Podcasts about mbchb

Burnout expert Dr Anton Janse van Rensburg is a practising medical doctor from Pretoria, South Africa, with 27 years of experience as an Integrative Practitioner. Besides his MBChB degree, he has a Master's degree in Applied Human Nutrition from the University of Pretoria, and an Advanced Management Diploma from Manchester Business School. He is also a trained metal toxicologist.His clinical practice focuses on burnout, mood disorders, adjuvant therapy for cancer patients, auto-immune disorders, severe intestinal conditions, and chronic infectious diseases.Summary of PodcastKey TakeawaysBurnout is a systemic depletion, not just fatigue. It results from neglecting many small, daily habits (rest, connection, diet), not just from overwork.Dr. Anton's method is prescriptive and holistic. It prioritises daily habits (e.g., 20-min power naps, strong connections) and uses comprehensive tests to find root causes before considering medication.Nutrition is a primary tool for managing chronic conditions. A high-fat, low-carb diet can reverse Type 2 diabetes and stabilise mood by reducing cravings for refined carbs and optimising brain chemistry.Purpose and challenge are critical for longevity. Complete retirement is a risk factor for rapid aging; staying engaged with meaningful work or new challenges is essential for maintaining brain health.Burnout: Root Causes & Holistic SolutionsDefinition: A systemic depletion from neglecting many small, interconnected daily habits (physiological, emotional), not just from overwork.Origin of Insight: Dr. Anton's experience managing health for 9,000 workers on a high-stress construction site in Maputo, Mozambique (2000–2003).This role involved diagnosing 30–40 malaria cases daily and managing fatalities, providing a "crossroads" experience that informed his later focus on burnout.Dr. Anton's Prescriptive Approach:Initial Assessment: A deep history of work hours, rest habits, and personal connections.Daily Respite: Prescribes short, scheduled breaks to manage the body's natural circadian dip.Power Naps: 20-minute naps are ideal; naps >1 hour are detrimental to brain health.Social Connection: Emphasises strong relationships with friends, family, and colleagues, citing research on their importance for resilience and longevity.Physiological Testing: Uses comprehensive tests (bloods, stress ECGs) to find root causes, not just manage symptoms.Kevin's Experience: Burnout led to "reduced performance"—sitting at the desk with a large to-do list but accomplishing nothing.Solution: Stepped away from the desk more often and re-prioritised tasks to reduce stress.Mood Disorders & The Role of NutritionDefinition: A broad term for unstable brain chemistry, which can manifest as sadness, cynicism, or even physical fatigue (e.g., heavy limbs, a known symptom of low serotonin).Societal Factors: Increased prevalence in younger generations is linked to social media exposure and a sedentary lifestyle, both of which negatively impact brain chemistry.Nutrition as a Primary Tool:Core Principle: The brain requires healthy fats (avocado, olive oil, nuts, meat) and is harmed by refined carbohydrates.Mechanism: A high-fat, low-carb diet reduces cravings for refined carbs, which drives illness and instability.Case Study (Mood Disorder): A patient with a severe mood disorder saw significant improvement within 48 hours of starting a high-fat, low-carb diet, avoiding hospitalization.Case Study (Type 2 Diabetes): A patient on metformin for 25 years was advised to challenge the medication's necessity.Process: A low-carb, high-fat diet for six months, monitored with fasting insulin and HbA1c tests, can reveal if the pancreas can function without medication.Outcome: If successful, medication can be slowly and carefully reduced.Calorie Counting: Dr. Anton strongly advises against restrictive diets and calorie counting, as they are unsustainable and against human nature.The Future of Work & PurposeAI's Impact: The potential for AI to eliminate jobs raises concerns about a loss of purpose and meaning, which are often tied to work and contribution.Retirement & Longevity: Dr. Anton cautions that complete retirement is a risk factor for rapid aging.Recommendation: Stay engaged with meaningful activities (consulting, volunteering, mentoring) to maintain brain health and purpose.Challenge: The brain, like a muscle, needs to be challenged to grow and stay healthy. Avoiding challenges is detrimental to long-term well-being.The Next 100 Days Podcast Co-HostsGraham ArrowsmithGraham founded Finely Fettled in 2014 to provide data from The UK High Net Worth Database to marketers targeting affluent and high-net-worth customers. He's the founder of MicroYES, a Partner for MeclabsAI, creating lead generation AI Agents & Workflows and introducing the MeclabsAI Platform. Graham also provides an Answer Engine Optimisation solution to get your website in shape to be found by LLMs.Kevin ApplebyKevin specialises in finance transformation and implementing business change. He's the COO of GrowCFO, which provides both community and CPD-accredited training designed to grow the next generation of finance leaders. You can find Kevin on LinkedIn and at kevinappleby.com

Guest: Carel le Roux, MBChB, MSC, FRCP, FRCPath, PhD New findings from the SYNCHRONIZE-1 trial reveal that survodutide's impact extends beyond weight reduction, with a demonstrated decrease in liver fat and meaningful improvements across multiple markers of metabolic health in patients without type 2 diabetes. Dr. Carel le Roux joins us to share the efficacy and safety data and explore what these results could mean for the future of metabolic disease management. Dr. Le Roux is the Director of the Metabolic Medicine Group and a Professor of Chemical Pathology in the School of Medicine at University College Dublin, and he presented these findings at the 2026 American Diabetes Association Scientific Sessions.

From ultra-processed foods and pesticides to environmental toxins, pharmaceuticals, and chronic disease, it can feel overwhelming to try to make sense of it all - - - especially when our health "authorities" seem to continuously change their minds about what's good for us and what's killing us - - - and everything seems to be poison now. In this eye-opening conversation, Jamie Belz, FNTP, MHC, sits down with veteran pediatrician, integrative physician, author, speaker, and health freedom fighter, and author Dr. Michelle Perro, MD, DHom, to discuss one of the biggest questions of today: How do we pursue true health in an increasingly toxic world? Drawing from more than four decades of clinical experience, Dr. Perro shares her perspective on the growing health challenges affecting children and adults alike, why so many people are searching for answers outside conventional approaches, and what practical steps individuals can take to reclaim their health. Together, Jamie and Michelle dive into topics including: • What's making our children sick and how we can begin making them well • Glyphosate, GMOs, fluoride, and environmental toxic burden • The MAHA (Make America Healthy Again) movement and why it continues to gain momentum • Why curiosity is one of the most important skills we can develop in today's world • The importance of critical thinking and informed decision-making • Finding trustworthy health information in an age of information overload • Lyme disease, chronic illness, and environmental health concerns • The role of food as the foundation of physical and mental wellness • Transhumanism, AI, technology, and the future of human health • Why community matters when pursuing a different path toward wellness • How young people can become empowered advocates for their own health • Why the choices we make today may impact future generations One of the most powerful themes throughout this conversation is the idea that health is often visible. Spend time around people who prioritize nutrient-dense food, clean water, movement, sunshine, meaningful relationships, and foundational wellness, and you'll often notice a difference. There is a vibrance, energy, resilience, and optimism that stands out. Jamie and Michelle discuss how surrounding yourself with people who value health can accelerate your own journey and help you stay the course when the path feels unconventional. Whether it's attending a health conference, joining a local Weston A. Price chapter, connecting with practitioners, or simply finding friends who share similar values, this episode highlights the importance of finding community and support as you pursue a healthier life. Most importantly, this conversation is a reminder that lasting change starts with paying attention. Asking questions. Staying curious. Learning to think critically. And taking ownership of the choices that shape your health and the future health of those around you. Please subscribe, leave a review, and share this episode! About Michelle Perro, MD Dr. Michelle Perro is a veteran pediatrician with more than 40 years of clinical experience caring for children and families. Formerly an attending physician at UCSF Benioff Children's Hospital Oakland, she has treated tens of thousands of patients throughout her career and has become a leading voice in children's environmental health. She is the founder and CEO of GMOScience and the co-author of the bestselling books What's Making Our Children Sick? and Making Our Children Well. Her work focuses on the connection between modern food systems, environmental exposures, chronic illness, and the long-term health of future generations. Dr. Perro regularly speaks internationally, educating parents, healthcare professionals, and communities about nutrition, environmental medicine, and informed healthcare choices. Dr. Michelle Perro's Books:  What's Making Our Children Sick?https://www.amazon.com/Whats-Making-Our-Children-Sick/dp/1603587578 Making Our Children Well GMOScience Other Resources Mentioned: Weston A. Price Foundation Find a Weston A. Price Local Chapter   S2E2: AI In the Kitchen S1E6: Dr. Francis M Pottenger Jr Story Health Revival Podcast Episode with Dr. Perro Jamie's "Scientific Advisory Council" or "SAC" (Copy/Paste/Store in Chat/Grok/Etc.) Del Bigtree Lindsey Berkson, DC, CNS William Burgdorfer, PhD Jill Carnahan, MD Ignacio Chapela, PhD Rangan Chatterjee, MBChB, MRCGP Alan Gaby, MD Michael Gerber Tyrone Hayes, PhD Jesse Inchauspé, BSc Mikhail Kogan, MD Patty Lemmer Elizabeth Lipski, PhD, CCN James Lyons-Weiler, PhD Peter McCullough, MD, MPH Jennifer McGruther Judy Mikovits, PhD Luc Montagnier, MD, PhD Candace Pert, PhD Michelle Perro, MD Francis M. Pottenger Jr., MD Weston A. Price, DDS Árpád Pusztai, PhD Robert F. Kennedy Jr., JD Jordan Rubin, NMD Gretchen Rubin, JD Sally Fallon Morell, MA Gilles-Éric Séralini, PhD Stephanie Seneff, PhD Troy Spurrill, MD Gerard Tortora, PhD Matthew Walker, PhD Jack Wolfson, DO, FACC  

