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3 episodes with michigan health system
3 episodes with michigan health system
2 episodes with michigan health system
2 episodes with michigan health system
2 episodes with michigan health system
2 episodes with michigan health system
It's Wednesday, February 19th, A.D. 2025. This is The Worldview in 5 Minutes heard on 125 radio stations and at www.TheWorldview.com. I'm Adam McManus. (Adam@TheWorldview.com) By Jonathan Clark Christians faced the most murders and abductions in Africa Global Christian Relief released the Violent Incidents Database last month in partnership with the International Institute for Religious Freedom. The publicly accessible resource records over 6,000 verified incidents of religious persecution starting from 2022. Christians faced the most murders and abductions in Africa according to the database. Europe led in terms of damage to religious buildings. Believers faced the most sentences and arrests in Asia. Asia also led in terms of attacks on houses and people being forced to leave their home or country. Global Christian Relief reported Nigeria, India, China, and Azerbaijan were some of the worst countries for the persecution of Christians in their 2025 Red List Report. British woman in trouble for holding pro-life sign outside abortion mill A retired medical scientist in England will face trial next month for her pro-life work. The case began when authorities confronted 63-year-old Livia Tossici-Bolt for holding a sign near an abortion mill. The sign read “Here to talk, if you want to.” Jeremiah Igunnubole, Legal Counsel for Alliance Defending Freedom UK, noted, “Under far-reaching and vaguely-written rules, we have seen volunteers like Livia criminalized simply for offering conversations to those in need; and others dragged through courts for praying, even silently, in their minds.” Christian physician assistant fired for affirming two genders In the United States, a Christian healthcare worker is fighting for her religious freedom with the help of First Liberty. Back in 2021, the University of Michigan Health System fired Valerie Kloosterman. The physician assistant lost her job for remaining committed to the Biblical definition of male and female. She took her case to the 6th U.S. Circuit Court of Appeals earlier this month. Kloosterman said, “I couldn't do this without my faith. This battle belongs to the Lord. I'm His instrument and I'm required to be faithful. I'm hoping that I do that every step of this process even though it can be difficult and hard.” 2 Chronicles 20:15 says, “Thus says the LORD to you: ‘Do not be afraid nor dismayed because of this great multitude, for the battle is not yours, but God's.” Trump announces reciprocal tariffs President Donald Trump announced reciprocal tariffs on Monday. He wrote on X, “On Trade, I have decided, for purposes of Fairness, that I will charge a RECIPROCAL Tariff -- meaning whatever Countries charge the United States of America, we will charge them. No more, no less!” A Trump administration official told The Hill the tariffs will apply equally to competitors, like communist China, or allies like the European Union or Japan or Korea. JP Morgan, Citigroup, & Morgan Stanley scrub DEI nonsense Big banks in the U.S. are reacting to President Trump's executive order against diversity, equity, and inclusion programs, also known as DEI. Banks like Morgan Stanley, JPMorgan, and Citigroup have scrubbed their public references to DEI in recent weeks, reports The Wall Street Journal. A White House fact sheet from last month noted, “In the private sector, many corporations and universities use DEI as an excuse for biased and unlawful employment practices and illegal admissions preferences, ignoring the fact that DEI's foundational rhetoric and ideas foster intergroup hostility.” Delta plane crashed at Canadian airport, flipped upside down A Delta Air Lines jet crashed at Canada's Toronto Pearson International Airport on Monday, reports Fox News. The flight was carrying 80 people on board from Minneapolis. The plane ended upside down on the runway, leaving passengers hanging from their seats “like bats” as one passenger described. At least 21 people were injured, but thankfully no one died in the crash. Republican Rep. Pete Stauber of Minnesota said, “I am praying for those involved and will continue to monitor this situation as details emerge. I am incredibly grateful for the quick response of the first responders on the ground!” Anniversary of John Bunyan's Pilgrim's Progress And finally, this week is the 347th anniversary of the publication of John Bunyan's Pilgrim's Progress. His first volume of the book was announced on February 18, 1678. With 250 million copies sold, it's one of the best-selling books of all time. If you don't have a copy, pick up one today. It's a must have volume for every Christian's library. Bunyan began the work from prison. He was sentenced for holding unsanctioned religious services. Despite suffering for his faith, he would produce a Christian classic that would influence the church for centuries. The 19th century English preacher Charles Spurgeon said of Bunyan, “Read anything of his, and you will see that it is almost like reading the Bible itself. He had read it till his very soul was saturated with Scripture; and though his writings are charmingly full of poetry, yet he cannot give us his Pilgrim's Progress—that sweetest of all prose poems—without continually making us feel and say, ‘Why, this man is a living Bible!'” Jeremiah 15:16 says, “Your words were found, and I ate them, and Your word was to me the joy and rejoicing of my heart; for I am called by Your name, O LORD God of hosts.” Close And that's The Worldview on this Wednesday, February 19th, in the year of our Lord 2025. Subscribe by Amazon Music or by iTunes or email to our unique Christian newscast at www.TheWorldview.com. Or get the Generations app through Google Play or The App Store. I'm Adam McManus (Adam@TheWorldview.com). Seize the day for Jesus Christ.
About Russ Richmond:Russ Richmond has diverse work experience spanning various industries and roles. Russ is the CEO and Co-founder of Laudio, a healthcare leadership company that improves frontline actions. Russ has also served as a Member of the Innovation Growth Board at Mass General Brigham. In addition, they have held positions such as Executive Chairman and Independent Board Director at Validic, Member of the Board of Directors at BioDigital, and CEO and Board Director at Advanced Practice Strategies (APS), where they successfully restructured the company and facilitated its acquisition. Russ has also worked at Explorys, an IBM company, as an Independent Board Director. Prior to that, they were the CEO and co-founder of Objective Health, a startup within McKinsey & Company, where they played a significant role in establishing the company and leading its performance insights efforts. Russ had earlier worked as a Consultant and Associate Principal at McKinsey & Company. Russ also has experience as the Executive Vice President of Verisk Health and as a resident physician at the University of Michigan Health System.Things You'll Learn:Laudio redefines healthcare management by empowering frontline leaders with integrated, AI-powered workflows, addressing issues like burnout and turnover.Laudio's strategy of publishing data-driven insights fosters a culture of informed leadership and drives the spread of Laudio's solutions.Laudio accelerates market adoption despite the typically slow healthcare sales cycle, building a teamwork-based approach to engage multiple executive stakeholders for impactful collaboration.The platform's AI-driven approach to automating managerial tasks can save up to 6 hours a week for health managers. The strategies that Laudio employs to foster customer acquisition, scaling effectively in an industry known for long sales cycles.Resources:Connect with and follow Dr. Russ Richmond on LinkedIn.Follow Laudio on LinkedIn and visit their website.
June 10, 2024 ~ Dr. David Miller, president of the University of Michigan Health System, joins Guy Gordon, Lloyd Jackson, and Jamie Edmonds to discuss groundbreaking healthcare expansions and innovative partnerships transforming patient care across Michigan. Discover how new specialized centers, including an advanced outpatient facility in Oakland County, aim to revolutionize accessibility and convenience. Plus, get an insider's look at cutting-edge cybersecurity measures, trailblazing cancer treatments, and the future of healthcare talent recruitment.
Crain's reporter Kurt Nagl talks with David Miller, president of University of Michigan Health System, at the 2024 Mackinac Policy Conference.
For this episode of “Ask the Expert: Research Edition,” "Increased Intracranial Pressure in Pediatric MOG Antibody Disease," Krissy Dilger of SRNA was joined by Dr. Cynthia Wang and Dr. Linda Nguyen. They discussed MOG antibody disease and the significance of MOG antibodies in diagnosis (00:00:02-00:03:36). Dr. Nguyen highlighted the background of the study and how this research focused on determining the impact of elevated intracranial pressure on patient outcomes (00:03:52-00:06:56). She reviewed the implications of the findings for patient management, emphasizing the importance of early recognition and intervention to mitigate disability (00:10:34-00:14:02). Dr. Wang and Dr. Nguyen anticipated future studies and stressed the collaborative effort required for better patient outcomes and the need for ongoing research in this field (00:17:16-00:20:30). Dr. Linda Nguyen completed her MD, PhD training at West Virgina University in 2017, and then pediatric neurology residency at University of California San Diego in 2022. Currently, she is a neuroimmunology fellow at University of Texas Southwestern. Dr. Cynthia Wang received her medical degree from University of Texas Southwestern Medical Center in Dallas, Texas and completed a pediatrics and pediatric neurology residency at Mott Children's Hospital, University of Michigan Health System in Ann Arbor, Michigan. Dr. Wang completed her James T. Lubin Fellowship under the mentorship of Dr. Benjamin Greenberg at The University of Texas Southwestern and Children's Health. Her research study was a prospective, longitudinal study on acute disseminated encephalomyelitis (ADEM) to identify the clinical characteristics, treatment methods, and follow-up interventions that are associated with better and worse patient-centered outcomes.
Maydis Caldwell Skeete is a lifelong learner, a passionate administrator, and a champion of God-given health principals. She holds a Bachelor of Science in Biology/Medical Technology and Master's in Public Administration /Health Administration. Maydis is a member of the American Heart Association, American College of Sports Medicine, and the Functional Aging Institute. She is the owner and president of ‘Get Up and Mooove, LLC: personal training that's fun and effective'. Maydis is the author of a recent publication “Self-care for the Caregiver: a guilt-free way to love yourself while caring for others”. This book provides insight and practical information that will guide a reader to greater self-awareness and wellness concepts. Knowledge gathered from a 40-year career at University of Michigan Health System, an understanding of Biblical principles and the personal life experiences of those engaged in caregiving, made this publication a reality. She is also a co-author in the bestselling book “For the Love of Caregiving” with visionary author, Sherrill D. Mims. Maydis retired from Health Care Administration in 2019 and now serves as a wellness coach and personal trainer in Ann Arbor, Michigan. She will be one of the featured speakers at the Global Caregivers Conference on November 10.
John Faulkner is an experienced Epic EHR consultant who has been working in the field for over a decade. He is dedicated to helping tech firms servicing health centres, hospitals, and hospitals themselves to manage their EHR systems more efficiently. John believes that hospitals are complex organisms that require strict observation and management to operate smoothly, and failing EHR systems can have a significant impact on their operations. As an Epic EHR consultant, he diagnoses and solves EHR issues at their roots to eliminate future problems while improving patient care.John's journey into the Epic world started when he received a phone call one hour before his wedding from a recruiter interested in finding teachers to facilitate training in Epic software. A few months later, John became an ASAP Credentialed Trainer for Sparrow Health System's Epic Implementation, supporting their go-live in December of that year. He then became an ASAP Credentialed Trainer with the University of Michigan Health System and quickly became credentialed in ClinDoc, Stork, and Ambulatory.John's expertise led him to work on Beaumont's Epic Security team, merging their current build into two other Epic instances, a massive project that required flawless coordination on various fronts. He then took on a role on their Epic ClinDoc/Stork team, supporting their modules and fetal monitoring software, before transitioning into their Ambulatory/Population Health team, where he implemented a Case Management module.In October 2021, John realized that he was missing out on valuable time with his family, and his priorities began to shift. However, he couldn't leave his career behind as he recognized the immense need for qualified Epic analysts in the healthcare industry. This led him to establish John Faulkner LLC, a consulting firm that provides efficient and effective EHR management solutions to hospitals and healthcare organizations. John's passion for technology and service to his fellow human beings is what drives him, and he is committed to maintaining a healthy healthcare system in the United States. Hosted on Acast. See acast.com/privacy for more information.
Dr. Billiserves as Professor Emeritus in Internal Medicine and Learning Health Sciences(Medical School), Health Management and Policy (Public Health), and IntegratedSystems and Design (Engineering) at the University of Michigan. Dr. Billi'smanagement and research interests are in health services delivery, especiallythe use of lean thinking to improve quality and efficiency, the use ofcommunity collaboratives to improve quality and population health, clinicalpractice transformation, the creation and use of evidence-based guidelines, andconflict of interest management. For 18 years Dr. Billiled the Michigan Quality System, the University of Michigan Health System's(UMHS) business strategy to transform clinical operations through deployment ofscientific problem solving and coaching at all levels. MQS built onclassic continuous quality improvement, incorporating holistic principles oflean thinking such as supporting workers and managers to take initiative to fixroot causes of problems daily, supported by daily management systems, valuestream management, and strategy deployment. The goal of MQS was toimprove safety, quality, timeliness, financial stewardship, and people engagementin healthcare delivery through problem solving by every worker and leader,every day.Dr Billi has helped hundreds of teams of physicians, other clinicians,administrative leaders, and trainees learn practical problem solving throughhands-on A3 workshops using their real work problems. Dr Billi led workshopson lean thinking within and outside UM, including a joint program with the UMCollege of Engineering with a nationwide draw.Dr. Billi hascontributed to many statewide initiatives to improve quality and efficiency ofcare, especially the use of community collaboration to supportimprovement. UMHS serves as the coordinating center for over 20 statewideCollaborative Quality Initiatives (www.bcbsm.com/providers/value-partnerships/collaborative-quality-initiatives.html) funded by BlueCross Blue Shield of Michigan; for almost 20 years Dr. Billi served asMedical Director for the University's coordinating role. For 20 years heco-chaired the Michigan Quality Improvement Consortium (www.mqic.org/), which developscommon, one-page practice guidelines endorsed by the Michigan Department ofHealth and health plans in Michigan. He serves on steering committee for theWashtenaw Health Initiative (
In our first CHD Spotlight episode, we'll discuss half-a-heart conditions -- hypoplastic left heart syndrome (HLHS), hypoplastic right heart syndrome (HRHS), and single ventricle hearts.Dr. Edward Bove is our expert guest. Dr. Bove spent most of his career as a pediatric cardiothoracic surgeon at the University of Michigan Health System. A graduate of the College of the Holy Cross and Albany Medical College, he went to the University of Michigan for his residency. He returned to U of M in 1985 and by 2012, he had performed 10,000 heart surgeries, mostly on babies. Dr. Bove is a long-time supporter of Hearts Unite the Globe and currently serves as the head of our Medical Advisory Board.In this CHD Spotlight, Dr. Bove explains what HLHS, HRHS, and single ventricle hearts are, what methods are used to treat these conditions, and how treatment for these conditions has changed over time.Former appearances by Dr. Bove on "Heart to Heart with Anna"Advancements in Treatments for HLHS Heart WarriorsLearning about ccTGA and the Double-Switch ProcedureSupport the showAnna's Buzzsprout Affiliate LinkBaby Blue Sound CollectiveSocial Media Pages:Apple PodcastsFacebookInstagramMeWeTwitterYouTubeWebsite
SEX! Sarah and Kelly really do cover everything, including the sex challenges that can arise (or not) from chronic Illness.Dr. Daniela Wittmann joins the Fork to discuss how sex therapy can help those suffering from sexual dysfunction, how medical practices can make it easier for their patients to address what they make be ashamed to admit, and what questions patients and their partners should ask.And Sarah add "repertoire" to her repertoire.Join us on the Unchosen Fork.Guest Speaker BioDaniela Wittmann, PhD, MSW; Department of Urology and School of Social WorkDaniela Wittmann, PhD, LMSW, is a Clinical Associate Professor in the University of Michigan Department of Urology in the University of Michigan Health System. She is an AASECT-certified sex therapist and a sex therapy supervisor. She received her BA Hons. in Russian Studies and Psychology at the University of Keele, Staffs., UK, her MSW at Simmons College School of Social Work, Boston and her PhD in Social Work at Michigan State University. She is one of the leading members in the Prostate Cancer Survivorship Program at the University of Michigan Rogel Cancer Center. She has 30 years of experience in individual, couple and family psychotherapy with patients with chronic illnesses including cancer and severe mental illness. Her research interests include the use of mixed methods to study the effect of cancer on sexual health and the development, testing and dissemination of interventions that promote sexual recovery after cancer treatment. She is currently the PI of a multisite study, funded by the Movember Foundation, aimed at developing and testing an intervention to support couples' sexual recovery after treatment for prostate cancer.Twitter @DrWittmannResourcesJones, A. C., Johnson, N. C., Wenglein, S., Elshershaby, S. T. (2019). The State of Sex Research in MFT and Family Studies Literature: A Seventeen-Year Content Analysis. Journal of Marital and Family Therapy, 45, 275– 295. https://doi.org/10.1111/jmft.12344AASECT (American Association of Sex Educators, Counselors, and Therapists) The Sexual Medicine Society of North America (SMSNA)The Society for Sex Therapy and Research (SSTAR)Will 2 Love - OPTIMIZING CARE FOR SEXUAL AND FERTILITY PROBLEMSRELATED TO CHRONIC ILLNESSES, INCLUDING CANCER. Malecare : America's leading men's cancer survivor support and advocacy national nonprofit organization. Follow the Unchosen Fork:FacebookInstagramTikTokDisclaimer: The contents of this podcast, including text, graphics, images, and other materials created and/or disseminated by The Unchosen Fork are for informational purposes only. The Contents are NOT intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition, before beginning a nutritional plan and/or taking nutritional supplements. Reliance on any information provided by this podcast, others content appearing on this podcast, or other visiSupport the show
We are honored to have Daniela Wittmann, PhD, LMSW, join our show this week. We explore the many ways Erectile Dysfunction impacts men and couples with our esteemed guest. Dr. Wittmann is a Clinical Associate Professor in the University of Michigan Department of Urology in the University of Michigan Health System. She is an AASECT-certified sex therapist and a sex therapy supervisor. Dr. Wittmann is well known for her clinical work and research regarding men and couples engaged in sexual recovery after prostate cancer treatment. The Erectile Dysfunction Radio Podcast is dedicated to educating and empowering men to address erectile dysfunction, improve confidence, and enhance the satisfaction in their relationships. This podcast is hosted by certified sex therapist, Mark Goldberg, LCMFT, CST. Learn to think differently about erections to resolve your ED struggles with our "Beyond the Little Blue Pill" eCourse: https://erectioniq.com/course For more free erectile dysfunction education and resources, please visit: https://erectioniq.com/ Mark Goldberg helps men resolve erectile dysfunction. He offers individual, one-on-one services to men throughout the world through a secure, telehealth platform. It's 100% confidential. You can visit the Center for Intimacy, Connection and Change website to schedule a free consultation: https://centericc.com/
Riz Hatton shares the latest news on the Spine & Ortho industry.
