Podcasts about The New England Journal of Medicine

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.

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.

At the Heart Failure Society of America (HFSA) Annual Scientific Meeting 2025, hosts Muthiah Vaduganathan, MD, MPH, a cardiologist and codirector of the Center for Cardiometabolic Implementation Science at Brigham and Women's Hospital, and Stephen Greene, MD, an advanced heart failure specialist at Duke University School of Medicine, discussed the evolving role of oral diuretic intensification as a potential endpoint in heart failure clinical trials. Historically, endpoints progressed from all-cause mortality to cardiovascular mortality, then to composites that included heart failure hospitalization and urgent outpatient visits. Recent trials have gone further, considering changes in oral loop diuretic therapy as signals of worsening disease. The rationale for including oral diuretic intensification is its frequency, prognostic value, and potential to increase event capture in trials. Data from real-world cohorts and secondary analyses demonstrate that escalation of oral diuretics is associated with increased risks of hospitalization and death, suggesting it is not a benign event. Incorporating these events could enhance trial efficiency by substantially increasing the number of captured endpoints, allowing for smaller and shorter studies while maintaining clinical relevance. However, challenges remain. Definitions vary across studies, raising questions about what constitutes a meaningful intensification—dose doubling, drug class switching, or short-term use of additional diuretics. Distinguishing heart failure–related changes from adjustments for comorbid conditions such as kidney disease or obesity further complicates endpoint validity. Concerns also exist that clinician-driven medication changes may introduce variability or bias unless standardized symptom-based criteria are applied. Despite these complexities, retrospective analyses suggest consistent findings across different statistical approaches, reinforcing the prognostic importance of oral diuretic changes. Broader adoption would require consensus definitions, regulatory acceptance, and frameworks to account for overlapping events, such as escalation followed by IV diuretics or hospitalization. The speakers concluded that oral diuretic intensification represents an important step toward more inclusive and globally applicable trial endpoints that better capture the continuum of worsening heart failure. Relevant disclosures for Vaduganathan include Amgen, AstraZeneca, Bayer AG, Boehringer Ingelheim Pharmaceuticals, Cytokinetics, Lexicon, and others. Relevant disclosures for Greene include Amgen, AstraZeneca, Bayer Healthcare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals, Cytokinetics, and others. References: Greene SJ, Butler J. Expanding the Definition of Worsening Heart Failure and Recognizing the Importance of Outpatient Escalation of Oral Diuretics. Circulation. 2023;148(22):1746-1749. doi:10.1161/CIRCULATIONAHA.123.066915 Packer M, Zile MR, Kramer CM, et al. Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity. N Engl J Med. 2025;392(5):427-437. doi:10.1056/NEJMoa2410027 Chapters 00:00 - Introduction and Evolution of Heart Failure Endpoints  03:02 - The Case for Oral Diuretic Intensification as an Endpoint 07:06 - Challenges in Adoption and Standardization 14:45 - Broader Implications and Summary

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.

Le COVID-19 n'est pas qu'une maladie respiratoire

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.

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.

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.

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.

Nicholas Bagley is a professor of law at the University of Michigan Law School. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. N. Bagley. Preventive Care at the Supreme Court. N Engl J Med 2025;393:729-731.

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).

In this special episode on Obstructive Sleep Apnea our host, Dr. Neil Skolnik will discuss treatment of OSA. In Part 1 we discussed and overview of OSA, in Part 2 we discussed making the diagnosis will, and Part 4 will look at cases. 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 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

Featuring articles on overweight, obesity and diabetes; lactated Ringer's solution versus normal saline; and spinal muscular atrophy; a review article on metabolic dysfunction–associated steatotic liver disease; a case report of a woman with respiratory failure and abnormal chest imaging; and Perspectives on dismantling public health infrastructure, on progress lost, on private law in American health care, and on the serendipitous dance between life and death.

Tom Frieden is the president and chief executive officer of Resolve to Save Lives and former director of the Centers for Disease Control and Prevention. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. T.R. Frieden. Dismantling Public Health Infrastructure, Endangering American Lives. N Engl J Med 2025;393:625-627.

