Podcasts about mdedge

Play Episode Listen Later May 27, 2021 32:06

Existing biosimilars are safe, effective alternatives to their reference biologics, and are increasingly being incorporated into oncology treatment guidelines. Technological advances that have emerged in the years since biologic agents entered the market allow for the careful assessment of “critical clinical attributes” of biosimilar agents. This helps ensure the safety and efficacy of biosimilars, as well as their structural, functional, and behavioral similarities to the original reference biologics, according to Gary Lyman MD, MPH, professor and senior lead, health care quality and policy at the Hutchinson Institute for Cancer Outcomes Research at Fred Hutchinson Cancer Research Center, Seattle. Biosimilars are increasingly being included as acceptable alternatives in treatment guidelines, and in this episode Dr. Lyman discussed the reasons why they are considered safe and effective, how they can add value for oncology patients, and the need for ongoing diligence in monitoring their effects. Biosimilars in oncology – key points: The developers of biosimilar agents must prove biosimilarity to the reference agent, and generally go through “many of the same, if not all, preclinical steps.” Regulatory requirements are sufficient to ensure there are no clinically meaningful differences in the safety, purity, strength, and efficacy of biosimilars. Unlike the originator biologics, biosimilars aren’t typically required to complete multiple costly phase 3 clinical studies that drive up drug costs. This has the potential to rein in drug prices for biologics, which have revolutionized oncology and many other fields – but at a significant price. There has been some progress with respect to biologic cost reductions in the wake of biosimilar approvals, but the cost effects of biosimilars for newer reference agents will take time to emerge. Further prolonging the cost-reducing effects of biosimilar availability is the fact that early biosimilars were mainly used for supportive care whereas newer biosimilars are more often used for curative intent, which may lead to slower uptake due to hesitancy among clinicians and patients. The European Medicines Agency (EMA) is about a decade ahead of the United States when it comes to approvals and acceptance of biosimilars. Of note, no approved biosimilar has been removed from the market due to concerns about safety and efficacy. This is “a huge testament to the durability of biosimilars and the strength of the regulatory process,” Dr. Lyman said, noting that the EMA and FDA have similar processes when it comes to such approvals. “Drift,” the inevitable changes over time in an agent’s characteristics, can lead to changes in safety and efficacy. This means that diligence in monitoring effects and outcomes with both biologics and biosimilars is essential. Any concerns should be reported immediately and investigated. Show notes written by Sharon Worcester, MA, a reporter for MDedge and Medscape. Disclosures Dr. Henry has no relevant disclosures. Dr. Lyman disclosed relationships with Amgen, Jazz Pharmaceuticals, Partners Therapeutics, Sandoz, Seattle Genetics, Bristol Myers Squibb, BeyondSpring, Samsung, G1 Therapeutics, and Merck. * * * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd

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EP #282 - 05.25.2021 -Vaccination Expert Roundtable

COVIDCalls

Play Episode Listen Later May 26, 2021 84:40

Today I welcome Maya Goldenberg, Tara Haelle, Ross Silverman, and Dorit Reiss for a roundtable discussion on COVID-19 vaccines and vaccination. Dorit Rubinstein Reiss is a professor of law at the University of California, Hastings College of the Law. Increasingly, her research and activities are focused on legal issues related to vaccines, including exemption laws and tort liability related to non-vaccination. She has published law review and peer reviewed articles and many blog posts on legal issues related to vaccines. Ross D. Silverman, JD, MPH, is Professor of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health and Professor of Public Health and Law at the Indiana University Robert H. McKinney School of Law in Indianapolis. He serves as a member of the Covid-19 Vaccine Allocation advisory committee for the Indiana State Health Department, and is an Associate Editor for the journal Public Health Reports, the official journal of the U.S. Surgeon General and the U.S. Public Health Service. Maya Goldenberg is Associate Professor of Philosophy at the University of Guelph (pronounced Gwelf) in Canada. She works in philosophy of medicine and has a new book on vaccine hesitancy coming out in March 2021. _Vaccine Hesitancy: Public Trust, Expertise, and the War on Science’_ is published by University of Pittsburgh Press. Tara Haelle is a freelance science journalist and photojournalist who serves as the AHCJ Core Topic Leader for Medical Studies. She particularly specializes in reporting on vaccines, pediatrics, maternal health, obesity, nutrition, mental health and medical research in general, and she regularly speaks on vaccine hesitancy. Her work has appeared in Elemental, Scientific American, New York Times, Forbes, Politico, Slate, NOVA, Wired and Science, and she writes and covers medical conferences regularly for Medscape and MDEdge.

Gene therapies in hemophilia with Dr. Glenn Pierce

Play Episode Listen Later May 13, 2021 24:10

A “very basic” type of gene therapy could potentially cure hemophilia, but a major hurdle has been the lack of an effective mode of delivery. Recent strides in using adeno-associated virus (AAV) vectors are changing that, and Glenn Pierce, MD, World Federation of Hemophilia Vice President, Medical, predicts approvals in the next 12-18 months. Dr. Pierce shared his personal experience with hemophilia and discussed his and others’ ongoing research on the use of AAV-mediated gene therapy with host David Henry, MD, in this episode. Hemophilia and AAV gene therapy key points: Hemophilia is caused by a monogenic defect and could, theoretically, be cured by gene replacement or augmentation, says Dr. Pierce, who notes that “it sounds disarmingly simple, but behind that simplicity is a very complex procedure.” The approach uses “gene addition,” which is a basic gene therapy involving the addition of a normal gene to the variant in an individual. This ultimately corrects the clotting factor deficiency. The complexity is in getting the normal gene into the body where it can have the intended therapeutic effect. After more than 20 years of working to overcome that barrier, Dr. Pierce and others are finding success with using AAVs. The approach has some similarities to that used in developing the mRNA COVID-19 vaccines but requires the use of DNA established within the virus (rather than mRNA) to provide a more stable effect. Questions about how long it will last are currently being investigated. Multiple phase 3 trials are underway or completed. Data from two of those have been released in recent months, and the results are very encouraging: “It’s a remarkable achievement – many patients are doing well and, for all intents and purposes, could be considered free of [hemophilia],” Dr. Pierce says, adding that he would “potentially … use the ‘C word’ – cured – for at least a period of time.” The therapy is generally well tolerated. Efforts are ongoing to identify the best ways to proactively and reactively use prednisone to manage side effects such as mild increases in transaminase levels. To date, the risk-benefit profile appears reasonable for patients with clotting factor IX deficiency, and it is likely that the therapy in that setting “will march toward the regulatory process to determine if it’s safe and effective for approval,” he said. Responses in those with clotting factor VIII deficiency have been more variable, with some patients requiring long-term prednisone use, which is problematic. More information is needed about this, but investigation is ongoing, he said. Registries are available and many companies are involved in clinical trials. Clinicians and patients can look for information at clinicaltrials.gov, wfh.org (which publishes trial results and conducts workshops and meetings), and at the US National Hemophilia Foundation (Hemophilia.org) and the Society of Thrombosis and Hemostasis (ISTH.org). Show notes written by Sharon Worcester, MA, a reporter for MDedge and Medscape. Disclosures Dr. Henry has no relevant disclosures. Dr. Pierce disclosed relationships with Ambys Medicines, BioMarin, BridgeBio, CRISPR Therapeutics, Decibel Therapeutics, Frontera, Geneception, Generation Bio, Novo Nordisk, Pfizer, Regeneron, Third Rock Ventures, Voyager Therapeutics, Global Blood Therapeutics, VarmX SAB, the National Hemophilia Foundation Medical and Scientific Advisory Council, and the World Federation of Hemophilia. * * * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd

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Thrombosis and thrombocytopenia caused by COVID-19 vaccines: How to identify and treat VITT, VIPIT, or TTS

Play Episode Listen Later May 6, 2021 23:11

At least 17 cases of thrombosis and thrombocytopenia have been reported in patients who received the Johnson & Johnson COVID-19 vaccine in the United States. Such events have been reported in patients who received the AstraZeneca vaccine as well. In this episode, Adam C. Cuker, MD, of the University of Pennsylvania, Philadelphia, tells host David H. Henry, MD, how to identify and manage patients with these vaccine-induced events. What’s in a name? The phenomenon of vaccine-induced thrombosis and thrombocytopenia has been given different names, including: Vaccine-induced immune thrombotic thrombocytopenia (VITT) Vaccine-induced prothrombotic immune thrombocytopenia (VIPIT) Thrombosis and thrombocytopenia syndrome (TTS). Dr. Cuker’s preferred acronym is VITT. VITT is an immune-mediated reaction to the Johnson & Johnson and AstraZeneca vaccines that “results in thrombocytopenia and a strong propensity for thrombosis,” Dr. Cuker explained. Dr. Henry noted that VITT is reminiscent of heparin-induced thrombocytopenia (HIT). Incidence unclear VITT appears to be “very rare,” but “we still don't have a great sense of how common it is” because additional cases may not have been recognized or have yet to present, Dr. Cuker said. VITT occurs about 5-30 days after vaccination. VITT appears to be mediated by IgG antibodies, which take time to build up. The exact mechanism is unknown, but VITT could be related to the adenovirus vector used in the Johnson & Johnson and AstraZeneca vaccines, Dr. Cuker said. The first 15 cases of VITT associated with the Johnson & Johnson vaccine occurred in women, and most patients were aged under 50 years. In Canada, where the AstraZeneca vaccine is available, cases of VITT have been reported in patients in their 80s and 90s. Diagnosing VITT Symptoms of VITT can include severe, unrelenting headache; severe abdominal pain; nausea and vomiting; as well as typical signs and symptoms of deep vein thrombosis or pulmonary embolism. To determine if a patient has VITT, Dr. Cuker recommends ordering a disseminated intravascular coagulation panel – prothrombin time, partial thromboplastin time, fibrinogen, and D-dimer – as well as a standard HIT enzyme-linked immunosorbent assay (ELISA). Rapid immunoassays for HIT are not reliable for VITT, so HIT ELISA must be used, Dr. Cuker emphasized. Most patients with VITT have a “strongly positive” ELISA with optical density values “well in excess of 100 or 1.0,” depending on the scale, Dr. Cuker said. Manage VITT like HIT Patients should receive an anticoagulant, but not heparin, Dr. Cuker said. It isn’t clear if heparin will be harmful in patients with VITT, but current guidelines recommend avoiding heparin. He also advised against using warfarin or vitamin K antagonists in patients with VITT “at least until their platelet count recovers.” High-dose intravenous immunoglobulin (e.g., 1 g/kg for 2 consecutive days) is recommended, as it is believed to interfere with platelet activation. Show notes written by M. Alexander Otto, a reporter for MDedge and Medscape. Disclosures Dr. Henry has no relevant disclosures. Dr. Cuker has served as a consultant for Synergy Pharmaceuticals; has received authorship royalties from UpToDate; and his institution has received research support on his behalf from Alexion, Bayer, Novartis, Novo Nordisk, Pfizer, Sanofi, Spark Therapeutics, and Takeda. * * * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd

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Toward more personalized treatment in prostate cancer: The CCR score predicts metastasis and guides treatment decisions after radiation

Health Professional Radio - Podcast 454422

Play Episode Listen Later Apr 29, 2021 28:23

The combined clinical cell-cycle risk (CCR) score uses clinical and genetic factors to assess the risk of metastasis after radiation therapy in patients with prostate cancer. The CCR score has proven accurate in studies and can guide post-radiation treatment decisions in practice, according to Jonathan D. Tward, MD, PhD, of the University of Utah, Salt Lake City. Dr. Tward discusses the CCR score with host David Henry, MD, in this episode. About the score The CCR score combines the cell-cycle progression (CCP) score (available commercially as the Prolaris test) and the Cancer of the Prostate Risk Assessment (CAPRA) score to more precisely determine the postradiation risk for metastatic disease. Investigators identified a threshold for determining precise risk levels (2.112), which allows for personalized treatment decision-making based on more individual characteristics than standard risk-group categorizations, according to Dr. Tward. He noted that standard risk groups can include a broad range of actual risk even within a given category. Risk groups are “reasonably good at prognosticating who may or may not go on to have metastasis etc., but they’re not that good,” Dr. Tward said. CCR score proves effective Dr. Tward and colleagues evaluated the CCR score in a retrospective study published in Clinical Genitourinary Cancer (https://bit.ly/3vlgUwe). The study included 718 men with intermediate- or high-risk localized prostate cancer who received single modality or multimodality therapy. Results showed that patients with CCR scores below the identified threshold (2.112) could safely forgo multimodality therapy. CCR score bests other scoring systems In another study, the CCR score proved more accurate than other scoring systems. Dr. Tward presented findings from this study at the 2021 Genitourinary Cancers Symposium (https://bit.ly/3eBvAjM). The study included 741 men with intermediate- or high-risk localized prostate cancer who received single modality or multimodality therapy. The CCR score predicted metastasis (hazard ratio, 2.21; C-index, 0.78) and did so better than National Comprehensive Cancer Network risk groups (C-index, 0.70), the CAPRA score alone (C-index, 0.71), or the CCP score alone (C-index, 0.69). Dr. Tward said he has used the CCR score in his own practice for years and found it helpful. Show notes written by Sharon Worcester, a reporter for MDedge and Medscape. Disclosures Both studies were funded by Myriad Genetics, the company that developed the Prolaris test. Dr. Tward disclosed relationships with Myriad Genetics and other companies. Dr. Henry has no relevant disclosures. * * * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd

university phd risk cancer utah md score results salt lake city guides investigators personalized predicts radiation interact ccp prostate cancer ccr capra medscape metastasis treatment decisions david henry myriad genetics national comprehensive cancer network genitourinary cancers symposium mdedge mdedge podcasts

Dr. Julie Harper discusses Galderma & AKLIEF® (trifarotene) Cream

Play Episode Listen Later Apr 27, 2021 9:10

Returning guest, Dr. Julie Harper, owner of Dermatology and Skin Care Center of Birmingham and Galderma consultant discusses Galderma & AKLIEF® (trifarotene) Cream, 0.005% launch of the "Me Being Me" campaign crafted in response to today's increasingly digital-focused world. The campaign aims to shed light on the connection between acne and self-confidence and equip acne sufferers with the information they need to talk to their dermatology provider about treatment options. She talks about the emotional impact acne has on patients, even in a virtual setting, why acne sufferers are interested in connecting with a dermatologist now more than ever and the important role dermatologists can play in treating acne and improving patients' quality of life. She covers available treatment options, the rise of adult-onset acne, and tips for connecting with patients virtually to discuss treatment. Julie C. Harper, MD, is a Dermatologist and Galderma consultant. She received her medical degree from the University of Missouri, Columbia School of Medicine, and went on to complete an internship in Internal Medicine. She completed her undergraduate degree at Southeast Missouri State University and her dermatology residency at the University of Missouri, Columbia. Dr. Harper is founding director and president-elect of the American Acne and Rosacea Society, a task force member of American Academy of Dermatology Telemedicine, a former American Academy of Dermatology Leadership Retreat Participant, and a former Women's Dermatologic Society Board of Directors Young Physician Representative. She has written and spoken on the subject of acne and rosacea extensively, specifically in MDedge. Dr. Harper has also been featured in Shape and Marie Claire. #AKLIEF #Galderma

