Podcasts about pmid

Husband-and-wife team William Firth Wells and Mildred Weeks Wells conducted research that had the potential to make a big difference in the safety of indoor air. But it didn’t really have a significant impact on public health. Research: Associated Press. “Super-Oyster Is On its Way to Dinner Table Bigger and Better Bivalve Sports Pedigree.” 3/13/1927. https://www.loc.gov/resource/sn84020064/1927-03-13/ed-1/?sp=14 “Brought Back to Texas.” The Houston Semi-Weekly Post. 12/26/1889. https://www.newspapers.com/image/1196039760/ Decatur Daily Review. “Scientists Fight Flu Germs with Violet Ray.” 7/30/1936. https://www.newspapers.com/image/94335504/ Evening Star. “Scientific Trap-shooter.” 6/26/1937. https://www.loc.gov/resource/sn83045462/1937-06-26/ed-1/?sp=7&q=William+Firth+Wells&r=0.668,0.557,0.438,0.158,0 Fair, Gordon M. and William Weeks Wells. “Method and Apparatus for Preventing Infection.” U.S. Patent 2,198,867. https://ppubs.uspto.gov/api/pdf/downloadPdf/2198867 Hall, Dominic. “New Center for the History of Medicine Artifact - Wells Air Centrifuge.” Harvard Countway Library. https://countway.harvard.edu/news/new-center-history-medicine-artifact-wells-air-centrifuge “Incubator Is Now Oyster Nurse.” Washington Times. 10/1/1925. https://www.loc.gov/resource/sn84026749/1925-10-01/ed-1/?sp=12 Lewis, Carol Sutton. “Mildred Weeks Wells’s Work on Airborne Transmission Could Have Saved Many Lives—If the Scientific Establishment Listened.” Lost Women of Science Podcast. Scientific American. 5/22/2025. https://www.scientificamerican.com/article/a-public-health-researcher-and-her-engineer-husband-found-how-diseases-can/ Library and Archives Team. “William Firth Wells and Mildred Weeks Wells.” Washington College. https://www.washcoll.edu/people_departments/offices/miller-library/archives-special-collections/archives-blog/Wells%20papers.php Molenti, Megan. “The 60-Year-Old Scientific Screwup That Helped Covid Kill.” Wired. 5/13/2021. https://www.wired.com/story/the-teeny-tiny-scientific-screwup-that-helped-covid-kill/ Perkins JE, Bahlke AM, Silverman HF. Effect of Ultra-violet Irradiation of Classrooms on Spread of Measles in Large Rural Central Schools Preliminary Report. Am J Public Health Nations Health. 1947 May;37(5):529-37. PMID: 18016521; PMCID: PMC1623610. Randall, Katherine and Ewing, E. Thomas and Marr, Linsey and Jimenez, Jose and Bourouiba, Lydia, How Did We Get Here: What Are Droplets and Aerosols and How Far Do They Go? A Historical Perspective on the Transmission of Respiratory Infectious Diseases (April 15, 2021). Available at SSRN: https://ssrn.com/abstract=3829873 Riley, Richard L. “What Nobody Needs to Know About Airborne Infection.” American Journal of Respiratory and Critical Care Medicine. Volume 163, Issue 1. https://www.atsjournals.org/doi/10.1164/ajrccm.163.1.hh11-00 Simon, Clea. “Did a socially awkward scientist set back airborne disease control?” The Harvard Gazette. 3/7/2025. https://news.harvard.edu/gazette/story/2025/03/did-a-socially-awkward-scientist-set-back-airborne-disease-control/ “Texas State News.” McKinney Weekly Democrat-Gazette. 4/17/1890. https://www.newspapers.com/image/65385350/ WELLS MW, HOLLA WA. VENTILATION IN THE FLOW OF MEASLES AND CHICKENPOX THROUGH A COMMUNITY: Progress Report, Jan. 1, 1946 to June 15, 1949, Airborne Infection Study, Westchester County Department of Health. JAMA. 1950;142(17):1337–1344. doi:10.1001/jama.1950.02910350007004 WELLS MW. VENTILATION IN THE SPREAD OF CHICKENPOX AND MEASLES WITHIN SCHOOL ROOMS. JAMA. 1945;129(3):197–200. doi:10.1001/jama.1945.02860370019006 WELLS WF, WELLS MW. AIR-BORNE INFECTION. JAMA. 1936;107(21):1698–1703. doi:10.1001/jama.1936.02770470016004 WELLS WF, WELLS MW. AIR-BORNE INFECTION: SANITARY CONTROL. JAMA. 1936;107(22):1805–1809. doi:10.1001/jama.1936.02770480037010 Wells, W F, and M W Wells. “Measurement of Sanitary Ventilation.” American journal of public health and the nation's health vol. 28,3 (1938): 343-50. doi:10.2105/ajph.28.3.343 Wells, William Firth and Gordon Maskew Fair. Viability of B. coli Exposed to Ultra-Violet Radiation in Air.Science82,280-281(1935).DOI:10.1126/science.82.2125.280.b Wells, William Firth and Mildred Weeks Wells. Measurement of Sanitary Ventilation American Journal of Public Health and the Nations Health 28, 343_350, https://doi.org/10.2105/AJPH.28.3.343 Zimmer, Carl. “Air-Borne: The Hidden History of the Life We Breathe.” Dutton. 2025. See omnystudio.com/listener for privacy information.

This is a fascinating podcast episode from Dr. Lipid himself on desmosterol.  What is it?  How do we measure it?  Why should we care? Pharmacists are well-positioned to guide patients in understanding the role of desmosterol, how medications may influence its levels, the options for measuring it, and the steps to take if levels are too high or too low. Dr. Thomas Dayspring: linkedin.com/in/thomas-dayspring-md-facp-fnla-3aaa876 or @DrLipid on X  Tamara Ruggles, PharmD: linkedin.com/in/tamara-ruggles-491882251 Resource on lipids recommended by Dr. Dayspring: https://familyheart.org/ Wages PA, Kim HH, Korade Z, Porter NA. Identification and characterization of prescription drugs that change levels of 7-dehydrocholesterol and desmosterol. J Lipid Res. 2018 Oct;59(10):1916-1926. doi: 10.1194/jlr.M086991. Epub 2018 Aug 7. PMID: 30087204; PMCID: PMC6168312.  Available at:  https://pubmed.ncbi.nlm.nih.gov/30087204/  The Geriatric Pharmacy Focus podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

Welcome to the Olink® Proteomics in Proximity podcast!  Below are some useful resources mentioned in this episode:  Olink tools and software·       Olink® Explore HT, Olink's most advanced solution for high-throughput biomarker discovery, measuring 5400+ proteins simultaneously with a streamlined workflow and industry-leading specificity: https://olink.com/products-services/exploreht/  UK Biobank Pharma Proteomics Project (UKB-PPP), one of the world's largest scientific studies of blood protein biomarkers conducted to date, https://www.ukbiobank.ac.uk/learn-more-about-uk-biobank/news/uk-biobank-launches-one-of-the-largest-scientific-studies  World Health Organization (2003). Adherence to long-term therapies: evidence for action (PDF). Geneva: World Health Organisation. ISBN 978-92-4-154599-0 Research articles and news·       Thermo Fisher Scientific's Olink Platform Selected for World's Largest Human Proteome Studyhttps://ir.thermofisher.com/investors/news-events/news/news-details/2025/Thermo-Fisher-Scientifics-Olink-Platform-Selected-for-Worlds-Largest-Human-Proteome-Study/default.aspx·       Hamilton Se-Hwee Oh et al 2025. Plasma proteomics links brain and immune system aging with healthspan and longevityhttps://www.nature.com/articles/s41591-025-03798-1. Nature Medicine (2025)·       Song, Y., Abuduaini, B., Yang, X. et al. Identification of inflammatory protein biomarkers for predicting the different subtype of adult with tuberculosis: an Olink proteomic study. Inflamm. Res. 74, 60 (2025). https://doi.org/10.1007/s00011-025-02020-9·       Ferhan Qureshi et al 2023. Analytical validation of a multi-protein, serum-based assay for disease activity assessments in multiple sclerosis. Proteomics clinical application 2023·       Dhindsa, R.S., Burren, O.S., Sun, B.B. et al. Rare variant associations with plasma protein levels in the UK Biobank. 2023 Nature, DOI: 10.1038/s41586-023-06547-xhttps://www.nature.com/articles/s41586-023-06547-x·       Sun, B.B., Chiou, J., Traylor, M. et al.  Plasma proteomic associations with genetics and health in the UK Biobank. 2023 Nature, DOI: 10.1038/s41586-023-06592-6 https://www.nature.com/articles/s41586-023-06592-6 https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehac495/6676779·       Eldjarn GH, et al. Large-scale plasma proteomics comparisons through genetics and disease associations. Nature. 2023 Oct;622(7982):348-358. doi: 10.1038/s41586-023-06563-xhttps://www.nature.com/articles/s41586-023-06563-x#Sec44·        Carrasco-Zanini et al 2024 Proteomic prediction of common and rare diseases. https://www.nature.com/articles/s41591-024-03142-z . NatureMedicine volume 30,  pages2489–2498 (2024)·       Watanabe K, Wilmanski T, Diener C, et al. Multiomic signatures of body mass index identify heterogeneous health phenotypes and responses to a lifestyle intervention.https://www.nature.com/articles/s41591-023-02248-0·       Petrera A, von Toerne C, Behlr J, et al. Multiplatform Approach for Plasma Proteomics: Complementarity of Olink Proximity Extension Assay Technology to Mass Spectrometry-Based Protein Profiling. (2020) Journal of Proteome Research, https://pubs.acs.org/doi/pdf/10.1021/acs.jproteome.0c00641·       Multicenter Collaborative Study to Optimize Mass Spectrometry Workflows of Clinical Specimens. Kardell O, von Toerne C, Merl-Pham J, König AC, Blindert M, Barth TK, Mergner J, Ludwig C, Tüshaus J, Eckert S, Müller SA, Breimann S, Giesbertz P, Bernhardt AM, Schweizer L, Albrecht V, Teupser D, Imhof A, Kuster B, Lichtenthaler SF, Mann M, Cox J, Hauck SM. J Proteome Res. 2024 Jan 5;23(1):117-129. doi: 10.1021/acs.jproteome.3c00473. Epub 2023 Nov 28. PMID: 38015820 https://pubs.acs.org/doi/10.1021/acs.jproteome.3c00473·       Wei, S., Shen, R., Lu, X. et al. Integrative multi-omics investigation of sleep apnea: gut microbiome metabolomics, proteomics and phenome-wide association study. Nutr Metab (Lond) 22, 57 (2025). https://doi.org/10.1186/s12986-025-00925-0·       Liu, L., Li, M., Qin, Y. et al. Childhood obesity and insulin resistance is correlated with gut microbiome serum protein: an integrated metagenomic and proteomic analysis. Sci Rep 15, 21436 (2025). https://doi.org/10.1038/s41598-025-07357-z·       Zhang, Xiaotao et al.Modulating a prebiotic food source influences inflammation and immune-regulating gut microbes and metabolites: insights from the BE GONE trial. eBioMedicine, Volume 98, 104873 (2023.).  10.1016/j.ebiom.2023.104873·      &nb...

