;16(4):e0238666. doi: 10.1371/journal.pone.0238666. PMID: 33861739; PMCID: PMC8051812. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases

Faça sua pré-inscrição no CURSO TdC de Pronto-atendimento e receba BÔNUS exclusivos: https://cursotdc.com.br/ Iago apresenta um caso de tontura para o Pedro e Kaue, com um foco na investigação da tontura e no exame físico direcionado (HINTS). Vídeo do HINTS comentado por Kaue e Pedro: https://youtu.be/keqwC-36HmM Referências: 1. Newman-Toker DE, Edlow JA. TiTrATE: a novel approach to diagnosing acute dizziness and vertigo. Neurol Clin 2015;33(3):577-599. doi:10.1016/j.ncl.2015.04.011 2. Edlow JA, Gurley KL, Newman-Toker DE. A new diagnostic approach to the adult patient with acute dizziness. J EmergMed 2018;54(4):469-483. doi:10.1016/j.jemermed.2017.12.024 3. Bisdorff AR, Staab JP, Newman-Toker DE. Overview of the international classification of vestibular disorders. Neurol Clin 2015;33:541-550. doi:10.1016/j.ncl.2015.04.010 4. Kerber KA. Episodic positional dizziness. Continuum (Minneap Minn) 2021; 27(2, Neuro-otology):348-368. 5. Newman-Toker DE, Cannon LM, Stofferahn ME, et al. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Mayo Clin Proc 2007;82(11):1329-1340. doi:10.4065/82.11.1329 6. Steenerson KK. Acute vestibular syndrome. Continuum (Minneap Minn) 2021; 27(2, Neuro-otology):402-419. 7. Wasay M, Dubey N, Bakshi R. Dizziness and yield of emergency head CT scan: is it cost effective? Emerg Med J 2005;22(4):312. doi:10.1136/ emj.2003.012765 8. Huang CY, Yu YL. Small cerebellar strokes may mimic labyrinthine lesions. J Neurol Neurosurg Psychiatry. 1985; 48(3):263–5. 9. Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM, Hill MD, Patronas N, Latour L, Warach S. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007; 369(9558):293–8. 10. Oppenheim C, Stanescu R, Dormont D, Crozier S, Marro B, Samson Y, Rancurel G, Marsault C. False-negative diffusion-weighted MR findings in acute ischemic stroke. AJNR Am J Neuroradiol. 2000; 21(8):1434–40.

In this episode, I discuss the evidence surrounding Omega-3 Fatty Acids and endurance performance.Website: www.peakendurancesolutions.comEmail: peakendurancesolutions@outlook.comInstagram: @ryaneckert_triReferences1. Philpott JD, Witard OC, Galloway SDR. Applications of omega-3 polyunsaturated fatty acid supplementation for sport performance. Res Sports Med. 2019 Apr-Jun;27(2):219-237. doi: 10.1080/15438627.2018.1550401. Epub 2018 Nov 28. PMID: 30484702.2. Bernasconi AA, Wiest MM, Lavie CJ, Milani RV, Laukkanen JA. Effect of Omega-3 Dosage on Cardiovascular Outcomes: An Updated Meta-Analysis and Meta-Regression of Interventional Trials. Mayo Clin Proc. 2021 Feb;96(2):304-313. doi: 10.1016/j.mayocp.2020.08.034. Epub 2020 Sep 17. PMID: 32951855.Love our content and want to support our show? Click the link here and consider supporting us by becoming a Patreon member with options to get exclusive branded merchandise!

Guest: Matthew J. Binnicker, Ph.D. (@DrMattBinnicker) Host: Amit K. Ghosh, M.D. (@AmitGhosh006)   In this podcast Matthew J. Binnicker, Ph.D. discusses the development of different types of testing available to diagnose SARS-CoV2 infection. Binnicker discusses the test characteristics of the rapid antigen tests and RT-PCR test and its variability based on the time when the test was performed. He also discusses the optimal timing of diagnostic testing (rapid testing, RT-PCR) and the role and limitations of antibody testing in COVID-19.   Additional resources: Shah AS, Tande AJ, Challener DW, O'Horo JC, Binnicker MJ, Berbari EF. Diagnostic stewardship: An essential element in a rapidly evolving COVID-19 pandemic. Mayo Clin Proc. 2020;95(9):S17-S19. DOI: https://doi.org/10.1016/j.mayocp.2020.05.039   Connect with the Mayo Clinic School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Episode 30: In this episode, host Angie Gust talks about Dr. Bruce Lipton's work with stem cells.  He showed that the stem cells changed with their environment. Dr. Lipton says that if you want to change your life, you have to change your perceptions.  This goes along with the research showing that people with more optimism have better health and better outcomes after surgery.  Turning to the environment, a recent UNICEF report warned that almost half the world's 2.2 billion children are already at “extremely high risk” because of climate change. Greta Thunberg and other youth climate leaders wrote in a recent article, "The fundamental goal of the adults in any society is to protect their young and do everything they can to leave a better world than the one they inherited." References Brummett BH, Helms MJ, Dahlstrom WG, Siegler IC. Prediction of all-cause mortality by the Minnesota Multiphasic Personality Inventory Optimism-Pessimism Scale scores: study of a college sample during a 40-year follow-up period. Mayo Clin Proc. 2006 Dec;81(12):1541-4. doi: 10.4065/81.12.1541. PMID: 17165632. Carrington, D. Aug 19, 2021 A billion children at ‘extreme risk' from climate impacts – Unicef.  The Guardian. https://www.theguardian.com/environment/2021/aug/20/a-billion-children-at-extreme-risk-from-climate-impacts-unicef Gustafson C. 2017. Bruce Lipton, PhD: The Jump From Cell Culture to Consciousness. Integrative medicine (Encinitas, Calif.), 16(6), 44–50. IPCC. Aug 9, 2021. Climate change widespread, rapid and intensifying. https://www.ipcc.ch/2021/08/09/ar6-wg1-20210809-pr/ Braun, S. Aug 19, 2021. Mushrooms: 4 uses that benefit the environment. Made for Minds. https://www.dw.com/en/mushrooms-4-uses-that-benefit-the-environment/a-58873874 Patel, K. Aug 19, 2021. Rain falls at the summit of Greenland Ice Sheet for first time on record. The Washington Post. https://www.washingtonpost.com/weather/2021/08/19/greenland-melt-august-summit-rain/?utm_campaign=Carbon%20Brief%20Daily%20Briefing&utm_content=20210820&utm_medium=email&utm_source=Revue%20Daily Plumer, B. Sept 2, 2021. New Yorkers Got Record Rain, and a Warning: Storms Are Packing More Punch The New York Times.https://www.nytimes.com/2021/09/02/climate/new-york-rain-climate-change.html?utm_campaign=Carbon%20Brief%20Weekly%20Briefing&utm_content=20210903&utm_medium=email&utm_source=Revue%20Weekly Stinnett, N. Apr 22, 2021. So You're Serious About Climate Change: Vote In Your Local Elections. Cognoscenti. https://www.wbur.org/cognoscenti/2021/04/22/mayors-climate-policy-earth-day-2021-elections-nathaniel-stinnett Thunberg, G et al. Aug 19 This is the world being left to us by adults. NY Times. https://www.nytimes.com/2021/08/19/opinion/climate-un-report-greta-thunberg.html