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Changing perspectives: Dr. Michael Weiner recounts his experiences as an oncologist who became a cancer patient and then a caregiver

Play Episode Listen Later Apr 22, 2021 25:28

Pediatric oncologists are used to dealing with emotional, heart-wrenching situations, but oncology took on a new dimension for Michael Weiner, MD, when both he and his daughter were diagnosed with cancer. Dr. Weiner, a pediatric oncologist at Columbia University, New York, describes his roles as oncologist, patient, and caregiver to host David H. Henry, MD, in this episode. Oncologist as patient: Lessons learned Dr. Weiner’s journey as a cancer patient began when he felt a lymph node on his neck that he knew wasn’t “normal.” A colleague examined Dr. Weiner and suggested the “watch-and-wait” approach, but Dr. Weiner insisted on immediate biopsy. The diagnosis was follicular lymphoma, and Dr. Weiner had a hard time accepting that his malignancy was treatable but not curable. One of the things Dr. Weiner learned as a cancer patient is that “you really need to connect with your doctor,” so he chose a doctor who felt like a good fit for him. Another lesson Dr. Weiner learned was that cancer can be very isolating. Though friends and family can offer help and support, “you take this journey alone,” he said. Dr. Weiner was treated with rituximab and radiation, which proved successful. It’s been 3 years since he completed his treatment. Dr. Weiner had been reluctant to undergo radiation because of the risk of thyroid cancer, and, unfortunately, he now has a small thyroid nodule that’s under observation. Update: After this episode was recorded, Dr. Weiner was diagnosed with papillary thyroid cancer. He is set to undergo a total thyroidectomy. Oncologist as caregiver: Taking a backseat Dr. Weiner’s daughter was diagnosed with papillary thyroid carcinoma after a nodule was found on a routine exam. Dr. Weiner and his daughter decided to educate themselves about her malignancy and opted for an aggressive course of treatment. “I tried very, very hard to be a parent and not a physician,” Dr. Weiner said. He decided to put his faith in her care team. “I in no way participated in the final decision-making,” he said. His daughter ultimately had a total thyroidectomy and high-dose radioactive iodine. The process, like his own cancer journey, was difficult. Dr. Weiner recounts these experiences in his book “Living Cancer: Stories from an Oncologist, Father, and Survivor,” which can be found here: https://bit.ly/3n7TB5Z. Show notes written by M. Alexander Otto, a reporter for MDedge and Medscape. Disclosures Dr. Weiner and Dr. Henry have no relevant disclosures. These show notes were updated on 4/22. * * * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd

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Improving cancer screening in the COVID era: Drive By Flu-FIT allows for socially distanced colorectal cancer screening

Play Episode Listen Later Apr 1, 2021 25:00

A program called Drive By Flu-FIT has allowed for socially distanced colorectal cancer (CRC) screening during the COVID-19 pandemic. Armenta Washington, senior research coordinator at the University of Pennsylvania, describes the program to guest host Alan Lyss, MD, subprincipal investigator emeritus for Heartland Cancer Research NCORP, in this episode. What is Drive By Flu-FIT? Drive By Flu-FIT is a socially distanced version of the Flu-Fecal Immunochemical Test (Flu-FIT) program. Flu-FIT was designed to increase access to CRC screening by offering take-home FIT tests to patients at the time of their annual flu shots. The goal of Drive By Flu-FIT is to provide a COVID-safe approach to CRC screening and counteract the decrease in CRC screening seen during the pandemic. Drive By Flu-FIT is a joint effort of the University of Pennsylvania, the Einstein Healthcare Network, Chi Eta Phi Sorority, and Enon Tabernacle Baptist Church, the largest Baptist church in the Philadelphia region. How does Drive By Flu-FIT work? To participate in a Drive By Flu-FIT event, community members had to complete eligibility, registration, and demographic questionnaires online. Patients who were enrolled watched a short educational video on CRC and completed two questionnaires – one on CRC screening knowledge (14 items) and one on screening intentions (5 items) – before and after watching the video. At the Drive By Flu-FIT events, patients remained in their cars while physicians in personal protective equipment handed out FITs and explained how to use them and return them. Patients could also receive a flu vaccine at each event. Results: High return rate According to initial data, 335 patients registered for a Drive By Flu-FIT event, but 80 (23.9%) ultimately didn’t attend and 63 (18.8%) were found to be ineligible. A total of 192 patients attended and received a FIT (57.3%). Scores on both questionnaires increased after patients watched the educational video. Patients’ baseline knowledge of CRC was high but lacking in four areas: risk factors for CRC, the optimal frequency of FITs, the link between Lynch syndrome and CRC, and the relationship between physical activity and CRC risk. Of the 192 patients who received a FIT, 38 (19.7%) did not return it. There were 141 patients (73.4%) with a negative FIT result, while 13 (6.7%) had a positive FIT result and were referred for colonoscopy. Resources For more information on Flu-FIT, visit http://flufit.org/. For more details on Drive By Flu-FIT, see: AACR Virtual Meeting: COVID-19 and Cancer, Abstract S02-04: https://bit.ly/3szf0Hp. MDedge coverage of the meeting presentation: https://bit.ly/3szfrl1. Ms. Washington disclosed no conflicts of interest. The study was supported by the National Cancer Institute. The FITs were donated by Polymedco, and the flu vaccines were donated by the Philadelphia Public Health Department. Dr. Lyss writes a column for MDedge Hematology/Oncology called “Clinical Insights” (https://bit.ly/3m76xIP). He has no other conflicts of interest. * * * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc Dr. Lyss on Twitter: @HeartlandOncDoc

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The ripple effects of the COVID-19 pandemic on mental health with Dr. Dost Öngür

Play Episode Listen Later Mar 17, 2021 26:56

Dost Öngür, MD, PhD, joins host Lorenzo Norris, MD, to discuss the emerging mental health effects of the pandemic. Dr. Öngür is chief of the Center of Excellence in Psychotic Disorders at McLean Hospital in Belmont, Mass. He also serves as the William P. and Henry B. Test Professor of Psychiatry at Harvard Medical School, Boston. Dr. Öngür has no disclosures. Dr. Norris is associate dean of student affairs and administration at George Washington University, Washington. He has no disclosures. Take-home points Without a doubt, the COVID-19 pandemic will have a lasting mental health impact on society. Öngür discusses the role of trauma, grief, mourning, and social isolation during the pandemic. Summary One emerging mental health effect of the pandemic is lasting psychiatric symptoms after infection and inflammatory response, including anxiety, depression, insomnia, and fatigue. Many individuals have lost loved ones or witnessed someone close to them experience severe illness and prolonged hospitalizations. Early in the pandemic, in a 2020 Centers for Disease Control and Prevention representative survey, 30% of Americans reported symptoms of depression and anxiety, 13% reported increased substance use, and 11% thought about suicide. Individuals report greater distress, substance use, and suicidal ideation in the United States, but deaths from suicide did not increase dramatically, compared with 2019. A recent study in JAMA Psychiatry noted, however, that emergency department visits for social and mental health emergencies such as suicide attempts, overdoses, and intimate partner violence were higher in mid-March through October 2020 during the COVID-19 pandemic, compared with the same period a year earlier. One possible resilience factor for individuals with mental illness may be the protective nature of family ties. Though the shutdown led to social isolation and detachment from some networks, certain individuals came to rely more on nuclear relationships, such as family. With the pandemic, mental illness and mental health treatment have entered the public consciousness and conversation more than ever before. After the pandemic, more people will need mental health services as the social effects continue to ripple for years to come. References Czeisler ME et al. Mental health, substance use, suicidal ideation during the COVID-19 pandemic – United States, June 24-30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1049-1057. Faust JS et al. Suicide deaths during the COVID-19 stay-at-home advisory in Massachusetts, March to May 2020. JAMA Netw Open. 2021 Jan 21;4(1):e2034273. John A et al. Trends in suicide during the COVID-19 pandemic. BMJ. 2020;371:m452. Tanaka T, Okamoto S. Increase in suicide following an initial decline during the COVID-19 pandemic in Japan. Nat Hum Behav. 2021 Jan 15;5:229-38. Holland KM et al. Trends in U.S. emergency department visits for mental health, overdose, and violence outcomes before and during the COVID-19 pandemic. JAMA Psychiatry. 2020 Feb 3. doi: 10.1001/jamapsychiatry.2020.4402. *** Show notes by Jacqueline Posada, MD, associate producer of the Psychcast; assistant clinical professor in the department of psychiatry and behavioral sciences at George Washington University in Washington; and staff physician at George Washington Medical Faculty Associates, also in Washington. Dr. Posada has no conflicts of interest. For more MDedge podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com

Treating patients with delusional infestation with Dr. John Koo and Dr. Scott Norton

Play Episode Listen Later Feb 24, 2021 57:02

John Koo, MD, and Scott A. Norton, MD, MPH, join host Lorenzo Norris, MD, for this special edition of the Psychcast. This is a crossover episode with our sister podcast, Dermatology Weekly. Dr. Koo is a psychiatrist and a dermatologist at the University of California, San Francisco. He has no disclosures. Dr. Norton is a dermatologist with the Uniformed Services University of the Health Sciences in Bethesda, Md., and with George Washington University, Washington. He has no disclosures. They are featured in an article on this topic online at MDedge.com/Psychiatry. Dr. Norris is associate dean of student affairs and administration at George Washington University. He has no disclosures. Take-home points Delusional infestation or delusions of infestation, also known as delusional parasitosis, is a fixed false belief that one has an infestation of animate or inanimate pathogens, despite strong evidence against infestation. Common precipitants of delusional infestation include previous exposure to external or internal parasites, stress, and travel. The condition is more common among highly functional older women. A recent study estimated the prevalence of delusional infestation as 1.9/100,000, though the condition is an area of limited study. Delusional infestation is poorly recognized by physicians, therapists, and families, which leads patients to search for an external cause of the symptoms and contributes to distress for patients and their loved ones. Patients with delusional parasitosis often lack insight into their disease, and it can be difficult to persuade them to take the recommended treatment of antipsychotics. Low-dose pimozide, a first-generation antipsychotic, is the most common treatment for delusional infestation, particularly because it does not have Food and Drug Administration approval as a treatment for psychosis. Therefore, patients are less biased against taking this medication. Summary Delusions of infestation are a monosymptomatic hypochondriacal psychosis in which the only delusion present is one of infestation, and patients do not have other symptoms of psychotic spectrum illness. Secondary delusions of infestation may occur in individuals who use drugs, such as methamphetamine or cocaine, or who have a primary psychotic disorder, such as schizophrenia. Delusions of infestation is related to Morgellons disease, which is defined as a skin condition characterized by the presence of “threads” or filaments that patients believe are embedded in their skin and might be accompanied by stinging and itching sensations. Patients with delusions of infestation usually present to a primary care physician or ED with symptoms of abnormal sensations of their skin, including crawling sensations. In addition, patients usually bring personal proof of their condition, such as a small bag of “specimens,” including pieces of lint, threads, or scabs. Some patients also bring in journals detailing the timing and associated factors of their symptoms. Dr. Norton advises that physicians treating the patients with delusions of infestation should mentally prepare themselves against initial bias and set aside time for longer visits or several follow-up visits. Dr. Norton starts with the premise that the patient has an actual infestation or other underlying cause of their pruritus and performs a thorough, full-body exam for dermatologic conditions, and examines the materials patients bring with them using a double-headed microscope – so that he and the patient can look at the specimens together. Dr. Koo often tells patients that they have Morgellons disease because it does not include the stigmatizing term of “delusional.” He reframes Morgellons as an infestation that cannot be cured by internal or external antiparasitic medications. He then pivots away from etiology to validation of their emotions and eventually to treatment. Dr. Koo usually often starts treatment with pimozide because it is an antipsychotic with FDA approval for Tourette syndrome – not schizophrenia. This perceived absence of a connection of the medication to psychiatric illness allows patients to be more open to taking the medication. For primary delusional infestation, Dr. Koo starts with pimozide. The dose, which is daily and taken orally, starts low at 0.5 mg and goes up by 0.5 mg every 2-4 weeks. The aim is to get up to 3 mg per day. Low doses of pimozide and other antipsychotics lead to decreased sensation of itching and formication. Dr. Koo refers to his treatment plan as a “trapezoid-like dosage strategy.” Once he gets the patient to 3 mg, he continues the medication until all the symptoms disappear and then continues the medication for an additional 3 months. Dr. Koo then slowly tapers the dosage over an additional few months. The keys to successful treatment include communicating with patients and working collaboratively with them. This approach builds trust and rapport. References Brown GE et al. J Clin Exp Dermatol Res. 2014;5:6. doi: 10.4172/2155-9554.1000241. Kohorst JJ et al. JAMA Dermatol. 2018 May 1;154(5):615-7. Lepping P et al. J Am Acad Dermatol. 2017 Oct;77(4):778-9. Middelveen MJ et al. Clin Cosmet Investig Dermatol. 2018;11:71-90. Lepping P et al. Acta Derm Venereol. 2020 Sep 16. doi: 10.2340/00015555-3625. Freudenmann RW et al. Br J Dermatol. 2012 Aug;167(2):247-51. Wolf RC et al. Neuropsychobiology. 2020;79:335-44. * * * Show notes by Jacqueline Posada, MD, associate producer of the Psychcast; assistant clinical professor in the department of psychiatry and behavioral sciences at George Washington University, Washington; and staff physician at George Washington Medical Faculty Associates, also in Washington. Dr. Posada has no conflicts of interest. For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com

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EP #201 - 01.13.2021 - COVID-19 & Vaccination Issues

COVIDCalls

Play Episode Listen Later Jan 14, 2021 72:20

Today we continue the discussion of COVID-19 vaccines and vaccination with Tara Haelle and Maya Goldenberg.Maya Goldenberg is Associate Professor of Philosophy at the University of Guelph (pronounced Gwelf) in Canada. She works in philosophy of medicine and has a new book on vaccine hesitancy coming out in March 2021. _Vaccine Hesitancy: Public Trust, Expertise, and the War on Science’_ is published by University of Pittsburgh Press.Tara Haelle is a freelance science journalist and photojournalist who serves as the AHCJ Core Topic Leader for Medical Studies. She particularly specializes in reporting on vaccines, pediatrics, maternal health, obesity, nutrition, mental health and medical research in general, and she regularly speaks on vaccine hesitancy. Her work has appeared in Elemental, Scientific American, New York Times, Forbes, Politico, Slate, NOVA, Wired and Science, and she writes and covers medical conferences regularly for Medscape and MDEdge. She co-authored an evidence-based parenting book, "The Informed Parent," and authored "Vaccination Investigation: The History and Science of Vaccines," along with a dozen children's science books.

Post-HSCT care at home: Can maintaining the patient’s microbiome prevent GVHD, improve other outcomes, decrease costs, and reduce the risk of COVID-19?