You might be wondering: how can a doctor charge several hundred dollars for a ten-minute office visit? Why can the hospital bill $100k for a three-day stay? Who makes up these numbers besides me? Today's episode is going to answer those questions so patients can get closer to what price transparency in healthcare should become.One hilarious irony of medicine is that you won't always know how much you need to pay for a visit and providers themselves don't know how much they'll get paid for the same visit until long after the fact. The dollars on your medical bill are going to be all over the place because of what your insurance covers, doesn't cover, and writes off. However, let's focus on the largest and usually shocking number on the EOB or invoice—the actual dollar amount billed to you or your insurance before any discounts. To be consistent, that top-line figure is called the charge or chargemaster price. The charge is nearly 100% at the discretion of the provider or whoever owns the facility. A general primary care doctor running their clinic might wake up one day and decide that a new patient office visit is $500. Or maybe $50. In either case, that charge is going straight to the insurance company. Charges vary a lot based on arbitrary choices about what providers believe their expertise is worth. However, there are some other factors based on a little common sense that influence healthcare prices.The first major drivers for charges are staff and equipment. Healthcare facilities are more than just doctors and front desk people. Nurses, administrators, and other professionals are necessary inputs for making sure the medical system breathes. Shortages of any given personnel will make the entire system more expensive. The extreme demand for nursing during these last couple years is one such clear example. Equipment quality and depreciation affects charges as well, especially for hospitals and larger medical groups. Getting an X-ray is going to cost you more than guessing if you have a compound fracture or not with a naked-eye glance. Two patients arrive with the same broken left forearm but patient A might have a blood clot or pressure problem that complicates treatment. If patient B has an otherwise unremarkable history, then charges for patient A would likely be higher due to the degree of care needed to deal with the same broken forearm.Let's return to our earlier example of a general doctor charging $500 or $50 for a standard new patient appointment (such a visit might be coded as 99203 for reference). Regardless of the charge, no two insurance companies will reimburse the same amount for the same visit code. Even if you control for the insurance company, the payout still changes based on the individual plan due to how deductibles and coinsurance are spread. Health insurers don't automatically pay the doctor a negotiated fee if the asking charge is less. For example, if the doctor bills $500 for the appointment, the health plan may reimburse $200 and write off $300 (assuming the patient doesn't have a copay or coinsurance). However, if the doctor chooses to bill $50, the insurance will pay $50 even if the negotiated compensation should be higher. Doctors have to overbill as part of this dance with the insurance companies. This incentive, more than any other factor, is why patients see astronomical medical charges. Dr. David Belk, who runs the True Cost of Healthcare website, shows this reality among other medical charge trends directly affecting patients. Dr. Belk's site and the other sources in this post will be on my page at rushinagalla.substack.com. There should be little surprise that providers are charging amounts several times more than what the final payment is. The requirements to get paid vary between health plans. Some insurers pay by the service, by the time, or by the diagnosis. Since these policies vary, providers have to submit all information possible on their claims as well as overbill to claim the max possible reimbursement. And if the insurance company chooses not to pay the doctor, the pumped-up tab is 100% on you.To follow up on this phenomenon, researchers at the Health Affairs policy journal reviewed costs for two portable and common procedures done at most facilities: colonoscopies and MRIs for lower limbs (which are coded 45380 and 73721, respectively). The study's data taken from Mass General Hospital, the University of Michigan Health System, and Vidant Medical Center (Greenville, NC), track the variation in cash fees, private insurance payments, and public insurance payments. The chargemaster prices for each of the procedures were 27% to 24x greater than the lowest respective final reimbursements. These health systems, all of which have a similar bed count, have such gaps between charges due to both patient demographics and overbilling incentives.These eye-popping numbers affect patients' wallets. Even though you may not be on the hook for a full chargemaster price, any increase of that charge will make either your cash payment higher or your long-term health insurance premiums higher. Per conventional wisdom, hospital and office payments across types of plans suggest that privately-insured patients with higher charges are subsidizing the low-margin public and self-pay patients such that everyone is getting the same level of care. The Journal of the American Medical Association debunked this “cost-shifting” with their own review of evidence from the Medicare Payment Advisory Commission. The newest evidence implies that cost shifting does not 100% apply to making up reduced earnings from publicly-insured patients; rather, a rise in private health plan payments go toward dealing with the rising costs of production to take care of that corresponding population. One economic fact about healthcare applying to this situation is that medical offices have mostly fixed expenses. That is, staffing, equipment, and real estate costs have to be paid no matter how strong the business is. Hospitals and large groups notice they get paid more from private health plans and in turn direct that extra money to raise profits while adding higher costs linked to attracting more of those patients. Medicine is an otherwise low-growth business so major providers have to exploit these gaps when possible. Equalizing medical quality for patients isn't part of the equation here. Reality shows that private vs public patients get different levels of care regardless of how payment trends change. Hence, cost shifting doesn't happen unless a multi-millionaire is consistently getting the same quality of care as someone on a low-income plan like Medicaid.Given all this commentary on how medical charges affect you, the last takeaway is that critical events are unfolding right now for helping you deal with the mysteries of billing. The Transparency in Coverage and No Surprises Act are recent laws among many requiring hospitals and insurance companies to disclose certain prices. Changes to come in 2023 make it so various health plans must offer price comparison platforms for 500+ common services and then for all major services in 2024. Although only 6% of US hospitals have been complying with publishing their cash prices as of July 2021, you can still be cognizant of the difference for what providers bill for service XYZ vs what insurance covers for service XYZ, and also be persistent in asking what the charges are.More patients inquiring about pricing are better for our system's accountability. By now it should be no surprise that Americans get sensitive to healthcare prices whether it be for drugs, services, or procedures. There is another certainty. No charges occur if there are no providers. Unfortunately, US doctors can't keep up with the American people's medical needs as things stand now. For the next pod, I'm going to break down the physician supply and demand time bomb that has a countdown much closer than we'd like it to be. Subscribe and stay tuned to Friendly Neighborhood Patient for modern healthcare consumer tips and tricks. I'll catch you at the next episode. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit rushinagalla.substack.com
Dr. Collier is a graduate of the University of Michigan Medical School and she completed her internal medicine residency and chief medical resident year at the University of Michigan Health System. She is the director of Michigan Medicine's program on Health, Spirituality & Religion. Her special clinical interests include preventative medicine, primary care, depression and heart disease. Special Guest: Kristin Collier, MD.
For this interview in honor of Testicular Cancer Awareness Month, Dr. Sam Kaffenberger, an Assistant Professor of Urology at the University of Michigan Health System, explains the importance of taking a nuanced approach to the management of individual patients with testicular cancer, with the goal of minimizing toxicity and achieving the best possible outcomes for treatment and surgery.
The Physician Organization of Michigan Accountable Care Organization (P.O.M. ACO) is a statewide ACO in the Medicare Shared Savings Program that has saved the Medicare Trust Fund more than $199 Million to-date. It is a physician-led partnership in operation since 2013 that supports more than 5,000 providers serving approximately 60,000 Medicare beneficiaries. P.O.M. ACO aligned with the University of Michigan Health System, whose Faculty Group Practice participated in a Medicare demonstration project that paved the way for ACOs under federal health care reform years ago. This is an outstanding Accountable Care Organization led by Dr. Tim Peterson and Kendall Cislo who are featured in this week's episode of the Race to Value. In this interview, you will learn how P.O.M. ACO has been successful by enabling localized solutions, in partnership with their provider network and beneficiary population, to improve care outcomes. We discuss how the ACO engages their beneficiaries through committee and Board participation, how primary care providers and specialists work together to build “localized” population health programs, and how care management interventions can provide meaningful outcomes in both rural and urban settings. This is an important interview for ACO leaders to listen to who are looking to establish improved relationships with both providers and patients to drive more effective care management interventions in caring for seniors and underserved populations. Episode Bookmarks: 02:00 Physician Organization of Michigan Accountable Care Organization (P.O.M. ACO) -- a statewide ACO that has saved more than $199 Million 02:40 Introduction to Dr. Tim Peterson (Population Health Executive for Michigan Medicine and ACO Executive and Chairman for P.O.M. ACO) and Kendall Cislo (Chief Operating Officer at P.O.M. ACO) 05:30 How ACO success has been determined by collaboration between a faculty academic practice and groups of independent physicians 10:00 Dr. Peterson discusses some of the unique public health and chronic disease challenges facing urban and rural Michiganders and how medical management programs of P.O.M. ACO meets patient needs 12:00 “Part of our ACO success has been the enablement of local solutions to address local problems.” 12:45 Recent study on patient perceptions of ACOs: Only 7 percent of 55- to 64-year-olds and 4 percent of those over 65 reported ever hearing about value-based care! 13:40 How beneficiary engagement and “the voice of the beneficiary” impact quality improvement and the Triple Aim 15:30 Why the economics of value-based payment shouldn't matter to patients (focus on quality care and out-of-pocket burden most important) 17:30 Utilizing a beneficiary engagement advisory committee as a key strategy for performance success 21:40 “The goal of our ACO is not to build a centralized infrastructure – it is instead to build localized solutions with our network of providers.” 24:30 Engaging patients to raise awareness of high cost (low value) specialists in the area 25:40 Partnering with dialysis centers to more effectively engage patients with kidney disease 28:30 “The key message to remember in healthcare is that we do everything for the patient. What would you do for a patient if it was your Mom.” 31:20 Engaging physicians to more effectively collaborate with them in population health and quality improvement strategies 34:30 Collaborative conversations to improve risk adjustment coding documentation to more adequately reflect burden of illness in the patient population 38:00 Building local market capabilities for pharmacy integration in rural primary care practices 40:30 Annual Wellness Visits as opportunities to address what is most important in a patient's life and how that has transformed the ACO 44:30 The importance of clinical integration in improving care coordination and why specialist participation in an ACO is a performance adva...
What does kale have to do with financial education? What do you need in order to create a budget—and stick to it? Where in your budget do you need to give yourself permission to stop spending? How is financial education like learning how to cook? This week's episode comes from the archives of a series of interviews I did for The Sorta Secret Sisterhood, a membership site I ran for women in perimenopause. It feels appropriate to post this as we head into tax season, when money and financial well-being—something we often like to ignore—become unavoidable. Because it's from early 2020, you'll hear us mentioning the beginning of the pandemic—which feels like a lifetime ago. bio Ellen Abramson is living her “second act.” After a thirty-year career in fundraising for the University of Michigan Health System, American Red Cross and Stephen M. Ross School of Business, Ellen carried out a plan to transition from full-time work for a large institution to a life in which she is in charge of her time and able to focus on what gives her life joy and meaning. To make this possible, Ellen and her husband paid down $93,000 of personal debt within a five-year period. She and her family live debt-free, empowered by a monthly plan for saving, spending and giving. Ellen holds a Bachelor of Arts degree from the University of Chicago and Master of Social Work degree from the University of Michigan. She is president of her family business and Money Mindfulness, LLC. Her book, The Money Game And How To Win It, is available at Amazon. ellen's resources Visit Ellen's website Buy Ellen's book, The Money Game and How to Win It simply: health coaching resources Listen to the Foundations of Wellness for Women panel discussion, Women + Money Schedule a time to chat about wellness programs for employees on the edge (or middle) of burnout Sign up for a free YOURstory consultation with Liza Baker Visit the Simply: Health Coaching website --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/liza-baker/message Support this podcast: https://anchor.fm/liza-baker/support
Host Diron Cassidy, PT, GCS is joined by Courtney Hall PT, PhD and Wendy Carender, PT, NCS to discuss the recently published update of the clinical practice guideline for vestibular rehabilitation for peripheral vestibular hypofunction. Dr. Hall is a Research Health Scientist at the Mountain Home Hearing and Balance Research Program at the James Quillen VA Medical Center and Professor in the Physical Therapy Program at East Tennessee State University. Ms. Carender is a physical therapist in the Department of Otolaryngology, Michigan Medicine, in the University of Michigan Health System. Both are co-authors of the updated clinical practice guideline, which is published online and will be in the April issue of the Journal of Neurologic Physical Therapy. For more resources for the updated clinical practice guideline visit neuropt.org.