In this World Shared Practice Forum Podcast, Drs. Mark Peters and Scott Weiss provide their expert insight on the methodology and development of the 2026 International Surviving Sepsis Campaign guidelines. They discuss challenges encountered during the process and review notable changes to these guidelines compared to previous iterations. The authors share the recommendations that will most impact their personal practice for patients with sepsis, and reflect on how we can improve global research infrastructure to address salient knowledge gaps in pediatric critical care. LEARNING OBJECTIVES - Understand the design and methodology for the 2026 Surviving Sepsis Campaign guidelines - Review notable changes in the 2026 sepsis guidelines compared to the 2020 edition - Discuss the implications of the altered recommendations for clinical practice changes - Consider methods to improve global pediatric research infrastructure and data organization AUTHORS Mark Peters, MBChB, PhD, MRCP, FFICM, FRCPCH Professor of Paediatric Intensive Care NIHR Senior Investigator UCL Great Ormond St Institute of Child Health Hon. Consultant Paediatric Intensivist Paediatric Intensive Care Unit and Children's Acute Transport Service Great Ormond St Hospital Scott Weiss, MD, MSCE Professor of Pediatrics and Pathology & Genomic Medicine, Division Chief of Critical Care, Vice-Chair of Research for the Department of Pediatrics, Nemours Children's Hospital, Sidney Kimmel Medical College at Thomas Jefferson University Jeffrey Burns, MD, MPH Emeritus Chief Division of Critical Care Medicine Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital Professor of Anesthesia Harvard Medical School DATE Initial publication date: May 26, 2026. ARTICLES REFERENCED & ADDITIONAL REFERENCES - Weiss SL, Peters MJ, Oczkowski SJW, et al. Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026. Pediatr Crit Care Med. 2026;27(4):379-434. https://pubmed.ncbi.nlm.nih.gov/41869844/ - Balamuth F, Weiss SL, Long E, et al. Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock. N Engl J Med. Published online April 24, 2026. https://pubmed.ncbi.nlm.nih.gov/42028918/ - Weiss SL, Balamuth F, Long E, et al. PRagMatic Pediatric Trial of Balanced vs nOrmaL Saline FlUid in Sepsis: study protocol for the PRoMPT BOLUS randomized interventional trial. Trials. 2021;22(1):776. Published 2021 Nov 6. https://pubmed.ncbi.nlm.nih.gov/34742327/ - Steven Pinker "Enlightenment Now” - https://stevenpinker.com/publications/enlightenment-now-case-reason-science-humanism-and-progress - Blood Poison: The Untold Story of Sepsis - https://amplifypublishinggroup.com/product/nonfiction/health-medicine-and-wellness/general-health-medicine-and-wellness/blood-poison/ TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/at/r9q8w9vhsbpg7wwzn35kbmz/202605_WSP_Peters_and_Weiss_Transcript.pdf Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge among healthcare providers worldwide who care for critically ill children across all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access, thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Peters MJ, Weiss SL, O'Hara J, Burns JP. Pediatric Surviving Sepsis: Insights From the Leadership. 05/2026. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/pediatric-surviving-sepsis-insights-from-the-leadership-by-m-peters-s-weiss-openpediatrics.

The U.S. Food and Drug Administration recently qualified "total hip bone mineral density" as a surrogate endpoint to support clinical trials for osteoporosis drugs. This decision will significantly impact clinical trials moving forward, as the traditional endpoint of "fracture outcomes" presented many challenges regarding sample size, duration, and cost. The change came about because of findings from the study to advance bone mineral density as a Regulatory Endpoint Project, also known as the SABRE project.What is the SABRE project, and how did it arrive at these findings? How will this decision affect the design of clinical trials and time to approval of new osteoporosis therapies? To help answer these questions and many more, Host Aaron Lohr spoke with three leaders of the SABRE Project: Dennis M. Black, PhD, professor of epidemiology and biostatistics at the University of California, San Francisco; Richard Eastell, MBChB, PhD, FRCP, FMedSci, professor of bone metabolism at the University of Sheffield, and Mary L. Bouxsein, PhD, professor of orthopedic surgery at Harvard Medical School.

Listen in to learn the latest on ART switch strategies for people living with virologically suppressed HIV. Hear from experts Chloe Orkin, MBChB, FRCP, MD, and Peter J. Ruane, MD, as they review how the recent approvals fit in the treatment landscape of 2-drug, single-tablet regimens. Stream on the go or follow along with our expert-curated slides.  Topics covered include:  Guideline recommendations on ART switch in the setting of virologic suppression Phase III clinical trial data supporting ART switch Individual considerations for ART switch Get access to all of our new podcasts by subscribing to the Decera Clinical Education Infectious Disease Podcast on Apple Podcasts, YouTube Music, or Spotify. Presenters: Chloe Orkin, MBChB, FRCP, MD Professor of Infection and Inequities Dean for Healthcare Transformation Faculty of Medicine and Dentistry Queen Mary University of London London, United Kingdom of Great Britain and Northern Ireland Honorary Consultant Physician Barts Health NHS Trust London, United Kingdom Peter J. Ruane, MD President Ruane Clinical Research Los Angeles, California Link to program page: https://bit.ly/3PkPoP4 Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Listen now as experts, Chloe Orkin, MBChB, FRCP, MD, and Jihad Slim, MD, explore the potential clinical implications of new data on novel options for optimizing HIV therapy, especially for treatment-experienced people with challenges using currently available regimens, high pill burdens, and reduced adherence. Listen on the go or follow along with our expert-curated slides. Topics covered include: Current Options for Simplifying ART DHHS and EACS Recommendations for 2-Drug Regimens The Latest Results of the ARTISTRY-1 and -2 Trials Future Directions for HIV Therapy Get access to all of our new podcasts by subscribing to the Decera Clinical Education Infectious Disease Podcast on Apple Podcasts, YouTube Music, or Spotify. Presenters: Chloe Orkin, MBChB, FRCP, MD Professor of Infection and Inequities Dean for Healthcare Transformation Faculty of Medicine and Dentistry Queen Mary University of London  Honorary Consultant Physician Barts Health NHS Trust London, United Kingdom Jihad Slim, MD Assistant Professor of Medicine New York Medical College Valhalla, New York Chief of Infectious Disease Saint Michael's Medical Center Newark, New Jersey Link to program page: https://bit.ly/4u31NGv Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Send us Fan MailJoin our guest host, Ron El-Hawary, MD, MSc, as he speaks with members from the past and current L.E.A.D. cohorts, Christina K. Hardesty, MD (2023-24), Annalise Noelle Larson, MD (2024-25), and Morgan Jones, MBChB, BSc, Hons, MSc (2025-26). L.E.A.D. SRS is a leadership development program aimed at the next generation of leaders within the SRS. This year-long program provides a cohort of individuals the opportunity to gain a deeper understanding of the SRS and how to be an impactful leader.L.E.A.D. applications open this Friday, May 1, 2026! Learn more on our website HERE.*The Scoliosis Research Society (SRS) podcast is aimed at delivering the most current and trusted information to clinicians that care for patients with scoliosis and other spinal conditions. From news in the world of spinal conditions, to discussions with thought leaders in the field, we aim to provide up-to-date, quality information that will impact the daily practice of spinal conditions.

Host Praveen Ranganath, MD is joined by cohost Manish Motwani, MBChB, PhD, FSCCT to facilitate a panel discussion on artificial intelligence in cardiac imaging. Panelists:Damini Dey, PhD, FSCCTArthur Shiyovich, MDAlan Vainrib, MDMarly van Assen, MSc, PhD Resources:•Artificial Intelligence and Machine Learning for Cardiovascular Computed Tomography (CCT): A White Paper of the Society of Cardiovascular Computed Tomography (SCCT)•AI/ML Toolkit AI and Innovations SymposiumFor more thought-provoking discussions on AI and machine learning in cardiac imaging, join us at the SCCT2026 AI and Innovations Symposium on July 9, 2026, where global experts will explore cutting-edge advances, real-world challenges and the future integration of AI into clinical practice.

In this episode, we explore the rapidly evolving field of regenerative medicine, focusing on a cutting-edge approach known as RPA (Regenerative Protein Array). Joined by leading medical experts, we break down how RPA differs from traditional therapies like PRP and stem cells, and how it leverages a complex network of proteins to support healing, recovery, and performance. The discussion covers real-world applications across elite athletes, aging populations, and neurocognitive conditions, while also addressing key questions around treatment frequency, safety, and effectiveness. Overall, this episode bridges the gap between emerging science and practical outcomes in modern regenerative care.Relevant links:Genesis Contact Information1-855-320-7559www.genesisregenerative.compatient-inquiry@genesisregenerative.comclinician-inquiry@genesisregenerative.com Dr. Jacobson Contact InformationMark Jacobson, M.D.Genesis Medical Director – MusculoskeletalMedical Imaging & Therapeutics, Lady Lake, FloridaFounder & Medical Directorwww.mitflorida.comDr. Bregman Contact InformationPeter Bregman, DPMGenesis Medical Director – Foot, Ankle, NeuropathyBregman Foot-Ankle & Nerve Center, Las Vegas, NVFounder & Medical Directorwww.bregmanfance.com Prof. Dr. Bankole Johnson Contact InformationProfessor Bankole Johnson,DSc, MD, MBChB, MPhil, DFAPA, FRCPysch, DAASCPGenesis Medical Director – Neuro & CognitiveMiami Stem Cell Clinic, Miami, FLFounder & Medical Directorwww.miamistemcell.clinicDisclaimer:The information provided in this podcast episode is for entertainment purposes and is NOT MEDICAL ADVICE. If you have any questions about your health, contact a medical professional. This content is strictly the opinions of Lucas Aoun and is for informational and entertainment purposes only. It is not intended to provide medical advice or to take the place of medical advice or treatment from a personal physician. All viewers of this content are advised to consult with their doctors or qualified health professionals regarding specific health questions. Neither Lucas Aoun nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this content. All consumers of this content especially taking prescription or over-the-counter medications should consult their physician before beginning any nutritional, supplement or lifestyle program.Timestamps 0:00 Intro0:52 Meet the Experts3:53 What is RPA?6:14 Limits of Current Treatments12:41 Steroids vs Healing13:42 Athletes vs Everyday Recovery16:50 Brain and Neuro Cases24:32 Evidence and Ethics25:57 Real Patient Results30:55 Autoimmune Effects32:10 Rapid Injury Recovery33:50 Avoiding Surgery Case35:50 How RPA is Delivered36:35 Broader Applications49:52 Vision Applications51:01 Safety vs Other Treatments56:00 Outro Hosted on Acast. See acast.com/privacy for more information.

In this podcast, experts Hope S. Rugo, MD, FASCO; Giuseppe Curigliano, MD, PhD; Paolo Tarantino, MD, PhD; and Alastair Thompson, MD, MBChB, BSc (Hons), FRCS (Ed), FACS; discuss and debate recently published results of pivotal clinical trials in early-stage, HER2-positive breast cancer and their implications for patient care.

