Podcasts about medstar washington hospital center

Dr. Ebony Hoskins and Dr. Andreas Obermair discuss the surgical management of gynecologic cancers, including the role of minimally invasive surgery, approaches in fertility preservation, and the nuances of surgical debulking. TRANSCRIPT Dr. Ebony Hoskins: Hello and welcome to the ASCO Daily News Podcast, I'm Dr. Ebony Hoskins. I'm a gynecologic oncologist at MedStar Washington Hospital Center in Washington, DC, and your guest host of the ASCO Daily News Podcast. Today we'll be discussing the surgical management of gynecologic cancer, including the role of minimally invasive surgery (MIS), approaches in fertility preservation, and the nuances of surgical debulking, timing, and its impact on outcomes. I am delighted to welcome Dr. Andreas Obermair for today's discussion. Dr. Obermair is an internationally renowned gynecologic oncologist, a professor of gynecologic oncology at the University of Queensland, and the head of the Queensland Center for Gynecologic Cancer Research. Our full disclosures are available in the transcript of this episode. Dr. Obermair, it's great speaking with you today. Dr. Andreas Obermair: Thank you so much for inviting me to this podcast. Dr. Ebony Hoskins: I am very excited.  I looked at your paper and I thought, gosh, is everything surgical? This is everything that I deal with daily in terms of cancer in counseling patients. What prompted this review regarding GYN cancer management? Dr. Andreas Obermair: Yes, our article was published in the ASCO Educational Book; it is volume 44 in 2024. And this article covers some key aspects of targeted precision surgical management principles in endometrial cancer, cervical cancer, and ovarian cancer. While surgery is considered the cornerstone of gynecologic cancer treatment, sometimes research doesn't necessarily reflect that. And so I think ASCO asked us to; so it was not just me, there was a team of colleagues from different parts of the United States and Australia to reflect on surgical aspects of gynecologic cancer care and I feel super passionate about that because I do believe that surgery has a lot to offer. Surgical interventions need to be defined and overall, I see the research that I'm doing as part of my daily job to go towards precision surgery. And I think that is, well, that is something that I'm increasingly passionate for. Dr. Ebony Hoskins: Well, I think we should get into it. One thing that comes to mind is the innovation of minimally invasive surgery in endometrial cancer. I always reflect on when I started my fellowship, I guess it's been about 15 years ago, all of our endometrial cancer patients had a midline vertical incision, increased risk of abscess, infections and a long hospital stay. Do you mind commenting on how you see management of endometrial cancer today? Dr. Andreas Obermair: Thank you very much for giving the historical perspective because the generation of gynecologic oncologists today, they may not even know what we dealt with, what problems we had to solve. So like you, when I was a fellow in gynecologic oncology, we did midline or lower crosswise incisions, the length of stay was, five days, seven days, but we had patients in hospital because of complications for 28 days. We took them back to the operating theaters because those are patients with a BMI of 40 plus, 45, 50 and so forth. So we really needed to solve problems. And then I was exposed to a mentor who taught minimal invasive surgery. And in Australia he was one of the first ones who embarked on that. And I can remember, I was mesmerized by this operation, like not only how logical this procedure was, but also we did rounds afterwards. And I saw these women after surgery and I saw them sitting upright, lipstick on, having had a full meal at the end of the day. And I thought, wow, this is the most rewarding experience that I have to round these patients after surgery. And so I was thinking, how could I help to establish this operation as standard? Like a standard that other people would accept this is better. And so I thought we needed to do a trial on this. And then it took a long time. It took a long time to get the support for the [LACE - Laparoscopic Approach to Cancer of the Endometrium] trial. And in this context, I just also wanted to remind us all that there were concerns about minimal invasive surgery in endometrial cancer at the time. So for example, one of the concerns was when I submitted my grant funding applications, people said, “Well, even if we fund you, wouldn't be able to do this trial because there are actually no surgeons who actually do minimally invasive surgery.” And at the time, for example, in Australia, there were maybe five people, a handful of people who were able to do this operation, right? This was about 20 years ago. The other concern people had was they were saying, could minimally invasive surgery for endometrial cancer, could that cause port side metastasis because there were case reports. So there were a lot of things that we didn't know anyway. We did this trial and I'm super happy we did this trial. We started in 2005, and it took five years to enroll. At the same time, GOG LAP2 was ramping up and the LACE trial and GOG LAP2 then got published and provided the foundations for minimally invasive surgery in endometrial cancer. I'm super happy that we have randomized data about that because now when we go back and now when people have concerns about this, should we do minimally invasive surgery in P53 mutant tumors, I'm saying, well, we actually have data on that. We could go back, we could actually do more research on that if we wanted to, but our treatment recommendations are standing on solid feet. Dr. Ebony Hoskins: Well, my patients are thankful. I see patients all the time and they have high risk and morbidly obese, lots of medical issues and actually I send them home most the same day. And I think, you know, I'm very appreciative of that research, because we obviously practice evidence-based and it's certainly a game changer. Let's go along the lines of MIS and cervical cancer. And this is going back to the LACC [Laparoscopic Approach to Cervical Cancer] trial.  I remember, again, one of these early adopters of use of robotic surgery and laparoscopic surgery for radical hysterectomy and thought it was so cool. You know, we can see all the anatomy well and then have the data to show that we actually had a decreased survival. And I even see that most recent updated data just showing it still continued. Can you talk a little bit about why you think there is a difference? I know there's ongoing trials, but still interested in kind of why do you think there's a survival difference? Dr. Andreas Obermair:  So Ebony, I hope you don't mind me going back a step. So the LACC study was developed from the LACE trial. So we thought we wanted to reproduce the LACE data/LAP2 data. We wanted to reproduce that in cervix cancer. And people were saying, why do you do that? Like, why would that be different in any way? We recognize that minimally invasive radical hysterectomy is not a standard. We're not going to enroll patients in a randomized trial where we open and do a laparotomy on half the patients. So I think the lesson that really needs to be learned here is that any surgical intervention that we do, we should put on good evidence footing because otherwise we're really running the risk of jeopardizing patients' outcomes. So, that was number one and LACC started two years after LACE started. So LACC started in 2007, and I just wanted to acknowledge the LACC principal investigator, Dr. Pedro Ramirez, who at the time worked at MD Anderson. And we incidentally realized that we had a common interest. The findings came totally unexpected and came as an utter shock to both of us. We did not expect this. We expected to see very similar disease-free and overall survival data as we saw in the endometrial cancer cohort. Now LACC was not designed to check why there was a difference in disease-free survival. So this is very important to understand. We did not expect it. Like, so there was no point checking why that is the case. My personal idea, and I think it is fair enough if we share personal ideas, and this is not even a hypothesis I want to say, this is just a personal idea is that in endometrial cancer, we're dealing with a tumor where most of the time the cancer is surrounded by a myometrial shell. And most of the time the cancer would not get into outside contact with the peritoneal cavity. Whereas in cervix cancer, this is very different because in cervix cancer, we need to manipulate the cervix and the tumor is right at the outside there. So I personally don't use a uterine manipulator. I believe in the United States, uterine manipulators are used all the time. My experience is not in this area, so I can't comment on that. But I would think that the manipulation of the cervix and the contact of the cervix to the free peritoneal cavity could be one of the reasons. But again, this is simply a personal opinion. Dr. Ebony Hoskins: Well, I appreciate it. Dr. Andreas Obermair: Ebony at the end of the day, right, medicine is empirical science, and empirical science means that we just make observations, we make observations, we measure them, and we pass them on. And we made an observation. And, and while we're saying that, and yes, you're absolutely right, the final [LACC] reports were published in JCO recently. And I'm very grateful to the JCO editorial team that they accepted the paper, and they communicated the results because this is obviously very important. At the same time, I would like to say that there are now three or four RCTs that challenge the LACC data. These RCTs are ongoing, and a lot of people will be looking forward to having these results available. Dr. Ebony Hoskins: Very good. In early-stage cervical cancer, the SHAPE trial looked at simple versus radical hysterectomy in low-risk cervical cancer patients. And as well all know, simple hysterectomy was not inferior to radical hysterectomy with respect to the pelvic recurrence rate and any complications related to surgery such as urinary incontinence and retention. My question for you is have you changed your practice in early-stage cervical cancer, say a patient with stage 1B1 adenocarcinoma with a positive margin on conization, would you still offer this patient a radical hysterectomy or would you consider a simple hysterectomy? Dr. Andreas Obermair:  I think this is a very important topic, right? Because I think the challenge of SHAPE is to understand the inclusion criteria. That's the main challenge. And most people simplify it to 2 cm, which is one of the inclusion criteria but there are two others and that includes the depth of invasion. Dr. Marie Plante has been very clear. Marie Plante is the first author of the SHAPE trial that's been published in the New England Journal of Medicine only recently and Marie has been very clear upfront that we need to consider all three inclusion criteria and only then the inclusion criteria of SHAPE apply. So at the end of the day, I think what the SHAPE trial is telling us that small tumors that would strictly fulfill the criteria of a 1B or 1B1 cancer of the cervix can be considered for a standard type 1 or PIVA type 1 or whatever classification we're trying to use will be eligible. And that makes a lot of sense. I personally not only look at the size, I also look at the location of the tumor. I would be very keen that I avoid going through tumor tissue because for example, if you have a tumor that is, you know, located very much in one corner of the cervix and then you do a standard hysterectomy and then you have a positive tumor margin that would be obviously, most people would agree it would be an unwanted outcome. So I'd be very keen checking the location, the size of the tumor, the depths of invasion and maybe then if the tumor for example is on one side of the cervix you can do a standard approach on the contralateral side but maybe do a little bit more of a margin, a parametrial margin on the other side. Or if a tumor is maybe on the posterior cervical lip, then you don't need to worry so much about the anterior cervical margin, maybe take the rectum down and maybe try to get a little bit of a vaginal margin and the margin on the uterus saccals. Just really to make sure that you do have margins because typically if we get it right, survival outcomes of clinical stage 1 early cervix cancer 1B1 1B 2 are actually really good. It is a very important thing that we get the treatment right. In my practice, I use a software to record my treatment outcomes and my margins. And I would encourage all colleagues to be cognizant and to be responsible and accountable to introduce accountable clinical practice, to check on the margins and check on the number on the percentage of patients who require postoperative radiation treatment or chemo radiation. Dr. Ebony Hoskins: Very good. I have so many questions for you. I don't know the statistics in Australia, but here, there's increased rising of endometrial cancer and certainly we're seeing it in younger women. And fertility always comes up in terms of kind of what to do. And I look at the guidelines and, see if I can help some of the women if they have early-stage endometrial cancer. Your thoughts on what your practice is on use of someone who may meet criteria, if you will. The criteria I use is grade 1 endometrioid adenocarcinoma. No myometria invasion. I try to get MRI'd and make sure that there's no disease outside the endometrium. And then if they make criteria, I typically would do an IUD. Can you tell me what your practice is and where you've had success? Dr. Andreas Obermair: So, we initiated the feMMe clinical trial that was published in 2021 and it was presented in a Plenary at one of the SGO meetings. I think it was in 2021, and we've shown complete pathological response rates after levonorgestrel intrauterine device treatment. And so in brief, we enrolled patients with endometrial hyperplasia with atypia, but also patients with grade 1 endometrial adenocarcinoma. Patients with endometrial hyperplasia with atypia had, in our series, had an 85 % chance of developing a complete pathological response. And that was defined as the complete absence of any atypia or cancer. So endometrial hyperplasia with atypia responded in about 85%. In endometrial cancer, it was about half, it was about 45, 50%. In my clinical practice, like as you, I see patients, you know, five days a week. So I'm looking after many patients who are now five years down from conservative treatment of endometrial cancer. There are a lot of young women who want to get pregnant, and we had babies, and we celebrate the babies obviously because as gynecologist obstetricians it couldn't get better than that, right, if our cancer patients have babies afterwards. But we're also treating women who are really unfit for surgery and who are frail and where a laparoscopic hysterectomy would be unsafe. So this phase is concluded, and I think that was very successful. At least we're looking to validate our data. So we're having collaborations, we're having collaborations in the United States and outside the United States to validate these data. And the next phase is obviously to identify predictive factors, to identify predictors of response. Because as you can imagine, there is no point treating patients with a levonorgestrel intrauterine joint device where we know in advance that she's not going to respond. So this is a very, very fascinating story and we got our first set of data already, but now we just really need to validate this data. And then once the validation is done, my unit is keen to do a prospective validation trial. And that also needs to involve international collaborators. Dr. Ebony Hoskins: Very good. Moving on to ovarian cancer, we see patients with ovarian cancer with, say, at least stage 3C or higher who started neoadjuvant chemotherapy. Now, some of these patients are hearing different things from their medical oncologist versus their gynecologic oncologist regarding the number of cycles of neoadjuvant chemotherapy after getting diagnosed with ovarian cancer. I know that this can be confusing for our patients coming from a medical oncologist versus a gynecologic oncologist. What do you say to a patient who is asking about the ideal number of chemotherapy cycles prior to surgery? Dr. Andreas Obermair: So this is obviously a very, very important topic to talk about. We won't be able to provide a simple off the shelf answer for that, but I think data are emerging.  The ASCO guidelines should also be worthwhile considering because there are actually new ASCO Guidelines [on neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer] that just came out a few weeks ago and they would suggest that we should be aiming for R0 in surgery. If we can maybe take that as the pivot point and then go back and say, okay, so what do need to do to get the patient to zero?  I'm not an ovarian cancer researcher; I'm obviously a practicing gynecologic oncologist. I think about things a lot and things like that. In my practice, I would want a patient to develop a response after neoadjuvant chemotherapy. So, if a patient doesn't have a response after two or three cycles, then I don't see the point for me to offer her an operation. In my circle with the medical oncologists that I work with, I have a very, very good understanding. So, they send the patient to me, I take them to the theater. I take a good chunk of tissue from the peritoneum. We have a histopathologic diagnosis, we have a genomic diagnosis, they go home the same day. So obviously there is no hospital stay involved with that. They can start the chemotherapy after a few days. There is no hold up because the chances of surgical complication in a setting like this is very, very low. So I use laparoscopy to determine whether the patient responds or not. And for many of my patients, it seems to work. It's obviously a bit of an effort and it takes operating time. But I think I'm increasing my chances to make the right decision. So, coming back to your question about whether we should give three or six cycles, I think the current recommendations are three cycles pending the patient's response to neoadjuvant chemotherapy because my aim is to get a patient to R0 or at least minimal residual disease. Surgery is really, in this case, I think surgery is the adjunct to systemic treatment. Dr. Ebony Hoskins: Definitely. I think you make a great point, and I think the guideline just came out, like you mentioned, regarding neoadjuvant. And I think the biggest thing that we need to come across is the involvement of a gynecologic oncologist in patients with ovarian cancer. And we know that that survival increases with that involvement. And I think the involvement is the surgery, right? So, maybe we've gotten away from the primary tumor debulking and now using more neoadjuvant, but surgery is still needed. And so, I definitely want to have a take home that GYN oncology is involved in the care of these patients upfront. Dr. Andreas Obermair: I totally support that. This is a very important statement. So when I'm saying surgery is the adjunct to medical treatment, I don't mean that surgery is not important. Surgery is very important. And the timing is important. And that means that the surgeons and the med oncs need to be pulling on the same string. The med oncs just want to get the cytotoxic into the patients, but that's not the point, right? We want to get the cytotoxic into the patients at the right time because if we are working under this precision surgery, precision treatment mantra, it's not only important what we do, but also doing it at the right time. And ideally, I I would like to give surgery after three cycles of neoadjuvant chemotherapy, if that makes sense. But sometimes for me as a surgeon, I talk to my med onc colleagues and I say, “Look, she doesn't have a good enough response to her treatment and I want her to receive six cycles and then we re-evaluate or change medical treatment,” because that's an alternative that we can swap out drugs and treat upfront with a different drug and then sometimes they do respond. Dr. Ebony Hoskins:  I have maybe one more topic. In the area I'm in, in the Washington D.C. area, we see lots of endometrial cancer and they're not grade 1, right? They're high-risk endometrial cancer and advanced. So a number of patients with stage 3 disease, some just kind of based off staging and then some who come in with disease based off of the CT scan, sometimes omental caking, ascites. And the real question is we have extrapolated the use of neoadjuvant chemotherapy to endometrial cancer. It's similar, but not the same. So my question is in an advanced endometrial cancer, do you think there's still a role, when I say advanced, I mean, maybe stage 4, a role for surgery? Dr. Andreas Obermair: Most definitely. But the question is when do you want to give this surgery? Similar to ovarian cancer, in my experience, I want to get to R0. What am I trying to achieve here? So, I reckon we should do a trial on this. And I reckon we have, as you say, the number of patients in this setting is increasing, we could do a trial. I think if we collaborate, we would have enough patients to do a proper trial. Obviously, we would start maybe with a feasibility trial and things like that. But I reckon a trial would be needed in this setting because I find that the incidence that you described, that other people would come across, they're becoming more and more common. I totally agree with you, and we have very little data on that. Dr. Ebony Hoskins: Very little and we're doing what we can. Dr. Obermair, thank you for sharing your fantastic insights with us today on the ASCO Daily News Podcast and for all the work you do to advance care for patients with gynecologic cancer. Dr. Andreas Obermair: Thank you, Dr. Hoskins, for hosting this and it's been an absolute pleasure speaking with you today. Dr. Ebony Hoskins: Definitely a pleasure and thank you to our listeners for your time today. Again, Dr. Obermair's article is titled, “Controversies in the Surgical Management of Gynecologic Cancer: Balancing the Decision to Operate or Hesitate,” and was published in the 2024 ASCO Educational Book. And you'll find a link to the article in the transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review and subscribe wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement. Find out more about today's speakers: Dr. Ebony Hoskins @drebonyhoskins Dr. Andreas Obermair @andreasobermair Follow ASCO on social media:       @ASCO on Twitter       ASCO on Bluesky   ASCO on Facebook       ASCO on LinkedIn       Disclosures:   Dr. Ebony Hoskins: No relationships to disclose. Dr. Andreas Obermair: Leadership: SurgicalPerformance Pty Ltd. Stock and Ownership Interests: SurgicalPerformance Pty Ltd. Honoraria: Baxter Healthcare Consulting or Advisory Role: Stryker/Novadaq Patents, Royalties, and Other Intellectual Property: Shares in SurgicalPerformance Pty Ltd. Travel, Accommodation, Expenses: Stryker    