Guest: Carol L. Kuhle, D.O., M.P.H. (@clkejd) Host: Anjali Bhagra, M.D. (@anjalibhagramd) Anjali Bhagra, M.D., and Carol L. Kuhle, D.O., M.P.H., discuss the narrative they recently published in Mayo Clinic Proceedings, which outlines and highlights the further widening of preexisting gender disparities in response to the COVID-19 pandemic. What can we do to identify and mitigate these issues? Additional resources: Nordhues, HC. Bhagra, A. Stroud, NN. Vencill, JA. Kuhle, CL. COVID-19 gender disparities and mitigation recommendations: a narrative review. Mayo Clin Proc. 2021 April 20; 96(7): 1907-1920. doi: https://doi.org/10.1016/j.mayocp.2021.04.009 Connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Wellness in medicine, is that even possible anymore? What if I'm burned out? Dr. Ryan Stegink talks about his own journey with wellness as an early career pediatrician in primary care on the first episode of The MedEdWell Podcast. With a passion to advance wellness for his colleagues and a diverse set of interests and skills, Dr. Stegink seeks to help others in medicine take the next step in their own wellness, personally, professionally, and financially. By hearing about Dr. Stegink's experience with burnout, you will have the opportunity to reflect on your core values, priorities, and where you are on your own wellness journey. Finally you will be challenged to choose something to change to take that next step forward based on your reflection. For those of you (typically not while in medical school) with an income to protect, consider getting a disability insurance quote from today's sponsor, Pattern. Get a policy in place if you don't already, or schedule a call to review your existing policy today. Visit www.patternlife.com/mededwell   Other references: Shanafelt et al. Relationship Between Clerical Burden and Characteristics of the Electronic Environment With Physician Burnout and Professional Satisfaction. Mayo Clin Proc. 2016 Living Like A Resident article from White Coat Investor

Central sensitization (CS) describes pathophysiologic changes in the central nervous system, including alterations in neurochemistry, CNS receptors, endogenous opioid system hyperactivity, cytokine and HPA axis dysregulation, and sympathetic hyperactivity. Collectively, these changes result in amplification of pain and sensory signals, leading to widespread pain, fatigue and other sensory sensitivities. Fibromyalgia and Chronic Fatigue Syndrome are established diagnoses/manifestations of central sensitization. In the era of the COVID-19 pandemic, we continue to learn about Post-Acute COVID-19 Syndrome, a manifestation of central sensitization similar to other post-infectious forms of CS, which underlies the persistent symptoms that many people experience after initial recovery from COVID-19. Elizabeth C. Wight, M.D. joins us to talk about Mayo Clinic's treatment approach to central sensitization, which is rooted in empowering patients with education and a framework for a self-management program. This includes stress management, moderation, positive thinking, decreasing focus on symptoms, sleep hygiene, and Cognitive Behavioral Therapy among others. Additional resources: Post-COVID Recovery on Mayo Clinic Connect: https://connect.mayoclinic.org/page/post-covid-recovery/ Mayo Clinic's “A Systematic Approach to Medically Unexplained Symptoms 2021” course can be found at https://ce.mayo.edu/internal-medicine/content/systematic-approach-medically-unexplained-symptoms-2021#group-tabs-node-course-default1 Clauw DJ. Fibromyalgia: A clinical review. JAMA. 2014;311(15):1547-1555. doi:1001/jama.2014.3266 Clauw DJ. Fibromyalgia and related conditions. Mayo Clin Proc. 2015 May;90(5):680-92. https://doi.org/10.1016/j.mayocp.2015.03.014 Harte, SE, Harris, RE, Clauw, DJ. The neurobiology of central sensitization. J Appl Behav Res. 2018; 23(2): e12137. https://doi.org/10.1111/jabr.12137 Connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

👉🏽 https://www.adidas.es/running ---------------------------------------------------------------------- En los últimos años ha aumentado el número de accidentes cardiacos entre corredores. La prensa se ha echo eco de ello y la alarma social es evidente. En este episodio, el Dr. Joaquín Barjau nos presenta la evidencia científica que hay sobre este tema y nos cuenta cómo funciona el corazón cuando corremos, qué es lo que puede fallar e intentamos posibles soluciones a este problema que ya es una realidad. RRSS del Dr. Barjau: @dr.barjau Estudios a los que se refiere el doctor en este episodio: 1. Training for Longevity: The Reverse J-Curve for Exercise. Mo Med. Jul-Aug 2020;117(4):355-361 2. Dose of jogging and long-term mortality: the Copenhagen City Heart Study. J Am Coll Cardiol. 2015 Feb 10;65(5):411-9. 3. Various Leisure-Time Physical Activities Associated With Widely Divergent Life Expectancies: The Copenhagen City Heart Study. Mayo Clin Proc. 2018 Dec;93(12):1775-1785. 4. Exercise-Related Acute Cardiovascular Events and Potential Deleterious Adaptations Following Long-Term Exercise Training: Placing the Risks Into Perspective–An Update: A Scientific Statement From the American Heart Association. Circulation. 2020;141:e705–e736 5. Charla TED de James Okeefe https://youtu.be/Y6U728AZnV0 6. Charla de Iñigo San Millán https://youtu.be/DZfOvYiQtow