APTA Vestibular SIG Podcast: Supported by the Academy of Neurologic Physical Therapy
Host Diron Cassidy, PT, GCS is joined by Courtney Hall PT, PhD and Wendy Carender, PT, NCS to discuss the recently published update of the clinical practice guideline for vestibular rehabilitation for peripheral vestibular hypofunction. Dr. Hall is a Research Health Scientist at the Mountain Home Hearing and Balance Research Program at the James Quillen VA Medical Center and Professor in the Physical Therapy Program at East Tennessee State University. Ms. Carender is a physical therapist in the Department of Otolaryngology, Michigan Medicine, in the University of Michigan Health System. Both are co-authors of the updated clinical practice guideline, which is published online and will be in the April issue of the Journal of Neurologic Physical Therapy. For more resources for the updated clinical practice guideline visit neuropt.org.
Dr. Kristin Collier joins Aaron to discuss primary care, spirituality, and burnout in the medical profession. Dr. Collier is Assistant Professor of Internal Medicine, Director of the Health, Spirituality, and Religion program, and the Associate Director of the Internal Medicine Residency Training program at the University of Michigan Medical School. She completed her internal medicine residency and chief medical resident year at the University of Michigan Health System. Her special clinical interests include preventative medicine, primary care, depression and heart disease. Her work was published in JAMA, the American Journal of Internal Medicine, and the American Journal of Hospice and Palliative Medicine, among others. She enjoys cooking, sports and spending time with her husband and sons. Please visit the Ethics and Public Policy's Bioethics and American Democracy program page for more information.
An interview with Dr. Leslie Fecher from the University of Michigan Health System, author on “Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update.” She reviews considerations for the use of steroids to manage immune-related adverse events in patients treated with immune checkpoint inhibitor therapy in the final episode of this 13-part series. For more information visit www.asco.org/supportive-care-guidelines TRANSCRIPT SPEAKER 1: 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. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. BRITTANY HARVEY: Hello, and welcome to the ASCO Guidelines podcast series, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content, and offering enriching insight into the world of cancer care. You can find all the shows, including this one, at asco.org/podcasts. My name is Brittany Harvey, and today we're continuing our series on the management of immune related adverse events. I am joined by Dr. Leslie Fecher from the University of Michigan Health System in Ann Arbor, Michigan, author on "Management of Immune Related Adverse Events in Patients Treated with Immune Checkpoint Inhibitor Therapy. ASCO Guideline Update" and "Management of Immune Related Adverse Events in Patients Treated with Chimeric Antigen Receptor T Cell Therapy, ASCO Guideline." And today we're focusing on considerations for the use of steroids to manage immune related adverse events in patients treated with immune checkpoint inhibitor therapy. Thank you for being here, Dr. Fecher. LESLIE FECHER: Thank you, Brittany, for this invitation. BRITTANY HARVEY: Great. Then I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The full conflict of interest information for this guideline panel is available online with a publication of the guidelines in the Journal of Clinical Oncology. Dr. Fecher, do you have any relevant disclosures that are related to these guidelines? LESLIE FECHER: The details of my disclosures are included in the manuscript, but I'd just like to note that I have received research funding, specifically in the form of clinical trial funding, from companies that do manufacture these immunotherapies. BRITTANY HARVEY: Thank you. Then getting into the content, so steroids are valuable agents in the management of immunotherapy related adverse events. So first, what should clinicians consider pretreatment with steroids? LESLIE FECHER: So I think one of the first things is obviously going back to the traditional history and physical exam, and making sure you understand any preexisting comorbid conditions, such as diabetes, high blood pressure, preexisting cataracts or glaucoma, infections, osteopenia or osteoporosis. It's always good to try and optimize things before getting started on steroids. Additionally, it's typically considered very reasonable to check hepatitis B and C serologies prior to starting immunotherapy treatment. And also consideration of assessment for tuberculosis, if there are specific risk factors, understanding if somebody already carries a diagnosis of HIV, and Understanding the status of that in advanced would be relevant. BRITTANY HARVEY: Those are important considerations. Then in addition to that, how should opportunistic infections be prevented? LESLIE FECHER: So one of the most common infections that we tend to try and prevent is pneumocystis jirovecii pneumonia, or PJP, previously known as PCP pneumonia. And this is one of the more common things that we recommend prevention for. So in patients who have received the equivalent of prednisone dosing of 20 milligrams per day for four or more weeks, or greater than 30 milligrams per day for three weeks or more, that's when it would reasonably be indicated. There are obviously specific institutional guidelines for the preferred regimen, but I think that's important to consider. The role of viral prophylaxis as well as antifungal prophylaxis is a bit less clear, but is something to be considered, especially depending on the duration of the steroid course. And whether or not in the setting of herpes zoster, for example, if the patient has had issues with zoster in the past. BRITTANY HARVEY: OK. and then the use of these steroids is to treat immunotherapy related adverse events. But what are the key recommendations for monitoring both the short term and long term adverse effects from steroids? LESLIE FECHER: So I think being aware of the side effects as well as making sure that the patients and the family members or loved ones that are helping them are aware of them as well. From a short term standpoint, typically we recommend things such as GI prophylaxis, with either a proton pump inhibitor or a histamine 2 antagonist, to reduce or prevent gastric ulcers or duodenal ulcers or gastritis. Given some of the long term effects, such as bone loss as well as steroid myopathies, we encourage exercise as well as physical therapy in some circumstances. But really one of the most important things is to make sure that you're constantly both assessing and eliciting from the patient and family members for any other side effects. So often, common acute short term side effects can be increased risk of infection. So making sure you're asking about it. They may not have the typical manifestations of infection, such as fevers or chills. Insomnia or difficulty with anxiety, irritability, skin changes for sure, or high blood pressure. And then obviously being aware that laboratory evaluation for glucose intolerance is important as well. BRITTANY HARVEY: Definitely. Those are important points for clinicians, patients, and caregivers. So then we've had some of the other authors on this guideline talk about tapering steroids. So what are those recommendations on how clinicians should taper steroids? LESLIE FECHER: So tapering is an art in and of itself in my opinion, and there's lots of different ways to do it. Some general concepts are you want to really try and understand what the side effect is that you are managing, because that will require frequent reassessment. And so when we talk about reassessing patients during the treatment of their toxicities, the management of the toxicities, in my opinion, is almost as important as the management of the immunotherapy itself. And so patients still need to be seen, still need to be assessed, still need blood work done. And so reassessment for the toxicity that you're managing, given that we can see rebounding of symptoms. So for example, if they were getting treated for diarrhea or colitis, having a really good understanding of what their baseline bowel movements were, how bad they got, and then a constant reassessment and making sure that the patient, as well as the family, knows that this should not come back again, if you will, in the midst of the taper. I think the other things to be aware of is that I tend to always reassess before giving the next decrease in dose of the steroids rather than having an automatic decrease. Because again, patients sometimes will follow those, even if their symptoms recur. So ensuring that there's that, again, reassessment. When we're on oral steroids, some of the general concepts we say is that the course should be at least usually about four weeks total, sometimes as long as six weeks or even longer, depending on the toxicity. And we think about, on average, decreasing from a prednisone or prednisolone amount roughly 10 milligrams every three to seven days, depending on the side effect that you're managing. The longer the taper, the slower you might need to go, depending at the end. And also being aware of the risk of adrenal insufficiency towards the end of a long steroid course is also an important thing to assess for. BRITTANY HARVEY: Great. I appreciate you reviewing those considerations. So then in your view, Dr. Fecher, how will these recommendations for the use of steroids in the management of immune related adverse effects impact both clinicians and patients? LESLIE FECHER: I think it will bring ongoing awareness to the physician and their team, as well as the patient and their team. I think that this is obviously really important that everybody is involved and aware. And I use the term engagement from a patient and family member standpoint. It's really critical to have an understanding of the side effects, have an understanding of the prednisone management. And explaining that not only to the physician team and nurses and other people involved in their care, but when patients call in, that they know to look out for rebounding of their symptoms and to report them immediately, as that can impact steroid tapering. I think, again, the awareness and engagement is going to ensure that patients get the best care and best results. BRITTANY HARVEY: Absolutely, and thanks for highlighting both that awareness and engagement. So thank you so much for your work on these guidelines, and for taking the time to speak with me today, Dr. Fecher. LESLIE FECHER: Thank you so much, Brittany. I appreciate your time. BRITTANY HARVEY: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast series. To read the full guideline, go to www.asco.org/supportive care guidelines. You can also find many of our guidelines and interactive resources in the free ASCO guidelines app, available in iTunes or the Google Play store. If you have enjoyed what you've heard today, please rate and review the podcast, and be sure to subscribe so you never miss an episode.
The Game-Changing Women of Healthcare Episode 2 - Sue Schade: “Own your Own Career”Today, on our second episode, host Meg Escobosa welcomes Sue Schade, a Principal at Starbridge Advisors and interim CIO at Boston Children's Hospital.Meg and Sue discuss Sue's early days in paper-based health data as a chart secretary and programmer; The evolution of health IT over 35+ years; The essential role of IT teams in making a difference in healthcare; Sue's legacy as a role model developing the next generation of health IT leaders; What will enable increased diversity in health IT leadership; Some of the risks Sue has taken & lessons learned; The importance of finding mentors & what Sue learned about being a more effective leader; Sue's observations about the evolution of Healthcare, C-Suite, information technology roles; and Promising healthcare startups that intend to increase access to basic and virtual healthcare.About Sue Schade:Sue Schade, is a Principal at Starbridge Advisors, a consulting firm that provides IT leadership advisory and interim management services to healthcare organizations. Sue has over 35 years of experience in healthcare information technology management. She has served as interim CIO for many distinguished organizations, including the University of Vermont Health Network, Stony Brook Medicine on Long Island, University Hospitals in Cleveland, Ohio and most recently for Boston Children's Hospital. Prior to this, for almost 13 years, she served as CIO for Brigham & Women's Hospital and then moved on to become the CIO of the University of Michigan Hospitals and Health Centers for several years. In 2015, under Sue's leadership, the University of Michigan Health System made the “HealthCare's Most Wired” list and achieved the HIMSS Analytics EMR Adoption Model Stage 6. That same year, she won the “CHIME-HIMSS John E. Gall, Jr. CIO of the Year Award.”Sue is currently serving as the Vice Chair of Health IT for the board of the Association for the Advancement of Medical Instrumentation® (AAMI) which is a nonprofit organization focused on the development, management, and use of safe and effective health technology. Sue achieved fellow status with both HIMSS and CHIME for which she also served as a board member.In addition, Sue is an investor/advisor to two organizations: Excelerate Health Ventures which is helping to usher in innovation in the realm of virtual care, and AlyxHealth, a platform that enables nurses and non-physician clinicians to deliver patient care as independent business owners and entrepreneurs by providing virtual, mobile, and primary care. LinkedIn | Twitter: @sgschadeFind Sue's weekly blog, HealthIT Connect, HERE!Further Reading: Starbridge Advisors | Boston Children's Hospital | John E. Gall Jr. CIO of the Year Award Winners | Health IT Connect Blog | CHIME Diversity, Equity & Inclusion | AlyxHealthEpisode Credits: The Game-Changing Women of Healthcare is a production of The Krinsky Company. Hosted by Meg Escobosa. Produced, edited, engineered, and mixed by Calvin Marty. Theme music composed and performed by Calvin Marty. Intro and outro voiced by John Parsons. Artwork by Paul Huber.©2021 The Krinsky Company
An interview with Dr. Bianca Santomasso from Memorial Sloan Kettering Cancer Center and Dr. Monalisa Ghosh from the University of Michigan Health System, authors on “Management of Immune-Related Adverse Events in Patients Treated With Chimeric Antigen Receptor T-Cell Therapy: ASCO Guideline.” They discuss recommendations for management of irAEs in patients treated with CAR T-Cell Therapy in Part 2 of this 13-part series. For more information visit www.asco.org/supportive-care-guidelines TRANSCRIPT [MUSIC PLAYING] SPEAKER: 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. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. [MUSIC PLAYING] BRITTANY HARVEY: Hello, and welcome to the ASCO Guidelines podcast series brought to you by the ASCO Podcast Network. A collection of nine programs covering a range of educational and scientific content, and offering enriching insight into the world of cancer care. You can find all the shows, including this one, at asco.org/podcasts. My name is Brittany Harvey, and today we're continuing our series on the management of immune-related adverse events. ASCO has developed two guidelines for the management of immune-related adverse events-- one for patients treated with immune checkpoint inhibitor therapy and a second for patients treated with CAR T-cell therapy. In our last episode, you heard an overview of the Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update. Today, we'll be focusing on the Management of Immune-Related Adverse Events in Patients Treated with Chimeric Antigen Receptor T-Cell Therapy: ASCO Guideline, and we'll have authors join us for future episodes to discuss the key recommendations for organ-specific management for patients treated with immune checkpoint inhibitor therapy. Today, I am joined by Dr. Monalisa Ghosh, from the University of Michigan Health System in Ann Arbor, Michigan and Dr. Bianca Santomasso from Memorial Sloan Kettering Cancer Center in New York, New York, authors on both Management of Immune-Related Adverse Events in Patients Treated with Chimeric Antigen Receptor T-Cell Therapy: ASCO Guideline and Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update. Thank you both for being here, Dr. Ghosh and Dr. Santomasso. In addition, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest policy is followed for each guideline. The full Conflict of Interest information for this guideline panel is available online with the publication of the guidelines in the Journal of Clinical Oncology. Dr. Ghosh, do you have any relevant disclosures that are directly related to this guideline? MONALISA GHOSH: No. I do not have any relevant disclosures. BRITTANY HARVEY: Thank you. And, Dr. Santomasso, do you have any relevant disclosures that are directly related to this guideline? BIANCA SANTOMASSO: Yes. I'd like to disclose that I've served as a paid consultant for Celgene, Janssen Pharmaceutical, and Legend Biotech for advising them on the topics of CAR T-cell therapy side effects. BRITTANY HARVEY: Thank you. Then, getting into these immune-related adverse events-- first, Dr. Ghosh, can you give us an overview of the scope and purpose of this guideline? MONALISA GHOSH: Sure. The purpose of this guideline is to offer expert guidance and recommendations on the management of immune-related adverse events in patients treated with chimeric antigen receptor or CAR T-cell therapy. This guideline offers guidance on the diagnosis, evaluation, and management of the most common toxicities of CAR T-cell therapy, which includes Cytokine Release Syndrome-- or CRS-- and immune effector associated neurologic syndrome-- or ICANS. As well as other potential, but less common toxicities, such as Hemophagocytic Lymphohistiocytosis-- or HLH-- B-cell aplasia, prolonged and recurrent cytopenias, Disseminated Intravascular Coagulation-- or DIC-- and infections. BRITTANY HARVEY: Great. Thank you. Then, Dr. Santomasso-- looking at this guideline, there's a few overarching recommendations. So, what are those general recommendations for the management of immune-related adverse events in patients receiving CAR T-cell therapy? BIANCA SANTOMASSO: Yes. The overarching recommendations are, really, first to recognize that these side effects exist. And that, as such, it's important to recognize that patients who develop these toxicities or side effects after CAR T-cell therapy need to be evaluated, or managed in, or transferred to a specialty center that has experience with the management of these toxicities. They're new toxicities. This is a new therapy. And patients are increasingly going to be managed in, or treated in, the outpatient setting, and, as such, they need to remain within a short distance of the treating center for about four to eight weeks post-therapy, and they should then return to their treating center upon experiencing any toxicities. Finally, as its flu season and infection season, it is recommended that inactivated influenza and COVID-19 vaccination be performed on patients and also family members as well. And any patient who does have an active infection, the CAR T-cell infusion should be delayed until that infection has been successfully treated or controlled. I often make a final point, which is that the immunogenicity of and efficacy of COVID-19 vaccines is uncertain in these patients with these agents, but the potential benefits outweigh the risks and uncertainties for most patients. BRITTANY HARVEY: Thank you. Those are important points for patients and treating clinicians. So then, Dr. Ghosh-- as you mentioned, this guideline addresses the seven most common CAR-T-related toxicities, and I'd like to review the key recommendations for each of those. So let's start with, what are the key recommendations for identification, evaluation, and management of cytokine-release syndrome? MONALISA GHOSH: Well, Cytokine Release Syndrome is one of the two major toxicities that occur immediately or within a short time period after infusion of CAR T-cells. We have defined Cytokine Release Syndrome, or CRS, as an immune-mediated phenomenon