How does genetic testing help doctors treat patients? How accurate are private companies like 23andMe? Does knowing your genetic risk help people lead healthier lives or is it just a waste of time and money? Sophie had a bunch of questions about how genetic testing is used in everyday medical practice and Chris was here to answer!   Become a supporter of our show today either on Patreon or through PayPal! Thank you! http://www.patreon.com/thebodyofevidence/ https://www.paypal.com/donate?hosted_button_id=9QZET78JZWCZE   Email us your questions at thebodyofevidence@gmail.com.   Editor:    Robyn Flynn Theme music: “Fall of the Ocean Queen“ by Joseph Hackl Rod of Asclepius designed by Kamil J. Przybos Chris' book, Does Coffee Cause Cancer?: https://ecwpress.com/products/does-coffee-cause-cancer   Obviously, Chris is not your doctor (probably). This podcast is not medical advice for you; it is what we call information. References: Studies evaluating the accuracy of Direct to Consumer genetic testing companies: Ng PC, Murray SS, Levy S, Venter JC. An agenda for personalized medicine. Nature. 2009 Oct 8;461(7265):724-6. doi: 10.1038/461724a. PMID: 19812653. Imai K, Kricka LJ, Fortina P. Concordance study of 3 direct-to-consumer genetic-testing services. Clin Chem. 2011 Mar;57(3):518-21. doi: 10.1373/clinchem.2010.158220.  Studies looking at how knowing the results of genetic testing affect medical treatment and lifestyle factors. Mega JL, et al. Genetic risk, coronary heart disease events, and the clinical benefit of statin therapy: an analysis of primary and secondary prevention trials. Lancet. 2015 Jun 6;385(9984):2264-2271. doi: 10.1016/S0140-6736(14)61730-X Khera AV, Emdin CA, Drake I, Natarajan P, Bick AG, Cook NR, Chasman DI, Baber U, Mehran R, Rader DJ, Fuster V, Boerwinkle E, Melander O, Orho-Melander M, Ridker PM, Kathiresan S. Genetic Risk, Adherence to a Healthy Lifestyle, and Coronary Disease. N Engl J Med. 2016 Dec 15;375(24):2349-2358. doi: 10.1056/NEJMoa1605086.  The Cochrane review and MI-GENES study which showed that genetic information did not change lifestyle behavior Hollands GJ, French DP, Griffin SJ, Prevost AT, Sutton S, King S, Marteau TM. The impact of communicating genetic risks of disease on risk-reducing health behaviour: systematic review with meta-analysis. BMJ. 2016 Mar 15;352:i1102. doi: 10.1136/bmj.i1102.  Kullo IJ, et al. Incorporating a Genetic Risk Score Into Coronary Heart Disease Risk Estimates: Effect on Low-Density Lipoprotein Cholesterol Levels (the MI-GENES Clinical Trial). Circulation. 2016 Mar 22;133(12):1181-8. doi: 10.1161/CIRCULATIONAHA.115.020109  

About this Episode Episode 48 of “The 2 View” – Burn Tx, Marijuana & CV Risk, Ocular Syphilis, and HSV 1 & 2 Segment 1 – Thermal Burn Treatment Levin NJ, Erben Y, Li Y, et al. Edited by Muacevic A, Adler JR. A Systematic Review and Meta-Analysis Comparing Burn Healing Outcomes Between Silver Sulfadiazine and Aloe vera. Cureus. 2022;14(10):e30815. Accessed August 11, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC9621733/ Aziz Z, Abdul Rasool Hassan B. The effects of honey compared to silver sulfadiazine for the treatment of burns: A systematic review of randomized controlled trials. Burns. 2017;43(1):50-57. Accessed August 11, 2025. https://pubmed.ncbi.nlm.nih.gov/27576926/ Segment 2A – Marijuana and Cardiovascular Risk Mohammadi L, Navabzadeh M, Jimenez-Tellez N, et al. Association of Endothelial Dysfunction With Chronic Marijuana Smoking and THC-Edible Use. JAMA Cardiol. Published online May 28, 2025. doi:10.1001/jamacardio.2025.1399. Accessed August 11, 2025. https://jamanetwork.com/journals/jamacardiology/fullarticle/2834540 Storck W, Elbaz M, Vindis C, et al. Eifling KP, Gaudio FG, Dumke C, et al. Cardiovascular risk associated with the use of cannabis and cannabinoids: a systematic review and meta-analysis. Heart. Published online June 17, 2025. doi:10.1136/heartjnl-2024-325429. Accessed August 11, 2025. https://pubmed.ncbi.nlm.nih.gov/40527600/ Page II RL, Allen LA, Kloner RA, et al. Medical Marijuana, Recreational Cannabis, and Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation. 2020;142(10);e131-152. https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000883 Segment 2B – Ocular Syphilis Zhou LR, Kirupaharan N, Birkenstock MK. Incidence and Prevalence of Syphilitic Uveitis and Associated Ocular Complications in the TriNetX Database. Am J Ophthalmol. 2025;277:387-394. https://www.sciencedirect.com/science/article/pii/S0002939425002843 Segment 3 - HSV 1 & 2 Langenberg AGM, Corey L, Ashley RL, et al. A Prospective Study of New Infections with Herpes Simplex Virus Type 1 and Type 2. N Engl J Med. 1999;341:1432-1438. https://www.nejm.org/doi/full/10.1056/nejm199911043411904 Lebrun-Vignes B, Bouzamondo A, Dupuy A, et al. A meta-analysis to assess the efficacy of oral antiviral treatment to prevent genital herpes outbreaks. J Am Acad Dermatol. 2007;57(20):238-246. 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.