Learning Objectives:By the end of this two-part series, listeners should be able to discuss:The physiologic rationale supporting the use of high-frequency percussive ventilation (Volumetric Diffusive Respiration, or HFPV).Patient populations most likely to benefit from HFPV.Key published evidence that informs our use of HFPV in pediatric critical care.An expert approach to managing a patient with HFPV.Next steps in research that will direct our understanding of the use of HFPV in pediatric critical care.About our Guest: Dr. John Lin is a Professor of Pediatrics at Washington University in St. Louis. He serves as the Critical Care Fellowship Program Director and Medical Director of Respiratory Care at St. Louis Children's Hospital. His academic interests are aimed at the implementation of specific task-based processes and systems-based interventions that increase team performance. References:Butler AD, Dominick CL, Yehya N. High frequency percussive ventilation in pediatric acute respiratory failure. Pediatr Pulmonol. 2021 Feb;56(2):502-508. doi: 10.1002/ppul.25191. Epub 2020 Dec 8. PMID: 33258557; PMCID: PMC7902396.Linda Melchor. (2021, July 22). High-Frequency Percussive Ventilation – Using the VDR, or HFPV-4. Criticalcarenow.Com.Salim, A., & Martin, M. (2005). High-frequency percussive ventilation. Critical Care Medicine, 33(Supplement), S241–S245. https://doi.org/10.1097/01.CCM.0000155921.32083.CEDominick, C., Nickel, A. J., & Yehya, N. (2022). High Frequency Percussive Ventilation in Viral Bronchiolitis: Do We Need a Standardized Approach to HFPV Management? Https://Home.Liebertpub.Com/Rcare, 67(7), 893–894. https://doi.org/10.4187/RESPCARE.10247White, B. R., Cadotte, N., McClellan, E. B., Presson, A. P., Bennett, E., Smith, A. G., & Aljabari, S. (2022). High-Frequency Percussive Ventilation in Viral Bronchiolitis. Respiratory Care, 67(7), 781–788. https://doi.org/10.4187/respcare.09350Questions, 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 Complex Care Journal Club podcast episode, Ms. Kathryn Knight and Dr. Brian K. Jordan discuss a national survey of families of children with medical complexity on access to home health nursing. They describe the impact of the nursing shortage on families, development of a nonprofit resource that facilitates connections between families and home nursing, and outline next steps from this work. Learn more about Hello Nurze: www.hellonurze.com Find additional details about the F.A.C.E.S. Project: www.hellonurze.com/p/faces-project SPEAKERS Kathryn Knight, BBA Co-Founder & Executive Director, Hello Nurze Brian K. Jordan, MD, PhD Associate Professor Oregon Health & Science University HOST Emily J. Goodwin, MD Clinical Associate Professor of Pediatrics University of Missouri Kansas City School of Medicine Pediatrician, General Academic Pediatrics Beacon Program Children's Mercy Kansas City DATE Initial publication date: September 8, 2025. JOURNAL CLUB ARTICLE Knight K, Knight G, Jordan BK. The Impact of the Lack of Access to Home Health Nursing on Families of Children with Medical Complexity in the United States. Home Healthc Now. 2025 Jul-Aug 01;43(4):213-220. doi: 10.1097/NHH.0000000000001356. Epub 2025 Jul 7. PMID: 40619624. OTHER ARTICLES REFERENCED Baker CD, Martin S, Thrasher J, Moore HM, Baker J, Abman SH, Gien J. A Standardized Discharge Process Decreases Length of Stay for Ventilator-Dependent Children. Pediatrics. 2016 Apr;137(4):e20150637. doi: 10.1542/peds.2015-0637. Epub 2016 Mar 10. PMID: 26966133; PMCID: PMC4811306. Hello Nurze. Connecting families and in-home nurses. Accessed August 27, 2025. https://www.hellonurze.com Moore PE, Boyer D, O'Connor MG, Baker CD, Rettig JS, Sterni L, Halbower A, Wilson KC, Thomson CC. Pediatric Chronic Home Invasive Ventilation. Ann Am Thorac Soc. 2016 Jul;13(7):1170-2. doi: 10.1513/AnnalsATS.201603-196CME. PMID: 27388405; PMCID: PMC5462000. TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/as/87x9cmw5xfnkkt74v5g5pv3/Jordan_and_Knight_Final_Transcript__9-5-25‌ Clinicians across healthcare professions, advocates, researchers, and patients/families are all encouraged to engage and provide feedback! You can recommend an article for discussion using this form: https://forms.gle/Bdxb86Sw5qq1uFhW6. 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 Knight K, Jordan BK, Goodwin EJ. From Crisis to Connection: Matching Families with Home Nursing Support in Complex Care. 09/2025. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/from-crisis-to-connection-matching-families-with-home-nursing-support-in-complex-care.

Dr. Lindsay Andras from Children's Hospital of Los Angeles joins the show to discuss her recent randomized control trial comparing outcomes of functional bracing and spica casting for pediatric femoral shaft fractures. Drs. Andras and co-author Dr. Julia Sanders share insights from their experience conducting a randomized control trial and the pearls and pitfalls of implementing the functional brace. The lightning round highlights articles on spinal involvement in hereditary multiple osteochondromas, outcomes of pediatric multi-ligamentous knee injuries, and the impact of Pavlik harness treatment on breastfeeding efficacy.   Your hosts are Will Morris (Scottish Rite for Children in Dallas), Julia Sanders (Children's Hospital of Colorado), Tyler McDonald (University of South Alabama), and Steph Logterman (Arnold Palmer Hospital for Children). Music by A. A. Aalto.   Disclosure: Drs. Lindsay Andras and Julia Sanders each receive royalties from Orthopediatrics who produce a version of the fracture brace discussed in this episode.   References: 1. Andras LM, Sanders JS, Phan TN, Purtell SR, Gasca J, Wren TAL, Sim AT, Skaggs D, Kramer A, Chavez M, Kay R. A Prospective, Randomized Comparison of Functional Bracing and Spica Casting for Femoral Fractures Showed Equivalent Early Outcomes. J Bone Joint Surg Am. 2025 Jun 26;107(16):1769-1776. doi: 10.2106/JBJS.24.01081. PMID: 40570075. 2. Casey VF, Chandler CC, Graham GD, Frick SL. Dynamic Femur Fracture Brace vs Hip Spica Cast for Pediatric Femoral Shaft Fractures: A Retrospective Comparative Cohort Study. J Pediatr Soc North Am. 2025 May 23;12:100203. doi: 10.1016/j.jposna.2025.100203. PMID: 40704087; PMCID: PMC12284357. 3. Lang PJ, Feroe A, Franco H, Hussain ZB, Tepolt FA, Kocher MS. Outcomes of Operative Management of Multi-Ligament Knee Injuries in an Adolescent Population: A Retrospective Case Series. J Pediatr Soc North Am. 2024 Feb 5;5(4):742. doi: 10.55275/JPOSNA-2023-742. PMID: 40432936; PMCID: PMC12088175. 4. Bram JT, Tracey OC, Trotzky Z, Jones RH, Jochl O, Cirrincione PM, Nichols E, Dodwell ER, Scher DM, Doyle SH, Sink EL. Pavlik Harness Treatment for Infantile Hip Dysplasia Lowers Breastfeeding Self-efficacy. J Pediatr Orthop. 2025 Sep 1;45(8):e701-e705. doi: 10.1097/BPO.0000000000002976. Epub 2025 Apr 21. PMID: 40256838. 5. Legler J, Benaroch LR, Pirshahid AA, Serhan O, Cheng D, Bartley D, Carey T, Rasoulinejad P, Singh S, Thornley P. Rate of Spinal Osteochondromas Diagnosed in Pediatric Patients With Hereditary Multiple Osteochondromas: A Systematic Review and Meta-Analysis. J Pediatr Orthop. 2025 Sep 1;45(8):e718-e723. doi: 10.1097/BPO.0000000000002975. Epub 2025 Apr 23. PMID: 40266849.

Learn how to sharpen your pediatric intubation skills and make evidence-based decisions at the bedside. Today, Dr. Pradip Kamat, Dr. Monica Gray, and Dr. Rahul Damania expertly dissect the nuances of selecting optimal induction agents for critically ill children in the PICU. Through engaging, real-world case scenarios, our hosts guide you through drug choices in complex situations such as cardiogenic shock, septic shock, and elevated intracranial pressure—always prioritizing hemodynamic stability and patient safety. Gain valuable insights into the advantages, limitations, and clinical pearls of agents like propofol, fentanyl, ketamine, and midazolam, along with practical strategies for rapid sequence intubation, neuromuscular blockade, and individualized patient care. Don't miss this high-yield discussion, packed with actionable knowledge!Show Highlights:Induction agents for endotracheal intubation in critically ill childrenClinical scenarios highlighting optimal choices of induction agents and neuromuscular blockersImportance of maintaining hemodynamic stability during intubationPharmacology and clinical considerations of various induction agents (e.g., propofol, ketamine, fentanyl, etomidate)Use of neuromuscular blocking agents (NMBAs) in pediatric intubationDifferences between depolarizing and non-depolarizing neuromuscular blockersRisks associated with specific induction agents in patients with cardiac dysfunction or septic shockModified rapid sequence intubation (RSI) techniques for unstable patientsKey takeaways for managing critically ill pediatric patients requiring intubationPractical tips for optimizing intubation conditions and minimizing complicationsReferences:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care 6th Edition. Chapters 127 - 135, Pages 1510 - 1610Hendrix JM, Regunath H. Intubation Endotracheal Tube Medications. [Updated 2025 Jan 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459276/Agrawal, Dewesh. Rapid sequence intubation (RSI) in children for emergency medicine: Medications for sedation and paralysis. UpToDate. Last updated Dec 4, 2024.Vanlinthout LE, Geniets B, Driessen JJ, Saldien V, Lapré R, Berghmans J, Uwimpuhwe G, Hens N. Neuromuscular-blocking agents for tracheal intubation in pediatric patients (0-12 years): A systematic review and meta-analysis. Paediatr Anaesth. 2020 Apr;30(4):401-414. doi: 10.1111/pan.13806. Epub 2020 Mar 9. PMID: 31887248.Tarquinio KM, Howell JD, Montgomery V, Turner DA, Hsing DD, Parker MM, Brown CA 3rd, Walls RM, Nadkarni VM, Nishisaki A; National Emergency Airway Registry for Children; Pediatric Acute Lung Injury and Sepsis Investigators Network. Current medication practice and tracheal intubation safety outcomes from a prospective multicenter observational cohort study. Pediatr Crit Care Med. 2015 Mar;16(3):210-8. doi: 10.1097/PCC.0000000000000319. PMID: 25581629.Conway JA, Kharayat P, Sanders RC Jr, Nett S, Weiss SL, Edwards LR, Breuer R, Kirby A, Krawiec C, Page-Goertz C, Polikoff L, Turner DA, Shults J, Giuliano JS Jr, Orioles A, Balkandier S, Emeriaud G, Rehder KJ, Kian Boon JL, Shenoi A, Vanderford P, Nuthall G, Lee A, Zeqo J, Parsons SJ, Furlong-Dillard J, Meyer K, Harwayne-Gidansky I, Jung P, Adu-Darko M, Bysani GK, McCarthy MA, Shlomovich M, Toedt-Pingel I, Branca A, Esperanza MC, Al-Subu AM, Pinto M, Tallent S, Shetty R, Thyagarajan S, Ikeyama T, Tarquinio KM, Skippen P, Kasagi M, Howell JD, Nadkarni VM, Nishisaki A; National Emergency Airway Registry for Children (NEAR4KIDS) and for the Pediatric Acute Lung Injury and Sepsis Investigators...

On Sept 10, 2023, er released an episode titled, “CS Ut Closure: Decidua or No Decidua?”. We highlighted the importance of AVOIDING the decidua at hysterotomy closure at CS. Now, in Sept 2025, in Obstetrics and Gynecology (the Green Journal), there is a new systematic review and meta-analysis on this very topic. Does this new study CONFIRM or REFUTE what we explained 2 years ago? Listen in for details. 1. Sept 10, 2023 Chapa Clinical Pearls Podcast: CS Ut Closure: Decidua or No Decidua?2. Lino GM, Galvão PVM, da Silva MLF, Conrado GAM. Not Closing Compared With Closing the Endometrial Layer During Cesarean Delivery: A Systematic Review and Meta-analysis. Obstet Gynecol. 2025 Jun 12;146(3):e55-e63. doi: 10.1097/AOG.0000000000005974. PMID: 40505112.

Herbs #22 and 23 on the top-selling herbs list for 2023 were milk thistle and black cohosh.Today we continue our series on commercially popular herbs, and share our views as herbalists on the actions, benefits, and applications of these.Milk thistle is widely known as an excellent herb for the liver, and this is a case where the common wisdom is correct. It's one of the safest herbs out there, and fortunately, it is also widely available and inexpensive. Hepatoprotective and even able to regenerate damaged liver tissue, it is at the same time a very gentle and benign plant. But don't try to make tea with it!Black cohosh's reputation is as a remedy for PMS and menopausal symptoms, and often this is attributed to phytoestrogenic activity or constituents. The reality is murky – and has remained so despite decades of argument and investigation on both sides of the claim. Regardless, black cohosh can often help. We find it best to view the herb through the lens of its action as a relaxant. If PMS or menopause are showing up with lots of tension, it's worth a try and most likely to help. But we can also apply that action much more broadly, for injuries, spasms, and (certain kinds of) headaches.22. Milk Thistle – Silybum marianaumMilk Thistle: Herb of the WeekMilk Thistle at Herbal RealityMilk Thistle in A Modern Herbal, M. Grieve, 1931 – presented in this text alongside multiple other thistles, which allows for close comparisons among them.23. Black Cohosh – Actaea racemosaWuttke, W., Seidlová-Wuttke, D. Black cohosh (Cimicifuga racemosa) is a non-estrogenic alternative to hormone replacement therapy. Clin Phytosci 1, 12 (2015). doi: 10.1186/s40816-015-0013-0.Mohapatra S, Iqubal A, Ansari MJ, Jan B, Zahiruddin S, Mirza MA, Ahmad S, Iqbal Z. Benefits of Black Cohosh (Cimicifuga racemosa) for Women Health: An Up-Close and In-Depth Review. Pharmaceuticals (Basel). 2022 Feb 23;15(3):278. doi: 10.3390/ph15030278. PMID: 35337076; PMCID: PMC8953734.Black Cohosh at Herbal RealityCimicifuga in King's American Dispensatory, 1898 – has an impressively long list of indications and applications for this remedy.If all you'd heard (before today) about black cohosh was that it's “good for menopause”, you might want to check out our Reproductive Health course! We discuss the whole range of human reproductive variability and herbal medicines to support all kinds of people. We even bust a few reproductive-health myths and herban legends. (Hint: vitex is not “a miracle herb for all women”!)If you have a moment, it would help us a lot if you could subscribe, rate, & review our podcast wherever you listen. This helps others find us more easily. Thank you!!Our theme music is “Wings” by Nicolai Heidlas.Support the showYou can find all of our online herbalism courses at online.commonwealthherbs.com!