Play Episode Listen Later Nov 12, 2020 28:07

Can receiving all posttransplant care at home benefit patients undergoing hematopoietic stem cell transplant (HSCT)? Researchers are conducting phase 2 trials to find out. Anthony D. Sung, MD, of Duke University School of Medicine, described this research to host David H. Henry, MD. Dr. Sung outlined the process of receiving post-HSCT care at home and discussed Duke's clinical trials assessing the impact of home care on costs, quality of life, the microbiome, and graft-versus-host disease (GVHD). Dr. Sung also discussed another Duke trial investigating whether a probiotic can prevent COVID-19. Post-HSCT care at home: How it works Cell collection (if applicable), conditioning, and HSCT all take place in the outpatient setting. From day 1 after transplant onward, the patient receives all care at home. A nurse practitioner or physician assistant visits the patient every morning to draw labs, which are run at the hospital. A nurse visits every afternoon to give the patient supportive care. Patients are given the tools to video chat with physicians. Patients must live within 1 hour of Duke’s transplant center or relocate to furnished apartments near the transplant center. Phase 1 trial: Feasible and safe Dr. Sung and colleagues have completed a phase 1 trial, which suggested that post-HSCT care at home was feasible and safe. Outcomes were similar to outcomes in patients who do not receive post-HSCT care at home. The results were presented at ASH 2017 (Blood. 2017;130:745; https://bit.ly/2UelgVo). Phase 2 trials: Microbiome, GVHD, and other outcomes With one phase 2 trial (NCT01725022), Dr. Sung and colleagues aim to determine if: Patients can maintain their normal bowel microbiota by receiving post-HSCT care at home, as opposed to outpatient or inpatient care. Treatment-related morbidities and mortality are similar between the groups. Care at home improves quality of life and reduces costs. Trial details can be found here: https://bit.ly/2JRnY0Y. In the other phase 2 trial (NCT02218151), the main goal is to compare the incidence of grade 2-4 acute GVHD at 6 months in patients receiving care at home vs. inpatient or outpatient care. The theory is that maintaining the microbiome will reduce the risk of GVHD. A case of GVHD can add $100,000 to the cost of care, Dr. Sung noted. Trial details can be found here: https://bit.ly/32vr8y3. COVID-19 and the microbiome Dr. Sung and colleagues are also conducting a trial of Lactobacillus rhamnosus GG (LGG) as prophylaxis for COVID-19 (NCT04399252). Research has shown that giving LGG to mice with Pseudomonas aeruginosa pneumonia can: Help prevent lung injury and significantly improve survival (Shock. 2013;40[6]:496-503; https://bit.ly/3khQBRr). Help modulate the microbiome and immune system, leading to decreased inflammation, TNF-alpha, IL-2, and IL-6, as well as increased regulatory T cells (Clin Nutr. 2017;36[6]:1549-1557; https://bit.ly/35lENJZ). Dr. Sung noted that TNF-alpha, IL-2, and IL-6 have also been implicated in COVID-19 and associated with increased lung injury. Dr. Sung and colleagues have theorized that LGG could decrease lung injury and the symptoms of COVID-19 and perhaps even prevent COVID-19. The researchers are conducting a randomized trial of LGG in household contacts of patients with COVID-19 (https://bit.ly/2GRSC9x). For more details on the trial, email protect-eha@duke.edu or visit https://bit.ly/2IsLjWh. Disclosures: Dr. Sung and Dr. Henry have no relevant disclosures. Duke's transplant trials are funded by grants from the National Institutes of Health. Funding for the COVID-19 trial is provided by the Duke Microbiome Center and philanthropic giving. The LGG and placebo used in the trial are provided by DSM. * * * For more MDedge podcasts, visit mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd

How I treat NSCLC in the era of PD-L1 inhibitors and the COVID-19 pandemic

Play Episode Listen Later Nov 5, 2020 31:18

In this episode, we review how PD-L1 inhibitors and COVID-19 have changed the management of non-small cell lung cancer (NSCLC). Jeffrey Crawford, MD, and Susan Blackwell, PA, both of Duke Cancer Institute, join host David H. Henry, MD, to discuss the use of pembrolizumab in NSCLC, two studies of PD-L1 inhibitors presented at ESMO 2020, and how COVID-19 has affected NSCLC care, particularly the use of granulocyte colony-stimulating factor (G-CSF). Diagnosis and treatment of NSCLC What information should be obtained from a biopsy? Is this lung cancer? If so, what kind of lung cancer is it: Small-cell lung cancer or NSCLC? Which subtype? Molecular studies for targets, including ALK, KRAS, EGFR, PD-L1. Treatment with pembrolizumab: If, for example, a patient has NSCLC and is positive for PD-L1, the treatment of choice is pembrolizumab. A multidisciplinary approach is essential to provide comprehensive education and care to patients taking pembrolizumab (and other immunotherapies). Pembrolizumab can have many side effects, including itching, fatigue, thyroiditis progressing to hypothyroidism, hypophysitis, or another off-target “-itis.” Ms. Blackwell and Dr. Crawford recommend listening to patients, checking the thyroid routinely, and checking cortisol based on index of suspicion. NSCLC studies presented at ESMO 2020 KEYNOTE-024 5-year OS update: First-line (1L) pembrolizumab (pembro) vs platinum-based chemotherapy (chemo) in patients (pts) with metastatic NSCLC and PD-L1 tumour proportion score (TPS) ≥50%. The 5-year survival is greater than 30% with pembrolizumab in this study. Historically, 5-year survival has been 1% to 2% in patients treated with chemotherapy alone, Dr. Crawford said. In the control arm of this study, patients received chemotherapy and then crossed over into the pembrolizumab arm, so overall survival was 16% at the 5-year mark. The results suggest immunotherapy should be used first-line if patients meet criteria, Dr. Crawford said. Source: Abstract LBA51. https://bit.ly/3mMYLTK. EMPOWER-Lung 1: Phase III first-line (1L) cemiplimab monotherapy vs platinum-doublet chemotherapy (chemo) in advanced non-small cell lung cancer (NSCLC) with programmed cell death-ligand 1 (PD-L1) ≥50%. The PD-L1 inhibitor cemiplimab improved overall and progression-free survival in NSCLC patients when compared with chemotherapy alone. Abstract LBA52. https://bit.ly/3mLT6xb. The effects of COVID-19 on NSCLC care Logistically, it’s more difficult to see patients during the pandemic, Dr. Crawford noted, but the many potential side effects of immunotherapy make it necessary to see patients regularly in person. How has COVID-19 affected the concern of febrile neutropenia and the use of G-CSF? Dr. Crawford said the pandemic has heightened the concern about infection risk. Prior guidelines for G-CSF: Before the pandemic, guidelines suggested routine prophylactic G-CSF in patients with a greater than 20% risk of febrile neutropenia. In patients with 10% to 20% risk, the recommendation was to consider the use of G-CSF based on the patient population and risk factors. Pandemic-specific guidelines for G-CSF: The National Comprehensive Cancer Network (NCCN) recommended relaxing guidelines during the pandemic. If the risk is greater than 20%, NCCN still recommends giving G-CSF. If the risk is 10% to 20%, NCCN recommends giving G-CSF even in the absence of additional risk factors. Dr. Crawford noted that lung cancer patients receiving chemotherapy are typically in the 10% to 20% risk category. Download the COVID-specific NCCN guidelines: https://bit.ly/3jQIco5. G-CSF biosimilars The most common complaint with biosimilars is bone pain. Ms. Blackwell advises first treating bone pain with acetaminophen or ibuprofen and warm blankets. For refractory pain, she suggests a low-dose narcotic or dexamethasone. Consider an antihistamine for prophylaxis, as patients report this can help with symptoms. Show notes written by Ronak Mistry, DO, a resident at Pennsylvania Hospital, Philadelphia. Disclosures: Dr. Crawford is on advisory boards at Amgen and Merck, makers of Onpro/Neulasta (pegfilgrastim) and Keytruda (pembrolizumab). Ms. Blackwell and Dr. Henry have no conflicts of interest. * * * For more MDedge podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd

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How to use antiemetics: Dr. Paul Hesketh reviews ASCO’s guidelines on antiemetic use in cancer patients receiving checkpoint inhibitors or antineoplastic agents

Play Episode Listen Later Oct 29, 2020 25:57

In this episode, we review the latest guidelines on antiemetics from the American Society of Clinical Oncology (ASCO). Host David H. Henry, MD, is joined by ASCO guideline author Paul J. Hesketh, MD, of Lahey Hospital and Medical Center in Burlington, Mass. Dr. Hesketh explains the recommendations for antiemetic use in cancer patients receiving checkpoint inhibitors (CPIs) or high-, moderate-, or low-emetic-risk antineoplastic agents. Checkpoint inhibitors The update to ASCO’s guidelines was primarily driven by questions about antiemetic use in patients receiving CPIs, according to Dr. Hesketh. After a literature review, Dr. Hesketh and coauthors concluded that: Patients receiving CPIs alone do not require an antiemetic regimen. When CPIs are given with chemotherapy, there is no need to modify the antiemetic regimen. Dexamethasone does not compromise the efficacy of CPIs. High-emetic-risk antineoplastic agents Adults treated with cisplatin and other high-emetic-risk single agents should be offered a four-drug combination: an NK1 receptor antagonist, a serotonin (5-HT3) receptor antagonist, dexamethasone, and olanzapine on day 1. Dexamethasone and olanzapine should be continued on days 2-4, as cisplatin can cause delayed emesis. Adults treated with an anthracycline plus cyclophosphamide should be offered a four-drug combination: an NK1 receptor antagonist, a 5-HT3 receptor antagonist, dexamethasone, and olanzapine on day 1. Unlike with cisplatin, only olanzapine should be continued on days 2-4. Olanzapine is an effective antiemetic in a number of settings, Dr. Hesketh said. For example, olanzapine is useful in the setting of hematopoietic stem cell transplant. A 5-mg dose of olanzapine has proven effective and may be better tolerated than a 10-mg dose. Moderate-emetic-risk antineoplastic agents Adults treated with higher-dose carboplatin (area under the curve ≥4 mg/mL per min) should be offered a three-drug combination: an NK1 receptor antagonist, a 5-HT3 receptor antagonist, and dexamethasone on day 1. Adults treated with moderate-emetic-risk antineoplastic agents (excluding higher-dose carboplatin) should be offered a two-drug combination: a 5-HT3 receptor antagonist and dexamethasone on day 1. Adults treated with cyclophosphamide, doxorubicin, oxaliplatin, and other moderate-emetic-risk antineoplastic agents known to cause delayed nausea and vomiting may be offered dexamethasone on days 2-3. Low-emetic-risk antineoplastic agents Adults treated with low-emetic-risk antineoplastic agents (e.g., fluorouracil, gemcitabine) should be offered a single dose of a 5-HT3 receptor antagonist or a single 8-mg dose of dexamethasone before antineoplastic treatment. Cannabinoids There is no good data on the use of cannabinoids, apart from those cannabinoids approved by the Food and Drug Administration, according to Dr. Hesketh. The ASCO guidelines state: There is insufficient evidence to make a recommendation regarding medical marijuana to prevent nausea and vomiting in cancer patients receiving chemotherapy or radiation. Similarly, there is insufficient evidence to make a recommendation on the use of medical marijuana in place of the approved cannabinoids dronabinol and nabilone for the treatment of nausea and vomiting in cancer patients receiving chemotherapy or radiation. SOURCE: Hesketh PJ et al. J Clin Oncol. 2020 Aug 20;38(24):2782-97. https://bit.ly/3oxahUP Show notes written by Alesha Levenson, MD, a resident at Pennsylvania Hospital, Philadelphia. Disclosures: Dr. Hesketh disclosed institutional research funding from AstraZeneca and F. Hoffmann-La Roche. Dr. Henry has no relevant disclosures. * * * For information on the negative effects of marijuana, listen to our sister podcast, Psychcast, on MDedge (https://bit.ly/3mBM6TB), Spotify (https://spoti.fi/3mwVvvn), or wherever you get your podcasts. * * * For more MDedge Podcasts, go to mdedge.com/podcasts. Email the show: podcasts@mdedge.com. Interact with us on Twitter: @MDedgehemonc. David Henry on Twitter: @davidhenrymd.

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Hem-Onc News: Aspirin linked to cancer progression in older adults, inhibitor could 'alter landscape' of RET+ tumors, and Black-White gap closing

Play Episode Listen Later Sep 1, 2020 14:48

MDedge Hematology-Oncology news for the first week of September 2020. Aspirin may accelerate cancer progression in older adults: https://bit.ly/2ENHRUc ASPREE trial: https://bit.ly/2QAsMYW Meta-analysis: https://bit.ly/2D6rXnl AsCaP: https://bit.ly/2G06X2I Black/White gap gone: ‘The only cancer where this has happened’: https://bit.ly/3jm8PBm Source: https://bit.ly/3lv4u0m Selpercatinib 'poised to alter the landscape' of RET+ cancers: https://bit.ly/34PYSbs Lung cancer results: https://bit.ly/3gB1FY7 Thyroid cancer results: https://bit.ly/2EHhCz5 Study confirms it's possible to get COVID-19 twice: https://bit.ly/3bd4wWg Email the show: podcasts@mdedge.com Learn more about MDedge and Blood & Cancer: https://www.mdedge.com/podcasts

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Diabetes + weight loss could mean a higher risk of pancreatic cancer, digital breast tomosynthesis vs digital mammography, and adjuvant chemo is beneficial for some with low-grade glioma

Play Episode Listen Later Aug 25, 2020 9:03

News for the week of August 24, 2020. Beyond baseline, DBT no better than mammography for dense breasts: https://bit.ly/2FTRnpp Study source: https://bit.ly/2FTLkkI Lead author: https://bit.ly/3graAv0 Subgroups predict adjuvant chemoradiotherapy benefits in low-grade glioma: https://bit.ly/31oHkkr Source: https://bit.ly/3aSVe1j Diabetes plus weight loss equals increased risk of pancreatic cancer: https://bit.ly/2Etmbws Source: https://bit.ly/2EyRBkV For more MDedge podcasts: htttps://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com

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Mason Plumlee: NBA star in the Orlando bubble, medical entrepreneur, and COVID-19 survivor

Play Episode Listen Later Aug 20, 2020 22:10

Dr. David Henry welcomes NBA power forward Mason Plumlee. Plumlee, who is now participating in the NBA's controlled COVID-19 environment, affectionately referred to as the "bubble," tested positive for COVID-19 before we knew that loss of taste and smell was a symptom. In a wellness and intellectual change-of-pace episode, Plumlee joins Dr. Henry to talk about his background in medicine and biology, his experiences in the NBA bubble, and his time playing for Duke University. Mason Plumlee on Twitter: @masonplumlee https://bit.ly/2FBSQ3r David Henry on Twitter: @DavidHenryMD http://bit.ly/2HXI6Lw You can find more MDedge podcasts at https://www.mdedge.com/podcasts/

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Introducing Run the List: the latest hem onc news - Earlier lung screening doubles eligibility, lifestyle reduces breast cancer risk regardless of genetics, FDA approves MDS/CMML drug, COVID mask exemptions

Play Episode Listen Later Jul 14, 2020 11:29

The latest news for hematology and oncology professionals. In this episode: USPSTF: Earlier lung cancer screening can double eligibility * Review and comment on the USPSTF site: https://bit.ly/3fppiD7* National Lung Screening Trial https://bit.ly/2CvNRQt Lifestyle choices may reduce breast cancer risk regardless of genetics* Read the article on MDedge: https://bit.ly/2ZrsWqN * Read the original research: https://bit.ly/3etRLGx (JAMA Netw Open. 2020;3(4):e203760). FDA approves oral therapy for myelodysplastic syndromes, CMML * Read the FDA news release: https://bit.ly/2WeUIVb Commentary: 'Doc, Can I Get a Mask Exemption?' * Read the full commentary from Dr. Rizzo: https://wb.md/2Wfoh9i* Read the CDC Recommendations: https://bit.ly/304OTed * Read more about Dr. Albert Rizzo: https://bit.ly/3j2QDgW For more MDedge Podcasts go to https://www.mdedge.com/podcasts/ Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeHemOnc

Picosecond laser predictions; wildfires and atopic dermatitis; and protecting your mental health: Psychiatry-Dermatology crossover

Play Episode Listen Later Jun 4, 2020 35:29

Physicians face unique challenges with regard to mental health but often are resistant to seeking professional treatment. In this special crossover episode, Guest Host Dr. Candrice Heath (@drcandriceheath) talks with Dr. Lorenzo Norris from the MDedge podcast Psychcast and psychiatrist Dr. Nicole Washington (@drnicolepsych) about common stressors and mental health conditions they encounter when treating the physician population. They discuss how dermatologists can evaluate and protect their mental health, particularly during the coronavirus disease 2019 (COVID-19) pandemic. “We will have to show ourselves some grace and realize that there are going to be some days where we don’t do as well as we think we should do, because we all have very high expectations for ourselves,” Dr. Washington advises. * * * We also bring you the latest in dermatology news and research: Authors of picosecond laser review predict more widespread use of the technology California wildfires caused uptick in clinical visits for atopic dermatitis COVID-19 update: distancing works, N95 respirators work better * * * Key takeaways from this episode: Common mental health disorders in physicians include anxiety spectrum disorder, depression, and substance use. Burnout and demoralization often present as precursors to these syndromes. Physicians have a higher suicide rate than do the general population, with an estimated 300-400 physicians dying by suicide each year. “If there are that many who actually complete, how many more are there who walk around with the thoughts daily who don’t complete? How many are there who we don’t include in the numbers that we have as far as the anxiety and depression and substance abuse because that relies on either them admitting to it or seeking treatment for it? The numbers I think are much larger,” Dr. Washington says. Economic uncertainty and financial stress brought on by fewer patient visits has created new anxiety for dermatologists that was not there before the COVID-19 pandemic. Some physicians feel guilty that they are not on the front lines of the COVID-19 pandemic. “They are feeling as if they’re watching their peers jump in and be in the game ... and they’re kind of just sitting on the bench. I’ve had multiple physicians talk about the guilt that they feel or feeling as if they aren’t doing enough and really being harder on themselves about their lack of action on the front lines, and that is affecting their mental health,” Dr. Washington observes. The amount of work physicians have taken on to keep outpatient care afloat during the pandemic can become a source of stress. “Many of my colleagues, even though they’re not necessarily seeing COVID patients, their workloads have increased tremendously ... it’s like the volume has gone down, but the stress of everything -- and meetings and constant information and education -- has gone up. So I kind of like to think sometimes COVID is everywhere and it just kind of depends on in what shape or form you have to deal with it,” Dr. Norris points out. The biggest thing dermatologists can do to protect their mental health is to be honest about their feelings and be willing to reach out and get professional assistance. Because dermatology often is perceived as the “happiest” specialty among medical professionals, dermatologists may not be pursuing treatment for their mental health because they feel bad about saying they are having a hard time. “Don’t let your circumstances or what you think people see as your circumstances stop you from reaching out,” Dr. Washington advises. * * * Hosts: Nick Andrews; Candrice R. Heath, MD (Temple University Hospital, Philadelphia) Guests: Lorenzo Norris, MD (George Washington University, Washington); Nicole Washington, DO, MPH (Elocin Psychiatric Services) Disclosures: Dr. Heath reports no conflict of interest. Dr. Norris reports no conflict of interest. Dr. Washington reports no conflict of interest. Show notes by: Alicia Sonners, Melissa Sears * * * You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

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Hair care products for African American women during COVID-19

Play Episode Listen Later Apr 23, 2020 36:31

Hosts of the dermatology podcast Dermasphere, Luke Johnson, MD, and Michelle Tarbox, MD, join MDedge host Nick Andrews to talk about COVID-19 and dermatology as well as how their podcast works. Dr. Johnson is assistant professor of dermatology at the University of Utah School of Medicine in Salt Lake City, and Dr. Tarbox is assistant professor of dermatology at Texas Tech University Health Science Center in Lubbock. You can find Dermasphere on Apple Podcasts, Google Podcasts, Spotify, and wherever podcasts are found. * * * Hair salon closures during the coronavirus pandemic have left women of African descent to care for their own hair -- whether natural, processed, or synthetic -- at home. Dr. Lynn McKinley-Grant, president of the Skin of Color Society, talks to Dr. Susan C. Taylor about hair care products these patients can use so that dermatologists can help African American women take care of their hair and manage dermatologic conditions. “With COVID-19, many women are at home -- me included -- and it’s important for women to understand that they have to continue to groom their hair. Just because no one sees you doesn’t mean that you don’t regularly shampoo and condition as well as comb and style your hair,” says Dr. Taylor. * * * Key takeaways from this episode: Dermatologists should know how to recognize and differentiate between natural, processed, and synthetic hair in women of African descent to inform diagnosis and treatment recommendations. Regardless of hairstyle, it is important for all African American patients to shampoo, condition, detangle, and style their hair with products that contain appropriate ingredients. Shampoos with sodium lauryl sulfate contain the harshest detergents that can dry out the hair and scalp. “For our skin of color patients, or African American patients, we suggest shampoos that contain sodium laureth sulfate, which is a much milder detergent to clean the hair, and it helps to leave the hair moisturized,” Dr. Taylor explains. Social distancing provides an opportunity for African American women to concentrate on conditioning the hair while taking a break from damaging hair care practices. “I personally think this is a great time to minimize what you do to your hair in regard to heat from blow-dryers and flat irons and curling irons. I also think it’s a great time if you have a weave or braids and extensions to take them out to really give your hair a rest,” Dr. Taylor recommends. Many patients seek to avoid products containing controversial ingredients such as parabens, mineral oil, and tetrasodium EDTA because of concerns that they may be carcinogens or endocrine disruptors. “I think the jury is still out. There are a whole host of products that do not contain those particular ingredients, so I think our patients have to have choices,” Dr. Taylor says. Prescription shampoos for seborrheic dermatitis in people of African descent can dry out the scalp. “What I suggest to my patients is that they apply the shampoo directly to the scalp with a 4- to 5-minute contact time and then rinse the shampoo out of the scalp, followed by the use of a conditioning shampoo to actually shampoo their strands of hair. That way they’re minimizing the contact time with the prescription shampoo,” Dr. Taylor advises. Although daily shampooing typically is not recommended for individuals of African descent, health care workers and first responders will need to wash their hair more frequently during the coronavirus pandemic. “I think rinsing the hair with water, not necessarily doing a full shampoo every day, could be helpful. [Also] putting in a leave-in conditioner and reapplying the leave-in conditioner every day I think can really help combat potential dryness they can experience,” Dr. Taylor suggests. It also is important to thoroughly dry the hair after each wash so it doesn’t stay damp, which could lead to infection. * * * Hosts: Nick Andrews; Lynn McKinley-Grant, MD (Howard University, Washington) Guest: Susan C. Taylor, MD (University of Pennsylvania, Philadelphia) Disclosures: Dr. Taylor reports no conflict of interest. Dr. McKinley-Grant reports no conflict of interest. Show notes by: Alicia Sonners, Melissa Sears * * * You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Keto diet and dermatology; plus dermatologists suited to treat LGBTQ+ patients

Play Episode Listen Later Feb 13, 2020 30:15

At the 2020 ODAC Dermatology, Aesthetic & Surgical Conference in Orlando, Angelo Landriscina, MD, revealed how dermatologists can help their LGBTQ+ patients. Dr. Landriscina, and MDedge reporter Jeff Craven join producer Nick Andrews to discuss how dermatologists are uniquely suited to treat sexual- and gender-minority patients. As patients are becoming more involved in their own care, physicians must stay up to date on trends such as the ketogenic (keto) diet to encourage better health and steer patients away from dangerous online advice. Dr. Vincent DeLeo spoke with Dr. Daren Fomin about benefits of the ketogenic diet for dermatologic conditions such as acne, diabetic skin diseases, and cutaneous malignancies. Dr. Fomin also provided tips for safely and effectively implementing this diet. “Coming alongside [patients] as more than just a diagnoser and treater of disease but [as a] promoter of health, I think that’s very valuable, and honestly I think that’s where medicine is moving,” Dr. Fomin said. * * * Things you will learn in this episode: Ketosis is the state of producing ketones, which is necessary to maintain proper organ function in the absence of sufficient dietary carbohydrates. Ketosis can be achieved through fasting; prolonged aerobic activity; certain physiologic states (e.g., pregnancy or the neonatal period); and processes such as the ketogenic diet, which tricks the body into a low glucose state that results in metabolic and cellular benefits without famine or fasting. Some dermatologic conditions might theoretically respond to a ketogenic diet. “From our reading of the literature, we think potential candidates would be acne, hidradenitis suppurativa, autoinflammatory syndromes, definitely diabetic skin diseases, melanoma, and perhaps other skin cancers, psoriasis, morphea, and ... obesity-related skin disease,” Dr. Fomin explained. Ketogenesis may provide a multiangle approach to acne treatment. Beta-hydroxybutyrate, the main ketone produced during ketogenesis, can potentially decrease or inhibit the inflammatory response in acne vulgaris. Ketogenesis also helps prevent the hyperproliferation of keratinocytes seen in acne and optimizes androgens to reduce sebum production. Low-carbohydrate regimens such as the ketogenic diet have been associated with risk reduction of such diabetic skin diseases as diabetic peripheral neuropathy, ulcers, acanthosis nigricans, microangiopathy, and cutaneous infections: “This is due to several known mechanisms,” Dr. Fomin noted. “Less glucose entering the body and less fat deposition as a product of that, less end-product glycation, less free radical production, enhanced fat loss and metabolic efficiency, increased insulin sensitivity, and then decreased inflammation, as well.” Because cancer cells from melanoma and other malignancies survive only in the presence of glycogen, there is serious potential that cancer could be “starved out” by feeding normal tissues with ketones. “Honestly, it’s my hope and kind of my optimistic thought that in 10-20 years, maybe we’ll see an increase in the number of patients being put on some sort of either endogenous or exogenous ketone therapy as an adjunct to their cancer treatments,” Dr. Fomin said. “I’d be curious to see if we can start adding this on to adjunctive melanoma therapy and see if there’s an improved outcome in our patients.” The ketogenic diet generally is well tolerated, but potential transient adverse effects include dehydration, acidosis, lethargy, hypoglycemia, dyslipidemia, prurigo pigmentosa, and gastrointestinal distress. Chronic side effects include nephrolithiasis and unintended weight loss. The ketogenic diet approach to managing skin disease takes a lot of self-motivation and work from patients. It is important to make sure patients know to expect a few days to weeks of potentially noticeable physiologic effects (e.g., hyperglycemia, lethargy) before they become adapted to the diet. When working with patients to initiate the ketogenic diet, dermatologists are encouraged to involve educated nutritionists if they have access to them. * * * Hosts: Elizabeth Mechcatie; Terry Rudd; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guests: Angelo Landriscina, MD (George Washington University, Washington); Daren A. Fomin, DO (Walter Reed National Military Medical Center, Bethesda, Md.). Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie * * * You can find more of our podcasts at www.mdedge.com/podcasts. Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Late-life mood disorders with Dr. George T. Grossberg

Play Episode Listen Later Feb 5, 2020 21:53

George T. Grossberg, MD, conducts a Masterclass on treating mood disorders in geriatric patients from the CP/AACP Psychiatry Update 2019 meeting in Las Vegas. The meeting was sponsored by Global Academy for Medical Education and Current Psychiatry. Dr. Grossberg is the Samuel W. Fordyce professor and director of geriatric psychiatry at St. Louis University School of Medicine in St. Louis. Later, Renee Kohanski, MD, discusses the first thing psychiatrists can do for patients. Take-home points from Dr. Grossberg: The prevalence of major depressive disorder among older adults who reside in the community is similar to that of the general population (6%). In nursing homes, the prevalence of significant clinical depression is close to 25%. Depression in older adults in long-term care facilities is underrecognized and undertreated. Risk factors for depression include advanced age (80-90 years), loneliness and lack of social support, painful conditions, frailty, and medical comorbidities. Medications that are central nervous system depressants, such as opiates and benzodiazepines, also can contribute to depression. Alcohol can also be a depressant. Depression in the face of cognitive impairment is extremely common and can even speed cognitive decline. Apathy, defined as lack of motivation, can look like depression. However, depression will have amotivation coupled with vegetative symptoms, such as disrupted sleep and loss of appetite, and mood changes, such as sadness and tearfulness. Low-dose stimulants are effective for apathy, but antidepressants are not; so, it’s important to differentiate the two. Undiagnosed and untreated depression contributes to a significant degree of morbidity because it can slow recovery in rehabilitative settings and impair adherence to essential medications. Treating depression also can improve pain control by making it more tolerable as a somatic symptom. Individuals older than 65 years account for more than 20% of all completed suicides in the United States. Psychological autopsy studies suggest that many of these individuals had undiagnosed depression. Clinicians should not shy away from treating geriatric patients for depression with medication and interventions such as cognitive-behavioral therapy. With pharmacotherapy, start low, go slow, and titrate up to a therapeutic dose. Older adults may take longer, up to 8-12 weeks, to respond to SSRIs, so it’s imperative not to give up on medications too soon. Electroconvulsive therapy is the most effective treatment for severe depression in geriatric patients. Some consider advanced age an indication for ECT; medical comorbidities are not a contraindication for ECT. It is unclear how effective ketamine is in older patients, but it deserves consideration. Prompt diagnosis and treatment of mood disorders is paramount in patients of advanced age and those living in long-term care facilities. Treating depression in the older patient also improves the quality of life for caregivers and professional staff. References Birer RB et al. Depression in later life: A diagnostic and therapeutic challenge. Am Fam Physician. 2004 May 15;69(10):2375-82. Sjoberg L et al. Prevalence of depression: Comparisons of different depression definitions in population-based samples of older adults. J Affect Disord. 2017 Oct 15;221:123-31. Grossberg GT et al. Rapid depression assessment in geriatric patients. Clin Geriatr Med. 2017 Aug;33(3):383-91. *** For more MDedge podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgePsych

ICYMI: Get to know Dr. Ilana Yurkiewicz

Play Episode Listen Later Dec 26, 2019 36:04

In this special edition podcast, Blood & Cancer revisits an interview with Ilana Yurkiewicz, MD, of Stanford (Calif.) University. Dr. Yurkewicz is the writer and producer of the podcast’s Clinical Correlation segment, which puts a human face on hematology-oncology care. She sits down with MDedge producer Nick Andrews for a wide-ranging interview that covers everything from the best advice she’s ever gotten to her favorite science fiction writer. The interview first aired on our sister podcast, Postcall. For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

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AAD 2019 Summer Meeting highlights

Play Episode Listen Later Nov 28, 2019 54:32

This week’s episode features highlights of the AAD 2019 Summer Meeting. Adam Friedman, MD, takes a closer look at nanotechnology from a dermatology perspective. Topical therapies often “have a very hard time getting to where they need to be, and nanotechnology, just by size alone, can really offer some unique benefits,” says Dr. Friedman, professor of dermatology and the interim chair of the dermatology department at George Washington University, Washington. Justin Ko, MD, director and chief of medical dermatology, Stanford (Calif.) Health Care, spoke with MDedge reporter Ted Bosworth about the use of augmented intelligence in dermatology. Dr. Ko is the coauthor of the American Academy of Dermatology’s position statement on augmented intelligence, which was released in May 2019. Henry W. Lim, MD, Henry Ford Hospital, Detroit, spoke with MDedge reporter Kari Oakes about potential environmental effects of sunscreen ingredients (particularly coral reef bleaching), as well as the FDA’s widely reported sunscreen absorption study published in May – and whether sunscreen use may be contributing to the increase in frontal fibrosing alopecia. Andrew Alexis, MD, professor and chair of the department of dermatology, Mount Sinai St. Luke’s, New York, provided practical information on treating hyperpigmentation in an interview with MDedge reporter Ted Bosworth. He details his views on the length of time he considers the use of hydroquinone-based therapies to be safe, as well as the use of non–hydroquinone based. Seemal R. Desai, MD, who is on the faculty at the University of Texas Southwestern Medical Center, Dallas, talked with MDedge editor Elizabeth Mechcatie about the treatment of patients with pigmentary disorders. The increasing interest in pigmentary disorders, particularly in patients with skin of color, “continues to be something that’s very relevant and very valid” to dermatologists, said Dr. Desai, who is the immediate past president of the Skin of Color Society. * * * Help us make this podcast better! Please take this short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 * * * Show notes by: Elizabeth Mechcatie For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

ISCHEMIA trial, DAPA-HF, and valsartan recall: AHA Special

Play Episode Listen Later Nov 26, 2019 32:06

In this special meeting edition of the Cardiocast, MDedge Cardiology editor Catherine Hackett is joined by MDedge reporters Mitchel L. Zoler, Bruce Jancin, and Richard Mark Kirkner. The MDedge cardiology team reviews three big stories from the 2019 annual scientific sessions of the American Heart Association in Philadelphia. * * * Help us make this podcast better! Please take this short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 * * * ISCHEMIA trial hailed as practice changing The results of the ISCHEMIA trial were emphatically declared practice changing by interventional cardiologists and noninterventionalists alike at the AHA meeting. Bruce Jancin discusses the story. DAPA-HF: Dapagliflozin's HFrRF efficacy confirmed in nondiabetes The results in nondiabetics from the practice-changing DAPA-HF trial gives clinicians strong evidence that the diabetes drug dapagliflozin is equally effective at reducing cardiovascular death and acute exacerbations in heart failure patients regardless of diabetes status. Mitchel L. Zoler discusses this report. Weakness exposed in valsartan recall ED visits for hypertension in the month after the 2018 recall spiked 55%. The 2018 recall of generic forms of the antihypertensive drug valsartan exposed weaknesses in the recall systems for generics in both the U.S. and Canada that caused many patients who were on the drug to fall through the cracks. Richard Mark Kirkner goes deeper into this story. * * * For full coverage of AHA 2019 visit MDedge Cardiology For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeCardio

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Thanksgiving episode: on-call workouts, sharing with patients, special codes

Play Episode Listen Later Nov 22, 2019 31:08

Medical Muggle Nick Andrews and Emi Okamoto, MD, talk about all things Thanksgiving in this special edition of the Postcall Podcast. We recommend saving this episode for Thanksgiving or Black Friday if you can't be with your friends/family for this holiday season. In the episode, we talk about how sharing with patients increases trust, the best gifts for doctors, what we're thankful for, a good in-hospital, on-call workout, and codes that you may need for your Thanksgiving shift. *** Help us make this podcast better! Please take our short, anonymous listener survey by clicking here. *** Links: Sharing stories with patients Weighing yourself every day helps with holiday poundage On-Call workout 20 Thanksgiving Codes The best gifts for doctors this season For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with MDedge on Twitter: @MDedgeTweets

thanksgiving training doctors sharing trauma wellness study student patients code epic md black friday medical gift injury fellow lonely med rn resident codes workouts coding weighing interact bsn billing np on call mdedge mdedge podcasts postcall podcast

Patients words can hurt; plus, harassment in surgical residency

Play Episode Listen Later Nov 1, 2019 37:08

Medical Muggle Nick Andrews and Emi Okamoto, MD, talk about the recent research in the New England Journal of Medicine about burnout and harassment in surgical residency. They also discuss the research in JAMA Internal Medicine about how patient behavior positively and negatively affects physicians, trainees, and medical students. * * * Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 * * * The interview this week is with MDedge reporter Kari Oakes on her article about addressing female physicians by their appropriate title: Doctor. You can follow Nick on Twitter at @Nick_Andrews__ and on Instagram @medicalmuggle. Timestamps: Jack Strong, MD, dies (01:08) Surgical residency discrimination, abuse (01:45) Impact of patient behavior on docs (08:15) #MyFirstNameIsDoctor/Addressing female physicians appropriately (12:35) Interview with Kari Okas (12:40) Links: Jack Strong, MD, Obit/Memoriam (Nola.com) Discrimination, abuse, harassment, and burnout in surgical residency training (N Engl J Med.) Demeaning patient behavior takes a toll (MDedge) #MyFirstNameIsDoctor (MDedge) The scene from A Few Good Men (YouTube) For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeTweets

Delivering bad news to patients

Gynecologic Surgeons Unscrubbed

Play Episode Listen Later Oct 24, 2019 26:59

Strategies and guidelines for delivering bad news to patients from David Henry, MD, and Ilana Yurkiewicz, MD. Timestamps: This week in Oncology (01:30) Conversation (04:22) This week, the host of Blood & Cancer and the writer, producer, and talent behind the Clinical Correlation segment sit down together for the first time ever. Dr. Henry and Dr. Yurkiewicz share strategies and anecdotes about their experiences learning how to give patients terrible news and --perhaps more importantly -- how not to. Links: SPIKES mnemonic Dr. Henry: Academic Biography Dr. Yurkiewicz Academic Biography Hard Questions column This week in Oncology. Immunotherapy enables nephrectomy with good outcomes in advanced RCCby Susan London Some patients with advanced renal cell carcinoma treated with immune checkpoint inhibitors can safely undergo nephrectomy and experience favorable surgical outcomes and pathologic responses according to a cohort study from Urologic Oncology. SOURCE: Singla N et al. Urol Oncol. 2019 Sep 12. doi: 10.1016/j.urolonc.2019.08.012 For more MDedge podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter @mdedgehemonc David Henry on Twitter @davidhenrymd Ilana Yurkiewicz on Twitter @ilanayurkiewicz

Gynecologic Surgeons Unscrubbed trailer

Play Episode Listen Later Oct 23, 2019 2:39

Here's a sneak peak of Gynecologic Surgeons Unscrubbed. A series-based podcast focusing on surgical and medical education, featuring interviews and practice-changing discussion, hosted by Cara King, DO, MS. This podcast is a collaboration between MDedge and the Society of Gynecologic Surgeons.

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Practice changing prevention data from ESC 2019 Part II

Play Episode Listen Later Oct 22, 2019 42:06

MDedge reporters discuss the latest in practice-changing data from the 2019 annual congress of the European Society of Cardiology in Paris. Join Mitchel L. Zoler, Bruce Jancin, Kari Oakes, and MDedge Cardiology editor Catherine Hackett as they discuss what they reported from the annual meeting.

'What would you do if this were your family member?'

Play Episode Listen Later Oct 10, 2019 24:53

In this edition, we conclude our 3-part series about having hard conversations with patients as a trainee. This week's case poses the following question: "What would you do if this were your family member?" Ilana Yurkiewicz, MD, Blood & Cancer cohost and producer of the Clinical Correlation segment, is joined by the two residents who have been behind the Blood & Cancer show notes from the beginning, Emily Bryer, DO, and Ronak Mistry, DO, both of the University of Pennsylvania, Philadelphia. David H. Henry, MD, editor in chief of MDedge Hematology-Oncology and the host of Blood & Cancer, joins the podcast to talk about whether multiple myeloma patients with should receive maintenance therapy until progression. Timestamps: TBD Dr. Henry's on difficult conversations (01:15) This week in Oncology (04:17) Difficult conversations for trainees part III (06:37) Links: This week in Oncology What is the optimal duration of maintenance in myeloma? Ilana Yurkiewicz, MD Dr. Yurkiewicz is a fellow in hematology and oncology at Stanford (Calif.) University. Hard Questions Emily Bryer, DO Ronak Mistry, DO For more MDedge podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

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Ending curative therapy even when the family wants it

Play Episode Listen Later Oct 3, 2019 18:34

Hematology/oncology requires clinicians to have some of the most difficult conversations in all of medicine. In part 2 of our 3-part series, we tackle how to talk about ending curative therapy even when the family wants to keep going. These conversations are hosted by Ilana Yurkiewicz, MD, the host and producer of the Clinical Correlation segment and the author of Hard Questions, a monthly column at MDedge Hematology-Oncology. She is joined by the two residents who have been behind the Blood & Cancer show notes from the beginning, Emily Bryer, DO, and Ronak Mistry, DO, both of the University of Pennsylvania, Philadelphia. David H. Henry, MD, editor in chief of MDedge Hematology-Oncology and the host of Blood & Cancer, also joins the podcast to talk about treatment discontinuation in multiple myeloma. Timestamps: This week in Hematology/Oncology: 04:00 Conversation: 08:00 Links: This Week in Oncology: Study finds no standard for treatment discontinuation in myeloma Ilana Yurkiewicz, MD: Dr. Yurkiewicz is a fellow in hematology and oncology at Stanford (Calif.) University. Hard Questions Emily Bryer, DO Ronak Mistry, DO For more MDedge podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

family university death health conversations care doctors phd research philadelphia therapy pennsylvania cancer student patients md medical ending fellow nurses physicians med rn resident residency interact oncology np hematology david h md dr medstudent blood cancer hematology oncology curative mdedge links this week clinical correlation mdedge hematology oncology

'How long do I have left?' Difficult conversations for trainees (part 1)

Play Episode Listen Later Sep 26, 2019 21:21

Hematology/oncology requires clinicians to have some of the most difficult conversations in all of medicine. In this edition, we begin a three-part series about having those conversations. These conversations will be hosted by Ilana Yurkiewicz, MD, the host and producer of the Clinical Correlation segment and the author of Hard Questions, a monthly column at MDedge Hematology-Oncology. She is joined by the two residents who have been behind Blood & Cancer show notes from the beginning, Emily Bryer, DO, and Ronak Mistry, DO, both of the University of Pennsylvania, Philadelphia. David H. Henry, MD, editor in chief of MDedge Hematology-Oncology and the host of Blood & Cancer, joins the podcast to talk about this week's discussion and a new Food and Drug Administration approval from earlier in September. Time stamps: Intro (00:05) This Week in Oncology (04:11) Conversation (07:30) Links: This Week in Oncology: FDA approves pembrolizumab/lenvatinib combo for advanced endometrial carcinoma Ilana Yurkiewicz, MD: Dr. Yurkiewicz is a fellow in hematology and oncology at Stanford (Calif.) University. Hard Questions Emily Bryer, DO Ronak Mistry, DO For more MDedge podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

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SGLT-2 inhibitors and more practice changing data from ESC 2019

Play Episode Listen Later Sep 16, 2019 22:05

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Aging, cognitive function, and technology with Dr. Phillip D. Harvey

Play Episode Listen Later Sep 4, 2019 19:39

In this masterclass, Philip D. Harvey, PhD, professor of psychiatry and behavioral sciences at the University of Miami, discusses the relationships between aging, neurocognition, and functional outcomes. And in a new segment from MDedge, called This Week in Psychiatry, we’d like to share a Current Psychiatry evidence-based review on using antidepressants for pediatric patients (PDF) by Jennifer B. Dwyer, MD, PhD, and Michael H. Bloch, MD, MS. Show Notes by Jacqueline Posada, MD, consultation-liaison psychiatry fellow with the Inova Fairfax Hospital/George Washington University program in Falls Church, Va. Introduction to normal aging Changes in cognitive abilities are part of normal aging. Crystalized intelligence, the storage of information learned throughout life, does not change over time in normal, healthy aging. Fluid intelligence, the ability to learn new information, solve problems, concentrate, and rapidly process information, starts changing at age 65 or so. Episodic memory performance, the ability to learn new verbal information, declines 30% between ages 65 to 80, followed by another equivalent decline from ages 80 to 90. Alzheimer’s disease and amnestic mild cognitive impairment are characterized by signature memory loss called rapid forgetting, which occurs in cases in which a person is unable to remember information right after being told. Older people who are self-aware and sensitive to their age-related cognitive changes have a better prognosis. Technology and aging Individuals in their 80s to 90s might have retired before the advent of technological advances such as ATMs, cell phones, the Internet, smartphones, and other touch screen devices. For these individuals, vital aspects of daily living, such as accessing finances online, requires using Internet navigation skills, and those skills were not acquired at a younger age. A direct connection exists between cognitive abilities and learning how to use technology for the first time. Healthy older people will be challenged by new technology the first time because of their lack of exposure. Yet, their ability to learn how to use technology is comparable to that of younger people. Embracing technology to prevent normative cognitive decline The ACTIVE study, sponsored by the National Institute on Aging, enrolled 2,800 older healthy adults, with a mean age of 75, to evaluate the effectiveness of cognitive interventions in maintaining cognitive health and functional independence in older adults. Participants were randomized to either computerized speed training, memory training, problem solving training, or psychosocial intervention. The computerized speed training produced the most significant benefit in cognitive functioning. Participants randomized to computerized speed training sustained their functioning of instrumental daily activities of living and had a 50% lower rate of at-fault motor vehicle collisions, compared with controls, over a 6-year follow-up period. The ACTIVE study results suggest that age-related changes might be reversible with 14 1-hour sessions of brain training. Normative age-related cognitive decline can be attenuated through the use of affordable, accessible technology. In summary, not all age-related cognitive complaints are pathological Clinicians must ask specifically about memory loss and rapid forgetting of information to differentiate normative age-related changes from Alzheimer’s dementia. Patients should be empowered to use technology to intervene for their cognition. Both brain and physical fitness are paramount to preventing dementia. Physical fitness is essential to prevention, because chronic illnesses such as type 2 diabetes are primary risk factors for dementia, and being overweight in middle age is a major predictor for developing type 2 diabetes. Physical exercise, brain exercise, and embracing technology are essential to preventing social isolation and subsequent dementia. References Antidepressants for pediatric patients by Jennifer B. Dwyer, MD, PhD; Michael H Bloch, MD, MD An evidence-based review from Current Psychiatry: 2019 September:18(9):26-30,32-36,41-42,42A-42F Click here for the webpage Click here for the downloadable PDF Tennstedt SL and FW Unverzagt. The ACTIVE study: Study overview and major findings. J Aging Health. 2013 Dec;25(8 0):3S-20S. doi: 10.1177/0898264313118133. Rebok GW et al. Ten-year effects of the ACTIVE cognitive training trial on cognition and everyday functioning of older adults. J Am Geriatr Soc. 2014 Jan;62(1):16-24. Harvey PD and MT Strassnig. Cognition and disability in schizophrenia: Cognition-related skills deficits and decision-making challenges add to morbidity. World Psychiatry. 2019 Jun;18(2):165-7. Brem AK and SL Sensi. Towards combinational approaches for preserving cognitive function in aging. Trends Neurosci. 2018 Dec;41(2):885-97.

Get to know Julie Croley, MD, from Dermatology Weekly's Resident Takeovers

Play Episode Listen Later Aug 28, 2019 21:29

Julie Croley, MD, also known as @dr.skinandsmiles on Instagram, joins MDedge producer and host of the Postcall Podcast, Nick Andrews. You can find more interviews like this on the Postcall Podcast at https://www.mdedge.com/podcasts/postcall-podcast

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Augmented intelligence: An interview with Dr. Justin Ko

American Journal of Psychiatry Residents' Journal Podcast

Play Episode Listen Later Aug 22, 2019 18:13

Dr. Justin Ko speaks with MDedge reporter Ted Bosworth about the use of augmented intelligence in dermatology. Dr. Ko is the coauthor of the American Academy of Dermatology’s position statement on augmented intelligence, which was released in May 2019. Dr. Ko addressed this topic during the plenary session at the AAD’s summer meeting in New York City, in a presentation titled “Augmented intelligence: Fusing technology with human expertise to enhance dermatologic care.” “Augmented intelligence is a term that’s specifically used so that we can move people away from conceptions about artificial intelligence,” Dr. Ko explained in the interview. “When we use that term, the first thing that pops into people’s minds are robots, terminators … other things that seem intimidating … that misconception is one that I really want to draw attention towards.” This week, we also bring you the following news: 1: Hidradenitis suppurativa linked to higher NAFLD risk https://www.mdedge.com/dermatology/article/206828/medical-dermatology/hidradenitis-suppurativa-linked-higher-nafld-risk 2: Nebraska issues SUNucate-based guidance for schools https://www.mdedge.com/dermatology/article/206581/dermatology/nebraska-issues-sunucate-based-guidance-schools Hosts: Elizabeth Mechcatie, Carol Nicotera-Ward, Vincent A. DeLeo, MD, of the Keck School of Medicine at the University of Southern California, Los Angeles Guest: Justin Ko, MD, of the department of dermatology at Stanford (Calif.) University. He is also on the faculty of Stanford’s Center for Artificial Intelligence in Medicine & Imaging. Show notes by Elizabeth Mechcatie You can find more of our podcasts at http://mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Overview of Psychiatry Podcasts with Badr Ratnakaran

Play Episode Listen Later Aug 19, 2019 41:51

In this episode, Neal Christopher and Badr Raknakaran give an overview of other podcasts that may be of interest to psychiatrists. Links to some resources below: (Not all are discussed in the episode) Psychopharmacology Updates Practical psychopharmacology updates for mental health clinicians. Useful for psychiatry / mental health professionals. Expert interviews and soundbites from CME presentations. Practical and free of commercial bias. Not sponsored by any pharmaceutical company. https://podcasts.apple.com/us/podcast/psychopharmacology-and-psychiatry-updates/id1425185370 MDedge https://podcasts.apple.com/us/podcast/mdedge-psychcast/id1382898254?mt=2 MDedge Psychcast is a weekly podcast from MDedge Psychiatry, online home of Clinical Psychiatry News and Current Psychiatry. Hosted by Editor in Chief Lorenzo Norris, MD, Psychcast features psychiatric clinicians discussing the issues and concerns that most affect their specialty. The information in this podcast is provided for informational and educational purposes only. The Medical Mind Podcast A podcast about innovation in mental health care from the APA Division of Education. APA Administration host Ann Thomas interviews APA members and other healthcare professionals about new initiatives in psychiatry. https://www.psychiatry.org/psychiatrists/education/podcasts/the-medical-mind-podcast Psychiatric Services From Pages to Practice Psychiatric Services Editor Lisa Dixon, M.D., M.P.H., and Podcast Editor and co-host Josh Berezin, M.D., M.S., discuss key aspects of research recently published by Psychiatric Services. Tune in to Psychiatric Services From Pages to Practice to learn about the latest mental health services research and why it is relevant. Topics include community-based treatment programs, collaborative care, evidence-based treatment and service delivery, criminal and social justice, policy analysis, and more. https://ps.psychiatryonline.org/podcast Psychiatry Unbound APA Publishing's Books podcast, hosted by APA Books Editor-in-Chief, Laura Roberts, M.D. Psychiatry Unbound offers the opportunity to hear the voices behind the most prominent psychiatric scholarship in the field today. Subscribe now to learn about important topics in the field of psychiatry and see how our authors are making an impact in clinical settings throughout the world. http://psychiatryunbound.apapublishing.libsynpro.com/ AJP Audio brings you highlights from each issue of The American Journal of Psychiatry. https://ajp.psychiatryonline.org/audio The Journal of Clinical Psychiatry Publisher's Podcast includes monthly audio updates of the features in each issue of JCP, plus special features added from time to time. https://podcasts.apple.com/us/podcast/the-journal-of-clinical-psychiatry-publishers-podcast/id386299220 Concepts in Psychiatry The premiere podcast for psychiatrists, psychiatry residents, and other mental health professionals interested in strengthening their knowledge of the fundamental concepts of psychiatry and learning the latest news in the treatment of mental health disorders. Hosted by Sarah DeLeon, MD, a third year psychiatry resident. https://podcasts.apple.com/us/podcast/concepts-in-psychiatry/id1257416543 PsychEd: educational psychiatry podcast This podcast is written and produced by psychiatry residents at the University of Toronto and is aimed at medical students and residents. Listeners will learn about fundamental and more advanced topics in psychiatry as our resident team explore these topics with world-class psychiatrists at U of T and abroad. https://podcasts.apple.com/us/podcast/psyched-educational-psychiatry-podcast/id1215646896 Journal of the American Academy of Child and Adolescent Psychiatry Each month JAACAP highlights a selected article found within the pages of the Journal by providing a podcast interview with the author. Tune in regularly to this feature of JAACAP, where we strive for a relaxed 'fireside chat' atmosphere in which authors can share aspects of their science that we are less often privy to. Podcasts are typically 15 to 20 minutes in length. https://podcasts.apple.com/us/podcast/journal-american-academy-child-adolescent-psychiatry/id660778429 Focus on Neurology and Psychiatry by ReachMD New research and clinical trials yield frequent developments in neuroscience and mental health. ReachMD welcomes an array of leading thinkers who lend their focused expertise to these principles, central to human function and ability. https://podcasts.apple.com/us/podcast/focus-on-neurology-and-psychiatry/id913720346 Mad in America podcast Welcome to the Mad in America podcast, a new weekly discussion that searches for the truth about psychiatric prescription drugs and mental health care worldwide. This podcast is part of Mad in America's mission to serve as a catalyst for rethinking psychiatric care. We believe that the current drug-based paradigm of care has failed our society and that scientific research, as well as the lived experience of those who have been diagnosed with a psychiatric disorder, calls for profound change. On the podcast we have interviews with experts and those with lived experience of the psychiatric system. Thank you for joining us as we discuss the many issues around rethinking psychiatric care around the world. https://podcasts.apple.com/us/podcast/focus-on-neurology-and-psychiatry/id913720346 SAGE Psychology & Psychiatry Welcome to the official free Podcast site from SAGE for Psychology & Psychiatry. SAGE is a leading international publisher of journals, books, and electronic media for academic, educational, and professional markets with principal offices in Los Angeles, London, New Delhi, and Singapore. https://podcasts.apple.com/us/podcast/sage-psychology-psychiatry/id871125966 Mental Health and Psychiatry (Video & Audio) Guest speakers, researchers and University of California faculty explore mental illness and mental health. https://podcasts.apple.com/us/podcast/mental-health-and-psychiatry-video/id522813934 https://podcasts.apple.com/us/podcast/mental-health-and-psychiatry-audio/id522813323 PeerView Neuroscience & Psychiatry CME/CNE/CPE Audio Podcast PeerView is an independent, professional medical publishing company focused on gathering and reporting information pertaining to clinically relevant advances and developments in the science and practice of medicine. As publishers of PeerView Publications, PeerView is solely responsible for the selection of publication topics, the preparation of editorial content and the distribution of all materials it publishes. https://podcasts.apple.com/us/podcast/peerview-neuroscience-psychiatry-cme-cne-cpe-audio/id179489480 Mental Health Book Club Podcast Sydney Timmins - a writer and Becky Lawrence - a secondary school teacher discuss books that contain mental health issues. Sydney and Becky will combine their love of reading and talking, working their way through anything from self-help, fiction and memoirs tackling a range of mental health issues. Trigger warning: this podcast discusses mental health topics that may cause distress to some listeners, we will give a full list of topics in each episodes show notes. https://podcasts.apple.com/us/podcast/mental-health-book-club-podcast/id1279210164 Mental - The Podcast to Destigmatise Mental Health Mental is the brain-child of Bobby Temps, who lives and thrives while managing his own mental health. Each week joined by a special guest Mental is intended to be a safe space to hear honest and open discussion about mental health in the hope listeners will feel more empowered to continue the conversation with others. This podcast is a chance for Bobby to give back for the support he has received and share what he continues to learn in the ongoing journey for optimum mental wellbeing. Covering many, many topics that influence mental health, we focus on identity and the sheer weight of being a human in our modern, technology-filled world. Learn about different conditions from first-hand experience, with statistics you can trust and inspiring guests. Mental health is something to be mindful of just as much as physical health, and Mental strives to let listeners know that they don't have to do so alone. Oh, and remember… you are enough! https://podcasts.apple.com/us/podcast/mental-the-podcast-to-destigmatise-mental-health/id1358920477 MQ Open Mind MQ: Transforming Mental Health https://www.mqmentalhealth.org/ MQ Open Mind looks at the science behind mental health and its potential to transform lives. The show digs deep into the cutting-edge research taking on mental illness and speaks to the people it could help. Hear conversations on a range of different conditions, from depression and anxiety to schizophrenia and bipolar. Brought to you by MQ: Transforming Mental Health, the new major mental health research charity https://podcasts.apple.com/us/podcast/mq-open-mind/id1271690765 Piece of Mind: Mental Health & Psychiatry We bring you the latest on mental health research at Cardiff University's MRC Centre and the National Centre for Mental Health (NCMH), plus real-life experiences of people affected by mental health problems. We would love to hear your feedback or ideas for future episodes, either comment on our latest episode, message us at info@ncmh.info or Tweet/Insta with #POMpod. https://podcasts.apple.com/us/podcast/piece-of-mind-mental-health-psychiatry/id1326789920 Mental Health Foundation podcast https://podcasts.apple.com/us/podcast/mental-health-foundation-podcast/id665005881 JAMA Psychiatry Author Interviews Interviews with authors of articles from JAMA Psychiatry. JAMA Psychiatry is an international peer-reviewed journal for clinicians, scholars, and research scientists in psychiatry, mental health, behavioral science, and allied fields. JAMA Psychiatry strives to publish original, state-of-the-art studies and commentaries of general interest to clinicians, scholars, and research scientists in the field. The journal seeks to inform and to educate its readers as well as to stimulate debate and further exploration into the nature, causes, treatment, and public health importance of mental illness. https://podcasts.apple.com/us/podcast/jama-psychiatry-author-interviews/id1227007379 ADD Lancet NEI Podcast Neuroscience Education Institute The Neuroscience Education Institute (NEI) is committed to help raise the standard of mental health by providing imaginative medical education that focuses on the highest level of learning. Each episode offers an opportunity to learn about current issues in psychiatry from key opinion leaders in the medical field. NEI's Podcast would be of value to anyone with an interest in neuropsychiatric diseases and psychopharmacology. https://podcasts.apple.com/us/podcast/nei-podcast/id288425495 Therapy We All Wear It Differently A podcast for early career psychologists. If you're looking for inspiration and advice for your psychology career, you're in the right place. Amy Felman interviews working psychologists from diverse fields with all levels of experience as they share their journeys, challenges and career breakthroughs that have lead them to where they are today. Tune in and discover how we all wear it differently. https://podcasts.apple.com/us/podcast/we-all-wear-it-differently-podcast-for-early-career/id992827102 Psychologists Off The Clock: A Psychology Podcast About The Science And Practice Of Living Well Ever wonder what therapists talk about over coffee? We are three clinical psychologists who love to chat about the best ideas from psychology. In this podcast, we explore the psychological principles we use in our clinical work, and bring you ideas from psychology that can help you flourish in your work, parenting, relationships, and health. Thank you for listening to Psychologists Off The Clock! https://podcasts.apple.com/us/podcast/psychologists-off-clock-psychology-podcast-about-science/id1176171178 Shrink Rap Radio David Van Nuys, Ph.D. All the psychology you need to know and just enough to make you dangerous... This podcast features renowned psychologist,Dr. David Van Nuys , brining you in-depth interviews on a broad array of psychological topics including: psychotherapy, dreams, consciousness, depth psychology, business psychology, developmental psychology, mind/body psychology, personal growth, psychology and art, research psychology, social issues, and spirituality. The roster of world-class guests includes: Philip Zimbardo, Charles Tart, Irvin Yalom, Jonathan Haidt, Sara Lazar, Robert Altemeyer, Stanley Krippner, Arnold Mindell, Dacher Keltner, Michael Meade, and David Barlow among others. https://podcasts.apple.com/us/podcast/shrink-rap-radio/id79491957 Speaking of Psychology American Psychological Association "Speaking of Psychology" is an audio podcast series highlighting some of the latest, most important and relevant psychological research being conducted today. Produced by the American Psychological Association, these podcasts will help listeners apply the science of psychology to their everyday lives. https://podcasts.apple.com/us/podcast/speaking-of-psychology/id705934263 Counselor Toolbox Podcast Dr. Dawn-Elise Snipes Counselors, coaches and sober companions help hundreds of thousands of people affected by Addictions and Mental Health issues each year. Learn about the current research and practical counseling tools to improve your skills and provide the best possible services. Counselor Toolbox targets counselors, coaches and companions, but can also provide useful counseling self-help tools for persons struggling with these issues and their loved ones. AllCEUs is an approved counseling continuing education provider for addiction and mental health counselors in most states. Counseling CEUs are available for each episode. https://podcasts.apple.com/us/podcast/counselor-toolbox-podcast/id1120947649 The Trauma Therapist Guy Macpherson, PhD This is a podcast about people helping people. Bruce Perry, Gabor Mate, Janina Fisher and many other of the world's leading master therapists, thought leaders and game-changers who specialize in PTSD, post-traumatic stress disorder, trauma, complex trauma and related fields join Guy Macpherson, PhD at thetraumatherapistpodcast.com for inspiring interviews about what it takes and what it means to sit with those who've been impacted by trauma. https://podcasts.apple.com/us/podcast/the-trauma-therapist/id899009517 The Thoughtful Counselor The Thoughful Counselor Team The Thoughtful Counselor is a podcast that is dedicated to producing great conversations around current topics in counseling and psychotherapy. We view counseling and psychotherapy as a deeply beautiful and complex process, and strive to incorporate both the art and science of the field in each episode. https://podcasts.apple.com/us/podcast/the-thoughtful-counselor/id1152853871 Between Us: A Psychotherapy Podcast Psychotherapists John Totten and Mason Neely bring you this psychotherapy podcast that explores what is happening between therapists and patients, from both sides of the relationship. https://podcasts.apple.com/us/podcast/between-us-a-psychotherapy-podcast/id1152775317 The Modern Therapist's Survival Guide with Curt Widhalm and Katie Vernoy Curt Widhalm, LMFT and Katie Vernoy, LMFT The Modern Therapist's Survival Guide: Where Therapists Live, Breathe, and Practice as Human Beings It's time to reimagine therapy and what it means to be a therapist. We are human beings who can now present ourselves as whole people, with authenticity, purpose, and connection. Especially now, when clinicians must develop a personal brand to market their private practices, and are connecting over social media, engaging in social activism, pushing back against mental health stigma, and facing a whole new style of entrepreneurship. To support you as a whole person, a business owner, and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. https://podcasts.apple.com/us/podcast/modern-therapists-survival-guide-curt-widhalm-katie/id1310770477 ACT in Context Association for Contextual Behavioral Science ACT in Context is freely available to anyone, and its episodes will take listeners on a journey from the history and development of ACT through its clinical application and the future of the work. This podcast will primarily focus on ACT, but it will often touch upon several related issues such as behavioral principles, the underlying theory of language (Relational Frame Theory) and philosophy of science. We hope that informal learners, potential consumers, researchers and clinicians alike find it useful. https://podcasts.apple.com/us/podcast/act-in-context/id748513885 The Learn Psych Podcast is a monthly educational podcast on topics in psychiatry. It is targeted towards students and trainees, though it is often relevant to a wide variety of healthcare providers. https://podcasts.apple.com/us/podcast/learn-psych-podcast/id1118809594 Psychiatry Today Join Dr. Scot Bay every Wednesday night at 7PM while he discusses Psychiatry and mental health with guests. https://podcasts.apple.com/us/podcast/psychiatry-today/id279601313 Psychiatric videos for teaching Psychiatric interviews created for teaching purposes. https://podcasts.apple.com/us/podcast/psychiatric-videos-for-teaching/id670271700 Psyched??! We answer your call for psychiatry and mental health topics with our new upcoming podcast. We are two psychiatrists, David Carreon, 100%-nerd with a side of philosophy, and Jessi Gold, down-to-earth, empathic and, at times, sarcastic. We're starting a podcast called "Psyched!" aimed to communicate stories in neuroscience and psychiatry to a wider audience. We're targeting psychiatrists as our primary listeners, but hope to have a program that's accessible, entertaining and informative for a broader audience. Basically, we want to be the Economist for psychiatry. We'll cover everything from the foundational to the cutting-edge, from the popular to the weird. We hope to capture and communicate the excitement of psychiatry, and have fun while doing it. https://podcasts.apple.com/us/podcast/psyched-a-psychiatry-blog-episodes/id1299266826 Let's Talk about Borderline Personality Disorder A podcast about Borderline Personality Disorder by the National Education Alliance for Borderline Personality Disorder (NEABPD) https://podcasts.apple.com/us/podcast/lets-talk-about-borderline-personality-disorder/id1310234795 Psychiatry from University of Oxford Psychiatry is a medical discipline seeking to understand and treat mental illness. These podcasts provide an introduction to core topics in psychiatry, and to research undertaken in the Oxford University Department of Psychiatry. This series is relevant to health-care professionals and members of the public. The topic podcasts are particularly relevant to medical students studying psychiatry. https://podcasts.apple.com/us/podcast/psychiatry/id796432735 MGH Psychiatry Academy Podcasts https://player.fm/series/mgh-psychiatry-academy-podcasts