Featuring articles on treatments for chronic kidney disease and type 2 diabetes, bubonic plague, and advanced breast cancer; a review article on hypogonadism; a Clinical Problem-Solving describing gasping for strength; a Medicine and Society on the infant mortality rate; and Perspectives on profit-driven medicine, on lead contamination in Milwaukee schools, on training health communicators, and on ER and becoming a physician.

Nancy Tomes is a professor of history at Stony Brook University. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. N. Tomes. A Gilded Age for Patients? The Broken Promises of Profit-Driven Medicine. N Engl J Med 2025;393:521-524.

Featuring articles on myeloma, mitochondrial DNA disease, cardiac surgery, and squamous-cell carcinoma; a review article on motor vehicle crash prevention; a case report of a woman with seizure-like activity and odd behaviors; a Medicine and Society article on the evaluation of occupational pulmonary impairment; and Perspectives on Covid-19 vaccines, on public policies, and on living on the edge of the valley of the sick.

Jason Schwartz is an associate professor in the Department of Health Policy and Management at the Yale School of Public Health. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. J.L. Schwartz. Revised Recommendations for Covid-19 Vaccines — U.S. Vaccination Policy under Threat. N Engl J Med 2025;393:417-419.

Watch the NEJM In Studio video of this interview at NEJM.org. Rohan Khazanchi is a research affiliate at the FXB Center for Health and Human Rights at Harvard University and a resident in the Harvard Medicine-Pediatrics Residency Program. Harleen Marwah, the interviewer, is a recent Editorial Fellow at the Journal. R. Khazanchi and Others. Reform and Remedy for Imprecision and Inequity — Ending the Race-Based Evaluation of Occupational Pulmonary Impairment. N Engl J Med 2025;393:508-514.

Contributor: Taylor Lynch, MD Educational Pearls: Dilutional Hyponatremia: Occurs when there is an excess of free water relative to sodium in the body. Causes a falsely low sodium concentration without a true change in total body sodium. Commonly seen in DKA: Hyperglycemia raises plasma osmolality. Water shifts from the intracellular to extracellular space. This dilutes serum sodium, creating apparent hyponatremia. Corrected sodium calculation: Use tools like MDCALC, or apply this formula: Add 1.6 mEq/L to the measured sodium for every 100 mg/dL increase in glucose above 100. Clinical relevance: Considering corrected sodium in DKA is crucial, as the lab value may not be reflective of actual sodium depletion. True severe hyponatremia can lead to complications like seizures May require treatment with hypertonic saline. References: Fulop M. Acid–base problems in diabetic ketoacidosis. Am J Med Sci. 2008;336(4):274-276. doi:10.1097/MAJ.0b013e318180f478 Palmer BF, Clegg DJ. Electrolyte and Acid–Base Disturbances in Patients with Diabetes Mellitus. N Engl J Med. 2015;373(6):548-559. doi:10.1056/NEJMra1503102 Spasovski G, Vanholder R, Allolio B, et al. Diagnosis and management of hyponatremia: a review. JAMA. 2014;312(24):2640–2650. doi:10.1001/jama.2014.13773 Summarized by Ashley Lyons, OMS3 | Edited by Ashley Lyons & Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/  