that's characterized by various symptoms that are indicative of immune activation and inflammation. And patients may experience signs and symptoms that could include fever, hypotension, hypoxia, tachycardia, shortness of breath, rash, nausea, headache, and various other symptoms that are a little less common. These symptoms are caused primarily by the release of cytokines. Cytokines are the messengers of the immune system, and most of them are released by bystander immune and non-immune cells. We know that the onset of Cytokine Release Syndrome is variable depending on the CAR T-cell product that's used, as well as the patient population that's treated. But it generally occurs anywhere from two to seven days after infusion of CAR T-cells, and in some rare cases can occur even a little bit later. A standard grading system has been developed and grade CRS, or Cytokine Release Syndrome, based on three parameters-- fever, hypotension, or low blood pressure; and hypoxia or low oxygen levels. CRS is primarily managed with IL-6 antagonists because IL-6 is an inflammatory cytokine that has been shown to mediate a lot of the systemic effects that we see from Cytokine Release Syndrome. And one of the treatments is the monoclonal antibody tocilizumab, which acts against-- or blocks-- the IL-6 receptor. CRS that is refractory to tocilizumab is generally treated with steroids. Then there's limited experience with additional therapies, especially in the setting of CRS, that does not respond to tocilizumab or steroids. There are other anti IL-6 therapies available. For example, siltuximab, which binds to IL-6 itself rather than the IL-6 receptor. However, there have been no direct comparative studies of these agents. Anakinra, which is also an IL-1 receptor antagonist has also been shown to mitigate CRS in some CAR T-cell recipients that have high grade CRS. BRITTANY HARVEY: OK. Thank you for reviewing those management strategies. So, following that-- Dr. Santomasso, what are key recommendations for identification, evaluation, and management of immune effector cell-associated neurotoxicity syndrome? BIANCA SANTOMASSO: Sure. Immune Effector Cell-associated Neurotoxicity Syndrome-- also known as ICANS-- is the second most frequent severe toxicity that can be seen after CAR T-cell therapy. So, what is ICANS? These are transient neurological symptoms that occur in the days after infusion, most commonly with CD19 CAR T-cell therapy. And the clinical manifestations of ICANS include encephalopathy, which is confusion, behavioral changes, expressive aphasia, or other language disturbance, change in handwriting or other fine motor impairment or weakness, and tremor and headache can also be seen. In more severe cases, patients can become obtunded with a depressed level of consciousness or even develop seizures, and they may require a higher level of ICU care, such as intubation for airway protection. And in very rare cases, malignant cerebral edema may develop, which may be fatal. ICANS can occur at the same time as Cytokine Release Syndrome, or can also occur several days after or shortly after CRS resolves, so it's important to have a high index of suspicion even after Cytokine Release Syndrome has resolved, but typically the side effects are self-limited and occur within the one month after infusion. Most symptoms lasts between 5 and 17 days, and the time of onset duration and severity of ICANS may really vary depending on the CAR T-cell product used or the disease state of the patient. So, what do I mean by that? Patients with high disease burden seem to be at increased risk for severe ICANS, so kind of knowing the disease that the patient has and the burden of disease is important. And then also there may be product-specific differences as well, so reviewing the product label is important as well because each may have its own risk evaluation and mitigation strategies that inform both the duration and the frequency of monitoring for ICANS after infusion. For evaluation of ICANS, we recommend, again, the ASTCT ICANS grading system. These allow for monitoring of several different aspects of neurologic function in these patients. Mental status changes are really what define the onset of ICANS. So for CRS, it's fever; for ICANS, it's mental status changes. And the severity of the mental status change can be determined by a standardized score known as the ICE score, which stands for Immune Effector Cell-associated Encephalopathy score. This is a simple 10-point scoring metric where points are assigned for orientation to year, month, city, hospital, ability to name three objects, ability to follow simple commands, write a standard sentence, and count backwards from 100 by tens. And for children younger than age 12 or those with developmental delay, The Cornell Assessment of Pediatric Delirium, also known as the CAPD, can be used in placement of the ICE assessment. Prior to CAR infusion, patients should be evaluated, including with an ICE score, for their baseline neurologic status. And what's nice is that this ICE assessment can be used as a daily screen after CAR infusion for the onset of ICANS during at-risk period. Then, other than the ICE score, there are four other neurologic domains that contribute to ICANS grading, and that's level of consciousness, seizures, severe motor weakness, and signs and symptoms of elevated intracranial pressure or cerebral edema, and patients are graded according to the most severe symptom in any of the five domains. So for patients who develop ICANS, it's recommended that they have workup, including blood work, CRP, CBC, comprehensive metabolic panel, fibrinogen, and coagulation tests. Neuroimaging with a non-contrast CT of the brain should be done and considering MRI of the brain in patients who are stable enough. In addition, electroencephalogram and lumbar puncture should be considered. And the electroencephalogram is really to rule out subclinical seizures, and the lumbar puncture is to assess the opening pressure-- or the pressure within the central nervous system-- and also to send studies to rule out infection. And again, these all have to be considered on an individual case by case basis, but are things to keep in mind. So for treatment of ICANS, the mainstay of treatment is, really, supportive care and corticosteroids. Tocilizumab, while it seems to rapidly resolve Cytokine Release Syndrome and most symptoms, actually does not resolve ICANS and may worsen it, so steroids are really typically used. The typical steroid is dexamethasone at a dose of 10 milligrams, and the interval really depends on the grade of the ICANS. Because of the possibility that tocilizumab may worsen neurotoxicity, ICANS really takes precedence over low grade CRS when the two occur simultaneously. And patients who don't show improvement within 24 hours after starting steroids or other supportive measures should have CSF evaluation and neuroimaging. Often treatment of seizures-- many patients are put on Keppra and levetiracetam or other anti-seizure medicine if they develop ICANS, and patients with grade 3 or greater ICANS may need an ICU level of care and escalation of steroid doses. The steroids are continued until ICANS improves to grade 1 and then tapered as clinically appropriate. And the most important thing to remember is that ICANS just needs to be monitored very closely as patients may worsen as some steroids are tapered. They also may improve rapidly after steroids are started, so steroids should be tapered quickly as patients improve. And, again, as with CRS, there's limited experience with other agents, such as Anakinra and siltuximab, but those could be considered in severe or refractory cases. BRITTANY HARVEY: Understood. I appreciate you going through when and how clinicians should screen for ICANS and those key management points. So, in addition to that-- Dr. Ghosh, what are the key recommendations regarding cytopenias? MONALISA GHOSH: So cytopenias can occur post-CAR T-cell infusion, and they can occur either in the early phase or in the later phase after CAR T-cell infusion. Meaning that they can occur early within the first few days to weeks post-CAR T-cell therapy or could even occur months to years later. These cytopenias include anemia, thrombocytopenia, leukopenia, neutropenia. Many patients may present with fatigue, weakness, shortness of breath, lightheadedness, frequent infections, fevers, bruising, and bleeding, and the symptoms usually are consistent with how they would present otherwise with anemia, thrombocytopenia, or neutropenia. Acute cytopenias within three months of CAR T-cell therapy are more common. This is due to usually the lymphodepleting chemotherapy that is administered prior to CAR T-cell therapy. Most patients receive a combination of fludarabine and cyclophosphamide prior to CAR T-cell infusion, or they may receive another agent, such as bendamustine. Most patients also come into CAR T-cell therapy with low lymphocyte counts from previous therapies. Early cytopenias, as I mentioned, are generally due to lymphodepleting chemotherapy or other recent therapies. There also could be an immune-mediated process due to the CAR T-cells. Usually prolonged cytopenias which occur beyond three months post-CAR T-cell infusion can be seen in a small number of patients. And the mechanism of prolonged cytopenias is really unclear at this time, but likely multifactorial. Most recipients of CAR T-cells who have prolonged cytopenias beyond three months post-CAR T-cell infusion should have a standard workup to rule out other common causes, such as vitamin or nutritional deficiencies. They should also have testing such as bone marrow biopsy and scans to rule out relapse disease-- relapse lymphoma or leukemia, for instance, that could be causing these cytopenias. Other examples would be myelodysplastic syndrome or other bone marrow failure syndromes. So cytopenias are generally managed with supportive care including growth factor and transfusion support. This applies to both cytopenias in the early period post-CAR T-cell therapy or more delayed prolonged cytopenias. In patients who have prolonged cytopenias of unclear cause that could be immune-mediated, other interventions such as high dose IVIG or even steroids could be considered depending on the situation. For those that have cytopenias in the first few months post-CAR T-cell therapy, generally they are monitored and treated with supportive care, and these cytopenias eventually resolve in the majority of patients. BRITTANY HARVEY: Great. Those are important considerations. Then, Dr. Santomasso, what are the key recommendations regarding Hemophagocytic Lymphohistiocytosis? BIANCA SANTOMASSO: The major recommendations for the identification, evaluation, and management of Hemophagocytic Lymphohistiocytosis, or HLH-- this is also known as macrophage activation syndrome. First, let's just start by saying that this is a dysfunctional immune response, and it's basically characterized by macrophages which are revved up and hyperactive and also possibly lymphocytes as well. There are high levels of pro-inflammatory cytokines during this state and tissue infiltration, and hemophagocytosis, and organ damage. This can occur outside of the context of CAR T-cell therapy, either as a primary HLH or secondary HLH that can be either triggered by infections, or autoimmune disease, or cancer-- especially hematological malignancies, but HLH has also been observed as a rare complication of CAR T-cell therapy. And outside of the setting of CAR T-cell therapy, HLH is defined by fever, cytopenias, hyperferritinemia-- or high ferritin level-- as well as bone marrow hemophagocytosis. And what's interesting is that this is very similar to what's seen during Cytokine Release Syndrome, and that can make it difficult for patients who have moderate to severe CRS to distinguish that from HLH. The laboratory results may be very similar. So the key to recognizing HLH is really to have it on your differential even though it occurs rarely after CAR T-cell therapy. It may occur with slightly different timing and may require more aggressive treatment. The lab alterations can include, again, as I mentioned, these elevated levels of several cytokines, such as interferon gamma. We can't normally send those in the hospital or the clinic, but sometimes soluble IL-2 receptor alpha can be sent and serum ferritin can be sent, and that's an especially useful marker. There have been diagnostic criteria for CAR T-cell-induced HLH that have been proposed, and these conclude very high ferritin levels-- over 10,000-- and at least two organ toxicities that are at least grade 3, such as transaminitis, increased bilirubin, renal insufficiency or oliguria, or a pulmonary edema, or evidence of hemophagocytosis in bone marrow or organs. Unlike other forms of HLH that occur outside of the context of CAR T-cell therapy, the patients may not have hepatosplenomegaly, lymphadenopathy, or overt evidence of hemophagocytosis. So just because a patient may not show those yet doesn't mean that HLH shouldn't be considered. If we see patients that have a persistent fever without an identified infection source or worsening fever, we basically should be considering HLH and doing the appropriate workup and treatment. Patients with HLH often have low fibrinogen, high triglycerides, and also cytopenias as well. The treatment-- just as there's an overlap kind of in the signs and symptoms, the treatment and the clinical management overlaps as well with CRS, so tocilizumab is typically administered. But corticosteroids should really be added for these patients, especially if there's clinical worsening or grade 3 or greater organ toxicity. And if there's insufficient response after 48 hours of corticosteroid therapy plus tocilizumab, many centers consider adding another medication such as Anakinra. I'll finally make a comment that, outside of the context of CAR T-cell therapy, HLH is sometimes treated with cytotoxic chemotherapy, such as etoposide. This approach generally is not used as a first line for patients undergoing CAR T-cell therapy due to etopiside's documented toxicity to T lymphocytes. And generally, the corticosteroids, plus the anti IL-6 agent, plus Anakinra is considered the first line of management. BRITTANY HARVEY: Got it. That's an important note on the management of HLH, and a great note on distinguishing CRS and HLH. So in addition, Dr. Ghosh-- what are the recommendations for management of B-cell aplasia? MONALISA GHOSH: B-cell aplasia, it's a disorder that's caused by low numbers or absent B-cells. And this is particularly relevant to CD19 directed CAR T-cell therapy, which is what most of the CAR T-cell therapies that are available right now target. They target CD19, and CD19 is present on normal as well as malignant B-cells. So most patients who receive anti-CD19 CAR T-cell therapy will develop B-cell aplasia at some point, and B-cell aplasia may be temporary or prolonged. It usually does, on one hand, indicate ongoing activity of the CD19 CAR T-cells and can be used as a surrogate marker. And increase in CD19 CAR T-cells could, in some patients, signal impending relapse, or dysfunction, or absence of activity of CD19 CAR T-cells. B-cell aplasia in CAR T-cell recipients is really due to, as I mentioned, an on-target, off-tumor effect. It can be prolonged and there is variability in rates of prolonged B-cell aplasia. The most significant consequence of B-cell aplasia is that it can lead to low immunoglobulin production. And immunoglobulin production is a very important part of the immune response by providing antibody-mediated immunity, so patients may present with frequent infections and low immunoglobulin levels. For most CAR T-cell recipients, this can be managed with infusions of Intravenous Immunoglobulins-- IVIG. However, the presence of B-cell aplasia can also present other challenges-- especially during this current pandemic, as Dr. Santomasso alluded to earlier, that it is unclear if patients will be able to mount a sufficient enough antibody response to the COVID-19 vaccines available since they cannot produce significant amounts of antibodies. This is an active area of research. However, we do advise that all CAR T-cell recipients do get the COVID vaccine and also other seasonal vaccines, such as the influenza vaccine. So it remains to be seen. We need some more long-term follow-up studies on how many people who receive CD19-directed CAR T-cell therapy will have prolonged B-cell aplasia and what the consequences will be. At this time, it is suggested that patients have their IgG levels monitored and-- if possible-- their actual B-cell numbers monitored. And if their IgG levels drop below a certain number, then they may receive IVIG infusions intermittently. We recommend in this guideline using 400 as a possible cutoff for IgG levels prior to administering IVIG. However, if patients have higher IgG levels and they have recurrent or life threatening infections, infusion of IVIG is recommended as a consideration to help boost the antibody response. BRITTANY HARVEY: OK. As you mentioned, those challenges are particularly relevant now. So then, Dr. Santomasso, what are the key recommendations regarding Disseminated Intravascular Coagulation? BIANCA SANTOMASSO: Disseminated Intravascular Coagulation is a disorder that's characterized by systemic pathological activation of blood clotting mechanisms, which results in both clot formation throughout the body and also bleeding. There's an increased risk of hemorrhage as the body is depleted of platelets and other coagulation factors. So it's basically important for clinicians to be aware that DIC-- or Disseminated Intravascular Coagulation-- can occur after CAR T-cell therapy, and it can occur either with or without concurrent Cytokine Release Syndrome. The treatment is primarily supportive care and replacing the factors, such as fibrinogen-- based on the levels-- and also replacing factors based on partial thromboplastin time and bleeding occurrences. But corticosteroids and IL-6 antagonist therapy can be used if there is concurrent CRS or in the setting of severe bleeding complications. There is limited evidence for other interventions. BRITTANY HARVEY: Great. Appreciate you reviewing those. So then, the last category of toxicity addressed in this guideline-- Dr. Ghosh, what are the key recommendations for identification, evaluation, and management of infections? MONALISA GHOSH: So a variety of infections can be seen after CAR T-cell therapy. And there are many factors that can lead to infection after CAR T-cell therapy including the presence of cytokines, such as neutropenia or leukopenia and B-cell aplasia that we earlier discussed-- leading to low immunoglobulin production and protection. As well as the increased risk of infection due to use of high-dose steroids to treat CAR T-cell-related toxicities, such as ICANS or CRS. Early after the infusion of CAR T-cell therapy-- that is, within three months-- patients often develop neutropenia due to lymphodepleting chemotherapy and/or the CAR T-cells themselves. And these patients are particularly susceptible to infection, so most of the infections that occur early on tend to be bacterial infections, and a few fungal infections have been observed as well. Patients who receive high-dose steroids for high grade CRS or ICANS have been shown to have increased serious infectious complications including bacterial infections, fungal infections, as well as viral reactivations. Infectious complications that occur later are often due to hypogammaglobulinemia due to B-cell aplasia and reduced production of immunoglobulins. And treatment is typically directed at the infectious source, as it would be even if these patients did not have CAR T-cell therapy. There are some prophylactic antimicrobials that are recommended for CAR T-cell recipients who have prolonged cytopenias. Especially those with prolonged neutropenia should be on some sort of bacterial and/or fungal prophylactic antimicrobials. Patients should also be monitored for hypogammaglobulinemia long term and should receive intravenous immunoglobulins as needed. As we have mentioned a couple of times already, being very aware that these patients are also more susceptible to seasonal infection, such as influenza, is important, and so vaccinations are very important for this patient population. Vaccinating against influenza and vaccinating against COVID-19. BRITTANY HARVEY: Thank you both for reviewing those key points for the most common CAR T-related toxicities. So, just to wrap us up-- Dr. Santomasso-- in your view, how will this guideline impact both clinicians and patients? BIANCA SANTOMASSO: Well, I think we've seen now that cell therapy is really one of the major advances in cancer treatment in the past decade. And I think it's reasonable to expect more of these cell therapies to be developed, and we'll hopefully see their use extend beyond very specialized centers. But CAR T-cell therapy side effects are manageable if they're recognized, so I think this guideline helps that, and they're reversible with proper supportive care. They can be serious and they require close vigilance and prompt treatment. But, again, we believe this guideline and recommendations will help members of clinical teams with both the recognition and management of all of these toxicities, and that will help patients by increasing their safety. BRITTANY HARVEY: Great. That's important to note that these toxicities can be severe, but are also manageable. So I want to thank you both for your work on these guidelines and for taking the time to speak with me today, Dr. Santomasso and Dr. Ghosh. BIANCA SANTOMASSO: Our pleasure. MONALISA GHOSH: Absolutely. It was my pleasure. BRITTANY HARVEY: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast series. Stay tuned for additional episodes on the management of immune-related adverse events in patients treated with immune checkpoint inhibitors. To read the full guidelines, go to www.asco.org/supportive care guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in iTunes or the Google Play store. If you have enjoyed what you've heard today, please rate and review the podcast, and be sure to subscribe so you never miss an episode. [MUSIC PLAYING]
An interview with Dr. Bryan Schneider from the University of Michigan Health System and Dr. Kathryn Bollin from Scripps MD Anderson Cancer Center, co-chairs of the Management of Immune-Related Adverse Events Guideline Expert Panel. They discuss an overview of the “Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update” in Part 1 of this 13-part series. For more information visit www.asco.org/supportive-care-guidelines TRANSCRIPT [MUSIC PLAYING] SPEAKER: 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. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. [MUSIC PLAYING] BRITTANY HARVEY: Hello and welcome to the ASCO Guidelines Podcast Series brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all the shows, including this one, at asco.org/podcasts. My name is Brittany Harvey, and I want to introduce you to our series on the Management of Immune-Related Adverse Events. ASCO has developed two guidelines for the management of immune-related adverse events, one for patients treated with immune checkpoint inhibitor therapy and a second for patients treated with CAR T-cell therapy. Today, we'll be focusing on an overview of the Management of Immune-Related Adverse Events in Patients Treated with Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update. And we'll have authors join us for future episodes to discuss the key recommendations for organ-specific management for patients treated with immune checkpoint inhibitor therapy and an episode to discuss the management of immune-related adverse effects in patients treated with CAR T-cell therapy. Today, I am joined by Dr. Bryan Schneider from the University of Michigan Health System in Ann Arbor, Michigan, and Dr. Kathryn Bollin from Scripps MD Anderson Cancer Center in San Diego, California, co-chairs on Management of Immune-Related Adverse Events in Patients Treated with Immune Checkpoint Inhibitor Therapy, ASCO Guideline Update and authors of the Management of Immune-Related Adverse Events in Patients Treated with Chimeric Antigen Receptor T-Cell Therapy, ASCO Guideline. Thank you for being here, Dr. Schneider and Dr. Bollin. BRYAN SCHNEIDER: Thank you, Brittany. KATHRYN BOLLIN: Thank you for having us. BRITTANY HARVEY: I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The full conflict of interest information for this guideline panel is available online with the publication of the guidelines in the Journal of Clinical Oncology. Dr. Schneider, do you have any relevant disclosures that are related to this guideline? BRYAN SCHNEIDER: I have research funding to my institution from Bristol Myers Squibb and Genentech Roche at the time of panel formation. BRITTANY HARVEY: Thank you. And, Dr. Bollin, do you have any relevant disclosures that are directly related to this guideline? KATHRYN BOLLIN: No disclosures. BRITTANY HARVEY: Thank you. Then, let's talk about this guideline. So first, Dr. Schneider, what prompted this update to the Management of Immune-Related Adverse Events in Patients Treated with Immune Checkpoint Inhibitor Therapy Guideline last published in 2018? BRYAN SCHNEIDER: Yeah. The previous guideline was widely used and consistently one of the top read articles of the JCO over the last couple of years. And since the original guideline publication in 2018, new data have emerged on the management of immune checkpoint inhibitor toxicities. So our goal was to build on the original guideline with more treatment options, especially for patients who fail initial steroid treatment. New strategies have developed for the management of many toxicities, especially GI, cardiac, and heme toxicities. And ASCO and the panel felt it was important to present these new options to the providers in the community. We also wanted to add sections that the providers would find valuable, including a table with many of the immunosuppressive agents used with typical dosages and schedules. We also added a table of commonly conducted testing while patients are on high-dose steroids as this is something many medical oncologists may not be used to handling as we typically do not have patients on steroids at high doses for several weeks or even months. BRITTANY HARVEY: Understood. Then, in addition to those updates that Dr. Schneider just mentioned, Dr. Bollin, what is the general scope and purpose of this guideline? KATHRYN BOLLIN: Yes. So the immune-related adverse event management guideline update and the CAR T-cell toxicity guideline serve to provide physicians that are prescribing these therapies with an understanding of the wide range of known potential toxicities of these agents and the best available evidence-based and expert opinion recommendations for their management. So up to 70% of patients treated with immune checkpoints will experience some form of immune-related adverse event, and nearly all patients getting CAR T-cell therapies experience toxicity. So recognition of the occurrence of these toxicities and appropriate management are essential for optimizing patient outcomes. BRITTANY HARVEY: Definitely, those are key points. So then, Dr. Schneider, what are the overarching recommendations for the management of immune-related adverse events irrespective of the affected organ? BRYAN SCHNEIDER: I think early recognition of the side effect is critical. So the guideline has typical signs and symptoms of each toxicity to help clinicians decide if this is occurring in their patients. Second, I think it's critical to grade the toxicity. We often don't do that with side effects related to traditional chemotherapy outside of clinical trials. So for example, if a patient has a platelet count of 75, I can't think off the top of my head what grade that is. I just know I'm going to hold chemotherapy for a week or two. But grading of the toxicity of these immune checkpoint therapies really is very important to decide whether patients can just be watched, whether they need to start steroids or whether they need to be admitted. I think still corticosteroids and dose holds are the first steps that clinicians will do. The majority of these toxicities-- although it would be nice if we could personalize the treatment based on the particular side effect and what we see under the microscope if the particular affected organ is biopsied, I think, in broad strokes, corticosteroids can be implemented easily, and a lot of our oncologists can be comfortable doing this potentially without subspecialty help. Having said that, I think multidisciplinary care is a must for the higher-grade side effects as, in oncology, we can't pretend to also be cardiologists, gastroenterologists, neurologists, dermatologist, and so on. And although there may be varying degrees of comfort from our subspecialists regarding the management of these toxicities, we do need their help for shared decision making, especially for the steroid refractory toxicities. We always want to emphasize a slow steroid taper oftentimes over at least four to six weeks. We get into trouble when we try to get them off the steroid quickly because they do have side effects that the patient may not enjoy. But oftentimes, we try to taper them quickly, and the side effect comes roaring back. And then, finally, to escalate immunosuppression quickly if no improvement with high-dose steroids is observed, oftentimes, that's done even within just a few days. But commonly, in practice, there's still hope that the steroid will kick in two or three weeks down the road, and that's not a good strategy. If the patient's having significant symptoms and steroids aren't helping, they do need to go on to a more important immunosuppressant. BRITTANY HARVEY: Those are important notes on the overarching management, particularly on how the adverse effects are different than those in patients treated with chemotherapy and the importance of multidisciplinary care. So then, Dr. Bollin, in your view, how will this guideline impact clinical practice? KATHRYN BOLLIN: So the impact of this guideline update is actually very broad. As with the previous guideline, as Dr. Schneider alluded to earlier, it's been very frequently accessed by readers since it offers symptom outlines and algorithmic recommendations for early identification and the management of immune-related adverse events based on the severity and organ system involved. What's really important to understand is that while initially, as hematology-oncology physicians prescribing these agents, we're doing so in the setting of early phase clinical trials. We were learning about the toxicities, and those physicians were often managing the toxicities themselves. But now, with the exponential increase and the therapeutic indications for immune checkpoint therapies in cancer, the experience with the toxicities and their management and the questions have also followed suit with an exponential rise. With this guideline update, we have experts among all of the internal medicine subspecialties that are now guiding the hematology-oncology physicians in immune-related adverse event management. We enlisted the experts in crafting this guideline update. So in summary, this serves not only as a tool for the prescribing hematology-oncology physicians but also for all of the subspecialists in the community and within academic centers for optimizing patient outcomes in the setting of immune-related adverse events. BRITTANY HARVEY: Great. Yeah, it sounds like this update will be hugely important for practicing clinicians. So then, in addition to those points raised by Dr. Bollin, Dr. Schneider, what are the implications for patients receiving immune checkpoint inhibitor therapy? BRYAN SCHNEIDER: So we really hope this will be an essential tool to help providers quickly treat patients when these toxicities present. Often, this is unexpected, and busy clinicians may be blindsided by these issues. So these guidelines will provide a quick resource to guide the workup and formulate a treatment plan that will expedite patient recovery. And ultimately, this should help promote quality of life for patients on these therapies and may help reduce trips to the emergency department, hospitalizations, and potentially allow the safe rechallenge of immune checkpoint therapy after resolution of the side effect. Many centers have the advantage of subspecialty support with experience in managing these toxicities. But for providers who may not have immediate access to, say, hepatology or endocrinology, we hope these guidelines will help the oncology providers provide the best treatment to facilitate the optimal clinical outcome. BRITTANY HARVEY: Absolutely, those are key for optimal care. Then, finally, Dr. Bollin, looking toward the future, what are the important outstanding questions and developing areas of research for the management of immune-related adverse events? KATHRYN BOLLIN: So while our recognition of immune-related adverse events, the testing for them, and management strategies have greatly improved with the expanded use of and experience with these therapies, large gaps in our knowledge remain. Translational and basic science research efforts are underway to understand these gaps, such as with the intrinsic and extrinsic drivers of autoimmunity, such as those with HLA allelic variations and the microbiomes interplay with our immune systems. There are also research efforts underway to develop rapid diagnostic tests to deploy early in the onset of irAE signs and symptoms and for the development of biomarkers and modeling tools that will aid us in predicting which patients are likely to experience immune-related adverse events. There have also been some interventional protocols that have attempted to prevent these immune-related adverse events by incorporating immune suppressants along with therapeutic agents. But so far, promising results with this strategy remain elusive. In regard to treatment for immune-related adverse events, investigators are working to learn the best strategies for selective immune suppression rather than just the use of glucocorticoids that will control immune-related adverse events while maintaining the clinical benefit of these incredible anticancer therapies. BRITTANY HARVEY: Thank you for highlighting those research gaps and both of you for your efforts to lead this guideline update. We'll be joined by authors on the guideline over the next episodes to review the key recommendations for organ-specific management in patients treated with immune checkpoint inhibitors and to review the recommendations for patients receiving CAR T-cell therapy. Stay tuned for these episodes highlighting the sections of the guidelines. And thank you for your time today, Dr. Schneider and Dr. Bollin. KATHRYN BOLLIN: Thank you so much. BRYAN SCHNEIDER: Thank you. BRITTANY HARVEY: And thank you to all of our listeners for tuning in to the ASCO Guidelines Podcast Series. To read the full guideline, go to www.asco.org/supportive-care-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in iTunes or the Google Play store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. [MUSIC PLAYING]
What is congenitally corrected transposition of the great arteries or ccTGA? Historically, people born with ccTGA tended to do fairly well. Why is it today doctors are choosing to operate on the hearts of babies born with ccTGA? What does Dr. Edward Bove think about the future of babies born with ccTGA?Erin Beckemeier is mom to Conway, born in 2007 with ccTGA, a large ventricular septal defect or VSD, and sub-pulmonic stenosis. He was later diagnosed with an Ebsteinoid tricuspid valve. At six months of age, he had an arterial switch with a Senning (a double switch), VSD closure, and resection of the stenosis. Conway's recovery from these procedures was rocky, as he suffered a seizure and complete heart block, requiring a dual-chambered pacemaker. By two years of age, he was struggling with atrial flutter and underwent a mitral annuloplasty and ablation/Maze procedure. At five years, his RV-PA conduit was replaced and he was upgraded to a bi-ventricular or CRT pacing system. At 11 years old he needed a new atrial lead and generator replacement. The new atrial lead became infected and was removed the following month. At age 14 he received 2 new leads and his 4th pacemaker. Due to a significant growth spurt, his mitral valve, RV-PA homograft, and left ventricular function are being closely monitored. Erin lives with her husband Greg and their five children. She is a fourth-grade teacher and she is here today to share her story with Anna.Dr. Edward Bove is a cardiac surgeon at C.S. Mott Children's Hospital and chair of the Department of Cardiac Surgery at the University of Michigan Health System is an internationally acclaimed, board-certified pediatric cardiac and thoracic surgeon and the chair of the Hearts Unite the Globe Medical Advisory Board! Earlier this year, Dr. Bove was awarded the 2021 Earl Bakken Scientific Achievement Award by The Society of Thoracic Surgeons during the organization's virtual 57th Annual Meeting.My long-time Listeners will remember Dr. Edward Bove from Season 9. His show was entitled, “Advancements in Treatments for HLHS Heart Warriors.” We are thrilled Dr. Bove is returning to the program to talk to us about a very complicated ccTGA patient of his. He will also be sharing with us a bit about the history of the double-switch procedure and who would most benefit from that invasive surgery, as well as, predictions for the future of ccTGA Heart Warriors in the years to come.Anna's Buzzsprout Affiliate Link (if you'd like to try Buzzsprout for your podcast and get a bonus gift card -- and Anna will, too!) use this link: https://www.buzzsprout.com/?referrer_id=16817Links to 'Heart to Heart with Anna' Social Media and Podcast Pages:Apple Podcasts: https://itunes.apple.com/us/podcast/heart-to-heart-with-anna/id1132261435?mt=2MeWe: https://mewe.com/i/annajaworskiFacebook: https://www.facebook.com/HearttoHeartwithAnna/Instagram: https://www.instagram.com/hearttoheartwithanna/Twitter: https://twitter.com/AnnaJaworskiYouTube: https://www.youtube.com/channel/UCGPKwIU5M_YOxvtWepFR5ZwWebsite: https://www.hug-podcastnetwork.com/Support the show (https://www.patreon.com/HearttoHeart)
Episode 13 discusses suicide prevention with James Svensson, clinical social worker at the University of Michigan Health System in the Psychiatric Emergency Service. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app
In this episode of The Live Life Longer Show, I interview Dr. Marvin Singh about a functional medicine approach to modern life, how to fix your gut health, the importance of exercise and how to live a healthier, holistic life. Chronic inflammation is a growing issue in today's world, and Dr. Marvin Singh's approach to medicine will hopefully fix that. Dr. Marvin Singh is an Integrative Gastroenterologist in San Diego, California, and a Member of the Board and Diplomate of the American Board of Integrative Medicine. A graduate of Virginia Commonwealth University School of Medicine, Dr. Singh completed his residency training in Internal Medicine at the University of Michigan Health System followed by fellowship training in Gastroenterology at Scripps Clinic Torrey Pines. He is dedicated to guiding his clients toward optimal wellness every step of the way, using the most cutting edge technologies to design highly personalized precision based protocols and help them stay on top of their health, rather than underneath disease. ➢Enjoy some of the best coffee I've ever had, Kion Coffee: https://getkion.com/collections/see-all/products/kion-coffee Save 15% off your order with code DANVOSS at checkout. ➢Support your gut health and immune system with Kion Colostrum, made with premium, grass-fed bovine milk:: https://getkion.com/collections/see-all/products/kion-colostrum Save 15% off your order with code DANVOSS at checkout. --------------Sleep Tools You NEED!----------------------- Best Sleep Mask: https://amzn.to/34bjWrB Blue Blocking Glasses: https://amzn.to/2K0aDnA Gravity Blanket: https://amzn.to/2Wd7xyU A Metabolism Book Should Have: https://amzn.to/2WdEhZ3 Best Mouth Tape (Nexcare): https://amzn.to/3oSFyB7 Breathe Right Strips: https://amzn.to/3qTwtda
This week on The Pet Buzz, Petrendologist Charlotte Reed and Michael Fleck, DVM, talk with Jason Kapica, President of Dryer Vent Wizard - a Neighborly company, about the hazards of pet hair build-up in the dryer; with University of Michigan Health System's orthopedic surgeon, Dr. Jaimo Ahn about the dog walking injuries suffered by senior pet owners; and with inventor, Javier Sanchez of Akvelon, about MeowTalk, a new app to communicate with your pet.