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Treating pigmentary disorders; plus vitamin A and SCC, and nanotechnology in dermatology

Play Episode Listen Later Aug 8, 2019 19:49

Seemal Desai, MD, talks with MDedge editor Elizabeth Mechcatie about the treatment of patients with pigmentary disorders in an interview at the summer meeting of the American Academy of Dermatology. We also bring you the latest in dermatology news and research: Higher dietary vitamin A linked to lower squamous cell carcinoma risk The results of the large prospective cohort study support the protective role of vitamin A against squamous cell carcinoma development. Adam Friedman, MD, takes a closer look at nanotechnology from a dermatology perspective. Ranking the best and worst states for health care Minnesota has more than just 10,000 lakes to brag about, the results of a WalletHub analysis suggest. Hosts: Elizabeth Mechcatie, Terry Rudd Guest: Seemal Desai, MD is in private practice in Dallas and is on the faculty at the University of Texas Southwestern Medical Center, Dallas. Show notes by Elizabeth Mechcatie and Terry Rudd. Dr. Friedman is a professor of dermatology and the interim chair of the dermatology department at George Washington University in Washington. For more MDedge Podcasts, go to http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Mara Antonoff, MD; PCPs unwilling to accept patients on opioids

Play Episode Listen Later Aug 2, 2019 53:56

Mara Antonoff, MD, of the MD Anderson Cancer Center, joins Nick to talk about female physicians being referred to by their first names. Nick and Emi Okamoto, MD, discuss a study that shows 40% of PCPs do not accept into their practice new patients who are using opioids. Time Stamps: Quiz (01:09) Acupuncture for chronic stable angina? (06:26) 40% of PCPs would not accept patients prescribed opioids (10:01) Introducing Mara Antonoff, MD (13:18) Interview with Dr. Antonoff (18:00) Relevant links: Quiz: Q1: Textured implant recall Q2: Advanced brain MRO in Havana Q3: Adults using aspirin for CVD Q4: Pregnancy/Birth stats Q5: UAB neurologic disease funding Acupuncture for chronic stable angina 40% of PCPs not willing to accept patients on opioids for pain JAMA research Twitter thread Mara Antonoff, MD: Official Bio Dr. Antonoff on Twitter You can contact the show at podcasts@mdedge.com. You can find Nick Andrews on Twitter @tribnic and you can find MDedge on Twitter @MDedgeTweets.

Dating advice for docs; Drug price tool, medical puns; boundaries with Pooja Lakshmin, MD

Play Episode Listen Later Jul 12, 2019 35:39

Ep 37: Time Stamps: Quiz (00:59) Tech tool for drug prices (04:35) Dating Advice for Doctors (08:05) Meet Pooja Lakshmin, MD (10:04) Dr. Shadowgazer medical puns (10:55) Interview with Dr. Lakshmin (12:11) Links: Quiz articles Fireworks injuries Dairy products and metabolic syndrome Cryptosporidiosis Transgender guidelines Vaccine legislation and vaccine rates Doctors slow to adopt tech tools that may save patients money on drugs Dr. Shadowgazer medical puns Pooja Lakshmin, MD, bio Dr. Lakshmin's website "We don't need self-care; we need boundaries" For more MDedge podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com

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Financial toxicity of cancer; the illusion of treatment options

Play Episode Listen Later Jul 11, 2019 24:59

David H. Henry, MD, host of Blood & Cancer, is joined by two experts on the financial toxicity of cancer. Melissa Monak and Kimberly Bell, both of the Cleveland Clinic, presented research at the 2019 annual meeting of the American Society of Clinical Oncology on the implementation of a financial navigation program at the Cleveland Clinic’s Taussig Cancer Center. In this podcast, they discuss the findings of their research and how just educating patients about their insurance benefits can improve access and patient satisfaction. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, revisits the “illusion of options” and what happens when this false hope originates with the treatment team. Show notes By Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia Prior authorizations, high deductibles, and out-of-pocket expenses often delay cancer treatment. Financial navigators connect with patients diagnosed with a malignancy who have not yet started treatment. These navigators identify insurance benefits, estimate out-of-pocket costs, and find copayment assistance programs or other charitable options. Resources Development of a financial navigation program to ease the burden of financial toxicity. J Clin Oncol 37. 2019 May 26. ASCO 2019, Abstract 6565. Patient financial burden: Considerations for oncology care and access – One organization’s approach to addressing financial toxicity (Cleveland Cancer Institute white paper). For more MDedge podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @mdedgehemonc

Emergency Oncology: ICYMI

Play Episode Listen Later Jul 5, 2019 26:14

Episode 26: ICYMI: Immunotherapy side effects in the ED In this special edition podcast, Blood & Cancer revisits an interview on the complications of immunotherapy, particularly how cancer patients present in the emergency department. David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, interviews emergency department physician Maura Sammon, MD, of Temple University, Philadelphia, about what happens when cancer patients come to the ED with side effects of their immunotherapy treatment, but they think they are being treated with chemotherapy. For more MDedge podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry, MD on Twitter: @davidhenrymd

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SPECIAL: ASCO Journal Club with Blood & Cancer host David Henry, MD

Daily Medical News

Play Episode Listen Later Jun 23, 2019 39:06

SPECIAL Crossover with Blood & Cancer, the official podcast of MDedge HematologyOncology. You can learn more about Blood & Cancer at http://www.mdedge.com/podcasts/blood-cancer SHOW NOTES: Alan P. Lyss, MD, a medical oncologist in community practice at Missouri Baptist Medical Center in St. Louis, joins Blood & Cancer host David H. Henry, MD, of the University of Pennsylvania, Philadelphia, to break down the most interesting and practice-changing studies at the recent 2019 annual meeting of the American Society of Clinical Oncology. Complete show notes by Ronak H. Mistry, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia, are available online here. For more MDedge podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @mdedgehemonc David Henry on Twitter: @DavidHenryMD Relevant links: Big Data Abstract LBA1 Abstract LBA5563 Abstract 110 CancerLinQ Database Colorectal Cancer Abstract 3500 Abstract 3501 Pancreatic Cancer Abstract 4000 Abstract LBA4 Prostate Cancer Abstract LBA2 Lung Cancer Abstract 8504 Breast Cancer Abstract 500 Abstract 502 TAILORx Abstract 503 Health Informatics Abstract 6509 Abstract 6510 Multiple Myeloma Multiple Myeloma Abstracts Smoldering Myeloma Abstract 8000 Myeloma Abstract 8002 Abstract 8007

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ASCO 2019 Special

Play Episode Listen Later Jun 22, 2019 38:09

Alan P. Lyss, MD, a medical oncologist in community practice at Missouri Baptist Medical Center in St. Louis, joins Blood & Cancer host David H. Henry, MD, of the University of Pennsylvania, Philadelphia, to break down the most interesting and practice-changing studies at the recent 2019 annual meeting of the American Society of Clinical Oncology. Complete show notes by Ronak H. Mistry, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia, are available online here. For more MDedge podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @mdedgehemonc David Henry on Twitter: @DavidHenryMD Relevant links: Big Data Abstract LBA1 Abstract LBA5563 Abstract 110 CancerLinQ Database Colorectal Cancer Abstract 3500 Abstract 3501 Pancreatic Cancer Abstract 4000 Abstract LBA4 Prostate Cancer Abstract LBA2 Lung Cancer Abstract 8504 Breast Cancer Abstract 500 Abstract 502 TAILORx Abstract 503 Health Informatics Abstract 6509 Abstract 6510 Multiple Myeloma Multiple Myeloma Abstracts Smoldering Myeloma Abstract 8000 Myeloma Abstract 8002 Abstract 8007

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Advice for interns/residents, and "Better Words for Better Deaths"

Play Episode Listen Later May 24, 2019 41:26

Emi takes the MDedge weekly quiz, she gives some advice for all the new interns out there, Nick suggests movies that could help interns and residents identify with the struggle, and Nick and Emi discuss the commentary "Better Words for Better Deaths" by this week's guest, Anna DeForest, MD. Show Outline: MDedge Quiz Emi answers questions from the #SoMeDocs Twitter chat. Nick's intern survival movie list: Miracle Whiplash Somm Nick and Emi discuss "Better Words for Better Deaths". Interview: Interview with Anna DeForest, MD about her work in the New England Journal of Medicine. Reasons to Live (Short stories by Amy Hempel). Terror Management Theory You can contact the show by emailing us at podcasts@mdedge.com and you can interact with Nick on Twitter @tribnic.

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Infection risk for cardiac rhythm device

Play Episode Listen Later May 17, 2019 8:21

Find more podcasts from MDedge on our website: https://www.mdedge.com/podcasts This week's top stories in cardiology: Risk score developed for cardiac-device infection AFib screening cuts hospitalizations and ED visits Arsenic exposure increases risk of left ventricular hypertrophy Ankylosing spondylitis patients taking COX-2 inhibitors may see fewer cardiovascular events You can contact the show be emailing us at podcasts@mdedge.com and you can interact with us on Twitter at @MDedgeCardio

Lung cancer: PD, PDL-1, and immunotherapy

Play Episode Listen Later May 16, 2019 35:22

Howard “Skip” Burris, MD, the chief medical officer of Sarah Cannon Cancer Institute in Nashville, Tenn., joins the podcast as the guest host for a discussion of PD1 and PDL1 in the treatment of lung cancer. Dr. Burris interviews Melissa Johnson, MD, the associate director of lung cancer research at Sarah Cannon. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University dives into the financial realities of cancer care. Show notes By Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia Programmed death ligand (PDL1) is a protein that is expressed by the tumor to escape detection by the immune system. T-cells produce PD1; when PD1 binds to PDL1, cancer can remain undetected. By blocking the binding of PD1 to PDL1, the immune system is able to recognize a tumor as foreign. Tumors with a high mutational burden typically have the most robust response to PD1 and PDL1 therapy. Treatment of patients with lung cancer with high mutational burden or high PDL1 score greater than 50% could likely be treated with monotherapy PDL1. Treatment of patients with lung cancer with low mutational burden or low PDL1 score consists of chemotherapy plus immunotherapy. In the field of lung cancer, tumor mutation burden is lower because lung cancer is typically driven by a single oncogene (EGFR, ALK, etc.). About 20% of lung cancer patients have a long and durable toxicity-free durable course when treated with PD1 and PDL1 inhibitors. Immunotherapy takes longer than chemotherapy to manifest a positive or beneficial change in patients. Monotherapy with PD1 and PDL1 inhibitors can cause autoimmune toxicity which may be recurrent. Upfront testing of PD1 and PDL1 in patients in clinics could lead to the early identification of patients who may benefit from immunotherapy. Additional reading: ESMO biomarker fact sheet for immunotherapy. J Immunother Cancer. 2018 Jan 23;6(1):8. doi: 10.1186/s40425-018-0316-z. You can contact the show at podcasts@mdedge.com and you can interact with us on Twitter at @MDedgeHemOnc To subscribe to this and other MDedge podcasts, go to www.mdedge.com/podcasts.

