Podcasts about The New England Journal of Medicine

In this solo episode, Darin reframes one of the most misunderstood forces in life — stress. Instead of seeing it as the enemy, he explores how stress is actually a messenger, guiding you back to alignment, safety, and awareness. Through science, spirituality, and lived experience, Darin breaks down how stress shows us where we're trying to control, where we're disconnected, and where our nervous system is calling for attention. He unpacks the layers of modern stress — from trauma and environment to community and purpose — and offers practical, embodied tools to restore calm, clarity, and resilience.     What You'll Learn 00:00:00 – Welcome to Super Life: Solutions for a Healthier Life and Better World 00:00:32 – Sponsor Spotlight: TheraSauna - Natural Healing Technologies (15% off with code Darrandai) 00:02:10 – The Super Life Podcast: Finding Contentment, Happiness, and Purpose 00:02:51 – Today's Topic: Stress - Reframing Stress as an Ally and Dashboard Light 00:04:54 – The "No Choice" Universe: Reconnecting to Infinite Possibilities 00:05:16 – The Reality of Stress: Statistics and the Impact of Chronic Stress 00:06:21 – Stress is Layered: Beyond a Single Cause, Addressing Chronic Stress 00:08:29 – Solutions for a Super Life: Safety over Calm and the Vagal Response 00:09:38 – The Inner Dialogue Layer: Trauma, Unconsciousness, and Spiritual Bypassing 00:11:47 – The Social Field Layer: Relationships, Community, and Finding Your Way Home 00:14:20 – Sponsor Spotlight: Bite Toothpaste - Sustainable, Non-Toxic Tabs (20% off with code Darin20) 00:16:35 – Creating Your Own Vision: Setting Boundaries with Media and Social Algorithms 00:17:29 – Finding Your Purpose: From Raising Children to Healing Injuries 00:18:35 – Environmental and Existential Stress Layers: Clutter, Noise, and Service 00:19:26 – Stress Load and Resiliency: Why Small Triggers Cause Blow-Ups 00:20:02 – Understanding the Dashboard Light: Acknowledging Unwillingness 00:20:35 – Safety as the Signal: Body Relaxation and Providing Inner Security 00:23:44 – Reframing Trauma: Was it the Protector You Needed at the Time? 00:25:00 – Releasing Trauma: Techniques, The Healing Code, and Waking the Tiger 00:26:06 – Finishing the Survival Response: Shaking, Crying, Screaming, and Stretching 00:26:38 – Stress as a Multiplier: Impact on Immune System, Heart, and Aging 00:28:10 – Stress Slows Repair: Inflammation, Cardiovascular Risk, and Cellular Aging 00:29:48 – The Integrative Approach: Changing Your Environments to Support Anti-Stress 00:30:07 – Actionable Stress Solutions: Circadian Rhythm, Nature, and Noise Reduction 00:30:44 – Actionable Stress Solutions: Gratitude, Conscious Breath, and Movement 00:31:32 – Energy Drains to Eliminate: Conflict, Clutter, Scrolling, and Late Caffeine 00:32:17 – Connecting to Greater Purpose: The Super Life Patreon Platform 00:32:54 – Morning/Night Questions: Letting Go, Creating, and Contributing 00:33:17 – Final Toolkit: Slow Breathing, Movement, Nature, Sauna, and Sleep 00:34:25 – The Invitation: Digging into all Layers of a Super Life on Patreon   Thank You to Our Sponsors Therasage: Go to www.therasage.com and use code DARIN at checkout for 15% off Bite Toothpaste: Go to trybite.com/DARIN20 or use code DARIN20 for 20% off your first order. Find More from Darin Olien: Instagram: @darinolien Podcast: SuperLife Podcast Website: superlife.com Book: Fatal Conveniences   Key Takeaway "Stress isn't your enemy — it's your compass. Every wave of tension points you back to what's asking for care, attention, and love. When you stop fighting stress and start listening to it, you don't just survive — you evolve."       Bibliography (selected, peer-reviewed) Sources: Gallup Global Emotions (2024); Gallup U.S. polling (2024); APA Stress in America (2023); Natarajan et al., Lancet Digital Health (2020); Orini et al., UK Biobank (2023); Martinez et al. (2022); Leiden University (2025). Cohen S, Tyrrell DA, Smith AP. Psychological stress and susceptibility to the common cold. N Engl J Med.1991;325(9):606–612. New England Journal of Medicine Cohen S, et al. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proc Natl Acad Sci USA. 2012;109(16):5995–5999. PNAS Kiecolt-Glaser JK, et al. Slowing of wound healing by psychological stress. Lancet. 1995;346(8984):1194–1196. The Lancet Kiecolt-Glaser JK, et al. Hostile marital interactions, proinflammatory cytokine production, and wound healing.Arch Gen Psychiatry. 2005;62(12):1377–1384. JAMA Network Tawakol A, et al. Relation between resting amygdalar activity and cardiovascular events. Lancet.2017;389(10071):834–845. The Lancet Epel ES, et al. Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci USA.2004;101(49):17312–17315. PNAS McEwen BS, Stellar E. Stress and the individual: mechanisms leading to disease. Arch Intern Med.1993;153(18):2093–2101. PubMed McEwen BS, Wingfield JC. Allostasis and allostatic load. Ann N Y Acad Sci. 1998;840:33–44. PubMed Felitti VJ, et al. Relationship of childhood abuse and household dysfunction to many leading causes of death in adults (ACE Study). Am J Prev Med. 1998;14(4):245–258. AJP Mon Online Edmondson D, et al. PTSD and cardiovascular disease. Ann Behav Med. 2017;51(3):316–327. PMC Afari N, et al. Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis.Psychosom Med. 2014;76(1):2–11. PMC Goyal M, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014;174(3):357–368. PMC Qiu Q, et al. Forest therapy: effects on blood pressure and salivary cortisol—a meta-analysis. Int J Environ Res Public Health. 2022;20(1):458. PMC Laukkanen T, et al. Sauna bathing and reduced fatal CVD and all-cause mortality. JAMA Intern Med.2015;175(4):542–548. JAMA Network Zureigat H, et al. Physical activity lowers CVD risk by reducing stress-related neural activity. J Am Coll Cardiol.2024;83(16):1532–1546. PMC Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med.2010;7(7):e1000316. PMC Chen Y-R, Hung K-W. EMDR for PTSD: meta-analysis of RCTs. PLoS One. 2014;9(8):e103676. PLOS Hoppen TH, et al. Network/pairwise meta-analysis of PTSD psychotherapies—TF-CBT highest efficacy overall.Psychol Med. 2023;53(14):6360–6374. PubMed van der Kolk BA, et al. Yoga as an adjunctive treatment for PTSD: RCT. J Clin Psychiatry. 2014;75(6):e559–e565. PubMed Kelly U, et al. Trauma-center trauma-sensitive yoga vs CPT in women veterans: RCT. JAMA Netw Open.2023;6(11):e2342214. JAMA Network Bentley TGK, et al. Breathing practices for stress and anxiety reduction: components that matter. Behav Sci (Basel). 2023;13(9):756. 

In this episode, we look at new trials on deferring arterial catheterization in shock, beta-blocker use after myocardial infarction, and a treatment for triple-negative breast cancer. We review acromegaly. A case describes a man with dyspnea, edema, and pacemaker lead displacement. We explore perspectives on the burdens of primary care, the erosion of harm reduction, child health policy, and the meaning of hospice.

About this Episode Episode 50 of “The 2 View” – BNPs, D-Dimers, and Sneakily Sick Kids Segment 1A - Needs of older nurses Clendon JA, Walker L. Nurses aged over 50 and their perceptions of flexible working: The experiences and needs of older nurses in relation to flexible working and the barriers and facilitators to implementation within workplaces. J Nurs Manag. 2016;24:336-346. doi:10.1111/jonm.12325 Segment 1B - WHO and Tropical Diseases Special Programme for Research and Training in Tropical Diseases. World Health Organization. Accessed August 19, 2025. https://tdr.who.int/about-us Segment 2A - BNP Silvers SM, Gemme SR, Hickey S, et al. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Heart Failure Syndromes. Ann Emerg Med. 2019;49(2): 232–241. Lamberta M, Chertoff A. BNP Level in the Emergency Department: Does it Change Management? EMDocs. June 20, 2016. Accessed November 4, 2025. https://www.emdocs.net/bnp-level-in-the-emergency-department-does-it-change-management/ Maisel AS, Krishnaswamy P, Nowak RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. 2002;347(3):161-167. doi: 10.1056/NEJMoa020233 Segment 2B - D-Dimer Wolf SJ, Hahn SA, Nentwich LM, et al. Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with suspected acute venous thromboembolic disease. Ann Emerg Med. 2018;71(5):e59–e109. doi:10.1016/j.annemergmed.2018.03.006 Righini M, Van Es J, Den Exter PL, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: The ADJUST-PE study. JAMA. 2014;311(11):1117–1124. doi:10.1001/jama.2014.2135 van der Hulle T, Cheung WY, Kooij S, et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): A prospective, multicentre, cohort study. Lancet. 2017;390(10091):289–297. doi:10.1016/S0140-6736(17)30885-1 Kearon C, de Wit K, Parpia S, et al. Diagnosis of pulmonary embolism with D-dimer adjusted to clinical probability. N Engl J Med. 2019;381(22):2125–2134. doi:10.1056/NEJMoa1909159 Lim w, Le Gal G, Bates SM, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: Diagnosis of venous thromboembolism. Blood Adv. 2018;2(22):3226-3256. doi:10.1182/bloodadvances.2018024828 Kabrhel C, Jaff MR, Channick RN. D-dimer. StatPearls. June 22, 2025. Accessed November 4, 2025. https://www.ncbi.nlm.nih.gov/books/NBK431064/ Tripodi A, Lippi G. How we manage a high D-dimer. Haematologica. 2020;106(6):1491-1494. doi:10.3324/haematol.2020.248344 Segment 3: Sneakily Sick Kids Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: An evidence-based clinical prediction algorithm. J Bone Joint Surg Am. 1999;81(12):1662-1670. doi:10.2106/00004623-199912000-00002 Caird MS, Flynn JM, Leung YL, et al. Factors distinguishing septic arthritis from transient synovitis of the hip in children: a prospective study. J Bone Joint Surg Am. 2006;88(6): 1251-1257. doi:10.2106/JBJS.E.00216 Recurring Sources Center for Medical Education. http://ccme.org The Proceduralist. http://www.theproceduralist.org The Procedural Pause. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. http://www.thesgem.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to.