Today’s episode of Have You Herd? with Dr. Fred Gingrich, Executive Director of AABP, is a discussion with Dr. Dick Weinshilboum, an M.D. from the Mayo Clinic in Rochester, MN. Dr. Weinshilboum has been involved in human pharmacogenomic research for over 40 years and was one of the initial investigators of this fascinating field in human medicine. Pharmacogenomics identifies the variety of genetic differences and how these variances might explain an individual’s response to chemicals in their environment. Dr. Weinshilboum explains that there have been twenty drug-gene pairs identified in the human genome for commonly prescribed drugs for which there are genetic variations. He discussed some specific examples of where identifying these drug-gene pairs can prevent an adverse reaction to a drug or improve therapeutic outcome. The primary clinical utility for this application is in cancer therapy, however he also identified the application of pharmacogenomics for treatment of cardiovascular disease with the drug clopidogrel and improving the outcome of treatment of depression with selective serotonin reuptake inhibitors. Dr. Weinshilboum predicts that there is no doubt pharmacogenomics will have application in veterinary medicine, including guiding antimicrobial therapy, determining how a drug might be metabolized in animals with identifiable genetic variants, and responses to other therapies. He also suggests that veterinary researchers can utilize what has already been discovered in human medicine and apply it to veterinary medicine as the scientific principals are the same and our patients have the advantage of less genetic diversity when applying pharmacogenomics. Relevant Research Papers: Richard Weinshilboum: Pharmacogenomics – The Future Is HereMol Interv. 2003 May;3(3):118-22https://bit.ly/3nUOGWg Pharmacogenomics in Practice. Wang L, Weinshilboum R.Clin Pharmacol Ther. 2019 Nov;106(5):936-938.https://bit.ly/3dthekC Pharmacogenomics: Precision Medicine and Drug Response. Weinshilboum RM, Wang L.Mayo Clin Proc. 2017 Nov;92(11):1711-1722.https://mayocl.in/33YCcoy Research Directions in the Clinical Implementation of Pharmacogenomics: An Overview of US Programs and Projects. Volpi S, et. alClin Pharmacol Ther. 2018 May;103(5):778-786. https://ascpt.onlinelibrary.wiley.com/doi/abs/10.1002/cpt.1048 Clopidogrel Pharmacogenetics. Pereira NL, et. alCirc Cardiovasc Interv. 2019 Apr;12(4):e007811. https://bit.ly/37bI8N0Pharmacogenomics-Driven Prediction of Antidepressant Treatment Outcomes: A Machine-Learning Approach With Multi-trial Replication. Athreya AP, et. alClin Pharmacol Ther. 2019 Oct;106(4):855-865. https://bit.ly/3k73TB6

Question: Would you use bisphosphonate drugs to treat spaceflight related bone loss for long duration space missions? Follow us on twitter! https://twitter.com/TalkSpaceMed Join our discord! https://www.google.com/url?q=https%3A%2F%2Fdiscord.gg%2FWtUcKYyH3b&sa=D&sntz=1&usg=AFQjCNFWSYEMvPusokT0AL50JKsRt2cg8g Credit: Everyday Astronaut for intro music! (Listen here) https://www.youtube.com/watch?v=LQMq4YEMvH8&list=PL-ptSDHlAdQNZ4LxFv_c5MEsmQ6i8bQUN&pbjreload=101&ab_channel=EverydayAstronaut (Buy here) https://www.amazon.com/Maximum-Aerodynamic-Pressure-Everyday-Astronaut/dp/B07KPVRG67/ref=sr_1_1?dchild=1&keywords=maximum+aerodynamic+pressure&qid=1612331710&sr=8-1 References 1. Watts NB, Bilezikian JP, Camacho PM, et al. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the diagnosis and treatment of postmenopausal osteoporosis. Endocr Pract. 2010;16(Suppl 3):1-37. doi:10.4158/EP.16.S3.1 2. Sibonga JD. Spaceflight-induced bone loss: Is there an Osteoporosis Risk? Curr Osteoporos Rep. 2013;11(2):92-98. doi:10.1007/s11914-013-0136-5 3. Kennel KA, Drake MT. Adverse Effects of Bisphosphonates: Implications for Osteoporosis Management. Mayo Clin Proc. 2009;84(7):632-638. doi:10.1016/s0025-6196(11)60752-0 4. Program HR. Human Research Program Integrated Research Plan.; 2020. 5. Sibonga JD, Spector ER, Johnston SL, Tarver WJ, Reeves JM. Evaluating bone loss in ISS astronauts. Aerosp Med Hum Perform. 2015;86(12 Suppl):A38-A44. doi:10.3357/AMHP.EC06.2015 6. Blaber EA, Dvorochkin N, Lee C, et al. Microgravity Induces Pelvic Bone Loss through Osteoclastic Activity, Osteocytic Osteolysis, and Osteoblastic Cell Cycle Inhibition by CDKN1a/p21. PLoS One. 2013;8(4). doi:10.1371/journal.pone.0061372 7. Blaber EA, Dvorochkin N, Torres ML, et al. Mechanical unloading of bone in microgravity reduces mesenchymal and hematopoietic stem cell-mediated tissue regeneration. Stem Cell Res. 2014;13(2):181-201. doi:10.1016/j.scr.2014.05.005 8. McCarthy I, Goodship A, Herzog R, Oganov V, Stussi E, Vahlensieck M. Investigation of bone changes in microgravity during long and short duration space flight: Comparison of techniques. Eur J Clin Invest. 2000;30(12):1044-1054. doi:10.1046/j.1365-2362.2000.00719.x 9. Leblanc A, Schneider V, Shackelford L, et al. Bone Mineral and Lean Tissue Loss after Long Duration Space Flight. Vol 1.; 2000. 10. Collet P, Uebelhart D, Vico L, et al. Effects of 1- and 6-month spaceflight on bone mass and biochemistry in two humans. Bone. 1997;20(6):547-551. doi:10.1016/S8756-3282(97)00052-5 11. Coulombe JC, Senwar B, Ferguson VL. Spaceflight-Induced Bone Tissue Changes that Affect Bone Quality and Increase Fracture Risk. Curr Osteoporos Rep. 2020;18(1). doi:10.1007/s11914-019-00540-y 12. LeBlanc A, Matsumoto T, Jones J, et al. Bisphosphonates as a supplement to exercise to protect bone during long-duration spaceflight. Osteoporos Int. 2013;24(7):2105-2114. doi:10.1007/s00198-012-2243-z 13. Mashiba T, Hirano T, Turner CH, Forwood MR, Johnston CC, Burr DB. Suppressed bone turnover by bisphosphonates increases microdamage accumulation and reduces some biomechanical properties in dog rib. J Bone Miner Res. 2000;15(4):613-620. doi:10.1359/jbmr.2000.15.4.613 14. Ammann P, Rizzoli R. Bone strength and its determinants. Osteoporos Int. 2003;14 Suppl 3. doi:10.1007/s00198-002-1345-4