If you're interested in boosting your cardiovascular fitness, I've got three steps for you to do.  Your cardiovascular fitness - VO2 max - is the most powerful predictor of longevity. Together with your lower body strength, they will tell the story of your future.    What is VO2 max? Oxygen consumed in milliliters per kilogram per minute. Strongest predictor of longevity, alongside lower body strength. VO2 Max and muscle mass peaks typically at age 25, with studies suggesting an average annual reduction of about 1% after.   Increasing your VO2 max can significantly increase your longevity. It can reduce all-cause mortality by 10-25%. Just going from low to above-average fitness levels can reduce mortality risk by 60-70% over a decade.    The 3 Steps to Improve Cardio Fitness 1. Long slow aerobic exercise  Walking, hiking, biking, swimming. Work just below threshold (can talk, slightly breathy). 80% of the time will be spent here. 20% should be spent doing HIIT or strength training. 2. High-Intensity Interval Training (HIIT)  10-15% improvement in 5-10 weeks 15–30 seconds of breathless effort (sprinting effect). Breathless in 30 seconds or less. 3. Strength training Improves muscle, may enhance your body composition or weight    Improving both your fitness (oxygen delivery and use) and reducing weight means your ml/kg/min will go up as you consume more oxygen with less body weight .. and even if you don't lose weight your muscle is metabolically active and consumes oxygen while fat doesn't.    So let's come back to the value of VO2 for reducing all cause mortality.  A modest increase of 3.5 ml/kg/min (1 MET) is all it takes to reduce all-cause mortality by up to 25%.    How do you know your Cardio Fitness is improving?    Short of getting a VO2 max test, you can measure in other ways:  Resting heart rate – first thing in morning  Recovery heart rate at end of interval and one minute later One-mile walk test   Why Muscle Still Matters? More muscle = higher oxygen demand → better VO2 Max. Fat mass doesn't contribute to oxygen use. Muscle quality declines with age → requires smarter training, especially during menopause.   Watch this episode on Flipping50TV YouTube.   References:  Journal of American College of Cardiology. 2018, PMID: 30384883. Circulation. 2007, PMID: 17548726.   Other Episodes You Might Like: Previous Episode - 80 Lb Perimenopausal Weight Loss After Corporate Burnout Next Episode - From Your Mouth to Your Gut: Hearing Health Whisper More Like This - Extended Cardio and Low Protein Equal Short Term Weight Loss   Resources:  Join the Hot, Not Bothered! Challenge to learn why timing matters and why what works for others is not working for you. Use Flipping 50 Scorecard & Guide to measure what matters with easy at-home self-assessment test you can do in minutes. Are you burning belly fat or burning out? Get the Menopause Fitness Guide to High-Intensity Interval Training to help you lose more fat and stay on track!  

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.

In dieser Folge sprechen wir über eine aktuelle Publikation aus Surgical Endoscopy, in der der Lernverlauf eines einzelnen Chirurgen bei 100 konsekutiven robotisch-assistierten Leberresektionen analysiert wurde. Die Ergebnisse zeigen vier klar abgrenzbare Phasen der Lernkurve mit einem Wendepunkt um Fall 65 – und geben wichtige Hinweise zur Standardisierung der Ausbildung in der robotischen Leberchirurgie.Was sind die Herausforderungen, was die Vorteile der roboterassistierten Technik? Und wie lange dauert es wirklich, bis man schwierige Fälle sicher beherrscht?Gast: Prof. Dr. Roland CronerModerator: PD Dr. Christoph Paasch Rahimli M, Gumbs AA, Perrakis A, Al-Madhi S, Dölling M, Stelter F, Lorenz E, Andric M, Franz M, Arend J, Croner RS. Learning curve analysis of 100 consecutive robotic liver resections. Surg Endosc. 2025 Apr;39(4):2512-2522. doi: 10.1007/s00464-025-11551-5. Epub 2025 Feb 27. PMID: 40014140; PMCID: PMC11933130.

According to the J Am Acad Orthop Surg Glob Res Rev. (2024), the incidence of pelvic ring injuries is 34.3 per 100,000 with trauma being the most obvious causation. Women account for approximately 69.7% of these injuries, 23% of which occur in women of childbearing age. In this specific patient population, concern is raised about one's future reproductive capability and method of delivery. The normal bony pelvic movements that occur during vaginal delivery are crucial for accommodating the passage of the fetus through the birth canal; this allows for the normal cardinal phases of labor to occur. These movements involve the widening and shifting of various pelvic joints and bones, primarily influenced by hormonal changes and the mechanical forces exerted by the baby. So, it is reasonable to ask if a patient with pelvic fractures and fixation can safely allow a trial of labor. Is a history of pelvic fractures with surgical fixation an indication for primary cesarean section? If it's not, in what scenario would a primary c-section be best after a pelvic fracture? Listen in for details. 1.Pelvic Fractures in Women of Childbearing Age.Cannada LK, Barr J. Clinical Orthopaedics and Related Research. 2010;468(7):1781-9. doi:10.1007/s11999-010-1289-5.2.Birth Outcomes Following Pelvic Ring Injury: A Retrospective Study. Hsu CC, Lai CY, Chueh HY, et al. BJOG : An International Journal of Obstetrics and Gynaecology. 2023;130(11):1395-1402. doi:10.1111/1471-0528.17487.3.Pregnancy and Delivery After Pelvic Fracture in Fertile-Aged Women: A Nationwide Population-Based Cohort Study in Finland. Vaajala M, Kuitunen I, Nyrhi L, et al. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2022;270:126-132. doi:10.1016/j.ejogrb.2022.01.008.4.Pregnancy Outcomes After Pelvic Ring Injury.Vallier HA, Cureton BA, Schubeck D. Journal of Orthopaedic Trauma. 2012;26(5):302-7. doi:10.1097/BOT.0b013e31822428c5.5.Caesarean Section Rates Following Pelvic Fracture: A Systematic Review. Riehl JT. Injury. 2014;45(10):1516-21. doi:10.1016/j.injury.2014.03.018.6.Unstable Pelvic Fractures in Women: Implications on Obstetric Outcome. Davidson A, Giannoudis VP, Kotsarinis G, et al. International Orthopaedics. 2024;48(1):235-241. doi:10.1007/s00264-023-05979-4.7.Management of Pelvic Injuries in Pregnancy.Amorosa LF, Amorosa JH, Wellman DS, Lorich DG, Helfet DL. The Orthopedic Clinics of North America. 2013;44(3):301-15, viii. doi:10.1016/j.ocl.2013.03.0058.Effect of Trauma and Pelvic Fracture on Female Genitourinary, Sexual, and Reproductive Function.Copeland CE, Bosse MJ, McCarthy ML, et al. Journal of Orthopaedic Trauma. 1997 Feb-Mar;11(2):73-81. doi:10.1097/00005131-199702000-00001.9. The Rate of Elective Cesarean Section After Pelvic or Hip Fracture Remains High Even After the Long-Term Follow-Up: A Nationwide Register-Based Study in Finland. Vaajala M, Kuitunen I, Liukkonen R, et al.European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2022;277:77-83. doi:10.1016/j.ejogrb.2022.08.10. Bajerová M, Hruban L. Movements of the pelvic bones of expectant mothers during vaginal delivery. Ceska Gynekol. 2024;89(4):335-342. English. doi: 10.48095/cccg2024335. PMID: 39242210. 11. Lewis AJ, Barker EP, Griswold BG, Blair JA, Davis JM. Pelvic Ring Fracture Management and Subsequent Pregnancy: A Summary of Current Literature. J Am Acad Orthop Surg Glob Res Rev. 2024 Feb 6;8(2):e23.00203. doi: 10.5435/JAAOSGlobal-D-23-00203. PMID: 38323930; PMCID: PMC10849384.12. Childbirth after Pelvic Fractures: Debunking the Myths: https://ota.org/sites/files/legacy_abstracts/ota09/otapa/OTA090132.htm13. Davidson A, Giannoudis VP, Kotsarinis G, Santolini E, Tingerides C, Koneru A, Kanakaris NK, Giannoudis PV. Unstable pelvic fractures in women: implications on obstetric outcome. Int Orthop. 2024 Jan;48(1):235-241. doi: 10.1007/s00264-023-05979-4. Epub 2023 Sep 15. PMID: 37710070

Contributor: Alec Coston, MD Educational Pearls: Hepatic encephalopathy (HE) is defined as a disruption in brain function that results from impaired liver function or portosystemic shunting. Manifests as various neurologic and psychiatric symptoms such as confusion, inattention, and cognitive dysfunction Although ammonia levels have historically been recognized as important criteria for HE, the diagnosis is ultimately made clinically. An elevated ammonia level lacks sensitivity and specificity for HE Trends in ammonia levels do not correlate with disease improvement or resolution A 2020 study published in the American Journal of Gastroenterology evaluated 551 patients diagnosed with hepatic encephalopathy and treated with standard therapy Only 60% of patients had an elevated ammonia level, demonstrating the limitations of ammonia levels However, a normal ammonia level in a patient with concern for HE should raise suspicion for other pathology. In patients with cirrhosis presenting with neuropsychiatric symptoms, consider HE as the diagnosis after excluding other potential causes of altered mental status (i.e., Seizure, infection, intracranial hemorrhage) The primary treatment is lactulose Works by acidifying the gastrointestinal tract. Ammonia (NH₃) is converted into ammonium (NH₄⁺), which is poorly absorbed and subsequently eliminated from the body Also exerts a laxative effect, further enhancing elimination References: Haj M, Rockey DC. Ammonia Levels Do Not Guide Clinical Management of Patients With Hepatic Encephalopathy Caused by Cirrhosis. Am J Gastroenterol. 2020 May;115(5):723-728. doi: 10.14309/ajg.0000000000000343. PMID: 31658104. Lee F, Frederick RT. Hepatic Encephalopathy-A Guide to Laboratory Testing. Clin Liver Dis. 2024 May;28(2):225-236. doi: 10.1016/j.cld.2024.01.003. Epub 2024 Jan 30. PMID: 38548435. Vilstrup, Hendrik1; Amodio, Piero2; Bajaj, Jasmohan3,4; Cordoba, Juan1,5; Ferenci, Peter6; Mullen, Kevin D.7; Weissenborn, Karin8; Wong, Philip9. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study Of Liver Diseases and the European Association for the Study of the Liver. Hepatology 60(2):p 715-735, August 2014. | DOI: 10.1002/hep.27210 Weissenborn K. Hepatic Encephalopathy: Definition, Clinical Grading and Diagnostic Principles. Drugs. 2019 Feb;79(Suppl 1):5-9. doi: 10.1007/s40265-018-1018-z. PMID: 30706420; PMCID: PMC6416238. Summarized by Ashley Lyons, OMS3 | Edited by Ashley Lyons & Jorge Chalit, OMS4 Get your tickets to Tox Talks Event, Sept 11, 2025: https://emergencymedicalminute.org/events-2/ Donate: https://emergencymedicalminute.org/donate/  

Mornings can set the tone for the rest of your day, and with PCOS, the right habits can make a huge difference. In this episode, I'm sharing five simple habits that support stable blood sugars, a regulated appetite, better focus, and healthier cortisol management. These aren't complicated or Instagram-perfect routines, but doable shifts you can start right away to make mornings less chaotic and create a ripple effect for the rest of your day. Ready to boost your energy, regulate cycles and feel confident with a clear plan to thrive with PCOS? Our PCOS Recovery Program is now open for enrolment - we start Sept 24th! This is your chance to move beyond short-term diets and finally feel confident in your health. Join us. If you enjoyed this episode, we'd love to hear it - please leave a rating and review! References:Malone JC, Thavamani A. Physiology, Gastrocolic Reflex. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549888/ Witbracht M, Keim NL, Forester S, Widaman A, Laugero K. Female breakfast skippers display a disrupted cortisol rhythm and elevated blood pressure. Physiol Behav. 2015 Mar 1;140:215-21. doi: 10.1016/j.physbeh.2014.12.044. Epub 2014 Dec 27. PMID: 25545767. Xiao K, Furutani A, Sasaki H, Takahashi M, Shibata S. Effect of a High Protein Diet at Breakfast on Postprandial Glucose Level at Dinner Time in Healthy Adults. Nutrients. 2022 Dec 24;15(1):85. doi: 10.3390/nu15010085. PMID: 36615743; PMCID: PMC9824806.