In this special episode on a Beta Cell Update Dr. Neil Skolnik discusses this emerging area with Dr. Melena Bellin. This special episode is supported by an independent educational grant from Sanofi. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health Melena Bellin.  Professor, Pediatric Endocrinology, and Surgery, Co-Director, Total Pancreatectomy and Islet Autotransplant Program and the Albert D. and Eva J. Corniea Chair, University of Minnesota/ Masonic Children's Hospital      Selected References: Consensus guidance for monitoring individuals with islet autoantibody-positive pre-stage 3 type 1 diabetes. Diabetes Care 2024;47(8):1276–1298 An Anti-CD3 Antibody, Teplizumab, in Relatives at Risk for Type 1 Diabetes. N Engl J Med 2019;381:603-613 Management of Latent Autoimmune Diabetes in Adults: A Consensus Statement . Diabetes 2020;69(10):2037–2047 Resources for Auto-antibody Testing: Type 1 Diabetes TrialNet Centers of Excellence Locations Type 1 Risk test         Trialnet  

Intravenous dihydropyridine calcium channel blockers can quietly worsen oxygenation by blunting hypoxic pulmonary vasoconstriction. In this episode, we break down the bedside mechanism, which agents are implicated, who's at highest risk (post-op atelectasis, obesity, pneumonia, focal ARDS, COPD), how soon it happens, and exactly what to do.The Vasopressor & Inotrope HandbookAmazon: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Affiliate Link)My Store: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)Citations:Weir EK, López-Barneo J, Buckler KJ, Archer SL. Acute oxygen-sensing mechanisms. N Engl J Med. 2005 Nov 10;353(19):2042-55. doi: 10.1056/NEJMra050002. PMID: 16282179; PMCID: PMC2803102.Weir EK, Olschewski A. Role of ion channels in acute and chronic responses of the pulmonary vasculature to hypoxia. Cardiovasc Res. 2006 Sep 1;71(4):630-41. doi: 10.1016/j.cardiores.2006.04.014. Epub 2006 Apr 27. PMID: 16828723.Lumb AB, Slinger P. Hypoxic pulmonary vasoconstriction: physiology and anesthetic implications. Anesthesiology. 2015 Apr;122(4):932-46. doi: 10.1097/ALN.0000000000000569. PMID: 25587641.Timour G, Fréderic V, Olivier S, Shango DN. Nicardipine-induced acute respiratory failure: Case report and literature review. Clin Case Rep. 2023 May 1;11(5):e7186. doi: 10.1002/ccr3.7186. PMID: 37143457; PMCID: PMC10151601.McMurtry IF, Davidson AB, Reeves JT, Grover RF. Inhibition of hypoxic pulmonary vasoconstriction by calcium antagonists in isolated rat lungs. Circ Res. 1976 Feb;38(2):99-104. doi: 10.1161/01.RES.38.2.99. PMID: 1245025.Simonneau G, Escourrou P, Duroux P, Lockhart A. Inhibition of hypoxic pulmonary vasoconstriction by nifedipine. N Engl J Med. 1981 Jun 25;304(26):1582-5. doi: 10.1056/NEJM198106253042606. PMID: 7231503.Kennedy T, Summer W. Inhibition of hypoxic pulmonary vasoconstriction by nifedipine. Am J Cardiol. 1982 Oct;50(4):864-8. doi: 10.1016/0002-9149(82)91246-2. PMID: 7124646.Chrétien B, Decros JB, Suard F, Dolladille C, Fischer MO, Alexandre J, Descamps R. Hypoxia Associated With Dihydropyridine Calcium Channel Inhibitors: A Pharmacovigilance Study in VigiBase. Clin Pharmacol Ther. 2023 Sep;114(3):686-692. doi: 10.1002/cpt.2970. Epub 2023 Jun 29. PMID: 37309986.Burghuber OC. Nifedipine attenuates acute hypoxic pulmonary vasoconstriction in patients with chronic obstructive pulmonary disease. Respiration. 1987;52(2):86-93. doi: 10.1159/000195309. PMID: 3671896.Suard F, Mombrun M, Fischer MO, Hanouz JL, Decros JB, Derville S, Gakuba C, Al Issa G, Menard C, Chretien B, Descamps R. Oxygenation Effects of Antihypertensive Agents in Intensive Care: A Prospective Comparative Study of Nicardipine and Urapidil. Clin Pharmacol Ther. 2025 Mar;117(3):742-748. doi: 10.1002/cpt.3509. Epub 2024 Nov 27. PMID: 39604146.

In this episode, we discuss long-term outcomes after chest-wall irradiation for breast cancer, new treatments for psoriasis and obesity, and early results on a vaccine for Lassa fever. We review opioid deprescribing and a clinical case describes spiraling into a distant past. Perspectives examine the corporatization of health care, the health effects of new energy legislation, and Medicaid cuts affecting U.S. children.

Yashaswini Singh is an assistant professor of health services, policy, and practice at Brown University. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. Y. Singh. The Antitrust Antidote to Hospital and Nursing Home Corporatization — Promises and Pitfalls. N Engl J Med 2025;393:1761-1764.

Right on the heels of the release of the 2025 AHA guidelines, including one on preferentially using IVs over IOs, comes two RCTs in the same edition of NEJM that compare intial attempts with IVs to IOs in out of hospital cardiac arrest. Dr Jarvis discusses these two papers while answer a listeners question, and tries to put this, and early epinephrine, into context. And he might throw in some commentary about the AHA's recommendations on mCPR and Heads Up CPR.Citations:1. Couper K, Ji C, Deakin CD, et al. A Randomized Trial of Drug Route in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2025;392(4):336-348. doi:10.1056/NEJMoa24077802. Vallentin MF, Granfeldt A, Klitgaard TL, et al. Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest. N Engl J Med. 2025;392(4):349-360. doi:10.1056/NEJMoa2407616

Schaue dir das Video zu dieser Folge auf YouTube an und abonniere den Kanal, um keine neue Folge mehr zu verpassen.ZusammenfassungJulia Tulipan & Ulrike Gonder analysieren Mai Thi Nguyen-Kims Protein-Video. Sie widerlegen die veraltete DGE-Empfehlung von 0,8 g/kg Protein, die nur ein Minimum sichert. Moderne Studien zeigen: Optimal sind 1,6-2,2 g/kg, bezogen auf das aktuelle Gewicht, um Muskeln zu erhalten – auch beim Abnehmen. Ältere benötigen mind. 1,2-1,5 g/kg gegen Sarkopenie. Tierisches Protein ist oft überlegen (Bioverfügbarkeit, Nährstoffe). Eiweiß sättigt, verhindert den Jo-Jo-Effekt und die "Protein-Hebel-Hypothese" erklärt, warum Proteinmangel zu Überessen führt. Wir diskutieren kritisch Studien zu Fleischkonsum und Sterblichkeit. Fazit: Ausreichend Protein ist essenziell für Muskeln, Knochen, Langlebigkeit und ein gesundes Körpergewicht. Tierische Lebensmittel sind zudem reich an bioverfügbaren Mineralien und Vitaminen.Was du in dieser Episode lernst

Un nouvel épisode du pharmascope est maintenant disponible! Dans de ce 102ème épisode, Nicolas, Sébastien et Isabelle discuteront de vitamine B12. Dans ce premier épisode d'une série de deux, on discute de manifestations cliniques, d'évaluation biochimique, d'approche diagnostique et de bénéfices (ou pas) du traitement d'un déficit en vitamine B12. Les objectifs pour cet épisode sont les suivants: Identifier les patients avec une indication de doser la vitamine B12 Discuter de la fiabilité du dosage de la vitamine B12 Discuter de l'approche diagnostique du déficit en vitamine B12 Expliquer les bénéfices d'un supplément de vitamine B12 dans le traitement et la prévention de diverses conditions   Ressources pertinentes en lien avec l'épisode Boughrassa F, Framarin A. Usage judicieux de 14 analyses biomédicales: Outil pratique. Institut national d'excellence en santé et services sociaux. Avril 2014. Solomon LR. Cobalamin-responsive disorders in the ambulatory care setting: unreliability of cobalamin, methylmalonic acid, and homocysteine testing. Blood. 2005;105:978-85. Hunt A, Harrington D, Robinson S. Vitamin B12 deficiency. BMJ. 2014;349:g5226. Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med. 2013;368:149-60. Didangelos T et coll. Vitamin B12 Supplementation in Diabetic Neuropathy: A 1-Year, Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients. 2021;13:395. Dangour AD et coll. Effects of vitamin B-12 supplementation on neurologic and cognitive function in older people: a randomized controlled trial. Am J Clin Nutr. 2015;102:639-47. McCleery J et coll. Vitamin and mineral supplementation for preventing dementia or delaying cognitive decline in people with mild cognitive impairment. Cochrane Database Syst Rev. 2018;11:CD011905. Rutjes AW et coll. Vitamin and mineral supplementation for maintaining cognitive function in cognitively healthy people in mid and late life. Cochrane Database Syst Rev. 2018;12:CD011906. Kwok T et coll. A randomized placebo-controlled trial of using B vitamins to prevent cognitive decline in older mild cognitive impairment patients. Clin Nutr. 2020;39:2399-2405. Kwok T et coll. A randomized placebo controlled trial of vitamin B12 supplementation to prevent cognitive decline in older diabetic people with borderline low serum vitamin B12. Clin Nutr. 2017;36:1509-1515. Van der Zwaluw NL et coll. Results of 2-year vitamin B treatment on cognitive performance: secondary data from an RCT. Neurology. 2014;83:2158-66. Almeida OP et coll. B vitamins to enhance treatment response to antidepressants in middle-aged and older adults: results from the B-VITAGE randomised, double-blind, placebo-controlled trial. Br J Psychiatry. 2014;205:450-7.

Un nouvel épisode du pharmascope est maintenant disponible! Dans de ce 103ème épisode, Nicolas, Sébastien et Isabelle discutent encore une fois de vitamine B12. Cette fois, on jase de plein de choses: les médicaments pouvant causer une déficience en B12, la supplémentation en B12 et même de l'effet de la B12 sur les performances au karaoké!   Les objectifs pour cet épisode sont les suivants: Identifier les médicaments ou substances susceptibles de causer une déficience en vitamine B12 Comparer les avantages et les inconvénients des différentes voies d'administration disponibles pour l'administration de vitamine B12 Discuter du suivi à effectuer suite à l'amorce de la vitamine B12   Ressources pertinentes en lien avec l'épisode Boughrassa F, Framarin A. Usage judicieux de 14 analyses biomédicales: Outil pratique. Institut national d'excellence en santé et services sociaux. Avril 2014. Hunt A, Harrington D, Robinson S. Vitamin B12 deficiency. BMJ. 2014;349:g5226. Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med. 2013;368:149-60. de Jager J et coll. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomised placebo controlled trial. BMJ. 2010;340:c2181. Sanz-Cuesta et coll; OB12 Group. Oral versus intramuscular administration of vitamin B12 for vitamin B12 deficiency in primary care: a pragmatic, randomised, non-inferiority clinical trial (OB12). BMJ Open. 2020;10:e033687. Wang H et coll. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. Cochrane Database Syst Rev. 2018;3:CD004655. Volkov I et coll. Effectiveness of vitamin B12 in treating recurrent aphthous stomatitis: a randomized, double-blind, placebo-controlled trial. J Am Board Fam Med. 2009;22:9-16.

Elinzanetant, sold under the brand name Lynkuet, receivedapproval from the U.S. Food and Drug Administration (FDA) on October 24, 2025, for the treatment of moderate to severe hot flashes due to menopause.  How is this different than Fezolinetant, which was approved in 2023? Listen in for details. 1.   Menegaz de Almeida, Artur MS; Oliveira, Paloma MS; Lopes, Lucca MD; Leite, Marianna MS; Morbach, Victória MS; Alves Kelly, Francinny MD; Barros, Ítalo MS; Aquino de Moraes, Francisco Cezar MS; Prevedello, Alexandra MD. Fezolinetant and Elinzanetant Therapy for Menopausal Women Experiencing Vasomotor Symptoms: A Systematic Review and Meta-analysis. Obstetrics & Gynecology 145(3):p 253-261, March 2025. | DOI: 10.1097/AOG.00000000000058122.     Pinkerton JV, Simon JA, Joffe H, Maki PM, NappiRE, Panay N, Soares CN, Thurston RC, Caetano C, Haberland C, Haseli Mashhadi N, Krahn U, Mellinger U, Parke S, Seitz C, Zuurman L. Elinzanetant for the Treatment of Vasomotor Symptoms Associated With Menopause: OASIS 1 and 2 Randomized Clinical Trials. JAMA. 2024 Aug 22;332(16):1343–54. doi: 10.1001/jama.2024.14618. Epub ahead of print. PMID: 39172446; PMCID: PMC11342219.3.     Cardoso F, Parke S, Brennan DJ, Briggs P,Donders G, Panay N, Haseli-Mashhadi N, Block M, Caetano C, Francuski M, Haberland C, Laapas K, Seitz C, Zuurman L. Elinzanetant for Vasomotor Symptomsfrom Endocrine Therapy for Breast Cancer. N Engl J Med. 2025 Aug 21;393(8):753-763. doi: 10.1056/NEJMoa2415566. Epub 2025 Jun 2. PMID: 40454634.STRONG COFFEE PROMO: 20% Off Strong CoffeeCompany https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

This week, we look at new findings from the European prostate cancer screening study, advances in lung cancer therapy, physical therapy for meniscal tear, and a promising vaccine for Salmonella Paratyphi A. We review noninvasive liver fibrosis assessment and a complex clinical case, and explore perspectives on concierge care, kidney disease equity, WIC enrollment, community health, FDA regulation, and standing with colleagues in Gaza.

This week, Gary, Kate, Mark and Henry discuss the optimal duration of anticoagulation after a provoked DVT, using low doses of mirtazapine or amitriptyline in adults with insomnia, whether a lower dose of semaglutide is still effective for weight loss, and adding aspirin for patients with coronary heart disease, a stent and who are also on a DOAC for another indication.Links:NICE Barrett Esophagus guideline: https://pubmed.ncbi.nlm.nih.gov/38553042/ Essential Evidence Plus: www.essentialevidenceplus.comDuration of anticoagulation: https://pubmed.ncbi.nlm.nih.gov/40888734/ Mirtazapine or amitriptyline for insomnia: ttps://pubmed.ncbi.nlm.nih.gov/39814428/ Lower dose semaglutide for obesity: https://pubmed.ncbi.nlm.nih.gov/40934115/ Adding aspirin: N Engl J Med . 2025 Oct 23;393(16):1578-1588https://pubmed.ncbi.nlm.nih.gov/40888725/

You've heard it all: “The truth about carbs,” “The truth about hormones,” “The truth about fasting.” But here's the real truth—context matters, and no single “truth” out there applies to every woman, every body, or every season of life.In this episode, I break down why most health advice is only a sliver of the full picture—and why lasting change doesn't come from copying and pasting what worked for someone else. Instead, you'll learn how to approach your health like a scientist: with curiosity, patience, and small, consistent actions that actually get down into your cells. You're not broken. You're just stuck in the wrong story.Here's what we cover:Why most “truths” about health are missing contextThe real reason your results aren't changingHow long it actually takes to see change at the cellular levelThe drip-drip-drip method vs. the bucket approach to health5 evidence-based habits to start today: walk, track, sleep, plan, eat proteinWhat your biology needs (and what it doesn't)There's no magic protocol. Just consistent inputs over time. Start anywhere. Because anywhere is better than “someday.”Get Weekly Health Tips:  thrivehealthcoachllc.comLet's Connect:@‌ashleythrivehealthcoach or via email: ashley@thrivehealthcoachingllc.comPodcast Produced by Virtually You!Sources: • Barrès, R., Yan, J., Egan, B., Treebak, J. T., Rasmussen, M., Fritz, T., & Zierath, J. R. (2012). Acute exercise remodels promoter methylation in human skeletal muscle. Cell Metab, 15(3), 405–411. https://doi.org/10.1016/j.cmet.2012.01.001 • Baumeister, R. F., & Tierney, J. (2011). Willpower: Rediscovering the greatest human strength. Penguin. • Berg, J. M., Tymoczko, J. L., & Gatto, G. J. (2019). Biochemistry (9th ed.). W. H. Freeman. • Cohen, A. A., Milot, E., Yong, J., Seplaki, C. L., Fülöp, T., & Fried, L. P. (2016). Multi-system physiological dysregulation during aging. Mech Ageing Dev, 156, 86–94. • Guyton, A. C., & Hall, J. E. (2021). Textbook of medical physiology (14th ed.). Elsevier. • Lee, I.-M., Shiroma, E. J., Kamada, M., Bassett, D. R., Matthews, C. E., & Buring, J. E. (2020). Steps, intensity, and mortality in older women. JAMA Intern Med, 180(8), 1103–1112. • Lichtman, S. W., Pisarska, K., Berman, E. R., Pestone, M., Dowling, H., & Heymsfield, S. B. (1992). Self-reported vs actual caloric intake and exercise. N Engl J Med, 327(27), 1893–1898. • McEwen, B. S. (1998). Protective and damaging effects of stress mediators. N Engl J Med, 338(3), 171–179. • Morton, R. W., Murphy, K. T., McKellar, S. R., Schoenfeld, B. J., Helms, E., & Phillips, S. M. (2018). Protein supplementation and resistance training. Br J Sports Med, 52(6), 376–384. • Richter, E. A., & Hargreaves, M. (2013). Exercise, GLUT4, and muscle glucose uptake. Physiol Rev, 93(3), 993–1017. • Spiegel, K., Tasali, E., Penev, P., & Van Cauter, E. (2004). Sleep curtailment lowers leptin, raises ghrelin. Ann Intern Med, 141(11), 846–850. • Turnbaugh, P. J., Ley, R. E., Mahowald, M. A., Magrini, V., Mardis, E. R., & Gordon, J. I. (2007). Obesity-associated gut microbiome. Nature, 444(7122), 1027–1031. • Van Cauter, E., Holmback, U., Knutson, K., Leproult, R., Miller, A., Nedeltcheva, A., & Spiegel, K. (2008). Sleep loss and metabolic function. Horm Support the show

Dr. Nicole Glaser is the Chief of Pediatric Endocrinology and a professor of Pediatrics at UC Davis Children's Hospital. She is recognized as an international expert in pediatric diabetic ketoacidosis (DKA), an important complication of diabetes in children. She has led many of the key multi-center studies that guide DKA management. She has also been involved in the development of several national and international guidelines for DKA management in children that guide current practice worldwide.Learning Objectives:By the end of this podcast, listeners should be able to:Describe best practices for triaging patients with DKAExplain the pathophysiology of acute cerebral edema in DKADescribe the evidence and physiologic basis for fluid selection and rate in DKA Describe the evidence supporting insulin infusion rates in pediatric DKA List best practices for lab monitoring in DKA, and how to define when a patient is ready for transition to subcutaneous insulin References: Abramo TJ, Szlam S, Hargrave H, Harris ZL, Williams A, Meredith M, Hedrick M, Hu Z, Nick T, Gonzalez CV. Bihemispheric Cerebral Oximetry Monitoring's Functionality in Suspected Cerebral Edema Diabetic Ketoacidosis With Therapeutic 3% Hyperosmolar Therapy in a Pediatric Emergency Department. Pediatr Emerg Care. 2022 Feb 1;38(2):e511-e518. doi: 10.1097/PEC.0000000000001774. PMID: 30964851.Kuppermann N, Ghetti S, Schunk J, et al. Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis. N Engl J Med. 2018;378:2275-2287.Glaser N, Barnett P, McCaslin I, et al. Risk factors for cerebral edema in children with diabetic ketoacidosis. N Engl J Med. 2001;344:264-269.Bergmann KR, Abuzzahab MJ, Perepelista V, Udeogu J, Qiu L, Lammers S, Nickel A, Watson D, Kharbanda A. Improving Emergency Department Care for Children With Medium- and High-Risk Diabetic Ketoacidosis. Pediatrics. 2025 Oct 1;156(4):e2024068959. doi: 10.1542/peds.2024-068959. PMID: 40907982.UC-Davis-Health-Magazine-Fall-2019.pdfQuestions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

In this episode, we look at new research on mucoactive therapy for bronchiectasis, aspirin use in anticoagulated patients with coronary disease, and sotatercept for early pulmonary arterial hypertension. We explore the genetics behind misdiagnosed common diseases and review uncertainty in medical training. We also share a case of woman with abdominal distention, edema, and pleural effusions and Perspectives on sickle cell disease, fetal personhood, and living with a genetic diagnosis.

Eberechi Nwogu-Onyemkpa is an assistant professor in the Division of Palliative Medicine at Washington University in St. Louis. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. E. Nwogu-Onyemkpa and Others. Involving Palliative Care to Improve Outcomes in Sickle Cell Disease. N Engl J Med 2025;393:1553-1556. E. Costa and Others. Thirty Years of Hydroxyurea for Sickle Cell Anemia — Scientific Progress, Global Health Gaps. N Engl J Med 2025;393:1556-1559.

This is a text-to-speech (TTS) AI reading of our most recent blog post: 6 Facts Every Clinician Needs to Know About Tumor Lysis Syndrome.https://www.pointofcaremedicine.com/blog-post/6-facts-every-clinician-needs-to-know-about-tumor-lysis-syndrome-2025Tumor Lysis Syndrome (NEJM, 2025)Bociek RG, Lunning M. Tumor Lysis Syndrome. N Engl J Med. 2025;393(11):1104-1116. doi:10.1056/NEJMra2300923‍Related ContentTumor Lysis Syndrome Admission Template

In this special series on The Cardiovascular Outcome Trials our host, Dr. Neil Skolnik will discuss the history and importance of the Cardiovascular Outcome Trials for diabetes medications . In Part 1 we discuss an historical perspective with Dr. Steven Nissan and how this has lead to the CVOTs that change the way we practice from EMPA-REG in 2015 to SURPASS-CVOT in 2025. This special episode is supported by an independent educational grant from Lilly. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health Steven Nissen, M.D., Chief Academic Officer of the Heart and Vascular Institute at the Cleveland Clinic and Professor of Medicine at the Clevland Clinic Lerner College of Medicine. Selected references: Nissen SE, Wolski K, Topol EJ. Effect of Muraglitazar on Death and Major Adverse Cardiovascular Events in Patients With Type 2 Diabetes Mellitus. JAMA. 2005;294:2581-2586 Kahn SE, Haffner SM, Heise MA, et al. Glycemic Durability of Rosiglitazone, Metformin, or Glyburide Monotherapy (ADOPT). N Engl J Med 2006;355:2427­43. DREAM trial investigators. Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial. Lancet 2006;368:1096 Nissen SE, Wolski K. Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes. N Engl J Med 2007;356:2457-2471.

On March 7, 2025, we released an episode summarizing key aspects of a NEJM publication regarding male partner therapy for women with recurrent BV. Although that study had limitations, the results were very surprising. Now, on 10/16/25 (7 months later), the ACOG has a new Clinical Practice Update (CPU) on this very issue. In this episode we will briefly summarize that March 2025 NEJM publication and highlight the TWO updated clinical recommendations from the ACOG regarding male partner therapy for the prevention of BV in women. PLUS, we will briefly discuss why although male partner therapy should be considered, partner EPT is “not recommended” at this time by the ACOG. 1. ACOG CLINICAL PRACTICE UPDATE: Concurrent Sexual Partner Therapy to Prevent Bacterial Vaginosis Recurrence Obstetrics & Gynecology ():10.1097/AOG.0000000000006102, October 16, 2025. | DOI: 10.1097/AOG.00000000000061022. Chapa Clinical Pearls March 2025 Episode: https://open.spotify.com/episode/4sW9tTe9CdYVQsCRBjqQQP3. Vodstrcil LA, Plummer EL, Fairley CK, Hocking JS, Law MG, Petoumenos K, et al. Male-partner treatment to prevent recurrence of bacterial vaginosis. N Engl J Med 2025;392:947–57. doi: 10.1056/NEJMoa2405404STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

In this episode, we look at new research in cervical cancer, lupus, gene therapy for immune deficiency, and malaria prevention in infants. We review hair loss in women, follow a case of tuberculosis in advanced HIV, and hear perspectives on vaccines, primary care, digital health, infection surveillance, AI in disaster response, Medicare policy, and bearing witness in conflict zones.

Michael Liu is a resident physician at Brigham and Women's Hospital. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. M. Liu, K.T. Kadakia, and R.K. Wadhera. Proliferation of Prior Authorization in Traditional Medicare — None the WISeR? N Engl J Med 2025;393:1457-1459.

In this episode, we explore new treatments for hypertension, hereditary amyloidosis, and malaria prevention, along with insights on mosquito-borne disease control. We review idiopathic intracranial hypertension, follow a striking case of a hidden foreign body, and hear perspectives on worker safety, immigrant health care, the role of pharmaceutical wholesalers, and the arc of a medical career.

Andrew Gabrielson is a pediatric urology fellow at Lurie Children's Hospital of Chicago. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. A.T. Gabrielson and C. Corwin. Occupational Health and Safety on the Chopping Block — What's at Stake? N Engl J Med 2025;393:1353-1355.

On today's episode we discuss the latest hot topic in the fitness industry - weight loss drug, Retatrutide. What are the benefits? Are there potential side effects? What does this mean for bikini competitors in prep, dieting hard for a show? Follow us on IG @preplifepodcast @glamgirlbikini @amyehinger @leemarie183 Watch on YouTube: Glam Girl Bikini   Join the team: https://www.glamgirlbi...   1st Phorm Supplements we use: https://1stphorm.com/?... Key references • Jastreboff AM, et al. Triple-Hormone-Receptor Agonist Retatrutide for Obesity. N Engl J Med / related publications (phase-2 reports). • Sanyal AJ, et al. Retatrutide and liver fat/liver outcomes. Nature Medicine 2024. • Wilding JPH, et al. Once-weekly semaglutide in adults with overweight or obesity (STEP). N Engl J Med 2021. • Jastreboff AM, et al. Tirzepatide once weekly for obesity (SURMOUNT) and related reports. PubMed/NEJM/SURMOUNT analyses. • Conceição-Furber E, et al. Is glucagon receptor activation the thermogenic solution? Frontiers in Endocrinology, review of GCGR and energy expenditure mechanisms. • Frampton J, et al. The acute effect of glucagon on components of energy expenditure. Int J Obes / Nature Metabolism meta-

Steven Shein, MD, FCCM, is the Chief of Pediatric Critical Care at University Hospitals Rainbow Babies & Children's Hospital in Cleveland, Ohio, and holds the Linsalata Family Distinguished Chair in Pediatric Critical Care and Emergency Medicine. He is also the Co-Director of the PICU Clinical, Basic & Translational Research Program and an Associate Director of the Pediatric Critical Care Medicine Fellowship program. His research focuses on critical bronchiolitis and long-term neuro-cognitive morbidity after critical illness. Jatinder Dhami, MD, is a Pediatric Intensivist at University Hospitals Rainbow Babies & Children's Hospital in Cleveland, Ohio. She completed her pediatrics residency at Penn State in Hershey, PA, and her PICU fellowship at Riley Children's Hospital in Indianapolis, Indiana. She is interested in clinical ethics in pediatric critical illness.Learning Objective:By the end of this podcast, listeners should be able to discuss an evidence-based and expert-guided approach to managing critical bronchiolitis.References:Managing Critical Bronchiolitis David G. Speicher, MD; and Steven L. Shein, MD, FCCMZurca et al. Management of Critical Bronchiolitis. Hosp Pediatr. 2023Plint et al. Epinephrine and dexamethasone in children with bronchiolitis. N Engl J Med. 2009.Schramm et al. Clinical Examination Does Not Predict Response to Albuterol in Ventilated Infants With Bronchiolitis. Pediatr Crit Care Med. 2017Shein at al. Antibiotic Prescription in Young Children With Respiratory Syncytial Virus-Associated Respiratory Failure and Associated Outcomes. Pediatr Crit Care Med. 2019.Gelbart et al. Pragmatic Randomized Trial of Corticosteroids and Inhaled Epinephrine for Bronchiolitis in Children in Intensive Care. J Pediatr. 2022.Shein et al. Derivation and Validation of an Objective Effort of Breathing Score in Critically Ill Children. Pediatr Crit Care Med. 2019.Shein SL, Rotta AT. Long-term NeurocognitQuestions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Featuring articles on severe acute malnutrition with gastroenteritis in children, medical imaging and pediatric cancer risk, moderate hypertriglyceridemia, preventing RSV disease in healthy infants, and treating hypertension in rural South Africa; a review article on monoclonal gammopathy of undetermined significance; a Clinical Problem-Solving on a shifting frame; and Perspectives on insight into corporate governance, on pharmaceutical tariffs, and on OUD medications.

Steven Lipstein is the former chief executive officer of BJC HealthCare. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. S. Lipstein. Insight into Corporate Governance — What Motivates Hospitals and Delivery Systems. N Engl J Med 2025;393:1249-1251.

Featuring articles on heart failure, provoked venous thromboembolism, chronic lymphocytic leukemia, and acute ischemic stroke; a review article on medical education to improve diagnostic equity; a case report of a man with embolic stroke and left ventricular apical aneurysm; two articles on the 2025 Lasker–DeBakey Clinical Medical Research Award; and Perspectives on structural and scientific racism, on the Gates Foundation's final chapter, and on Dr. Kolhouse and the cowboy.

Is that penicillin or amoxicillin allergy real? Probably not. In this episode, we explore how to assess risk, talk to parents, and refer for delabeling. You'll also learn what happens in the allergy clinic, why the label matters, and how to be a better antimicrobial steward. Learning Objectives Describe the mechanisms and clinical manifestations of immediate and delayed hypersensitivity reactions to penicillin, including diagnostic criteria and risk stratification tools such as the PEN-FAST score. Differentiate between low-, moderate-, and high-risk penicillin allergy histories in pediatric patients and identify appropriate candidates for direct oral challenge or allergy referral based on current evidence and guidelines. Formulate an evidence-based approach for evaluating and counseling families in the Emergency Department about reported penicillin allergies, including when to recommend outpatient referral for formal delabeling. Connect with Brad Sobolewski PEMBlog: PEMBlog.com Blue Sky: @bradsobo X (Twitter): @PEMTweets Instagram: Brad Sobolewski References Khan DA, Banerji A, Blumenthal KG, et al. Drug Allergy: A 2022 Practice Parameter Update. J Allergy Clin Immunol. 2022;150(6):1333-1393. doi:10.1016/j.jaci.2022.08.028 Moral L, Toral T, Muñoz C, et al. Direct Oral Challenge for Immediate and Non-Immediate Beta-Lactam Allergy in Children. Pediatr Allergy Immunol. 2024;35(3):e14096. doi:10.1111/pai.14096 Castells M, Khan DA, Phillips EJ. Penicillin Allergy. N Engl J Med. 2019;381(24):2338-2351. doi:10.1056/NEJMra1807761 Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and Management of Penicillin Allergy: A Review.JAMA. 2019;321(2):188–199. doi:10.1001/jama.2018.19283 Transcript Note: This transcript was partially completed with the use of the Descript AI and the Chat GPT 5 AI  Welcome to PEM Currents, the Pediatric Emergency Medicine podcast. As always, I'm your host, Brad Sobolewski, and today we are taking on a label that's misleading, persistent. Far too common penicillin allergy, it's often based on incomplete or inaccurate information, and it may end up limiting safe and effective treatment, especially for the kids that we see in the emergency department. I think you've all seen a patient where you're like. I don't think this kid's really allergic to amoxicillin, but what do you do about it? In this episode, we're gonna break down the evidence, walk through what actually happens during de labeling and dedicated allergy clinics. Highlight some validated tools like the pen FAST score, which I'd never heard of before. Preparing for this episode and discuss the current and future role of ED based penicillin allergy testing. Okay, so about 10% of patients carry a penicillin allergy label, but more than 90% are not truly allergic. And this label can be really problematic in kids. It limits first line treatment choices like amoxicillin, otitis media, or penicillin for strep throat, and instead. Kids get prescribed second line agents that are less effective, broader spectrum, maybe more toxic or poorly tolerated and associated with a higher risk of antimicrobial resistance. So it's not just an EMR checkbox, it's a label with some real clinical consequences. And it's one, we have a role in removing. And so let's understand what allergy really means. And most patients with a reported penicillin allergy, especially kids, aren't true allergies in the immunologic sense. Common misinterpretations include a delayed rash, a maculopapular, or viral exum, or benign, delayed hypersensitivity, side effects, nausea, vomiting, and diarrhea. And unverified childhood reactions that are undocumented and nonspecific. Most of these are not true allergies. Only a very small subset of patients actually have IgE mediated hypersensitivity, such as urticaria, angioedema, wheezing, and anaphylaxis. These are super rare, and even then they may resolve over time without treatment. If a parent or sibling has a history of a penicillin allergy, remember that patient might actually not be allergic, and that is certainly not a reason to label a child as allergic just because one of their first degree relatives has an allergy. So right now, in 2025, as I'm recording this episode, there are clinics like the Pats Clinic or the Penicillin Allergy Testing Services at Cincinnati Children's and in a lot of our peer institutions that are at the forefront of modern de labeling. Their approach reflects the standard of care as outlined by the. Quad ai or the American Academy of Allergy, asthma and Immunology and supported by large trials like Palace. And you know, you have a great trial if you have a great acronym. So here's what happens step by step. So first you stratify the risk. How likely is this to be a true allergy? And that's where a tool like the pen fast comes. And so pen fast scores, a decision rule developed to help assess the likelihood of a true penicillin allergy based on the patient's history. The pen in pen fast is whether or not the patient has a self-reported history of penicillin allergy. They get two points if the reaction occurred in the past five years. Two points if the reaction is anaphylaxis or angioedema. One point if the reaction required treatment, and one point if the reaction was not due to testing. And so you can get a total score of. Up to six points. If you have a score of less than three. This is a low risk patient and they can be eligible for direct oral challenge. A score greater than three means they're higher risk and they may require skin testing. First validation studies show that the PEN FFA score of less than three had a negative predictive value of 96.3%. Meaning a very, very low chance of a true allergy. And this tool has been studied more extensively in adults, but pediatric specific adaptations are emerging, and they do inform current allergy clinic protocols. But I would not use this score in the emergency department just to give a kid a dose of amoxicillin. So. For low risk patients, a pen fast score of less than three or equivalent clinical judgment clinics proceed with direct oral challenge with no skin testing required. The protocol is they administer one dose of oral amoxicillin and they observe for 62 120 minutes monitoring for signs of reaction Urticaria. Respiratory symptoms or GI upset. This approach is safe and effective. There was a trial called Palace back in 2022, which validated this in over 300 children. In adolescents. There were no serious events that occurred. De labeling was successful in greater than 95% of patients. And skin tested added no benefit in low risk patients. So if the child tolerates this dose, then you can remove that allergy immediately from the chart. Parents and primary care doctors will receive a summary letter noting that the challenge was successful and that there's new guidance. Children and families are told they can safely receive all penicillins going forward. And providers are encouraged to document this clearly in the allergy section of the EMR. So you're wondering, can we actually do this in the emergency department? Technically, yes, you can do what you want, but practically we're not quite there yet. So we'd need clearer risk stratification tools like the Pen fast, a safe place for monitoring, post challenge, clinical pathways and documentation support. You know, a clear way to update EMR allergy labels across the board and involvement or allergy or infectious disease oversight. But it's pretty enticing, right? See a kid you diagnose otitis media. You think that their penicillin allergy is wrong, you just give 'em a dose of amox and watch 'em for an hour. That seems like a pretty cool thing that we might be able to do. So some centers, especially in Canada and Australia, do have some protocols for ED or inpatient based de labeling, but they rely on that structured implementation. So until then, our role in the pediatric emergency department is to identify low risk patients, avoid over document. Unconfirmed reactions and refer to allergy ideally to a clinic like the pets. So who should be referred and good candidates Include a child with a rash only, especially one that's remote over a year ago. Isolated GI symptoms. Parents unsure of the details at all. No history of anaphylaxis wheezing her hives, and no recent serious cutaneous reactions. I would avoid referring and presume that this allergy is true. If they've had recent anaphylaxis, they've had something like Stevens Johnson syndrome dress, or toxic epidermolysis necrosis. Fortunately, those are very, very rare with penicillins and there's a need for penicillin during the ED visit without allergy backup. So even though we don't have an ED based protocol yet. De labeling amoxicillin or penicillin allergy can start with good questions in the emergency department. So here's one way to talk to patients and families. You can say, thanks for letting me know about the amoxicillin allergy. Can I ask you a few questions to better understand what happened? This is gonna help us decide the safest and most effective treatment for your child today, and then possibly go through a process to remove a label for this allergy that might not be accurate. You wanna ask good, open-ended questions. What exactly happened when your child took penicillin or amoxicillin? You know, look for rash, hives, swelling, trouble breathing, or anaphylaxis. Many families just say, allergic, when the reaction was just GI upset, diarrhea or vomiting, which is not an allergy. How old was your child when this happened? Reactions that occurred before age of three are more likely to be falsely attributed. How soon after taking the medicine did the reaction start? Less than one hour is an immediate reaction, but one hour to days later is delayed. Usually mild and probably not a true allergy. Did they have a fever, cold or virus at that time? Viral rashes are often misattributed to antibiotics, and we shouldn't be treating viruses with antibiotics anyway, so get good at looking at ears and know what you're seeing. And have they taken similar antibiotics since then? Like. Different penicillins, Augmentin, or cephalexin. So if they said that they were allergic to amoxicillin, but then somehow tolerated Augmentin. They're not allergic. If a patient had rash only, but no hive swelling or difficulty breathing, no reaction within the first hour. It occurred more than five years ago or before the kid was three. And especially if they tolerated beta-lactam antibiotics. Since then, they're a great candidate for de labeling and I would refer that kid to the allergy clinic. Generally, they can get them in pretty darn quick. Alright, we're gonna wrap up this episode. Most kids labeled penicillin allergic or amoxicillin allergic, or not actually allergic to the medication. There are some scores like pen fasts that are validated tools to assess risk and support de labeling. Direct oral challenge for most patients is safe, efficient, and increasingly the standard of care. There are allergy clinics like the Pats at Cincinnati Children's that can dela children in a single visit with oral challenges alone, needing no skin testing, and emergency departments can play a key role in identifying and referring these patients and possibly de labeling ourselves in the future. Well, that's all for this episode on Penicillin Allergy. I hope you learn something new, especially how to assess whether an allergy label is real, how to ask the right questions and when to refer to an allergy testing clinic. If you have feedback, send it my way. Email, comment on the blog, a message on social media. I always appreciate hearing from you all, and if you like this episode, please leave a review on your favorite podcast app. Really helps more people find the show and that's great 'cause I like to teach people stuff. Thanks for listening for PEM Currents, the Pediatric Emergency Medicine podcast. This has been Brad Sobolewski. See you next time.

Nancy Krieger is a professor of social epidemiology at the Harvard T.H. Chan School of Public Health. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. N. Krieger and M.T. Bassett. Structural and Scientific Racism, Science, and Health — Evidence versus Ideology. N Engl J Med 2025;393:1145-1148.

In this special episode on Obstructive Sleep Apnea our host, Dr. Neil Skolnik will discuss treatment of OSA. In Part 1 we discussed an overview of OSA, in Part 2 we discussed making the diagnosis, Part 3 was treatment, and in Part 4 we bring it all together with a case to explore clinical decision making for OSA. This special episode is supported by an independent educational grant from Lilly. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health Dr. Sanjay Patel, M.D, Professor of Medicine, Epidemiology, & Clinical and Translational Science, and Director of the Center for Sleep and Cardiovascular Outcomes Research; Medical Director of the Comprehensive Sleep Disorders Program, University of Pittsburgh Medical Center Susan Kuchera, M.D. - Clinical Associate Professor of Family and Community Medicine at the Sidney Kimmel Medical College of Thomas Jefferson University and Program Director of the Family Medicine Residency at Jefferson Health Abington. Selected references: Diagnosis and Management of Obstructive Sleep Apnea - A Review. JAMA. 2020;323(14):1389-1400 Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity. N Engl J Med 2024;391:1193-1205  

In this World Shared Practice Forum Podcast, Dr. Kathryn Maitland discusses the findings of the GASTROSAM trial, which investigates the safety and efficacy of intravenous rehydration for children with severe acute malnutrition and gastroenteritis. The trial explores the effectiveness of intravenous fluids as a safe alternative to current rehydration guidelines for malnourished children. Dr. Maitland reviews the trial's design, key outcomes, and implications for clinical practice, providing valuable insights for healthcare professionals involved in pediatric care in resource-limited settings. LEARNING OBJECTIVES - Understand the key findings of the GASTROSAM trial and their implications for rehydration practices in children with severe acute malnutrition. - Identify the challenges and limitations of current rehydration guidelines for malnourished children in resource-limited settings. - Discuss the safety concerns associated with intravenous rehydration and how the GASTROSAM trial addresses these issues. - Explore the importance of simplifying the rehydration guidelines for children in resource-limited settings AUTHORS Kathryn Maitland, FMedSc, OBE Professor of Tropical Paediatric Infectious Disease Department of Surgery & Cancer Faculty of Medicine Director of ICCARE Centre at the Institute for Global Health Innovation, Imperial College, London Jeffrey Burns, MD, MPH Emeritus Chief Division of Critical Care Medicine Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital Professor of Anesthesia Harvard Medical School DATE Initial publication date: September 22, 2025. ARTICLES REFERENCED - Maitland K, Ouattara SM, Sainna H, et al. Intravenous Rehydration for Severe Acute Malnutrition with Gastroenteritis. N Engl J Med. Published online June 13, 2025. doi:10.1056/NEJMoa2505752 - Maitland K, Kiguli S, Opoka RO, et al. Mortality after fluid bolus in African children with severe infection. N Engl J Med. 2011;364(26):2483-2495. doi:10.1056/NEJMoa1101549 - Brent B, Obonyo N, Akech S, et al. Assessment of Myocardial Function in Kenyan Children With Severe, Acute Malnutrition: The Cardiac Physiology in Malnutrition (CAPMAL) Study. JAMA Netw Open. 2019;2(3):e191054. Published 2019 Mar 1. doi:10.1001/jamanetworkopen.2019.1054 TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/at/xvv7vchn4skmc6m6wv25xfw/UPDATED_202509_WSP_Maitland_Transcript.pdf Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Maitland K, Burns JP. GASTROSAM Key Insights: Safe Rehydration for Malnourished Children. 09/2025. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/gastrosam-key-insights-safe-rehydration-for-malnourished-children-by-k-maitland-openpediatrics.

In this second-ever collaboration between SIDP's Breakpoints and ESCMID's Communicable podcasts, hosts Erin McCreary and Angela Huttner invite the two principal investigators and visionaries who spearheaded the Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness (BALANCE) trial, Nick Daneman and Rob Fowler from Sunnybrook Health Sciences Centre in Toronto, for a “deep dive into all things that went into this trial.” The BALANCE trial spanned over ten years investigating - as the acronym title suggests - whether a shorter treatment duration of seven days was non-inferior to the standard of care of fourteen days for bacteremia. The conversation covers everything from the initial hallway discussions that sparked the trial, the trial itself that screened over 36,000 patients and enrolled +3,600, its impact on clinical practice, key takeaways, and what's next for Daneman and Fowler. References: BALANCE Investigators, et al. Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections. N Engl J Med. 2025 March. DOI: https://doi.org/10.1056/NEJMoa2404991

In this second-ever collaboration between SIDP's Breakpoints and ESCMID's Communicable podcasts, hosts Erin McCreary and Angela Huttner invite the two principal investigators and visionaries who spearheaded the Bacteraemia Antibiotic Length Actually Needed for Clinical Effectiveness (BALANCE) trial, Nick Daneman and Rob Fowler (Sunnybrook Health Sciences Centre, Toronto), for a “deep dive into all things that went into this trial” (1). The BALANCE trial spanned over ten years investigating - as the acronym title suggests - whether a shorter treatment duration of seven days was non-inferior to the standard of care of fourteen days for bacteraemia. The conversation covers everything from the initial hallway discussions that sparked the trial to the trial itself that screened over 36,000 patients and enrolled +3,600, its key takeaways and its impact on clinical practice as well as what's next for Daneman and Fowler.This episode was edited by Kathryn Hostettler and Megan Klatt, and peer reviewed by Dr. Arjana Zerja of Mother Theresa University Hospital Centre, Tirana, Albania.Related podcast episodesCommunicable episode 36: Finding BALANCE in antibiotic durations—the BALANCE trial https://share.transistor.fm/s/b680895eCommunicable episode 26: SNAP out of it—rethinking anti-staphylococcal penicillins for S. aureus bacteremia, the SNAP trial PSSA/MSSA results https://share.transistor.fm/s/2a3c3bb4Breakpoints episode covering IDWeek (December 2024) https://breakpoints-sidp.org/108-idweek-2024-recap-late-breaker-abstracts-and-stewardship-talks/ ReferencesBALANCE Investigators, et al.  Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections. N Engl J Med. 2025 March. DOI: 10.1056/NEJMoa2404991Further reading Fowler VG. Eight days a week – BALANCING duration and efficacy. N Engl J Med. 2025 March. DOI: 10.1056/NEJMe2414037   Dulhunty JM, et al. Continuous vs Intermittent β-Lactam Antibiotic Infusions in Critically Ill Patients With Sepsis: The BLING III Randomized Clinical Trial. JAMA 2024. DOI: 10.1001/jama.2024.9779  Yahav D, et al. Seven versus 14 days of antibiotic therapy for uncomplicated Gram-negative bactermia: A noninferiority randomized controlled trial. Clin Infect Dis 2018. DOI: 10.1093/cid/ciy1054 Von Dach E, et al. Effect of C-reactive protein-guided antibiotic treatment duration, 7-day treatment, or 14-day treatment on 30-day clinical failure rate in patients with uncomplicated Gram-negative bacteremia, a randomized clinical trial. JAMA 2020. DOI: 10.1001/jama.2020.6348 Ong SWX, et al. Identifying heterogeneity of treatment effect for antibiotic duration in bloodstream infection: an exploratory post-hoc analysis of the BALANCE randomised clinical trial. EClinicalMedicine 2025. DOI: 10.1016/j.eclinm.2025.103195Wallach JD, et al. Evaluation of evidence of statistical support and corroboration of subgroup claims in randomized clinical trials. JAMA Intern Med 2017. DOI: 10.1001/jamainternmed.20169125

Stress isn't just something to “manage” — it's a signal, a teacher, and often, an invitation to look deeper at our health, our choices, and our lives. In this solo episode, Darin reframes stress not as an enemy, but as a dashboard light pointing toward misalignments in our nervous system, environment, relationships, and purpose. Drawing on science, practical tools, and personal insight, Darin reveals how layered stress silently drains our vitality — and how to transform it into an ally for growth, healing, and deeper contentment. Whether it's hidden trauma, toxic environments, unresolved conflict, or the modern distractions constantly pulling at our attention, Darin lays out a roadmap to stop the leaks and reclaim the energy already within you. This episode is a powerful reminder: stress isn't the end of the story — it's the beginning of awareness, safety, and a super life.     What You'll Learn in This Episode [00:00] Introduction to the Super Life podcast [03:27] Why stress might not be your enemy [04:17] Stress as an ally: the signals it gives us about misalignment [04:32] The dashboard light metaphor: how stress reveals hidden issues [05:28] The illusion of “no choice” and the infinite possibilities always available [06:12] Global stress statistics and why most people underestimate their stress load [07:23] Hidden stress revealed through heart rate variability and physiology [08:23] Layered stress: how sleep, exercise, and poor choices compound each other [09:25] Safety vs. calm — why your nervous system craves safety first [10:15] Trauma and the unconscious mind: how old wounds drive our stress response [11:54] Inner narratives and negative self-talk as hidden stress multipliers [12:22] The role of community and your social field in stress and resilience [13:53] Relationships, honesty, and how your circle shapes your energy [14:55] Why boundaries around media and politics are vital for mental clarity [17:42] Finding micro-purpose when life feels overwhelming [18:52] Environmental layers of stress — light, air, and clutter [19:15] The existential layer: stress from living without service or purpose [20:12] Stress as a risk amplifier — how it undermines healing and health [20:55] The deeper truth of safety, connection, and higher power [23:00] Practical tools: breathing, grounding, nature, and conscious choices [24:01] Trauma reframed: not a problem, but a protector at the time [25:25] Lessons from Peter Levine and wild animals: releasing trauma physically [26:04] Questions to ask trauma: “What are you protecting me from?” [26:56] Stress as a multiplier of aging, disease, and poor outcomes [29:20] Why stress isn't a single cause — it's layered and chronic [30:18] Anti-stress strategies: circadian rhythm, nature, and gratitude [31:49] Energy leaks to avoid: clutter, poor food, scrolling, bad boundaries [32:22] What matters most: service, contribution, and alignment [33:28] Final toolkit: breathwork, movement, nature, sleep, and gratitude [34:38] The deeper invitation: step into sovereignty and live your SuperLife     Thank You to Our Sponsors: Manna Vitality: Go to mannavitality.com/  or use code DARIN20 for 20% off your order. Bite Toothpaste: Go to trybite.com/DARIN20 or use code DARIN20 for 20% off your first order.     Find More from Darin Olien: Instagram: @darinolien Podcast: SuperLife Podcast Website: superlife.com Book: Fatal Conveniences Check out my podcast with Dr. Amy Abbington     Key Takeaway “Stress is not the enemy. It's a dashboard light — a teacher showing you where you're out of alignment. When you reframe stress, you reclaim your energy and create space for healing, safety, and the joy of living a super life.”     Bibliography (selected, peer-reviewed) Sources: Gallup Global Emotions (2024); Gallup U.S. polling (2024); APA Stress in America (2023); Natarajan et al., Lancet Digital Health (2020); Orini et al., UK Biobank (2023); Martinez et al. (2022); Leiden University (2025). Cohen S, Tyrrell DA, Smith AP. Psychological stress and susceptibility to the common cold. N Engl J Med.1991;325(9):606–612. New England Journal of Medicine Cohen S, et al. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proc Natl Acad Sci USA. 2012;109(16):5995–5999. PNAS Kiecolt-Glaser JK, et al. Slowing of wound healing by psychological stress. Lancet. 1995;346(8984):1194–1196. The Lancet Kiecolt-Glaser JK, et al. Hostile marital interactions, proinflammatory cytokine production, and wound healing.Arch Gen Psychiatry. 2005;62(12):1377–1384. JAMA Network Tawakol A, et al. Relation between resting amygdalar activity and cardiovascular events. Lancet.2017;389(10071):834–845. The Lancet Epel ES, et al. Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci USA.2004;101(49):17312–17315. PNAS McEwen BS, Stellar E. Stress and the individual: mechanisms leading to disease. Arch Intern Med.1993;153(18):2093–2101. PubMed McEwen BS, Wingfield JC. Allostasis and allostatic load. Ann N Y Acad Sci. 1998;840:33–44. PubMed Felitti VJ, et al. Relationship of childhood abuse and household dysfunction to many leading causes of death in adults (ACE Study). Am J Prev Med. 1998;14(4):245–258. AJP Mon Online Edmondson D, et al. PTSD and cardiovascular disease. Ann Behav Med. 2017;51(3):316–327. PMC Afari N, et al. Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis.Psychosom Med. 2014;76(1):2–11. PMC Goyal M, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014;174(3):357–368. PMC Qiu Q, et al. Forest therapy: effects on blood pressure and salivary cortisol—a meta-analysis. Int J Environ Res Public Health. 2022;20(1):458. PMC Laukkanen T, et al. Sauna bathing and reduced fatal CVD and all-cause mortality. JAMA Intern Med.2015;175(4):542–548. JAMA Network Zureigat H, et al. Physical activity lowers CVD risk by reducing stress-related neural activity. J Am Coll Cardiol.2024;83(16):1532–1546. PMC Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med.2010;7(7):e1000316. PMC Chen Y-R, Hung K-W. EMDR for PTSD: meta-analysis of RCTs. PLoS One. 2014;9(8):e103676. PLOS Hoppen TH, et al. Network/pairwise meta-analysis of PTSD psychotherapies—TF-CBT highest efficacy overall.Psychol Med. 2023;53(14):6360–6374. PubMed van der Kolk BA, et al. Yoga as an adjunctive treatment for PTSD: RCT. J Clin Psychiatry. 2014;75(6):e559–e565. PubMed Kelly U, et al. Trauma-center trauma-sensitive yoga vs CPT in women veterans: RCT. JAMA Netw Open.2023;6(11):e2342214. JAMA Network Bentley TGK, et al. Breathing practices for stress and anxiety reduction: components that matter. Behav Sci (Basel). 2023;13(9):756. 

Featuring articles on PI3K-altered colorectal cancer, type 2 diabetes, oral semaglutide, and proportional-assist ventilation; a review article on tumor lysis syndrome; a case report of a girl with chest pain and bone and liver lesions; and Perspectives on integrating pharmacotherapy into tobacco control, on Medicaid enrollees with chronic conditions, and on ultraprocessed food.

John Ayanian is the director of the Institute for Healthcare Policy and Innovation at the University of Michigan. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. J.Z. Ayanian. Protecting Medicaid Enrollees with Chronic Conditions amid Work Requirements. N Engl J Med 2025;393:1044-1046.

Silvia and Rodrigo are joined by Dr Ray Wang, Director of the multidisciplinary Foundation of Caring Lysosomal Storage Disorder Program at the Children's Hospital of Orange County. Silvia asks Dr Wang and Rodrigo (who also happens to be a researcher in this field) about cutting-edge advances in LSD research: from base editing in Pompe disease and patient-specific in vivo gene editing, to new biomarkers and scoring systems in Gaucher disease, insights into lipid dysregulation across lysosomal storage disorders, and the first clinical trial of anakinra in Sanfilippo syndrome. Papers discussed include: Christensen CL, et al Base editing rescues acid α-glucosidase function in infantile-onset Pompe disease patient-derived cells. Mol Ther Nucleic Acids. 2024 May 21;35(2):102220. doi: 10.1016/j.omtn.2024.102220. PMID: 38948331; PMCID: PMC11214518. Starosta RT, et al Predicting liver fibrosis in Gaucher disease: Investigation of contributors and development of a clinically applicable Gaucher liver fibrosis score. Mol Genet Metab. 2025 Feb;144(2):109010. doi: 10.1016/j.ymgme.2025.109010. Epub 2025 Jan 3. PMID: 39788861. Kell P, et al Secondary accumulation of lyso-platelet activating factors in lysosomal storage diseases. Mol Genet Metab. 2025 Jun 17;145(4):109180. doi: 10.1016/j.ymgme.2025.109180. Polgreen LE, et al Anakinra in Sanfilippo syndrome: a phase 1/2 trial. Nat Med. 2024 Sep;30(9):2473-2479. doi: 10.1038/s41591-024-03079-3. Epub 2024 Jun 21. Erratum in: Nat Med. 2024 Sep;30(9):2693. doi: 10.1038/s41591-024-03207-z. Musunuru K, et al Patient-Specific In Vivo Gene Editing to Treat a Rare Genetic Disease. N Engl J Med. 2025 Jun 12;392(22):2235-2243. doi: 10.1056/NEJMoa2504747.

Featuring articles on hypertrophic cardiomyopathy, rehabilitation after myocardial infarction in older adults, the 2024 Marburg virus disease outbreak in Rwanda, and medications for opioid use disorder in county jails; a case report of a woman with dyspnea and fatigue; a Medicine and Society on the race-correction debates; and Perspectives on recent efforts toward equity, on medical research funding in a divided America, and on the end of days.

Amanda Janitz is an associate professor at the University of Oklahoma Health Sciences Hudson College of Public Health. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. A.E. Janitz and Others. Improving Care Coordination for Indigenous Patients with Cancer. N Engl J Med 2025;393:940-942.

Darshali Vyas is a pulmonary and critical care fellow at Massachusetts General Hospital. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. D.A. Vyas, L.G. Eisenstein, and D.S. Jones. The Race-Correction Debates — Progress, Tensions, and Future Directions. N Engl J Med 2025;393:1029-1036.

Summer hikes and backyard play mean we're bound to see a few snakebites in the ED—and getting the first steps right makes all the difference. In the first half of this 2 part series, Medical Toxicologist Dr. Jonathan Ford joins us to walk through the key steps in caring for patients with snake envenomations. We'll walk through what to do (and not to do) in terms of pre-hospital care, how to triage and assess patients when they arrive in the ED, and how to decide which patients need antivenom. Dr. Ford reviews dosing strategies, monitoring, and key considerations for children, elderly, and pregnant patients. And we discuss practical guidance on supportive care, from pain control to wound management. By the end of this episode, you'll be ready to provide effective, evidence-based care for your next snakebite patient. Have you had a patient with a serious or challenging envenomation?  How did you manage it? Share your story with us social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. Jonathan Ford, Professor of Emergency Medicine and Medical Toxicologist at UC Davis Resources: Seifert SA, Armitage JO, Sanchez EE. Snake Envenomation. N Engl J Med. 2022 Jan 6;386(1):68-78. doi: 10.1056/NEJMra2105228. PMID: 34986287; PMCID: PMC9854269. **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Featuring articles on obesity, type 1 diabetes, syphilis, and heparin-induced thrombocytopenia; a review article on the management of acute type B aortic dissection; a Clinical Problem-Solving describing a fruitful workup; and Perspectives on the corporatization deal, on advancing physician-scientist training in China, and on the rise of drug innovation in China.

Amitabh Chandra is a professor of public policy at the Harvard Kennedy School of Government and a professor of business administration at Harvard Business School. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. A. Chandra and M. Shepard. The Corporatization Deal — Health Care, Investors, and the Profit Priority. N Engl J Med 2025;393:833-835.

Drs. Whitney Hartlage (@whithartlage11) and Sam Windham join Dr. Ryan Moenster to discuss updates in the diagnosis and management of community-acquire pneumonia. Hear from our guests on the role of rapid diagnostic tests such as multiplex PCR and urinary antigen tests in the inpatient and outpatient setting, considerations for initiating steroids and withholding macrolides, and when to use short antibiotic durations. Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/. Visit our website! https://breakpoints-sidp.org/ References: Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, Cooley LA, Dean NC, Fine MJ, Flanders SA, Griffin MR, Metersky ML, Musher DM, Restrepo MI, Whitney CG. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67. doi: 10.1164/rccm.201908-1581ST. PMID: 31573350; PMCID: PMC6812437. Chaudhuri D, Nei AM, Rochwerg B, Balk RA, Asehnoune K, Cadena R, Carcillo JA, Correa R, Drover K, Esper AM, Gershengorn HB, Hammond NE, Jayaprakash N, Menon K, Nazer L, Pitre T, Qasim ZA, Russell JA, Santos AP, Sarwal A, Spencer-Segal J, Tilouche N, Annane D, Pastores SM. 2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia. Crit Care Med. 2024 May 1;52(5):e219-e233. doi: 10.1097/CCM.0000000000006172. Epub 2024 Jan 19. PMID: 38240492. Odeyemi Y, Tekin A, Schanz C, Schreier D, Cole K, Gajic O, Barreto E. Comparative effectiveness of azithromycin versus doxycycline in hospitalized patients with community acquired pneumonia treated with beta-lactams: A multicenter matched cohort study. Clin Infect Dis. 2025 May 16:ciaf252. doi: 10.1093/cid/ciaf252. Epub ahead of print. PMID: 40378193. Butler AM, Nickel KB, Olsen MA, Sahrmann JM, Colvin R, Neuner E, O'Neil CA, Fraser VJ, Durkin MJ. Comparative safety of different antibiotic regimens for the treatment of outpatient community-acquired pneumonia among otherwise healthy adults. Clin Infect Dis. 2024 Oct 23:ciae519. doi: 10.1093/cid/ciae519. Epub ahead of print. PMID: 39442057; PMCID: PMC12355227. Furukawa Y, Luo Y, Funada S, Onishi A, Ostinelli E, Hamza T, Furukawa TA, Kataoka Y. Optimal duration of antibiotic treatment for community-acquired pneumonia in adults: a systematic review and duration-effect meta-analysis. BMJ Open. 2023 Mar 22;13(3):e061023. doi: 10.1136/bmjopen-2022-061023. PMID: 36948555; PMCID: PMC10040075 Schober T, Wong K, DeLisle G, et al. Clinical outcomes of rapid respiratory virus testing in emergency departments. JAMA Intern Med. 2024;184(5):528-536. Clark T, Lindsley K, Wigmosta T, et al. Rapid multiplex PCR for respiratory viruses reduces time to result and improves clinical care: results of a systematic review and meta-analysis. J Infect. 2023;86(5):462-475. May L, Robbins EM, Canchola JA, Chugh K, Tran NK. A study to assess the impact of the cobas point-of-care RT-PCR assay (SARS-CoV-2 and Influenza A/B) on patient clinical management in the emergency department of the University of California at David Medical Center. J Clin Virol. 2023:168:105597. Cartuliares MB, Rosenvinge FS, Mogensen CB, Skovsted TA, Andersen SL, Østergaard C, et al. Evaluation of point-of-care multiplex polymerase chain reaction in guiding antibiotic treatment of patients acutely admitted with suspected community-acquired pneumonia in Denmark: a multicentre randomised controlled trial. PLoS Med. 2023;20:e1004314. doi: 10.1371/ journal.pmed.1004314. Vaughn VM, Dickson RP, Horowitz JK, Flanders SA. Community-acquired pneumonia: a review. JAMA. 2024;332(15):1282-1295. Davis MR, McCreary EK, Trzebucki AM. Things we do for no reason – ordering Streptococcus pneumoniae urinary antigen in patients with community-acquired pneumonia. Open Forum Infect Dis. 2024;11(3):ofae089. Centers for Disease Control and Prevention. Laboratory Testing for Legionella. Updated June 9, 2025. Accessed July 13, 2025. https://www.cdc.gov/legionella/php/laboratories/index.html. Jain S, Self WH, Wunderink RG. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015;373(5):415-427. Kamat IS, Ramachandram V, Eswaran H, Guffey D, Musher DM. Procalcitonin to distinguish viral from bacterial pneumonia: a systematic review and meta-analysis. Clin Infect Dis. 2020;70(3):538-542. Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single blinded intervention trial. Lancet. 2004;363:600–7. doi: 10.1016/S0140- 6736(04)15591-8. Schuetz P, Christ-Crain M, Thomann R, Falconnier C, Wolbers M, Widmer I, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA. 2009;302:1059–66. Schuetz P, Muller B, Christ-Crain M, Stolz D, Tamm M, Bouadma L, et al. Procalci- € tonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Datab System Rev. 2017;10(10):CD007498. doi: 10.1002/14651858. cd007498.pub2. Huang DT, Yealy DM, Filbin MR, Brown AM, Chang C-CH, Doi Y, et al. Procalcitonin-guided use of antibiotics for lower Respiratory tract infection. New Engl J Med. 2018;379:236–49. doi: 10.1056/NEJMoa1802670. Dequin PF, Meziani F, Quenot JP, et al. Hydrocortisone in severe community-acquired pneumonia. N Engl J Med. 2023;389(19):1623-1634. doi:10.1056/NEJMoa2215145. Gupta AB, Flanders SA, Petty LA, et al. Inappropriate diagnosis of pneumonia among hospitalized adults. JAMA Intern Med. 2024;184(5):548-556. Jones BE, Chapman AB, Ying J, et al. Diagnostic Discordance, Uncertainty, and Treatment Ambiguity in Community-Acquired Pneumonia: A National Cohort Study of 115 U.S. Veterans Affairs Hospitals. Ann Intern Med. 2024;177(9):1179-1189. doi:10.7326/M23-2505. Hartlage W, Imlay H, Spivak ES. The role of empiric atypical antibiotic coverage in non-severe community-acquired pneumonia. Antimicrob Steward Healthc Epidemiol. 2024;4(1):e214. doi:10.1017/ash.2024.453. Dinh A, Barbier F, Bedos JP, et al. Update of guidelines for management of community acquired pneumonia in adults by the French Infectious Disease Society (SPILF) and the French-Speaking Society of Respiratory Diseases (SPLF). Endorsed by the French Infectious Disease Society (SPILF) and the French-Speaking Society of Respiratory Diseases (SPLF); endorsed by the French Intensive Care Society (SRLF), the French Microbiology Society (SFM), the French Radiology Society (SFR), and the French Emergency Society (SFMU). Respir Med and Res. 2025. El Moussaoui R, de Borgie CAJM, van den Broek P, et al. Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate-severe community acquired pneumonia: randomised, double blind study. BMJ. 2006;332(7554):1355. doi:10.1136/bmj.332.7554.1355. Dinh A, Ropers J, Duran C, et al. Discontinuing β-lactam treatment after 3 days for patients with community-acquired pneumonia: a randomized, non-inferiority trial. Lancet. 2021;397(10280):1195-1203.

Featuring articles on lung cancer, vasomotor symptoms in breast cancer, autoimmune pulmonary alveolar proteinosis, and high-risk cutaneous squamous-cell carcinoma; a review article on educational strategies for clinical supervision of AI use; a case report of a woman with fatigue and myalgias; a Sounding Board on vaccine policy in the U.S.; and Perspectives on preventive care at the Supreme Court, regulating private equity in health care, reforming the prescription drug user fee program, and on the consultant.

We've covered pre-oxygenation strategies and intubation alot on this podcast, mayber more than anyting else. We covered the definition of FPS in E74, the DEVICE trial on DL vs VL in E75, and the PREOXI trial of NIV vs Mask Pre-oxygenation in E86. Now we have another Preoxygenation paper, this one that reports no difference between preoxygenation with BVM and face mask. WTAF? Better listen, because it turns out words matter, definitions are... definitional, and we absolutely MUST read more than just the abstract.  Citations:1.     Gottlieb M, Alexander R, Love AK: Comparison of Preoxygenation Strategies for Intubation of Critically Ill Patients. Annals of Emergency Medicine. doi: 10.1016/j.annemergmed.2025.06.621 (Epub ahead of print).2.     Chou CD, Palakshappa JA, Haynie H, Garcia K, Long D, Gibbs KW, White HD, Ghamande S, Dagan A, Stempek S, et al.: Association of Two Preoxygenation Approaches With Hypoxemia During Tracheal Intubation: A Secondary Analysis. Annals of Emergency Medicine. doi: 10.1016/j.annemergmed.2025.06.003 (Epub ahead of print).3.     Pitre T, Liu W, Zeraatkar D, Casey JD, Dionne JC, Gibbs KW, Ginde AA, Needham-Nethercott N, Rice TW, Semler MW, et al.: Preoxygenation strategies for intubation of patients who are critically ill: a systematic review and network meta-analysis of randomised trials. The Lancet Respiratory Medicine. 2025;July;13(7):585–96.4.     Gibbs KW, Semler MW, Driver BE, Seitz KP, Stempek SB, Taylor C, Resnick-Ault D, White HD, Gandotra S, Doerschug KC, et al.: Noninvasive Ventilation for Preoxygenation during Emergency Intubation. N Engl J Med. doi: 10.1056/NEJMoa2313680 (Epub ahead of print).5.     Prekker ME, Driver BE, Trent SA, Resnick-Ault D, Seitz KP, Russell DW, Gaillard JP, Latimer AJ, Ghamande SA, Gibbs KW, et al.: Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. N Engl J Med. 2023;June 16;389(5):418–29.6.     Trent SA, Kaji AH, Carlson JN, McCormick T, Haukoos JS, Brown CA, National EARI: Video Laryngoscopy is Associated With First-Pass Success in Emergency Department Intubations for Trauma Patients: A Propensity Score Matched Analysis of the National Emergency Airway Registry. Ann Emerg Med. doi: 10.1016/j.annemergmed.2021.07.115 (Epub ahead of print).