Caleb York is the Channel Development Manager for VirtueSense and joined the company as a result of witnessing the ineffectiveness of other fall-prevention technologies during his time working at the University of Michigan Health System.While other industries have successfully become more automated and as technologically advanced, healthcare continues to lag behind. Most senior care facilities find it extremely difficult to purchase vital technologies with the potential to save lives because they are already struggling just to stay afloat. Though fall prevention technologies such as pressure pads and bed alarms are used in many senior care facilities, these are often loud, disrupting, and have been known to give just as many false as they do legitimate alarms. While more advanced fall-prevention technology systems such as camera-based monitoring do exist, these are only designed to be used as a means to determine how falls typically occur. VirtueSense utilizes an infrared depth sensor piloted by an AI and is trained with over 1.5 million hours of patient data. It's able to recognize bodily mechanical errors that typically result in falls and prevent them on the spot. Once the AI observes that a patient is likely to fall, it sends an alert, via an app, containing their room number to a nurse who can then catch the patient before it is too late. Rather than only helping to clean up falls, this advanced system predicts and prevents such adverse accidents before they can happen. LEARN MORE ABOUT CALEB AND VIRTUESENSE!LinkedIn: https://www.linkedin.com/in/caleb-york-524584155/ Website: https://virtusense.ai/ RELATED EPISODES52 - Investors Focusing on the Senior Care Space - LinkedIn Best Practices51 - Solving the Staffing Challenge in Nursing Homes49 - Better Care Coordination; Real Patient Choice34 - Detect Coronavirus 2 Weeks Before Fevers Surface!
Diversity PreMedical, LLC presents a weekly series 'Lessons Learned'
Diversity PreMedical, LLC presents Dr. Femi Showole Cardiologist, an Osteopathic Physician at MidMichigan Health- University of Michigan Health System. Specializing in Cardiology. He shares some of his wisdom and experience.
Resources/Links: https://drmarvinsingh.com/ https://www.amazon.com/Integrative-Gastroenterology-Weil-Medicine-Library/dp/0190933046 Marvin Singh, M.D is an Integrative Gastroenterologist in San Diego, California, and a Member of the Board and Diplomate of the American Board of Integrative Medicine. He is also trained and board certified in Internal Medicine and Gastroenterology/Hepatology. A graduate of Virginia Commonwealth University School of Medicine, Singh completed his residency training in Internal Medicine at the University of Michigan Health System followed by fellowship training in Gastroenterology at Scripps Clinic Torrey Pines. Singh was trained by Andrew Weil, M.D., a pioneer in the field of integrative medicine, at the Andrew Weil Center for Integrative Medicine. Singh is currently the Director of Integrative Gastroenterology at the Susan Samueli Integrative Health Institute at UC Irvine. He is also currently a voluntary Assistant Clinical Professor at UCSD in the Department of Family Medicine and Public Health; prior to this, he has been a Clinical Assistant Professor at UCLA and an Assistant Professor of Medicine at Johns Hopkins University. Singh is a member of the American Academy of Anti-Aging Medicine, American College of Lifestyle Medicine, and many other societies. He is actively involved in the American Gastroenterological Association. He is one of the editors of the textbook of Integrative Gastroenterology, 2nd edition (a Weil Series text) and has written several book chapters and articles. He is dedicated to guiding his clients toward optimal wellness every step of the way, using the most cutting edge technologies to design highly personalized precision based protocols and help them stay on top of their health, rather than underneath disease. Towards this end, he founded Precisione Clinic, to bring the best in preventive medicine to his clients.
Fibromyalgia patients typically present with chronic, widespread body pain and almost always have accompanying comorbid symptoms such as fatigue, memory difficulties, and sleep and mood difficulties. Physical examination is typically normal but there is often diffuse tenderness. Daniel Clauw, Professor of Medicine, Division of Rheumatology, University of Michigan Health System, Ann Arbor, gives us a clinical overview of the condition. For more on fibromyalgia, visit BMJ Best Practice: bestpractice.bmj.com/topics/en-gb/187 - The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.
In our latest episode, Dr. Rebecca Patrias, North Star Reach Medical Director, talks about how parents caring for a child with a serious health challenge can seek out the best care possible during this time of COVID-19. A graduate of the University of Michigan Medical School, Dr. Patrias has been a practicing physician at the University of Michigan Health System, where she also taught medical students and served as a staff physician, and at St. Joseph Mercy Hospitals in Ann Arbor and Chelsea. Along with her role as North Star Reach Medical Director, “Dr. Becky” runs a private practice in Chelsea, her hometown, for which readers of the Chelsea Guardian voted her “Best Physician.”
Just a quick warning, I will be talking about sexual things. If you are sensitive to that I completely understand but this may not be the blog for you. For complete show notes and links to resources visit the website. In 2014 the Journal of Women’s Health published a study done by the University of Michigan Health System titled “The Impact of Vulvar Lichen Sclerosus on Sexual Dysfunction”. They studied 337 women divided into three groups one group had valvular Lichen Sclerosus, one chronic yeast infections, and the last was completely healthy. The women were of various ages, races, relationship statuses, and social-economic situations. The study concluded, Women with Lichen Sclerosus suffer from a greater degree of sexual dysfunction than both healthy women and those with Candida infections…Women with Lichen Sclerosus have less frequent sexual activity and less satisfying sexual activity when compared with controls. How Does Lichen Sclerosus Affect sex? There are four main ways Lichen Sclerosus affects our sex lives. Pain Lichen Sclerosus makes our vulva skin thin. This makes us susceptible to tearing. If you have ever touched an open sore you will understand the pain it causes. Now imagine sliding your finger over and over across that sore with varying degrees of pressure, that’s how sex can feel when you have LS. The friction of rubbing skin can also cause burns. Rub your hands together. Feel your skin get hot. Now think about how that would feel if the skin on your palms was paper-thin. It would be manageable but not pleasant. Let’s not forget the pain of having sex when you have fissures, blisters or tears already, sex just amplifies that pain. Sometimes we force ourselves to have sex because our partners want to and we do not want to deny them, either out of love, obligation, or because we desire them as well. This is not healthy for us mentally or physically. Continuing to have sex when we anticipate pain can lead to vaginismus (the contraction of the vagina muscles when approached by something trying to penetrate it), which will lead to more complications. Women who have partial fusing of the labia may find that their capacity to be penetrated is greatly reduced and will feel pain if penetration is forced. Some may not know that their opening is smaller because they do not look at their vulva. They run the risk of tearing and causing greater damage as well. Libido Our desire to have sex or libido is closely tied to our self-esteem. If we do not feel worthy, desirable, or sexy our libido will lower drastically. Our lower self-esteem will have us questioning ourselves. Does my partner still desire me? Do they still find me sexy? What if I can’t perform the way I use to? All these question race through our mind causing anxiety. Stressing us out and leading to fear. Fear of not being good enough. Fear of losing our relationship, on top of the fear sex will hurt again. Mentally and Emotionally All of this anxiety and self-doubt can manifest mentally and emotionally. We can start withdrawing because we don’t want to get hurt, emotionally and physically. Our minds can play tricks on us. Things our partners do could be misconstrued as signs they no longer desire us because we already question ourselves. Physically Our physical body plays a big part in our sex life. If we are having an outbreak or have fissures, blisters, or legions we are less likely to want to have sex (see pain). If you are suffering any type of atrophy (fusing) your hole may be too small for your partner to penetrate you. Forcing sex in any of these contains can cause vaginismus, creating another complication to a healthy sex life.
Dr. William Chey, MD, a Professor of Gastroenterology & Nutrition Sciences, and Director of the GI Nutrition and Behavioral Wellness Program, University of Michigan Health System, discusses the findings from a survey called "Current Insights About Constipation" that was conducted by The Harris Poll on behalf of Shire (now Takeda) that shows the extent Chronic Idiopathic Constipation (CIC) has on daily life though few people talk about it. This year's sub-analysis of the survey was done looking specifically at how women are impacted by CIC.
A federal study released by the Centers for Disease Control shows 27.5 percent of high school students have used e-cigarettes in the past 30 days. Now the CDC, the U.S. Food and Drug Administration, and state and local health departments are investigating a multistate outbreak of lung disease associated with e-cigarette use. uh-PARENT-ly cohosts Anne Johnsos and Tracy Weiner talk to Dr. MeiLan K. Han, professor of internal medicine in the Division of Pulmonary and Critical Care Medicine at the University of Michigan Health System and spokesperson for the American Lung Association, about the dangers of vaping and how parents can educate their kids.
In Functional Medicine, we put a heavy emphasis on gut health. We know that a strong gut is not just essential for digesting food and absorbing nutrients, but that it plays a vital role in the immune system and affects the health of the entire body. On today’s Broken Brain Podcast, our host, Dhru, talks to Dr. Marvin Singh, an integrative gastroenterologist. Dr. Singh graduated from the Virginia Commonwealth University School of Medicine, and completed his residency training in internal medicine at the University of Michigan Health System, followed by a fellowship training in Gastroenterology at Scripps Clinic and Green Hospital. Dr. Singh was also trained by Dr. Andrew Weil, a pioneer in the field of integrative medicine, at the University of Arizona Center for Integrative Medicine. Dr. Singh uses cutting-edge tests and personally designed protocols to develop a truly individualized plan for his patients based on their genetics, microbiome, metabolism, and lifestyle.In this episode, Dhru and Dr. Singh talk about the cutting edge research of DNA methylation PhenoAge, which can predict things like aging, inflammation, and heart disease. They discuss how changes in the gut microbiome can impact gene expression, how our microbiome influences the dietary choices we make, and how our gut health can have a significant effect on healthy aging. They also talk about the implications of diet and the gut microbiome in neuroinflammatory and neurodegenerative disease. In this episode, we dive into:-How DNA methylation can predict age and age-related outcomes (2:24)-How our gut microbiome influences our food choices (9:35)-The gut-brain connection (13:22)-The gut microbiome and neurodegenerative diseases (17:35)-Dr. Singh’s personal health journey (21:51)-Why personalization is so important when it comes to our gut health (43:29)-Food sensitivity testing (46:56)-Gut microbiome testing (54:05)-Probiotics (59:49)-How exercise impacts our gut health (1:07:12)-Prebiotics (1:09:59)-Digestive enzymes (1:13:05)-Fecal transplants (1:20:33)-Colon hydrotherapy (1:26:39)-How social connections impact our health (1:32:19)-Learn more about Dr. Singh and his work (1:38:16)For more on Dr. Marvin Singh, be sure to follow him on Instagram @DrMarvinSingh, on Facebook @DrMarvinSingh, and on Twitter @DrMarvinSingh. Check out his website https://drmarvinsingh.com, and download his FREE 4 Week Gut Reset e-book, right here. Dr. Singh was also featured in the Interconnected Docu-series which you can watch here. If you’re looking to work with an integrative practitioner you can search for one here:-The Institute for Functional Medicine: https://www.ifm.org/find-a-practitioner/ -The Andrew Weil Center for Integrative Medicine: https://integrativemedicine.arizona.edu/alumni.htmlLastly, check out the article Dhru referenced during the interview from Anahad O’Connor: Is There an Optimal Diet for Humans?Sponsor: This episode is sponsored by our partnership with the AirDoctor Air Filter. To get exclusive access to this deal visit www.brokenbrain.com/filter See acast.com/privacy for privacy and opt-out information.
Hospice and palliative care can seem like a frightening concept for caregivers and the patients and loved ones they are caring for. On this week’s podcast, Cynthia speaks with Dr. Jane Hinshaw about the profound benefits of palliative care and how it actually betters the lives of sick patients and their caregivers. Dr. Jane (Carnahan) Hinshaw is a Clinical Instructor of Psychiatry at the University of Michigan Health System, and Staff Psychiatrist at the Mental Health Clinic at Ann Arbor Veterans Administration Medical Center. Her area of special interest involves psychiatric issues in palliative care. Drs. Daniel and Jane Hinshaw have committed their lives to studying and offering palliative and hospice care not only in the United States, but also in Romania, Serbia, Uganda, and in Ethiopia. Link to her books, “Suffering and the Nature of Healing” Is it time to make some changes in your life? Do you want to stop the madness and get on track with your health? Maybe coaching is right for you. I've helped many people gain their health back over the years, and would love to talk with you. Just reach out with the link below to get on my schedule. From time to time I have openings for new clients, and accept them on a first come first serve basis. Book a Discovery Call
What does an integrative approach combining Diet therapy, Behavioural therapy and Medical therapy look like for IBS? IBS is likely not a single disease. So, what is it? Dr. William Chey spent some time with me at Digestive Disease Week (DDW) talking about these interesting topics. He is an authoritative expert in functional bowel and motility disorders including Irritable Bowel Syndrome (IBS) and there is a good reason why he is called the UMFoodDoc. Dr. Chey is a Professor of Gastroenterology & Nutrition Sciences and Director, GI Nutrition & Behavioral Wellness Program in the Division of Gastroenterology at the University of Michigan Health System in Ann Arbor, Michigan.Find Jeffrey Roberts and IBS Patient Support Group at:Website: https://www.ibspatient.orgFacebook: https://www.facebook.com/ibspatientTwitter: https://twitter.com/ibspatientInstagram: https://www.instagram.com/ibspatientPinterest: https://www.pinterest.com/ibspatient Music:Werq Kevin MacLeod (incompetech.com)Licensed under Creative Commons: By Attribution 3.0 Licensehttp://creativecommons.org/licenses/by/3.0/
In this two part interview, I talked with Rob Ferguson, an occupational therapist in the University of Michigan Health System whose practice involves the use of virtual contexts, virtual reality, gaming, and other computer technologies to help clients reach their occupational goals.
In this two part interview, I talked with Rob Ferguson, an occupational therapist in the University of Michigan Health System whose practice involves the use of virtual contexts, virtual reality, gaming, and other computer technologies to help clients reach their occupational goals.
Without better technology, nephrologists can’t catch acute kidney injury early enough to prevent it. We recently caught up with Dr. Michael Heung to talk about the challenges of Acute Kidney Injury (AKI) in Critical Care Medicine and what is needed to tackle them. Connect with Dr. Heung on Twitter @KeepingitRenal Dr. Heung graduated from the Boston University School of Medicine. After finishing his Internal Medicine training at the University of Cincinnati Hospitals, he completed Fellowship training in Nephrology at the University of Michigan Health System. He has been a member of the University of Michigan faculty since 2005, and currently serves as Associate Division Chief for Clinical Affairs in the Division of Nephrology. His primary clinical and research interests are in the areas of acute kidney injury and critical care nephrology.
My guest Daniela Wittmann is an expert on prostate health and urology. In fact, she is a very prominent member of the Prostate Cancer Survivorship Program; in addition, she is an associate professor of Urology and Social Work in the University of Michigan Health System. In this interview, she informs listeners on prostate health and penile rehabilitation--particularly after surgery, radiation, or hormone treatment for males who have had prostate cancer. It is a very informative and important talk, and even if you aren't currently going through the complications of prostate cancer, getting a jumpstart on learning about the subject is very important. Screening for Prostate Cancer As Daniela states, prostate cancer is asymptomatic, which means that symptoms don't show up until well after it has already metastasized or shown up in the prostate. It is screened, if there are abnormalities caught in the screen then a biopsy is usually done and then a number of treatment options are available as a next step. Daniela goes into more detail during the episode. Treatment Options That Affect Sexual Functioning If non-aggressive and very localized, men can always go under ‘active surveillance.' At this point, physicians simply monitor and watch to see if the cancer gets more aggressive. This treatment method has no sexual side effects. Another treatment is when the cancer is localized, so treatment typically centers around radiation or surgery. Side effects do occur with this type of treatment. For most men, after they do the surgery, they will experience erectile dysfunction because the nerves responsible for making the penis erect are damaged during surgery. In addition, urinary incontinence can occur as well. For more information on treatment options, as well as the side effects of radiation, Daniella provides a succinct breakdown of the treatment options. Men Resisting or Putting Off Treatment? Because there are considerable side effects like loss of libido, lower testosterone, and impaired erectile function, to name a few, some men choose to resist treatment. Daniela states that there are a number of studies which show that men choose not to get treatment because of how daunting the choice can be. Of course, one would want to treat cancer, but to lose sexual function is not attractive to anyone. Some men choose to only monitor their cancer and wait until it gets much worse. Things to Be Aware Of Among many other facets, Daniela stresses the importance of communicating concerns about loss of sexual function to your physician. But as she says, when it comes to cancer, many physicians downplay the importance of communicating sexual side effects because cancer is the far more serious factor at play. As a result, Daniela says that many men are often surprised by the side effects after treatment. Communication is key between patient and physician. Also requesting to the surgeon that as many nerves be spared as possible during surgery, is a very important thing to consider. What Does Penile Rehabilitation Look Like? Penile rehabilitation in this context means to protect the penile tissue from atrophying. Daniela highlights a number of strategies that are used to accomplish this: low doses of Viagra or Cialis to breathe oxygen and blood into the penis; another is penile injections which do the same thing, and stimulation of the nerves in the penis to maintain penile tissue. For erections, a vacuum pump can be used to maintain a hard erection as well. And all of this is used to maintain the ability for sexual function once the penis has been rehabilitated enough. For much more, tune in. Recommended Time Rehabilitating and The Frequency Although Daniela says that there is no conclusive time period that one should most effectively rehabilitate, the minimum amount of time should be about three-six months or so. “And the frequency,” you might ask? Although there isn't an exact, prescribed standard that physicians recommend, for Daniela, she states that 3x a week is what she asks of her patients. As well as have orgasms through masturbation or with the help of a partner 3-4 times a week. She goes into more detail during the interview. Advice for Couples Daniela preaches the importance of patience. For those who are still wanting to be sexually active in their relationships, the erections take time to come back. Patience is key. She encourages understanding between couples and support with orgasms and erections. Don't over-focus on penetration; look to oral sex and other methods as well. It is a challenge but being flexible and shifting sexual priority is very important. Final Thoughts Daniela stresses the importance of communicating with one another during the sexual difficulties that often occur after surgery. Because it can be easy to not talk about it while things are healthy and working smoothly, learning how to communicate is one of the most important facets of the whole process. And for her final closing thought, really listen in and take in all that she has to say on this very important topic. Check the links below to learn more about Daniela. Key Links for Daniela Wittmann Daniela's Bio and University of Michigan Information: https://medicine.umich.edu/dept/urology/daniela-wittmann-phd-lmsw Prostate Survivorship Program: https://www.rogelcancercenter.org/prostate-cancer/survivorship More info: Book and New Course - https://sexwithoutstress.com Web - https://www.bettersexpodcast.com/ Sex Health Quiz - http://sexhealthquiz.com/ If you're enjoying the podcast and want to be a part of making sure it continues in the future, consider being a patron. With a small monthly pledge, you can support the costs of putting this show together. For as little as $2 per month, you can get advance access to each episode. For just a bit more, you will receive an advance copy of a chapter of my new book. And for $10 per month, you get all that plus an invitation to an online Q&A chat with me once a quarter. Learn more at https://www.patreon.com/bettersexpodcast Better Sex with Jessa Zimmerman https://businessinnovatorsradio.com/better-sex/More info and resources: How Big a Problem is Your Sex Life? Quiz – https://www.sexlifequiz.com The Course – https://www.intimacywithease.com The Book – https://www.sexwithoutstress.com Podcast Website – https://www.intimacywithease.com Access the Free webinar: How to make sex easy and fun for both of you: https://intimacywithease.com/masterclass Secret Podcast for the Higher Desire Partner: https://www.intimacywithease.com/hdppodcast Secret Podcast for the Lower Desire Partner: https://www.intimacywithease.com/ldppodcast
My guest Daniela Wittmann is an expert on prostate health and urology. In fact, she is a very prominent member of the Prostate Cancer Survivorship Program; in addition, she is an associate professor of Urology and Social Work in the University of Michigan Health System.In this interview, she informs listeners on prostate health and penile rehabilitation--particularly after surgery, radiation, or hormone treatment for males who have had prostate cancer.It is a very informative and important talk, and even if you aren’t currently going through the complications of prostate cancer, getting a jumpstart on learning about the subject is very important.Screening for Prostate CancerAs Daniela states, prostate cancer is asymptomatic, which means that symptoms don’t show up until well after it has already metastasized or shown up in the prostate. It is screened, if there are abnormalities caught in the screen then a biopsy is usually done and then a number of treatment options are available as a next step. Daniela goes into more detail during the episode.Treatment Options That Affect Sexual FunctioningIf non-aggressive and very localized, men can always go under ‘active surveillance.’ At this point, physicians simply monitor and watch to see if the cancer gets more aggressive. This treatment method has no sexual side effects.Another treatment is when the cancer is localized, so treatment typically centers around radiation or surgery. Side effects do occur with this type of treatment. For most men, after they do the surgery, they will experience erectile dysfunction because the nerves responsible for making the penis erect are damaged during surgery. In addition, urinary incontinence can occur as well.For more information on treatment options, as well as the side effects of radiation, Daniella provides a succinct breakdown of the treatment options.Men Resisting or Putting Off Treatment?Because there are considerable side effects like loss of libido, lower testosterone, and impaired erectile function, to name a few, some men choose to resist treatment. Daniela states that there are a number of studies which show that men choose not to get treatment because of how daunting the choice can be. Of course, one would want to treat cancer, but to lose sexual function is not attractive to anyone. Some men choose to only monitor their cancer and wait until it gets much worse.Things to Be Aware OfAmong many other facets, Daniela stresses the importance of communicating concerns about loss of sexual function to your physician. But as she says, when it comes to cancer, many physicians downplay the importance of communicating sexual side effects because cancer is the far more serious factor at play. As a result, Daniela says that many men are often surprised by the side effects after treatment. Communication is key between patient and physician.Also requesting to the surgeon that as many nerves be spared as possible during surgery, is a very important thing to consider.What Does Penile Rehabilitation Look Like?Penile rehabilitation in this context means to protect the penile tissue from atrophying. Daniela highlights a number of strategies that are used to accomplish this: low doses of Viagra or Cialis to breathe oxygen and blood into the penis; another is penile injections which do the same thing, and stimulation of the nerves in the penis to maintain penile tissue. For erections, a vacuum pump can be used to maintain a hard erection as well. And all of this is used to maintain the ability for sexual function once the penis has been rehabilitated enough. For much more, tune in.Recommended Time Rehabilitating and The FrequencyAlthough Daniela says that there is no conclusive time period that one should most effectively rehabilitate, the minimum amount of time should be about three-six months or so. “And the frequency,” you might ask? Although there isn’t an exact, prescribed standard that physicians recommend, for Daniela, she states that 3x a week is what she asks of her patients. As well as have orgasms through masturbation or with the help of a partner 3-4 times a week. She goes into more detail during the interview.Advice for CouplesDaniela preaches the importance of patience. For those who are still wanting to be sexually active in their relationships, the erections take time to come back. Patience is key. She encourages understanding between couples and support with orgasms and erections. Don’t over-focus on penetration; look to oral sex and other methods as well. It is a challenge but being flexible and shifting sexual priority is very important.Final ThoughtsDaniela stresses the importance of communicating with one another during the sexual difficulties that often occur after surgery. Because it can be easy to not talk about it while things are healthy and working smoothly, learning how to communicate is one of the most important facets of the whole process. And for her final closing thought, really listen in and take in all that she has to say on this very important topic. Check the links below to learn more about Daniela.Key Links for Daniela WittmannDaniela's Bio and University of Michigan Information:https://medicine.umich.edu/dept/urology/daniela-wittmann-phd-lmswProstate Survivorship Program:https://www.rogelcancercenter.org/prostate-cancer/survivorshipMore info:Book and New Course - https://sexwithoutstress.comWeb - https://www.bettersexpodcast.com/Sex Health Quiz - http://sexhealthquiz.com/If you’re enjoying the podcast and want to be a part of making sure it continues in the future, consider being a patron. With a small monthly pledge, you can support the costs of putting this show together. For as little as $2 per month, you can get advance access to each episode. For just a bit more, you will receive an advance copy of a chapter of my new book. And for $10 per month, you get all that plus an invitation to an online Q&A chat with me once a quarter. Learn more at https://www.patreon.com/bettersexpodcastBetter Sex with Jessa Zimmermanhttps://businessinnovatorsradio.com/better-sex/
My guest Daniela Wittmann is an expert on prostate health and urology. In fact, she is a very prominent member of the Prostate Cancer Survivorship Program; in addition, she is an associate professor of Urology and Social Work in the University of Michigan Health System.In this interview, she informs listeners on prostate health and penile rehabilitation--particularly after surgery, radiation, or hormone treatment for males who have had prostate cancer.It is a very informative and important talk, and even if you aren’t currently going through the complications of prostate cancer, getting a jumpstart on learning about the subject is very important.Screening for Prostate CancerAs Daniela states, prostate cancer is asymptomatic, which means that symptoms don’t show up until well after it has already metastasized or shown up in the prostate. It is screened, if there are abnormalities caught in the screen then a biopsy is usually done and then a number of treatment options are available as a next step. Daniela goes into more detail during the episode.Treatment Options That Affect Sexual FunctioningIf non-aggressive and very localized, men can always go under ‘active surveillance.’ At this point, physicians simply monitor and watch to see if the cancer gets more aggressive. This treatment method has no sexual side effects.Another treatment is when the cancer is localized, so treatment typically centers around radiation or surgery. Side effects do occur with this type of treatment. For most men, after they do the surgery, they will experience erectile dysfunction because the nerves responsible for making the penis erect are damaged during surgery. In addition, urinary incontinence can occur as well.For more information on treatment options, as well as the side effects of radiation, Daniella provides a succinct breakdown of the treatment options.Men Resisting or Putting Off Treatment?Because there are considerable side effects like loss of libido, lower testosterone, and impaired erectile function, to name a few, some men choose to resist treatment. Daniela states that there are a number of studies which show that men choose not to get treatment because of how daunting the choice can be. Of course, one would want to treat cancer, but to lose sexual function is not attractive to anyone. Some men choose to only monitor their cancer and wait until it gets much worse.Things to Be Aware OfAmong many other facets, Daniela stresses the importance of communicating concerns about loss of sexual function to your physician. But as she says, when it comes to cancer, many physicians downplay the importance of communicating sexual side effects because cancer is the far more serious factor at play. As a result, Daniela says that many men are often surprised by the side effects after treatment. Communication is key between patient and physician.Also requesting to the surgeon that as many nerves be spared as possible during surgery, is a very important thing to consider.What Does Penile Rehabilitation Look Like?Penile rehabilitation in this context means to protect the penile tissue from atrophying. Daniela highlights a number of strategies that are used to accomplish this: low doses of Viagra or Cialis to breathe oxygen and blood into the penis; another is penile injections which do the same thing, and stimulation of the nerves in the penis to maintain penile tissue. For erections, a vacuum pump can be used to maintain a hard erection as well. And all of this is used to maintain the ability for sexual function once the penis has been rehabilitated enough. For much more, tune in.Recommended Time Rehabilitating and The FrequencyAlthough Daniela says that there is no conclusive time period that one should most effectively rehabilitate, the minimum amount of time should be about three-six months or so. “And the frequency,” you might ask? Although there isn’t an exact, prescribed standard that physicians recommend, for Daniela, she states that 3x a week is what she asks of her patients. As well as have orgasms through masturbation or with the help of a partner 3-4 times a week. She goes into more detail during the interview.Advice for CouplesDaniela preaches the importance of patience. For those who are still wanting to be sexually active in their relationships, the erections take time to come back. Patience is key. She encourages understanding between couples and support with orgasms and erections. Don’t over-focus on penetration; look to oral sex and other methods as well. It is a challenge but being flexible and shifting sexual priority is very important.Final ThoughtsDaniela stresses the importance of communicating with one another during the sexual difficulties that often occur after surgery. Because it can be easy to not talk about it while things are healthy and working smoothly, learning how to communicate is one of the most important facets of the whole process. And for her final closing thought, really listen in and take in all that she has to say on this very important topic. Check the links below to learn more about Daniela.Key Links for Daniela WittmannDaniela's Bio and University of Michigan Information:https://medicine.umich.edu/dept/urology/daniela-wittmann-phd-lmswProstate Survivorship Program:https://www.rogelcancercenter.org/prostate-cancer/survivorshipMore info:Book and New Course - https://sexwithoutstress.comWeb - https://www.bettersexpodcast.com/Sex Health Quiz - http://sexhealthquiz.com/If you’re enjoying the podcast and want to be a part of making sure it continues in the future, consider being a patron. With a small monthly pledge, you can support the costs of putting this show together. For as little as $2 per month, you can get advance access to each episode. For just a bit more, you will receive an advance copy of a chapter of my new book. And for $10 per month, you get all that plus an invitation to an online Q&A chat with me once a quarter. Learn more at https://www.patreon.com/bettersexpodcastBetter Sex with Jessa Zimmermanhttps://businessinnovatorsradio.com/better-sex/
Catheter-associated UTIs are a preventable health problem that is common in nursing home residents. Recent innovations designed to prevent Catheter-associated UTIs or CAUTIs are recently recommended. In today's episode, nursing home abuse attorneys Rob Schenk and Will Smith discuss the hazard of Catheter-associated UTIs in nursing home residents and methods of prevention with guest Dr. Jennifer Meddings, an Associate Professor of Internal Medicine and Pediatrics at the University of Michigan Health System.
The Nontraditional Pharmacist Partners With The Pharmacy Podcast Network to bring a new dynamic to the leading network dedicated to the Pharmacy Profession. "We are here to provide a single pharmacy platform that showcases unique roles, connects the world's pharmacists, and helps build your pharmacy professional toolbox." - Nick Kirkpatrick, PharmD About TNP Co-Hosts: Lynn Switaj, PharmD Lynn Switaj was born and raised just outside Cleveland, Ohio and will be moving back after 8 years of school between Chicago and Ann Arbor. Lynn is an incredible athlete and played collegiate hockey for Lake Forest College. She continues to compete today! During pharmacy school Lynn gained research experience while working with one of the Deans of the College of Pharmacy. They were able to produce a publication for their work and presented their findings at numerous conferences. She also gained retail experience from a local independent pharmacy. Lynn's future plans include working as a pharmacist at Walgreen's pharmacy. She is particularly excited about exploring the world of MTM. She loves the idea of these clinical services redefining the traditional community pharmacy! Fun Fact: Has the best golden lab in the entire world, named Duke. Matt Paterini, PharmD Matt Paterini is originally from Saline, just outside of Ann Arbor, MI (not including his younger southern upbringing). Some would say he is pretty good at golf, considering he has won numerous local tournaments and holds several records. Matt was the Chief Intern for the University of Michigan Health System pharmacy internship program. He primarily worked in the Cancer Center outpatient infusion clinic. Regarding future plans, Matt has never been one to follow the standard path. He completed IBM's Global Sales School as the #1 Top Performer and will begin his career in IBM's healthcare cloud software division. His nontraditional role was a driving force for the creation of our website so others can see the wide range of opportunities available in the pharmacy profession. Fun fact: Holds the Course Record at his home golf course. Nick Kirkpatrick, PharmD Nick Kirkpatrick, also known as “Nikykirk”, is a native Michigander from St. Joseph. Despite never passing up a good time, he earned his way to the top of the pharmacy class, graduating with high honors and too many cords around his robe to count. His past pharmacy experience includes interning in both the hospital and retail settings, along with a managed care internship at Blue Cross Blue Shield of Michigan, working on both the commercial and Medicare Part D teams. He has a ton of experience! Following graduation, Nick began his career with CVS Health - Target Channel as a floating pharmacist, a position he was offered while on P4 APPE due to his strong networking skills. He recently moved into a pharmacy manager role and is very excited about this opportunity as it has great potential to help him learn about the business aspects of pharmacy, while also developing his management skills. Fun fact: Nick was an All-State pitcher in high school. CONTACT TNP: https://www.thenontraditionalpharmacist.com/contact/ See omnystudio.com/listener for privacy information.
On this week's holiday episode our News & Views segment starts at Krispy Kreme to see if we can extract any good take-aways from the recent class-action lawsuit filed against the chain. Then, it's on to a recent study about what happens when you don't feed your gut bacteria...what do they eat instead? The segment is rounded out with coverage of recent research on whole milk for kids and a new—somewhat strange–non-pharmaceutical weight-loss pill. The Moment of Paleo segment offers thoughts on restriction and upcoming holiday feasts. And After the Bell features a talk about life's invisible feast. Enjoy the show! Links for this episode:Latest in Paleo on Facebook — Leave a Comment About this Episode or Post a News LinkWhy & How to Support Latest in PaleoRecommended Food & ProductsRecommended Books & AudiobooksKrispy Kreme Lawsuit Claims Company Misled Over Doughnut FruitA Fruitless Suit?: Krispy Kreme Sued Over Fake Berry-Flavored Donuts - Law Street (TM)Kreme-filled lies — Doughnut company faces a Krispy $5M lawsuit - NY Daily NewsA Dietary Fiber-Deprived Gut Microbiota Degrades the Colonic Mucus Barrier and Enhances Pathogen Susceptibility: CellHigh-fiber diet keeps gut microbes from eating the colon’s lining, protects against infection, animal study shows | University of Michigan Health SystemEating fiber keeps gut microbes from eating you - Medical News TodayEat Fiber: Whole Grains Prevent Gut Microbes From Eating Intestine Lining, Increasing Infection Risknew The Hungry Microbiome: why resistant starch is good for you - YouTubeWhich Foods to Eat: The Hungry MicrobiomeRelation between milk-fat percentage, vitamin D, and BMI z score in early childhoodDo we have it backward on giving kids low fat milk instead of whole? - Health - CBC NewsKids who drink whole milk slimmer than those who don'tUses for skim milk before it was marketed as a nonfat diet product: Hog slop and wool.A 6-Month Swallowable Balloon System Results In Sustainable Weight Loss At 1 Year: Results from A Prospective, Randomized Sham-Controlled Trial - Surgery for Obesity and Related DiseasesBalloon-in-a-Pill Helped Obese Patients Lose Weight: MedlinePlus Health NewsThis Weight Loss Pill Inflates a Balloon In Your Stomach | TIMEWeight-loss balloon helps shed twice the weight, research says - CNN.comWatch "Possibilities—life's invisible feast: Sarah Susanka at TEDxSanDiego" Video at TEDxTalksVisit PuraKai to shop for eco-friendly clothing and stand-up paddle boards. Be sure to use coupon code "latest in paleo" for 15% off all clothing purchases.
TWIPO hosts Dr. Timothy Cripe and Dr. Nilay Shah (Nationwide Children's Hospital) along with guest host Dr. Ryan Roberts (Nationwide Children's Hospital), interview Dr. Elizabeth Lawlor who is a Professor of Pediatric Oncology at University of Michigan and the Director of the Cancer Biology Training Program at University of Michigan Health System. Dr. Lawlor, a Ewing Sarcoma specialist, discusses new approaches to the cellular eco-system of tumors and provides commentary on the growing landscape for women in science.
This month, AMA Journal of Ethics theme editor Trisha Paul, a second-year medical student at the University of Michigan Medical School, interviewed Kelly Parent about what makes patient- and family-centered care an inclusive approach to health care delivery and how this approach is being implemented. Kelly Parent is the patient- and family-centered care program specialist for quality and safety at the University of Michigan Health System.
Host Dr. Barry Mennen welcomes Dr. Ryan Stidham, Assistant Professor of Internal Medicine at the Inflammatory Bowel Diseases Center of the University of Michigan Health System, to discuss the current therapeutic landscape for IBD based on recent comparative clinical trials.
Host Dr. Barry Mennen welcomes Dr. Ryan Stidham, Assistant Professor of Internal Medicine at the Inflammatory Bowel Diseases Center of the University of Michigan Health System, to discuss the current therapeutic landscape for IBD based on recent comparative clinical trials.
The Association for the Advancement of Medical Instrumentation Podcast - AAMI
Increasingly seen as a crucial discipline in effective healthcare, risk management can mean different things to different people, but one common theme is that it can help create a “safe environment” for patients. Jacque Mitchell, RN, a risk manager at Sentara Norfolk General Hospital in Norfolk, VA, and past president of the American Society for Healthcare Risk Management, and Salim Kai, CBET, a clinical safety specialist at the University of Michigan Health System in Ann Arbor, talk about what healthcare facilities should be doing to ensure all of their employees think like risk managers Produced By: AAMI and Healthcare Tech Talk
On today's show we discuss the topic of stress and how living in urban cities appears to affect our brains. A recent study shows that people who were raised in cities versus rural areas process stress differently. Another study examines the mental benefits of walking in nature. We talk about how our self-talk and tendency to over-generalize can cause us mental distress. And, a recent report by the World Wildlife Fund indicates that animal populations around the globe are also under stress...and dying at a fast rate. The Moment of Paleo segment is called "Becoming You." And, the After the Bell segment features a TEDx Talk, "Nature as Source Code." Links for this episode:English - MicroBirthCity living and urban upbringing affect neural social stress processing in humans : Nature : Nature Publishing GroupStress and the city: Urban decay : Nature News & CommentLiving Sick and Dying Young in Rich America - The AtlanticRichard Manning on the Cage of Civilization - YouTubeuntitled - 2010-peen.pdfExamining Group Walks in Nature and Multiple Aspects of Well-Being: A Large-Scale Study | AbstractStudy: Hiking Makes You Happier | News from the Field | OutsideOnline.comWalking off depression and beating stress outdoors? Nature group walks linked to improved mental health | University of Michigan Health SystemWalking, Biking to Work Seems to Have Mental Health Benefits – WebMDDepression: A Walking Prescription - YouTubeNeanderthink: No Shame on You | Psychology TodayWWF - Living Planet ReportEarth has lost half of its wildlife in the past 40 years, says WWF | Environment | The GuardianEarth lost 50% of its wildlife in the past 40 years, says WWF | AlternetNature as source code | Trevor Herriot | TEDxRegina - YouTube Purakai.com - Shop for Organic Clothing from PuraKai - Use coupon code "latest in paleo" for free shipping!
Does long-standing sibling rivalry really have an impact on a marriage? So where does sibling rivalry start in the first place? According to academic professionals at the University of Michigan Health System, the most fundamental effect and characteristic of sibling rivalry is jealousy. Constant arguments between siblings create a strong feeling of tension in the […]
Episode #110 is a chat with Dr. Jack Billi from the University of Michigan Health System and Medical School. Here, we talk about their lean work and how Dr. Billi works with physicians to engage them in lean, tying lean problem solving methods, including the A3 approach, to the scientific method and medical thinking. Dr. Billi talks about the right approach to the lean concept of "standardized work" in a way that works for medicine and complex patient situations. This episode is also #3 of the new podcast series from the Healthcare Value Leaders Network series. The Healthcare Value Leaders podcast page is www.healthcarevalueleaders.org/podcast. To point others to this, use the simple URL: www.leanblog.org/110. For earlier episodes of the Lean Blog Podcast, 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. More about Dr. Billi: Jack E. Billi, M.D. Associate Dean for Clinical Affairs, Medical School and Associate Vice President, Medical Affairs jbilli@umich.edu Dr. Billi is Professor of Internal Medicine and Medical Education. He leads the Michigan Quality System, the University of Michigan Health System's unified approach to improve quality, safety, efficiency, appropriateness and service using lean tools and philosophy. Dr. Billi's research and leadership interests are in health services delivery and the use of community consortia for quality improvement. He is active on statewide and regional groups affecting quality of care, pay-for-performance and public reporting. He chairs the Michigan State Medical Society's Committee on Quality, Efficiency and Economics and the Essential Benefit Design Work Group and is a member of MSMS's Board of Directors. Dr. Billi co-chairs the Medical Director Committee for the Michigan Quality Improvement Consortium which develops and disseminates evidence-based practice guidelines used by Blue Cross Blue Shield of Michigan and 15 other health plans representing over six million members. Episode Host: Mark Graban
Guest: Sue Kling-Colson, PA-C Host: Lisa Dandrea Lenell, PA-C, MPAS, MBA Hyperglycemia in critically ill patients increases the risk factor for inpatient morbidity and mortality. Host Lisa D'Andrea explores with guest Sue Kling-Colson, a physician assistant at the University of Michigan Health System, the intensive insulin protocols established for managing hyperglycemic inpatients. Ms. Colson outlines the protocols and explains the responsibilities of the physician assistant under the Hospital Intensive Insulin Program.
Folafoluwa O. Odetola, MD, MPH, discusses an article published in the January 2008 issue of Pediatric Critical Care Medicine, "Do outcomes vary according to the source of admission to the pediatric intensive care unit?" Dr. Odetola is from Mott Children's Hospital, University of Michigan Health System, and from the Child Health Evaluation and Research Unit Department of Pediatrics and Communicable Diseases at the University of Michigan Ann Arbor. (Pediatr Crit Care Med. 2008;9[1]:20)
Folafoluwa O. Odetola, MD, MPH, discusses an article published in the January 2008 issue of Pediatric Critical Care Medicine, "Do outcomes vary according to the source of admission to the pediatric intensive care unit?" Dr. Odetola is from Mott Children's Hospital, University of Michigan Health System, and from the Child Health Evaluation and Research Unit Department of Pediatrics and Communicable Diseases at the University of Michigan Ann Arbor. (Pediatr Crit Care Med. 2008;9[1]:20)
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