Traditionally, we have learned that any imbalance in the estrogen: progesterone relationship can trigger irregular uterine bleeding. That makes sense, right? During anovulation, prolonged unopposed estrogen can result in HMB. In such a case, we give progesterone as both a therapeutic as well as diagnostic intervention. On the contrary, with progestin only contraception, we consider estrogen predominant products when progesterone breakthrough bleeding (BTB) occurs to restore endometrial stabilization. But a new RCT (AJOG) adds credence to adding MORE progesterone in cases of progesterone associated BTB. Listen in for details.1. Zigler RE, Madden T, Ashby C, Wan L, McNicholas C. Ulipristal Acetate for Unscheduled Bleeding in Etonogestrel Implant Users: A Randomized Controlled Trial. Obstet Gynecol. 2018 Oct;132(4):888-894. doi: 10.1097/AOG.0000000000002810. PMID: 30130351; PMCID: PMC6153077.2.ANDRADE MCR, et al. Norethisterone for Prolonged Uterine Bleeding Associated with Etonogestrel Implant (IMPLANET): A Randomized Controlled Trial, American Journal of Obstetrics and Gynecology (2025), doi: https://doi.org/10.1016/j.ajog.2025.08.029.

Zone 2 is the most popular training zone - but is it the only training zone you need? We delve into all five training zones and their unique benefits. You'll learn how to determine each zone by heart rate, rate of perceived exertion (RPE), and talk test, plus how to use them in training. *Laura misspoke around minute 23. The Cori cycle converts lactate into glucose, not glycogen, to then be shuttled back into the muscles to undergo anaerobic glycolysis. Thank you to our sponsors:✨ Upstep: Custom orthotics, molded from the comfort of your home. Use code RUNTOTHEFINISH at https://www.upstep.com/?ref=cajmuang for $20 off your purchase. ✨ Previnex: Previnex creates clinically effective, third-party tested supplements made with high-quality ingredients, including Muscle Health Plus (creatine). Use the code treadlightly for 15% off your first order at previnex.comIn this episode, you will learn:✅ Why you need to train at intensities beyond zone 2✅ How to calculate your training zones✅ Is it worth running in zone 1?✅ Is zone 3 really “the gray zone”?✅ The value of threshold/zone 4 workouts✅ The benefits of training in zone 5 (interval training)✅ Why heart rate monitoring is less reliable in zone 5✅ Can heart rate zones be used on race day?References:

If you've ever doubted your ability to make muscle mass and strength gains after menopause, this episode is for you. It's not too late to gain strength and lean muscle mass can be gained at any age—even after 85.   Based on a 2024 Study on Resistance Training in Older Adults by Int. Journal of Sports Nutrition & Exercise Metabolism, here's what happened and the results: Participants:  17 adults aged 65–75. 12 adults aged 85+. Program:  Duration: 12 weeks, 3x per week Structure: Warm-up  4 lower body sets 3 upper body exercises (2 sets each) Stretching Results: Quadriceps strength increased in all participants 65–75 group: 1–18%  85+ group: 6–21%  1RM leg extension increased in all participants 65–75 group: 38% ± 20%  85+ group: 46% ± 14%  Improvements were seen in lean mass, strength and functional activities like chair stands, gait speed, timed up-and-go.   Defining Muscle Mass and Strength Gains After Menopause Exercise intensity is based on decreasing repetitions to muscular fatigue.  Exercise volume is based on the number of sets.   Considerations for Exercise Volume in Women in Menopause Volume = sets x reps x weight or total weekly workload. Start small (1–2 sets, 2x per week if inactive). Build to 3x only once consistent. Balance recovery: not just alternating workout/rest days, but also factoring in life stress. Menopausal women may need 48–72 hours between resistance sessions, per muscle group.   For women post menopause; increasing the number of days per week to reach greater exercise volume can be problematic because of the need for balance with recovery days. We don't mean 1 day work, 1 day rest. It can mean 1 day of high intensity work and 2 or 3 days light or moderate exercise for another type for recovery.   Start Your Strength Gains After Menopause The beginning phases of exercise should last longer for a woman starting in her 60s or 70s. Muscle, ligaments and tendons collectively are not as resilient at 60 as they were at 20. Since most early improvements are due to neural adaptations and heavier weights don't accelerate that, progress at a pace so you know you've exercised muscles but aren't sore or uncomfortable. You're in this for life. There's time.   The adaptive response to resistance training is preserved even in males and females over 85.   Protein & Resistance Training Two drivers of muscle protein synthesis: Resistance Training Adequate Protein. For metabolic health: ~100g/day (for 160 lb woman). For optimal fitness: closer to 160g/day. Protein recommendation for a 160lb adult is 60 grams of protein day. Only 46% of older adults get that.   5-Step Protein & Resistance Training Process: Track your current protein intake. Compare with recommendations based on age, weight, activity. Identify gaps without judgment. Close the gap gradually. Set short-term goals, especially starting with breakfast protein.   Muscle Mass and Strength Gains After Menopause are Dependent On… Relative Strength Training Power decreased significantly after the age of 50 years and was negatively and strongly associated with mobility limitations.   Mobility & Longevity Connection Strength must be paired with mobility to prevent limitations. Key focus areas: ankles, hips, upper back. Loss of mobility = harder to regain later. More… much more on mobility in upcoming posts. References:  Journal of Cachexia Sarcopenia and Muscle. 2021, PMID: 34216098. Journal of Nutrition, Health and Aging. 2019, PMID: 30932132. International Journal of Sport Nutrition and Exercise Metabolism. 2023, PMID: 37875254.   Other Episodes You Might Like: Previous Episode - Aging with Power, (Without an Outage) with Vonda Wright Next Episode - 80 Lb Perimenopausal Weight Loss After Corporate Burnout More Like This: What Is Sarcopenia and How to Avoid Sarcopenia In Menopause What's Best Total Body or Split Routine in Menopause   Resources for Strength Gains After Menopause:  Join the Hot, Not Bothered! Challenge to learn why timing matters and why what works for others is not working for you. Get the Flipping 50 STRONGER 12-week program for your at-home safe, sane, simple exercises. Get your lean, clean Flipping 50 Protein Powders to maintain muscle and support metabolism.  

LISTENER DISCRETION IS ADVISED. References: Buxton. Sustained Monomorphic VT: Clinical Manifestations, Diagnosis, and Evaluation. Up-to-Date. Farré J, Rubio JM, Sternick EB. Confounding factors leading to misdiagnosing ventricular tachycardia as supraventricular in the emergency room. Indian Pacing Electrophysiol J. 2023;23(1):1-13. doi:10.1016/j.ipej.2022.11.002 Kashou AH, Evenson CM, Noseworthy PA, et al. Differentiating wide complex tachycardias: A historical perspective. Indian Heart J. 2021;73(1):7-13. doi:10.1016/j.ihj.2020.09.006 Salim Rezaie, "SVT With Aberrancy Versus VT", REBEL EM blog, November 22, 2013. Available at: https://rebelem.com/svt-aberrancy-versus-vt/. 
Steinman RT, Herrera C, Schuger CD, Lehmann MH. Wide QRS tachycardia in the conscious adult. Ventricular tachycardia is the most frequent cause. JAMA. 1989 Feb 17;261(7):1013-6. PMID: 2915409. Vereckei A. Current algorithms for the diagnosis of wide QRS complex tachycardias. Curr Cardiol Rev. 2014 Aug;10(3):262-76. doi: 10.2174/1573403x10666140514103309. PMID: 24827795; PMCID: PMC4040878.

Episode 201: AKI Roadmap.  Future Dr. Ayyagari describes the different types of acute kidney injury and shares some elements of management for each category. Dr. Arreaza shares some input about statistics and the importance of drinking water during summer.Written by Tejasvi Ayyagari, MSIV, Ross University School of Medicine. Edits and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.INTRODUCTION:Dr. Arreaza: Hello everyone, and welcome back to Rio Bravo qWeek — your weekly dose of knowledge. I'm Dr. Arreaza, I am a faculty member and associate program director of the Rio Bravo FM residency program. In Episode 126, we briefly introduced the topic of Acute Kidney Injury (AKI), but today, we're taking a deep dive into the matter. I have here alongside my cohost, future Dr. Ayyagari, AKA TJ. Please, TJ, introduce yourself.TJ: Hey everyone, good to be back on the podcast. My name is TJ Ayyagari, and I am currently finishing my last rotation of medical school with Rio Bravo CSV outpatient.  I hope everyone is doing well and staying safe.Dr. Arreaza: So, TJ prepared this discussion about acute kidney injury, also known as AKI. This is a critical topic for our Kern community, especially during the summer months when the risk of AKI increases. You will face many patients with AKI on the wards, in the clinic, and especially on your future board exam. Hopefully, by the end of this episode, you all will have more information on AKI, but also the three different types: prerenal, intrinsic, and postrenal. TJ: Without further ado, let's get started, Dr. Arreaza.SECTION 1 – What is AKI?Dr Arreaza: Let's start with the definition. Let's explain what AKI is. TJ: Absolutely.  So, an AKI is not just a bump in the patient's creatinine. According to the Kidney Disease Improving Global Outcomes (KDIGO) definition, an AKI embodies any of the following criteria:Increase in serum creatinine by ≥0.3 mg/dL within 48 hours, ORIncrease in serum creatinine to ≥1.5 times baseline within the prior 7 days, ORUrine volume 20:1).  There is also a lab value called the Fractional excretion of sodium, otherwise known as FeNa, which will appear as 20:1 — looks like prerenal.FeNa 500 mOsm/kg.In the later phase (after prolonged obstruction → tubular injury):BUN: Cr ratio ~10–15:1 — now looks intrinsic.FeNa >2%.Urine osmolality ~300 mOsm/kg.Dr. Arreaza: BUN:Cr ratio and FeNa are not reliable to diagnose postrenal AKI, so we must rely more in imaging and clinical presentation. Let´s talk about the management of postrenal AKI.TJ: Absolutely!  The main way to treat a post-renal AKI is to relieve the obstruction causing it in the first place, whether it be through surgery, TURP, lithotripsy, etc.Dr. Arreaza: I think the favorite treatment done by urology to relieve obstruction is a ureteral stent, which, remember, needs to be removed later. Typically, 1-2 weeks is sufficient to treat kidney stones. The risk of encrustation and infection increases significantly after 4–6 weeks, and stents should ideally be exchanged within 3 months to minimize complications. SECTION 5 – ClosingDr. Arreaza: I know you've spent a decent amount of time explaining the details of the AKI types with us, TJ, but could you give us a summary?TJ: Viewers, if there's anything to take away from this, remember:Prerenal: Poor perfusion, fix the flow.Intrinsic: Structural damage inside the kidney — think ATN, AIN, GN.Postrenal: Obstruction — relieve the blockage.When you see AKI, think: Before the kidney, in the kidney, or after the kidney? That simple framework can help you move fast and help your patient recover kidney function.Dr. Arreaza, any advice you want to give to the viewers?Dr. Arreaza: Yes,weare in the middle of summer, and we treat a large amount of farm workers, construction workers and people who spend time outdoors, in general, remind your patients to drink water. Water is life, especially for the kidneys, there is no substitute. That's it for today's episode of Rio Bravo qWeek. If you enjoyed this review, share it with a colleague or medical student who could use a quick AKI refresher. And remember — the kidneys may be small, but they're mighty… and they hold grudges when you ignore them. I'm Dr. Arreaza, signing off.TJ: Thank you for tuning in, everyone. Have a nice day!Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney International Supplements. 2012;2:1–13. https://kdigo.org/guidelines/acute-kidney-injury/.Kaur A, Sharma GS, Kumbala DR. Acute kidney injury in diabetic patients: A narrative review. Medicine (Baltimore). 2023 May 26;102(21):e33888. doi: 10.1097/MD.0000000000033888. PMID: 37233407; PMCID: PMC10219694. https://pmc.ncbi.nlm.nih.gov/articles/PMC10219694/Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/. 

Life doesn't always follow your training plan, and that's okay. In this episode, I'll teach you how to pivot your strength and cycling workouts when work, family, or stress throw curveballs. You'll learn my “3 R Framework” (Reduce, Replace, Reschedule) so you can stay consistent, avoid burnout, and actually build resilience as a busy professional who loves to ride. We'll cover: Why adaptable training beats rigid plans for long-term success How to pivot when you're short on time, energy, or equipment The mindset shift that separates thriving athletes from frustrated ones Actionable steps to create your own adaptable training toolkit Whether you're balancing a demanding career or just navigating life's chaos, this episode will help you train smarter, stay consistent, and feel empowered.

We programme strength, cardio, and mobility — but almost never relaxation. Yet research shows Progressive Muscle Relaxation lowers stress, calms anxiety, improves mood, and even deepens the most restorative stages of sleep.In this episode, I break down the evidence — from large systematic reviews to athlete studies — and then guide you through a full Progressive Muscle Relaxation session. You'll finish not just knowing why relaxation matters, but experiencing its benefits in real time.Study 1: Muhammad Khir S, Wan Mohd Yunus WMA, Mahmud N, Wang R, Panatik SA, Mohd Sukor MS, Nordin NA. Efficacy of Progressive Muscle Relaxation in Adults for Stress, Anxiety, and Depression: A Systematic Review. Psychol Res Behav Manag. 2024 Feb 1;17:345-365. doi: 10.2147/PRBM.S437277. PMID: 38322293; PMCID: PMC10844009.Study 2: Simon KC, McDevitt EA, Ragano R, Mednick SC. Progressive muscle relaxation increases slow-wave sleep during a daytime nap. J Sleep Res. 2022 Oct;31(5):e13574. doi: 10.1111/jsr.13574. Epub 2022 Mar 30. PMID: 35355351; PMCID: PMC9786620.Study 3: Battaglini MP, Pessôa Filho DM, Calais SL, Miyazaki MCOS, Neiva CM, Espada MC, de Moraes MG, Verardi CEL. Analysis of Progressive Muscle Relaxation on Psychophysiological Variables in Basketball Athletes. Int J Environ Res Public Health. 2022 Dec 19;19(24):17065. doi: 10.3390/ijerph192417065. PMID: 36554945; PMCID: PMC9778808.