In this episode, we focus on the history of researchers discovering the clinical applicability of the IL 23/17 axis, with a particular emphasis on psoriasis, psoriatic arthritis and axial SpA   ·        Intro 0:01 ·        In this episode 0:12 ·        Leonard Calabrese, DO, is listening! 0:54 ·        Recap of last episode 3:09 ·        Putting the pieces together 5:12 ·        Quick overview of this science heavy episode 6:11 ·        What is psoriasis? 7:26 ·        Immunosuppressants for psoriasis/ Throwing meds at people and seeing what happens 10:10 ·        In the modern world of 1986 – olive oil placebo trial 11:36 ·        A quick aside into fungi 12:35 ·        What kind of T-cells are involved here? 16:41 ·        The TH-1 hypothesis 18:20 ·        IL-23 and IL-17 are doing something 19:34 ·        Going back to the drawing board in 2004 20:00 ·        p40 + p19 = IL-23 21:00 ·        IL-23 via minicircle DNA in mice 23:05 ·        Brand new and shiny TH-17 25:23 ·        The family of IL-17 26:36 ·        What do we know about IL-17 and psoriasis? 27:10 ·        IL-17A vs IL-17F in mouse studies 27:35 ·        Finding the difference between IL-17A and IL-17F in humans 28:23 ·        What exactly is IL-17 doing? 29:30 ·        The articular manifestations of psoriatic arthritis 30:57 ·        Spondylarthritis and the IL 23/17 axis 33:56 ·        T-cells we haven't talked about 35:40 ·        Summary of this episode 39:08 ·        Thanks for listening 41:34   We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. References: Bashyam H. J Exp Med. 2007;doi:10.1084/jem.2042fta Bjerke R J. Acta Derm Venereol. 1982;PMID:6179355 Cargill M, et al. Am J Hum Genet. 2007;doi:10.1086/511051 Chan J R, et al. J Exp Med. 2006;doi:10.1084/jem.20060244 Cuthbert R J, et al. Ann Rheum Dis. 2019;doi:10.1136/annrheumdis-2019-215210 Ellis C N, et al. JAMA. 1986;doi:10.1001/jama.1986​ Ettehadi P, et al. Clin Exp Immunol. 1994;doi:10.1111/j.1365-2249.1994.tb06244.x Furue M, et al. Int J Mol Sci. 2020;doi:10.3390/ijms21041275 Gooderham M J, et al. J Eur Acad Dermatol Venereol. 2018;doi:10.1111/jdv.14868 Lee E, et al. J Exp Med. 2004;doi:10.1084/jem.20030451 Leonardi C L, et al. Lancet. 2008;doi:10.1016/S0140-6736(08)60725-4 Mease P J, et al. Lancet. 2000;doi:10.1016/S0140-6736(00)02530-7 Menon B, et al. Arthritis Rheumatol. 2014;doi:10.1002/art.38376 Moos S, et al. J Invest Dermatol. 2019;doi:10.1016/j.jid.2019.01.006 Muelle W, et al. N Engl J Med. 1979;doi:10.1056/NEJM197909063011016 Papp K A, et al. Lancet. 2008;doi:10.1016/S0140-6736(08)60726-6 Reinhardt A, et al. Arthritis Rheumatol. 2016;doi:10.1002/art.39732 Sherlock J P, et al. Nat Med. 2012;doi:10.1038/nm.2817 Tribe H T. Mycologist. 1998;doi:10.1016/S0269-915X(98)80100-6 Yawalkar N, et al. J Invest Dermatol. 1998;doi:10.1046/j.1523-1747.1998.00446.x Zaba L C, et al. J Allergy Clin Immunol. 2009;doi:10.1016/j.jaci.2009.08.046   Disclosures: Brown reports no relevant financial disclosures.

Featuring articles on type 2 diabetes, gastric cancer, lung cancer, and malaria; a review article on competency-based medical education; a case report of a man with cough, dyspnea, and hypoxemia; and Perspectives on brain death in pregnancy, on the Supreme Court's failure to protect trans minors, on real-world data, and on avocado and salt.

Katie Watson is a professor of medical education, medical social sciences, and obstetrics and gynecology at the Northwestern University Feinberg School of Medicine. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. K. Watson. Brain Death in Pregnancy — Abortion, Advance-Directive, or End-of-Life Law? N Engl J Med 2025;393:313-315.

