Podcasts about MetroWest Medical Center

On our podcast this week, we hear from Dr. Adam Urato. Adam graduated from Harvard Medical School in 1997 and has been practicing medicine for over 25 years, specializing in obstetrics and gynecology. He cares for pregnant women on a daily basis as an attending maternal-fetal medicine physician at MetroWest Medical Center in Framingham, Massachusetts. He writes and lectures regularly on antidepressant use during pregnancy. Adam has contributed to Mad in America's continuing education efforts and his free course "Antidepressants and Pregnancy" can be found on Mad in America's education section. It is an informative and comprehensive look into a little-discussed but very important area of women's health. For this interview, Adam joined me to discuss what we do and don't know about the effects of antidepressants on babies and mothers and also the importance of counselling in order to aid families in making important decisions about pharmaceutical drug use. *** Thank you for being with us to listen to the podcast and read our articles this year. MIA is funded entirely by reader donations. If you value MIA, please help us continue to survive and grow. To find the Mad in America podcast on your preferred podcast player, click here

This week on the ITS Telehealth Podcast we host Daniel Wright the Chief Nursing Officer for MetroWest Medical Center. This episode is a great one as Daniel and Keenan get into the challenges of life, what benefits moving to a new state can bring, and leaning into opportunities. It was truly a pleasure to host Daniel on the show - we hope you enjoy this week's conversation - let us know what you thought about this week's episode in the comments section below! Remember to LIKE & SUBSCRIBE! You can find a lot more episodes just like this one on the ITS Telehealth Youtube Channel - https://www.youtube.com/channel/UCJ13Z2_3HT9bnqs4UOR8YSQ

These days, hatred and conflict seem to be everywhere, from conversations around our dinner tables to interactions with total strangers. How can we come together to replace prejudice and generalization with understanding and unity?Clinical psychologist and author Dr. Arthur P. Ciaramicoli believes the answer lies in empathy and understanding. Before we can address conflict on a global scale, however, we must first understand where our own prejudices and ideas stem from.In this episode, Suzanne and Dr. Arthur Ciaramicoli discuss how we can heal our wounds and foster understanding. Dr. Ciaramicoli talks about highlights from his most recent book, America Reunited, why empathy is so important, how to find common ground with others, and much more. Topics Include: - How to overcome conflict- Healing our wounds - Highlights from Dr. Ciaramicoli's latest book, America Reunited- The dangers of black and white thinking - The importance of looking back at ourselves - Finding common ground in disagreements- Listening, instead of reacting- The importance of neutrality- Why empathy is key- Unlearning the suppression of empathy- Implementing these ideas in daily life- And other topics…Dr. Arthur P. Ciaramicoli is a clinical psychologist who has been in practice for more than 35 years. Dr. Ciaramicoli has served on the faculty at Harvard Medical School, as the Chief Psychologist at Metrowest Medical Center, and as the director of the Metrowest Counseling Center and the Alternative Medicine division of Metrowest Wellness Center in Farmington, Massachusetts. Dr. Ciaramicoli is currently on faculty at the IAWP. He is a member of the American Psychological Association and the Massachusetts Psychological Association. Dr. Ciaramicoli is currently in private practice.Dr. Ciaramicoli appears as an expert on programs like CNN, CNNfx, Fox News, Good Morning America Weekend, along with many other television and radio shows. He is the author of several books including, America Reunited: A Relational Solution to Bridging the Political, Social and Personal Chasm Dividing Our Nation (2021), The Power of Empathy: A Practical Guide to Creating Intimacy, Self-understanding, and Lasting Love in Your Life (2021), The Stress Solution: Using Empathy and Cognitive Behavioral Therapy to Reduce Anxiety and Develop Resilience (2016), and more. Connect with Dr. Arthur P. Ciaramicoli:Linkedin: https://www.linkedin.com/in/drarthurciaramicoli/Website: https://www.balanceyoursuccess.com/Resources Mentioned:America Reunited: https://www.amazon.com/gp/product/B096FS5PWS/ref=dbs_a_def_rwt_bibl_vppi_i2 Dr. Ciaramicoli's Amazon Author Page: https://www.amazon.com/Arthur-P-Ciaramicoli/e/B001ITXCI4?ref=sr_ntt_srch_lnk_1&qid=1639506607&sr=1-1Edwin Rutsch's Empathy Circles: http://cultureofempathy.com/Projects/Empathy-Movement/index.htmThe IAWP Ultimate Guide to Becoming Your Best Self and Living Life on Your Own Terms: https://iawpwellnesscoach.com/guide

“Empathy is the heart of diversity”, actually, I think that empathy is the heart of being a good human. In this episode, we learn that plus so much more from Dr. Arthur Ciaramicoli. I think that Dr. Ciaramicoli knocked the ball out of the park with his latest best-selling book titled ‘Triumph of Diversity: How to Rejoice and Benefit from the Interconnectedness of Mankind' If you have not figured it out, you will know very soon that I am a geek when it comes to understanding how empathy runs through every facet of life. Ranging from friendships, marriage, parenting, leadership, negotiating, and now longevity. This entire podcast is a highlight reel and you will hear where I short-circuited a couple of times and was speechless. That's very rare for me. Prepare for your mind to be blown, too. If I had to pick 3 things that really stick out as ah-ha moments I pick these. Growing in life is about unlearning. We are addicted to negative self-talk, and. Stress is not only shortening your life but also your stress could shortening the lives of the people you love the most and future generations. As Dr. Ciaramicoli says, “First slow down and then build awareness when you slow down” after you do that grab a pen and a clean sheet of paper in your journal to take some detailed notes. In The Triumph of Diversity, Dr. Ciaramicoli analyzes prejudice by tracing it to personal origins and relates true stories of courageous individuals who have overcome hatred, cruelty, and sadism to become open-minded, loving resilient people. He re-emphasizes that we are in desperate need of those who unite rather than those who ostracize. Dr. Ciaramicoli shares his observations as a psychologist in clinical practice, his interviews with laymen, clinicians and clergy, and data from current research to conclude, as Thomas Paine said, “My Country is the World; my Religion is to do Good,” and that learned prejudices can be laid bare and redirected to give way to genuine empathy and inclusion over exclusion. For a copy of The Triumph of Diversity click here https://amzn.to/314K1X6 Bio from http://www.balanceyoursuccess.com/ Arthur P. Ciaramicoli, Ed.D., Ph.D., is a licensed clinical psychologist who has been treating clients for more than 30 years. He is a member of the American Psychological Association and the Massachusetts Psycho­logical Association. Currently, in private practice, Dr. Ciaramicoli has been on the faculty of Harvard Medical School for several years, lecturer for the American Cancer Society, Chief Psychologist at Metrowest Medical Center, and director of the Metrowest Counseling Center and of the Alter­native Medicine division of Metrowest Wellness Center in Framingham, Massachusetts. In addition to treating patients, Dr. Ciaramicoli has lectured at Harvard Health Services, Boston College Counseling Center, the Space Telescope Science Institute in Baltimore as well as being a consultant to several ma­jor corporations in the Boston area. Interested in one-on-one coaching from Scott Stanfield email at modernlongevitarian@gmail.com Join our private Facebook group at https://www.facebook.com/groups/longevitarian/ Please visit our website https://modernlongevitarian.com/ --- Support this podcast: https://anchor.fm/modernlongevitarian/support

Dr. Ciaramicoli is a contributor to The Creative Living Foundation and formerly the Chief Medical Officer of Soundmindz. Dr. Ciaramicoli has been on the faculty of Harvard Medical School for several years, lecturer for the American Cancer Society, Chief Psychologist at Metrowest Medical Center, and director of the Metrowest Counseling Center and of the Alternative Medicine division of Metrowest Wellness Center in Framingham, Massachusetts. Dr. Ciaramicoli speaks with us about his latest book: The Soulful Leader: Success with Authenticity, Integrity and Empathy.  Listen to The Tony DUrso Show on VoiceAmerica Influencers Platform every Friday at 2pm Pacific. You can also catch this on Apple Podcasts or tonydurso.com.

Dr. Ciaramicoli is a contributor to The Creative Living Foundation and formerly the Chief Medical Officer of Soundmindz. Dr. Ciaramicoli has been on the faculty of Harvard Medical School for several years, lecturer for the American Cancer Society, Chief Psychologist at Metrowest Medical Center, and director of the Metrowest Counseling Center and of the Alternative Medicine division of Metrowest Wellness Center in Framingham, Massachusetts. Dr. Ciaramicoli speaks with us about his latest book: The Soulful Leader: Success with Authenticity, Integrity and Empathy.  Listen to The Tony DUrso Show on VoiceAmerica Influencers Platform every Friday at 2pm Pacific. You can also catch this on Apple Podcasts or tonydurso.com.