Breast cancer is an hormone responsive malignancy, meaning it may use estrogen and progesterone, reduced in high quantities during a pregnancy, for growth. However, as medical evidence evolves quickly, physicians have come to understand that breast cancer diagnosis during pregnancy doesn't always mean worse prognoses. While older studies- including meta analysis-reflected worse prognoses for pregnancy related breast cancer compared to non-pregnancy related cases, these studies either included studies from the 1960s and 70s when diagnosis and treatment were radically different, had inconsistent definitions of PABC, and/or were poorly age and staged matched. Therefore, as stated in the new UK (Aug 2025) guidance, “the applicability to modern day practice of the findings from these reports is limited”. The more updated clinical stance is that, “By using diagnostic and treatment pathways for women with {pregnancy related breast cancer} which are as close as possible to women with non-pregnancy related breast cancer, similar outcomes can be achieved” (RCOG Green Top recommendations No 12). In this episode, we will summarize key points from the recently released Green Top Guidance No 12 (25 Aug 2025) which has shifted the perspective on treating breast cancer DURING pregnancy. 1. Cubillo A, Morales S, Goñi E, Matute F, Muñoz JL, Pérez-Díaz D, de Santiago J, Rodríguez-Lescure Á. Multidisciplinary consensus on cancer management during pregnancy. Clin Transl Oncol. 2021 Jun;23(6):1054-1066. doi: 10.1007/s12094-020-02491-8. Epub 2020 Nov 16. PMID: 33191439; PMCID: PMC8084770.2. https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/pregnancy-and-breast-cancer-green-top-guideline-no-12/3. Sundermann AC, Cate JM, Campbell AK, Dotters-Katz SK, Myers ER, Federspiel JJ. Maternal morbidity and mortality among patients with cancer at time of delivery. Am J Obstet Gynecol. 2023 Sep;229(3):324.e1-324.e7. doi: 10.1016/j.ajog.2023.06.008. Epub 2023 Jun 7. PMID: 37295633; PMCID: PMC10593119.

Episode 107 of Trail Society kicks off with life updates from Keely and Hillary, before diving into listener-submitted news and research. They discuss a BBC story where undercover officers highlighted the prevalence of street harassment, with 94% of local women reporting experiences of catcalling. This transitions into a conversation around exercise during pregnancy, sparked by a listener question about heart rate guidelines. The hosts review current research showing that, for athletes already active, higher intensity exercise can be safe and even beneficial during pregnancy, lowering risks like gestational diabetes and improving newborn Apgar scores. They emphasize that heart rate is an imprecise measure, and individualized approaches are important. The main feature of the episode is an interview with Anne Flower, an ER physician and elite trail runner who recently won and set a new course record at the Leadville 100, her debut 100-mile race. Anne shares how she balances training at a world-class level with her demanding medical career, and how lessons from the ER and ultrarunning inform each other. She reflects on her road-to-trail transition, the highs and lows of Leadville, and her mindset of tackling hard things as practice for resilience. Anne also discusses her role as Chief Medical Officer for Mountains to Mountains, her future racing goals, and offers advice for women entering the sport. The episode closes with listener shoutouts, stories of recovery after long races, training adaptations for different terrains, and heartfelt community support, reinforcing the podcast's commitment to uplifting women in endurance sports.   SPONSORSHIP:  We are so excited to be partnering with rabbit as our primary apparel sponsor this year! Send us some DMS about your favorite apparel and what you would like to see built for the trail running space!  So snag some of the new Trail Society x rabbit line before it's gone! New Code through the end of August—> HOPPER10   Keep sliding into our DMs with your messages, they mean so much to us!  FOLLOW US on Instagram: @trail.society And go follow our NEW youtube channel @trailsociety_podcast   Pregnancy and Exercise Research Citations:  Dalhaug EM, Sanda B, Bø K, Brown WJ, Sundgot-Borgen J, Haakstad LAH. Exceeding the guidelines: A descriptive study of exercise, pregnancy, maternal and neonatal health outcomes in elite and recreational athletes. BMC Pregnancy Childbirth. 2025 Apr 23;25(1):475. doi: 10.1186/s12884-025-07572-6. PMID: 40269794; PMCID: PMC12020307. Worska A, Laudańska-Krzemińska I, Ciążyńska J, Jóźwiak B, Maciaszek J. New Public Health and Sport Medicine Institutions Guidelines of Physical Activity Intensity for Pregnancy-A Scoping Review. J Clin Med. 2024 Mar 18;13(6):1738. doi: 10.3390/jcm13061738. PMID: 38541963; PMCID: PMC10971148.  

Weighted vests can be useful, but let's be honest about the benefits.Topics discussed:(00:06) - Who's excited about a weighted vest? (00:48) - Why is Lindsay not jumping on getting a weighted vest? (02:46) - Does it help with bone density? (03:28) - Does it build more muscle and strength? (05:54) - Does it burn more body fat? (13:56) - The nuance of the studies being used to justify weighted vests (21:08) - I love food! (26:43) - I appreciate your words of encouragement Walking alone is not a strong enough stimulus for muscle or bone.Inactive postmenopausal women who walked with or without a vest for 18 months had no significant bone density changes (PMID: 22338922). Full breakdown belowEven wearing a vest for 8 hours/day (PMID: 40540267) or 10 hours/day (PMID: 30095153) showed minimal skeletal benefit.The muscle and bone gains you see in the research?They're mostly in untrained individuals doing loaded exercises like squats, lunges, and jumps with the vest (PMID: 10995045, 9467434, 17724395).In these cases, the vest is just a hands-free way to add weight — not magic. As people progress, they'll need more load than a vest alone can provide.And for fat loss?Calorie burn from vest-walking is only ~10–15% higher than without it. That's 30–50 kcal for an hour walk — about a single untracked bite of food.Long-term fat loss comes from managing intake, not chasing small increases in burn. Your diet is the real game changer.If you lift weights regularly, walk, and are mindful about food, a weighted vest probably isn't a “must-have” for you. it's most effective in the right context.Study Overview: Walking With vs. Without a Weighted Vest  PMID: 22338922Authors & Journal: Tantiwiboonchai N., Kritpet T., Yuktanandana P. in Journal of the Medical Association of Thailand, 2011 (EurekaMag).Participants: 48 working women aged 30–60, randomly split into two groups: one walking with a weighted vest, the other walking without, on a treadmill 3×/week for 12 weeks (EurekaMag).Protocol: Vest group started walking without it for the first 2 weeks, then began adding 2% of body weight weekly until reaching 8% by week 6 (EurekaMag).FindingsBone Markers: Both groups showed large decreases in bone resorption (β-CrossLaps)—~19.1% for the vest group vs. ~21.8% for the non-vest group—no significant difference between them (EurekaMag).Physical Fitness: Improvements in leg and arm strength, endurance, and VO₂ max were seen in both groups—again, no significant differences between vest vs. non-vest walkers (EurekaMag).Bottom Line—What This MeansWalking, with or without a weighted vest, helped with fitness and reduced bone resorption—but wearing the vest didn't offer any extra benefit. So if you're thinking the vest is a cheat code for stronger bones or muscles… this study says otherwise.

Send us a textAssociation of patent ductus arteriosus treatment in extremely low gestational age neonates with two year kidney outcomes: a secondary analysis of the preterm erythropoietin neuroprotection trial (PENUT).Condit PE, Guillet R, Kaluarachchi D, Griffin RL, Menon S, Askenazi DJ, Harer MW.BMC Nephrol. 2025 Mar 19;26(1):138. doi: 10.1186/s12882-025-04065-8.PMID: 40108500 Free PMC article. Clinical Trial.Support 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!

Send us a textKidney Health Monitoring in Neonatal Intensive Care Unit Graduates: A Modified Delphi Consensus Statement.Starr MC, Harer MW, Steflik HJ, Gorga S, Ambalavanan N, Beck TM, Chaudhry PM, Chmielewski JL, Defreitas MJ, Fuhrman DY, Hanna M, Joseph C, Kwiatkowski DM, Krawczeski CD, Liberio BM, Menon S, Mohamed TH, Rumpel JA, Sanderson KR, Schuh MP, Segar JL, Slagle CL, Soranno DE, Vuong KT, Charlton JR, Gist KM, Askenazi DJ, Selewski DT; Neonatal Kidney Health Consensus Workshop.JAMA Netw Open. 2024 Sep 3;7(9):e2435043. doi: 10.1001/jamanetworkopen.2024.35043.PMID: 39269711 Free article.Support 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!

Ready for a deep dive into a real-life pediatric ICU situation? Today, Dr. Pradip Kamat, Dr. Monica Gray, and Dr. Rahul Damania will walk you through the case of a seven-year-old girl with Hemoglobin SC (HbSC) disease, who presents with abdominal swelling, pneumonia, low oxygen, and pain.In this episode, our team unpacks the spleen's anatomy and its crucial role in immunity, then zooms in on how sickle cell disease can throw a wrench in splenic function. You'll hear how they approach the diagnosis and management of acute splenic sequestration crisis, sharing clinical pearls along the way. Plus, they'll break down why quick recognition is so important and discuss strategies for both immediate and long-term care in pediatric sickle cell patients. Don't miss these practical insights from the frontlines of pediatric critical care!Show Highlights:Case study of a seven-year-old girl with hemoglobin SC diseasePresentation of symptoms: abdominal distension, pneumonia, hypoxia, and body painDiscussion of acute splenic sequestration crisis as a complication of sickle cell diseaseAnatomy and physiology of the spleenThe role of the spleen in sickle cell disease and how sickled cells affect splenic functionAcute splenic sequestration crisis, including clinical features and laboratory evaluationsManagement strategies for acute splenic sequestration crisis in the ICUImportance of blood transfusions and supportive care in treatmentProphylactic measures to prevent recurrence of splenic sequestrationEducational emphasis on recognizing clinical signs and the need for timely interventionReferences:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 88. Hemoglobinopathies. Baender, MA, Marsh Anne. Pages: 1457-1470Rogers' textbook of pediatric intensive care: Hematologic Emergencies. McCory MC, Bhar S, and Blaine E. Pages 2003-2005Brousse V, Buffet P, Rees D. The spleen and sickle cell disease: the sick(led) spleen. Br J Haematol. 2014 Jul;166(2):165-76. doi: 10.1111/bjh 12950. Epub 2014 May 26. PMID: 24862308.Waleed S, Aldabsa M, Gouher S. Splenic Sequestration Induced by Parvovirus B19: A Case Report. Cureus. 2024 May 23;16(5):e60937. doi: 10.7759/cureus. 60937. PMID: 38915956; PMCID: PMC11195323.Solanki DL, Kletter GG, Castro O. Acute splenic sequestration crises in adults with sickle cell disease. Am J Med. 1986 May;80(5):985-90. doi: 10.1016/0002-9343(86)90649-2. PMID: 3706382.Karna B, Jha SK, Al Zaabi E. Hemoglobin C Disease. [Updated 2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559043/

What happens if ChatGPT makes you a training plan? Will wearing a weighted vest protect you from the symptoms of perimenopause? Are continuous glucose monitors the tool for improving your nutrition? We tackle several social media trends and give our unfiltered, evidence-based hot takes.Thank you to our sponsors:✨ Tailwind: Complete sport nutrition made simple, including hydration mixes, high-carb sport drinks, endurance fuel, and recovery mixes. Use code TREADLIGHTLY20 at https://tailwindnutrition.com/TREADLIGHTLY for 20% off your first purpose.✨ Previnex: Previnex creates clinically effective, third-party tested supplements made with high-quality ingredients, including Muscle Health Plus (creatine). Use the code treadlightly for 15% off your first order at previnex.comIn this episode, you will learn:✅ Do you need electrolytes?✅ Our hot take on AI coaching✅ Do nasal strips improve running performance?✅ Are continuous glucose monitors beneficial?✅ Do carbon plated shoes increase your injury risk?✅ Should you change your workouts based on your menstrual cycle (cycle syncing)?✅ Does weighted vest training help perimenopausal athletes?References:

Contributor: Aaron Lessen, MD Educational Pearls: Recorded March 2025 What is the best treatment for a fever? Tylenol? Ibuprofen? Combined? Alternating the two? The journal Pediatrics aimed to answer this question with a meta-analysis of 31 randomized controlled trials including 5,009 febrile children. Results showed that both combined and alternating acetaminophen/ibuprofen regimens were significantly more effective at reducing fever at 4 and 6 hours compared with acetaminophen alone, with numbers needed to treat (NNT) of 3 and 4, respectively. High-dose ibuprofen alone also offered modest benefit (NNT 8). What dose should I use? Oral acetaminophen 10 to 15 mg/kg Every 4–6 hours as needed Do not exceed 75 mg/kg/day (or 4,000 mg/day maximum for older/larger kids) Oral ibuprofen 5 to 10 mg/kg Every 6–8 hours as needed Do not exceed 40 mg/kg/day (or 2,400 mg/day maximum for older/larger kids) References De la Cruz-Mena JE, Veroniki AA, Acosta-Reyes J, Estupiñán-Bohorquez A, Ibarra JA, Pana MC, Sierra JM, Florez ID. Short-term Dual Therapy or Mono Therapy With Acetaminophen and Ibuprofen for Fever: A Network Meta-Analysis. Pediatrics. 2024 Oct 1;154(4):e2023065390. doi: 10.1542/peds.2023-065390. PMID: 39318339. Summarized by Jeffrey Olson, MS4 | Edited by Jeffrey Olson and Jorge Chalit, OMS4 Get your tickets to Tox Talks Event, Sept 11, 2025: https://emergencymedicalminute.org/events-2/ Donate: https://emergencymedicalminute.org/donate/

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.