In this episode we meet Dr Shailla Vaidya MD a Canadian physician with a background in Emergency Medicine and Family Practice who also holds a Masters in Public Health from Harvard University.  Dr Vaidya has also undergone extensive training in Ayurveda, Yoga therapy, Mindfulness and Trauma informed practices.  She combines her knowledge, skills and experience in her practice in Toronto with particular focus on working with groups and individuals to help manage burnout and the physical and emotional sequelae of chronic stress related illness. We discuss occupational burnout particularly with reference to the current COVID19 global pandemic, the impacts of chronic stress and trauma on health and well-being and yoga as a tool for self calibration.  Website: www.theYogaMD.caTwitter:@ShaillaVaidyaFacebook: Dr. Shailla Vaidya the YogaMDLinkedIn: Shailla VaidyInstagram:the.Yoga.MDreferences:Shanafelt TD, Noseworthy JH. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clin Proc. 2017;92(1):129‐146. doi:10.1016/j.mayocp.2016.10.004resources:www.drs4drs.com.auwww.beyondblue.org.auwww.lifeline.org.au 13 11 14Disclaimer: The content in this podcast is not intended to constitute or be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health care professional.  Moreover views expressed here are our own and do not  necessarily reflect those of  our employers or other official organisations.

This episode was recorded on April 3, 2020Claim credit here: https://ce.mayo.edu/covid19podcastGuest:  Michael J. Ackerman, M.D., Ph.D. (@MJAckermanMDPhD)Host: Amit K. Ghosh, M.D., M.B.A. (@AmitGhosh006)The administration of hydroxychloroquine and azithromycin, along with other very common medications could result in drug-induced sudden cardiac death caused by drug-induced QT prolongation, in some patients. In order to avoid the wrong medication, for the wrong patient, at the wrong time, Dr. Michael Ackerman shares how to assess your patient’s risk, how to find and measure their QTc value, and neutralize the threat.Deeper Dive:Link to Journal Pre-Proof:https://mayoclinicproceedings.org/pb/assets/raw/Health%20Advance/journals/jmcp/jmcp_covid19.pdfLink to COVID-19 QTc Calculator and other resources:https://www.covidqtc.com/#WRchTxt7-12veGiudicessi JR, Noseworthy PA, Friedman PA, Ackerman MJ. Urgent guidance for navigating and circumventing the QTc prolonging and torsadogenic potential of possible pharmacotherapies for COVID-19 [published online ahead of print March 25, 2020]. Mayo Clin Proc. https://doi.org/10.1016/j.mayocp.2020.03.024.FDA Emergency Use Authorization (EUA) of hydroxychloroquine sulfate: https://www.fda.gov/media/136538/downloadMayo Clinic Connected Care - Genetic Heart Rhythm Diseases https://connect.mayoclinic.org/page/genetic-heart-rhythm-disorders/tab/covid-19/#Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

ReferencesBartoszewska M, Kamboj M, Patel DR (2010) Vitamin D, muscle function, and exercise performance. Pediatr Clin North Am 57:849-861. doi:10.1016/j.pcl.2010.03.008 Brazier M, Grados F, Kamel S et al (2005) Clinical and laboratory safety of one year's use of a combination calcium + vitamin D tablet in ambulatory elderly women with vitamin D insufficiency: results of a multicenter, randomized, double-blind, placebo-controlled study. Clin Ther 27:1885-1893. doi:10.1016/j.clinthera.2005.12.010 Hoang MT, Defina LF, Willis BL, Leonard DS, Weiner MF, Brown ES. (2011) Association between low serum 25-hydroxyvitamin D and depression in a large sample of healthy adults: the Cooper Center longitudinal study. Mayo Clin Proc. 2011 Nov;86(11):1050-5.Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL (2011) Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res 26:2341-2357. doi:10.1002/jbmr.463; 10.1002/jbmr.463 Jones G (2008) Pharmacokinetics of vitamin D toxicity. Am J Clin Nutr 88:582S-586S Karaplis AC, Chouha F, Djandji M, Sampalis JS, Hanley DA (2011) Vitamin D status and response to daily 400 IU vitamin D3 and weekly alendronate 70 mg in men and women with osteoporosis. Ann Pharmacother 45:561-568. doi:10.1345/aph.1P439 Kimball SM, Ursell MR, O'Connor P, Vieth R (2007) Safety of vitamin D3 in adults with multiple sclerosis. Am J Clin Nutr 86:645-651 Koutkia P, Chen TC, Holick MF (2001) Vitamin D intoxication associated with an over-the-counter supplement. N Engl J Med 345:66-67. doi:10.1056/NEJM200107053450114 Lips P, Binkley N, Pfeifer M et al (2010) Once-weekly dose of 8400 IU vitamin D(3) compared with placebo: effects on neuromuscular function and tolerability in older adults with vitamin D insufficiency. Am J Clin Nutr 91:985-991. doi:10.3945/ajcn.2009.28113 Maalouf J, Nabulsi M, Vieth R et al (2008) Short- and long-term safety of weekly high-dose vitamin D3 supplementation in school children. J Clin Endocrinol Metab 93:2693-2701. doi:10.1210/jc.2007-2530 Matthews LR, Ahmed Y, Wilson KL, Griggs DD, Danner OK (2012) Worsening severity of vitamin D deficiency is associated with increased length of stay, surgical intensive care unit cost, and mortality rate in surgical intensive care unit patients. Am J Surg . doi:10.1016/j.amjsurg.2011.07.021 Roth DE (2011) Vitamin D supplementation during pregnancy: safety considerations in the design and interpretation of clinical trials. J Perinatol 31:449-459. doi:10.1038/jp.2010.203; 10.1038/jp.2010.203 Vieth R (1999) Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr 69:842-856 Vieth R (1999) Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr 69:842-856 Wang Y, DeLuca HF (2011) Is the vitamin d receptor found in muscle? Endocrinology 152:354-363. doi:10.1210/en.2010-1109 Wielders JP, Muskiet FA, van de Wiel A (2010) Shedding new light on vitamin D--reassessment of an essential prohormone. Ned Tijdschr Geneeskd 154:A1810 