Join us as Katelyn Moser, Senior Director of Patient Experience at MedStar Washington Hospital Center, shares insights from Career and Communication Day—an innovative initiative that brings elementary school students to her campus. This program not only reinforces essential communication skills among staff but also introduces children to the diverse career opportunities within healthcare. Don't miss this engaging discussion on how a fresh perspective from young learners can enhance workplace communication.

This brief episode offers an update from Mary Lynn McPherson, PharmD, PhD, FAAHPM and Alexandra L. McPherson, PharmD, MPH. Listen for an update on the patient discussed in Episode 38. Related Resources: Episode 38: Discharged to Airport: Navigating Complex Symptom Management Down on the Pharm: Contemporary Issues in Pharmacopalliation   About the Speakers: Mary Lynn McPherson, PharmD, PhD, FAAHPM Dr. McPherson has practiced hospice and palliative care as a clinical pharmacist her entire career. She is a professor at the University of Maryland and executive program director of the online Graduate Studies in Palliative Care (Graduate Certificates, MS, PhD) program. She has served as a resource to medical staff for pain and symptom consultations, opioid conversion calculations, methadone dosing and other medication-related issues. McPherson is particularly interested in assuring patients with a serious illness receive goal-concordant medication therapy. She has authored five books including the popular Demystifying Opioid Conversion Calculations: A Guide to Effective Dosing and numerous peer-reviewed articles and chapters.   Alex McPherson, PharmD, MPH Dr. McPherson received her Bachelor of Science in International Business from the University of Maryland in College Park, MD, followed by her Master of Public Health (MPH) with a dual certificate in International Health and Pharmaceutical Assessment, Management, and Policy from Boston University in Boston, MA. She went on to receive her Doctor of Pharmacy from the University of Maryland School of Pharmacy in Baltimore, MD. Subsequently she completed a Pharmacy Practice Residency at Einstein Medical Center in Philadelphia, PA and Pain Management and Palliative Care Specialty Residency at the University of Maryland School of Pharmacy/MedStar Health. She is currently a Palliative Care Clinical Pharmacy Specialist at MedStar Washington Hospital Center in Washington, DC, where she serves as faculty in the interdisciplinary Hospice and Palliative Medicine Fellowship program. In addition, she serves as a faculty member for the nation's first M.S. in Medical Cannabis Science and Therapeutics (University of Maryland School of Pharmacy), and M.S. in Palliative Care (University of Maryland Graduate School) programs. She is an active member of the American Academy of Hospice and Palliative Medicine and the Society of Pain and Palliative Care Pharmacists and has published and presented internationally on topics pertaining to pain management and palliative care. Her academic interests include early integration of palliative care in advanced illness, navigating transitions of care at the end-of-life, and the pharmacologic management of symptoms in serious illness. Her newest interest includes the integration of narrative medicine practices as a tool for reducing burnout and improving resiliency among palliative care providers.

Send us a textLung cancer is the leading cause of cancer deaths in both men and women, resulting in more cancer deaths than breast, prostate, and colorectal cancers combined. It can take years to develop and is difficult to detect in early stages when there is greater potential for a cure. Fortunately, lung cancer survival rates are improving, thanks to advances in screening and treatment options, including breakthrough therapies that we're leading at MedStar Health. In partnership with the Georgetown Lombardi Comprehensive Cancer Center—a National Cancer Institute-designated comprehensive cancer center—we can offer our patients promising clinical trials years before they become the standard of care. Dr. Edward Chan is the Chief of Thoracic Surgery at MedStar Washington Hospital Center. Dr. Chan sees patients at MedStar Washington Hospital Center and MedStar Georgetown University Hospital. Dr. Chan is double-board certified and specializes in general thoracic surgery. He treats patients for lung cancer, esophageal cancer, benign esophageal diseases (such as acid reflux/hiatal hernia and achalasia), and mediastinal tumors. For an interview with Dr. Edward Chan, or for more information about this podcast, contact MedStar Georgetown University Hospital Manager Media Relations, Ryan.M.Miller2@Medstar.net.  Learn more about Dr. Chan. For more episodes of MedStar Health DocTalk, go to medstarhealth.org/doctalk.

In this episode, Mary Lynn McPherson, PharmD, PhD, FAAHPM and Alexandra L. McPherson, PharmD, MPH discuss a complicated case involving a patient in her mid-50s from East Africa who is suffering from metastatic cancer. The conversation highlights the challenges of complex pain & symptom management while supporting a patient's goals of care. Related Resources: Down on the Pharm: Contemporary Issues in Pharmacopalliation About the Speakers: Mary Lynn McPherson, PharmD, PhD, FAAHPM Dr. McPherson has practiced hospice and palliative care as a clinical pharmacist her entire career. She is a professor at the University of Maryland and executive program director of the online Graduate Studies in Palliative Care (Graduate Certificates, MS, PhD) program. She has served as a resource to medical staff for pain and symptom consultations, opioid conversion calculations, methadone dosing and other medication-related issues. McPherson is particularly interested in assuring patients with a serious illness receive goal-concordant medication therapy. She has authored five books including the popular Demystifying Opioid Conversion Calculations: A Guide to Effective Dosing and numerous peer-reviewed articles and chapters.   Alex McPherson, PharmD, MPH Dr. McPherson received her Bachelor of Science in International Business from the University of Maryland in College Park, MD, followed by her Master of Public Health (MPH) with a dual certificate in International Health and Pharmaceutical Assessment, Management, and Policy from Boston University in Boston, MA. She went on to receive her Doctor of Pharmacy from the University of Maryland School of Pharmacy in Baltimore, MD. Subsequently she completed a Pharmacy Practice Residency at Einstein Medical Center in Philadelphia, PA and Pain Management and Palliative Care Specialty Residency at the University of Maryland School of Pharmacy/MedStar Health. She is currently a Palliative Care Clinical Pharmacy Specialist at MedStar Washington Hospital Center in Washington, DC, where she serves as faculty in the interdisciplinary Hospice and Palliative Medicine Fellowship program. In addition, she serves as a faculty member for the nation's first M.S. in Medical Cannabis Science and Therapeutics (University of Maryland School of Pharmacy), and M.S. in Palliative Care (University of Maryland Graduate School) programs. She is an active member of the American Academy of Hospice and Palliative Medicine and the Society of Pain and Palliative Care Pharmacists and has published and presented internationally on topics pertaining to pain management and palliative care. Her academic interests include early integration of palliative care in advanced illness, navigating transitions of care at the end-of-life, and the pharmacologic management of symptoms in serious illness. Her newest interest includes the integration of narrative medicine practices as a tool for reducing burnout and improving resiliency among palliative care providers.    

When you are obese or morbidly obese it can be difficult to get started with a movement or exercise routine. Today we have Dr. Joe Greene on the show to talk about the best forms of exercise, and how to get started. He shares some research done about pre and post op movement, and how to prepare for your surgery and recovery. Tune in for some great tips to uncover the best types of movement for you!  IN THIS EPISODE: [2:22] How did Dr. Joe Greene find a love for movement?  [4:00] How Dr. Greene helps patients feel confident in their movement journey [6:15] What is the best exercise?  [9:00] What should you do if you are feeling nervous to start getting movement in?   [10:00] Should you wait until after surgery to start an exercise routine?  KEY TAKEAWAYS: Some of the best forms of exercise for people who struggle with obesity are cycling, swimming, and low impact exercises. The best exercise is the one that you enjoy doing because if you don't enjoy doing it, you're not going to do it. It has to be fun and engaging! Pre-operative movement actually helps people be in better condition for their surgery. The stronger you are with both physical conditioning and pulmonary conditioning, the better your recovery will be.  RESOURCES: Joseph Greene's Instagram Joseph A. Greene's YouTube Dr. Joe Greene's Website BariNation Website  Join the BariNation Membership community meetups to support you on your journey with obesity treatment - https://barination.com/pages/join-our-community Want to see bonus content? Head over to Patreon to get more and to support the podcast for as low as $5 per month! https://www.patreon.com/BariNationPodcast  BIOGRAPHY: Dr. Joe Greene is a board-certified and fellowship-trained Bariatric, Robotic, and Advanced Laparoscopic Surgeon. He completed his residency in general surgery at MedStar Washington Hospital Center. Following residency, he was accepted for fellowship in Bariatric and Advanced Laparoscopic Surgery at Inova Fair Oaks Hospital. Dr. Greene currently serves as the Medical Director of Bariatric Surgery and Section Chair of Bariatric Surgery at Holy Cross Germantown Hospital. Dr. Greene performs a range of bariatric operations including Sleeve Gastrectomy (VSG), Roux-en-Y Gastric Bypass (RYGB), Single Anastomosis Duodenal Ileostomy with Sleeve (SADI-S or Loop Duodenal Switch), as well as Revision and Conversion Bariatric Surgery. Dr. Greene has extensive training and experience on the Intuitive DaVinci Surgical System for both Bariatric and General surgical procedures. Dr. Greene is a Diplomate of the American Board of Surgery and a Fellow of the American College of Surgeons. He is also a member of the American Society of Metabolic and Bariatric Surgery (ASMBS), the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), and the American Medical Association (AMA). Dr. Greene has a passion for movement, which can be seen through his engagement with Peloton. He believes that all patients can move their bodies, and brings gentle accountability while bringing the bariatric world together.  --- Support this podcast: https://podcasters.spotify.com/pod/show/barination/support

We discuss the practicalities of using airway pressure release ventilation (APRV) with Dr. Rory Spiegel (@EMnerd_), emergency physician and intensivist at MedStar Washington Hospital Center (and EMNerd at Emcrit). Find us on Patreon here! Buy your merch here! Takeaway lessons

Hosts Dr. Mark Hoffman and Dr. Amy Park invite Dr. Vadim Morozov, a minimally invasive gynecologic surgeon at MedStar Washington Hospital Center, to discuss the applications and implications of artificial intelligence (AI) in gynecologic surgery both currently and in the future. --- SYNPOSIS Dr. Morozov shares his insights on the basics of AI as well as how it is currently being used in medicine and research. He shares his experiences working with AI to develop algorithms for robotic gynecologic procedures. Furthermore, he predicts the direction AI is going in medicine and highlights the complexities and ethical considerations of integrating AI into medical practice. The conversation delves into the advancements, potentials, and concerns surrounding AI, addressing its impact on surgery, privacy, and the future of medical practice. --- TIMESTAMPS 00:00 - Introduction 03:52 - AI in Gynecologic Surgery 06:10 - Understanding AI Basics 13:24 - AI in Medical Applications 17:09 - Future of AI in Medicine 33:24 - AI in Surgery 45:10 - Data and Privacy Concerns 57:35 - Call to Action: Get Involved --- RESOURCES BUMP Study: Goodday, S.M., Karlin, E., Brooks, A. et al. Better Understanding of the Metamorphosis of Pregnancy (BUMP): protocol for a digital feasibility study in women from preconception to postpartum. npj Digit. Med. 5, 40 (2022). https://doi.org/10.1038/s41746-022-00579-9

On episode 105 of PSQH: The Podcast, Loral Patchen, a senior faculty midwife attending at MedStar Washington Hospital Center, and Anish Sebastian, CEO of Babyscripts, talk about ways to reduce maternal mortality.

In the 6 AM Hour: Larry O'Connor and Julie Gunlock discussed: DC CARJACKING: A senior citizen died after a woman carjacked an SUV at MedStar Washington Hospital Center in D.C., drove off with the senior still inside and crashed, police say.  FOX 5 DC: Senior citizen dies after car thief steals SUV from DC hospital, crashes with her still inside: police Gallaudet University named most dangerous campus in America: report Jury is chosen in Hunter Biden's federal firearms case and opening statements are set for Tuesday Fauci Grilled by Lawmakers on Masks, Vaccine Mandates and Lab Leak Theory Where to find more about WMAL's morning show:  Follow the Show Podcasts on Apple podcasts, Audible and Spotify. Follow WMAL's "O'Connor and Company" on X: @WMALDC, @LarryOConnor,  @Jgunlock,  @patricepinkfile and @heatherhunterdc.  Facebook: WMALDC and Larry O'Connor Instagram: WMALDC Show Website: https://www.wmal.com/oconnor-company/ How to listen live weekdays from 5 to 9 AM: https://www.wmal.com/listenlive/ Episode: Tuesday, June 4, 2024 / 6 AM Hour  O'Connor and Company is proudly presented by Veritas AcademySee omnystudio.com/listener for privacy information.

We chat about pulmonary/critical care medicine fellowship with recent graduate Nicholas Ghionni (@pulmtoilet), a first-year attending at the MedStar Baltimore Hospital system. He completed PCCM fellowship at MedStar Washington Hospital Center where he also served as chief fellow. Find us on Patreon here! Buy your merch here!

WTOP Entertainment Reporter Jason Fraley catches up with six-time "Dancing with the Stars" champion Derek Hough, who performs “Symphony of Dance” live at Capital One Hall in Tysons, Virginia this Wednesday night. They preview the show and recap his wife's medical emergency the last time they were in the D.C. area in December, when she started feeling disoriented at MGM National Harbor and was rushed to MedStar Washington Hospital Center for an emergency craniotomy. (Theme Music: Scott Buckley's "Clarion") Learn more about your ad choices. Visit podcastchoices.com/adchoices

WTOP Entertainment Reporter Jason Fraley catches up with six-time "Dancing with the Stars" champion Derek Hough, who performs “Symphony of Dance” live at Capital One Hall in Tysons, Virginia this Wednesday night. They preview the show and recap his wife's medical emergency the last time they were in the D.C. area in December, when she started feeling disoriented at MGM National Harbor and was rushed to MedStar Washington Hospital Center for an emergency craniotomy. (Theme Music: Scott Buckley's "Clarion") Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Linah Alqurashi, Ph.D., MS, RD, LDN, is a registered dietitian nutritionist with expertise in critical care nutrition and managing chronic disease.  She holds a doctorate in Nutritional Sciences from Howard University, Master of Science in Nutrition and Dietetics from the University of the District of Columbia in Washington DC, and Bachelor of Science in Clinical Nutrition from Umm-AL Qura University, Collegeof Applied Sciences in Saudi Arabia. Linah currently, works as a Clinical Dietitian and researcher at MedStar Washington Hospital Center. This episode was recorded on 2/4/24 and is hosted by Christina M. Rollins, MBA, MS, RDN, LDN, FAND, CNSC.

“I can think of examples where I have two patients. They have the same diagnosis, but they have two different insurance companies, treatment plan's the same. ‘Patient A' isn't going to get the optimal treatment plan because their insurance company won't approve it. ‘Patient B' is going to get the Cadillac version of this treatment plan, and what am I supposed to do about it,” Lucia D. Wocial, PhD, RN, FAAN, HEC-C, senior clinical ethicist in the John J. Lynch Center for Ethics at the MedStar Washington Hospital Center in Washington, DC, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about how access-to-care issues can produce moral dilemmas for nurses and how to manage this.   You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.   Music Credit: “Fireflies and Stardust” by Kevin MacLeod  Licensed under Creative Commons by Attribution 3.0  Earn 1.0 contact hours of nursing continuing professional development (NCPD), which may be applied to the nursing practice and oncology nursing practice ILNA categories, by listening to the full recording and completing an evaluation at myoutcomes.ons.org by January 5, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.  Learning outcome: The learner will report an increase in knowledge in moral dilemmas in nursing practice.  Episode Notes  Complete this evaluation for free NCPD. How to advocate for your patients.  ONS position statement: Access to Quality Cancer Care  Oncology Nursing Podcast: Episode 222: Ethical and Moral Dilemmas of Futility in Cancer Care and Treatment Episode 253: The Ethics of Caring for People You Know Personally Episode 277: Futility in Care: How to Advocate for Your Patients and Prevent Ethical Distress  ONS Voice articles: Four R's and Resilience Approach Help Oncology Nurses Respond to Morally Distressing Challenges It Takes a Team to Confront Moral Distress Cope With Moral Distress by Focusing on the Possibilities The Case of the Blurred Boundaries  Clinical Journal of Oncology Nursing articles: Moral Distress: A Qualitative Study of Experiences Among Oncology Team Members Moral Distress: Identification Among Inpatient Oncology Nurses in an Academic Health System Moral Distress: One Unit's Recognition and Mitigation of This Problem The Role of Oncology Nurses as Ethicists: Training, Opportunities, and Implications for Practice  Oncology Nursing Forum article:  Ethical Challenges Encountered by Clinical Trials Nurses: A Grounded Theory Study Reducing Compassion Fatigue in Inpatient Pediatric Oncology Nurses Moral Resilience   Moral Resilience ONS Huddle Card  American Cancer Society: Road to Recovery  American Nurses Association position statement: The Nurse's Role When a Patient Requests Medical Aid in Dying (ONS endorsed)  Dr. Lorna Breen Heroes' Foundation: Improving Licensure and Credentialing Applications Toolkit  Guttmacher Institute: Roe v. Wade Overturned: Our Latest Resources  General ethics resources: Center for Practical Bioethics Harvard Implicit Association Test  Johns Hopkins Berman Institute of Ethics Markkula Center for Applied Ethics at Santa Clara University The John J. Lynch, MD Center for Ethics: MedStar Washington Hospital Center   To discuss the information in this episode with other oncology nurses, visit the ONS Communities.   To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.  To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.  Highlights From Today's Episode  “When people think of a moral dilemma, sometimes what I think they're considering is what I call a 'moral temptation.' So, that's a situation where there's one right and clearly a wrong answer. And usually, the wrong thing is about doing something that benefits you.” TS 2:50  “An ethical dilemma is a situation in which you are compelled to make a choice between two or more actions—I say two or more; it's very rarely just two—that will affect the well-being of someone else, usually. So, the actions that you're considering can be reasonably justified, both of them, as being good or bad. Neither action is obviously good or obviously bad, and maybe the goodness of the action is uncertain. So, sometimes people will say choices between two equally good choices, and sometimes people say between equally bad choices. But the fact is you have to pick one.” TS 4:13  “Even stories with happy endings sometimes have a really bumpy road on the way to that happy ending. Some people also think of this as what's called a 'vicarious secondary trauma.' ‘I was there. I walked through this patient's journey, and I know the patient was traumatized by it, but so was I.' You know, sometimes people will experience compassion fatigue when they feel unable to help someone overcome the barriers that are keeping them from getting better.” TS 6:18  “Meet your social worker. Be as nice as possible as you can to them. They, like you, are not paid enough for what they do. Know and become familiar with resources that are available in the community. The American Cancer Society, for example, has a wealth of resources for cancer patients, including rides to clinic appointments. Knowing how to tap into them is really, really important.” TS 14:52  “Fourteen states ban abortion outright. Just think about that. It is not uncommon, and I know your nurses know this, for cancer to be diagnosed during pregnancy. And there are women who are faced with the decision of initiating chemo or terminating a pregnancy or initiating chemo and risking the teratogenic effects of the chemo. Most physicians would really struggle with that. So, they have to choose, literally choose between themselves and a fetus. In some states, the laws are quite clear. People who assist individuals getting termination of pregnancy can be criminally prosecuted. That's a big deal, and it weighs pretty heavily on folks.” TS 21:09  “Many people do not realize that Planned Parenthood, as a resource, the bulk of their work is screening. It's screening and contraception and other things which, you know, think about vaccination to prevent viruses that we know can lead to cervical cancer. And when those organizations are forced to close, that limits access, and that means, usually, you will see an increased incidence of cancers that could have been prevented or detected earlier.” TS 23:57  “I do know people who are making choices with their feet. Those who are able to, they're moving and leaving states, and the data is clear about that. States that have significant restrictions on abortion are seeing an exodus of healthcare providers. So, it is a really complicated issue. It's going to be a difficult time until it works itself out. Hopefully it will work itself out. I think there will be a clear distinction between states that have access and states that don't.” TS 24:44  “All of your patients are at risk for financial ruin. Insurance companies change their enrollment practices. People whose spouses who carry them on their insurance lose their jobs. Everybody's at risk. The best thing you can do is to acknowledge it upfront and figure out how you're going to cope with the inequities that exist in our healthcare system. It's not a pretty answer, and it's not an easy answer for me to say out loud.” TS 27:29  “There are things to not do. So, there are times when you care for a patient, and you form a special bond, and the patient hits some hard times. Please don't give them money. I know you're tempted, and I know it seems really easy—like a cup of coffee, that's not a big deal. Now, this is where frequently, from a professional ethics standpoint, people ask me like, ‘What's a boundary crossing? What's a violation?' Like when people are in trouble is when nurses are most vulnerable because they're the most compassionate people I know. And they really, really, really want to help.” TS 32:24  “You need to be able, as a bedside nurse, to say, ‘Hey, have you reached out to our financial office? Have you reached out to this? Have you done this? And oh, I know it's really hard for you to ask, but we have a program for families who have this sort of circumstances. I really encourage you to apply.' I think that's the other thing about this is we still are in a society where it's shameful to not have money. I wish we could fix that one, but we can't. So, you know, the best thing nurses can do, really, is to help normalize the experience of not having enough resources to get what you deserve.” TS 34:26  “I will say for nurses who have a deep philosophical opposition to medical aid in dying, if one of your patients asks you about it, the most graceful thing you can say is, if you're in a state where it's legal, ‘I would encourage you to talk to your doctor about that. And going forward, I may not be a nurse who can take care of you in that circumstance.' You don't have to say why. You just have to say it may not be possible. If you're opposed to it and a patient approaches you about it, the thing not to say is, ‘You know, that's morally wrong.' If you struggle with it, then it's your opportunity to connect the patient with someone who can talk to them about it.” TS 37:44  “The data on systemic racism in health care is overwhelming, and it makes me sad every time I look at it. I don't work with people who I know would intentionally not provide good care to someone because they were of a different color or had a different financial background. And yet, the data is really clear. So, that means we all have to get a big, fat mirror and look at it, and it's painful.” TS 44:55 

No, your sunscreen is not causing cancer! In fact, it's well-established and backed by extensive research that sunscreen serves as a protective shield against the harmful ultraviolet (UV) rays from the sun. Don't miss this week's podcast episode featuring Dr. Mamina where we delve deep into the world of sunscreen, exploring its significance and debunking common rumors surrounding it!  -What is sunscreen anyway and why is it important? (4:33) -What are the rumors surrounding sunscreen and where did they come from? (6:20) -Studies showing benzene in skincare products like sunscreen are scary? What's the real scoop with this? (7:30) - What about studies showing absorption of sunscreen in our blood stream? Should we worry about this? (10:07) Are there certain products we should look for in our sunscreen? Certain ones to avoid? (18:00) - Can you leave our listeners with your top 3 takeaways about the misinformation surrounding sunscreen? (23:13) Mamina Turegano, MD, is a triple board-certified dermatologist, internist, and dermatopathologist practicing in the greater New Orleans area specializing in medical and cosmetic dermatology. She is also certified in integrative dermatology. Dr. Mamina completed a five-year double residency program in internal medicine and dermatology and served as chief resident at Georgetown University Hospital and MedStar Washington Hospital Center in Washington, D.C. l Follow Dr. Mamina here:- https://instagram.com/dr.mamina?igshid=OGQ5ZDc2ODk2ZA==   https://youtube.com/@dr.mamina?si=GPV6oxvwBo-iiZ51   Follow Dr. Mina here:-  https://instagram.com/drminaskin?igshid=OGQ5ZDc2ODk2ZA== For more great skin care tips, subscribe to The Skin Real Podcast or visit www.theskinreal.com  Baucom & Mina Derm Surgery, LLC  Email - scheduling@atlantadermsurgery.com Contact - (404) 844-0496  Instagram - @baucomminamd Thanks for listening! The content of this podcast is for entertainment, educational, and informational purposes and does not constitute formal medical advice.

“One of the things about futility is many people will say, ‘Oh this is futile care,' when what they really mean is, ‘Who in their right mind would want this?' or ‘I would never ever want this,' and that's different. That's not futile care. That's potentially inappropriate care. And sometimes that's the big step for folks,” Lucia D. Wocial, PhD, RN, FAAN, HEC-C, senior clinical ethicist in the John J. Lynch Center for Ethics at the MedStar Washington Hospital Center in Washington, DC, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about futile care: how to recognize it, how to approach communication during difficult situations, and how to address a nurse's associated ethical distress.  You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.   Music Credit: “Fireflies and Stardust” by Kevin MacLeod  Licensed under Creative Commons by Attribution 3.0  Earn 1.0 NCPD contact hours of nursing continuing professional development (NCPD), which may be applied to the treatment care continuum, psychosocial dimensions of care, or quality of life ILNA category, by listening to the full recording and completing an evaluation at myoutcomes.ons.org by September 15, 2025. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.  Learning outcome: The learner will report an increase in knowledge related to futility in care and how to speak up for patients and prevent ethical distress.   Episode Notes  Complete this evaluation for free NCPD.   Wocial's Moral Distress Thermometer for Nurses   Oncology Nursing Podcast:  Episode 222: Ethical and Moral Dilemmas of Futility in Cancer Care and Treatment  Episode 78: Ethical Distress Impacts Nursing Practice  ONS Voice articles:  Moral Injury and Trauma in Nursing  Four R's and Resilience Approach Help Oncology Nurses Respond to Morally Distressing Challenges  Sort Through Ethical Dilemmas in Medically Futile Care  When Do You Stop Fighting?  Clinical Journal of Oncology Nursing articles:  The Ethical Dilemma of Medical Futility: The Case of Mr. X  Understanding the Moral Distress of Nurses Witnessing Medically Futile Care  When Does Treatment in Cancer Care Become Futile?  American Association of Critical Care Nurses moral distress resources  American Nurses Association moral distress toolkit  End-of-Life Nursing Education Consortium (ELNEC)    To discuss the information in this episode with other oncology nurses, visit the ONS Communities.   To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.  To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.  Highlights From Today's Episode  “It's a term that appeared in the literature back in the 1980s when it became clear that we had medical technology that could sustain people's lives but not actually return them to a healthy state. And so, there was this attempt to try and identify and define when it was that the care we were providing, the treatments we were providing, could no longer work. And so, some people tried ‘qualitative futilities,' some people tried ‘quantitative futility.' People have been working on it for a long time, but the shortest definition is a treatment intervention that will not have its intended effect.” TS 1:52  “And first of all, it says futility is a definition that should be used sparingly. There are lots of times when a treatment may be considered what we call ‘potentially inappropriate.' And when thinking about what's the difference between futility and potentially inappropriate? Futility is, it's clearly not going to work. Potentially inappropriate is, well, it might work, but there are lots of competing reasons why maybe we ought not to do it. And some of those reasons might be significant burden. Some of them may be the patient won't be able to achieve a neurologic state where they be able to actually perceive the benefit of ongoing biological existence. That statement, it has some very clear recommendations about: be very careful about how you use the words.” TS 7:15  “In my work as a clinical ethicist, far and away the more frequent reason we get called is families want to keep going. It's not the other way around. And in fact, when a family or a patient is ready to stop, those become incredibly difficult for the healthcare team, particularly when there's a physician who feels like, ‘But I know this will work. Don't not do this. You have a 50%, 60%, 70% chance of surviving. don't you want to try?' So to know that you have the ability to give them a chance is one thing.” TS 13:33  “And here's the tragedy in this, and I hear oncologists say this, ‘Well, it's not time yet.' That's my favorite response, it's, ‘Not yet. Not yet.' So, when you ask most people, ‘If you knew that you were going to die in the next three months, are there things that you would want to do before you die?' most people are like, ‘Well yeah'. To fail to invite this conversation robs them of this choice.” TS 16:04  “Step one: Don't keep it to yourself. A lot of it is making sure that you talk with other folks, and if you work in an inpatient setting and your hospital is Joint Commission certified, then there is some mechanism in place in your institution for dealing with an ethics challenge. But the idea is what we do is hard. And one of the biggest challenges for people who are experiencing ethics distress or moral distress is very rarely do ethical challenges happen when people are having a good time. There's a tragedy somewhere, and part of the big challenge is to separate the tragedy, like the cosmic unfairness, injustice, from ‘Are we as a healthcare team contributing to the injustice?'” TS 40:51 

In this episode, host Dr. Michael Barazza interviews Dr. John Smirniotopoulos about genicular nerve ablation, an innovative treatment option for the management of osteoarthritis. --- SHOW NOTES Dr. John Smirniotopoulos is an assistant professor of clinical radiology in the IR department at MedStar Georgetown University and MedStar Washington Hospital Center in DC. He developed the idea of genicular nerve ablation after consulting with his orthopedic colleagues at Georgetown about various pain interventions. He then formulated a treatment algorithm that begins with a conservative approach, using a nerve block for ablation. If the initial response is limited, a second ablation can be performed within six months. However, if the patient experiences only a short-term response, genicular artery embolization may be considered. Genicular nerve ablation proves to be a valuable therapy for patients who are not yet ready for knee replacements or need to postpone the procedure due to factors like high BMI or recent organ transplant. The therapy uses fluoroscopy or ultrasound to target four trunks of nerves, including the superomedial genicular, superolateral, inferomedial, and the suprapatellar nerves. The procedure is done under conscious sedation, and Dr. Smirniotopoulos aims for 50% pain reduction with his patients which is usually reached at six weeks. Dr. Smirniotopoulos and his team recently conducted a study to evaluate the outcomes of genicular nerve ablation. The results indicated a significant reduction in both the WOMAC score, which measures pain and functionality, and the Visual Analogue Scale (VAS) score, which is a subjective measure of pain. Surprisingly, they discovered that age over 50 was the biggest predictor of positive outcomes, contrary to their initial expectation that BMI would play a more significant role. They attribute this finding to a higher prevalence of advanced OA in the older age group. Additionally, patients under 50 may have more sports-related injuries such as meniscal tears, leading them to return to high-intensity activities sooner than older patients. Dr. Smirniotopoulos has also seen success in performing nerve ablation in the hip, shoulder, SI, and intervertebral joints. This wide application of the procedure makes it a valuable and versatile treatment option for patients. --- RESOURCES Genicular Nerve Radiofrequency Ablation: Is There a Predictor of Outcomes?: https://www.jvir.org/article/S1051-0443(22)01597-4/fulltext

Dr. Glenn W. Wortmann, FIDSA, FACP is the Section Director of Infectious Diseases at MedStar Washington Hospital Center and the Medical Director of Infection Prevention at the MedStar Institute of Quality and Safety.  He maintains academic appointments at Georgetown University Hospital as a Professor of Clinical Medicine and at the Uniformed Services University of the Health Sciences as Professor of Medicine. He presents a lecture entitled "Healthcare Associated Infections in the ICU" as part of the DC5 lecture series

Disease/Critical Care Medicine at MedStar Washington Hospital Center presents a talk entitled "Ethical Issues in the ICU" as part of the DC5 lecture series.

Dr. Chadi Abouassaly, Assistant Program Director of General Surgery at Medstar Washington Hospital Center and Associate Medical Director of the Trauma and Burn ICU presents a lecture on Pancreatitis as part of the DC5 lecture series.

In this podcast, Adam Brufsky from the UPMC Hillman Cancer Center, Magee-Women's Hospital, University of Pittsburgh Medical Center in Pittsburgh, and Christopher Gallagher from the Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC discuss how real-world data in heterogeneous patient populations can complement clinical trial data in informing treatment decision making for patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2−) metastatic breast cancer. Specifically, their focus is on P-REALITY X, an observational retrospective analysis that was recently published in npj Breast Cancer.  This podcast is published open access in Targeted Oncology and is fully citeable. You can access the original published podcast article through the Targeted Oncology website and by using this link: https://link.springer.com/article/10.1007/s11523-023-00968-4. All conflicts of interest can be found online. Open Access This podcast is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The material in this podcast is included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

“Nursing ethics is relationship centered because when your friend, family member, or colleague becomes a patient, that relationship can't be uninformed by how you know that person before they got sick. The first thing is to recognize you know them, and caring or them poses some fairly unique challenges in terms of, ‘How do I maintain professional boundaries?'” Lucia D. Wocial, PhD, RN, FAAN, HEC-C, senior clinical ethicist at the Lynch Center for Ethics at the MedStar Washington Hospital Center in Washington, DC, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS, about the ethical considerations and implications of providing cancer care when people you know become the patient—whether they're a friend, family member, or a colleague. You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by March 31, 2025. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: The learner will report an increase in knowledge related to the ethical issues surrounding caring for personal acquaintances. Episode Notes Complete this evaluation to earn free NCPD. Learn more about the 988 suicide and crisis lifeline. Learn more about National Healthcare Decisions Day on April 16. Oncology Nursing Podcast episodes: Episode 21: Normalizing the Use of Advance Directives in Cancer Care Episode 78: Ethical Distress Impacts Nursing Practice ONS Voice resources: Ethics in nursing topic tag Advance care planning topic tag My Practice video: Advance Care Planning Clinical Journal of Oncology Nursing articles: Strategies to Mitigate Moral Distress in Oncology Nursing Advance Care Planning: Having Goals-of-Care Conversations in Oncology Nursing Advance Care Planning: Advanced Practice Provider–Initiated Discussions and Their Effects on Patient-Centered End-of-Life Care ONS Moral Resilience Huddle Card™ ONS Nurse Well-Being Learning Library ONS Advance Care Planning Worksheet ONS Advance Care Planning Video National Council for State Boards of Nursing: Information on professional boundaries VitalTalk training program: IMPACT-ICU Nursing Code of Ethics The Conversation Project Conversation tools and games: Hello GoWish card game To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From Today's Episode “Nursing ethics is relationship centered because when your friend, family member, or colleague becomes a patient, that relationship can't be uninformed by how you know that person before they got sick. The first thing is to recognize you know them, and caring or them poses some fairly unique challenges in terms of, ‘How do I maintain professional boundaries?'” Timestamp (TS) 02:55 “Many oncology nurses will see patients over years, so they develop relationships with them, and maybe you see those patients outside of the hospital. It's hard to turn on and off the professional you from the personal you when those natural relationships form. So, how can you prepare yourself for that? One is: Think about it. If you're in an environment like a small town or at an important cancer center even in a mid to large city, if you are the cancer center, people are going to come and want to be cared for. So, chances are pretty good that you will, one day, encounter someone that you know in this professional capacity.” TS 09:30 “It's challenging because there's this middle zone of helpfulness where on one end, there's clearly a boundary violation, and on the other end is maybe a boundary crossing. And there's no right line when we're taking care of a family member or friend. It's not like an alarm is going to go off when you cross a boundary and make a slip. So thinking about it in advance is really important, and talking with your colleagues about it openly.” TS 10:41 “Nurses are so well positioned to have conversations with patients about values and goals. If you can learn about patients' values and goals, you can help them and physicians frame serious news they have to deliver. We're the most trusted profession. People look to us and think they can have these conversations with us. . . . Some of these patients feel like your friends because you've cared for them for years. You have a deep relationship with them that's been built over several years. Those are the times where you feel like somebody's got to have this conversation, and I know the information. What is my role here? What does the code of ethics tell me I'm supposed to do?” TS 26:07 “People ask me all the time: ‘What would you do?' Do I answer the question? When people ask me that question, I learned recently a really nice way to answer that question. ‘First of all, I'm not you, but I'd like to help you think about it. Can I help you think about this?'. . . And sometimes after all of that, patients will still press, ‘Well, what would you do?' And as long as you're clear and say, ‘I'm not you. If I tell you the decision I would make, I need to tell you why. And here's the decision I would make and here's why.'. . . What's within your scope of practice? It is within everybody's scope to ask permission to the patient and say, ‘Would it be okay if I shared something with you?'” TS 28:44

Guest: Ana Barac, MD, PhD The American College of Cardiology's 72nd Scientific Session & Expo featured the latest advancements in all fields of cardiovascular medicine, including cardio-oncology. To learn more, Dr. Javed Butler sits down with Dr. Ana Barac from the MedStar Washington Hospital Center to take a look at clinical data from the STOP-CA trial.

Chaplains provide spiritual care to anyone and everyone. This can mean accompanying those with whom the chaplain may have profound spiritual, religious, political, cultural, or other differences. What is the “radical acceptance” required to provide meaningful spiritual care, and how can aspiring chaplains begin preparing themselves for this crucial, but often quite difficult, aspect of the work? Tahara Akmal is Clinical Pastoral Education Manager at MedStar Washington Hospital Center in Washington, DC. Jason Callahan is an instructor in the Department of Patient Counseling, College of Health Professions, and chaplain for the Thomas Palliative Care Unit in Virginia Commonwealth University Massey Cancer Center.

The following question refers to Section 7.3 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. The question is asked by Palisades Medical Center medicine resident & CardioNerds Intern Dr. Maryam Barkhordarian, answered first by MedStar Washington Hospital Center cardiology hospitalist & CardioNerds Academy Graduate Dr. Luis Calderon, and then by expert faculty Dr. Gregg Fonarow.Dr. Fonarow is the Professor of Medicine and Interim Chief of UCLA's Division of Cardiology, Director of the Ahmanson-UCLA Cardiomyopathy Center, and Co-director of UCLA's Preventative Cardiology Program.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #8 Ms. Flo Zinn is a 60-year-old woman seen in cardiology clinic for follow up of her chronic HFrEF management. She has a history of stable coronary artery disease, hypertension, hypothyroidism, and recurrent urinary tract infections. She does not have a history of diabetes and recent hemoglobin A1c is 5.0%. Her current medications include carvedilol, sacubitril-valsartan, eplerenone, and atorvastatin. Her friend was recently placed on an SGLT2 inhibitor and asks if she should be considered for one as well. Which of the following is the most important consideration when deciding to start this patient on an SGLT2 inhibitor? A The patient does not have a history of type 2 diabetes and so does not qualify for SGLT2 inhibitor therapy B While SGLT2 inhibitors improve hospitalization rates for HFrEF, there is no evidence that they improve cardiovascular mortality C Patients taking SGLT2 inhibitors tend to suffer a more rapid decline in renal function than patients not taking SGLT2 inhibitor therapy D Patients may be at a higher risk for genitourinary infections if an SGLT2 inhibitor is started Answer #8 Explanation   The correct answer is D – SGLT2 inhibitors have been associated with increased risk of genitourinary infections. Sodium-glucose co-transporter protein 2 (SGLT2) inhibitors have gathered a lot of press recently as the new kid on the block with respect to heart failure management. While they were initially developed as antihyperglycemic medications for treating diabetes, early cardiovascular outcomes trials showed reduced rates of heart failure hospitalization amongst study participants independent of glucose-lowering effects and irrespective of baseline heart failure status – only 10-14% of patients carried a heart failure diagnosis at baseline. This prompted trials to study the effects of SGLT2 inhibitors in patients with symptomatic chronic HFrEF who were already on guideline directed medical therapy irrespective of the presence of type 2 diabetes mellitus. The DAPA-HF and EMPEROR-Reduced trials showed that dapagliflozin and empagliflozin, respectively, both conferred statistically significant improvements in a composite of heart failure hospitalizations and cardiovascular death (Option B). Most interestingly, these effects were seen irrespective of diabetes history. In light of these findings, the 2022 HF guidelines recommend SGLT2 inhibitors in patients with chronic, symptomatic HFrEF with or without diabetes to reduce hospitalization for HF and cardiovascular mortality (Class I, LOE A). The benefits of SGLT2 inhibitors extend beyond cardiovascular health.

In this episode, Dr. Mark Hoffman invites Dr. Cheryl Iglesia to shed light on the topic of cosmetic gynecology. --- SHOW NOTES Dr. Iglesia is the Director of the Section of Female Pelvic Medicine and Reconstructive Surgery at MedStar Washington Hospital Center, as well the current President of the Society of Gynecologic Surgeons. In addition to being involved with a consensus document regarding cosmetic gynecology, Dr. Iglesia has contributed numerous studies to the growing field and hopes to educate other providers on the topic. The episode begins with Dr. Iglesia sharing how she became passionate about cosmetic gynecology. Her experience initially began with a weekend course in California learning about topics such as “laser vaginal rejuvenation” and “designer laser vaginoplasty,” which were early marketing terms used for the field. After multiple years of training and education within a field filled with gray areas and limited evidence-based medicine, she later helped develop a consensus document about cosmetic gynecology procedures, which provides clarification for patients and opportunity for future research studies. Dr. Iglesia then describes the field of cosmetic gynecology, which includes the elective intervention to alter the aesthetic appearance of the external genitalia or modify the genital organs. These elective, functional procedures may be performed in the absence of any pathology (e.g., no incontinence, prolapse, etc.) with the goal of improving a person's quality of life (e.g., sexual function). She describes two pillars of the field, including cosmetic (e.g., labiaplasty) versus functional (e.g., surgical tightening of the vagina for vaginal laxity) procedures. The physicians then address the concerns of societal pressure, agreeing that the goal is to help patients make well-informed, ethical decisions, which requires discussing goals with patients. After discussing the field as a whole, Dr. Iglesia then highlights different procedures and technologies. For example, a fractionated laser may be used to stimulate tissue growth and may be utilized for diagnosis such as genitourinary syndrome (GSM) of menopause or lichen sclerosis. In addition, she briefly mentions aesthetic procedures, including a clitoral frenulum reduction (frenulectomy) or clitoral amplification with platelet rich plasma or the O-Shot. She addresses that a lot of the procedures and technologies are proprietary, have limited evidence, and are not risk-free. Ultimately, Dr. Iglesia states that there is a need for more data, urging the need for future level I trials. --- RESOURCES Developed by the Joint Writing Group of the International Urogynecological Association and the American Urogynecologic Society. Joint Report on Terminology for Cosmetic Gynecology. Int Urogynecol J. 2022 Jun;33(6):1367-1386. Li FG, Maheux-Lacroix S, Deans R, Nesbitt-Hawes E, Budden A, Nguyen K, Lim CY, Song S, McCormack L, Lyons SD, Segelov E, Abbott JA. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Symptom Severity in Women With Postmenopausal Vaginal Symptoms: A Randomized Clinical Trial. JAMA. 2021 Oct 12;326(14):1381-1389. Paraiso MFR, Ferrando CA, Sokol ER, Rardin CR, Matthews CA, Karram MM, Iglesia CB. A randomized clinical trial comparing vaginal laser therapy to vaginal estrogen therapy in women with genitourinary syndrome of menopause: The VeLVET Trial. Menopause. 2020 Jan;27(1):50-56. Burkett LS, Siddique M, Zeymo A, Brunn EA, Gutman RE, Park AJ, Iglesia CB. Clobetasol Compared With Fractionated Carbon Dioxide Laser for Lichen Sclerosus: A Randomized Controlled Trial. Obstet Gynecol. 2021 Jun 1;137(6):968-978. Cosmetic Gynecology and the Elusive Quest for the “Perfect” Vagina: https://journals.lww.com/greenjournal/Citation/2012/10000/Cosmetic_Gynecology_and_the_Elusive_Quest_for_the.34.aspx

The following question refers to Section 7.3.1 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.  The question is asked by Palisades Medical Center medicine resident & CardioNerds Intern Dr. Maryam Barkhordarian, answered first by MedStar Washington Hospital Center cardiology hospitalist & CardioNerds Academy Graduate Dr. Luis Calderon, and then by expert faculty Dr. Robert Mentz.  Dr. Mentz is associate professor of medicine and section chief for Heart Failure at Duke University, a clinical researcher at the Duke Clinical Research Institute, and editor-in-chief of the Journal of Cardiac Failure. Dr. Mentz is a mentor for the CardioNerds Clinical Trials Network as lead principal investigator for PARAGLIDE-HF and is a series mentor for this very 2022 heart failure Decipher the Guidelines Series. For these reasons and many more, he was awarded the Master CardioNerd Award during ACC22. Welcome Dr. Mentz!  The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #7 Ms. Valarie Sartan is a 55-year-old woman with a history of HFrEF (EF 35%) and well controlled, non-insulin dependent diabetes mellitus who presents to heart failure clinic for routine follow up. She is currently being treated with metoprolol succinate 200mg daily, lisinopril 10mg daily, empagliflozin 10mg daily, and spironolactone 50mg daily. She notes stable dyspnea with moderate exertion, making it difficult to do her yardwork. On exam she is well appearing, and blood pressure is 115/70 mmHg with normal jugular venous pulsations and trace bilateral lower extremity edema. On labs, her potassium is 4.0 mmol/L and creatinine is 0.7 mg/dL with an eGFR > 60 mL/min/1.73m2. Which of the following options would be the most appropriate next step in heart failure therapy?  A  Increase lisinopril to 40mg daily  B  Increase spironolactone to 100mg daily  C  Add sacubitril-valsartan to her regimen  D  Discontinue lisinopril and start sacubitril-valsartan in 36 hours  E  No change  Answer #7 Explanation   The correct answer is D – transitioning from an ACEi to an ARNi is the most appropriate next step in management.   The renin-angiotensin aldosterone system (RAAS) is upregulated in patients with chronic heart failure with reduced ejection fraction (HFrEF). Blockade of the RAAS system with ACE inhibitors (ACEi), angiotensin receptor blockers (ARB), or angiotensin receptor neprilysin inhibitors (ARNi) have proven mortality benefit in these patients.   The PARADIGM-HF trial compared sacubitril-valsartan (an ARNi) with enalapril in symptomatic patients with HFrEF. Patients receiving ARNi incurred a 20% relative risk reduction in the composite primary endpoint of cardiovascular death or heart failure hospitalization. Based on these results, the 2022 heart failure guidelines recommend replacing an ACEi or ARB for an ARNi in patients with chronic symptomatic HFrEF with NYHA class II or III symptoms to further reduce morbidity and mortality (Option D). This is a class I recommendation with level of evidence of B-R and is also of high economic value. Making no changes at this time would be inappropriate (Option E).  While it would be reasonable to increase the dose of lisinopril to 40mg (Option A), this should be pursued only if ARNi therapy is not tolerated.   Mineralocorticoid receptor antagonists (MRAs) have a class I (LOE A...

UzObi, Inc. is the first health technology company to specialize in providing ethically guided values-based health care decision-making tools to patients through their providers, insurers and hospital systems. UzObi empowers patients to have their identities and voices at the center of all health care decisions from routine, emergency to end of life medical decisions. Bio: Dr. Nneka Sederstrom received her BA in Philosophy from George Washington University in 2001. She began her career at the Center for Ethics at Medstar Washington Hospital Center in Washington DC the same year. She completed her Masters in Philosophy and Public Policy from Howard University in 2003 and proceeded to begin her PhD studies in Medical Sociology and Race, Class, and Gender Inequalities at the same university. After beginning her PhD studies, she was made Director of the Center for Ethics and Director of the Spiritual Care Department. She proceeded to hold these positions until she left to join Children's Minnesota in March 2016 where she served as the Director of the Clinical Ethics Department for almost 5 years. She has recently joined the executive leadership team at Hennepin Healthcare System as the new Chief Health Equity Officer where she will lead efforts in addressing health disparities, equity, and antiracism in the institution and community. Her PhD is in Sociology with concentrations in Medical Sociology and Race, Class, and Gender Inequality, MPH in Global Health Management, and MA in Philosophy. She is a member of several professional societies and holds a leadership position in CHEST Medicine and the Society of Critical Care Medicine. She is a Fellow of the American College of Chest Physicians and a Fellow of the American College of Critical Care Medicine. She is widely published in Equity and Clinical Ethics and speaks regularly at national and international meetings.  uzobiinc.com 

In this episode, we're going beyond cervical cancer screening and talking about cervical cancer with Dr. Renee Cowan, MD, MPH, MSc. Dr. Cowan, a gynecologic oncologist, completed two fellowships from Memorial Sloan Kettering Cancer Cancer in New York. Her first was a clinical research fellowship in gynecologic oncology (2015-2017) followed by a gynecologic oncology fellowship (2017-2021). She received her bachelor's degree in biology from Cornell University in Ithaca, N.Y., and her medical degree along with a master's in public health from Temple University in Philadelphia, Pa. She went on to complete her residency at MedStar Washington Hospital Center in Washington, D.C.