In the last 2 episodes we covered new updates in menopausal hormone therapy. However, we did not address TESTOSTERONE use. This episode idea comes from one our podcast family members and good friend, Eric. Eric is 100% correct: Testosterone replacement, when done correctly, has come along way. When is this indicated? Is this endorsed by professional medical/endocrine groups? What's the dose? We have fun stuff to review, so listen in!1. Davis SR, Baber R, Panay N, Bitzer J, Perez SC, Islam RM, Kaunitz AM, Kingsberg SA, Lambrinoudaki I, Liu J, Parish SJ, Pinkerton J, Rymer J, Simon JA, Vignozzi L, Wierman ME. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019 Oct 1;104(10):4660-4666. doi: 10.1210/jc.2019-01603. PMID: 31498871; PMCID: PMC6821450.2. Sharon J. Parish, James A. Simon, Susan R. Davis, Annamaria Giraldi, Irwin Goldstein, Sue W. Goldstein, Noel N. Kim, Sheryl A. Kingsberg, Abraham Morgentaler, Rossella E. Nappi, Kwangsung Park, Cynthia A. Stuenkel, Abdulmaged M. Traish, Linda Vignozzi, International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women, The Journal of Sexual Medicine, Volume 18, Issue 5, May 2021, Pages 849–867, https://doi.org/10.1016/j.jsxm.2020.10.0093. Levy, Barbara MD, MSCP; Simon, James A. MD, MSCP. A Contemporary View of Menopausal Hormone Therapy. Obstetrics & Gynecology 144(1):p 12-23, July 2024. | DOI: 10.1097/AOG.00000000000055534. NAMS The 2022 hormone therapy position statement of The North American Menopause Society: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf

In this episode, we're diving headfirst into the world of baby wearing with Jordan Morillo, a perinatal health OT, certified babywearing consultant, and toddler mom. We're talking everything from the ABCs of carrier choices to spotting a perfect carry (and avoiding the not-so-perfect ones). You'll learn how to safely position your baby, back carry like a pro, tandem wear without losing your mind, and even breastfeed on the go. We tackle fears, hot-weather hacks, and ethical carrier picks, so whether you're a newbie or a seasoned wearer, you'll walk away confident, informed, and ready to rock that baby wearing life. 00:00 Introduction and Importance of Baby Wearing 05:42 Key Safety Components: The ABCs of Baby Wearing 08:53 Understanding the M Position for Baby's Legs 15:21 Choosing the Right Baby Carrier 20:59 Addressing Common Concerns and Misconceptions 25:03 Risks and Benefits of Baby Wearing 29:36 Special Considerations for NICU and Preemie Babies 33:40 Misleading Marketing and Safety Testing 39:22 Addressing Baby's Discomfort with Carriers 39:45 Tips for Easing Baby into Baby Wearing 41:05 Understanding Baby's Resistance to Carriers 45:14 Debunking Myths: Baby Wearing and Clinginess 48:52 Breastfeeding Benefits and Baby Wearing 50:55 Toddler Wearing: Tips and Techniques 54:44 Tandem Wearing: Managing Two Kids 56:21 Forward Facing: When and How 01:00:21 Favorite Carriers for Different Scenarios 01:07:44 Water Safe Baby Wearing 01:11:22 Final Thoughts and Takeaways   Guest Bio: Jordan Morillo is a perinatal health OT, certified babywearing consultant, and toddler mom, who is passionate about empowering families with the knowledge they need to babywear safely, comfortably, and with confidence. She provides parent support through worldwide virtual 1:1 consultations, home health services, and by sharing free resources and tutorials on social media. INSTAGRAM: Connect with HeHe on IG  Connect with HeHe on YouTube   Connect with Jordan on IG    BIRTH EDUCATION: Join The Birth Lounge here for judgment-free childbirth education that prepares you for an informed birth and how to confidently navigate hospital policy to have a trauma-free labor experience!   Download The Birth Lounge App for birth & postpartum prep delivered straight to your phone!   LINKS MENTIONED: Visit Motherhoodtherapyservices.janeapp.com to book a consultation with Jordan!  Babywearing Resources Everyday Carriers Hoppediz Primeo – https://hoppediz.de/en/baby-carriers/primeo A buckle carrier that's perfect for smaller babies. Neko Tiny – https://www.nekoslings.com/en/ A stretchy wrap–buckle hybrid carrier for newborns. Solly Baby – https://sollybaby.com/ Lightweight stretchy wraps designed for comfort in the early months. Boba – https://boba.com/ Known for soft structured carriers and stretchy wraps. Ring Slings – Popular ones are from Sakura Bloom https://sakurabloom.com/collections/ring-sling and Mama & Roos https://www.mama-roo.com/collections/ring-slings Easy to adjust and stylish for on-the-go babywearing. Onbuhimo Buckle Carrier Strap-and-back-only carrier, ideal for toddlers who want up and down often. Forward Facing Options – ErgoBaby Omni https://ergobaby.com/omni-breeze-baby-carrier and Tula Explore https://babytula.com/products/explore-baby-carrier Safe forward-facing carry for older babies. Jordan's favorite ethical/organic brands:  Ethically made, sustainable carriers with thoughtful design. Hope & Plum https://www.hopeandplum.co/collections/baby-carriers Heritage Baby Designs https://heritagebaby.ca/ LoveHeld https://loveheld.com/collections/shop-all-baby-carriers  Beluga Baby https://belugababy.ca/ Size Inclusive Carriers Ring Slings – Sakura Bloom https://sakurabloom.com/collections/ring-sling, Mama & Roos https://www.mama-roo.com/collections/ring-slings Adjustable and versatile for all body types. Woven Wraps – Didymos https://www.didymos.de/en/Baby-Wraps/, Oscha Slings https://oschaslings.com/collections/baby-wraps Endless tying options for perfect fit and comfort. Keep Close(r) – https://keepcloser.com/ Designed specifically with plus-size parents in mind. Kinderpack – https://kindercarry.com/ Extended sizes and supportive structure for all bodies. Integra Baby – https://integrababy.co.uk/ Lightweight carriers with adjustable straps for inclusivity. Hope & Plum – https://www.hopeandplum.co/collections/baby-carriers Ring slings made for every parent's comfort. LoveHeld – https://loveheld.com/collections/shop-all-baby-carriers Soft, ethically made carriers with flexible sizing. Tula Belt Extenders – https://babytula.com/products/tula-waistband-extenders Expand Tula carriers for a more inclusive fit. Meh Dai Carriers – Didymos https://www.didymos.de/en/Meh-Dai/, BabyHawk https://babyhawk.com/ Tie-on carriers with a customizable fit. Lamb (Europe) – https://lamb-babycarriers.com/ European-made woven carriers, size-friendly. WildBird – https://wildbird.co/ Long-tail ring slings for flexible carrying options. Water Wearing Carriers Integra Solar – https://integrababy.co.uk/collections/integra-solar Quick-drying, lightweight carrier for water activities. Hope & Plum Hemp Sling – https://www.hopeandplum.co/collections/baby-carriers Breathable sling, perfect for summer and pool days. LoveHeld Hemp Carrier – https://loveheld.com/collections/shop-all-baby-carriers Durable hemp blend, suitable for water and sun. Aloha & Light Eco Silk Hemp Blend – https://alohaandlight.com/ Soft, eco-friendly slings designed for hot climates. Beachfront Baby – https://beachfrontbabywraps.com/ Mesh Meh Dais and wraps made for swimming and beach days. Gustine Mesh Sling – https://gustinebabycarriers.com/ Breathable mesh sling perfect for water play. RESEARCH: Study on reduction of PMADs: Randomized controlled trial to prevent postpartum depressive symptomatology: An infant carrier intervention. Little EE, Bain L, Hahn-Holbrook J. J Affect Disord. 2023 Nov 1;340:871-876. doi: 10.1016/j.jad.2023.08.044. Epub 2023 Aug 15. PMID: 37586649. Study on decreased cry time when worn: Increased Carrying Reduces Infant Crying: A Randomized Controlled Trial.Urs A. Hunziker; Ronald G. Barr. Pediatrics (1986) 77 (5): 641–648 Vital signs regulation:  https://pubmed.ncbi.nlm.nih.gov/39369660/ 

[12] Avoid the trap of false growth mindset This episode was first released on February 18, 2025. Description: - In this episode, Adam discusses the complexities of growth mindset in medical education with guests Milad Memari and Katie Gavinski. They explore the differences between growth and fixed mindsets, the dangers of misapplying mindset theory, and the trap of false growth mindset. The conversation emphasizes practical strategies for educators to promote a growth mindset among learners, the challenges of assessment in medical training, and the need for systemic changes informed by mindset theory to support learner development.  Length of Episode:   45:09 Resources to check out :    Memari M, Gavinski K, Norman MK. Beware False Growth Mindset: Building Growth Mindset in Medical Education Is Essential but Complicated. Acad Med. 2024 Mar 1;99(3):261-265.  https://pubmed.ncbi.nlm.nih.gov/37643577/   PISA 2018 Results (Volume I): https://www.oecd.org/en/publications/pisa-2018-results-volume-i_5f07c754-en/full-report.html   A national experiment reveals where a growth mindset improves achievement: https://pubmed.ncbi.nlm.nih.gov/31391586/   Yeager DS, Dweck CS. What can be learned from growth mindset controversies? Am Psychol. 2020 Dec;75(9):1269-1284. doi: 10.1037/amp0000794. PMID: 33382294; PMCID: PMC8299535. https://pmc.ncbi.nlm.nih.gov/articles/PMC8299535/  @MemariMD   @katiegavinski     Contact us: keylime@royalcollege.ca     Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski   

Jasmine Gonzalvo, PharmD, MPH, CDCES, FADCES, joins this episode to discuss the importance of curiosity, effective communication and cultural sensitivity in diabetes care. She shares her personal approach to exploring barriers to insulin in clients and highlights how motivational interviewing can be a powerful tool in navigating treatment conversations—especially when addressing common misconceptions about insulin. The conversation emphasizes the importance of open-ended questions, recognizing personal biases, and creating safe spaces for honest dialogue. By nurturing relationships and meeting patients where they are, diabetes care and education specialists can better support lasting behavior change and improve health outcomes.This episode is sponsored by Lilly. ResourcesA link to the insulin myths tip sheet mentioned in this episode is coming soon. ReferencesNahid Dehghan-Nayeri, Fatemeh Ghaffari, Tahereh Sadeghi, Naser Mozaffari; Effects of Motivational Interviewing on Adherence to Treatment Regimens Among Patients With Type 1 Diabetes: A Systematic Review. Diabetes Spectr 1 May 2019; 32 (2): 112–117.Guy E H M Rutten, Heidi Van Vugt, Eelco de Koning - Person-centered diabetes care and patient activation in people with type 2 diabetes: BMJ Open Diabetes Research & Care 2020;8:e001926.Entwistle VA, Carter SM, Cribb A, McCaffery K. Supporting patient autonomy: the importance of clinician-patient relationships. J Gen Intern Med. 2010 Jul;25(7):741-5. doi: 10.1007/s11606-010-1292-2. Epub 2010 Mar 6. PMID: 20213206; PMCID: PMC2881979. 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.