Anemia in cancer

Play Episode Listen Later Apr 11, 2019 27:28

You can contact Blood & Cancer at podcasts@mdedge.com and you can follow MDedge Hematology Oncology on Twitter @MDedgeHemOnc. Episode 11: Blood & Cancer host David Henry, MD, welcomes John Glaspy, MD, to talk about anemia in cancer. And in today's Clinical Correlation, Ilana Yurkiewicz, MD, talks apathy. Dr. Yurkiewicz has a column at MDedge, which you can find by clicking here. Show notes By Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania Hemoglobin is associated with quality of life and functional status, and quality of life improves continuously as hemoglobin rises from low (8 g/dL) to normal (12 g/dL) levels. The complete workup of anemia involves reticulocyte count, iron studies, folate, B12, peripheral smear, and creatinine. Anemia is a consequence of 1) cancer and 2) chemotherapy In patients with malignancy, the inflammatory state results in iron-restricted erythropoiesis, so patients may be functionally iron deficient even if their iron stores are replete. How do we treat anemia in cancer? Blood transfusion to rapidly improve hemoglobin Intravenous iron, if iron deficient Erythrocyte stimulating agents (ESA), if iron stores are replete. (Although IV iron augments ESA response in all cancer studies reported so far.) Risks associated with blood transfusion: Infection, transfusion-related-lung-injury, reactions to mismatched or well-matched blood, and iron overload (specifically in myelodysplastic syndrome). Recent FDA-mandated studies in anemic metastatic breast and non-small-cell lung cancer patients have demonstrated that there is no difference in survival among patients who receive ESA or placebo to treat their cancer/chemotherapy-associated anemia. HIF-1-alpha (hypoxia-inducible-factor) is a transcription factor produced in response to hypoxia. New class of drugs stabilizing HIF can result in both an increase in erythropoiesis and a decrease in hepcidin. References 2010 Dec 2;116(23):4754-61. Cancer Metastasis Rev.2007 Jun;26(2):341-52. Support Care Cancer.2006 Dec;14(12):1184-94. Cochrane Database Syst Rev.2016 Feb 4;2:CD009624. International Journal of Clinical Transfusion Medicine. 2018;6:21-31.

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ESMO 2018 and more

Play Episode Listen Later Feb 14, 2019 23:46

David Henry, MD, welcomes Daniel G. Haller, MD, to rehash research from ESMO 2018 as well as the way the meeting itself was run. And Ilana Yurkiewicz, MD, stops by for this week’s Clinical Correlation. Dr. Yurkiewicz is a Hematology Fellow at Stanford and is also a columnist at MDedge Hematology/Oncology. More from Dr. Yurkiewicz here. Contact us: podcasts@mdedge.com MDedge on Twitter: @mdedgehemonc Dr. Ilana Yurkiewicz on Twitter: @ilanayurkiewicz SHOW NOTES By Emily Bryer, DO Resident in the department of internal medicine, University of Pennsylvania Health System CheckMate 142: Durable clinical benefit with nivolumab plus low-dose ipilimumab as first-line therapy in microsatellite high (MSI-H) and non-MSI-H colon cancer Phase 2 study included 45 patients with metastatic colorectal cancer Overall response rate (primary end point) was 60% and disease control rate was 84% Almost every patient had some response and the therapy was well-tolerated https://bit.ly/2TljlQE Tribe 2: FOLFOXIRI plus bevacizumab followed by reintroduction of FOLFOXIRI plus bevacizumab versus FOLFOX plus bevacizumab followed by FOLFIRI plus bevacizumab Phase 3 study of 654 patients with unresectable metastatic colorectal cancer Progression free survival (primary end point) of FOLFOXIRI regimen was 18.9 months, compared with 16.2 months of the FOLFOX then FOLFIRI regimen Side effects of FOLFOXIRI: febrile neutropenia, neutropenia, GI toxicities https://bit.ly/2EMKBOa Trifluridine/tipiracil versus placebo in patients with heavily pretreated metastatic gastric cancer (TAGS): a randomized, double-blind, placebo-controlled, phase 3 trial Phase 3 study included 506 patients with metastatic gastric cancer Trifluridine/tipiracil (oral drug) provided a 2-month overall survival advantage (primary end point), compared with placebo Major side effect: neutropenia https://bit.ly/2tW7PMI Safety and clinical activity of 1L atezolizumab plus bevacizumab in a phase 1b study in hepatocellular carcinoma (HCC) Phase 1B study included 100 patients with HCC who had not received prior therapy Disease control rate was high as was duration of response Primary outcomes included safety and efficacy The overall response rate was 34% and the most common side effect was hypertension https://bit.ly/2EEPKaO

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Antiemetics: Richard Gralla

Play Episode Listen Later Jan 31, 2019 27:03

In the first episode of Blood & Cancer, David Henry, MD (http://bit.ly/2MFDfzm), welcomes Richard J. Gralla, MD (http://bit.ly/2ShsxEv), or the Albert Einstein College of Medicine in New York. The topic today centers around antiemetics and ways to use them. And later, Ilana Yurkiewicz, MD (https://stanford.io/2RXPixR), debuts her segment Clinical Correlations all about hematology care. Visit MDedge/hematology-oncology Show Notes By Emily Bryer, DO Highly emetic chemotherapy regimens include cisplatin, dacarbazine, anthracycline, and cyclophosphamide combinations Treatment should include an NK1 receptor antagonist, dexamethasone, and a 5HT3 antagonist All 5HT3 antagonists should be given only once (no evidence that prn or delayed administration is helpful) Olanzapine is an effective antiemetic, although its precise role and dose are undergoing investigation An all-oral regimen for highly emetic could include Netupitant (NK1) and palonosetron (long-acting 5HT3) (NEPA) + Oral Dex + Olanzapine Moderately emetic chemotherapy regimens include irinotecan and taxotere Treatment should include 5HT3 antagonist and dexamethasone Carboplatin causes more emesis than initially thought Improvement with NK1 antagonist yields a 15% decreased risk of emesis Guidelines now recommending NK1 with carboplatin Low emetic chemotherapy regimens include gemcitabine, pemetrexed as single agent Single drug: one dose of corticosteroid or one dose of 5HT3 antagonist Minimal emetic chemotherapy regimens include vincristine or bleomycin No drugs are recommended for acute or delayed nausea/emesis 20 mg Dexamethasone IV (or 12 mg PO 12 mg) should be administered only on day 1 of chemotherapy. Dexamethasone can be spared after that unless cisplatin (would require 2 days of steroids) Marijuana and THC have some antiemetic properties, but are about one quarter as effective as 5HT3 antagonists Lorazepam may be used in anticipatory emesis started a few days prior to chemotherapy References: Ann Oncol. 2014 Jul;25(7):1333-9. JCSO 2015;13(4):128-30. JCSO 2016;4(1):11-20. Contact information: Contact us: podcasts@mdedge.com MDedge on Twitter: @mdedgehemonc Dr. Ilana Yurkiewicz on Twitter: @ilanayurkiewicz Dr. Yurkiewicz on MDedge: http://bit.ly/2DItTAb

Bullied by antivaxxers: Monique Tello Part I

Distillations | Science History Institute

Play Episode Listen Later Jan 18, 2019 21:08

Dontact the show: podcasts@mdedge.com MDedge on Twitter: @MDedgeTweets Dr. Tello on Twitter: @drmoniquetello Anti-vaccination protesters targeted Monique A. Tello, MD, MPH (http://bit.ly/2QSYMoB), in late summer 2018 by leaving bad online ratings and writing false and defamatory comments in her online profiles. Dr. Tell wrote about her experience in a blog post (http://bit.ly/2FyR1Dd) where she opened up about how difficult the process has been, and how she has found support in a community of her colleagues.

Sex(ism), Drugs, and Migraines

Play Episode Listen Later Jan 15, 2019 42:10

Egyptian scriptures from 1200 BCE describe painful, migraine-like headaches, so we know the disorder has afflicted people for at least three thousand years. Still, the condition continues to mystify us today. Anne Hoffman is a reporter, a professor, and a chronic migraine sufferer. She spent the past year tracing the history of migraines, hoping to discover clues about a treatment that actually works for her. The journey took her in some interesting directions. One common theme she found? A whole lot of stigma. Credits Hosts: Alexis Pedrick and Elisabeth Berry Drago Senior Producer: Mariel Carr Producer: Rigoberto Hernandez Reporter: Anne Hoffman Photo illustration by Jay Muhlin Additional audio production by Dan Drago Music Theme music composed by Zach Young. "Valantis" and "Valantis Vespers" by Blue Dot Sessions, courtesy of the Free Music Archive. Additional music courtesy of the Audio Network. Research Notes Interviews Matthew Crawford, Doan Fellow, Science History Institute. Margaret Heaney, professor of neurobiology, Columbia University Irving Medical Center. Joanna Kempner, sociologist and author of Not Tonight: Migraine and the Politics of Gender and Health. Anne MacGregor, medical researcher and clinician. Brian McGeeney, assistant professor of neurology, Boston University School of Medicine. Sources Brooklyn Museum, Elizabeth A. Sackler Center for Feminist Art. “Hildegarde of Bingen.” McClory, Robert. “Hildegard of Bingen: No Ordinary Saint.” National Catholic Reporter, March 24, 2012. Meares, Hadley. “The Medieval Prophetess Who Used Her Visions to Criticize the Church.” Atlas Obscura, July 13, 2016. PBS Frontline. “Hildegard’s Scivias.” Songfacts. Für Hildegard Von Bingen. Wikipedia. “Scivias.” Last modified October 23, 2018, https://en.wikipedia.org/wiki/Scivias. Cannabidiol (CBD): Bazelot, Michaël, Chen Tong, Ibeas Bih, Dallas Mark, Clementino Nunn, Alistair V. W. Whalley Benjamin. “Molecular Targets of Cannabidiol in Neurological Disorders.” Neurotherapeutics 12 (2015): 699–730. Chen, Angus. “Some of the Parts: Is Marijuana’s ‘Entourage Effect’ Scientifically Valid?” Scientific American, April 20, 2017. Grinspoon, Peter. “Cannabidiol (CBD)—What We Know and What We Don’t.” Harvard Health Blog, Harvard Health Publishing, Harvard Medical School, August 24, 2018. Science Vs. “CBD: Weed Wonder Drug?” Podcast audio, November 15, 2018.. Migraine: Kempner, Joanna. “The Birth of the Dreaded ‘Migraine Personality.’” Migraine Again, November 30, 2017. Neighmond, Patti. “Why Women Suffer More Migraines Than Men.” Shots: Health News from NPR, National Public Radio, April 16, 2012. Peterlin, B. Lee, Saurabh Gupta, Thomas N. Ward, and Anne MacGregor. “Sex Matters: Evaluating Sex and Gender in Migraine and Headache Research.” Headache 51(6) (2011): 839–842. Sharkey, Lauren. “Why Don’t We Know More about Migraines?” BBC Future, British Broadcasting Corporation, July 2, 2018. Wikipedia. “Aretaeus of Cappadocia.” Last modified December 6, 2018. https://en.wikipedia.org/wiki/Aretaeus_of_Cappadocia. Cannabis for Migraine: Mandal, Ananya. “Migraine History.” News-Medical, August 23, 2018. MDede. “Are Cannabinoids and Hallucinogens Viable Treatment Options for Headache Relief?” Neurology Reviews 22(5) (2014): 22–23. Available at MDedge, Clinical Neurology News. Archival: Grass—The History of Marijuana. Directed by Ron Mann. Toronto: Sphinx Productions, 1999. Hildegard of Bingen. Directed by James Runcie. London: British Broadcasting Corporation, 1994. Reefer Madness. Directed by Louis J. Gasnier. Los Angeles: George A. Hirliman Productions, 1938.

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Ray Barfield Part II: Philosophy and Medicine

Play Episode Listen Later Jan 11, 2019 28:07

Contact us: podcasts@mdedge.com Ray Barfied, MD, is professor of pediatrics and of Christian philosophy at Duke University. In part I of the conversation, Dr. Barfield and MDedge host Nick Andrews discussed physician burnout and Dr. Barfield’s journey back to medicine. In this episode, Dr. Barfield and Nick discuss philosophy and science. You can listen to part I of this conversation here: http://bit.ly/2QxXAHh

ICYMI: Lorenzo Norris

Play Episode Listen Later Dec 21, 2018 56:34

Introducing the Postcall Podcast from MDedge. In the first edition, MDedge producer and host, Nick Andrews sits down with Lorenzo Norris, MD. Dr. Norris is the host of the MDedge Psychcast (http://bit.ly/2uWxaG6) as well as the editor-in-chief of MDedge Psychiatry and Dean at the George Washington University School of Medicine and Health Sciences.

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First Episode: Lorenzo Norris

Play Episode Listen Later Oct 12, 2018 55:47

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Lorenzo Norris: Solo

Play Episode Listen Later Sep 26, 2018 46:22

Lorenzo Norris, MD, gives his thoughts on everything from Autumn to residency. If you have thoughts or questions on Dr. Norris’ commentary please comment below. And stick around for Dr. RK on invisible people.

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ESC 2018: Part II

Play Episode Listen Later Sep 21, 2018 55:43

The MDedge cardiology team is back for the second edition of their debrief on the 2018 annual congress of the European Society of Cardiology. The team includes MDedge editor Catherine Hackett and MDedge reporters Bruce Jancin and Mitchel Zoler.

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Behavioral intervention in obese adults

Daily Medical News

Play Episode Listen Later Sep 20, 2018 6:29

The U.S. Preventative Services Task Force advises clinicians to refer or offer intensive behavioral weight-loss interventions to obese adults (http://bit.ly/2DbYO9F). Also today, stop treating gout and start curing it (http://bit.ly/2QIhaBO) the FDA has a new risk evaluation mitigation strategy for immediate-release opioids (http://bit.ly/2Df9AvY), and the United Nations aims to eradicate tuberculosis by the year 2030 (http://bit.ly/2DenEFN).

Joseph Pierre: Dual Diagnoses part I

Play Episode Listen Later Sep 5, 2018 22:44

What is the ideal treatment for patients with dual diagnoses -- what is the real-world treatment? Dr. Lorenzo Norris returns to the MDedge psychcast this week to discuss dual diagnoses. His guest is Dr. Joseph M. Pierre, MD, health sciences clinical professor in the department of psychiatry and behavioral sciences at the David Geffen School of Medicine at the University of California, Los Angeles. Dr. Pierre recently published an article for MDedge Psychiatry on the real-world challenges in managing these patients. Dr. Norris and Dr. Pierre discuss ideal treatment compared to real-world treatment. Next week in part II, Dr. Norris and Dr. Pierre dive into addressing malingering and avoiding clinical errors. And Dr. RK joins us to give a talk about, well, words.

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Michael Gitlin: Stimulants

Play Episode Listen Later Aug 22, 2018 10:05

In this edition of the MDedge psychcast, Michael Gitlin, MD, of UCLA discusses the current role of stimulants in psychiatry. Dr. Gitlin raises a number of topics including ADHD and bipolar disorder. In recent years, more data have become available about patients with bipolar who are taking mood stabilizers. And Dr. RK notes the differences in therapy and psychiatry. She says that the profession has work to do on this front.

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Laura Marsh: Parkinson’s

Play Episode Listen Later Aug 15, 2018 13:31

In this edition of the MDedge psychcast Laura Marsh, MD, returns to discuss Parkinson's disease. And later, the Dr. RK gives part 2 in her talk on HIPPA.

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Laura Marsh: Epilepsy

Play Episode Listen Later Aug 8, 2018 11:21

Laura Marsh of Baylor College of Medicine joins this episode to discuss manifestations of epilepsy. And later, Dr. Renee Kohanski begins a series into HIPPA.

Antibody cleared amyloid plaques, slowed cognitive decline

Daily Medical News

Play Episode Listen Later Jul 27, 2018 7:28

An experimental agent slowed cognitive decline and cleared Alzheimer’s plaques. Can meteorology predict migraines? Why closing a patent foramen ovale is the right approach to prevent recurring ischemic stroke. And claims that cannabis relieves noncancer pain go up in smoke.

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Dr. Leslie Citrome: addressing tardive dyskinesia