For many women, a history of breast cancer has meant an automatic “no” when it comes to menopausal hormone therapy. But is the story really that simple? In this video, we explore a more nuanced and evolving conversation—one grounded in decades of research, including the work of Avrum Z. Bluming, MD, and other leading experts who have closely examined the data on hormone therapy after breast cancer. Across multiple studies and reviews spanning over 40 years, the evidence paints a more complex picture. While certain risks—such as thromboembolism with oral formulations—are well documented, the long-held belief that hormone therapy universally increases breast cancer recurrence or mortality is increasingly being questioned. In fact, most studies have not shown an increase in breast cancer–related death, and only one trial demonstrated a limited increase in local (not distant) recurrence. At the same time, menopausal hormone therapy remains the most effective treatment for symptoms that deeply affect quality of life—while also offering potential benefits for cardiovascular health, bone strength, cognitive function, and longevity. So where does this leave us? This video is not about giving a one-size-fits-all answer. It's about encouraging thoughtful, informed decision-making. It's about moving beyond fear-based assumptions and toward individualized care—where risks and benefits are carefully weighed, and where women feel empowered to ask questions, seek multiple perspectives, and have meaningful conversations with their physicians. Because the most important takeaway is this: you deserve to be fully informed. Resources: Hormone Replacement Therapy After Breast Cancer: It Is Time Avrum Z. Bluming, MD LINK - https://bit.ly/4st0uji Menopausal Hormone Therapy for Breast Cancer Patients: What Is the Current Evidence? Sarah Glynne, MBBS, MSc, MRCP, MRCGP; James Simon, MD; Anthony Branson, FRCP; Stephen Payne, FRCS; Louise Newson, MBChB; Isaac Manyonda, PhD; Susan Cleator, PhD; Michael Douek, MD; Sasha Usiskin, MRCP; Jeffrey S. Tobias, MD; Jayant S. Vaidya, PhD LINK - https://bit.ly/41leKyt

In this episode Dr. Simon Ruffell joins to discuss the research on ayahuasca for PTSD. Dr. Ruffell is a psychiatrist, researcher, and student of curanderismo (Amazonian shamanism) working at the intersection of Western psychiatry, traditional plant medicine, and Indigenous knowledge systems. He is Executive Director of Onaya, Lecturer in Psychology and Psychedelics at the University of Exeter, and Chief Medical Officer of MINDS, with a focus on integrative and relational approaches to healing and consciousness. In this conversation, Dr. Ruffell explores the emerging research on ayahuasca as a treatment for PTSD, drawing on both Western scientific models and Indigenous Shipibo knowledge systems. He outlines how ayahuasca may work through mechanisms such as increased neuroplasticity, disruption of rigid predictive models, and potential epigenetic shifts related to stress and trauma, while emphasizing that these biological explanations exist alongside Indigenous understandings of "cleaning ancestral lines." Sharing preliminary findings from his ongoing research with military veterans in collaboration with Heroic Hearts Project, Dr. Ruffell discusses significant reductions in PTSD symptoms at six-month follow-up, the powerful role of community and ceremony, and the ethical complexities of studying sacred practices through Western scientific tools. He closes with a moving story of a veteran whose healing journey illustrates both the promise and the limits of psychedelic medicine when embedded in relational and cultural context.   In this episode, you'll hear: Western scientific theories for how ayahuasca may alleviate PTSD How trauma-related epigenetic changes may be transmitted across generations Preliminary results from Dr. Ruffell's study of ayahuasca for veterans diagnosed with PTSD The role of community bonding and peer support among veterans in maintaining therapeutic gains Why ayahuasca research in the Amazon includes a broader plant-based healing system—not just the brew itself How Indigenous healers interpret epigenetic findings as confirmation of longstanding ancestral frameworks The ethical considerations of bringing Western measurement tools (like EEG) into sacred ceremonial contexts   Quotes: "This is what I find most interesting about our research—that it is cutting edge science but at the same time, when we conduct it with indigenous healers, we get a whole new perspective on what could be happening when it comes to interpreting the results and also making decisions of what to research as well." [14:09] "According to measures of PTSD on the scales that we're looking at, over 80% of the participants that were scoring for PTSD before their ayahuasca retreats and no longer scoring for PTSD at that six month follow up. So it's not just immediately after the ayahuasca retreats. It's six months later. And that's super, super encouraging." [15:52] "When we take things to the lab, one of the reasons that we might see the effect size diminishing is because we no longer have shamanism, basically, which is exerting a huge effect." [16:55] "Traditionally what would happen is that the curandero would drink ayahuasca and the participants would just be there and the curandero would use the visions that they had with ayahuasca to look into the participants and to diagnose them. And then the healing would come through them singing their medicinal chants, which are the icaros. And then afterwards they would give them a prescription of plants or whatever it is that they needed. And sometimes the prescription would be to drink ayahuasca, but most of the time it wouldn't be. [27:18] "You can't separate like DMT, in my eyes, from the rest of the compounds in ayahuasca, from the ceremony, from the jungle. That, in my opinion, is what makes up Shipibo. Otherwise you just have a bunch of chemicals." [28:20]   Links: Dr. Ruffell's website Dr. Ruffell on LinkedIn Dr. Ruffell on Instagram Onaya website Onaya Science website Onaya on LinkedIn Onaya on Instagram Previous episode: Can Ayahuasca Heal PTSD? with Former Army Ranger Jesse Gould Psychedelic Medicine Association Porangui

Anne Walling, MB ChB, joins the Faculty Factory Podcast this week to discuss some incredible stories of resilience she uncovered while researching her new book "Women in Medicine: Stories from the Girls in White." Dr. Walling interviewed 37 women who fought for credibility, worked harder than is almost imaginable, and graduated from medical school between 1948 and 1975. She wanted to learn why they went into medicine and how their experiences unfolded throughout medical school, residency, and entry into practice. The work was conducted by Dr. Walling as formal qualitative research with IRB oversight and open-ended questions. She joined us at the Faculty Factory for her second interview on our show to share the stories and insights she gathered. You can learn more about the book here: https://www.routledge.com/Women-in-Medicine-Stories-from-the-Girls-in-White/Walling/p/book/9781032873190 Dr. Walling is Professor Emerita at the University of Kansas School of Medicine—Wichita and is also the author of "Academic Promotion for Clinicians: A Practical Guide to Promotion and Tenure in Medical Schools." Learn about that book here: https://link.springer.com/book/10.1007/978-3-031-84036-4 As mentioned, this is her second appearance on our show. You can listen to her first appearance “Episode 334 – A Deep Exploration of Academic Promotions for Clinicians with Anne Walling, MB ChB,” here: https://facultyfactory.org/anne-walling/

David Kavanagh, MBChB, PhD, FRCP - A Clinically Considered Real-World Case Series: Practice Essentials From Biopsy To Diagnosis in Immune-Mediated Glomerular Diseases

David Kavanagh, MBChB, PhD, FRCP - A Clinically Considered Real-World Case Series: Practice Essentials From Biopsy To Diagnosis in Immune-Mediated Glomerular Diseases

David Kavanagh, MBChB, PhD, FRCP - A Clinically Considered Real-World Case Series: Practice Essentials From Biopsy To Diagnosis in Immune-Mediated Glomerular Diseases

David Kavanagh, MBChB, PhD, FRCP - A Clinically Considered Real-World Case Series: Practice Essentials From Biopsy To Diagnosis in Immune-Mediated Glomerular Diseases

Alice Sheridan, MD, FASN, Jean Francis, MD, FASN, and Martina McGrath, MBChB, FASN, interview editors Klement Yeung, MD, and Christopher T. Chan, MD on nephSAP editorial "It's Time for Home Hemodialysis to be Treated as an Established Dialysis Modality."

Alice Sheridan, MD, FASN, Jean Francis, MD, FASN, and Martina McGrath, MBChB, FASN, interview editors Klement Yeung, MD, and Christopher T. Chan, MD on nephSAP editorial "It's Time for Home Hemodialysis to be Treated as an Established Dialysis Modality."

Liz Gunn sits down with Dr David Cartland, a respected and deeply caring, ethical family doctor with impeccable qualifications (BMedSci 1st class, MBChB, MRCGP).David bravely spoke out against lockdowns, masks, PCR 'over-cycling', and mRNA COVID injections.The Hounds of Hell were unleashed upon him for his deep courage and personal integrity.This is a story of institutional bullying, loss of livelihood, and one man's unyielding commitment to his patients, to humanity's better future and above all, to Truth.Twitter/X Post: Masks the ultimate IQ test! Hypoxia, hypercapnia, a Petri dish and a Cochrane review shows Meta-analysis that they don't work!: https://x.com/cartlanddavid/status/1827609950761189697?s=46Sign the Dr David Cartland Petition: https://www.change.org/p/demand-justice-for-dr-david-cartlandTwitter/X: https://x.com/cartlanddavidInstagram: https://www.instagram.com/dr_david_cartlandYouTube https://youtube.com/@davidcartlandSubstack: https://substack.com/@drdavidcartlandWebsite: https://www.drdavidcartland.com/GiveSendGo Campaign: https://www.givesendgo.com/davidlegalBooks:Do No Harm: Diaries of a 'Vaccinated' Antivaxxer (Amazon): https://amzn.eu/d/0czQQIB3A Doctor's Despair: Second Edition (Amazon): https://amzn.eu/d/05NMEIXUSupport FreeNZ:Substack: https://freenz.substack.com/Locals: https://freenz.locals.comBuy Me A Coffee: www.buymeacoffee.com/supportfreenzKo-fi: https://ko-fi.com/freenzhttps://freenz.carrd.coAffiliates:Dioxi Care - Chlorine Dioxide based Oral Care, Skin Care & Veterinary & Wound Care: https://frontierpharm.com/?sca_ref=9717384.brQladA5pgSnoot Spray - Chlorine Dioxide based Nasal Cleaner: https://www.snootspray.com/?sca_ref=9667634.AV2NJQvGlTNavigate the matrix with this 2026 Year of the Fire Horse Numerology & Astrology Calendar: https://gumroad.com/a/809846675/itcfmgWide Awake Media - Freedom T-Shirts: https://wideawake.clothing/en-nz?sca_ref=9458851.1aXfjvGDqL

Melanie J. Davies, CBE, MBChB, MD, FMedSci / Linong Ji, MD - Managing the Cost of Type 2 Diabetes: The Impact of Effective Use of Established Therapies