Primary hyperparathyroidism is an underdiagnosed condition which leads to decreased bone mineral density, fracture, renal disease, among other symptoms that can decrease the quality of a patient's life. Moreover, once diagnosed, only a small fraction of patients with the diease end up being offered surgery. Whether it is because of misunderstood indications and benefits of surgery, non-localization of disease, or various other reasons, we thought it was worthwhile to review relevant literature. Hosts: Dr. Becky Sippel is an endowed professor of surgery at Division Chief of endocrine surgery at University of Wisconsin Madison and she is the most recent past president of the AAES.  She is an internationally recognized leader in the field of endocrine surgery. She has over 250 publications. She was the PI for a RCT which studies prophylactic central neck dissections which is a widely read and quoted study in endocrine surgery. Dr. Amanda Doubleday is a fellowship trained endocrine surgeon in private practice with an affiliation to UW Health. Her primary practice is with Waukesha Surgical Specialists in Waukesha WI.  Dr. Simon Holoubek is a fellowship trained endocrine surgeons affiliated with UW Health. He works for UW Health with privileges at UW Madison and UW Northern Illinois. His clinical interests are aggressive variants of thyroid cancer, parathyroid autofluorescence, and nerve monitoring.  Learning Objectives: 1 Understand the natural history of primary hyperparathyroidism and how the disease process can affect bone mineral density. 2 Learn about fracture risk associated with primary hyperparathyroidism. 3 Learn about decreased fracture risk in patients with primary hyperparathyroidism who have parathyroidectomy compared to those who are observed.  References: 1 Rubin MR, Bilezikian JP, McMahon DJ, Jacobs T, Shane E, Siris E, Udesky J, Silverberg SJ. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab. 2008 Sep;93(9):3462-70. doi: 10.1210/jc.2007-1215. Epub 2008 Jun 10. PMID: 18544625; PMCID: PMC2567863. https://pubmed.ncbi.nlm.nih.gov/18544625/ 2 Frey S, Gérard M, Guillot P, Wargny M, Bach-Ngohou K, Bigot-Corbel E, Renaud Moreau N, Caillard C, Mirallié E, Cariou B, Blanchard C. Parathyroidectomy Improves Bone Density in Women With Primary Hyperparathyroidism and Preoperative Osteopenia. J Clin Endocrinol Metab. 2024 May 17;109(6):1494-1504. doi: 10.1210/clinem/dgad718. PMID: 38152848. https://pubmed.ncbi.nlm.nih.gov/38152848/ 3 VanderWalde LH, Liu IL, Haigh PI. Effect of bone mineral density and parathyroidectomy on fracture risk in primary hyperparathyroidism. World J Surg. 2009 Mar;33(3):406-11. doi: 10.1007/s00268-008-9720-8. PMID: 18763015. https://pubmed.ncbi.nlm.nih.gov/18763015/ 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

This is a requested follow up to our most recent episode. Menopausal hormone therapy (HT) prescribing practices have evolved over the last few decades guided by the changing understanding of the treatment's risks and benefits. We know that dose, route of administration, and choice of agent (estradiol versus a more synthetic option, and micronized progesterone over other progestins.) alter the risk benefit ratio. Compared to natural progesterone, synthetic progestins have 10-100- fold greater activity. Synthetic MPA is vasoconstrictive while natural progesterone and drospirenone cause vasodilation and lower blood pressure. Micronized progesterone is bioidentical to the hormone made endogenously and has efficient oral absorption. Progestogens come in oral and transdermal forms, and it can also be given vaginally. Is there data that micronized progesterone is safer for the breast for a menopausal hormone therapy? This podcast topic recommendation comes from one of our podcast family members. Listen for details. 1. Gompel A. Micronized progesterone and its impact on the endometrium and breast vs. progestogens. Climacteric. 2012 Apr;15 Suppl 1:18-25. doi: 10.3109/13697137.2012.669584. PMID: 22432812.2. Stute P, Wildt L, Neulen J. The impact of micronized progesterone on breast cancer risk: a systematic review. Climacteric. 2018 Apr;21(2):111-122. doi: 10.1080/13697137.2017.1421925. Epub 2018 Jan 31. PMID: 29384406.3. Eden J. The endometrial and breast safety of menopausal hormone therapy containing micronised progesterone: A short review. Aust N Z J Obstet Gynaecol. 2017 Feb;57(1):12-15. doi: 10.1111/ajo.12583. PMID: 28251642.4. Asi N, Mohammed K, Haydour Q, Gionfriddo MR, Vargas OL, Prokop LJ, Faubion SS, Murad MH. Progesterone vs. synthetic progestins and the risk of breast cancer: a systematic review and meta-analysis. Syst Rev. 2016 Jul 26;5(1):121. doi: 10.1186/s13643-016-0294-5. PMID: 27456847; PMCID: PMC4960754.5.AHA J Circulation: Rethinking Menopausal Hormone Therapy: For Whom, What, When, and How Long? 2023

In the second half of this two part episode, Dr. David Leon unpacks some of the most hotly debated topics in resuscitation—fluids, blood products, ECMO, and post-arrest care. He breaks down the pros and cons of crystalloids (yes, even the “pasta water” debate), explains why lactated Ringer's is often preferred over normal saline, and dips into the use of albumin and colloids. Dr. Leon also discusses the promise and challenges of extracorporeal life support (ECLS), the evolving role of targeted temperature management (TTM), and even peeks into what advances the future might hold. It's a thoughtful, forward-looking conversation every resuscitationist should hear. What do you think of Dr. Leon's tips? Are you using these tools in your practice? We'd love to hear from you. Share them with us on 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. David Leon, Assistant Professor of Emergency Medicine and Anesthesia at UC Davis Resources: American Heart Association (AHA) Algorithms Perman SM, Elmer J, Maciel CB, Uzendu A, May T, Mumma BE, Bartos JA, Rodriguez AJ, Kurz MC, Panchal AR, Rittenberger JC; American Heart Association. 2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2024 Jan 30;149(5):e254-e273. doi: 10.1161/CIR.0000000000001194. Epub 2023 Dec 18. PMID: 38108133. **** 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.

In this episode of the Saving Lives Podcast, Eddy Joe breaks down a 2025 Journal of Critical Care study examining how the choice of the internal jugular vein for initial central line placement impacts outcomes when patients later need hemodialysis catheters. You'll learn why using the left IJV first may reduce the need for repeat procedures and complications. Essential insights for optimizing central line strategy in the ICU.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%)Citation: Gharaibeh KA, Abdelhafez MO, Guedze KEB, Siddiqi H, Hamadah AM, Verceles AC. Impact of initial jugular vein insertion site selection for central venous catheter placement on hemodialysis catheter complications. J Crit Care. 2025 Jun;87:155011. doi: 10.1016/j.jcrc.2024.155011. Epub 2025 Jan 3. PMID: 39755012.

Send us a textWhole-Body Hypothermia for Neonatal Encephalopathy in Preterm Infants 33 to 35 Weeks' Gestation: A Randomized Clinical Trial.Faix RG, Laptook AR, Shankaran S, Eggleston B, Chowdhury D, Heyne RJ, Das A, Pedroza C, Tyson JE, Wusthoff C, Bonifacio SL, Sánchez PJ, Yoder BA, Laughon MM, Vasil DM, Van Meurs KP, Crawford MM, Higgins RD, Poindexter BB, Colaizy TT, Hamrick SEG, Chalak LF, Ohls RK, Hartley-McAndrew ME, Dysart K, D'Angio CT, Guillet R, Kicklighter SD, Carlo WA, Sokol GM, DeMauro SB, Hibbs AM, Cotten CM, Merhar SL, Bapat RV, Harmon HM, Sewell E, Winter S, Natarajan G, Mosquera R, Hintz SR, Maitre NL, Benninger KL, Peralta-Carcelen M, Hines AC, Duncan AF, Wilson-Costello DE, Trembath A, Malcolm WF, Walsh MC; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.JAMA Pediatr. 2025 Apr 1;179(4):396-406. doi: 10.1001/jamapediatrics.2024.6613.PMID: 39992674 Free PMC article. Clinical Trial.EBNEO Commentary: Is Therapeutic Hypothermia Beneficial to Infants Born Between 33 and 35 Weeks Gestation?Spahic H, Zoubovsky SP, Dietz RM.Acta Paediatr. 2025 Jul;114(7):1742-1743. doi: 10.1111/apa.70098. Epub 2025 Apr 18.PMID: 40251839 No abstract available.Support 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!

Send us a textFenton Third-Generation Growth Charts of Preterm Infants Without Abnormal Fetal Growth: A Systematic Review and Meta-Analysis.Fenton TR, Elmrayed S, Alshaikh BN.Paediatr Perinat Epidemiol. 2025 Jun 19. doi: 10.1111/ppe.70035. Online ahead of print.PMID: 40534585 Review.Birth weight and head circumference for 22-29 weeks gestation neonates from an international cohort.Fenton TR, Alshaikh B, Kusuda S, Helenius K, Modi N, Norman M, Lui K, Lehtonen L, Battin M, Klinger G, Vento M, Lastrucci V, Gagliardi L, Adams M, Marba STM, Isayama T, Hakansson S, Bassler D, Shah PS; International Network for Evaluation of Outcomes (iNeo) of Neonates Investigators.Arch Dis Child Fetal Neonatal Ed. 2025 Jun 19;110(4):401-408. doi: 10.1136/archdischild-2024-327845.PMID: 39762001Support 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!

Send us a textRetinopathy of Prematurity and Risk of Structural Brain Abnormalities on Magnetic Resonance Imaging at Term Among Infants Born at Less Than or Equal to 32 Weeks of Gestation.Roy S, Peterson L, Kline-Fath B, Parikh NA; Cincinnati Infant Neurodevelopment Early Prediction Study (CINEPS) Investigators.J Pediatr. 2025 Jun 27;286:114711. doi: 10.1016/j.jpeds.2025.114711. Online ahead of print.PMID: 40582695 Free article.Support 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!

Send us a textEarly Neurodevelopment of Extremely Preterm Infants Administered Autologous Cord Blood Cell Therapy: Secondary Analysis of a Nonrandomized Clinical Trial.Zhou L, Razak A, McDonald CA, Yawno T, McHugh DT, Whiteley G, Connelly K, Sackett V, Miller SL, Jenkin G, Novak I, Hunt RW, Malhotra A.JAMA Netw Open. 2025 Jul 1;8(7):e2521158. doi: 10.1001/jamanetworkopen.2025.21158.PMID: 40608334 Free PMC article. Clinical Trial.Support 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!

Send us a textDiaphragm Position on Chest Radiograph to Estimate Lung Volume in Neonates.Dahm SI, Sett A, Gunn EF, Ramanauskas F, Hall R, Stewart D, Koeppenkastrop S, McKenna K, Gardiner RE, Rao P, Tingay DG.JAMA Pediatr. 2025 Jul 21:e252108. doi: 10.1001/jamapediatrics.2025.2108. Online ahead of print.PMID: 40690243 Free PMC article.Support 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!

You can't scroll social media without seeing someone tell you how you have to hit a 180 spm cadence, stop overstriking, or do these exercises for better running form. But do you really need to change your running form? We dive into the science and discuss whether or not changing form is beneficial - plus offer some practical tips if you do want to improve your own natural running form. Thank you to our sponsors:✨ Tailwind: Complete sport nutrition made simple, including hydration mixes, high-carb sport drinks, endurance fuel, and recovery mixes. Use code TREADLIGHTLY20 at https://tailwindnutrition.com/TREADLIGHTLY for 20% off your first purchase. ✨ Shokz: Open ear headphones so you can enjoy your music or audiobook while staying safe and aware of your surroundings. Use code RUNTOTHEFINISH for $10 off at https://shokz.com?utm_source=TLR&utm_medium=website&utm_campaign=podcastIn this episode, you will learn:✅ Should you change your running form?✅ Is strength training the most effective way to improve running form?✅ Should you change your foot strike?✅ Does your running form vary with your pace?✅ What changes in your running form can tell you about fatigue✅ Should your cadence be 180?✅ Drills to improve your running formReferences:

There's a lot of fear and misinformation around HRT, and one of the biggest myths is that HT is a highly significant cause of breast cancer. That is not the case. This is a remnant concept from 2002, with MANY caveats. Calls for the removal of the black box warning on hormone replacement therapy (HRT) stems primarily from the outdated and limited nature of the data from the Women's Health Initiative (WHI) study published in 2002. The WHI, while groundbreaking at the time, focused predominantly on a specific formulation of conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA) in older, postmenopausal women, leading to concerns about its generalizability to the broader population of women considering HRT. This is why on July 17, 2025, the FDA met with a panel of experts, in open forum, to hear the petition of removing the black box warning on hormone replacement therapy. Listen in for details. 1. Writing Group for the Women's Health Initiative Investigators. Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results From the Women's Health Initiative Randomized Controlled Trial. JAMA.2002;288(3):321–333. doi:10.1001/jama.288.3.3212. Manson JE, Crandall CJ, Rossouw JE, Chlebowski RT, Anderson GL, Stefanick ML, Aragaki AK, Cauley JA, Wells GL, LaCroix AZ, Thomson CA, Neuhouser ML, Van Horn L, Kooperberg C, Howard BV, Tinker LF, Wactawski-Wende J, Shumaker SA, Prentice RL. The Women's Health Initiative Randomized Trials and Clinical Practice: A Review. JAMA. 2024 May 28;331(20):1748-1760. doi: 10.1001/jama.2024.6542. PMID: 38691368.3. NAMS: The 2022 hormone therapy position statement of The North American Menopause Society (Menopause)