Dr. Merv Travers is a Senior Research Scholar working in the area of low back pain, tendon pain and exercise rehabilitation at the School of Physiotherapy, The University of Notre Dame Australia. In today's episode, Merv discusses what exactly strength training is, why it’s important for all of our bodies and how physiotherapists can get their patients started and progressing. And of course my son, Rylan, had to compete with his sister in podcast recording (and special blooper takes at the end). Check out the reference list below Merv kindly put together for us! More about Merv...he completed his PhD at Curtin University where he also maintains an Adjunct Research Fellow role. His teaching areas include anatomy and exercise rehabilitation. He has a Masters of Manipulative Therapy and is a qualified strength & conditioning coach (Australian Strength and Conditioning Association – Level 2). Merv’s clinical background includes working in professional rugby union and he provides clinical consultation for complex musculoskeletal conditions at Star Physio, WA. Merv guest lectures nationally and internationally on the topics of strength and conditioning for physiotherapists and tendinopathy rehabilitation, as well as runs an international strength conditioning course for physiotherapists. Optimise Rehab - courses for Strength and Conditioning courses for physios Some key references pertaining to some of this things we spoke about: Public Health and strength training: Steele, J., Fisher, J., Skivington, M., Dunn, C., Arnold, J., Tew, G., . . . Winett, R. (2017). A higher effort-based paradigm in physical activity and exercise for public health: making the case for a greater emphasis on resistance training. BMC Public Health, 17(1), 300. Dankel, S. J., Loenneke, J. P., & Loprinzi, P. D. (2016). Determining the Importance of Meeting Muscle-Strengthening Activity Guidelines: Is the Behavior or the Outcome of the Behavior (Strength) a More Important Determinant of All-Cause Mortality? Mayo Clin Proc, 91(2), 166-174. Strain, T., Fitzsimons, C., Kelly, P., & Mutrie, N. (2016). The forgotten guidelines: cross-sectional analysis of participation in muscle strengthening and balance & co-ordination activities by adults and older adults in Scotland. BMC Public Health, 16(1), 1108. Physio knowledge of guidelines: Lowe, A., Littlewood, C., McLean, S., & Kilner, K. (2017). Physiotherapy and physical activity: a cross-sectional survey exploring physical activity promotion, knowledge of physical activity guidelines and the physical activity habits of UK physiotherapists. BMJ Open Sport & Exercise Medicine, 3(1) Lifting with a neutral spine: Saraceni, N., Kent, P., Ng, L., Campbell, A., Straker, L., & O'Sullivan, P. (2019). To Flex or Not to Flex? Is There a Relationship Between Lumbar Spine Flexion During Lifting and Low Back Pain? A Systematic Review With Meta-Analysis. J Orthop Sports Phys Ther, 1-50 Achilles tendon pain and loading: Murphy, M., Travers, M., Gibson, W., Chivers, P., Debenham, J., Docking, S., & Rio, E. (2018). Rate of Improvement of Pain and Function in Mid-Portion Achilles Tendinopathy with Loading Protocols: A Systematic Review and Longitudinal Meta-Analysis. Sports Medicine. Placebo and Exercise: Crum, A. J., & Langer, E. J. (2007). Mind-set matters: exercise and the placebo effect. Psychol Sci, 18(2), 165-171. Minimum strength dosage: Androulakis-Korakakis, P., Fisher, J. P., & Steele, J. (2019). The Minimum Effective Training Dose Required to Increase 1RM Strength in Resistance-Trained Men: A Systematic Review and Meta-Analysis. Sports Medicine.  

We investigate the claim that a subjective assessment is an accurate way to measure functional capacity. We also explore whether self-reported ability to climb two flights of stairs is the best subjective method to assess functional capacity and whether exercise tolerance greater than or equal to 4 metabolic equivalents predicts the risk of perioperative complications in any major non-cardiac surgery. Our guests today are Dr. Elisa Walsh and Dr. Laurie Shapiro of the Massachusetts General Hospital.  Full show notes available at depthofanesthesia.com.  Connect with us @DepthAnesthesia on Twitter or depthofanesthesia@gmail.com. Thanks for listening! Please rate us on iTunes and share with your colleagues.  Music by Stephen Campbell, MD.  -- References Wijeysundera et al. Assessment of functional capacity before major non-cardiac surgery: an international, prospective cohort study. Lancet. 2018; 391: p2631-2640. Fleisher et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 130: e278-e333. Hlatky et al. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol. 1989 Sep 15;64(10):651-4. Wang et al. Plasma natriuretic peptide levels and the risk of cardiovascular events and death. N Engl J Med. 2004;350(7):655. Kistrop et al. N-terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults. JAMA. 2005;293(13):1609. Struthers et al. The potential to improve primary prevention in the future by using BNP/N-BNP as an indicator of silent ‘pancardiac’ target organ damage. European Heart Journal, Volume 28, Issue 14, July 2007, Pages 1678–1682 Carliner et al. Routine preoperative exercise testing patients undergoing major noncardiac surgery. Am J Cardiol 1985;56;51-58. Sgura et al. Supine exercise capacity identifies patients at low risk for perioperative cardiovascular events and predicts long-term survival. Am J Medicin 2000; 108. Kistorp et al. N-terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults. JAMA. 2005;293(13):1609. Reilly et al. Self-reported exercise tolerance and the risk of serious perioperative complications. Arch Intern Med. 1999 Oct 11;159(18):2185-92. Melon et al. Validated questionnaire vs physicians' judgment to estimate preoperative exercise capacity. JAMA Intern Med. 2014 Sep;174(9):1507-8. Weinstein et al. Comparison of Preoperative Assessment of Patient's Metabolic Equivalents (METs) Estimated from History versus Measured by Exercise Cardiac Stress Testing. Anesthesiol Res Pract. 2018; 2018: 5912726. Ryding et al. Prognostic Value of Brain Natriuretic Peptide in Noncardiac Surgery: A Meta-analysis. Anesthesiology. 8 2009, Vol.111, 311-319. Wright et al. Examining Risk: A Systematic Review of Perioperative Cardiac Risk Prediction Indices. Mayo Clin Proc. 2019. Wiklund RA, Stein HD, Rosenbaum SH. Activities of daily living and cardiovascular complications following elective, noncardiac surgery. Yale J Biol Med 2001; 74: 75–87 Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett Jr DR, Tudor-Locke C, Greer JL, Vezina J, Whitt-   Glover MC, Leon AS. 2011 Compendium of Physical Activities: a second update of codes and MET values. Medicine and Science in Sports and Exercise, 2011;43(8):1575-1581. --

In this episode, I explore the latest evidence on the use of saline locks! A saline lock - sometimes called a “hep-lock” in reference to how it used to be used - is an intravenous (IV) catheter that is threaded into a peripheral vein, flushed with saline, and then capped off for later use. Nurses use saline locks to have easy access to the vein for potential injections. They can be useful in administering drugs as needed, and in the event of emergency surgery. What is the latest research on the use of saline locks in labor and delivery? What is the evidence for the saline lock in someone who wants an un-medicated birth or wants to avoid medical interventions as much as possible? Should a saline lock be in place “just in case” it may be needed? I’ll cover the evidence on this topic, along with the risks and benefits. For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on Facebook, Instagram, and Pinterest. Ready to get involved? Check out our Professional membership (including scholarship options) and our Instructor program. Find an EBB Instructor here, and click here to learn more about the Evidence Based Birth® Childbirth Class. RESOURCES: Bailey, J. M., C. Bell, R. Zielenski (2019). “Timing and outcomes of an indication-only use of intravenous cannulation during spontaneous labor.” J Midwifery Womens Health 00:1-7.  Bateman, B. T., M. F. Berman, et al. (2010). “The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries.” Anesthesia and analgesia 110(5): 1368-1373. Maki, D. G., D. M. Kluger, et al. (2006). “The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies.” Mayo Clin Proc 81(9): 1159-1171. Newton, N., M. Newton, et al. (1988). “Psychologic, physical, nutritional, and technologic aspects of intravenous infusion during labor.” Birth 15(2): 67-72. Rickard, C. M., D. McCann, et al. (2010). “Routine resite of peripheral intravenous devices every 3 days did not reduce complications compared with clinically indicated resite: a randomised controlled trial.” BMC Med 8: 53. Want evidence on more topics? Access all of the Evidence Based Birth Signature Articles at our blog.

Author: Peter Bakes, MD Educational Pearls:   Important to find out if patients mean dysequilibrium, lightheadedness, or vertigo when patients say they are “dizzy.” Differentiate central vs. peripheral vertigo Central vertigo typically present with bulbar syndromes (difficulty swallowing, facial nerve palsy) and cerebellar symptoms (ataxia). Peripheral vertigo typically present with sudden onset vertigo with nausea and vomiting in the absence of bulbar symptoms. Episodic? BPPV or Meniere’s Disease. BPPV has not auditory symptoms and is associated with head position; Meniere’s has hearing loss, tinnitus, and ear fullness. Constant? Neuronitis has no auditory symptoms, while labyrinthitis has associated hearing loss/tinnitus and is associated with a recent infection (OM).   References Baloh RW. Differentiating between peripheral and central causes of vertigo. Otolaryngol Head Neck Surg 1998; 119:55. Chase M, Goldstein JN, Selim MH, et al. A prospective pilot study of predictors of acute stroke in emergency department patients with dizziness. Mayo Clin Proc 2014; 89:173. Kerber KA, Brown DL, Lisabeth LD, et al. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke 2006; 37:2484.

Worldwide Injection Technique Questionnaire Study: Population Parameters and Injection Practices. Mayo Clin Proc. 2016 Sep;91(9):1212-23

It's a busy shift.  Today no one seems to have a chief complaint. Someone sends a troponin on a child.  Good, bad, or ugly, how are you going to interpret the result? And while we’re at it – what labs do I need to be careful with in children – sometimes the normal ranges of common labs can have our heads spinning! Read on to go from bread-and-butter pediatric blood work to answer the question – what’s up with troponin, lactate, d-dimer, and BNP in kids?   A fundamental tenet of emergency medicine:     We balance our obligation to detect a dangerous condition with our suspicion of the disease in given patient. Someone with a cough and fever may simply have a viral illness, or he may have pneumonia.  Our obligation is to evaluate for the pneumonia.  It’s ok if we “miss” the diagnosis of a cold. It could be bad if we don’t recognize the pneumonia.   How do we decide?  Another fundamental concept:     The threshold. Depending on the disease and the particular patient, we have a threshold for testing, and the threshold for treating.  Every presentation – and every patient for that matter – has a complicated interplay between what we are expected to diagnose, how much we suspect that particular serious diagnosis, and where testing and treating come into play.     What's wrong with "throwing on some labs"? Easy to do right?  They are but a click away… Often a good history and physical exam will help you to calibrate your investigational thresholds.  This is especially true in children – the majority of pediatric ambulatory visits do not require blood work to make a decision about acute care.  If your patient is ill, then by all means; otherwise, consider digging a bit deeper into the history, get collateral information, and make good use of your general observation skills. First, a brief word about basic labs.     The punchline is, use a pediatric reference. If you don’t have a trusted online reference available during your shift, make sure you have something like a Harriett Lane Handbook accessible to you. Don’t rely on your hospital’s lab slip or electronic medical record to save you, unless you are sure that they use age-specific pediatric reference ranges to flag abnormal values. Believe it or not, in this 21st century of ours, some shops still use adult reference ranges when reporting laboratory values on children.   Notable differences in basic chemistries Potassium: tends to run a bit higher in infants, because for the first year of life, your kidneys are inefficient in excreting potassium. BUN and creatinine: lower in children due to less muscle mass, and therefore less turnover (and usually lack of other chronic disease) Glucose: tends to run lower, as children are hypermetabolic and need regular feeding (!) Alkaline phosphatase: is always high in normal, growing children, due to bone turn over (also fond in liver, placenta, kidneys) Ammonia: high in infancy, due to immature liver, trends down to normal levels by toddlerhood ESR and CRP: low in healthy children, as chronic inflamation from comorbidities is not present; both increase steadily with age Thyroid function tests: all are markedly high in childhood, not as a sign of disease, but a marker of their increased metabolic activity     Big Labs     Troponin Reliably elevated in myocarditis, and may help to distinguish this from pericarditis (in addition to echocardiography) Other causes of elevated troponin in children include: strenuous activity, status epilepticus, toxins, sepsis, myocardial infarction (in children with congenital anomalies).  Less common causes of troponemia are: Kawasaki disease, pediatric stroke, or neuromuscular disease.   Don't go looking, if you won't do anything with the test.   Brain natriuretic peptide (BNP) In adults, we typically think of a BNP < 100 pg/mL as not consistent with symptoms caused by volume overload. Luckily, we have data in children with congenital heart disease as well.  Although each company's assay reports slightly different cut-offs, in general healthy pediatric values match healthy adult values. One exception is in the first week of life, when it is high even in healthy newborns, due to the recent transition from fetal to newborn circulation. Use of BNP in children has been studied in both clinic and ED settings. Cohen et al. in Pediatrics used BNP to differentiate acute heart failure from respiratory disease in infants admitted for respiratory distress. They compared infants with known CHF, lung disease, and matched them with controls. Later, Maher et al. used BNP in the emergency department to differentiate heart failure from respiratory causes in infants and children with heart failure and those with no past medical history. The bottom line is: BNP reliably distinguishes cardiac from respiratory causes of shortness of breath in children with a known diagnosis of heart failure.   D-dimer To cut to the chase: d-dimer for use as a rule-out for pulmonary embolism has not been studied in children. The only data we have in using d-dimer in children is to prognosticate in established cases. It is only helpful to track therapy for children who have chronic clots. This is where our adult approach can get us into trouble. Basically, think of the d-dimer in children like it doesn’t even exist. It’s not helpful in our setting for our indications.   An adult may have an idiopathic PE – in fact, up to a third of adults with PE have no known risk factor, which makes decision tools and risk stratification important in this population. Children with PE almost always have a reason for it. There is at least one identifiable risk factor in up to 98% of children with pulmonary embolism. The majority have at least two risk factors. If you’re suspecting deep venous thrombosis, perform ultrasonography, and skip the d-dimer. If you’re worried about PE, go directly to imaging. In stable patients, you may elect to use MR angiography or VQ scan, but most of us will go right to CT angiography. Radiation is always a concern, but if you need to know, get the test. This is yet another reminder that your threshold is going to be different in children when you think about PE – they should have a reason for it. After you have excluded other causes of their symptoms, if they have risk factors, and you are still concerned, then do the test you feel you need to keep this child safe. You are the test. Risk factors only inform you, and you’ll have to just pull the trigger on testing in the symptomatic child with risk factors.   Lactate A sick child with sepsis syndrome? The short answer – yes. In the adult literature, we know that a lactate level above 4 mmol/L in patients with severe sepsis was associated with the need for critical care. This has been studied in children as well, and an elevated lactate in children – typically above 4 – was a predictor of prolonged ICU course and mortality in septic patients. The acute recognition and treatment of sepsis is first and foremost, clinical. And it’s all about perfusion and providing oxygen to the tissues. Lactate and other laboratory testing is not a substitute for clinical assessment – it should be used as an extension of your assessment.  There are two main reasons for an elevated lactate: the stress state and the shock state. The stress state is due to hypermetabolism and an increase in glycolysis, as an example, in early sepsis. The shock state is due to tissue hypoxia, seen in septic shock. The confusion and frustration with lactate is that we often test the wrong people for it. We could use it to track treatment, and see if we can clear the lactate; decreased lactate levels are associated with a better outcome in adults. Serial clinical assessments are even more useful to gauge your success with treatment. We should use lactate to detect occult shock. Children compensate so well for shock, that subtle tissue hypoxia may not be detected until later. It may inform your decision for level of care, intensive care versus some other lower level. Have you every been in this situation: "Why, oh why, did we send a lactate?" There are times when a lactate is ordered – maybe by protocol or maybe accidentally – or maybe in retrospect, the patient didn’t need it. Here is a quick mnemonic to remember the reasons for an elevated lactate: LACTATES L – liver – any liver disease affects how lactate is metabolized by the Cori cycle A – albuterol (or for our international friends, salbutamol), beta-agonists like albuterol, increase lactate production via cyclic amp C – “can’t breathe” – respiratory distress and increased work of breathing shifts the ratio of aerobic and anerobic repiration T – toxins – all kinds of wonder drugs and recreational drugs do it – look up your patient’s list if you’re suspicious A – alcohol, not an infrequent offender T – thiamine deficiency – think of this in your cachectic or malnourished patients E – epinephrine – a by-product of the cori cycle, how lactate is metabolized. Difficult to interpret lactates when a patient is on an epinephrine drip. S – seizure or shock – most commonly septic, but can be any type: cardiogenic, bstructive, hypovolemic, distributive. Bottom line: high serum lactate levels have been associated with morbidity and mortality in children with sepsis and trauma, the two best-studied populations.   A summary of how labs can help you – or hurt you – in pediatric emergency medicine: Have a good reference for normal values and always be skeptical of how your lab reports them. Troponin testing is great for the child with suspected cardiogenic shock, myocarditis, or in unwell children with congenital heart disease. BNP in children can be used just like you do in adults – to get a sense of whether the presenting symptoms are consistent with heart failure. D-dimer is mostly a waste of time in the PED. Lactate can be useful in the right patient – use it to risk-stratify the major trauma patient or the patient with sepsis that may be suffering from occult shock. And lastly, make sure that you are mindful of your threshold for testing, and our threshold for treatment. If will vary by disease and by the patient at hand.   References Troponin Gupta SK, Naheed Z. Chest Pain in Two Athletic Male Adolescents Mimicking Myocardial Infarction. Pediatr Emer Care. 2014;30: 493-495. Kelley WE, Januzzi JL, Christenson RH. Increases of Cardiac Troponin in Conditions other than Acute Coronary Syndrome and Heart Failure. Clinical Chemistry. 2009; (55) 12:2098–2112. Kobayashi D, Aggarwal S, Kheiwa A, Shah N. Myopericarditis in Children: Elevated Troponin I Level Does Not Predict Outcome. Pediatr Cardiol. 2012; 33:1040–1045. Koerbin G, Potter JM, Abhayaratna WP et al. The distribution of cardiac troponin I in a population of healthy children: Lessons for adults. Clinica Chimica Acta. 2016; 417: 54–56. Liesemer K, Casper TC, Korgenski K, Menon SC. Use and Misuse of Serum Troponin Assays in Pediatric Practice. Am J Cardiol. 2012;110:284 –289. Newby KL et al. for the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. ACCF 2012 Expert Consensus Document on Practical Clinical Considerations in the Interpretation of Troponin Elevations. J Am Coll Cardiol. 2012; 60(23): 2427-2463. Schwartz MC, Wellen S, Rome JJ et al. Chest pain with elevated troponin assay in adolescents. Cardiology in the Young; 2013. 23: 353–360. BNP Auerbach SR, Richmond ME, Lamour JM. BNP Levels Predict Outcome in Pediatric Heart Failure Patients Post Hoc Analysis of the Pediatric Carvedilol Trial. Circ Heart Fail. 2010;3:606-611. Cohen S, Springer C, Avital A et al. Amino-Terminal Pro-Brain-Type Natriuretic Peptide: Heart or Lung Disease in Pediatric Respiratory Distress? Pediatrics. 2005;115:1347–1350. Fried I, Bar-Oz B, Algur N et al. Comparison of N-terminal Pro-B-Type Natriuretic Peptide Levels in Critically Ill Children With Sepsis Versus Acute Left Ventricular Dysfunction. Pediatrics. 2006; 118(4): 1165-1168. Koch A, Singer H. Normal values of B type natriuretic peptide in infants, children, and adolescents. Heart. 2003;89:875–878. Maher KO, Reed H, Cuadrado A et al. , B-Type Natriuretic Peptide in the Emergency Diagnosis of Critical Heart Disease in Children. Pediatrics. 2008;121:e1484–e1488. Mir TS, Marohn S, Laeer S, Eistelt M. Plasma Concentrations of N-Terminal Pro-Brain Natriuretic Peptide in Control Children From the Neonatal to Adolescent Period and in Children With Congestive Heart Failure. Pediatrics. 2002;110(6)1:6. Mir TS, Laux R, Hellwege HH et al. Plasma Concentrations of Aminoterminal Pro Atrial Natriuretic Peptide and Aminoterminal Pro Brain Natriuretic Peptide in Healthy Neonates: Marked and Rapid Increase After Birth. Pediatrics. 2003;112:896–899. D-Dimer Goldenberg NA, Knapp-Clevenger RA, Manco-Johnson MJ. Elevated Plasma Factor VIII and d-Dimer Levels as Predictors of Poor Outcomes of Thrombosis in Children for the Mountain States Regional Thrombophilia Group. Pediatrics. 2003;112:896–899. Manco-Johnson MJ. How I treat venous thrombosis in children. Blood. 2006; 107(1)21-31. Naqvi M, Miller P, Feldman L, Shore BJ. Pediatric orthopaedic lower extremity trauma and venous thromboembolism. J Child Orthop. 015;9:381–384. Parasuraman S, Goldhaber SZ. Venous Thromboembolism in Children. Circulation. 2006;113:e12-e16. Strouse JJ, Tamma P, Kickler TS et al. D-Dimer for the Diagnosis of Venous Thromboembolism in Children. N Engl J Med. 2004;351:1081-8. Lactate Andersen LW, Mackenhauer J, Roberts JC et al. Etiology and therapeutic approach to elevated lactate. Mayo Clin Proc. 2013; 88(10): 1127–1140. Bai et al. Effectiveness of predicting in-hospital mortality in critically ill children by assessing blood lactate levels at admission. BMC Pediatrics. 2014; 14:83. Scott HF, Donoghue AJ, Gaieski DF et al. The Utility of Early Lactate Testing in Undifferentiated Pediatric Systemic Inflammatory Response Syndrome. Acad Emerg Med. 2012; 19:1276–1280. Shah A, Guyette F, Suffoletto B et al. Diagnostic Accuracy of a Single Point-of-Care Prehospital Serum Lactate for Predicting Outcomes in Pediatric Trauma Patients. Pediatr Emer Care. 2013; 29:715-719. Topjian AA, Clark AE, Casper TC et al. for the Pediatric Emergency Care Applied Research Network. Early Lactate Elevations Following Resuscitation From Pediatric Cardiac Arrest Are Associated With Increased Mortality. Pediatr Crit Care Med. 2013; 14(8): e380–e387. This post and podcast are dedicated to Daniel Cabrera, MD for his vision and his leadership in thinking 'outside the box'. Troponin     |     BNP     |     D-Dimer     |     Lactate Powered by #FOAMed -- Tim Horeczko, MD, MSCR, FACEP, FAAP

This week we discuss an article on door to balloon time and focus on the EPs role in patients who present with ST elevations on their EKG. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_35_0_Final_Cut.m4a Download Leave a Comment Tags: Cardiology, Door to Balloon Time, Resuscitation, STEMI Show Notes Fanari Z et al. Aggressive measures to decrease “door to balloon” time and incidence of unnecessary cardiac catheterization: potential risks and role of quality improvement. Mayo Clin Proc 2015. PMID: 26549506 REBEL EM: December 2015: All Cardiology REBELCast Read More

This week we discuss an article on door to balloon time and focus on the EPs role in patients who present with ST elevations on their EKG. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_35_0_Final_Cut.m4a Download Leave a Comment Tags: Cardiology, Door to Balloon Time, Resuscitation, STEMI Show Notes Fanari Z et al. Aggressive measures to decrease “door to balloon” time and incidence of unnecessary cardiac catheterization: potential risks and role of quality improvement. Mayo Clin Proc 2015. PMID: 26549506 REBEL EM: December 2015: All Cardiology REBELCast Read More

This week we discuss an article on door to balloon time and focus on the EPs role in patients who present with ST elevations on their EKG. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_35_0_Final_Cut.m4a Download Leave a Comment Tags: Cardiology, Door to Balloon Time, Resuscitation, STEMI Show Notes Fanari Z et al. Aggressive measures to decrease “door to balloon” time and incidence of unnecessary cardiac catheterization: potential risks and role of quality improvement. Mayo Clin Proc 2015. PMID: 26549506 REBEL EM: December 2015: All Cardiology REBELCast Read More

An interview with Peter J. Dyck, MD, coauthor of Histologic and teased-fiber measurements of sural nerve in disorders of lower motor and primary sensory neurons. Mayo Clin Proc 1968;43:81-123. Interviewed by Ted Burns, MD and Erik Ensrud, MD.

An interview with Peter J. Dyck, MD, coauthor of Histologic and teased-fiber measurements of sural nerve in disorders of lower motor and primary sensory neurons. Mayo Clin Proc 1968;43:81-123. Interviewed by Ted Burns, MD and Erik Ensrud, MD.