Today I speak with Cheryl B. Iglesia, MD, FACOG, FPMRS. She is Director of the Section of Female Pelvic Medicine and Reconstructive Surgery (FPMRS) at MedStar Washington Hospital Center and Director of the National Center for Advanced Pelvic Surgery (NCAPS) at MedStar Health, an internationally renowned center that combines urogynecology and minimally invasive gynecologic surgery. She is also Professor of Obstetrics/Gynecology and Urology at Georgetown University School of Medicine. As a double board-certified physician in Ob/Gyn and female pelvic medicine and reconstructive surgery with more than 30 years in the field, Dr. Iglesia specializes in diagnosing and treating pelvic floor disorders, including urinary incontinence, fecal incontinence, overactive bladder, and pelvic organ prolapse. She also specializes in treating complex pelvic floor complications after prior surgery, including urinary and bowel fistulas; complications after pregnancy and childbirth, including pain from episiotomies and lacerations, as well as accidental bowel and bladder leakage; and complications after cancer treatment, such as sexual health issues and vaginal dryness. She has special expertise in managing complications associated with transvaginal mesh and its removal.Dr. Iglesia is also one of my very first mentors in gynecology, in fact, we go back 23 years!We talk about:-finding facts on social media  -changes in management of pelvic organ prolapse-starting with conservative care-high tone affect on POP symptoms-breastfeeding and affects on symptoms-talk around the 4th trimester-collaborative care Time Stamps1:00 introduction3:15 fear surrounding pelvic organ prolapse10:00 conservative care before surgery18:14 pelvic floor prolapse or decreased tone26:45 recommendations for getting additional care28:45 tissue healing and RED-S30:10 PTs collaborating with surgeonsCONNECT WITH CARRIEIG: https://www.instagram.com/carriepagliano/Website: https://carriepagliano.comCONNECT WITH CHERYLIG: https://www.instagram.com/cbiglesia/Website: https://www.medstarhealth.org/doctors/cheryl-bernadette-iglesia-mdThe Active Mom Postpartum Podcast is A Real Moms' Guide to Postpartum for active moms & the postpartum professionals who help them in their journey.  This show has been a long time in the making!   You can expect conversation with moms and postpartum professionals from all aspects of the industry.   If you're like me, you don't have a lot of free time (heck, you're probably listening at 1.5x speed), so theses interviews will be quick hits to get your the pertinent information FAST!  If you love what you hear, share the podcast with a friend and leave us a 5 sThe Active Mom Postpartum Podcast is A Real Moms' Guide to Postpartum for active moms & the postpartum professionals who help them in their journey. This show has been a long time in the making! You can expect conversation with moms and postpartum professionals from all aspects of the industry. If you're like me, you don't have a lot of free time (heck, you're probably listening at 1.5x speed), so theses interviews will be quick hits to get your the pertinent information FAST! If you love what you hear, share the podcast with a friend and leave us a 5 start rating and review. It helps us become more visible in the search algorithm! (Helps us get seen by more moms that need to hear these stories!!!!)

Dr. Emil Oweis is a board-certified pulmonary and critical care attending physician and is an Associate Medical Director of Respiratory Therapy at MedStar Washington Hospital Center. He gives a lecture as part of the DC5 Lecture Series entitled "Mechanical Ventilation in Obstructive Lung Disease".

Hospitals in our area are struggling to keep up with increasing number of respiratory patients amid a mounting nurse staff shortage. Today, city officials are meeting with the D.C. Hospital Association to figure out whether a legislative move could help at all. WTOP's Scott Gelman fills us in on what to expect. Then, Dr. Glenn Wortmann, chief of Infectious Diseases, at MedStar Washington Hospital Center tells us how best to get through this holiday season without getting the flu, RSV or COVID-19.

Hospitals in our area are struggling to keep up with increasing respiratory patients amid a mounting nurse staff shortage. Today, city officials are meeting with the D.C. Hospital Association to figure out whether a legislative move could help at all. WTOP's Scott Gelman fills us in on what to expect. Then, Dr. Glenn Wortmann, chief of Infectious Diseases, at MedStar Washington Hospital Center tells us how best to get through this holiday season without getting the flu, RSV or COVID-19.

Vaani Panse Garg, MD, is a Cardiologist at MedStar Washington Hospital Center. She is board certified in internal medicine, cardiovascular disease, nuclear cardiology, and adult comprehensive echocardiography. She presents a lecture entitled "Endocarditis and the Critical Care Setting" as part of the DC5 Lecture Series.

Dr. Caitlin Delaney, MD, is a practicing Emergency Physician at MedStar Washington Hospital Center, Director of Business Development and Medical Advisor at flipMD, and on the faculty at Georgetown University School of Medicine. Dr. Delaney is also a US Navy combat veteran. She is passionate about bringing the voice of the practicing physician to industry, and is working to create sustainable careers for physicians. https://ymyhealth.com/2022/06/22/the-war-in-healthcare-is-still-raging-millennial-combat-veteran-and-emergency-medicine-doctor-shares-how-healthcare-workers-are-suffering-moral-injury-not-just-burnout/ To support the podcast: https://www.fixmoralinjury.org/get-started Twitter - @fixmoralinjury Instagram - @moralinjury Facebook - @moralinjuryofhc LinkedIn - @moral Injury of Healthcare  

Rollin J. “Terry” Fairbanks, MD, MS, is the Vice President Quality and Safety at MedStar Health, Professor of Emergency Medicine at Georgetown University, and Founding Director of the National Center for Human Factors in Healthcare. A board-certified emergency physician, he practices in the MedStar Washington Hospital Center emergency department. Dr. Fairbanks also holds an academic appointment as adjunct associate professor of Industrial Systems Engineering at the University at Buffalo. He earned a bachelors degree in mathematics and physics and a masters degree in industrial systems engineering/human factors engineering, and after medical school he completed specialty training in emergency medicine, the HRET/NPSF Patient Safety Leadership Fellowship, and Wharton's Physician Leadership Certificate Program at MedStar Health. Trained in safety science prior to entering the medical field, Dr. Fairbanks is also a former paramedic, EMS medical director, and general aviation pilot, he is known for inspiring people to think differently about healthcare's approach to quality, safety, and risk. As a member of the MedStar Health Leadership Team, he is responsible for system-wide quality and safety. Dr. Fairbanks has contributed more than 120 publications to the healthcare quality and safety, human factors engineering and medical literature, and co-edited a book on cognitive systems engineering in healthcare. Dr. Fairbanks has served in many national and international roles, including the National Patient Safety Foundation Board of Advisors, the POLITICO Health IT Advisory Forum, AHRQ Patient Safety Network Technical Expert Advisory Panel, and he is a Health Research and Educational Trust (HRET) Senior Fellow. He has served in advisory roles for the Office of the National Coordinator for Health IT, Pew Charitable Trusts, the American Medical Association, and has held formal consultative roles with the US, Australian, British, and Spanish governments. In 2017, he was listed by Becker's Hospital Review in Top 50 Experts Leading the Field of Patient Safety. View Dr. Fairbanks' publications on PubMed View Dr. Fairbanks' Complete Bibliography Learn more about NDM: NaturalisticDecisionMaking.org Journal of Cognitive Engineering and Decision Making Where to find the hosts: Brian Moon Brian's website Brian's LinkedIn Brian's Twitter Laura Militello Laura's website Laura's LinkedIn Laura's Twitter

With multiple degrees and residency experience from some of the nation's top schools and hospitals, such as Stanford Medical School, Georgetown, and Johns Hopkins, Dr. Erin C. Hall has no shortage of experience and expertise under her belt, which is why she is employed at one of the top trauma centers in the country.  On this week's episode of Trauma Ties, brought to life by the https://www.nvrdc.org/ (Network for Victim Recovery of DC (NVRDC)) and hosted by Bridgette Stumpf and Lindsey Silverberg, Dr. Hall discusses her work as a trauma surgeon at MedStar Washington Hospital Center and the Medical Director for both the Surgical Intensive Care Unit and the Community Violence Intervention Program (CVIP).   During this episode, the three women delve into the lasting realities of physical trauma and the ways in which Dr. Hall, through her work with CVIP, hopes to bridge the gap between acute and immediate medical care and the lasting physical and emotional effects of trauma. Featured GuestName: https://www.medstarhealth.org/doctors/erin-carlyle-hall-md (Dr. Erin C. Hall, MD MPH FACS) What she does: Dr. Hall is a trauma surgeon at MedStar Washington Hospital Center, where she serves as Medical Director for the Surgical Intensive Care Unit and the Medical Director of the hospital's Community Violence Intervention Program. Company: https://www.medstarhealth.org/locations/medstar-washington-hospital-center (MedStar Washington Hospital Center) Episode Highlights [05:15] Striving for change: Dr. Hall discusses the sequelae of the patients she sees in the trauma operation room. In other words, the effects of the patient's trauma aside from just the physical injuries, such as the mental, emotional, and social changes that are also a result of their pain.  [11:10] The seen and unseen: Host Bridgette Stumpf conveys the differences between physical and psychological trauma, which ultimately comes down to the one being visible (physical) and the other being invisible (psychological).  [16:04] Human rights: Dr. Hall believes, unequivocally, that health is a human right. One of the aspects she loves so much about being a trauma surgeon is the lack of judgment in the OR. When a patient comes in, there is no time for wondering who they are outside of a person in need of immediate help.  [20:07] CVIP: As the Medical Director of MedStar Health https://www.medstarhealth.org/blog/investigators-seek-to-ease-the-burden-of-trauma-among-victims-of-violent-injuries (Community Violence Intervention Program), Dr. Hall talks about bridging the gap between inpatient medical treatment and post-treatment care for the six months following patient discharge.  [29:11] The value of understanding: Bridgette details her own personal trauma and experiences with medical professionals when it felt as though they did not care about or understand her worries and concerns.  [47:13] Trauma-informed care: Working at one of the nation's top centers for trauma care, Dr. Hall talks about seeing a shift in care and language. She says there is a real shift toward all encompassing trauma-informed care.  Connect with the Network for Victim Recovery of DC☑️ Follow us on https://twitter.com/NVRDC (Twitter), https://www.facebook.com/NetworkforVictimRecoveryDC/ (Facebook), http://www.instagram.com/nvrdc (Instagram) & https://www.linkedin.com/company/nvrdc/ (LinkedIn). ☑️ Subscribe to TraumaTies on https://podcasts.apple.com/us/podcast/traumaties/id1612126516 (Apple Podcasts), https://open.spotify.com/show/5PbJbBq6IIiDvA2DLPy79R?si=48ea896c4d324fde (Spotify), or https://podcasts.google.com/feed/aHR0cHM6Ly90cmF1bWF0aWVzLmNhcHRpdmF0ZS5mbS9yc3NmZWVk (Google Podcasts). Brought to you by Network for Victim Recovery of DC (NVRDC), TraumaTies: Untangling Societal Harm & Healing After Crime is a podcast that creates space and conversations to dissect the structural and systemic knots that keep us from addressing trauma.

We are pleased to welcome back Anne Kelemen, one of Healwell's favorite recurring guests. Anne joins Kerry and Rebecca to talk about intimacy and chronic illness. ********** Check out Anne's latest course, "The Power of Our Words": https://online.healwell.org/courses/power-of-our-words ********** Read Anne's research about assessing the impact of illness on intimacy and sexuality here: https://tinyurl.com/2p8vu2jv and here: https://tinyurl.com/37rmnvx6 ********** About Our Guest: Anne Kelemen is the Director of Psychosocial/Spiritual Care for the Section of Palliative Care at MedStar Washington Hospital Center in Washington, DC, where she conducts patient care, teaches and participates in a variety of research activities. Prior to joining the Hospital Center staff, Ms. Kelemen instituted the first palliative care service at MedStar Good Samaritan Hospital in Baltimore, Maryland. She also is the founding director of the Palliative Social Work Fellowship Program at the Hospital Center. An Assistant Professor of Medicine at Georgetown University Medical Center, her research interests include the intersection between language and medicine and intimacy and chronic illness. Ms. Kelemen is also Vice-Chair of the Social Work Hospice and Palliative Network (SWHPN).

How do the words we use affect the people we serve? What could be problematic about some of the common things we say as care providers? What happens when we listen to our words from a different perspective? Cal and Cathy welcome Anne Kelemen to the podcast to consider the question of language. (This episode originally aired in February, 2021.) **** Check out Anne Keleman's course on Healwell's online course portal: https://online.healwell.org/courses/to-chart-or-not-to-chart ***** Anne Kelemen's articles: Ambiguity in End-of-Life Care Terminology—What Do We Mean by “Comfort Care?” https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2698147 Poor prognostication: hidden meanings in word choices https://spcare.bmj.com/content/7/3/267 ***** About Our Guest: Anne Kelemen is the Director of Psychosocial/Spiritual Care for the Section of Palliative Care at MedStar Washington Hospital Center in Washington, DC, where she conducts patient care, teaches and participates in a variety of research activities. She also serves as an Associate Professor of Medicine at Georgetown University and as Associate Program Director for the MedStar Georgetown Interprofessional Palliative Care Fellowship Program. Prior to joining the Hospital Center staff, Ms. Kelemen instituted the first palliative care service at MedStar Good Samaritan Hospital in Baltimore, Maryland. She is board certified in hospice and palliative social work and is a board member for the Social Work Hospice and Palliative Network (SWHPN) where she currently chairs the membership committee.

Andrew Velasquez is a NICU Nurse at MedStar Washington Hospital Center. He also runs his own business: Velasquez Legal Nurse Consulting. Andrew discusses his approach on starting a business and having an introverted personality, caring for babies in the NICU department, and his passion for being in the healthcare system. Andrew also plays a game of “Picture Association” looking at pictures of his favorite (and random) people and describing what they mean to him.

Hospitals nationwide are losing resources to the most recent surge of COVID-19, causing bed shortages and increasing wait times. This week, we asked two medical specialists at MedStar Washington Hospital Center how their Emergency Room is doing. Dr. Susan O'Mara is the Chair of Emergency Medicine and Dr. Glenn Wortmann is the Chief of Infectious Diseases. They take us into the hospital and talked about what patients can expect, whether ER staff are burnt out and fatigued, and how you can talk to your friends and family about their vaccination status.

DJ interviews Breathwork Facilitator, Lauren Chelec Cafritz. She explains how the breath can release deeply stored trauma, help cure, and activate our hidden potential. Website: https://davidlloydjr.com/LaurenCafritz Vitality Breath Class: https://davidlloydjr.com/BreathworkClass Breath Love (Book): https://davidlloydjr.com/BreathLoveBook YouTube: https://davidlloydjr.com/LaurenCafritzYT Instagram: https://davidlloydjr.com/LaurenCafritzIG LinkedIn: https://davidlloydjr.com/LaurenCafritzLk Facebook: https://davidlloydjr.com/LaurenCafrtizFbPg Twitter: https://davidlloydjr.com/LaurenCafritzTw Breathwork Talk at MedStar Washington Hospital Center: https://davidlloydjr.com/LaurenCafritzBreathworkTalk DJ's SOCIAL SITES YOUTUBE: https://davidlloydjr.com/YT INSTAGRAM: https://davidlloydjr.com/IG FACEBOOK: https://davidlloydjr.com/Fb EMAIL:

Tune into Fundraising Forward this week to hear about the future of health care philanthropy and the impact of big data at all stages of the donor journey from Harvey Green, FAHP, CFRE, Vice President of Philanthropy, MedStar Washington Hospital Center.

Crystal sits down with Rachel Watkins, RN, of MedStar Washington Hospital Center and currently serves as the Nursing Director of 2 units, 1E front and4C. These units have treated COVID-19 patients since the start of the pandemic, so Rachel and her team have been on the front lines throughout this entire pandemic.

In the first episode of  Capital Region Catalyze, Greater Washington Partnership CEO JB Holston talks equity and inclusive growth with Matt Kelly, CEO of JBG SMITH, and Sarah Rosen Wartell, President of the Urban Institute. From housing and gentrification to Amazon and leading through a pandemic, Sarah and Matt dive into personal narratives, the history and trajectory of the region, and the glaring inequities that COVID-19 has laid bare. Hosted by JB Holston. Produced by Maribeth Romslo and Nina Sharma. Edited by Maribeth Romslo. Engineered by Micah Johnson. With support from Jenna Klym, Ian Lutz, Justin Matheson-Turner, and Colie Touzel. About our guests:Sarah Rosen Wartell is the president of the Urban Institute, an economic and social science research and policy organization whose researchers, experts, and other staff believe in the power of evidence to improve lives and strengthen communities. Previously, Wartell was deputy assistant to the president for economic policy and deputy director of the National Economic Council. She also worked in various roles at the US Department of Housing and Urban Development. Wartell currently serves on the boards of Enterprise Community Partners and the Georgetown Day School, Bank of America's National Community Advisory Council, and The Sadie Collective's Advisory Board. Her areas of expertise include community development, consumer finance, asset building, and housing finance. Wartell has a bachelor's degree with honors in urban affairs from the Princeton School of Public and International Affairs. She has a JD degree from Yale Law School.Matt Kelly is the CEO of JBG SMITH. Prior to the formation of JBG SMITH, Matt served as a Managing Partner of the JBG Companies and was co-head of JBG's Investments Group. Prior to that, he was a co-founder of ODAC Inc., a media software company, and worked in private equity and investment banking with Thomas H. Lee Partners in Boston and Goldman Sachs, & Co in New York. Matt serves on the boards of the Urban Institute and the Smithsonian National Museum of Natural History. He is Chairman of the Board of the Medstar Washington Hospital Center and serves as an Executive in Residence of the Steers Center at the McDonough School of Business at Georgetown University. He holds a Bachelor of Arts from Dartmouth College and a Masters of Business Administration from Harvard Business School.JB Holston is the CEO of the Greater Washington Partnership, a civic alliance of business leaders with the mission to foster unity and catalyze solutions to make the Capital Region the most inclusive in the country. JB has 30 years of success as a global scale-up CEO and entrepreneur and is active in a range of civic initiatives around innovation, open government, entrepreneurship, impact investing, and media. Prior positions include Dean of the University of Denver's Daniel Felix Ritchie School of Engineering and Computer Science, founding Executive Director for the Blackstone Entrepreneurs Network and founding CEO for NewsGator (now Sitrion). He served as President of Ziff Davis International and senior executive positions at NBC and GE after starting his career with the Boston Consulting Group. JB has a BA and MBA from Stanford University.

How do the words we use affect the people we serve? What could be problematic about some of the common things we say as care providers? What happens when we listen to our words from a different perspective? Cal and Cathy welcome Anne Kelemen to the podcast to consider the question of language. **** Check out Anne Keleman's course on Healwell's online course portal: https://online.healwell.org/courses/to-chart-or-not-to-chart ***** Anne Kelemen's articles: Ambiguity in End-of-Life Care Terminology—What Do We Mean by “Comfort Care?” https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2698147 Poor prognostication: hidden meanings in word choices https://spcare.bmj.com/content/7/3/267 ***** Support us on Patreon! Early access to full, ad-free episodes, bonus material, and more! patreon.com/interdisciplinary ***** About Our Guest: Anne Kelemen is the Director of Psychosocial/Spiritual Care for the Section of Palliative Care at MedStar Washington Hospital Center in Washington, DC, where she conducts patient care, teaches and participates in a variety of research activities. She also serves as an Associate Professor of Medicine at Georgetown University and as Associate Program Director for the MedStar Georgetown Interprofessional Palliative Care Fellowship Program. Prior to joining the Hospital Center staff, Ms. Kelemen instituted the first palliative care service at MedStar Good Samaritan Hospital in Baltimore, Maryland. She is board certified in hospice and palliative social work and is a board member for the Social Work Hospice and Palliative Network (SWHPN) where she currently chairs the membership committee.

Although the country has justifiably turned its attention to the COVID-19 crisis, maternal mortality remains a public health crisis.The maternal mortality rate in the United States is higher than any other high-income nation. Approximately 60% of maternal deaths are preventable. Inexcusably, women of color are disproportionately impacted by this crisis. Black women experience mortality as a result of complications of pregnancy at a rate THREE TO FOUR times higher than white women. American Indian and Alaska Native women die at a rate two to three times higher. This must stop.   Today on the podcast is Dr. Tamika Auguste, an OB/GYN at MedStar Washington Hospital Center in Washington, DC, and a member of the Board of Directors for the American College of Obstetricians and Gynecologists (ACOG).    Dr. Tamika Auguste discusses the American maternal mortality crisis, and in particular, why there are such stark racial disparities in maternal mortality. As a contributor to ACOG's guidance on optimizing postpartum care, Dr. Auguste also discusses why postpartum care is so important, what often gets overlooked in postpartum care, how we can ensure moving forward that postpartum care is more accessible to everyone - both so that we can reduce maternal mortality and generally increase the health and wellbeing of postpartum people.   Dr. Auguste and Femtastic host Katie Breen discuss both clinical solutions and public policy solutions to this crisis, and what you can do to help.    Lastly, Dr. Auguste tells us about ACOG's new book, available on January 26, 2021, called Your Pregnancy and Childbirth: Month to Month. Parents who are in the pre-conception, pregnancy, or postpartum period can learn more about pregnancy from the top medical experts on the topic. Offering real clinical guidance without the clinical jargon, this straightforward book breaks down each step of pregnancy, month-by-month, in ways that every person can understand and relate to during each phase of the pregnancy experience. It answers parents' most pressing questions, including what bodily changes to expect each month; changes in fetal development; how to manage self-care; how to think about pain relief during labor and delivery; how to handle travel, work, and exercise; COVID-19 considerations; and a new chapter where new parents and parents-to-be can find quick answers to frequently asked questions.  Resources: - Buy ACOG's new book from independent booksellers - Learn more about the American College of Obstetricians and Gynecologists (ACOG), including their helpful guidance for handling COVID-19 precautions and vaccinations in pregnancy, delivery, postpartum, and breastfeeding    

Bio Matt Kelly is the CEO of JBG SMITH and a member of the Board of Trustees. Prior to the formation of JBG SMITH, Matt served as a Managing Partner of the JBG Companies and a member of the firm's Executive Committee and Investment Committee and was co-head of JBG's Investments Group. Prior to joining the JBG Companies in 2004, he was a co-founder of ODAC Inc., a media software company, and worked in private equity and investment banking with Thomas H. Lee Partners in Boston and Goldman Sachs, & Co in New York.   Matt Kelly currently serves on the boards of various industry, civic and philanthropic organizations including the Urban Institute and the Smithsonian National Museum of Natural History.  He is Chairman of the Board of the Medstar Washington Hospital Center and serves as an Executive in Residence of the Steers Center at the McDonough School of Business at Georgetown University. He holds a Bachelor of Arts with honors from Dartmouth College and an Masters of Business Administration from Harvard Business School. Show Notes Current Role Matt Kelly transition to being a public company CEO from a private company partner/leader (2:30)Oversight and accountability of firm (3:30)Day to day role making investment decisions has stayed pretty much the same (3:50)Chief “Cheerleader” is shared among senior team and is now more focused with him during the pandemic (4:20)Changes were significant (5:30)Private to publicIncreased size to 4X larger with assets Partnership structure to a REIT Combining two big teamsApprovals?Physical location of peopleIntegrate accounting & health care systemsHe had never worked for a public company so felt his biggest challenge was to give confidence to the team (6:30)Determining “who needed to be in the room” (7:00)Brought on a series of new people to help solve issues (7:15)Fortunate that almost all new people fit in well and worked out (7:45)Had to rely on people to accommodate all the changes (8:10)Balance of leading with confidence without doing it before (8:50) Personal Background & Education Raised in the St. Louis area (9:55)Father was an Irish immigrant and went to medical school in Ireland, now a psychoanalystMother from IndianaRaised by parents that motivated him to move away (11:00)Attended Dartmouth College (11:20)Quite an adjustment to live in the East and an outdoors environment (12:00)Spanish, Biology major initially (14:00)Dad told him that he should be “called” to medicine, which he realized he was not “called” (15:00)Dad’s advice- “Study what you want to do and interest you” (15:50)Decided to become History major which was his passion (16:15)Friends turned him on to business (17:10)Interviewed with Goldman Sachs and other banks due to “fascination” with business and learn (18:00) Matt Kelly’s Career Trajectory Went to work for Goldman Sachs in NYC (18:30)Learned after two weeks he did not want to be an investment ban

Dr Carolyn Lam:                Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Today's feature discussion revolves around important hemodynamic and echo data from the reprise three trial, comparing the lotus and core valve transcatheter aortic valves in patients with high surgical risk. Can't wait? Well it's coming right up after these summaries.                                                 The first original paper this week provide experimental data showing that the endothelium controls cardiomyocyte metabolism and function via notch signaling. Corresponding author, Dr. Fischer, from German Cancer Research Center in Heidelberg, Germany, and colleagues, studied fatty acid transport in cultured endothelial cells and transgenic mice with endothelial specific notch inhibition, or wild type mice treated with neutralizing antibodies against the Notch ligand. They showed that notch signaling in the endothelium controlled blood vessel formation and fatty acid transport in the adult mouse heart. Inhibition of Notch signaling in the vasculature led to expansion of the cardiac vasculature and impairment of fatty acid transport to cardiomyocytes. This resulted in metabolic reprogramming and heart failure.                                                 Together, these data provide compelling evidence for a central role of Notch signaling at the coordination of nutrient transport processes in the heart. These findings help to explain how pharmacological inhibition of Notch signaling, for example, in oncology could lead to heart failure. The findings also help to identify the signals and molecules involved in endothelial transport capacity and show how these could offer new targets for the treatment of heart failure.                                                 The next paper raises the prospect of new treatment options to combat ischemic heart disease and its progression to heart failure. Ischemic injury to the myocardium is known to trigger a robust, inflammatory response, which is an integral part of the healing process, although much effort has been directed at tempering the inflammatory response in hopes of achieving clinical gain. Major efforts have focused on individual cytokines, the complement cascade, and antibodies to adhesion molecules preventing leukocyte invasion.                                                 In contrast, relatively little effort has focused on macrophages. Although macrophage transformation is known to be crucial to myocardial repair, the events governing this transformation are poorly understood. In today's paper, co-corresponding authors of the trial in Hill, from UT Southwestern Medical Center, performed an elegant series of experiments and showed that release of DNA from necrotic tissue during myocardial infarction, triggered in macrophages a recently described innate immune response known as the GMP-AMP synthase-stimulator of interferon genes pathway or cGAS-STING pathway.                                                 This response in turn promoted an inflammatory macrophage phenotype. Suppression of the pathway promoted emergence of reparative macrophages, thereby mitigating pathological ventricular remodeling. These results therefore reveal for the first time, that the cytosolic DNA receptor, GMP-AMP synthase, functions during cardio ischemia as a pattern recognition receptor in the sterile immune response.                                                 Furthermore, this pathway governs macrophage transformation, thereby regulating post injury cardiac repair. As modulators of this pathway are currently in clinical use, these findings raise the prospect of new treatment options to combat ischemic heart disease and its progression to heart failure.                                                 Cigarette smoking is a well-known risk factor for atherosclerotic cardiovascular disease. However, less is known about the risk for heart failure. First author, Dr. Kamimura, corresponding author, Dr. Hall, from University of Mississippi Medical Center, and their colleagues investigated 4129 black participants without a history of heart failure or coronary heart disease at baseline in the Jackson Heart Study.                                                 They examined the relationship between cigarette smoking and left ventricular strength and function by using cardiac magnetic resonance imaging. They found that current cigarette smoking status, smoking intensity in terms of cigarettes per day, and smoking burden in pack-years, were independently associated with higher left ventricular mass, lower left ventricular strain, higher brain natriuretic peptides, higher BNP levels and higher risk of incident heart failure hospitalization in blacks.                                                 These relationships were significant after adjustment for coronary heart disease, suggesting mechanisms beyond atherosclerosis may contribute myocardial dysfunction and increased risk of heart failure in smokers. In summary, these findings suggest that smoking is associated with structural and functional left ventricular abnormalities that lead to heart failure in blacks and that smoking cessation should be encouraged in those with risk factors for heart failure.                                                 What happens to the risk modifying effects of exercise in individuals with increased genetic risk of cardiovascular disease. Drs. Tikkanen, Gustafsson, and Ingelsson from Stanford University School of Medicine performed the study in about 500,000 individuals from the UK Biobank and reported and compared the association's objective and subjective measures of fitness and physical activity with prospective cardiovascular disease events and all-cause death.                                                 They found consistent and robust inverse association, particularly between objective measures of fitness and physical activity and six cardiovascular outcomes and total mortality. Using genetic risk scores for coronary heart disease and atrial fibrillation, they showed that these inverse associations were present in each genetic risk category, suggesting that elevated genetic risk for these diseases can be compensated for by exercise.                                                 The knowledge that lifestyle choices have substantial effects on disease risk could encourage individuals to initiate a healthier lifestyle to reduce their overall risk. In the longer term, identifying subgroup space on genetic risk that benefit most from lifestyle interventions, could help personalize preventive strategies for chronic diseases.                                                 Well, that wraps it up for our summaries, now for our feature discussion.                                                 Today's featured paper deals with transcatheter aortic valve replacement, which we are all going to recognize has rapidly emerged as a treatment of choice in inoperable patients and, it's a reasonable alternative to surgical aortic valve replacement in high- and intermediate-surgical-risk patients. However, the success of this technology is in large part due to the rigor with which quantitative echocardiography by core laboratories has been used to assess the native and prosthetic aortic valve function.                                                 Today's feature paper gives us such important data from the REPRISE III trial, which compares the Lotus and the CoreValve transcatheter aortic valve in patients with high and extreme surgical risk. I'm so pleased to have the corresponding author, Dr. Federico Asch, from MedStar Washington Hospital Center, as well as our associate editor, Dr. Dharam Kumbhani from UT Southwestern. All right Federico, please help me here, so as a noninterventionist and a person who doesn't deal with all these different types of valves every day, please tell us what was the motivation of looking so closely at the echocardiographic data from REPRISE, because the REPRISE III trial results were already published? Dr Federico Asch:             The most interesting aspect of this analysis is really that there is a very methodic, blinded comparison of two different valves. The valve that is being tested and that the reason why Boston Scientific has sponsored the study, is the Lotus valve, the Lotus System is, if you want, a new valve that is not clinically approved in the United States yet, that basically, it's a completely repositionable bovine pericardial valve that comes in different sizes.                                                 The three sizes that were tested in here are what we would call the small, or 23 millimeters, the medium, 25 millimeters, and the large, 27 millimeters. Each patient, at the moment of randomization, or at the moment of inclusion, were randomized to the small, medium, or large Lotus valve vs the clinically approved CoreValve, which is a Medtronic product. Obviously, this is taken as the control group because this is one of the valves that is widely clinically available nowadays in the United States and worldwide.                                                 This is exactly the motivation here. On one side, to prove whether this valve was as good as CoreValve or not and whether it was as safe as the CoreValve as well, and that, the study was about. Every three patients that were randomized, two were randomized to the new valve, the Lotus, and one was randomized to the CoreValve.                                                 An important note to make here is because the control arm included clinically available valves at the beginning of the study, the previous generation of CoreValve was used and then about halfway through the trial, the Evolut valve was the one being used, so there's two different valves on the CoreValve system that were tested in this trial while Lotus was a single earlier generation valve. We focus here on the hemodynamic implications, that meaning, the gradients and the degree, if you want, of obstruction that these valves could have over time, and the amount of regurgitation that these two valves and how they compare to each other. Dr Carolyn Lam:                That's great. Could I ask if you had any hypothesis going in, because as I recall, the Lotus valve actually met the non-inferiority comparison, but it did have significantly higher rates of new pacemaker implantation and valve thrombosis, right? So, was that perhaps a hypothesis going in and what did you find? Dr Federico Asch:             So, the initial hypothesis of the trial overall was that this new valve was one that was designed to have less paravalvular regurgitation, which is something as you probably know, has been of significant concern in the cardiology world ever since the initial clinical trials for Tyler with Partner and CoreValves.                                                 Patients with more significant paravalvular leak did have worse outcome over time, so, one of the main goals of this valve itself, was to prevent that paravalvular regurgitation. So, that was the initial idea behind this product I would say, not just the clinical trial and obviously, this clinical trial tried to prove that, indeed, as I mentioned before, the primary effectiveness end point was mortality, disabling stroke, and paravalvular leak, the main driver on the difference between the two valves there was indeed a much lower paravalvular regurgitation on the Lotus valve compared to CoreValve.                                                 There was also lower stroke rate, but the most important difference was on the paravalvular aortic regurgitation. Of course, when you think of any of these devices, for them to be able to prevent paravalvular leak, they have to have some kind of skirt or cushioning around the valve, an adaptive seal, which in the case of the Lotus valve, that would prevent any flow around the stent, but one of the risks of that of course is that by trying to seal the valve, you're actually, you may be decreasing a little bit the effective orifice area, so it was actually very important to understand whether gradients with this valve were higher and whether the potential differences in the gradients did turn into any difference in clinical outcomes. Dr Carolyn Lam:                That is super clear now. What did you find? Dr Federico Asch:             I would say, the findings from a hemodynamic standpoint, we can briefly summarize them in two aspects of it. No surprise, the paravalvular leak was significantly lower for Lotus compared to CoreValve, and that was true for any of the three sizes, for the small, medium, and large size in all of them, the rate was significantly lower for Lotus. It was actually under 1% of the patients with moderate or higher paravalvular leak, as opposed to an average of 6.7% on the CoreValve, but on the other side of the spectrum, the gradients and the effective orifice area, and the dimensional index were all significantly better on the CoreValve compared to the Lotus.                                                 The bottom line is, we have two valves that each of them has a specific strength. On one side, Lotus has less paravalvular leak. On the other hand, CoreValve has a better gradient profile than Lotus. I would say in two lines, that's the findings of this study. We did take these findings further and compared among different valve sizes and we saw that these differences were consistent at each of the valve size, so if we would compare the small Lotus with the small CoreValve or the large Lotus with CoreValve, the findings were very similar.                                                 They were always significant, and what is important is that while there was a difference, both for paravalvular leak and for gradients and other hemodynamic parameters, the reality is that when it came to clinical outcomes, there was no significant difference among the two. Dr Carolyn Lam:                Dharam, you have to weigh in now as an interventional cardiologist, what does this mean to you. Dr Dharam Kumbhani:   First of all, Federico, congrats to you and Ted and the rest of the group. I think this is obviously a very important trial and I think this hemodynamics paper, I think definitely moves, helps understand the differences a little bit better, so I think this is a very valuable contribution. I think you said it exactly right. I think what is really interesting is that you have a significant introduction into the paravalvular leak, but yet you have, because of difference in valve design, one being annular vs the other being super annular, you have higher gradients with the Lotus valve compared with the CoreValve, so you wonder if the two differences can cancel themselves out in some way, because you don't see any difference in clinical end points at one year, and also, I guess, what we've learned from the Partner data and other CoreValve data is it would be really helpful to see how this evolves over time, whether there will be any late separation of the curves or just a long-term follow-up, whether that will still be important.                                                 I think that is the really interesting insight that we glean from this analysis. I want to make two other points. I think the other interesting thing about the design of the Lotus valve, and probably having such a great seal for the paravalvular leak reduction and having higher radial strength, I would think, at the annulus, I suspect that that's probably also the reason why the pacemaker rate is higher with this, compared with CoreValve, so it's almost 30% in this trial. About 20%, 18% already had an existing pacemaker, so particularly I guess, as we move to lower-risk population, I think that will certainly, balancing the two and deciding probably one valve doesn't fit everybody and we may have to have strategies to figure out which may be the best valve for a given patient based on this.                                                 The other point I'd like to make is the question about stents or valve thrombosis and I know that your group has been heavily invested in that research, because I know in the JAMA paper, there was a report of few valve thrombosis events and you also bring that home here in this hemodynamics paper. Is there anything you want to elaborate on that or any insights that you feel would be helpful for the next set of trials and next generation of the Lotus valve? Dr Federico Asch:             Yeah, you're bringing two very, very important points. Let me address the thrombosis one first. As you very well described, we have been working a lot on multiple different valves and understanding why this is happening. It's clearly something of concern. In this study in particular, we did not have data collected to detect subclinical thrombosis, which is what most of us have been talking mostly about over the last few years. The diagnosis of thrombosis here was not so clinical. These were patients that mostly, because gradients were going up, were detected. They were image ... there was one or two cases with TE and the other ones with CTs and then they were given anticoagulation and those results, and based on that is that the diagnosis of thrombosis was made. All those cases, nine cases, indeed, happen on the Lotus group. The CoreValve is one in that overall has shown to have lower rates of thrombosis in general and I'm not just talking about our own report. Our report was consistent with that.                                                 That may be something related to the fact that it's a super annular valve and the flow through the valve may be better, if you want, but we don't know that. The rate of thrombosis, again, clinical thrombosis, in this case, for the Lotus valve was 1.5%, which is still low, but it's impossible to compare to all those new reports that are coming out because those are mostly subclinical, which is not the case here.                                                 One could argue that if would have done CTs on every patient here at 30, 45 days, we would have found much higher rates in both valves, but we don't know that. We don't have the data to address that. Dr Dharam Kumbhani:   As I remember, almost all of them, I think seven out of eight of those reported, were in the 23 valve, right? They were not ... I think the larger valves ... Dr Federico Asch:             Exactly. There were nine cases overall, eight of them were on the small valve, on the 23 millimeters, and one was in the middle size, on the 25 millimeters. You are completely right. Dr Dharam Kumbhani:   I don't know what to make of that, but that was an interesting observation as well. Dr Federico Asch:             Yeah. It's interesting because when you look at reports of subclinical thrombosis, actually some of the reports suggest that this is more common in bigger valves than in smaller valves. Registries, I'm talking about, but that didn't seem to be the case here, but again, we need to understand the limitations. This was not a study geared towards detecting sub clinical thrombosis or thrombosis overall. These are just clinically reported cases that were analyzed thoroughly but they were triggered by some kind of clinical event, what's mostly an increase in the gradient.                                                 That's all that I would make out of the thrombosis. I think there is definitely more that we need to learn about it. We know that both CoreValve and Lotus have been reported to have cases of thrombosis, but in general, CoreValve seems to be of all the type of devices, the one with the lowest incidents. Dr Dharam Kumbhani:   Maybe your studies will help in understanding the influence of hemodynamic profile, patient-prosthesis mismatch, to the risk of thrombosis. I think the interactions are not well understood. I think that will be very interesting going forward. Dr Federico Asch:             Exactly. And the other comment that I wanted to make, Dharam, regarding your first impression about the pacemakers and the gradients, a couple of observations that I want to make out of that, one is that the difference in gradients between Lotus and CoreValve seem to be the highest early and then over months, that difference seemed to get smaller and smaller, still significant though, even at one year, but one could argue that if, as we continue following up these patients, maybe the difference starts getting smaller and smaller to the point that to become irrelevant, but we don't know that. That is just the impression that we get at looking at the curves over time.                                                 The pacemaker, obviously, as you can imagine, this is something that is of concern for everybody. It's a high rate, the newer Lotus generations are geared towards having lower paravalvular leak, like the head Lotus Edge and so we would expect that in the future that would be the case, but we don't know. The same way that it is important to mention that CoreValve has been addressing their initial concern, which was paravalvular leak.                                                 I mentioned before that the control arm in this clinical trial included CoreValve classic, earlier generations from roughly half of the patients, and the paravalvular leak in that group was a little bit over 10%, while the second group, which was the Evolut R had already a much lower rate of paravalvular leak, but was still significantly higher than Lotus, but was definitely better.                                                 I think what this points out to, is that all these devices are so early in their life, in their history, that all the efforts that each of these companies are making into fixing the specific problems that each of them have, really turn into a next generation that addresses more aggressively all these things. In the case of CoreValve, definitely the paravalvular leak is one and they are making very good progress in the care of Lotus, the permanent pacemaker is one and we expect in subsequent generations to improve as well. Dr Carolyn Lam:                It's been very enlightening for me and I'm sure for all our listeners. Thank you for joining us today listeners. Don't forget to tune in again next week.