Fast fat loss in menopause is not really the goal. Let's be realistic and say this right out of the gate. Fast fat loss is a myth.  You may, however, drop inflammation fairly quickly with the right type of exercise.    Part 1: The Fat Burning Fundamentals Let's start with the basics. When we talk about fat burning during exercise, we need to understand two key concepts:  Percentage of Fat Used for Fuel  Total Calories Burned Here's something surprising: At rest, we burn about 85% fat for fuel. Your body is already a fat-burning machine when you're sitting on the couch!  Here's where it gets interesting.. During low-intensity exercise like walking, you burn a higher percentage of fat for fuel, but you're burning calories at a slower rate overall. During high-intensity exercise like running, you burn a lower percentage of fat for fuel, but you're torching calories much faster. Part 2: The EPOC Effect - Your Metabolic Afterburn EPOC or Excess Post-Exercise Oxygen Consumption, but I like to call it your metabolic afterburn. This is the energy your body continues to burn AFTER your workout is over. High-intensity exercise creates a significant EPOC effect. Your body keeps burning calories for hours after you finish your workout as it works to restore oxygen levels, repair tissues, and return to its normal state. It's like your metabolism stays revved up long after you've stopped moving. Low-intensity exercise produces minimal EPOC. Once you stop walking, your metabolism pretty quickly returns to baseline. You burned calories during the activity, but the party's over when you stop. This is where high-intensity exercise starts to look really appealing for fat loss. You're not just burning calories during the workout - you're creating a metabolic boost that lasts for hours. Know the Best Strategy for Fast Fat Loss in Menopause May Surprise You Part 3: Sprints vs Steady-State Running - The Game Changer When we compare running at a slow to moderate pace versus doing sprint intervals, the sprint work wins hands down for fat loss.  Sprint intervals create a massive EPOC effect. Your body works harder to recover from intense bursts, burning calories long after you're done. Sprint intervals are incredibly effective at burning both total body fat AND visceral belly fat. The beauty of sprints is that you can get incredible results in much less time. A 15-20 minute sprint session can be more effective for fat loss than an hour of steady jogging. For busy women in menopause, this efficiency factor is huge. Part 4: The Cortisol Connection - Why This Matters in Menopause Now we need to talk about cortisol, because this is where things get really important for women in menopause. High-intensity exercise creates a greater rise in cortisol compared to low-intensity exercise. This isn't necessarily bad! This cortisol response is actually normal and necessary. It's how your body releases blood sugar to be used as fuel and creates energy for exercise. Low-intensity exercise like walking creates little rise in cortisol. Comfortable walking, dancing, yoga, or tai chi often actually REDUCE cortisol levels. The problem isn't the acute cortisol rise from exercise itself. The problem is chronic elevated cortisol combined with high-intensity exercise when your system is already overloaded. If your stress bucket is already overflowing from work, relationships, poor sleep, and hormonal changes, adding high-intensity exercise makes it spill over. When cortisol is chronically elevated, it can sabotage your adrenal function and ultimately affect your thyroid. This is particularly relevant during menopause when our hormone systems are already in flux.  Choosing the Right Cardio for Fast Fat Loss in Menopause The Hot Not Bothered is open for enrollment as this episode goes live. If you need support getting a start, restart or reset, now is the time! Learn More Here   Part 5: The Real Running vs Walking Debate Here's where I want to challenge the traditional running versus walking debate. Maybe it's less about the percentage of fat burned for fuel and more about not burning yourself out. Let me give you a practical example from my own experience: Walking at a 5.0 pace on the treadmill is NOT comfortable for me. It's an effort - I'm breathing hard, I'm sweating, I'm working. But jogging at 5.8? That's actually quite slow for running. It's likely harder on my knees while not really providing enough impact to benefit my bone density. Here's a crucial point: Every time you run - meaning both feet leave the ground - you add four times your body weight in impact to your knee joints. Yet ironically, this repetitive impact isn't the kind of stimulus that optimally benefits bone density once you do it regularly. While jumping and purposeful impact exercises do provide bone density benefits, repetitive exercise loads like jogging don't create additional stress - they just create more of the same stress. So sometimes, a challenging walk might actually give you better results than an easy jog, with less wear and tear on your joints. The sad myth about running vs walking is that it will result in fast fat loss in menopause - or any time for that matter. Smarter Workouts for Fast Fat Loss in Menopause — Without Burnout Part 6: When Your Body Is Telling You to Slow Down Chronic cortisol elevation is often linked to inadequate recovery - particularly nutrition - than to workout intensity itself. If you're on a chronically low-carbohydrate or low-calorie diet, you may experience prolonged cortisol elevations regardless of your exercise. When your body lacks fuel, it compensates by releasing more cortisol to break down fat, muscle, and even bone tissue for energy. Chronic cortisol is more likely under these conditions: Too much too soon (occasional overreaching isn't a problem, but repeated overreaching is) Undereating before, during, or after exercise Lack of rest time between workouts for repair Inadequate sleep Planned diet or fasting state Lower intensity workouts may work better because you're not eating enough, not sleeping enough, or not managing your overall stress load. The biggest problem? Not eating enough. Going too low carb. Making statements like "my body loves this" when it's giving you signs you're exhausted, holding onto weight, or failing to gain muscle. No, it doesn't love it. Part 7: Making the Right Choice for YOU How do you decide between running and walking, or between steady-state and sprint work? Assess your current stress load: How's your sleep? Are you eating enough, especially carbohydrates? How are your energy levels throughout the day? Are you seeing the results you want? If you're well-rested, well-fed, and managing stress effectively, higher intensity work including sprints is incredibly effective for fat loss. If you're stressed, under-fueled, or sleep-deprived, walking or other lower-intensity activities is better right now.  That's not settling for less - that's being smart about working WITH your body instead of against it. The best exercise program is what you can do consistently while feeling energized and strong, not depleted and exhausted. Fast Fat Loss in Menopause Differs for Every Body in Every Stage Part 8: Practical Applications For sprint work: Start with just 1-2 sprint sessions per week. These could be 15-30 second all-out efforts followed by as much time needed for recovery, repeated 4-6 times. This gives you maximum fat-burning benefit with minimal time investment. For steady-state work: If you choose to run steadily, make sure it's at an intensity that's appropriately challenging. If you choose to walk, don't be afraid to make it challenging - hills, speed, or resistance can all increase the demand. For recovery: Always prioritize adequate nutrition and sleep. Your results happen during recovery, not just during the workout. Listen to your body's feedback. If you're consistently tired, holding onto weight despite "doing everything right," or feeling burnt out, it might be time to dial down the intensity and focus on recovery. Conclusion The bottom line? Both running and walking can be effective for fat loss, but the devil is in the details.  Sprint work offers incredible efficiency and targets visceral fat effectively. Steady-state cardio has its place, especially when recovery demands are high. The key is matching your exercise intensity to your body's current capacity for stress and recovery. During menopause, this becomes even more critical as our hormone systems are already adapting to change. Your exercise program should energize you, not exhaust you. It should work with your lifestyle, not against it. And it should leave you feeling strong and capable, not depleted and overwhelmed.   Remember, there's no real magic trick for fast fat loss in menopause. However, you can get there faster - sometimes by slowing down and sometimes by sprinting. But always by weight lifting.    References for Fast Fat Loss in Menopause:  Psychoneuroendocrinology. 2022, PMID: 35777076. Front Public Health, 2019, PMID: 31921741. Experimental Physiology, 2020, PMID: 32613697. Journal of Exercise Science & Fitness, 2023, PMID: 37927356. Diabetes & Metabolism, 2016, DOI: 10.1016/j.diabet.2016.07.031.   Other Episodes You Might Like: Previous Episode - Take Up Space: A Perimenopause BodyBuilder on Her Strength Journey Next Episode - The New Menopause Therapy: Confessions of a Femme Fatale More Like This What's Better Running or Walking for Midlife Fat Loss (and why) 8 Ways to Make Walking in Menopause MORE Beneficial   Resources:  Join the Hot, Not Bothered! Challenge to learn why timing matters and why what works for others is not working for you. Use Flipping 50 Scorecard & Guide to measure what matters with easy at-home self-assessment test you can do in minutes. Don't know where to start? Book your Discovery Call with Debra.

In this episode, we dive into a new pilot RCT exploring the addition of acetazolamide to furosemide in critically ill patients. We break down the study's methods, findings, and practical implications for fluid management in the ICU. Could this inexpensive, decades-old drug be the key to sustaining diuresis and preventing metabolic alkalosis? Tune in to find out.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%)Citation: Maeda A, Brown A, Spano S, Chaba A, Phongphithakchai A, Hikasa Y, Pattamin N, Kitisin N, Nübel J, Nielsen B, Holmes J, Peck L, Young H, Eastwood G, Bellomo R, Neto AS. Furosemide with adjunctive acetazolamide vs furosemide only in critically ill patients: A pilot two-center randomized controlled trial. J Crit Care. 2025 Apr;86:155002. doi: 10.1016/j.jcrc.2024.155002. Epub 2024 Dec 16. PMID: 39689380.

Deep Dive in DDH is a three part limited series where experts in the field of DDH have been invited to discuss the controversies in the management of hip dysplasia. Episode 1 discusses the management of DDH in infants under 6 months of age from stable sonographic dysplasia through refractory developmental hip dislocation. We are joined by Kishore Mulpuri from BC Children's hospital, Simon Kelley from Texas Children's Hospital, and Wudbhav Sankar from Children's hospital of Philadelphia as we discuss areas of consensus and discord in Pavlik harness treatment, second line therapy, and what to do when problems arise. Hosted by Will Morris (Scottish Rite for Children). Edited by Carter Clement (Manning Family Children's Hospital). Music by A. A. Aalto. Referenced Publications Behman AL, Bradley CS, Maddock CL, Sharma S, Kelley SP. Testing of an Ultrasound-Limited Imaging Protocol for Pavlik harness Supervision (TULIPPS) in developmental dysplasia of the hip: a randomized controlled trial. Bone Joint J. 2022 Sep;104-B(9):1081-1088. doi: 10.1302/0301-620X.104B9.BJJ-2022-0350.R2. PMID: 36047018. Gans I, Flynn JM, Sankar WN. Abduction bracing for residual acetabular dysplasia in infantile DDH. J Pediatr Orthop. 2013 Oct-Nov;33(7):714-8. doi: 10.1097/BPO.0b013e31829d5704. PMID: 23812157. Swarup I, Talwar D, Sankar WN. Part-time Abduction Bracing in Infants With Residual Acetabular Dysplasia: Does Compliance Monitoring Support a Dose-dependent Relationship? J Pediatr Orthop. 2021 Feb 1;41(2):e125-e129. doi: 10.1097/BPO.0000000000001704. PMID: 33165268. Striano B, Schaeffer EK, Matheney TH, Upasani VV, Price CT, Mulpuri K, Sankar WN; International Hip Dysplasia Institute. Ultrasound Characteristics of Clinically Dislocated But Reducible Hips With DDH. J Pediatr Orthop. 2019 Oct;39(9):453-457. doi: 10.1097/BPO.0000000000001048. PMID: 31503230. Harper P, Joseph BM, Clarke NMP, Herrera-Soto J, Sankar WN, Schaeffer EK, Mulpuri K, Aarvold A; International Hip Dysplasia Institute (IHDI). Even Experts Can Be Fooled: Reliability of Clinical Examination for Diagnosing Hip Dislocations in Newborns. J Pediatr Orthop. 2020 Sep;40(8):408-412. doi: 10.1097/BPO.0000000000001602. PMID: 32555048; PMCID: PMC7458090. Murnaghan ML, Browne RH, Sucato DJ, Birch J. Femoral nerve palsy in Pavlik harness treatment for developmental dysplasia of the hip. J Bone Joint Surg Am. 2011 Mar 2;93(5):493-9. doi: 10.2106/JBJS.J.01210. PMID: 21368082.

Contributor: Aaron Lessen, MD Educational Pearls: There are many techniques for reducing a shoulder dislocation A recent study discussed a new variation of closed reduction technique: wrist-clamping shoulder-lifting The patient is in a sitting position The provider holds the wrist of the injured arm with both hands and slowly rotates the arm to 90 degrees of abduction and 60 degrees of external rotation After this traction, the arm is slowly moved to 45 degrees of abduction and 60 degrees of external rotation The provider then secures the patient's wrist between the provider's knees and places their hand on the axilla to gently lift the shoulder upward for successful reduction There were 36 patients with shoulder dislocations in this study, and all 36 dislocations were successfully reduced with this technique There were no neurovascular complications or fractures No sedation or medication was required All procedures were performed by a single provider without assistance References Dai W, Liu L, Zong S, Zhou Y, Zheng J, Li X. An original closed reduction technique for acute shoulder dislocation: the wrist-clamping and shoulder-lifting. Int J Emerg Med. 2025 Mar 26;18(1):60. doi: 10.1186/s12245-025-00866-8. PMID: 40140973; PMCID: PMC11948627. Summarized by Meg Joyce, MS2 | Edited by Meg Joyce & Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/