Dr. Ciaramicoli is a contributor to The Creative Living Foundation and formerly the Chief Medical Officer of Soundmindz. Dr. Ciaramicoli has been on the faculty of Harvard Medical School for several years, lecturer for the American Cancer Society, Chief Psychologist at Metrowest Medical Center, and director of the Metrowest Counseling Center and of the Alternative Medicine division of Metrowest Wellness Center in Framingham, Massachusetts. Dr. Ciaramicoli speaks with us about his latest book: The Soulful Leader: Success with Authenticity, Integrity and Empathy.  Listen to The Tony DUrso Show on VoiceAmerica Influencers Platform every Friday at 2pm Pacific. You can also catch this on Apple Podcasts or tonydurso.com.

Dr. Ciaramicoli is a contributor to The Creative Living Foundation and formerly the Chief Medical Officer of Soundmindz. Dr. Ciaramicoli has been on the faculty of Harvard Medical School for several years, lecturer for the American Cancer Society, Chief Psychologist at Metrowest Medical Center, and director of the Metrowest Counseling Center and of the Alternative Medicine division of Metrowest Wellness Center in Framingham, Massachusetts. Dr. Ciaramicoli speaks with us about his latest book: The Soulful Leader: Success with Authenticity, Integrity and Empathy.  Listen to The Tony DUrso Show on VoiceAmerica Influencers Platform every Friday at 2pm Pacific. You can also catch this on Apple Podcasts or tonydurso.com.

Dr. Ciaramicoli is a contributor to The Creative Living Foundation and formerly the Chief Medical Officer of Soundmindz. Dr. Ciaramicoli has been on the faculty of Harvard Medical School for several years, lecturer for the American Cancer Society, Chief Psychologist at Metrowest Medical Center, and director of the Metrowest Counseling Center and of the Alternative Medicine division of Metrowest Wellness Center in Framingham, Massachusetts. Dr. Ciaramicoli speaks with us about his latest book: The Soulful Leader: Success with Authenticity, Integrity and Empathy.  Listen to The Tony DUrso Show on VoiceAmerica Influencers Platform every Friday at 2pm Pacific. You can also catch this on Apple Podcasts or tonydurso.com.

Dr. Ciaramicoli is a contributor to The Creative Living Foundation and formerly the Chief Medical Officer of Soundmindz. Dr. Ciaramicoli has been on the faculty of Harvard Medical School for several years, lecturer for the American Cancer Society, Chief Psychologist at Metrowest Medical Center, and director of the Metrowest Counseling Center and of the Alternative Medicine division of Metrowest Wellness Center in Framingham, Massachusetts. Dr. Ciaramicoli speaks with us about his latest book: The Soulful Leader: Success with Authenticity, Integrity and Empathy.  Listen to The Tony DUrso Show on VoiceAmerica Influencers Platform every Friday at 2pm Pacific. You can also catch this on Apple Podcasts or tonydurso.com.

  Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine's Emergency Medicine Practice. I'm Jeff Nusbaum, and I'm back with my co-host, Nachi Gupta. This month, we're talking about a topic that is ripe for review this time of year. We're talking Influenza… Diagnosis and Management. Nachi: Very appropriate as the cold is settling in here in NYC and we're already starting to see more cases of influenza. Remember that as you listen through the episode, the means we're about to cover one of the CME questions for those of you listening at home with the print issue handy. Jeff: This month's issue was authored by Dr. Al Giwa of the Icahn School of Medicine at Mount Sinai, Dr. Chinwe Ogedegbe of the Seton Hall School of Medicine, and Dr. Charles Murphy of Metrowest Medical Center. Nachi: And this issue was peer reviewed by Dr. Michael Abraham of the University of Maryland School of Medicine and by Dr. Dan Egan, Vice Chair of Education of the Department of Emergency Medicine at Columbia University. Jeff: The information contained in this article comes from articles found on pubmed, the cochrane database, center for disease control, and the world health organization. I'd say that's a pretty reputable group of sources. Additionally, guidelines were reviewed from the american college of emergency physicians, infectious disease society of america, and the american academy of pediatrics. Nachi: Some brief history here to get us started -- did you know that in 1918/1919, during the influenza pandemic, about one third of the world's population was infected with influenza? Jeff: That's wild. How do they even know that? Nachi: Not sure, but also worth noting -- an estimated 50 million people died during that pandemic. Jeff: Clearly a deadly disease. Sadly, that wasn't the last major outbreak… fifty years later the 1968 hong kong influenza pandemic, H3N2, took between 1 and 4 million lives. Nachi: And just last year we saw the 2017-2018 influenza epidemic with record-breaking ED visits. This was the deadliest season since 1976 with at least 80,000 deaths. Jeff: The reason for this is multifactorial. The combination of particularly mutagenic strains causing low vaccine effectiveness, along with decreased production of IV fluids and antiviral medication because of the hurricane, all played a role in last winter's disastrous epidemic. Nachi: Overall we're looking at a rise in influenza related deaths with over 30,000 deaths annually in the US attributed to influenza in recent years. The ED plays a key role in outbreaks, since containment relies on early and rapid identification and treatment. Jeff: In addition to the mortality you just cited, influenza also causes a tremendous strain on society. The CDC estimates that epidemics cost 10 billion dollars per year. They also estimate that an epidemic is responsible for 3 million hospitalized days and 31 million outpatient visits each year. Nachi: It is thought that up to 20% of the US population has been infected with influenza in the winter months, disproportionately hitting the young and elderly. Deaths from influenza have been increasing over the last 20 years, likely in part due to a growing elderly population. Jeff: And naturally, the deaths that we see from influenza also disproportionately affect the elderly, with up to 90% occurring in those 65 or older. Nachi: Though most of our listeners probably know the difference between an influenza epidemic and pandemic, let's review it anyway. When the number of cases of influenza is higher than what would be expected in a region, an epidemic is declared. When the occurrence of disease is on a worldwide spectrum, the term pandemic is used. Jeff: I think that's enough epidemiology for now. Let's get started with the basics of the influenza virus. Influenza is spread primarily through direct person-to-person contact via expelled respiratory secretions.

  Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta. This month, we’re talking about a topic that is ripe for review this time of year. We’re talking Influenza… Diagnosis and Management. Nachi: Very appropriate as the cold is settling in here in NYC and we’re already starting to see more cases of influenza. Remember that as you listen through the episode, the means we’re about to cover one of the CME questions for those of you listening at home with the print issue handy. Jeff: This month’s issue was authored by Dr. Al Giwa of the Icahn School of Medicine at Mount Sinai, Dr. Chinwe Ogedegbe of the Seton Hall School of Medicine, and Dr. Charles Murphy of Metrowest Medical Center. Nachi: And this issue was peer reviewed by Dr. Michael Abraham of the University of Maryland School of Medicine and by Dr. Dan Egan, Vice Chair of Education of the Department of Emergency Medicine at Columbia University. Jeff: The information contained in this article comes from articles found on pubmed, the cochrane database, center for disease control, and the world health organization. I’d say that’s a pretty reputable group of sources. Additionally, guidelines were reviewed from the american college of emergency physicians, infectious disease society of america, and the american academy of pediatrics. Nachi: Some brief history here to get us started -- did you know that in 1918/1919, during the influenza pandemic, about one third of the world’s population was infected with influenza? Jeff: That’s wild. How do they even know that? Nachi: Not sure, but also worth noting -- an estimated 50 million people died during that pandemic. Jeff: Clearly a deadly disease. Sadly, that wasn’t the last major outbreak… fifty years later the 1968 hong kong influenza pandemic, H3N2, took between 1 and 4 million lives. Nachi: And just last year we saw the 2017-2018 influenza epidemic with record-breaking ED visits. This was the deadliest season since 1976 with at least 80,000 deaths. Jeff: The reason for this is multifactorial. The combination of particularly mutagenic strains causing low vaccine effectiveness, along with decreased production of IV fluids and antiviral medication because of the hurricane, all played a role in last winter’s disastrous epidemic. Nachi: Overall we’re looking at a rise in influenza related deaths with over 30,000 deaths annually in the US attributed to influenza in recent years. The ED plays a key role in outbreaks, since containment relies on early and rapid identification and treatment. Jeff: In addition to the mortality you just cited, influenza also causes a tremendous strain on society. The CDC estimates that epidemics cost 10 billion dollars per year. They also estimate that an epidemic is responsible for 3 million hospitalized days and 31 million outpatient visits each year. Nachi: It is thought that up to 20% of the US population has been infected with influenza in the winter months, disproportionately hitting the young and elderly. Deaths from influenza have been increasing over the last 20 years, likely in part due to a growing elderly population. Jeff: And naturally, the deaths that we see from influenza also disproportionately affect the elderly, with up to 90% occurring in those 65 or older. Nachi: Though most of our listeners probably know the difference between an influenza epidemic and pandemic, let’s review it anyway. When the number of cases of influenza is higher than what would be expected in a region, an epidemic is declared. When the occurrence of disease is on a worldwide spectrum, the term pandemic is used. Jeff: I think that’s enough epidemiology for now. Let’s get started with the basics of the influenza virus. Influenza is spread primarily through direct person-to-person contact via expelled respiratory secretions. It is most active in the winter months, but can be seen year-round. Nachi: The influenza virus is a spherical RNA-based virus of the orthomyxoviridae family. The RNA core is associated with a nucleoprotein antigen. Variations of this antigen have led to the the 3 primary subgroups -- influenza A, B, and C, with influenza A being the most common. Jeff: Influenza B is less frequent, but is more frequently associated with epidemics. And Influenza C is the form least likely to infect humans -- it is also milder than both influenza A or B. Nachi: But back to Influenza A - it can be further classified based on its transmembrane or surface proteins, hemagglutinin and neuraminidase - or H and N for short. There are actually 16 different H subtypes and 9 different N subtypes, but only H1, H2, H3, and N1 and N2 have caused epidemic disease. Jeff: Two terms worth learning here are antigen drift and anitgen shift. Antigen drift refers to small point mutations to the viral genes that code for H and N. Antigen shift is a much more radical change, with reassortment of viral genes. When cells are infected by 2 or more strains, a new strain can emerge after genetic reassortment. Nachi: With antigen shift, some immunity may be maintained within a population infected by a similar subtype previously. With antigen drift, there is loss of immunity from prior infection. Jeff: The appearance of new strains of influenza typically involves an animal host, like pigs, horses, or birds. This is why you might be hear a strain called “swine flu”, “equine flu”, or “avian flu”. Close proximity with these animals facilitates co-infection and genetic reassortment. Nachi: I think that’s enough basic biology for now, let’s move on to pathophysiology. When inhaled, the influenza virus initially infects the epithelium of the upper respiratory tract and alveolar cells of the lower respiratory tract. Viral replication occurs within 4 to 6 hours. Incubation is 18 to 72 hours. Viral shedding is usually complete roughly 7 days after infection, but can be longer in children and immunocompromised patients. Jeff: As part of the infectious process and response, there can be significant changes to the respiratory tract with inflammation and epithelial cell necrosis. This can lead to viral pneumonia, and occasionally secondary bacterial pneumonia. Nachi: The secondary bacterial pathogens that are most common include Staph aureus, Strep pneumoniae, and H influenzae. Jeff: Despite anything you may read on the internet, vaccines work and luckily influenza happens to be a pathogen which we can vaccinate against. As such, there are 3 methods approved by the FDA for producing influenza vaccines -- egg-based, cell-based, or recombinant influenza vaccine. Once the season’s most likely strains have been determined, the virus is introduced into the medium and allowed to replicate. The antigen is then purified and used to make an injection or nasal spray. Nachi: It isn’t easy to create vaccines for all strains. H3N2, for example, is particularly virulent, volatile, and mutagenic, which leads to poor prophylaxis against this particular subgroup. Jeff: In fact, a meta-analysis on vaccine effectiveness from 2004-2015 found that the pooled effectiveness against influenza B was 54%, against the H1N1 pandemic in 2009 was 61%, and against the H3N2 virus was 33%. Not surprisingly, H3N2 dominant seasons are currently associated with the highest rates of influenza cases, hospitalizations, and death. Nachi: Those are overall some low percentages. So should we still be getting vaccinated? The answer is certainly a resounding YES.. Despite poor protection from certain strains, vaccine effectiveness is still around 50% and prevents severe morbidity and mortality in those patients. Jeff: That’s right. The 2017-2018 vaccine was only 40% effective, but this still translates to 40% less severe cases and a subsequent decrease in hospitalizations and death. Nachi: But before we get into actual hospitalization, treatment, and preventing death, let’s talk about the differential. We’re not just focusing on influenza here, but any influenza like illness, since they can be hard to distinguish. The CDC defines “influenza-like illness” as a temperature > 100 F, plus cough or sore throat, in the absence of a known cause other than influenza. Jeff: Therefore, influenza should really be considered on the differential of any patient who presents to the ED with a fever and URI symptoms. The differential when considering influenza might also include mycoplasma pneumoniae, strep pneumoniae, adenovirus, RSV, rhinovirus, parainfluenza virus, legionella, and community acquired MRSA. Nachi: With the differential in mind, let’s move on to prehospital care. For the prehospital setting, there isn’t much surprising here. Stabilize and manage the respiratory status with all of your standard tools - oxygen for those with mild hypoxia and advanced airway maneuvers for those with respiratory distess. Jeff: Of note, EMS providers should use face masks themselves and place them on patients as well. As community paramedicine and mobile integrated health becomes more common, this is one potential area where EMS can potentially keep patients at home or help them seek treatment in alternate destinations to avoid subjecting crowded ED’s to the highly contagious influenza virus. Nachi: It’s also worth noting, that most communities have strategic plans in the event of a major influenza outbreak. Local, state, and federal protocols have been designed for effective care delivery. Jeff: Alright, so now that the EMS crew, wearing proper PPE of course, has delivered the patient, who is also wearing a mask, to the ED, we can begin our ED H&P. Don’t forget that patients present with a range of symptoms that vary by age. A typical history is 2-5 days of fever, nasal congestion, sore throat, and myalgias. You might see tachycardia, cough, dyspnea, and chills too. Nachi: Van Wormer et al conducted a prospective analysis of subjective symptoms to determine correlation with lab confirmed influenza. They found the most common symptoms were cough in 92%, fatigue in 91%, and nasal congestion in 84%, whereas sneezing was actually a negative predictor for influenza. Jeff: Sneezing, really? Can’t wait to get the Press-Gany results from the sneezing patient I discharge without testing for influenza based on their aggressive sneezes! Nachi: Aggressive sneezes…? I can’t wait to see your scale for that. Jeff: Hopefully I’ll have it in next month’s annals. In all seriousness, I’m not doing away with flu swabs just yet. In another retrospective study, Monto et al found that the best multivariate predictors were cough and fever with a positive predictive value of 79%. Nachi: Yet another study in children found that the predominant symptoms were fever in 95%, cough in 77%, and rhinitis in 78%. This study also suggested that the range of fever was higher in children and that GI symptoms like vomiting and diarrhea were more common in children than adults. Jeff: Aside from symptomatology, there are quite a few diagnostic tests to consider including viral culture, immunofluoresence, rt-pcr, and rapid antigen testing. The reliability of testing varies greatly depending on the type of test, quality of the sample, and the lab. During a true epidemic, formal testing might not be indicated as the decision to treat is based on treatment criteria like age, comorbidities, and severity of illness. Nachi: We’ll get to treatment in a few minutes, but diving a bit deeper into testing - there are 3 major categories of tests. The first detects influenza A only. The second detects either A or B, but cannot distinguish between them; and the third detects both influenza A and B and is subtype specific. The majority of rapid testing kits will distinguish between influenza A and B, but not all can distinguish between them. Fluorescent antibody testing by DFA is relatively rapid and yields results within 2 to 4 hours. Jeff: Viral culture and RT-PCR remain the gold standard, but both require more time and money, as well as a specialized lab. As a result, rapid testing modalities are recommended. Multiple studies have shown significant benefit to the usefulness of positive results on rapid testing. It’s safe to say that at a minimum, rapid testing helps decrease delays in treatment and management. Nachi: Looking a bit further into the testing characteristics, don’t forget that the positive predictive value of testing is affected by the prevalence of influenza. In periods of low influenza activity (as in the summer), a rapid test will have low PPV and high NPV. The test is more likely to yield false positive results -- up to 50% according to one study when prevalence is below 5%. Jeff: And conversely, in periods of high influenza activity, a rapid test will have higher PPV and lower NPV, and it is more likely to produce a false negative result. Nachi: In one prospective study of patients who presented with influenza-like illness during peak season, rapid testing was found to be no better than clinical judgement. During these times, it’s probably better to reserve testing for extremely ill patients in whom diagnostic closure is particularly important. And since the quality of the specimen remains important, empiric treatment of critically ill patients should still be considered. Jeff: Which is a perfect segway into our next topic - treatment, which is certainly the most interesting section of this article. To start off -- for mild to moderate disease and no underlying high risk conditions, supportive therapy is usually sufficient. Nachi: Antiviral therapy is reserved for those with a predicted severe disease course or with high risk conditions like long-standing pulmonary disease, pregnancy, immunocompromise, or even just being elderly. Jeff: Note to self, avoid being elderly. Nachi: Good luck with that. Anyway, early treatment with antivirals has been shown to reduce influenza-related complications in both children and adults. Jeff: Once you’ve decided to treat the patient, there are two primary classes of antivirals -- adamantane derivatives and neuraminidase inhibitors. Oh and then there is a new single dose oral antiviral that was just approved by the FDA… baloxavir marboxil (or xofluza), which is in a class of its own -- a polymerase endonuclease inhibitor. Nachi: The oldest class, the adamantane derivatives, includes amantadine and rimantadine. Then the newer class of neuraminidase inhibitors includes oseltamavir (which is taken by mouth), zanamavir (which is inhaled), and peramivir (which is administered by IV). Jeff: Oseltamavir is currently approved for patients of all ages. A 2015 meta analysis showed that the intention-to-treat infected population had a shorter time to alleviation of all symptoms from 123 hours to 98 hours. That’s over a day less of symptoms, not bad! There were also fewer lower respiratory tract complications requiring antibiotics and fewer admissions for any cause. Really, not bad! Nachi: Zanamavir is approved for patients 7 and older -- or for children 5 or older for disease prevention. Zanamavir has been associated with possible bronchospasm and is contraindicated in patients with reactive airway disease. Jeff: Peramivir, the newest drug in this class, is given as a single IV dose for patients with uncomplicated influenza who have been sick for 2 days or less. Peramavir is approved for patients 2 or older. This is a particularly great choice for a vomiting patient. Nachi: And as you mentioned before, just last month, the FDA approved baloxavir, a single dose antiviral. It’s effective for influenza type A or B. Note that safety and efficacy have not been established for patients less than 12 years old, weighing less than 40 kg, or pregnant or lactating patients. Jeff: Unfortunately, there has been some pretty notable antiviral resistance in the recent past, moreso with the adamantane class, but recently also with the neuraminidase inhibitors. In 2007-2008, an oseltamivir-resistant H1N1 strain emerged globally. Luckily, cross-resistance between baloxavir and the adamantanes or neuraminidase inhibitors isn’t expected, as they target different viral proteins, so this may be an answer this year, and in the future. Nachi: Let’s talk chemoprophylaxis for influenza.. Chemoprophylaxis with oseltamavir or zanamavir can be considered for patients who are at high risk for complications and were exposed to influenza in the first 2 weeks following vaccination, patients who are at high risk for complications and cannot receive the vaccination, and those who are immunocompromised. Jeff: Chemoprophylaxis is also recommended for pregnant women. For postexposure prophylaxis for pregnant women, the current recommendation is to administer oseltamivir. Nachi: We should also discuss the efficacy of treatment with antivirals. This has been a hotly debated topic, especially with regards to cost versus benefit… In a meta-analysis, using time to alleviation of symptoms as the primary endpoint, oseltamavir resulted in an efficacy of 73% (with a wide 95% CI from 33% to 89%). And this was with dose of 150mg/day in a symptomatic influenza patient. Jeff: Similarly zanamavir given at 10mg/day was 62% effective, but again with a wide 95% CI from 15% to 83%. And, of note, other studies have looked into peramivir, but have found no significant benefits other than the route of delivery. Nachi: In another 2014 study by Muthuri et al., neuraminidase inhibitors were associated with a reduction in mortality -- adjusted OR = 0.81 (with a 95% CI 0.70 to 0.93). Also when comparing late treatment with early treatment (that is, within 2 days of symptom onset), there was a reduction in mortality risk with adjusted OR 0.48 (95%CI 0.41-0.56). These associations with reduction in mortality risk were less pronounced and less significant in children. Jeff: Mortality benefit, not bad! They further found an increase in mortality hazard ratio with each day’s delay in initiation of treatment up to 5 days, when compared to treatment initiated within 2 days. Nachi: But back to the children for a second -- another review of neuraminidase inhibitors in children < 12 years old found duration of clinical symptoms was reduced by 36 hours among previously healthy children taking oseltamivir and 30 hours by children taking zanamivir. Jeff: I think that’s worth summarizing - According to this month’s author’s review of the best current evidence, use of neuraminidase inhibitors is recommended, especially if started within 2 days, for elderly patients and those with comorbidities. Nachi: Seems like there is decent data to support that conclusion. But let’s not forget that these medications all have side effects. Jeff: These drugs actually tend to be well tolerated.The most frequently noted side effect of oseltamavir is nausea and vomiting, while zanamavir is associated with diarrhea. Nachi: Amazing. Let’s talk disposition for your influenza patient. Jeff: Disposition will depend on many clinical factors, like age, respiratory status, oxygen saturation, comorbid conditions, and reliability of follow up care. Admission might be needed not only to manage the viral infection, but also expected complications. Nachi: If you’re discharging a patient, be sure to engage in shared decision making regarding risks and benefits of available treatments. Ensure outpatient follow up and discuss return to er precautions. Jeff: Also, the CDC recommends that these patients stay home for at least 24 hours after their fever has broken. Nachi: With that -- Let’s summarize the key points and clinical pearls from this month’s issue J: Even though influenza vaccine effectiveness is typically only 50%, this still translates to a decrease in influenza-related morbidity and mortality. 2. The CDC defines influenza-like illness as a temperature > 100 F with either cough or sore throat, in the absence of a known cause other than influenza. 3. When influenza is suspected in the prehospital setting, patients and providers should wear face masks to avoid spreading the virus. 4. In the emergency department, standard isolation and droplet precautions should be maintained for suspected or confirmed infections. 5. The most common symptoms of influenza in adults are cough, fatigue, nasal congestion, and fever. Sneezing is a negative predictor in adults. 6. In children, the most common presenting symptoms are fever, cough, and rhinitis. Vomiting and diarrhea is also more common in children than adults. 7. Rapid testing and identification results in decreased delays in treatment and management decisions. 8. During peak flu season, clinical judgement may be as good as rapid testing, making rapid testing less necessary. J: Rapid testing may be more beneficial in times of lower disease prevalence. 10. Empiric treatment of critically ill patients should be considered even if rapid testing is negative. J: For mild to moderate disease and no underlying high-risk conditions, supportive therapy is usually sufficient. 12.For more ill patients or those at substantial risk for complications, consider antiviral treatment. 13.Oseltamivir is approved for patients of all ages, and reduces the length of symptoms by one day. 14.When treating influenza, peramivir is an ideal agent for the vomiting patient. 15.Baloxavir is a new single-dose antiviral agent approved by the FDA in October 2018. It works in a novel way and is effective for treatment of influenza A and B. 16.Chemoprophylaxis with oseltamivir or zanamivir should be considered in patients who are immunocompromised or patients who are at elevated risk for complications and cannot receive the vaccination. 17.Consider oseltamivir as post exposure prophylaxis in pregnant women. 18.Neuraminidase inhibitors are associated with decreased duration of symptoms and complications, especially if started within 2 days of symptom onset. J: So that wraps up episode 23 - Influenza: Diagnosis and Management in the Emergency Department. N: Additional materials are available on our website for Emergency Medicine Practice subscribers. For our subscribers: be sure to go online to get your CME credit for this issue, which includes 3 pharmacology CME credits. J: Also, for our NP and PA listeners, we have a special offer this month: You can get a full year of access to Emergency Medicine Practice for just $199--including lots of pharmacology, stroke, and trauma CME--and so much more! To get this special deal, go to www.ebmedicine.net/APP. Again, that’s www.ebmedicine.net/APP. N: If you’re not a subscriber, consider joining today. You can find out more at www.ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credits. You’ll also get enhanced access to the podcast, including the images and tables mentioned. You can find everything you need to know at ebmedicine.net/subscribe. J: And the address for this month’s credit is ebmedicine.net/E1218. As always, the you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at emplify@ebmedicine.net with any comments or suggestions. Talk to you next month!    