Melanie J. Davies, CBE, MBChB, MD, FMedSci / Linong Ji, MD - Managing the Cost of Type 2 Diabetes: The Impact of Effective Use of Established Therapies

Melanie J. Davies, CBE, MBChB, MD, FMedSci / Linong Ji, MD - Managing the Cost of Type 2 Diabetes: The Impact of Effective Use of Established Therapies

Tune into this podcast to revisit discussions led by global experts, Karine Lacombe, MD, PhD, and Chloe Orkin, MBChB, FRCP, MD, featuring the latest updates on HIV treatment and prevention from the 2025 IDWeek and EACS conferences.Topics covered include:Real-world safety and efficacy of long-acting ARTART switch: preferences, treatment satisfaction, changes in weight and metabolic parameters, and HBV reactivation riskInvestigational therapiesUpdates on long-acting PrEP: persistence, use in people with substance use disorder, and coadministration with gender-affirming hormone therapyHIV and STI screening with PrEPSTI prevention To download the accompanying slides, visit the program page for this episode:https://bit.ly/3MGvegMPresenters:Karine Lacombe, MD, PhDProfessor of MedicineSorbonne UniversityHead of Infectious Diseases UnitSt Antoine Hospital, AP-HPParis, FranceChloe Orkin, MBChB, FRCP, MDProfessor of Infection and InequitiesDean for Healthcare TransformationQueen Mary University of LondonFaculty of Medicine and DentistryHonorary Consultant PhysicianBarts Health NHS TrustLondon, United KingdomGet access to all of our new episodes by subscribing to the Decera Clinical Education Infectious Diseases Podcast on Apple Podcasts, YouTube Music, or Spotify. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Fear of virologic failure is a major barrier to ensuring that people living with virally suppressed HIV are receiving the most optimal antiretroviral therapy (ART) regimen for them. Stream this Medical Minute to learn more about key guideline recommendations regarding ART switch and reassuring clinical data regarding efficacy, tolerability, and quality of life associated with switching a suppressive ART regimen. Topics covered include:Efficacy of switching to 2-drug oral ART: real-world evidenceReal-world analyses of virologic failure with switch to long-acting cabotegravir plus rilpivirinePatient selection to reduce risk of virologic failure with switch Regimen-specific switch considerationsPresenters:Dima Dandachi, MD, MPH, FIDSA, FACPAssociate Professor of MedicineDivision of Infectious DiseasesUniversity of MissouriMedical DirectorHIV Treatment and Prevention Program, MUHCMedical DirectorBoone County Public Health and Human ServicesColumbia, MissouriChloe Orkin, MBChB, FRCP, MDProfessor of Infection and InequitiesDean for Healthcare TransformationQueen Mary University of LondonFaculty of Medicine and DentistryHonorary Consultant PhysicianBarts Health NHS TrustLondon, United KingdomLink to full program and accompanying slides:https://bit.ly/3KPN0xbGet access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Interview with Darren Shu Jeng Ting, MBChB, PhD, author of Performance of Foundation Models vs Physicians in Textual and Multimodal Ophthalmological Questions. Hosted by Neil Bressler, MD. Related Content: Performance of Foundation Models vs Physicians in Textual and Multimodal Ophthalmological Questions Mastering Ophthalmology in the Digital Age

Interview with Darren Shu Jeng Ting, MBChB, PhD, author of Performance of Foundation Models vs Physicians in Textual and Multimodal Ophthalmological Questions. Hosted by Neil Bressler, MD. Related Content: Performance of Foundation Models vs Physicians in Textual and Multimodal Ophthalmological Questions Mastering Ophthalmology in the Digital Age

Alice M. Turner, MBChB, PhD - Cross-Talk Between Lung and Liver in Alpha-1 Antitrypsin Deficiency: A Call for Integrated Care

Alice M. Turner, MBChB, PhD - Cross-Talk Between Lung and Liver in Alpha-1 Antitrypsin Deficiency: A Call for Integrated Care

Alice M. Turner, MBChB, PhD - Cross-Talk Between Lung and Liver in Alpha-1 Antitrypsin Deficiency: A Call for Integrated Care

In this insightful episode, Dr. Bruce Hoffman discusses the intricacies of modern medicine, the importance of understanding the human body's response to environmental stressors, and the future of healthcare. Dr. Hoffman shares his journey and the development of his New Medical Curriculum, which emphasizes a holistic approach to health and healing.

Suphi Taneri, MD, FEBOS-CR; Radhika Rampat, MBBS, BSc(Hons), FRCOphth, CertLRS, FWCRS; Gilles Lesieur, MD; Paul Dupeyre, MSc; Ben LaHood, MBChB, PGDipOphth, PhD, FRANZCO, FWCRS; Aylin Kiliç, MDRecorded live at ESCRS 2025 in Copenhagen, this special edition of CRST: The Podcast, presented by Eyetube's Meeting Coverage, features leading voices reflecting on the innovations and discussions shaping this year's meeting. Topics highlighted include: Emerging presbyopia-correcting IOL technologies (Suphi Taneri, MD, FEBOS-CR); Sustainability in ophthalmology and unconscious gender bias (Radhika Rampat, MBBS, BSc[Hons], FRCOphth, CertLRS, FWCRS); Frameworks to simplify premium IOL selection (Gilles Lesieur, MD, and Paul Dupeyre, MSc); Strategies for toric IOL optimization (Ben LaHood, MBChB, PGDipOphth, PhD, FRANZCO, FWCRS); and Advances in tissue addition techniques (Aylin Kiliç, MD)

This program, led by Christiaan Scott, MD, Professor of Pediatric Rheumatology at the University of Ottawa and Raphaella Stander, MBCHB, Pediatrician at Atlantic Children's Practice, focused  on three case studies to provide physicians with education on best practices to: 1) suspect and diagnose FOP, 2) monitor and manage younger children with FOP, and 3) monitor and manage older children and adults with FOP. This accredited CME program provides healthcare professional with timely and practical education on fibrodysplasia ossificans progressiva (FOP). It is supported by an educational grant from Ipsen Biopharmaceuticals.To obtain CME credit, visit https://checkrare.com/learning/p-case-studies-in-diagnosing-and-managing-fop/ Target AudienceThis activity has been designed to meet the educational needs of physicians specializing in pediatrics, rheumatology, genetics, family medicine, and orthopedics. Other members of the care team may also participate.Learning ObjectivesAfter participating in the activity, learners should be better able to:Apply best practices for suspecting and diagnosing FOP.List best practices for managing young children with FOP.Identify best practices to manage older children and adults with FOP.Christiaan Scott, Professor of Medicine, University of OttawaRaphaella Stander, MBCHB, Pediatrician, Atlantic Children's PracticeDisclosure StatementAccording to the disclosure policy of the Academy, all faculty, planning committee members, editors, managers and other individuals who are in a position to control content are required to disclose any relationships with any ineligible company(ies). The existence of these relationships is not viewed as implying bias or decreasing the value of the activity. Clinical content has been reviewed for fair balance and scientific objectivity, and all of the relevant financial relationships listed for these individuals have been mitigated.Disclosure of relevant financial relationships are as follows:Faculty Educator/PlannerDr. Scott discloses the following relevant financial relationships with ineligible companies:Grant/Research Support: Regeneron*, Incyte*, Janssen*, Roche*; Speaker's Bureau:  Ipsen*, Regeneron*, Springer*, Jannsen**Relationships have endedDr. Stander has no relevant financial relationships with ineligible companies.Other Planners for this activity have no relevant financial relationships with any ineligible companies.This activity will review off-label or investigational information.The opinions expressed in this educational activity are those of the faculty, and do not represent those of the Academy or CheckRare CE. This activity is intended as a supplement to existing knowledge, published information, and practice guidelines. Learners should appraise the information presented critically, and draw conclusions only after careful consideration of all available scientific information.Accreditation and Credit DesignationIn support of improving patient care, this activity has been planned and implemented by American Academy of CME, Inc. and CheckRare CE. American Academy of CME, Inc. is Jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.PhysiciansAmerican Academy of CME, Inc., designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Other HCPsOther members of the care team will receive a certificate of participation.There are no fees to participate in the activity.  Participants must review the activity information including the learning objectives and disclosure statements, as well as the content of the activity. To receive CME credit for your participation, please complete the pre and post-program assessments. Your certificate will be emailed to you within 30 days.PrivacyFor more information about the American Academy of CME privacy policy, please access http://www.academycme.org/privacy.htm  For more information about CheckRare's privacy policy, please access https://checkrare.com/privacy/ContactFor any questions, please contact: CEServices@academycme.orgCopyright© 2025. This CME-certified activity is held as copyrighted © by American Academy of CME and CheckRare CE. Through this notice, the Academy and CheckRare CE grant permission of its use for educational purposes only. These materials may not be used, in whole or in part, for any commercial purposes without prior permission in writing from the copyright owner(s).

Hear from experts in HIV care Beatriz Grinsztejn, MD, PhD, and Rosie Mnggibisa, MBChB, MPH, as they discuss their insights on some of the most clinically relevant new data presented at IAS 2025, including studies on: Gaps in care for adolescents and young adults living with HIVGlobal impact of funding cutsAntiretroviral therapy for treating HIVPatient management strategies for people living with HIV and obesityPresenters:Beatriz Grinsztejn, MD, PhDDirectorSTI/HIV Clinical Research LaboratoryEvandro Chagas National Institute of Infectious Diseases – FIOCRUZRio de Janeiro, BrazilRosie Mngqibisa, MBChB, MPHClinical DirectorPrincipal InvestigatorEnhancing Care FoundationDurban, South AfricaLink to full program: https://bit.ly/4otF8AR

Melissa E. Middeldorp, MPH, PhD is joined by Martin K. Stiles, MBChB, PhD, FHRS, University of Auckland and Waikato Hospital and Eloi Marijon, MD, PhD, Paris University & European Georges Pompidou Hospital, to discuss this Danish nationwide study examines the relationship between socioeconomic position (SEP) and sudden cardiac death (SCD) as well as all-cause mortality (ACM). Analyzing all deaths in Denmark from 2010, researchers found a strong inverse association between both income and education level and the risk of SCD and ACM. Individuals in the lowest income and education groups had significantly higher rates of SCD, even after adjusting for age, sex, and comorbidities. The study highlights that despite Denmark's universal healthcare system, socioeconomic disparities in health outcomes persist, suggesting that factors beyond healthcare access—such as health literacy, lifestyle, and systemic inequalities—play a crucial role. The findings call for further research into the mechanisms driving these disparities and the development of targeted prevention strategies.  https://www.hrsonline.org/education/TheLead https://academic.oup.com/europace/article/27/4/euaf001/7958953?login=false Host Disclosure(s): M. Middeldorp: Nothing to disclose. Contributor Disclosure(s): E. Marijon: Honoraria/Speaking/Consulting: Zoll Medical Corporation, Boston Scientific  Research: Biotronik, Boston Scientific, MicroPort Scientific Corporation, Medtronic, Zoll Medical Corporation, Abbott  M. Stiles: Honoraria/Speaking/Consulting: Abbott Medical, Medtronic, Inc., Boston Scientific