On this episode of the Huddle, Kelly Postiglione Cook, RN, MSN, ANP-BC, CDCES, BC-ADM, and Sean Oser, MD, MPH, CDCES have a conversation about the importance of utilizing automated insulin delivery systems, like the iLet bionic pancreas, more widely in primary care. They provide insight into a study that evaluated the success of implementing use of the iLet bionic pancreas in a primary care setting, how the results illustrated that this technology can be more widely utilized in these settings, and the role diabetes care and education specialists can play in this work.This episode is sponsored by Beta Bionics. Episode References: Bionic Pancreas Research Group. Multicenter, randomized trial of a bionic pancreas in type 1 diabetes. N Engl J Med 2022;387:1161-1172 DOI: 10.1056/NEJMoa2205225 Russell SJ, Selagamsetty R, Damiano E. Real-world efficacy of the iLet bionic pancreas in adults and children during the first eighteen months of commercial availability. Presented at the American Diabetes Association 85th Scientific Sessions, June 20-23, 2025, Chicago, IL.   Oser SM, Putman MS, Russel SJ, et al. Assessing the iLet Bionic Pancreas deployed in primary care and via telehealth: a randomized clinical trial. Clin Diabetes 2025; cd240104. https://doi.org/10.2337/cd24-0104 Oser C, Parascando JA, Kostiuk M, et al. Experiences of people with type 1 diabetes using the iLet bionic pancreas in primary care: A qualitative analysis. Clin Diabetes 2024 https://doi.org/10.2337/cd24-0060.  Sulik B, Postiglione Cook K, MacLeod J. Meals no longer need to be math problems: Shifting from precise carbohydrate counting to a continuum of carbohydrate awareness as automated insulin delivery advances. Diabetes Technology and Obesity Medicine 2025;1(1):79-83. DOI: 10.1089/dtom.2025.0010.  Resources:Learn more about Beta Bionics here: https://www.betabionics.com/Explore the latest in diabetes technology on danatech: danatech l Diabetes Technology Education for Healthcare ProfessionalsLearn more about a two-part course on integrating diabetes technology into primary care, put on through the collaboration of AANP and ADCES:Part 1: Integrating Diabetes Technology into Primary Care Part 1: Overview and Clinical ScenariosPart 2: Integrating Diabetes Technology into Primary Care Part 2: Interactive Case StudiesDive deeper into how diabetes technology can be incorporated into primary care on another recent episode of The Huddle featuring Kathryn Evans Kreider DNP, FNP-BC, BC-ADM, FAANP: https://thehuddle.simplecast.com/episodes/embracing-diabetes-technology-in-primary-care Listen to more episodes of The Huddle at adces.org/perspectives/the-huddle-podcast.Learn more about ADCES and the many benefits of membership at adces.org/join.

The 2017 NEJM study, ALPS, compared amiodarone, lidocaine, and placebo for refractory shockable rhythms in adults with out of hospital cardiac arrest. They found no significant difference in survival to hospital discharge or functional survival between any of the arms. If that study has left you confused, you're not alone. And you're in luck. Tanner Smida joins us again to discuss his latest paper using something called target trial emulation to assess the difference in ROSC and survival to discharge between amiodarone and lidocaine. This is a great discussion of his paper, the methodology, and how we can put his results into the context of ALPS.Citations:1.Smida T, Crowe R, Price BS, Scheidler J, Martin PS, Shukis M, Bardes J: A retrospective ‘target trial emulation' comparing amiodarone and lidocaine for adult out-of-hospital cardiac arrest resuscitation. Resuscitation. 2025;March;208:110515.2. Kudenchuk PJ, Brown SP, Daya M, Rea T, Nichol G, Morrison LJ, Leroux B, Vaillancourt C, Wittwer L, Callaway CW, et al.: Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2016;May 5;374(18):1711–22.3.Hernán MA, Robins JM: Using Big Data to Emulate a Target Trial When a Randomized Trial Is Not Available: Table 1. Am J Epidemiol. 2016;April 15;183(8):758–64.