Arthur P. Ciaramicoli, Ed.D., Ph.D., is a licensed clinical psychologist who has been treating clients for more than 35 years. He is the Chief Medical Officer of Soundmindz.org a popular mental health site. He is also a member of the American Psychological Association and the Massachusetts Psycho-logical Association. Currently in private practice, Dr. Ciaramicoli has been on the faculty of Harvard Medical School for several years, lecturer for the American Cancer Society, Chief Psychologist at Metrowest Medical Center, and director of the Metrowest Counseling Center and of the Alternative Medicine division of Metrowest Wellness Center in Framingham, Massachusetts. In addition to treating patients, Dr. Ciaramicoli has lectured at Harvard Health Services, Boston College Counseling Center, the Space Telescope Science Institute in Baltimore as well as being a consultant to several major corporations in the Boston area. Dr. Ciaramicoli is the author of The Stress Solution: How Using Empathy and Cognitive Behavioral Therapy decreases Anxiety and increases Resilience, The Curse of the Capable: The Hidden Challenges to a Balanced, Healthy, High Achieving Life, Performance Addiction: The Dangerous New Syndrome and How to Stop It from Ruining Your Life  and The Power of Empathy: A Practical Guide to Creating Intimacy, Self-Understanding, and Lasting Love, which is now published in 7 languages. His first book, Treatment of Abuse and Addiction, A Holistic Approach was selected as Book of the Month by The Psychotherapy Book News. He is also the coauthor of Beyond the Influence: Understanding and Defeating Alcoholism. You can follow his daily insights at www.twitter.com/docapc.

Today Dr. Arthur P. Ciaramicoli, a licensed clinical psychologist joins us.  He has been treating clients for more than 35 years. He has been on the faculty of Harvard Medical School for several years, Chief Psychologist at Metrowest Medical Center, and director of the Metrowest Counseling Center and of the Alternative Medicine division of Metrowest Wellness Center in Framingham, Massachusetts. Dr. Ciaramicoli has written numerous books and has appeared on national TV shows like CNN, Fox News Boston, Good Morning America Weekend, The O’Reilly Report, and other shows.  His latest book, The Stress Solution: Using Empathy and Cognitive Behavioral Therapy to Reduce Anxiety and Develop Resilience was recently published in China. Contact Information for Dr. Ciaramicoli: Book: The Stress Solution: Using Empathy and Cognitive Behavioral Therapy to Reduce Anxiety and Develop Resilience.  Website Additional Resource Information: Alzheimer’s Speaks Website           Keynote Speaker         

Arthur P. Ciaramicoli, Ed.D., Ph.D., is a licensed clinical psychologist who has been treating clients for more than 35 years. He is a member of the American Psychological Association and the Massachusetts Psychological Association. He is a contributor to The Creative Living Foundation, was formerly the Chief Medical Officer of Soundmindz.org and is also in private practice, Dr. Ciaramicoli has been on the faculty of Harvard Medical School for several years, lecturer for the American Cancer Society, Chief Psychologist at Metrowest Medical Center, and director of the Metrowest Counseling Center and of the Alternative Medicine division of Metrowest Wellness Center in Framingham, Massachusetts. In addition to treating patients, Dr. Ciaramicoli has lectured at Harvard Health Services, Boston College Counseling Center, the Space Telescope Science Institute in Baltimore as well as being a consultant to several major corporations in the Boston area. Dr. Ciaramicoli is the author of The Curse of the Capable: The Hidden Challenges to a Balanced, Healthy, High Achieving Life, Performance Addiction: The Dangerous New Syndrome and How to Stop It from Ruining Your Life and The Power of Empathy: A Practical Guide to Creating Intimacy, Self-Understanding, and Lasting Love. Dr. Ciaramicoli’s latest book, The Stress Solution: Using Empathy and Cognitive Behavioral Therapy to Reduce Anxiety and Develop Resilience.www.balanceyoursuccess.com

Date: April 5, 2012 Featuring: Gary Cohen, President and Co-Founder, Health Care Without Harm John Messervy, AIA, Director of Capital and Facility Planning, Partners HealthCare, Inc. Amy Collins, MD, Emergency Physician, MetroWest Medical Center; Chair, Go Green Committee, MetroWest How green is your hospital? Green, as you know, has become shorthand for everything from recycling to the use of safer products to shrinking one's carbon footprint to preventing pollutants from spewing into the air. There are any number of urgent reasons for the health care sector to be examining its green practices. One of them is just the sheer amount of resources hospitals consume: in the US, that’s tons and tons of water and 836 trillion BTU of energy annually. These same hospitals dispose of 6,600 tons of waste per day. Fortunately, we can all now point to visible efforts at most hospitals to “think and act” a lot greener. But even these well-intentioned efforts have a tendency to stall or lose steam, too often dependent on staff volunteers and lacking a bigger, bolder vision that cuts across the entire organization and how it's run. Aiming to build on existing progress and to make a giant leap forward on the environmental front, three organizations are now joining forces to launch what’s being dubbed the Healthier Hospitals Initiative. The new effort is anchored by some large hospital systems in the US whose green practices are already exemplary and demonstrate the wisdom behind linking environmental stewardship to efforts to improve safety and reduce health care costs. The Healthier Hospitals Initiative hopes to enlist some 1,000 hospitals in the broad-based campaign, focused on an agenda that includes increased use of safer materials and products for patients and staff alike; reduction of energy consumption and waste; and adoption of policies to ensure sustainability. WIHI host Madge Kaplan welcomes three guests to the program. Gary Cohen is the co-founder and president of Healthcare Without Harm and Practice Greenhealth, whose work has helped lay the groundwork for this larger initiative. Dr. Amy Collins, who leads a number of efforts at MetroWest Medical Center in Framingham, Massachusetts, is helping MetroWest garner a number of environmental excellence awards. John Messervy founded the Partners Sustainability Initiative in 2008, and he has tremendous knowledge of the environmental engineering changes possible throughout a large hospital system.

This week on Relationships 2.0 my guest is Arthur Ciaramicoli PhD author of The Stress Solution. We discuss the stressful period we all endured during the Presidential campaign and election, as well as the challenges we continue to face individually and collectively. Many relationships are strained and need to be healed. So, I thought it would be a good time to discuss the importance of compassion, character and values. We need to find ways to come together rather than grow further apart. My guest: Arthur P. Ciaramicoli, Ed.D., Ph.D., is a licensed clinical psychologist who has been treating clients for more than 35 years. He is the Chief Medical Officer of Soundmindz.org a popular mental health site. He is also a member of the American Psychological Association and the Massachusetts Psycho-logical Association. Currently in private practice, Dr. Ciaramicoli has been on the faculty of Harvard Medical School for several years, lecturer for the American Cancer Society, Chief Psychologist at Metrowest Medical Center, and director of the Metrowest Counseling Center and of the Alternative Medicine division of Metrowest Wellness Center in Framingham, Massachusetts. In addition to treating patients, Dr. Ciaramicoli has lectured at Harvard Health Services, Boston College Counseling Center, the Space Telescope Science Institute in Baltimore as well as being a consultant to several major corporations in the Boston area. Dr. Ciaramicoli is also a seasoned media expert. He has appeared on CNN, CNNfn, Fox News Boston, Comcast TV, New England Cable News, Good Morning America Weekend, The O’Reilly Report, and other shows. He has been a weekly radio guest on Your Healthy Family on Sirius Satellite Radio and Holistic Health Today, and has been interviewed on The People’s Pharmacy, The Gary Null Show, and more than two dozen other radio programs airing on NPR, XM Radio, and numerous AM and FM stations. Dr. Ciaramicoli is the author of The Stress Solution: How Using Empathy and Cognitive Behavioral Therapy decreases Anxiety and increases Resilience (New World Library, 2016), The Curse of the Capable: The Hidden Challenges to a Balanced, Healthy, High Achieving Life (Wiley, 2010), Performance Addiction: The Dangerous New Syndrome and How to Stop It from Ruining Your Life (Wiley 2004) and The Power of Empathy: A Practical Guide to Creating Intimacy, Self-Understanding, and Lasting Love (Dutton 2000), which is now published in 7 languages. His first book, Treatment of Abuse and Addiction, A Holistic Approach (Jason Aronson, 1997) was selected as Book of the Month by The Psychotherapy Book News. He is also the coauthor of Beyond the Influence: Understanding and Defeating Alcoholism (Bantam 2000).