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/EBAH/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/UMD865. CME/MOC/EBAH/NCPD/CPE/AAPA/IPCE credit will be available until July 10, 2026.The Road Ahead for Enhanced Sequential Care in CLL—Updates With Targeted Therapy In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and CLL Society. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/EBAH/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/UMD865. CME/MOC/EBAH/NCPD/CPE/AAPA/IPCE credit will be available until July 10, 2026.The Road Ahead for Enhanced Sequential Care in CLL—Updates With Targeted Therapy In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and CLL Society. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/EBAH/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/UMD865. CME/MOC/EBAH/NCPD/CPE/AAPA/IPCE credit will be available until July 10, 2026.The Road Ahead for Enhanced Sequential Care in CLL—Updates With Targeted Therapy In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and CLL Society. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

Idiopathic intracranial hypertension (IIH), a condition of increased intracranial pressure (ICP), causes debilitating headaches and, in some, visual loss. The visual defects are often in the periphery and not appreciated by the patient until advanced; therefore, monitoring visual function with serial examinations and visual fields is essential. In this episode, Kait Nevel, MD speaks with John J. Chen, MD, PhD, and Susan P. Mollan, MBChB, PhD, FRCOphth, authors of the article “Treatment and Monitoring of Idiopathic Intracranial Hypertension” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Chen is a professor of ophthalmology and neurology at the Mayo Clinic in Rochester, Minnesota. Dr. Mollan is an honorary professor of metabolism and systems science in the department of neuro-ophthalmology at University Hospitals Birmingham in Birmingham, United Kingdom. Additional Resources Read the article: Treatment and Monitoring of Idiopathic Intracranial Hypertension Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @IUneurodocmom Guests: @chenmayo, @DrMollan Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Nevel: Hello, this is Dr Kate Nevel. Today, I'm interviewing Drs John Chen and Susan Mollan about their article on treatment and monitoring of idiopathic intracranial hypertension, which appears in the June 2025 Continuum issue on disorders of CSF dynamics. Drs Chen and Mollan, welcome to the podcast. And please, could you introduce yourselves to the audience? Dr Chen: Hello, everyone. I'm John Chen, one of the neuro-ophthalmologists at the Mayo Clinic. Thanks for having us here. Dr Mollan: Yeah, it's great to be with you here. I'm Susan Mollan. I'm a consultant neuro-ophthalmologist in Birmingham, England. Dr Nevel: Wonderful. So great to have you both here today, and our listeners. To start us off, talking about your article, can you share with us what you think is the most important takeaway from your article for the practicing neurologist out there? Dr Chen: Yeah, so our article talked about the treatment and monitoring of IIH. And I think one takeaway point is, IIH is becoming much more prevalent now that there's this worldwide obesity epidemic with obesity having- essentially being the largest risk factor for IIH other than female. It's really important to monitor vision because vision loss is often peripheral vision loss at first, which the patient may be completely unaware of. And so, it's important to pair up with an ophthalmologist so you can monitor the papilledema of the visual fields and make sure they don't get permanent vision loss. And in the article, we also talk about- there's been changes in the treatment of severe IIH, where traditionally, we used VP shunts; but there's been a trend toward using more venous sinus stenting in addition to the traditional surgeries. Dr Nevel: Great, thank you. I think probably most of our listeners or a lot of neurologists out there have a pretty good understanding of kind of the basics of the IIH. But can you kind of just go over a few key characteristics of IIH, and maybe some things that are less commonly known or things that are maybe just been kind of better understood over the past decade, perhaps? Dr Mollan: Yes, certainly. I think, as Dr Chen said, it's because this condition is becoming more prevalent, people recognize it. I think it's- we like to go back to the diagnostic criteria so that we're making a very accurate diagnosis. So, the patients may come in to the emergency room with, say, papilledema that's been identified elsewhere or crashing headaches. And it's important to go through that sort of diagnostic pathway, taking a blood pressure, taking a full blood count to make sure the patient is anemic, and then moving forward with that confirmation of papilledema into urgent neuroimaging, whether it's CT or MRI, but including venography to exclude a venous sinus thrombosis. And then if you have no structural lesion that's causing the raised ICP, it's moving forward with your lumbar puncture and carefully checking those pressures. But the patients may not only have crashing headache, they often have pulsatile tinnitus and neck pain. I think some of the features that we're now recognizing is the systemic metabolic effects that are unique to IIH. And so, there's an increased risk of cardiometabolic disease that's over and above what is conferred by obesity. Also, our patients have a sort of maternal health burden where they get impaired fertility, gestational diabetes and preeclampsia. And there's also an associated mental health burden, amongst other things. So we're really starting to understand the spectrum of the disease a bit more. Dr Nevel: Yeah, thank you for that. And that really struck me in your article, how important it is to be aware of those things so that we're making sure that we're managing our whole patient and connecting them with the appropriate providers for some of those other issues that may be associated. For the practicing neurologist out there without all the neuro-ophthalmology equipment, if you will, what should our bedside exam focus on to help us get maybe an early but accurate picture of the patient's visual function when we suspect IIH to be at play, perhaps before they can get in with the neuro-ophthalmologist? Dr Chen: Yeah, I think at the bedside you can still check visual acuity and confrontational visual fields, you know, with finger counting. Of course, you have to know that those are, kind of, crude kind of ways of screening. With papilledema, oftentimes the visual acuity is intact. And the confrontational visual fields aren't as sensitive as automated perimetry. Another important thing will be to do your direct ophthalmoscope and look at the amount of papilledema. If it's grade one or two papilledema on the more mild side, it's actually not vision threatening. It's the higher degrees of papilledema that can cause rapid vision loss. And so, if you look in and you see grade one papilledema, obviously you need to do the full workup, the MRI, MRV, lumbar puncture. But in terms of rapidly getting to an ophthalmologist to screen for vision loss, it's not going to be as important because you're not going to have vision loss at that low grade. If you look in and you see this rip-roaring papilledema, grade five papilledema, that patient is going to be at very severe risk of vision loss. So, I think that exam, looking at the optic nerve can be very helpful. And of course, talking to the patient about symptoms; is there decreased vision Is there double vision from a sixth nerve palsy? Are there transient visual obscurations which would indicate at least a higher degree of papilledema? That'd be helpful as well. Dr Nevel: Great, thank you. And when the patient does get in with a neuro-ophthalmologist, you talk in your article and, of course, in clinical practice, how OCT testing is important to monitor in this condition. Can you provide for the listeners the definition of OCT and how it plays a role in monitoring patients with IIH? Dr Mollan: Sure. So, OCT is short for optical coherence tomography imaging, and really the eye has been at the forefront of OCT alone. Our sort of cardiology colleagues are catching up on the imaging of blood vessels. But what it allows us to do is give us really good cross-sectional, anatomical-level changes that we can see both in the retina and also at the optic nerve head. And it gives us some really good measurements. It's not so good at sort of saying, is this definitely papilledema or not? That sort of lower end of disc elevation. But it is very good at ruling out what we call the pseudopapilledema. So, things like drusens or these other little masses we find underneath the optic nerve head. But in terms of monitoring, because we can longitudinally take these images and the reproducibility is pretty good at the optic nerve head, it allows us to see whether there's direct changes: either the papilledema getting worse or the papilledema getting better at the optic nerve head. It also gives us some indication of what's going on in the ganglion cell layer complex. And that can be helpful when we're thinking about sort of looking at structure versus function. So, ophthalmologists in general, we love OCT; and we spend much more time nowadays looking at the OCT than we really do the back of the eye. And it's just become critical for patients with papilledema to be able to be very accurate from visit to visit to see what's changing. Dr Nevel: How do you determine how frequently somebody needs to see the neuro-ophthalmologist with IIH and how often they need that OCT evaluation? Dr Chen: Once the diagnosis of IIH is made, how often they need to be seen and how frequent they need to be seen depends on the degree of papilledema. And again, OCT is really nice. You can quantify it and then different providers can actually use the same OCT numbers, which is super helpful. But again, if it's grade three papilledema or higher, or article thickness of 200 or higher, I tend to follow them a little bit more closely, trying to treat them more aggressively. Try to get the papilledema down into a safer zone. If it's grade one or two papilledema, we see them less frequently. So, my first visit might be three months out. They come with grade five papilledema, I'm seeing them within a few days to make sure that's papilledema's come down quickly because we're trying to decide, are they going to need surgery or not? Dr Nevel: Yeah, great. And that's a nice segue into talking a little bit about how we treat patients with IIH after the diagnosis is confirmed. And I'd like to just point out you have a very lovely figure in your article---Figure 5-6,---that I'd like to direct our listeners to read your article and check out that figure, which is kind of an algorithm on how we think about the various treatment options for patients who have IIH, which seems to rely a lot on the degree of presence of papilledema and the presence of vision disturbance. Could you maybe walk us through a little bit about how you think about the different treatment options for patients with IIH and when more urgent surgical intervention might be indicated? Dr Mollan: Yeah, sure. We always find it quite hard in any medical specialty to write these kind of flow diagrams because it's really an individual we're looking at. But these are kind of what we'd say is “broad brushstrokes” into those patients that we worry about, sort of, red disease in those patients, more amber disease. Now obviously, even those patients that may not have severe papilledema, they may have crashing headaches. So, they may be an urgent referral themselves because of that. And so, it's nice to try and work out which end of the spectrum you're working with. If we think of the papilledema, Dr Chen's already laid out the sort of lower end of the prison's scale---our grades one, our grades two---that we're less anxious about. And those patients, we would definitely be having discussions about medical management, which includes acetazolamide therapy; but also thinking about weight management. And it may well be that we talk a little bit further about weight management, but I think it's helpful to sort of coach those conversations after you've made a definite diagnosis. And then laying out the risk that's caused, potentially, the IIH in an individual. And then having a sort of open conversation with them about what changes they can have in their lifestyle alongside thinking about medical therapy. There's some patients with very low levels of papilledema that we decide not to put on medicines initially. As patients progress up that papilledema grade, we're definitely thinking about medical therapy. And our first line from the IIH treatment trial would be using acetazolamide, but we need to be thinking about using appropriate dosing. So, a lot of the patients that I see can be sent to me with very low doses that may be inappropriate for that person. In the IIHTT they used up to four grams daily in a divided dose. And you do need to counsel your patients when you're putting them on acetazolamide because of the side effects. You've got quite a nice table in this article about the side effects. I think if you get the patient on board, that they understand that they will experience side effects, that is helpful because they will expect it, and then possibly tolerate it a bit better. Moving through to that area where we're more anxious, that visual-threatening papilledema. As Dr Chen said, it's sort of like you look in and it's sort of “blood and thunder” in there. And you need to be getting on and encouraging the ophthalmologist to get a formal assessment of the visual field. It's very difficult to determine exactly the level at which- and we talk about the mean deviation in a lot of our research studies. But in general, it's a combination of things: the patient's journey to get to you, their symptoms, what's going on with the visual field, but what's also happening at the OCT. So, we look in and we see that fluid is seeping towards the fovea. We get very anxious, and those patients may not even have enough time for a rapid escalation of acetazolamide. It may well be at the first presentation, which we would term, like, fulminant; that we'd be thinking about surgical intervention. And I think before I stop, the other thing to say is, the surgical landscape is really changing. So, we're having some good studies coming out in terms of stenting. And so, there is a sort of bracket where it may well be that we are thinking about neuroradiological intervention in an earlier case. They may not quite be at that visual-threatening stage, but they may be resistant to medical treatments. Dr Nevel: Thank you for that. What do you think is a potential pitfall or a mistake to avoid, if you will, in the management of patients with IIH? Dr Chen: I think it's- in terms of pitfalls, I think the potential pitfalls I've seen are essentially patients where we don't necessarily create a good patient physician relationship. Where they don't have buy-ins on the treatment, they don't have buy-ins to come back, and they're lost to follow-up. And these patients can be dangerous, because they could have vision threatening papilledema and if not getting the appropriate treatment---and if they're not monitoring the vision---this can lead to poor outcomes. So, I've definitely seen that happen. As Dr Mollan said, you really have to tell them about the side effects from the medications. If you just take acetazolamide, letting them know the paresthesias and the changes in taste and some of these other side effects, they're going to immediately stop the medication. Again, and these medications do work, proven in the IIH treatment trial. So again, I think that patient-physician relationship is very important to make sure they have appropriate follow up. Dr Nevel: The topic of weight loss in this patient population can be tricky, and I know I talked with Susie in a prior interview about how to approach this topic with our patients in a sensitive and compassionate manner. Once this topic is broached, I find many patients are looking for advice on strategies for weight loss, or potentially medications or other interventions. How do you prioritize or think about the different weight loss strategies or treatments with your patients, and how do you think about the way that you recommend these different treatments or not? Dr Mollan: Yeah. I think that's a really great question because we sort of stray here into a specialty that we have not been trained in. One thing I definitely ask my patients: if they've been on a weight loss journey before, and what's worked for them and what's not worked for them. And within our different healthcare systems, we have access to different tiers of weight management approaches. But for the person sitting in front of me, that possibly there may be a long journey to access more professional care, it's about understanding. iIs there things that are free, such as, we have some apps in the National Health Service which are weight management applications where they can actually just start putting in their calories, their daily calorie intake. And those apps can be quite helpful and guiding in terms of targeting areas, but also informing the patient of what types of foods to avoid in their diet and what types of foods to include in their diet. And with some of the programs that are completely complementary, they also sometimes add on things about exercise. But I think it is a really difficult thing to manage as, say, an ophthalmologist or a neurologist, mainly because it's not our area of expertise. And I think we've all got to find, in our local hospitals and healthcare systems, those pathways where the patients may be able to access nutritional support, and sort of behavioral lifestyle therapy support, all the way through to the new medications for weight loss; and also for some people, bariatric surgery pathways. It's a tricky topic. Dr Nevel: So how should we counsel our patients about what to expect in the future in terms of visual outcomes? Dr Chen: I think a lot of that depends on the degree of papilledema when they present. If a patient comes in with grade five papilledema, that fulminant IIH that Dr Mollan had mentioned, these patients can have very severe vision loss. And even if we treat them very aggressively with high-dose medications and urgent surgical interventions, sometimes they can have permanent vision loss. And so, we counsel them that, you know, there's a strong chance that they're going to have a good amount of vision loss. But some patients, we're very surprised and we get a lot of vision back. So, we kind of set expectations, but we're cautiously optimistic that we can get vision back. If a patient presents with more mild papilledema like grade one or two papilledema, they're most likely not going to have any permanent vision loss as long as we're treating them, we're monitoring their vision, they're coming to their follow-ups. They tend to do very well from a vision perspective. Dr Nevel: That's great, thank you. And you know, ties into what you said earlier about really making sure that, you know, we create good- as with any patient, but good physician-patient relationships so that they, you know, trust us and they come to follow up so we can really monitor their vision appropriately. What do you think is going on in research in this area that's exciting? What do you think one of the next breakthroughs or thing that we need to understand the most about treatment and monitoring of IIH? Dr Chen: I think surgically, venous sinus stenting is going to probably take over the bulk of surgeries. We still need that randomized clinical trial, but we have some amazing outcomes with venous sinus stenting. And there's many efforts on randomized clinical trials for venous sinus stenting. So we'll have those results soon. From a medical standpoint, Dr Mollan can actually say, actually, more about this. Dr Mollan: I completely agree. The GLP-1 receptor agonists, the twofold prong approach: one is the weight loss where these patients, you know, have significant weight loss to put their disease into remission; and the other side of it is whether certain GLP-1s have the ability to reduce intracranial pressure. So, a phase 2 study that we undertook here in Birmingham did show that we were able to reduce intracranial pressure, but we don't think it's a class effect. So, I think the sort of big breakthrough will be looking at novel therapies like xenotide and other drugs that, say, work on the proximal kidney tubule. Are they able to reduce intracranial pressure directly? And I think we are on the cusp of a real breakthrough for this disease. Dr Nevel: Great. Thank you so much for chatting with me today. And I really learned a lot, appreciated the opportunity. I hope our listeners learned something today, too. So again, today I've been interviewing Drs John Chen and Susan Mollan about their article on treatment and monitoring of idiopathic intracranial hypertension, which appears in the most recent issue of Continuum on disorders of CSF dynamics. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/AZC865. CME credit will be available until 19 June 2026.Navigating the Layers of Complexity in R/R B-Cell Cancers: From Clinical Prognosis to Emerging Therapeutic Prospects in CLL/SLL, MCL, and DLBCL In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/AZC865. CME credit will be available until 19 June 2026.Navigating the Layers of Complexity in R/R B-Cell Cancers: From Clinical Prognosis to Emerging Therapeutic Prospects in CLL/SLL, MCL, and DLBCL In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc.Disclosure information is available at the beginning of the video presentation.

The Faculty Factory podcast is back this week with a deep exploration of academic promotions for clinicians as we interview Anne Walling, MB, ChB, who has written extensively about the topic. Her writings are based on her years of practical on-the-job experience with faculty. Dr. Walling is a professor emerita at the University of Kansas School of Medicine-Wichita in Wichita, Kansas and is the author of Academic Promotion for Clinicians: A Practical Guide to Promotion and Tenure in Medical Schools. She joins our show this week as a first-time guest to discuss the second edition of this book, along with exploring a variety of aspects related to promotions in academic medicine from many different angles. You can learn more about her book here: https://link.springer.com/book/10.1007/978-3-031-84036-4

Interview with Michael McDermott, MBChB, author of CT Angiography, Healthy Lifestyle Behaviors, and Preventive Therapy: A Nested Substudy of the SCOT-HEART 2 Randomized Clinical Trial, and Pamela S. Douglas, MD, author of The Last Mile in Prevention—Can Coronary CT Angiography Help? Hosted by Ann Marie Navar, MD, PhD. Related Content: CT Angiography, Healthy Lifestyle Behaviors, and Preventive Therapy The Last Mile in Prevention—Can Coronary CT Angiography Help?

Interview with Michael McDermott, MBChB, author of CT Angiography, Healthy Lifestyle Behaviors, and Preventive Therapy: A Nested Substudy of the SCOT-HEART 2 Randomized Clinical Trial, and Pamela S. Douglas, MD, author of The Last Mile in Prevention—Can Coronary CT Angiography Help? Hosted by Ann Marie Navar, MD, PhD. Related Content: CT Angiography, Healthy Lifestyle Behaviors, and Preventive Therapy The Last Mile in Prevention—Can Coronary CT Angiography Help?

Join hosts Nidhi Madan, MD; Prashant Nagpal, MD, FSCCT; Jill Jacobs, MD, MS-HQSM, FSCCT and Cristina Fuss, MD, PhD, FSCCT as they take a deep dive into featured articles in the March – April 2025 issue of the Journal of Cardiovascular Computed Tomography (JCCT). Our hosts chat with Jonathan Weir McCall, MBChB, PhD, FRCR, FSCCT; Tilman Emrich, MD; Akos Varga-Szemes, MD, PhD; Emese Zsarnoczay, MD; David Wilson, PhD and Juhwan Lee, PhD . This episode will explore:A new business paradigm to make coronary CT angiography (CCTA) accessible to allPredicting Mortality After Transcatheter Aortic Valve Replacement Using AI-Based Fully Automated Left Atrioventricular Coupling IndexPrediction of obstructive coronary artery disease using coronary calcification and epicardial adipose tissue assessments from CT calcium scoring scansSupport the show

Papilledema describes optic disc swelling (usually bilateral) arising from raised intracranial pressure. Due to its serious nature, there is a fear of underdiagnosis; hence, one major stumbling points is correct identification, which typically requires a thorough ocular examination including visual field testing. In this episode, Kait Nevel, MD speaks with Susan P. Mollan, MBChB, PhD, FRCOphth, author of the article “Papilledema” in the Continuum® April 2025 Neuro-ophthalmology issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Mollan is a professor and neuro-ophthalmology consultant at University Hospitals Birmingham in Birmingham, United Kingdom. Additional Resources Read the article: Papilledema Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @IUneurodocmom Guest: @DrMollan Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Nevel: Hello, this is Dr Kait Nevel. Today I'm interviewing Dr Susan Mollan about her article Papilledema Diagnosis and Management, which appears in the April 2025 Continuum issue on neuro-ophthalmology. Susie, welcome to the podcast, and please introduce yourself to our audience. Dr Mollan: Thank you so much, Kait. It's a pleasure to be here today. I'm Susie Mollan, I'm a consultant neuro-ophthalmologist, and I work at University Hospitals Birmingham- and that's in England. Dr Nevel: Wonderful. So glad to be talking to you today about your article. To start us off, can you please share with us what you think is the most important takeaway from your article for the practicing neurologist? Dr Mollan: I think really the most important thing is about examining the fundus and actually trying to visualize the optic nerves. Because as neurologists, you're really acutely trained in examining the cranial nerves, and often people shy away from looking at the eyes. And it can give people such confidence when they're able to really work out straightaway whether there's going to be a problem or there's not going to be a problem with papilledema. And I guess maybe a little bit later on we can talk about the article and tips and tricks for looking at the fundus. But I think that would be my most important thing to take away. Dr Nevel: I'm so glad that you started with that because, you know, that's something that I find with trainees in general, that they often find one of the more daunting or challenging aspects of learning, really, how to do an excellent neurological exam is examining the fundus and feeling confident in diagnosing papilledema. What kind of advice do you give to trainees learning this skill? Dr Mollan: So, it really is practice and always carrying your ophthalmoscope with you. There's lots of different devices that people can choose to buy. But really, if you have a direct ophthalmoscope, get it out in the ward, get it out in clinic. Look at those patients that you'd know have alternative diagnosis, but it gives you that practice. I also invite everybody to come to the eye clinic because we have dilated patients there all the time. We have diabetic retinopathy clinics, and it makes it really easy to start to acquire those skills because I think it's very tricky, because you're getting a highly magnified view of the optic nerve and you've got to sort out in your head what you're actually looking at. I think it's practice. and then use every opportunity to really look at the fundus, and then ask your ophthalmology colleagues whether you can go to clinic. Dr Nevel: Wonderful advice. What do you think is most challenging about the evaluation of papilledema and why? Dr Mollan: I think there are many different aspects that are challenging, and these patients come from lots of different areas. They can come from the family doctor, they can come from an optician or another specialist. A lot of them can have headache. And, as you know, headache is almost ubiquitous in the population. So, trying to pull out the sort of salient symptoms that can go across so many different conditions. There's nothing that's pathognomonic for papilledema other than looking at the optic nerves. So, I think it's difficult because the presentation can be difficult. The actual history can be challenging. There are those rare patients that don't have headache, don't have pulsatile tinnitus, but can still have papilledema. So, I think it- the most challenging thing is actually confirming papilledema. And if you're not able to confirm it, getting that person to somebody who's able to help and confirm or refute papilledema is the most important thing. Dr Nevel: Yeah, right. Because you talk in your article the importance of distinguishing between papilledema and some other diagnoses that can look like papilledema but aren't papilledema. Can you talk about that a little bit? Dr Mollan: Absolutely. I think in the article it's quite nice because we were able to spend a bit of time on a big table going through all the pseudopapilledema diagnoses. So that includes people with shortsightedness, longsightedness, people with optic nerve head drusen. And we've been very fortunate in ophthalmology that we now have 3D imaging of the optic nerve. So, it makes it quite clear to us, when it's pseudopapilledema, it's almost unfair when you're using the direct ophthalmoscope that you don't get a cross sectional image through that optic nerve. So, I'd really sort of recommend people to delve into the article and look at that table because it nicely picks out how you could pick up pseudopapilledema versus papilledema. Dr Nevel: Perfect. In your article, you also talk about what's important to think about in terms of causes of papilledema and what to evaluate for. Can you tell us, you know, when you see someone who you diagnose with papilledema, what do you kind of run through in terms of diagnostic tests and things that you want to make sure you're evaluating for or not missing? Dr Mollan: Yeah. So, I think the first thing is, is once it's confirmed, is making sure it's isolated or whether there's any additional cranial nerve palsies. So that might be particularly important in terms of double vision and a sixth nerve palsy, but also not forgetting things like corneal sensation in the rest of the cranial nerves. I then make sure that we have a blood pressure. And that sounds a bit ridiculous in this day and age because everybody should have a blood pressure coming to clinic or into the emergency room. But sometimes it's overlooked in the panic of thinking, gosh, I need to investigate this person. And if you find that somebody does have malignant hypertension, often what we do is we kind of stop the investigational pathway and go down the route of getting the medics involved to help with lowering the blood pressure to a safe level. I would then always think about my next thing in terms of taking some bloods. I like to rule out anemia because anemia can coexist in a lot of different conditions of raised endocranial pressure. And so, taking some simple blood such as a complete blood count, checking the kidney function, I think is important in that investigational pathway. But you're not really going to stop there. You're going to move on to neuroimaging. It doesn't really matter what you do, whether you do a CT or an MRI, it's just getting that imaging pretty much on the same day as you see the patient. And the key point to that imaging is to do venography. And you want to rule out a venous sinus thrombosis cause that's the one thing that is really going to cause the patient a lot of morbidity. Once your neuroimaging is secure and you're happy, there's no structural lesion or a thrombosis, it's then reviewing that imaging to make sure it's safe to proceed with lumbar puncture. And so, we would recommend the lumbar puncture in the left lateral decubitus position and allowing the patient to be as calm and relaxed as possible to be able to get that accurate opening pressure. Once we get that, we can send the CSF for contents, looking for- making sure they don't have any signs of meningitis or raised protein. And then, really, we're at that point of saying, you know, we should have a secure diagnosis, whether it would be a structural lesion, venous sinus thrombosis, or idiopathic intracranial hypertension. Dr Nevel: Wonderful. Thank you for that really nice overview and, kind of, diagnostic pathway and stepwise thought process in the evaluations that we do. There are several different treatments for papilledema that you go through in your article, ranging from surgical to medication options. When we're taking care of an individual patient, what factors do you use to help guide you in this decision-making process of what treatment is best for the patient and how urgent treatment is? Dr Mollan: I think that's a really important question because there's two things to consider here. One is, what is the underlying diagnosis? Which, hopefully, through the investigational save, you'll have been able to achieve a secure diagnosis. But going along that investigational pathway, which determines the urgency of treatment, is, what's happening with the vision? If we have somebody where we're noting that the vision is affected- and normally it's actually through a formal visual field. And that's really challenging for lots of people to get in the emergency situation because syndromes of raised endocranial pressure often don't cause problems with the visual acuity or the color vision until it's very late. And also, you won't necessarily get a relative afferent papillary defect because often it's bilateral. So I really worry if any of those signs are there in somebody that may have papilledema. And so, a lot rests on that visual field. Now, we're quite good at doing confrontational visual fields, but I would say that most neurologists should be carrying pins to be able to look at the visual fields rather than just pointing fingers and quadrants if you're not able to get a formal visual field early. It's from that I would then determine if the vision is affected, I need to step up what I'm going to do. So, I think the sort of next thing to think about is that sort of vision. So, if we have somebody who, you know, you define as have severe sight loss at the point that you're going through this investigational pathway, you need to get an ophthalmologist or a neuro-ophthalmologist on board to help discuss either the surgery teams as to whether you need to be heading towards an intervention. And there are a number of different types of intervention. And the reason why we discuss it in the article---and we'll also be discussing it in a future issue of Continuum---is there's not high-class evidence to suggest one surgery over another surgery. We may touch on this later. So, we've got our patients with severe visual loss who we need to do something immediately. We may have people where the papilledema is moderate, but the vision isn't particularly affected. They may just have an enlarged blind spot. For those patients, I think we definitely need to be thinking about medical therapy and talking to them about what the underlying cause is. And the commonest medicine to use for raised endocranial pressure in this setting is acetazolamide, a carbonic anhydrous inhibitor. And I think that should be started at the point that you believe somebody has moderate papilledema, with a lot of discussion around the side effects of the medicine that we go into the article and also the fact that a lot of our patients find acetazolamide in an escalating dose challenging. There are some patients with very mild papilledema and no visual change where I might say, hey, I don't think we need to start treatment immediately, but you need to see somebody who understands your disease to talk to you about what's going on. And generally, I would try and get somebody out of the emergency investigational pathway and into a formal clinic as soon as possible. Dr Nevel: Thank you so much for that. One thing that I was wondering that we see clinically is you get a consult for a patient, maybe, who had an isolated episode of vertigo, back to their normal self, completely resolved… but incidentally, somebody ordered an MRI. And that MRI, in the report, it says partially empty sella, slight flattening of the posterior globe, concerns for increased intracranial pressure. What should we be doing with these patients who, you know, normal neurological exam, maybe we can't detect any definite papilledema on our endoscopic exam. What do you think the appropriate pathway is for those patients? Dr Mollan: I think it's really important. The more neuroimaging that we're doing, we're sort of seeing more people with signs that are we don't believe are normal. So, you've mentioned a few, the sort of partially empty sella, empty sella, tortuosity of the optic nerves, flattening of the globes, changes in transverse sinus. And we have quite a nice, again, table in the article that talks about these signs. But they have really low sensitivity for a diagnosis of raised endocranial pressure and isolation. And so, I think it's about understanding the context of which the neuroimaging has been taken, taking a history and going back and visiting that to make sure that they don't have escalating headache. And also, as you said, rechecking the eye nerves to make sure there's no papilledema. I think if you have a good examination with the direct ophthalmoscope and you determine that there's no papilledema, I would be confident to say there's no papilledema. So, I don't think they need to necessarily cry doubt. The ophthalmology offices, we certainly are having quite a few additional referrals, particularly for this, which we kind of called IIH-RAD, where patients are coming to us for this exclusion. And I think, in the intervening time, patients can get very anxious about having a sort of MRI artifact picked up that may necessarily mean a different diagnosis. So, I guess it's a little bit about reassurance, making sure we've taken the appropriate history and performed the examination. And then knowing that actually it's really a number of different signs that you need to be able to confidently diagnose raised ICP, and also the understanding that sometimes when people have these signs, if the ICP reduces, those signs remain. You know, we're learning an awful lot more about MRI imaging and what's normal, what's within normal limits. So, I think reassurance and sensible medical approach. Dr Nevel: Absolutely. In the section in your article on idiopathic intracranial hypertension, you spend a little bit of time talking about how important it is that we sensitively approach the topic of potential weight loss for those patients who are overweight. How do you approach that discussion in your clinic? Because I think it's an important part of the holistic patient care with that condition. Dr Mollan: I think this is one of the things that we've really listened to the patients about over the last number of years where we recognize that in an emergency situation, sometimes we can be quite quick to sort of say, hey, you have idiopathic endocranial hypertension and weight loss is, you know, the best treatment for the condition. And I think in those circumstances, it can be quite distressing to the patient because they feel that there's a lot of stigma attached around weight management. So, we worked with the patient group here at IIH UK to really come up with a way of a signposting to our patients that we have to be honest that there is a link, you know, a strong evidence that weight gain and body shape change can cause someone to fall into a diagnosis of IIH. And we know that weight loss is really effective with this condition. So, I think where I've learned from the patients is trying to use language that's less stigmatizing. I definitely signpost that I'm going to talk about something sensitive. So, I say I'm going to talk about something sensitive and I'm going to say, do you know that this condition is related to body shape change? And I know that if I listen to this podcast in a couple of years, I'm sure my words will have changed. And I think that's part of the process, is learning how to speak to people in an ever-changing language. And they think that sort of signpost that you're going to talk about something sensitive and you're going to talk about body shape change. And then follow up with, are you OK with me talking about this now? Is it something you want to talk about? And the vast majority of people say, yes, let's talk about it. There'll be a few people that don't want to talk about it. And I usually come in quite quickly, say, is it OK if I mention it at the next consultation? Because we have a duty of care to sort of inform our patients, but at the same time we need to take them on that journey to get them back to health, and they need to be really enlisted in that process. Dr Nevel: Yeah, I really appreciate that. These can be really difficult conversations and uncomfortable conversations to have that are really important. And you're right, we have a duty as medical providers to have these conversations or inform our patients, but the way that we approach it can really impact the way patients perceive not only their diagnosis, but the relationship that we have with our patients. And we always want that to be a positive relationship moving forward so that we can best serve our patients. Dr Mollan: I think the other thing as well is making sure that you've got good signposts to the professionals. And that's what I say, because people then say to me, well, you know, kind of what diet should I be on? What should I be doing? And I say, well, actually, I don't have professional experience with that. I'm, I'm very fortunate in my hospital, I'm able to send patients to the endocrine weight management service. I'm also able to send patients to the dietetic service. So, it's finding, really, what suits the patient. Also what's within licensing in your healthcare system to be able to provide. But not being too prescriptive, because when you spend time with weight management professionals, they'll tell you lots of different things about diets that people have championed and actually, in randomized controlled trials, they haven't been effective. I think it's that signpost really. Dr Nevel: Yeah, absolutely. So, could you talk a little bit about what's going on in research in papilledema or in this area, and what do you think is up-and-coming? Dr Mollan: I think there's so much going on. Mainly there's two parts of it. One is image analysis, and we've had some really fantastic work out of the Singapore group Bonsai looking at a machine learning decision support tool. When people take fundal pictures from a normal fundus camera, they're able to say with good certainty, is this papilledema, is this not papilledema? But more importantly, if you talk to the investigators, something that we can't tell when we look in is they're able to, with quite a high level of certainty, say, well, this is base occupying lesion, this is a venous sinus thrombosis, and this is IIH. And you know, I've looked at thousands and thousands of people's eyes and that I can't tell why that is. So, I think the area of research that is most exciting, that will help us all, is this idea about decision support tools. Where, in your emergency pathway, you're putting a fundal camera in that helps you be able to run the image, the retina, and also to try and work out possibly what's going on. I think that's where the future will go. I think we've got many sort of regulatory steps and validation and appropriate location of a learning to go on in that area. So, that's one side of the imaging. I think the other side that I'm really excited about, particularly with some of the work that we've been doing in Birmingham, is about treatment. The surgical treatments, as I talked about earlier… really, there's no high-class evidence. There's a number of different groups that have been trying to do randomized trials, looking at stenting versus shunting. They're so difficult to recruit to in terms of trials. And so, looking at other treatments that can reduce intracranial pressure. We published a small phase two study looking at exenatide, which is a glucagon-like peptide receptor agonist, and it showed in a small group of patients living with IIH that it could reduce the intracranial pressure two and a half hours, twenty-four hours, and also out to three months. And the reason why this is exciting is we would have a really good acute therapy---if it's proven in Phase III trials---for other diseases, so, traumatic brain injury where you have problems controlling ICP. And to be able to do that medically would be a huge breakthrough, I think, for patient care. Dr Nevel: Yeah, really exciting. Looking forward to seeing what comes in the future then. Wonderful. Well, thank you so much for chatting with me today about your article. I really enjoyed learning more from you during our conversation today and from your article, which I encourage all of our listeners to please read. Lots of good information in that article. So again, today I've been interviewing Dr Susie Mollan about her article Papilledema Diagnosis and Management, which appears in the most recent issue of Continuum on neuro-ophthalmology.Please be sure to check out Continuum episodes from this and other issues. And thank you to our listeners for joining us today. Thank you, Susie. Dr Mollan: Thank you so much. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