AI-boost for mammograms—a bridge too far? Plastics and heart disease; What does a high CRP mean? Social media marketing of female aphrodisiac dinged with FDA warning; Roundup gets a makeover; Artificial sweeteners may hasten puberty in kids; Plus an encore of our interview with Dr. Jeffrey Bland introducing Himalayan Tartary Buckwheat as a hedge against age-related immune decline.

Send us a textPatient-Specific In Vivo Gene Editing to Treat a Rare Genetic Disease.Musunuru K, Grandinette SA, Wang X, Hudson TR, Briseno K, Berry AM, Hacker JL, Hsu A, Silverstein RA, Hille LT, Ogul AN, Robinson-Garvin NA, Small JC, McCague S, Burke SM, Wright CM, Bick S, Indurthi V, Sharma S, Jepperson M, Vakulskas CA, Collingwood M, Keogh K, Jacobi A, Sturgeon M, Brommel C, Schmaljohn E, Kurgan G, Osborne T, Zhang H, Kinney K, Rettig G, Barbosa CJ, Semple SC, Tam YK, Lutz C, George LA, Kleinstiver BP, Liu DR, Ng K, Kassim SH, Giannikopoulos P, Alameh MG, Urnov FD, Ahrens-Nicklas RC.N Engl J Med. 2025 Jun 12;392(22):2235-2243. doi: 10.1056/NEJMoa2504747. Epub 2025 May 15.PMID: 40373211Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Are your current stroke interventions in line with the latest clinical data? Dr. Blaise Baxter, interventional radiologist at Sutter Health, and Dr. Jim Milburn, interventional neuroradiologist at the Ochsner Health, join host Dr. Michael Barraza to discuss the latest advancements in stroke interventions. --- This podcast is supported by: Imperative Carehttps://imperativecare.com/stroke/zoom-stroke-solution/ --- SYNPOSIS The episode begins with a discussion on the different pathways to becoming a neurointerventionalist, emphasizing why interventional radiologists are uniquely equipped for this transition. They dive into cutting-edge stroke interventions, sharing key takeaways from major trials on large core and medium vessel occlusions. Dr. Baxter and Dr. Milburn highlight the HERMES trial, which showed that endovascular thrombectomy led to beneficial effects on patients with anterior circulation occlusion. They then cover the BAOCHE trial, which showed better functional outcomes with thrombectomy over medical therapy. Milburn and Baxter also share their perspectives on the shifting role of perfusion imaging and why the field may be moving beyond it. To close the discussion, the doctors underscore the powerful impact of rehabilitation in driving patient recovery, and stress the ongoing need for innovation and improved training in the field of neurointerventional radiology. --- TIMESTAMPS 00:00 - Introduction06:18 - Training and Certification in Neurointervention13:11- Large Core Trials and Their Impact19:42 - CT Perfusion and Treatment Decisions29:45 - Understanding Stroke Scale Scores and ICAD30:31 - Thrombectomy Trials and Treatment Strategies34:48 - Challenges in Randomizing Patients for Trials44:25 - Advancements in Robotics and Stroke Treatment51:37 - Future Directions in Stroke Rehabilitation53:11 - Global Thrombectomy Adoption and Training --- RESOURCES Hermes trial: Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723-1731. doi:10.1016/S0140-6736(16)00163-X BAOCH trial: Jovin TG, Li C, Wu L, et al. Trial of Thrombectomy 6 to 24 Hours after Stroke Due to Basilar-Artery Occlusion. N Engl J Med. 2022;387(15):1373-1384. doi:10.1056/NEJMoa2207576

Featuring articles on gastric and gastroesophageal junction cancer, pulmonary sarcoidosis, graft-versus-host disease, gastroenteritis in children, the rapid recovery of donor hearts after circulatory death, and an on-table reanimation of a pediatric heart from donation after circulatory death; a review article on fragile X disorders; a case report of a woman with neck swelling and dysphagia; and Perspectives on vaccine policy, on new mammography tools, and on the second life of Jacqui B.

Featuring articles on mild asthma, cardiovascular risk factors, stroke, advanced breast cancer, and transforming health care; a review article on juvenile idiopathic arthritis; a case report of a man with headache and ataxia; and Perspectives on who will care for America, on hospital financial assistance policies, and on libraries burned, and a life lived.