In this week's episode, The Stress Solution with Dr. Arthur P. Ciaramicoli, we discuss the importance of empathy, the ramifications of stress, and ways to work with Cognitive Behavioral Therapy to reduce stress in your life. Direct download: Tranquility du Jour #385: The Stress Solution   Upcoming Events Facebook Live Event: December 30 New Year's Eve Mini-Retreat: December 31 Tranquility du Jour Live: January 12 Mindfulness Urban Retreat: January 22 Yoga, Creativity + Mindfulness in Costa Rica: February 18-25 Yoga + Art in West Virginia: May 19-21 Writing in the Woods: October 20-22   Featured guest: Arthur Ciaramicoli   Arthur P. Ciaramicoli, EdD, PhD, is the author of The Stress Solution: Using Empathy and Cognitive Behavioral Therapy to Reduce Anxiety and Develop Resilience. He is a licensed clinical psychologist and the chief medical officer of soundmindz.org, a popular mental health platform. He has been on the faculty of Harvard Medical School and chief psychologist of Metrowest Medical Center. The author of several books, including The Power of Empathy and Performance Addiction, he lives with his family in Massachusetts and his website is www.balanceyoursuccess.com.   Tranquility du Jour Savvy Sources Find Arthur balanceyoursuccess.com Twitter Facebook His book: The Stress Solution: Using Empathy and Cognitive Behavioral Therapy to Reduce Anxiety and Develop Resilience Mentioned in podcast Daybook 5.0 {3 copies left} Facebook Live Video: Holiday Tips HTC10 Holiday Playlist on Spotify Thoughts Are Not Facts article Social Media Eye candy on Instagram Pin along with me on Pinterest Let’s connect on Facebook Follow moi on Twitter Tranquility Tips + Tools My 5 Books New to Tranquility du Jour? Peruse the FAQs Go back to school with these tranquility-filled E-courses Download the Tranquility du Jour Podcast App: iPhone and Android Download the latest Tranquility du Jour Live Shop slow fashion: TranquiliT’s fall look book Sign up for bi-monthly Love Notes and access Tranquil Treasures Read about my passion for animals Request Pen a review on iTunes and/or share this podcast via social media, s‘il vous plaît Ask questions, share what you do while listening, or how this podcast has helped you. I love hearing from you! Techy To listen, click on the player at the top of the post or click here to listen to older episodes. New to podcasting? Get more info at Podcast 411. Do you have iTunes? Click here and subscribe to the podcast to get the latest episode as released. Get the Tranquility du Jour apps to download the podcast "automagically" on iOS or Android.

I thought I'd try a different format on the show this week. We have so much great content and so many incredible guests I thought we'd reach back and pull out a couple fantastic interviews on Stress to help you understand how to reduce stress in different ways. I brought back Dr. Ciaramicoli author of The Stress Solution to share some of his tips and insights with us. Briefly Dr. Ciaramicoli is a licensed clinical psychologist and the chief medical officer of soundmindz.org, a popular mental health platform. He has been on the faculty of Harvard Medical School and chief psychologist of Metrowest Medical Center. And we've also have Rick Titan who is the author of Crush Stress, and has first hand experience on living a stressful lifestyle as a professional athlete which has brought his to teach others how to reduce stress. Thank you so much for your interest in this show of Exploring Mind and Body, if you haven't done so already please take a moment and leave a quick rating and review of the show in iTunes by clicking below. It will keep us delivering valuable content each week and give others an opportunity to find the show as well. Click here to subscribe via iTunes (and or leave a rating)

This week on Relationships 2.0 my guest is Arthur Ciaramicoli, EdD, PhD (part 3) author of The Stress Solution: Using Empathy and Cognitive Behavioral Therapy to Reduce Anxiety and Develop Resilience. Our conversation is specifically focused on prejudice and bias and the link to increased stress. About the book: Therapeutic tools for fighting the anxiety, fear, and depression caused by stress “We work too much, sleep too little, love with half a heart, and wonder why we are unhappy and unhealthy,” writes clinical psychologist Arthur Ciaramicoli. In The Stress Solution, Ciaramicoli provides readers with simple, realistic, powerful techniques for using empathy and cognitive behavioral therapy to perceive situations accurately, correct distorted thinking, and trigger our own neurochemistry to produce calm, focused energy. He developed this approach over thirty-five years of working with clients struggling with depression, anxiety, and addictions. Over and over again, he has helped sufferers overcome old hurts and combat performance anxiety, fears, and excessive worry. Ciaramicoli’s pioneering approach offers new promise to readers facing a variety of stress-based concerns. About the author: Arthur P. Ciaramicoli, Ed.D., Ph.D., is a licensed clinical psychologist who has been treating clients for more than 35 years. He is the Chief Medical Officer of Soundmindz.org a popular mental health site. He is also a member of the American Psychological Association and the Massachusetts Psycho-logical Association. Currently in private practice, Dr. Ciaramicoli has been on the faculty of Harvard Medical School for several years, lecturer for the American Cancer Society, Chief Psychologist at Metrowest Medical Center, and director of the Metrowest Counseling Center and of the Alternative Medicine division of Metrowest Wellness Center in Framingham, Massachusetts. Dr. Ciaramicoli is the author of The Stress Solution: How Using Empathy and Cognitive Behavioral Therapy decreases Anxiety and increases Resilience (New World Library, 2016),The Curse of the Capable: The Hidden Challenges to a Balanced, Healthy, High Achieving Life(Wiley, 2010), Performance Addiction: The Dangerous New Syndrome and How to Stop It from Ruining Your Life (Wiley 2004) and The Power of Empathy: A Practical Guide to Creating Intimacy, Self-Understanding, and Lasting Love (Dutton 2000), which is now published in 7 languages. His first book, Treatment of Abuse and Addiction, A Holistic Approach (Jason Aronson, 1997) was selected as Book of the Month by The Psychotherapy Book News. He is also the coauthor of Beyond the Influence: Understanding and Defeating Alcoholism(Bantam 2000). Dr. Ciaramicoli lives in a suburb of Boston with his wife of 37 years. His newsletter, blog comments and contact information are available at his web site,www.BalanceYourSuccess.com. You can follow his daily insights at www.twitter.com/docapc.

This week on Relationships 2.0 my guest is Arthur P. Ciaramicoli, EdD, PhD author of The Stress Solution: Using Empathy and Cognitive Behavioral Therapy to Reduce Anxiety and Develop Resilience. This is part 2 of our chat about his book. About the book: Therapeutic tools for fighting the anxiety, fear, and depression caused by stress “We work too much, sleep too little, love with half a heart, and wonder why we are unhappy and unhealthy,” writes clinical psychologist Arthur Ciaramicoli. In The Stress Solution, Ciaramicoli provides readers with simple, realistic, powerful techniques for using empathy and cognitive behavioral therapy to perceive situations accurately, correct distorted thinking, and trigger our own neurochemistry to produce calm, focused energy. He developed this approach over thirty-five years of working with clients struggling with depression, anxiety, and addictions. Over and over again, he has helped sufferers overcome old hurts and combat performance anxiety, fears, and excessive worry. Ciaramicoli’s pioneering approach offers new promise to readers facing a variety of stress-based concerns. About the author: Arthur P. Ciaramicoli, Ed.D., Ph.D., is a licensed clinical psychologist who has been treating clients for more than 35 years. He is the Chief Medical Officer of Soundmindz.org a popular mental health site. He is also a member of the American Psychological Association and the Massachusetts Psycho-logical Association. Currently in private practice, Dr. Ciaramicoli has been on the faculty of Harvard Medical School for several years, lecturer for the American Cancer Society, Chief Psychologist at Metrowest Medical Center, and director of the Metrowest Counseling Center and of the Alternative Medicine division of Metrowest Wellness Center in Framingham, Massachusetts. Dr. Ciaramicoli is the author of The Stress Solution: How Using Empathy and Cognitive Behavioral Therapy decreases Anxiety and increases Resilience (New World Library, 2016), The Curse of the Capable: The Hidden Challenges to a Balanced, Healthy, High Achieving Life (Wiley, 2010), Performance Addiction: The Dangerous New Syndrome and How to Stop It from Ruining Your Life (Wiley 2004) and The Power of Empathy: A Practical Guide to Creating Intimacy, Self-Understanding, and Lasting Love (Dutton 2000), which is now published in 7 languages. His first book, Treatment of Abuse and Addiction, A Holistic Approach (Jason Aronson, 1997) was selected as Book of the Month by The Psychotherapy Book News. He is also the coauthor of Beyond the Influence: Understanding and Defeating Alcoholism (Bantam 2000). Dr. Ciaramicoli lives in a suburb of Boston with his wife of 37 years. His newsletter, blog comments and contact information are available at his web site, www.BalanceYourSuccess.com. You can follow his daily insights at www.twitter.com/docapc.

Arthur P. Ciaramicoli, EdD, PhD, is the author of The Stress Solution: Using Empathy and Cognitive Behavioral Therapy to Reduce Anxiety and Develop Resilience. He is a licensed clinical psychologist and the chief medical officer of soundmindz.org, a popular mental health platform. He has been on the faculty of Harvard Medical School and chief psychologist of Metrowest Medical Center. The author of several books, including The Power of Empathy and Performance Addiction. www.balanceyoursuccess.com This is to confirm you for a 30-45 minute phone interview with Michele Meiche on Awakenings Radio on August 3, 2016 at 12:45pm PT which is 3:45 pm ET. ________________________ Awakenings With Michele Meiche is Your place for tips and insight to live a more fulfilling life, and your relationships. Learn how to attract healthy relationships, and how to create a life you really love. Awakenings broadcasts live every Wed. 12pm -1:30 pm PT   Call in for Intuitive Readings #347-539-5122 Michele answers questions about Awakening, Spirituality, Metaphysics and Self/Soul Development. Michele also answers listener questions from email, twitter and facebook On Air. Email awakeningspodcast@gmail.com to have your questions answered or to share your insights On Air. 

Aired Sunday, 24 July 2016, 9:00 PM ETThe amount of stress in America and throughout the world today is rapidly rising. We work too much, sleep too little, love with half a heart, and wonder why we are unhappy and unhealthy.We know that personal and professional success does not come without sacrifice, but it should not ruin our health and leave our relationships devoid of love and intimacy.Joining Sylvia on today’s show is Dr. Arthur P. Ciaramicoli, a licensed clinical psychologist. Dr. Ciaramicoli will share how you can use empathy to calm the emotional brain and strategies based on Cognitive Behavioral Therapy that correct distorted stressful thinking and thoughts.About the Guest Dr. Arthur P. CiaramicoliArthur P. Ciaramicoli, Ed.D., Ph.D., is a licensed clinical psychologist and is the Chief Medical Officer of soundmindz.org. He is a member of the American Psychological Association and the Massachusetts Psycho­logical Association.Dr. Ciaramicoli has been on the faculty of Harvard Medical School for several years, a lecturer for the American Cancer Society, the Chief Psychologist at Metrowest Medical Center, and the Director of the Metrowest Counseling Center, and Director of the Alter­native Medicine division of Metrowest Wellness Center in Framingham, Massachusetts.Dr. Ciaramicoli is the author of a number of books, including but are not limited to: The Stress Solution: Using Empathy and Cognitive Behavior Therapy to Reduce Anxiety and Develop Resilience; The Curse of the Capable: The Hidden Challenges to a Balanced, Healthy, High Achieving Life; Performance Addiction: The Dangerous New Syndrome and How to Stop It from Ruining Your Life; and The Power of Empathy: A Practical Guide to Creating Intimacy, Self-Understanding, and Lasting Love, which is now published in 7 languages.Dr. Ciaramicoli has appeared on CNN, Fox News Boston, Comcast TV, New England Cable News, Good Morning America Weekend, The O’Reilly Report, and other shows. He has been a weekly radio guest on Your Healthy Family on Sirius Satellite Radio and Holistic Health Today, and has been interviewed on The People’s Pharmacy, The Gary Null Show, and over two dozen other radio programs airing on NPR, XM Radio, and numerous AM and FM stations.Dr. Ciaramicoli lives in a suburb of Boston with his wife and two daughters.For more information about Dr. Arthur P. Ciaramicoli, please visit: www.BalanceYourSuccess.com

Most people are stressed. High achievers have even more stress than the average Joe. Stress causes the body to release cortisol, which causes chronic inflammation in the body, leading to things such as weight gain, hair loss, breakdown of muscle tissue, depression, anxiety, memory loss, and cancer. This is why it’s critical to find the solution to stress. The author of “The Stress Solution”, Dr. Arthur Ciaramicoli, states that by controlling negative thinking and eliminating cognitive distortion, we can see things as they are and not drive this stress response in the body. To give you an idea of just how extreme this stress epidemic is, here are just a few of the statistics. 75% of Americans state that they suffer physically or psychologically from stress everyday. 75% of visits to primary care physicians last year were due to stress. And 50% of Americans state they wake up every night due to stress.  Those numbers are staggering. The stress epidemic has amplified dramatically in the last few years. Americans have fewer friends, trusts rates are down, prejudice rates are up, and empathy is down. “Being busy” is the definition of successful.   That’s why Dr. Arthur Ciaramicoli decided to write a book specifically to solve this daunting epidemic. Dr. Arthur and I discuss how stress is mainly caused by perception. Being able to perceive accurately is the key to decrease stress, says Dr. Arthur. Not only is stress psychological, there’s also a stress response that happens on a biological level. When we release the stress hormone cortisol on a regular basis, it causes negative thinking, inflammation, weight gain, hair loss, break down of muscle tissue, flabbiness, depression, anxiety and memory loss. By being more empathetic, we can produce calming neurochemicals naturally. Dr. Arthur discusses the fact that Americans are medication-oriented, trying to fix internal problems with external agents. He states that it is critical to discover the cause. Through empathy and cognitive behavioral therapy, we can stop the stress response, while developing deeper relationships with those around us. Currently in private practice, Dr. Ciaramicoli has been on the faculty of Harvard Medical School for several years, lecturer for the American Cancer Society, Chief Psychologist at Metrowest Medical Center, and director of the Metrowest Counseling Center and of the Alter­native Medicine division of Metrowest Wellness Center in Framingham, Massachusetts. In this episode… Why stress has become a chronic problem in today’s world. Stress is a driver of inflammation. What stress does to the body. Why high-achieving people are the most stressed and most likely to develop illnesses that stem from chronic stress and inflammation. Empathy and Cognitive Behavioral Therapy (CBT) are the most comprehensive self-help tool to date. Sympathy vs. empathy. Why certain people overreact to stressful situations. Perception is key to reducing stress. Six steps to become empathetic and develop deep, lasting relationship with those around you. To find out more about Dr. Arthur Ciaramicoli, you can visit www.balanceyoursuccess.com  To enter to win a FREE copy of Dr. Arthur’s book The Stress Solution, join our Facebook community: https://www.facebook.com/groups/nuvisionexcel/?ref=br_tf  Stay connected with Dr. Nick Zyrowski at http://www.nuvisionexcel.com

Arthur P. Ciaramicoli, Ed.D., Ph.D., is a licensed clinical psychologist who has been treating clients for more than 30 years. He is a member of the American Psychological Association and the Massachusetts Psycho­logical Association. Currently in private practice, Dr. Ciaramicoli has been on the faculty of Harvard Medical School for several years, lecturer for the American Cancer Society, Chief Psychologist at Metrowest Medical Center, and director of the Metrowest Counseling Center and of the Alter­native Medicine division of Metrowest Wellness Center in Framingham, Massachusetts. In addition to treating patients, Dr. Ciaramicoli has lectured at Harvard Health Services, Boston College Counseling Center, the Space Telescope Science Institute in Baltimore as well as being a consultant to several major corporations in the Boston area. Dr. Ciaramicoli is also a seasoned media expert. He has appeared on CNN, CNN, Fox News Boston, Comcast TV, New England Cable News, Good Morning America Weekend, The O’Reilly Report, and other shows. He has been a weekly radio guest on Your Healthy Family on Sirius Satel­lite Radio and Holistic Health Today, and has been interviewed on The People’s Pharmacy, The Gary Null Show, and more than two dozen other radio programs airing on NPR, XM Radio, and numerous AM and FM sta­tions. Learn more about Dr. Arthur P. Ciaramicoli at http://www.balanceyoursuccess.com/   Click here to visit the show notes page!   Like this episode? Please leave an honest rating on iTunes. Ratings and reviews are extremely helpful and greatly appreciated! They do matter in the rankings of the show, and I read each and every one of them. P.S: Just takes a minute! :)   SUBSCRIBE ON ITUNES  Click here to leave us a rating & review on iTunes Follow us on social media:  | Facebook | Twitter | Join our Facebook Tribe    

Aired Wednesday, 6 July 2016, 8:00 PM ETGot stress? A recent survey says that Americans have high stress levels and 53% said they received little or no stress management support from their health care providers. Two thirds of office visits to primary care physicians can be tied to stress. Stress can lead to inflammation which contributes to long term health problems like cancer and heart disease. My guest this week, Clinical Psychologist Dr. Arthur Ciaramicoli, says….”We work too much, sleep too little, love with half a heart, and wonder why we are unhappy and unhealthy.” In his new book, The Stress Solution, he provides readers with simple, realistic, powerful techniques for using empathy and cognitive behavioral therapy to perceive situations accurately, correct distorted thinking, and trigger our own neurochemistry to produce calm, focused energy.Dr. Ciaramicoli is a licensed clinical psychologist and the chief medical officer of soundmindz.org, a popular mental health platform. He has been on the faculty of Harvard Medical School and chief psychologist of Metrowest Medical Center. He is the author of several books, including The Power of Empathy and Performance Addiction. His website is: www.balanceyoursuccess.com

About the book: Therapeutic tools for fighting the anxiety, fear, and depression caused by stress “We work too much, sleep too little, love with half a heart, and wonder why we are unhappy and unhealthy,” writes clinical psychologist Arthur Ciaramicoli. In The Stress Solution, Ciaramicoli provides readers with simple, realistic, powerful techniques for using empathy and cognitive behavioral therapy to perceive situations accurately, correct distorted thinking, and trigger our own neurochemistry to produce calm, focused energy. He developed this approach over thirty-five years of working with clients struggling with depression, anxiety, and addictions. Over and over again, he has helped sufferers overcome old hurts and combat performance anxiety, fears, and excessive worry. Ciaramicoli’s pioneering approach offers new promise to readers facing a variety of stress-based concerns. About the author: Arthur P. Ciaramicoli, Ed.D., Ph.D., is a licensed clinical psychologist who has been treating clients for more than 35 years. He is the Chief Medical Officer of Soundmindz.org a popular mental health site. He is also a member of the American Psychological Association and the Massachusetts Psycho-logical Association. Currently in private practice, Dr. Ciaramicoli has been on the faculty of Harvard Medical School for several years, lecturer for the American Cancer Society, Chief Psychologist at Metrowest Medical Center, and director of the Metrowest Counseling Center and of the Alternative Medicine division of Metrowest Wellness Center in Framingham, Massachusetts. In addition to treating patients, Dr. Ciaramicoli has lectured at Harvard Health Services, Boston College Counseling Center, the Space Telescope Science Institute in Baltimore as well as being a consultant to several major corporations in the Boston area. Dr. Ciaramicoli is also a seasoned media expert.

Steven Radelet renowned expert on international development and global poverty, and is a Distinguished Professor of Development at Georgetown University. He has been working in developing countries for 30 years since he started as a Peace Corps Volunteer in Samoa in the 1980s. He lived in Indonesia for several years, and West Africa for several more. He has also held senior positions in the US Treasury and State Department. Along with his work at Georgetown, he serves as an economic adviser to the President of Liberia. In fact, he is joining us by phone today from Liberia in West Africa Dr. Arthur P. Ciaramicoli, EdD, PhD, is the author of The Stress Solution: Using Empathy and Cognitive Behavioral Therapy to Reduce Anxiety and Develop Resilience. He is a licensed clinical psychologist and the chief medical officer of soundmindz.org, a popular mental health platform. He has been on the faculty of Harvard Medical School and chief psychologist of Metrowest Medical Center. The author of several books, including The Power of Empathy and Performance Addiction  For more information go to MoneyForLunch.com. Connect with Bert Martinez on Facebook. Connect with Bert Martinez on Twitter. Need help with your business? Contact Bert Martinez. Have Bert Martinez speak at your event!

Arthur P. Ciaramicoli, EdD, PhD, is the author of The Stress Solution: Using Empathy and Cognitive Behavioral Therapy to Reduce Anxiety and Develop Resilience. He is a licensed clinical psychologist and the chief medical officer of soundmindz.org, a popular mental health platform. He has been on the faculty of Harvard Medical School and chief psychologist of Metrowest Medical Center. The author of several books, including The Power of Empathy and Performance Addiction, he lives with his family in Massachusetts and his website is www.balanceyoursuccess.com. Show Notes: what is performance addiction why we are material rich and spiritually poor we love with half a heart what really brings love and respect what produces stress hormones 50% of adults wake up in the middle of the night stressed out 75% of adults deal with stress on a daily basis empathy teaches us how to slow down turn down the dial know how to slow down take a mental vacation from yourself goodness and giving Focus on the present stop 'mind reading' we must rewrite our story 'edit the book' we need other people's help trust, give Follow Dr. Ciaramicoli on Twitter HERE. [Tweet ""We have less stress when we have empathy" -@docapc"] Thank you so much for your interest in this show of Exploring Mind and Body, if you haven't done so already please take a moment and leave a quick rating and review of the show in iTunes by clicking below. It will keep us delivering valuable content each week and give others an opportunity to find the show as well. Click here to subscribe via iTunes (and or leave a rating)

Arthur P. Ciaramicoli, EdD, PhD, is the author of The Stress Solution: Using Empathy and Cognitive Behavioral Therapy to Reduce Anxiety and Develop Resilience. He is a licensed clinical psychologist and the chief medical officer of soundmindz.org, a popular mental health platform. He has been on the faculty of Harvard Medical School and chief psychologist of Metrowest Medical Center. Join us to learn how to improve your relationships by reducing your anxiety, using empathy and cognitive behavorial therapy techniques.

In this episode, Bo Bennett speaks with Lisa Montoya, organizational development coach and current seminary student. From Lisa's website: Lisa Montoya is pursuing her own personal and spiritual development by attending One Spirit Interfaith Seminary. As a soon-to-be ordained interfaith/interspiritual minister, she is also a volunteer pastoral care visitor at the Leonard Morse Hospital at MetroWest Medical Center in Natick, MA. Additionally, she is a certified Grief Recovery Specialist, helping people work through the pain of major life losses (divorce, death, job loss, etc.). This grief work ties directly to her work with organizations going through major change. Lisa is especially skilled at helping managers assist their employees with the emotional aspect of change which, if not acknowledged and handled properly, can delay or derail the change efforts, regardless of how rational they may be. When not working, Lisa enjoys yoga, walks in nature, spending time with family and friends, and traveling.

Learn About the History of Lipids and Heart Disease Risk and the State of Lipids as Cardiovascular Risk Factors in 2011 Kirk Hamilton interviews Dr. William Castelli who received a B.S. in Zoology from Yale College and a Doctor of Medicine, Surgery and Obstetrics from the Catholic University of Louvain in Belgium. Dr. Castelli joined the Framingham Heart Study in 1965 where he reorganized the Framingham laboratory to measure lipoproteins such as LDL, VLDL, IDL, HDL and sinking Pre-Beta (Lp {a}). In 1979 Dr. Castelli became the third director of the Framingham Heart Study which now includes four generations of Framingham people. Associations with three medical schools in the area have led to his teaching epidemiology and prevention of atherosclerotic cardiovascular disease for 34 years at the Harvard Medical School, 22 years at the Boston University School of Medicine and 15 years at the University of Massachusetts Medical School. He currently is the medical director of a new wellness program at the MetroWest Medical Center in Framingham Massachusetts which specializes in the aggressive management of cardiovascular risk factors. He also lectures frequently on heart disease risk assessment and treatment. Download or Open:

LeanBlog Podcast #65 is a discussion with Kevin Frieswick, a Lean Process Manager, with MetroWest Medical Center in Framingham, MA. I found Kevin earlier this year when I discovered their YouTube video about innovations at MWMC, which included a unique error proofing device to help encourage handwashing by staff and physicians before entering patient rooms. I recommend you first watch the video here (http://www.leanblog.org/2009/02/error-proofing-handwashing.html) before listening to the podcast. In this podcast, Kevin gives us more details behind the invention of the device and how it has been received in the hospital. For earlier episodes, visit the main Podcast page at www.leanpodcast.org, which includes information on how to subscribe via RSS or via Apple iTunes. If you have feedback on the podcast, or any questions for me or my guests, you can email me at leanpodcast@gmail.com or you can call and leave a voicemail by calling the "Lean Line" at (817) 776-LEAN (817-776-5326) or contact me via Skype id "mgraban". Please give your location and your first name. Any comments (email or voicemail) might be used in follow ups to the podcast.