In this episode of Pushing the Limits, we dive deep into female hormone health with Dr. Samantha Newman, founder of Female GP. Whether you're in your 20s or navigating menopause, hormones play a crucial role in energy, mood, metabolism, fertility, and overall well-being. Dr. Newman shares her holistic and medical approach to hormone optimisation, helping women achieve hormonal balance through functional medicine, lifestyle, nutrition, and biohacking strategies. Topics Covered: The biggest hormonal imbalances affecting women today The role of stress, sleep, and nutrition in hormone health How to optimise your hormones The impact of perimenopause and menopause on energy, weight, and mood Bioidentical hormones and natural supplements for hormonal balance How to get your doctor to work with you on your hormone journey  The importance of understanding your hormone history to understand where you are at today. If you're struggling with PMS, low energy, mood swings, brain fog, weight gain, or burnout, this episode is packed with actionable insights to help you take control of your hormonal health. Subscribe & share if you know someone who needs this info! Dr. Samantha Newman Bio: Dr. Samantha Newman, MBChB, BSc (hons), PGDipOMG, General Practitioner with a Specialist Interest in Women's Health | Honorary Lecturer at the University of Auckland | Adjunct Associate Researcher University of Monash Dr Samantha runs a specialist women's health clinic and works as a GP at a Family Practice. Her practice is founded upon empowering women to understand their body and mind, and how pelvic, musculoskeletal, brain and hormone health are inseparable. Dr Sam is involved in research projects, is a founder and trustee of women's health charity, Rose Gold Trust, and has a passion for educating.

Americans say there is no place for the likes of McDonald's and Chick-fil-A in hospitals.   The giants of fast food are serving greasy, fatty, artery-clogging foods in the same building where patients are receiving artery-opening stents and pacemakers. Often these lifesaving surgeries are just a floor or two above where the unhealthy combo meals are being served up.   In a way it's like having an Alcoholics Anonymous meeting above a bar. It just doesn't make sense.   Eating fast food four times a week may increase heart disease risk by 80%, according to one study.   So, why is it happening?   Dr. Roxanne Becker joins "The Weight Loss Champion" Chuck Carroll on The Exam Room Podcast to talk about the findings of the hospital survey that revealed mounting frustrations with the state of hospital food.   — — SHOW LINKS — — Hospital Fast Food Survey Background: https://bit.ly/PCRMHospitalFoodSurvey Full survey: https://bit.ly/FastFoodHospitals2024 — — — Roxanne Becker, MBChB, DipIBLM Bio: https://www.pcrm.org/about-us/staff/roxanne-becker — — — Free Athlete Nutrition E-Book https://www.pcrm.org/athlete — — BECOME AN EXAM ROOM VIP — — Sign up: https://www.pcrm.org/examroomvip — — THIS IS US — — The Exam Room Podcast Instagram: https://www.instagram.com/theexamroompodcast — — — Chuck Carroll Instagram: https://www.instagram.com/ChuckCarrollWLC Facebook: http://wghtloss.cc/ChuckFacebook X: https://www.twitter.com/ChuckCarrollWLC — — — Physicians Committee Instagram: https://www.instagram.com/physicianscommittee Facebook: https://www.facebook.com/PCRM.org X: https://www.twitter.com/pcrm YouTube: https://www.youtube.com/user/PCRM Jobs: https://www.pcrm.org/careers — — SUBSCRIBE & SHARE — — 5-Star Success: Share Your Story Apple: https://apple.co/2JXBkpy​​ Spotify: https://spoti.fi/2pMLoY3 Please subscribe and give the show a 5-star rating on Apple Podcasts, Spotify, or many other podcast providers. Don't forget to share it with a friend for inspiration!

Precision medicine — the approach to health care that involves tailoring medical interventions to an individual's genetic makeup, environment and lifestyle — promises to deliver the right treatment to the right person at the right time. From preventing diseases decades before they appear, to specially designed cocktails of cancer drugs, to genetic modification of rare diseases, many of these applications sound straight out of science fiction. At the forefront of precision medicine and medical genomics is Euan Ashley, MBChB, DPhill, Chair of Medicine at Stanford University Medical Center. A cardiologist and intensive care physician by training, Dr. Ashley has pioneered the use of genetic sequencing to identify risk factors for heart disease and new treatments for rare diseases. He is also the author of The Genome Odyssey: Medical Mysteries and the Incredible Quest to Solve Them (2021).Over the course of our conversation, we discuss his path from growing up in a small Scottish town to now working at the cutting edge of medicine, the excitement and fulfillment he experiences as a clinician in the cardiac intensive care unit, remarkable patient stories of healing and resilience, the future of precision medicine, why he is optimistic about the development of artificial intelligence, and more.In this episode, you'll hear about: 2:24 - Dr. Ashley's path to medicine and to cardiology 7:19 - What life is like working in the CCU21:34 - How the Undiagnosed Diseases Network was founded and what it does33:22 - An overview of precision medicine38:09 - The impact that genetic testing and genomic medicine is having on modern medicine and where it could go from here 45:00 - Dr. Ashley's thoughts on how AI will change the field of medicine 51:40 - Making access to medical advancements in AI and genomics more equitable 1:04:39 - Dr. Ashley's advice for healthcare professionals in training Dr. Euan Ashley can be found on Twitter/X at @euanashley. Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to info@thedoctorsart.com.Copyright The Doctor's Art Podcast 2024