In the corner of the ICU, on multiple pressors, distended, oliguric, and intubated you'll find the necrotizing pancreatitis patient. Sounds intimidating, but with the persistence, patience, and the proper care these patients can make it! In this episode from the HPB team at Behind the Knife listen in as we discuss the Step-Up approach, when to surgically intervene, various approaches to pancreatic Necrosectomy, and additional aspects of the multidisciplinary care required for the successful treatment of necrotizing pancreatitis.  Hosts Anish J. Jain MD (@anishjayjain) is a current PGY3 General Surgery Resident at Stanford University and a former T32 Research Fellow at the University of Texas MD Anderson Cancer Center. Jon M. Harrison is a 2nd year HPB Surgery Fellow at Stanford University. He will be joining as faculty at the Massachusetts General Hospital in Boston, MA at the conclusion of his fellowship in July 2024.    Learning Objectives ·      Develop an understanding of the severity of necrotizing pancreatitis and the proper indications to surgical intervene on this often-tenuous patients.  ·      Develop an understanding of the Step-Up approach and key aspects (reimaging, clinical status, physiologic status, etc.) that determine when to “step-up” treatment for patients with necrotizing pancreatitis. ·      Develop an understanding of long term sequalae and complications associated with necrotizing pancreatitis and operative management ·      Develop an understanding of multidisciplinary care and long-term follow-up necessary for adequate treatment of patients suffering from necrotizing pancreatitis. Suggested Reading Maurer LR, Fagenholz PJ. Contemporary Surgical Management of Pancreatic Necrosis. JAMA Surg. 2023;158(1):81–88. doi:10.1001/jamasurg.2022.5695 https://pubmed.ncbi.nlm.nih.gov/36383374/ Harrison JM, Day H, Arnow K, Ngongoni RF, Joseph A, Aldridge T, Wheeler KJ, DeLong JC, Bergquist JR, Worth PJ, Dua MM, Friedland S, Park W, Eldika S, Hwang JH, Visser BC. What's Behind it all: A Retrospective Cohort Study of Retrogastric Pancreatic Necrosis Management. Ann Surg. 2024 Sep 3. doi: 10.1097/SLA.0000000000006521. https://pubmed.ncbi.nlm.nih.gov/39225420/ Harrison JM, Visser BC. Not Dead Yet: Managing the Abdominal Catastrophe in Necrotizing Pancreatitis. Pancreas. 2025 May 20. doi: 10.1097/MPA.0000000000002512. https://pubmed.ncbi.nlm.nih.gov/40388698/ Harrison JM, Li AY, Sceats LA, Bergquist JR, Dua MM, Visser BC. Two-Port Minimally Invasive Nephrolaparoscopic Retroperitoneal Debridement for Pancreatic Necrosis. J Am Coll Surg. 2024 Dec 1;239(6):e7-e12. doi: 10.1097/XCS.0000000000001152. https://pubmed.ncbi.nlm.nih.gov/39051721/ van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, van Goor H, Schaapherder AF, van Eijck CH, Bollen TL, van Ramshorst B, Nieuwenhuijs VB, Timmer R, Laméris JS, Kruyt PM, Manusama ER, van der Harst E, van der Schelling GP, Karsten T, Hesselink EJ, van Laarhoven CJ, Rosman C, Bosscha K, de Wit RJ, Houdijk AP, van Leeuwen MS, Buskens E, Gooszen HG; Dutch Pancreatitis Study Group. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010 Apr 22;362(16):1491-502. doi: 10.1056/NEJMoa0908821. https://pubmed.ncbi.nlm.nih.gov/20410514/ Bang JY, Arnoletti JP, Holt BA, Sutton B, Hasan MK, Navaneethan U, Feranec N, Wilcox CM, Tharian B, Hawes RH, Varadarajulu S. An Endoscopic Transluminal Approach, Compared With Minimally Invasive Surgery, Reduces Complications and Costs for Patients With Necrotizing Pancreatitis. Gastroenterology. 2019 Mar;156(4):1027-1040.e3. doi: 10.1053/j.gastro.2018.11.031. https://pubmed.ncbi.nlm.nih.gov/30452918/ Zyromski NJ, Nakeeb A, House MG, Jester AL. Transgastric Pancreatic Necrosectomy: How I Do It. J Gastrointest Surg. 2016 Feb;20(2):445-9. doi: 10.1007/s11605-015-3058-y. https://pubmed.ncbi.nlm.nih.gov/26691148/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen