Podcasts about pmid

Welcome to the latest Midlife Minute. Today, I'm taking a closer look at oral contraceptive use in perimenopause and menopause, exploring how oral contraceptives work, how they suppress or blunt perimenopausal and menopausal symptoms, alter hormone signaling and testing, what women may experience when they stop taking them, and why the gut microbiome is an essential part of the conversation. IN THIS EPISODE, YOU WILL LEARN: How oral contraceptives suppress certain key signaling hormones, making it difficult to assess women's menopausal status accurately What women may experience when transitioning off oral contraceptives How long-term oral contraceptive use can alter gut microbial function and inflammatory pathways The association between long-term oral contraceptive use and nutrient depletion Why the standard reproductive hormone markers used to assess menopause (especially FSH/LH) are unreliable while on the pill How the microbiome changes that occur as women age may compound the effects of previous oral contraceptive use Helpful dietary, microbiome, and lifestyle strategies to support women navigating the post-pill transition Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia's website. Submit your questions to support@cynthiathurlow.com  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia's book, The Menopause Gut. Cynthia's Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Resources:  Sitruk-Ware R, Nath A. Characteristics and metabolic effects of estrogen and progestins contained in oral contraceptive pills. Best Practice and Research: Clinical Endocrinology and Metabolism. 2013;27(1):13–24. doi:10.1016/j.beem.2012.09.004 Schaffir J, Worly BL, Gur TL. Combined hormonal contraception and its effects on mood: a critical review. European Journal of Contraception and Reproductive Health Care. 2016;21(5):347–355. doi:10.1080/13625187.2016.1217327 Panzer C, Wise S, Fantini G, Kang D, Munarriz R, Guay A, Goldstein I. Impact of oral contraceptives on sex hormone-binding globulin and androgen levels: a retrospective study in women with sexual dysfunction. Journal of Sexual Medicine. 2006;3(1):104–113. doi:10.1111/j.1743-6109.2005.00198.x Palmery M, Saraceno A, Vaiarelli A, Carlomagno G. Oral contraceptives and changes in nutritional requirements. European Review for Medical and Pharmacological Sciences. 2013;17(13):1804–1813. PMID:23852908 Khalili H, Higuchi LM, Ananthakrishnan AN, Richter JM, Feskanich D, Fuchs CS, Chan AT. Oral contraceptives, reproductive factors and risk of inflammatory bowel disease. Gut. 2013;62(8):1153–1159. doi:10.1136/gutjnl-2012-302362 Flores R, Shi J, Fuhrman B, Xu X, Veenstra TD, Gail MH, Gajer P, Ravel J, Goedert JJ. Fecal microbial determinants of fecal and systemic estrogens and estrogen metabolites: a cross-sectional study. Journal of Translational Medicine. 2012;10:253. doi:10.1186/1479-5876-10-253 Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen-gut microbiome axis: physiological and clinical implications. Maturitas. 2017;103:45–53. doi:10.1016/j.maturitas.2017.06.025 Hua X, Cao Y, Morgan DM, Miller K, Chin SM, Bellavance D, Khalili H. Longitudinal analysis of the impact of oral contraceptive use on the gut microbiome. Journal of Medical Microbiology. 2022;71(4):001512. doi:10.1099/jmm.0.001512 Mihajlovic J, Leutner M, Hausmann B, Kohl G, Schwarz J, et al. Combined hormonal contraceptives are associated with minor changes in composition and diversity in gut microbiota of healthy women. Environmental Microbiology. 2021;23(6):3037–3047. doi:10.1111/1462-2920.15461 Seelig MS. Increased magnesium need with use of combined oestrogen and calcium supplementation. Magnesium Research. 1990;3(3):197–215. PMID:2133742 Donders GGG, Bellen G, Mendling W. Management of recurrent vulvo-vaginal candidosis as a chronic illness. Gynecologic and Obstetric Investigation. 2010;70(4):306–321. doi:10.1159/000314022 Krog MC, Hugerth LW, Fransson E, et al. The healthy female microbiome across body sites: effect of hormonal contraceptives and the menstrual cycle. Human Reproduction. 2022;37(7):1525–1543. doi:10.1093/humrep/deac094

In this Complex Care Journal Club podcast episode, Patricia Basualto discusses a qualitative study of service provider perspectives on access to disability services for children with neurodevelopmental disabilities in British Columbia, Canada. She describes the importance of cross-sectoral collaboration, actionable policy and program recommendations, and next steps from this work.‌ SPEAKER Patricia Basualto, MHP, PhD Candidate Assistant Professor, Physiotherapist Pontificia Universidad Católica de Chile PhD Candidate in Kinesiology (Rehabilitation) University of Calgary HOST Kathleen Huth, MD, MMSc Pediatrician, Complex Care Service, Division of General Pediatrics Boston Children's Hospital Assistant Professor of Pediatrics Harvard Medical School DATE Initial publication date: June 8, 2026. JOURNAL CLUB ARTICLE Basualto P, Senevirathna AM, Seth A, Dimitropoulos G, Zwicker JD. Improving Equitable Access to Disability Services and Support for Children With Neurodevelopmental Disabilities: Service Provider and Decision-Maker Perspectives. Child Care Health Dev. 2026 Jan;52(1):e70213. doi: 10.1111/cch.70213. PMID: 41457809; PMCID: PMC12746062. TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/as/7wvf65c7rjcxkvvt4vjspx9v/Basualto_Final_Transcript_5-27‌ 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 Basualto P, Huth K. Opening a Wider Door: Access to Services for Children with Neurodevelopmental Disabilities‌‌‌. 06/2026. OPENPediatrics. Online Podcast.

Long COVID and sports injuries are becoming impossible to ignore—and this episode explores why more athletes may be dealing with fatigue, soft tissue breakdown, and prolonged recovery after viral illness. In this powerful conversation, Dr. Greg Jones sits down with Dr. Muhammad Mansour, a naturopathic doctor and regenerative medicine specialist who treats elite athletes at the highest levels.In this episode, you'll learn how long COVID may affect skeletal muscle, mitochondrial function, exercise tolerance, and systemic inflammation—and why these issues can persist even after the initial infection appears to resolve. Dr. Mansour explains how athletes can miss early warning signs, why “pushing through” fatigue may backfire, and how a more individualized recovery strategy may be critical in the post-pandemic era.If you're an athlete, coach, practitioner, or health-conscious listener trying to understand the intersection of long COVID, inflammation, and injury risk, this episode offers a science-informed perspective on what recovery may require now.

In our last episode, we discussed the physiology of running in the heat, including why you run slower. However, you are not doomed to suffer through slow slogs all summer long. In part two of our summer running series, we discuss heat acclimation strategies and cooling techniques to make summer running a little less miserable.Thank you to our sponsors:✨Title Nine: Comfortable sports bras that actually fit, from a women-owned company. Use code RUNTOTHEFINISH for free shipping at https://runtothefinish.com/title-nine/✨ Mizuno: Shop Mizuno's newest bouncy supertrainer: https://runtothefinish.com/neovista3/In this episode, you'll learn:✅ How long it takes to acclimate to running in the heat✅ If year-round heat acclimation is beneficial✅ Pre- and mid-run cooling techniques for running in the heat✅ If hyperhydration strategies work?✅ How much sodium you need for summer runs✅ Signs and symptoms of heat illnessReferences

Triggering. Controversial. Frustrating. Today, we're talking about foods that trigger Vestibular Migraine. As a person who does not have a vestibular disorder, I'm confident I can give you an objective answer for this. For some, there are foods that always trigger a migraine attack. For others, there's a bit of a gray zone—some foods that sometimes trigger a migraine attack. And still others may find that food isn't a contributing factor to their threshold. Where do you fall and what's your best course of action? Tune in! In this episode, we'll dig into: The truth about “trigger foods” and why the topic is so controversial How the migraine threshold works & why food is often just the tipping point, not the cause Histamine, inflammation, and why leftovers can hit differently than fresh food What’s actually going on in the body when caffeine and alcohol are consumed What CGRP is and why it matters for migraine treatment Why trigger foods are wildly person-dependent The vestibular-migraine overlap when it comes to food If you have questions about this or you want to start working on building a bigger bucket so you can start adding foods back into your diet, join us in Vestibular Group Fit (use code GROUNDED)! Related Episodes: Why the “Heal Your Headache Diet” Should be Temporary: https://thevertigodoctor.com/podcast/135-heal-your-headache-diet-should-be-temporary/  Guide to CGRP Medications For Treating Migraine Disorder: https://thevertigodoctor.com/podcast/95-cgrp-medications-for-migraine/  Links Mentioned: Vestibular Group Fit (code GROUNDED at checkout for 15% off!): https://thevertigodoctor.com/vestibular-group-fit Study on diet and migraine Tu YH, Chang CM, Yang CC, Tsai IJ, Chou YC, Yang CP. Dietary Patterns and Migraine: Insights and Impact. Nutrients. 2025 Feb 13;17(4):669. doi: 10.3390/nu17040669. PMID: 40004997; PMCID: PMC11858445. Free Resources: ⁠The 4 Steps to Managing Vestibular Migraine: https://thevertigodoctor.myflodesk.com/cb5js0y78n ⁠The PPPD Management Masterclass⁠: https://thevertigodoctor.myflodesk.com/new-pppd ⁠What your Partner Should Know About Living with Dizziness⁠: https://thevertigodoctor.myflodesk.com/partnership ⁠The FREE Mini VGFit Workout⁠: https://thevertigodoctor.myflodesk.com/minifit ⁠The FREE POTS – safe Workouts⁠: https://thevertigodoctor.myflodesk.com/pots Connect with Dr. Madison (@TheVertigoDoctor): https://instagram.com/thevertigodoctor Work with Dr. Madison: For 1:1 Vestibular Rehabilitation Therapy, email madison@thevertigodoctor.com Otherwise, I'll see ya in Vestibular Group Fit! Connect with Dr. Jenna (@dizzy.rehab.therapist): https://www.instagram.com/dizzy.rehab.therapist/ Learn about the Oak Method: http://thevertigodoctor.com/why-vestibular-group-fit Love what you heard?Consider leaving a review on your favorite podcast platform to help us reach more vestibular warriors like you! This podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here. ————————————— migraine trigger foods, common migraine trigger foods, migraine headache trigger foods, vestibular group fit, living with vestibular migraine, migraine theory threshold, prodrome food craving, caffeine and migraine, alcohol and migraine, histamine intolerance, reduce inflammation

Chuck and Chris continue the initiative working with The Journal of Hand Surgery on a quarterly journal club.  Nash and Macerena choose the articles from the previous quarter and Chris and Chuck review the articles and discuss practical implications.  See articles below.In addition, we discuss a case of possible pronator syndrome together with carpal tunnel syndrome including debate on the role of nerve studies, physical examination, and ultrasound.1) Rames JD, Emanuels AF, Tunaboylu MF, Moran SL. A 40-Year Retrospective Evaluation of Vascularized Bone Grafting for Kienböck Disease. J Hand Surg Am. 2026 Jan;51(1):13.e1-13.e9. doi: 10.1016/j.jhsa.2025.07.025. Epub 2025 Aug 29. PMID: 40879579.2) Suzuki T, Kiyota Y, Matsumura N, Sato K, Nakamura M, Iwamoto T. Anatomical Reconstruction of the Terminal Tendon and Lateral Band for Severe Chronic Tendon Mallet Injury. J Hand Surg Am. 2026 Jan;51(1):92.e1-92.e7. doi: 10.1016/j.jhsa.2025.04.025. Epub 2025 Jun 21. PMID: 40542795.3) Lee C, Shin S, Fraipont G, Hung V, McGarry MH, Lee TQ. Dermal Allograft Augmentation With Proximal Row Carpectomy: A Biomechanical Study. J Hand Surg Am. 2026 Feb;51(2):143-152. doi: 10.1016/j.jhsa.2025.05.006. Epub 2025 Jul 4. PMID: 40613810.4) Jaarsma EH, Ring D, Tonn MD, Brinkman N. Do Patients Older Than 40 Years with Work Claims for Unilateral Wrist Symptoms Have Symmetric, Bilateral MRI Signal Changes That Do Not Correspond with Symptoms? J Hand Surg Am. 2026 Mar;51(3):313-320. doi: 10.1016/j.jhsa.2025.11.012. Epub 2026 Jan 29. PMID: 41609546.5) Pohl NB, Brush PL, Parson JP, Fitzgerald P, Charlton A, Beredjiklian PK, Fletcher DJ. Incidence and Predictors of Subsequent Triggering Requiring Treatment After Trigger Finger Release. J Hand Surg Am. 2026 Feb;51(2):203.e1-203.e8. doi: 10.1016/j.jhsa.2025.02.009. Epub 2025 Apr 9. PMID: 40202483.We are in need of a podcast intern!  We would appreciate any referrals!See www.practicelink.com/theupperhand for more information from our partner on job search and career opportunities.The Upper Hand Podcast is sponsored by Checkpoint Surgical, a provider of innovative solutions for peripheral serve surgery. To learn more, visit https://checkpointsurgical.com/.As always, thanks to @iampetermartin for the amazing introduction and concluding music.For additional links, the catalog.  Please see https://www.ortho.wustl.edu/content/Podcast-Listings/8280/The-Upper-Hand-Podcast.aspx

It doesn't have to be a cruel summer of slogging through hot, humid runs. You can adjust your training so that summer running is productive and enjoyable. In part 1 of our summer running episodes, we discuss the physiological impacts of running in the heat and humidity, and how to adjust your training based on those responses.Thank you to our sponsors:✨ Good Ranchers: American-grown meat, delivered frozen to your doorstep. Use code IRON for $40 off the first order, or$100 off across the first three orders when customers start a subscription. Plus free protein with every order (choice of burgers, bacon, or chicken breasts). Be sure to mention “Tread Lightly Podcast” for how you heard about the company! https://www.goodranchers.com/✨ 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.✨ Mizuno: Shop running shoes and clothes at Mizuno's Memorial Day sale: https://runtothefinish.com/memorial-day-sale-mizuno-usa/In this episode, you'll learn:✅ What happens to your body when you run in the heat✅ Why you need to change your recovery strategy during the summer✅ Why humidity, UV index, and air quality, matter as much as temperature✅ How to adjust your paces for running in the heat✅ How to adjust your interval and tempo runs for the heat and humidityFurther Resources:Heat-Adjusted Pace Calculator: https://apps.runningwritings.com/heat-adjusted-pace/How to Adjust Your Workouts for Heat and Humidity: https://lauranorrisrunning.substack.com/p/how-to-adjust-your-running-workoutsReferences

In this episode, Yoga Medicine founder Tiffany Cruikshank and Katja Bartsch take a deep dive into the latest stretching research and what it means for yoga teachers, athletes, and movement professionals. Together, they unpack the latest recommendations around stretching for flexibility, stiffness, strength, hypertrophy, vascular health, recovery, and injury prevention while exploring the limitations of stretching as a standalone tool. Tiffany and Katja discuss why prolonged static stretching before explosive activity may impair athletic performance, how longer-held yin-style stretches may influence tissue stiffness, and why emerging vascular research around stretching is generating so much interest. They also explore why yoga recovery likely involves far more than just stretching mechanics, including nervous system regulation, breathwork, and relaxation. "We do not overestimate or underestimate what stretching can do." — Katja Bartsch. — What You'll Learn: What the new 2025 stretching consensus paper reveals about flexibility research [02:57] • Definitions of static, dynamic, and PNF stretching in both research and yoga practice [06:00] • Acute vs. chronic stretching effects on range of motion and mobility [13:54] • Recommendations for improving long-term flexibility and maintaining mobility with age [20:09] • The "Goldilocks" principle of tissue stiffness and athletic performance [27:24] • Why longer yin-style holds may influence connective tissue adaptation [32:12] • How stretching impacts strength, explosive performance, and warm-ups [34:32] • Research on stretching for strength gains and muscle hypertrophy [37:36] • Emerging evidence around stretching and vascular health [42:01] • Breathwork, nervous system regulation, and yoga's broader therapeutic effects [51:24] • Why stretching alone may not improve recovery or prevent soreness [54:07] • The limitations of flexibility-only approaches for injury prevention [1:00:13] • Why individualized mobility, stability, and strength work matter in yoga practice [1:01:40] • Final takeaways on stretching frequency, recovery, and long-term mobility [1:04:32] — Links Mentioned: Watch this episode on YouTube Warneke K, Thomas E, Blazevich AJ, Afonso J, Behm DG, Marchetti PH, Trajano GS, Nakamura M, Ayala F, Longo S, Babault N, Freitas SR, Costa PB, Konrad A, Nordez A, Nelson A, Zech A, Kay AD, Donti O, Wilke J. Practical recommendations on stretching exercise: A Delphi consensus statement of international research experts. J Sport Health Sci. 2025 Dec;14:101067. doi: 10.1016/j.jshs.2025.101067. Epub 2025 Jun 11. PMID: 40513717; PMCID: PMC12305623. — Learn More: Find the full show notes at YogaMedicine.com/podcast-167. Learn more about insider tips, online classes or information on our teacher trainings at YogaMedicine.com. To support our work, please leave us a 5 star review with your feedback on iTunes/Apple Podcasts or wherever you listen to podcasts. 

Does GABA Actually Help With Sleep? What the Research Says for Brain Injury Recovery Someone in our community recently asked me about GABA for sleep. They’d seen it recommended online, understood that sleep was critical for their recovery, and wanted to know whether the supplement was worth exploring or just noise. It’s a genuinely good question. And it deserves a proper answer. In this post, I’m going to walk you through what GABA is, what the clinical research actually shows about its effect on sleep, why the blood-brain barrier debate matters (and why it might not derail the whole argument), and what the evidence says about the relationship between sleep and brain recovery. By the end, you’ll have enough to have an informed conversation with your medical team. I’m not a doctor. I’m a three-time haemorrhagic stroke survivor who has spent years researching the science of brain recovery and interviewing hundreds of clinicians and survivors on the Recovery After Stroke podcast. What I offer is a careful read of the evidence, not a clinical prescription. What Is GABA and Why Does It Matter for Sleep? GABA (gamma-aminobutyric acid) is the brain’s primary inhibitory neurotransmitter. If your nervous system were a car, GABA is the brake pedal. It reduces neuronal excitability, quiets cortical arousal, suppresses the brain’s primary arousal centre (the locus coeruleus), and modulates the HPA axis, the stress-response system that drives cortisol. Most sedative medications work by amplifying GABA activity. Benzodiazepines, for instance, bind to GABA-A receptors to increase chloride channel opening, producing their calming effect. GABA isn’t doing something unusual here – it’s doing something fundamental. The question with supplemental oral GABA is more specific: Does taking GABA as a capsule or powder actually produce meaningful neurological effects? What Does the Research Show? Finding 1 — Oral GABA Reduces Sleep Latency (and EEG Can Measure It) A 2015 clinical trial published in the Journal of Nutritional Science and Vitaminology by Yamatsu and colleagues used EEG measurement, actual brainwave monitoring, rather than self-reported sleep questionnaires. One hundred milligrams of oral GABA shortened sleep latency (time to fall asleep) by 5.3 minutes compared to placebo. That might sound modest. But for someone lying awake for 30–40 minutes each night, it’s a meaningful shift. Crucially, this was objective neurophysiological data, not a survey response. (PMID: 26052150) Finding 2 — A 90-Day RCT Showed Improved Sleep Efficiency and Mood A 2024 randomised double-blind placebo-controlled trial published in the Journal of Dietary Supplements (Guimarães et al.) gave 200 mg of GABA daily for 90 days to sedentary overweight women also undergoing an exercise program. The GABA group showed significantly improved Pittsburgh Sleep Quality Index (PSQI) scores, significantly reduced depression scores, and improved heart rate variability, a marker of parasympathetic nervous system activity. The HRV finding is particularly interesting. It suggests GABA may be doing something broader than simply reducing sleep latency – it appears to support the overall physiological state that makes rest restorative. (PMID: 38321713) Finding 3 — But a High-Dose RCT Found No Effect Here’s where intellectual honesty matters. A 2023 Dutch RCT (de Bie et al.) published in the American Journal of Clinical Nutrition gave participants 500 mg of GABA three times daily, 1,500 mg/day total, and found no significant effect on self-reported sleep quality. Fasting plasma GABA wasn’t significantly elevated either, raising real bioavailability questions at that dose. This isn’t a reason to dismiss GABA entirely. It is a reason to pay attention to the dose. The evidence base supports 100–300 mg, not 1,500 mg. Higher is not better, and the non-linear dose response is clinically important. (PMID: 37495019) The Blood-Brain Barrier Debate — and Why the Gut May Be the Point The most common objection to oral GABA supplementation is this: GABA is a zwitterion at physiological pH, meaning it has low lipophilicity and poor predicted ability to cross the blood-brain barrier via passive diffusion. So if it can’t get into the brain directly, how does it produce neurological effects? The emerging explanation involves the gut-brain axis. The enteric nervous system, your gut’s own neural network, has GABA receptors. When oral GABA activates these enteric receptors, it can signal the brain via vagal afferents without needing to cross the BBB at all. Think of it as a side door rather than the front entrance. Supporting this: a 2024 RCT (Li et al.) found that a probiotic strain engineered to increase gut GABA production significantly improved objective sleep duration as measured by wearable devices, alongside reduced cortisol and suppressed HPA axis activity. The mechanism wasn’t direct CNS access – it was gut-brain signalling. (PMID: 39385735) The BBB debate doesn’t negate the clinical effect. It changes how we understand the mechanism. Why Sleep Is Not Optional in Brain Recovery This is the part that I think gets underweighted in recovery conversations — and the research is unambiguous. A 2026 large retrospective cohort study (Muhtar et al., Sleep Medicine) matched over 35,000 stroke patients and found that post-stroke insomnia was associated with a 29% higher risk of post-stroke cognitive impairment and a 30% higher risk of all-cause dementia. The association with Alzheimer’s disease was also significant. (PMID: 41924789) A 2024 observational study from Monash University and Alfred Health (Smith et al.) found that in stroke rehabilitation patients, poor sleep quality was significantly associated with higher fatigue severity and lower salivary BDNF gene expression. BDNF (brain-derived neurotrophic factor) is one of the primary molecular drivers of neuroplasticity. Less BDNF means a less receptive environment for the neurological rewiring that rehab is trying to build. (PMID: 38802847) And then there’s the glymphatic system: the brain’s waste-clearance mechanism that is most active during deep sleep. Poor sleep means reduced clearance of metabolic byproducts, including proteins associated with neurodegeneration. This is not a theoretical risk. It is an active, ongoing process. Sleep is not passive recovery. It is one of the primary mechanisms of recovery. What to Do With This Information Here are three practical steps if you’re exploring GABA for sleep: 1. Measure your sleep baseline first. Use the Pittsburgh Sleep Quality Index (freely available online) before you make any changes. Understanding whether you’re struggling with latency, duration, or quality will determine what you actually need to address. 2. If you trial GABA, choose the right form and dose. Look for PharmaGABA — naturally fermented GABA, derived from Lactobacillus hilgardii, which has the strongest clinical evidence base. A dose of 100–300 mg taken 30–60 minutes before bed is consistent with the positive studies. Avoid very high doses; the null result at 1,500 mg/day is important context. Important drug interaction note: If you are taking benzodiazepines, anticonvulsants (gabapentin, pregabalin, valproate), or any other GABAergic medication, discuss GABA supplementation with your prescriber before adding it. The additive sedative effect is a real risk. The same applies if you drink alcohol regularly. 3. Don’t skip the foundation. Sleep hygiene interventions, consistent sleep and wake times, a dark and cool room, and no screens in the 60 minutes before bed, are consistently among the highest-leverage sleep interventions in the literature. GABA may provide a genuine incremental benefit. But it cannot compensate for a fundamentally disrupted sleep environment. The Bottom Line The evidence for GABA and sleep is more substantive than I expected when I started researching it. The EEG data is real. The 90-day RCT showed meaningful clinical outcomes. The gut-brain axis mechanism is biologically plausible and now has direct RCT support. And the consequences of poor sleep in neurological recovery are not trivial – they are quantifiable, significant, and, to a degree, addressable. GABA is not a guaranteed fix. Individual responses vary. The research is not yet definitive at the level of large multi-centre trials in neurological populations. But as one tool in a comprehensive approach to sleep quality alongside good sleep hygiene, appropriate medical support, and consistent rehabilitation, the case for cautious exploration is reasonable. The next step is a conversation with your neurologist, GP, or rehab physician. Take the research with you if it’s useful. Research References All studies cited in this post are retrievable via PubMed: Yamatsu et al. — GABA sleep latency EEG clinical trial (2015) — PMID: 26052150 Guimarães et al. — GABA 200mg RCT, sleep efficiency + mood (2024) — PMID: 38321713 de Bie et al. — GABA high-dose RCT, null sleep result (2023) — PMID: 37495019 Li et al. — Gut-brain GABA axis and sleep RCT (2024) — PMID: 39385735 Muhtar et al. — Post-stroke insomnia and cognitive decline cohort (2026) — PMID: 41924789 Smith et al. — Sleep, BDNF, and fatigue in stroke rehabilitation (2024) — PMID: 38802847 This post is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before making changes to your supplementation or treatment plan. If you or someone you care about is recovering from a stroke, brain injury, or any neurological condition, the Recovery After Stroke podcast and this blog exist for you. Subscribe on YouTube @BillGasiamis, or visit Recovery After Stroke to find episodes, resources, and community. The post GABA, Sleep, and Brain Health – Neurological Recovery appeared first on Recovery After Stroke.

Contributor: Travis Barlock, MD Educational Pearls:   Endocannabinoid System: THC binds CB1 and CB2 receptors in neurons and immune cells Δ9-Tetrahydrocannabinol (THC) is the main psychoactive compound in cannabis CB1 and CB2 receptors typically bind endogenously-produced 2-arachidonoylglycerol (2-AG) and anandamide (AEA) to regulate pain, stress, and inflammation THC similarly binds CB1 and CB2, leading to the cannabinoid high: euphoria, paranoia, anxiety, analgesia, anti-inflammation, and appetite, among a variety of others Ingestion via edibles, vice inhalation via smoking, leads to chemical modification of Δ9-THC to 11-hydroxy-Δ9-THC, which more easily crosses the blood-brain barrier and binds CB1 with higher affinity, leading to increased psychoactivity   Cannabinoid Hyperemesis Syndrome (CHS): Chronic THC use leading to the classic presentation of persistent nausea and intense, frequent vomiting Chronic activation of CB1 receptors in brain builds a tolerance and dependence on THC, in addition to chronic activation of the capsaicin and vanilloid receptor TRPV1, which binds capsaicin or is activated by heat Treatment by warm showers works due to TRPV1 activation by heat Treated with benzodiazepines, fluids, and gastro-intestinal or central nervous system agents according to patient presentation   Over 200 synthetic cannabinoids have been created (K2, spice, black mamba, mojo, etc), which are more dangerous and can lead to a variety of etiologies   Acetaminophen binds CB1 receptors to reduce inflammatory pain   References Loganathan P, Gajendran M, Goyal H. A Comprehensive Review and Update on Cannabis Hyperemesis Syndrome. Pharmaceuticals (Basel). 2024;17(11):1549. Published 2024 Nov 18. doi:10.3390/ph17111549  Wall ME, Sadler BM, Brine D, Taylor H, Perez-Reyes M. Metabolism, disposition, and kinetics of delta-9-tetrahydrocannabinol in men and women. Clin Pharmacol Ther. 1983 Sep;34(3):352-63. doi: 10.1038/clpt.1983.179. PMID: 6309462.  Mills B, Yepes A, Nugent K. Synthetic Cannabinoids. Am J Med Sci. 2015 Jul;350(1):59-62. doi: 10.1097/MAJ.0000000000000466. PMID: 26132518. Klinger-Gratz PP, Ralvenius WT, Neumann E, et al. Acetaminophen Relieves Inflammatory Pain through CB1 Cannabinoid Receptors in the Rostral Ventromedial Medulla. J Neurosci. 2018;38(2):322-334. doi:10.1523/JNEUROSCI.1945-17.2017   Summarized by Sam Pahl | Edited by Sam Pahl & Ahmed Abdel-Hafiz, NREMT-P   Donate: https://emergencymedicalminute.org/donate/ Join our mailing list: http://eepurl.com/c9ouHf

Part 3 of the Women's Health SeriesBloating, gas, urgency, abdominal pain, and that relentless “what if something happens?” loop can turn sex from a close connection into stress fast. Digestive symptoms can quietly impact some of the most vulnerable parts of our lives...including intimacy, relationships, and self-esteem. And often, the shame surrounding those experiences feels heavier than the symptoms themselves. If you've ever pulled away from connection because your gut felt unpredictable, this conversation is for you. In this episode, we're opening up an honest and empowering discussion about gut health, confidence, and reclaiming intimacy without fear or embarrassment.We dive into this topic with our expert guest, Dr. Alyse Bedell, GI psychologist and Certified Sex Therapist, covering: • Why digestive functions feel taboo in sexual relationships • How IBS and IBD symptoms can impact desire, relaxation, and satisfaction • Myth-busting the idea that sex must be spontaneous to be pleasurable • Scripts and “reset” strategies for handling symptoms in the moment • Redefining intimacy so closeness does not always imply intercourse • Flexible planning around meals, energy, triggers, and symptom patterns • Partner support that reassures without becoming patronizing • The circular sexual response cycle and starting from sexual neutrality • Rebuilding sexual self-esteem with stigma work and acting with "as if” confidence This episode has been sponsored by Ardelyx. References: Ballou S, McMahon C, Lee HN, et al. Effects of Irritable Bowel Syndrome on Daily Activities Vary Among Subtypes Based on Results From the IBS in America Survey. Clin Gastroenterol Hepatol. 2019 Nov;17(12):2471-2478.e3. Fretz KM, Hunker KE, Tripp DA. The Impact of Inflammatory Bowel Disease on Intimacy: A Multimethod Examination of Patients' Sexual Lives and Associated Healthcare Experiences. Inflamm Bowel Dis. 2024 Mar 1;30(3):382-394. doi: 10.1093/ibd/izad106. PMID: 38206426; PMCID: PMC10906359.Wang J, Varma MG, Creasman JM, et al. Pelvic floor disorders and quality of life in women with self-reported irritable bowel syndrome. Aliment Pharmacol Ther. 2010;31(3):424-431. doi:10.1111/j.1365-2036.2009.04180.xDubinsky MC, Potts Bleakman A, Schreiber S, et al.. Impact of moderate-to-severe ulcerative colitis and Crohn's disease on sexual activity: United States and European patient perspectives from the communicating needs and features of IBD experiences (CONFIDE) survey. Curr Med Res Opin. 2025 Jun;41(6):1017-1030. doi: 10.1080/03007995.2025.2530736. Epub 2025 Jul 17. PMID: 40635574.Come As You Are: Revised and Updated: The Surprising New Science That Will Transform Your Sex Life by Emily Nagoski Ph.D.  Becoming Cliterate: Why Orgasm Equality Matters--And How to Get It by Laurie MintzThe American Association of Sexuality Educators, Counselors and Therapists (AASECT) (great resources as well as a place to find a certified sex therapist)Give us a follow us on social media @TheGutHealthPodcast, where we'd love for you to share your thoughts, questions, and experiences. Learn more about Kate and Dr. Riehl:Website: www.katescarlata.com and www.drriehl.comInstagram: @katescarlata @drriehl and @theguthealthpodcastOrder Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.  The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment.  Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

No weights for home pole dance conditioning? No problem! Dr. Rosy Boa addresses how pole dancers can build strength at home without gym access or heavy weights. She explains the basic strength principle of applying load and allowing recovery, noting weights are the most efficient for rapid, targeted gains, with free weights often preferable to machines for pole due to stabilization and range-of-motion demands. She then covers three accessible alternatives: isometrics (80–100% maximal effort holds for 1–5 seconds, scaling well but joint-angle specific), scalable bodyweight training (using variations such as changing points of contact, lever length, duration, reps, and power), and resistance bands (types, selecting by length/shape/resistance, variable tension through range, latex cautions, and use for assistance/spotting). She emphasizes consistency, enjoyable training, and doing the conditioning you will actually do.Are you a pole nerd interested in trying out online pole classes with Slink Through Strength? We'd love to have you! Use the code “podcast” for 10% off the Intro Pack and try out all of our unique online pole classes: https://app.acuityscheduling.com/catalog/25a67bd1/?productId=1828315&clearCart=true  Chapters:00:00 Welcome and Topic00:58 Membership Shoutouts02:59 Strength Basics05:56 Isometrics Explained09:11 Bodyweight Training12:04 Scaling Difficulty16:55 Resistance Bands24:52 Consistency Over Intensity28:47 Wrap Up and Invite Citations: Weights (machines or free weights) do have the largest effect size in building strength... but that's not necessarily our only goalWiedenmann T, Held S, Morat T, Rappelt L, Isenmann E, Berndsen E, Hopp NH, Donath L. The Effects of Different Resistance Training Modalities on Muscle Strength in Community-Dwelling Older Adults: A Network Meta-Analysis. Gerontology. 2025;71(7):576-588. doi: 10.1159/000546346. Epub 2025 May 27. PMID: 40452461. Isometrics scale with strength! (but you gotta PUSH: 80 - 100% effort and hold for a couple seconds)Lum D, Barbosa TM. Brief Review: Effects of Isometric Strength Training on Strength and Dynamic Performance. Int J Sports Med. 2019 May;40(6):363-375. doi: 10.1055/a-0863-4539. Epub 2019 Apr 3. PMID: 30943568. Bands do help with strength, might be more helpful with explosive/powerStanković D, Lazić A, Trajković N, Okičić M, Bubanj A, Vencúrik T, Gašić T, Bubanj S. Effects of Elastic Band Training on Physical Performance in Team Sports: A Systematic Review and Meta-Analysis. J Funct Morphol Kinesiol. 2025 Oct 17;10(4):402. doi: 10.3390/jfmk10040402. PMID: 41133592; PMCID: PMC12551113.

Send us Fan MailIn this episode of Journal Club, we wrap up a marathon recording session with a deep dive into the world of neonatal neuroprognostication. Daphna reviews a systematic review and meta-analysis from Pediatric Neurology that evaluates whether combining EEG and MRI provides better answers for families of preterm infants. While MRI remains a powerful tool for structural assessment, the data suggests that adding the functional insights of EEG significantly boosts specificity, particularly when predicting severe neurodevelopmental outcomes. We discuss the importance of timing these studies and the clinical value of sleep-wake cycling as a developmental milestone at the bedside.----Combined Use of Electroencephalography and Magnetic Resonance Imaging in the Prognostication of Neurodevelopmental Outcomes in Preterm Infants - A Systematic Review and Meta-Analysis. Forrest CD, Biagioni T, Liley HG, Lai MM, Colditz PB, Ware RS, Boyd RN, Roberts JA.Pediatr Neurol. 2026 Feb;175:116-129. doi: 10.1016/j.pediatrneurol.2025.11.005. Epub 2025 Nov 13.PMID: 41337899 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!

Spring is a season of rapid change inside the hive, and in this Bee Science segment, Dr. Dewey Caron walks through what drives colony expansion—and how beekeepers can respond effectively.   Dewey emphasizes that spring growth is fundamentally tied to pollen availability and favorable flying weather. Colonies in warmer climates may expand gradually, while northern colonies often experience a compressed and intense buildup. This variability makes local awareness and timing essential. Nutrition plays a central role. Research going back to Heather Mattila's 2006 work shows that colonies receiving pollen or protein supplements begin brood rearing earlier and build stronger populations. More recent work reinforces that locally sourced pollen may improve effectiveness, and emerging commercial feeds are showing measurable gains in overwinter survival and pollination strength. As colonies grow, so does the risk of swarming. Dewey underscores the importance of proactive management—providing adequate space, maintaining ventilation, and monitoring brood nest congestion. Once swarm preparation begins, options narrow quickly, making early intervention key. The episode also introduces the "Goldilocks effect" in evaluating colony strength. Colonies that are too weak struggle to build, while overly strong colonies risk swarming. The goal is finding that "just right" balance through regular inspection, brood assessment, and strategic frame movement. Health risks remain present during this expansion phase. Diseases like European foulbrood and chalkbrood, along with pesticide exposure and nutritional stress, can limit colony development. At the same time, brood expansion creates ideal conditions for varroa reproduction, reinforcing the need for integrated management. Dewey's central message is clear: spring requires active, informed management—but not overmanagement. Listen to the bees, respond to conditions, and aim for balance between growth and control. Links and references mentioned in this episode: Caron, Dewey M. Bee MD Bee MD [https://idtools.org/thebeemd/index.cfm?pageID=3094] Mattila, Hearther R. and Gard W Otis. 2006. Influence of pollen diet in spring on development of honey bee (Hymenoptera: Apidae) colonies. J. Econ Entomol. 99(3):604-13. doi: 10.1603/0022-0493-99.3.604 Kulhanek, Kelly, et. al.  2026. Enhanced Honey Bee Colony Strength and Economic Returns from Fall and Winter Feeding with a Complete Pollen-Replacing Feed. Insects 2026, 17(3), 243; https://doi.org/10.3390/insects17030243 Basu, Priya. 2024 Honey bee Nutrition HBHC https://honeybeehealthcoalition.org/nutritionguide/ Tew, James. 2025. Giving it Your Best Guess. March. Bee Culture DeGrandi-Hoffman G, Gage SL, Corby-Harris V, Carroll M, Chambers M, Graham H, Watkins DeJong E, Hidalgo G, Calle S, Azzouz-Olden F, Meador C, Snyder L, and  Ziolkowski N. 2018. Connecting the nutrient composition of seasonal pollens with changing nutritional needs of honey bee (Apis mellifera L.) colonies. J Insect Physiol.109:114-124. doi: 10.1016/j.jinsphys.2018.07.002. Epub 2018 Jul 7.PMID: 29990468 Hoover SE, Ovinge LP, and Kearns JD.  2022. Consumption of Supplemental Spring Protein Feeds by Western Honey Bee (Hymenoptera: Apidae) Colonies: Effects on Colony Growth and Pollination Potential. J. Econ Entomol.115(2):417-429. doi: 10.1093/jee/toac006.PMID: 35181788Free PMC article. ______________ Brought to you by Betterbee – your partners in better beekeeping.   Betterbee is the presenting sponsor of Beekeeping Today Podcast. Betterbee's mission is to support every beekeeper with excellent customer service, continued education and quality equipment. From their colorful and informative catalog to their support of beekeeper educational activities, including this podcast series, Betterbee truly is Beekeepers Serving Beekeepers. See for yourself at www.betterbee.com _______________ We hope you enjoy this podcast and welcome your questions and comments in the show notes of this episode or: questions@beekeepingtodaypodcast.com Thank you for listening!  Podcast music: Be Strong by Young Presidents; Epilogue by Musicalman; Faraday by BeGun; Walking in Paris by Studio Le Bus; A Fresh New Start by Pete Morse; Wedding Day by Boomer; Christmas Avenue by Immersive Music; Red Jack Blues by Daniel Hart; Bolero de la Fontero  by Rimsky Music; Perfect Sky by Graceful Movement; Original guitar background instrumental by Jeff Ott. Beekeeping Today Podcast is an audio production of Growing Planet Media, LLC ** As an Amazon Associate, we may earn a commission from qualifying purchases Copyright © 2026 by Growing Planet Media, LLC

Send us Fan MailIs your NICU considering the shift to 24 hour in house attending coverage? In this episode of Journal Club, we explore a provocative brief communication from the Journal of Perinatology. Ben and Daphna discuss the impact of moving from home call to on site presence at UC Davis. While the change was intended to improve patient care, the data reveals a surprising 15 percent decrease in work RVUs. We examine how proactive weaning and bedside presence might actually lower billing levels under current CPT codes. Are we being penalized for doing the right thing for our patients?----From on-call to on-site: the impact of 24-hour in-house neonatology on billing patterns and physician productivity. Donohue L, Lakshminrusimha S.J Perinatol. 2026 Feb;46(2):289-292. doi: 10.1038/s41372-025-02530-8. Epub 2026 Jan 5.PMID: 41490931 Free PMC article. 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!

What are the experts saying about thyroid cancer treatment in 2025?  Maybe it's time to discuss deescalation of aggressive surgical care for lower risk thyroid cancers.  We can accept that less surgery may be appropriate in select cases, including more thyroid lobectomies versus total thyroidectomies, consider less invasive approaches such as percutaneous ablation techniques, and utilize more observation with active surveillance.  Early assessment of treatment may allow appropriate reduction in use of radioactive iodine ablation and more relaxed routine monitoring can reduce surveillance burden to patients and providers. Hosts:  - Amanda Doubleday, DO, MBA, Assistant Professor, Waukesha Surgical Specialists, ProHealth Care.  Affiliated with University of Wisconsin School of Medicine and Public Health, Department of Surgery.  - Simon Holoubek, DO, MPH, Assistant Professor, University of Wisconsin School of Medicine and Public Health, Department of Surgery.  - Alexander Chiu, MD, Assistant Professor, University of Wisconsin School of Medicine and Public Health, Department of Surgery.  - Rebecca S Sippel, MD, FACS, Professor and Chair of Division of Endocrine Surgery, Vice Chair of Academic Affairs and Professional Development, University of Wisconsin School of Medicine and Public Health, Department of Surgery.  Learning Objectives:- Risk stratification system now includes 4 categories: low, low-intermediate, high-intermediate, and high-TSH suppression targets are simplified:  below the normal range if there is structural or biochemical disease and in the normal range if disease free. - Thyroid lobectomy is recommended for tumors < 2cm cT1N0 tumors and can be considered for tumors 2-4 cm. - Micro-Papillary Thyroid Carcinoma (

In this special Complex Care Journal Club podcast episode, co-hosts Drs. Emily Goodwin, Kristie Malik, and Kathleen Huth interview presenters of posters and oral abstracts relevant to the care of children with medical complexity at the Pediatric Academic Societies (PAS) 2026 annual meeting, as well as at a pre-PAS event focused on home- and community-based care and training in complex care. Speakers describe their key findings, messages for care teams including patients and families, and opportunities to translate their findings into practice.‌ SPEAKERS Flor Arellano, MPH Clinical Research Coordinator, University of California, Los Angeles Jennifer Arnold, MD, MSc Medical Director, Skeletal Health, Boston Children's Hospital Ryan Brewster, MD Neonatal- Perinatal Medicine Fellow, Stanford University School of Medicine Meg Comeau, MHA Senior Project Director, Center for Innovation in Social Work & Health, Boston University School of Social Work John Greenwood, PT Executive Director for Physical Therapy, Occupational Therapy and Rehabilitation Services, Boston Children's Hospital Elaine Lin, MD Complex Care Pediatrician, Boston Children's Hospital Michelle Macy, MD, MS Professor of Pediatrics, Northwestern University Feinberg School of Medicine Scientific Director, Community, Population Health, and Outcomes, Research and Evaluation Center, Ann & Robert H. Lurie Children's Hospital of Chicago Ashley Nmoh, BA Medical Student, Duke University School of Medicine Jennifer Peralta, MD, MSHPN Assistant Clinical Professor, University of California, Los Angeles Nora Renthal, MD, PhD Assistant Professor of Pediatric Endocrinology, Boston Children's Hospital Erin Ward, MEd Patient Engagement Consultant, Complex Care Service, Boston Children's Hospital HOSTS 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 Kristina Malik, MD Assistant Professor of Pediatrics, University of Colorado School of Medicine Medical Director, KidStreet Pediatrician, Special Care Clinic, Children's Hospital Colorado Kathleen Huth, MD, MMSc Pediatrician, Complex Care Service, Division of General Pediatrics, Boston Children's Hospital Assistant Professor of Pediatrics, Harvard Medical School DATE Initial publication date: May 11, 2026. ARTICLES REFERENCED - Brewster RC, Kats DJ, Elborki M, Chilukuri N, Ray M, Shaar N, Hron J, Khan A. Clinical Outcomes of Postedited Artificial Intelligence Translation for Discharge Instructions. Hosp Pediatr. 2026 Apr 10:e2025008986. doi: 10.1542/hpeds.2025-008986. Epub ahead of print. PMID: 41956490. - FamilyCIRCLE. University of Wisconsin–Madison, Department of Pediatrics. Accessed May 4, 2026. https://familycircle.pediatrics.wisc.edu/ - Pediatric Academic Societies. Online program guide. Accessed May 4, 2026. https://2026.pas-meeting.org/ - Pediatric Academic Societies. Who we are. Accessed May 4, 2026. https://www.pas-meeting.org/about/ - Pediatric Academic Societies. Academic Pediatric Association (APA) awards. Accessed May 4, 2026. https://www.pas-meeting.org/2026-awards-apa/‌ TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/as/k7qqm93qqpqgb5k3jw4f3w2t/PAS_2026_conference_transcript_5-8-26‌ 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. CITATION Goodwin EJ, Malik K, Arellano F, Arnold J, Brewster R, Comeau M, Greenwood J, Lin E, Macy M, Nmoh A, Peralta J, Renthal N, Ward E, Huth K. Practice-Changing Research in Complex Care at the Pediatric Academic Societies 2026 Annual Meeting. 05/2026. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/practice-changing-research-in-complex-care-pediatric-academic-societies-2026.

In this episode of PICU Doc on Call, Dr. Monica Gray and Dr. Pradip Kamat chat about flexible fiberoptic bronchoscopy (FFB) in the pediatric ICU. They walk through a case involving an eight-year-old who's dealing with respiratory failure after a stem cell transplant. Along the way, they talk about when and why you might use bronchoscopy both for diagnosis and treatment—plus how to approach sedation and what effects the procedure can have on the heart and lungs. They also dive into important topics like managing hypoxia, handling increased airway and pulmonary vascular resistance, and what to keep in mind if your patient has a traumatic brain injury. The episode wraps up with tips for managing fever after the procedure and a quick look at how rigid bronchoscopy compares.Show Highlights:Use of flexible fiberoptic bronchoscopy (FFB) in the pediatric ICU (PICU)Indications for performing bronchoscopy (diagnostic and therapeutic)Management of sedation and analgesia during bronchoscopyCardiovascular effects associated with bronchoscopy proceduresRespiratory effects and complications during bronchoscopySpecial considerations for bronchoscopy in patients with traumatic brain injury (TBI)Post-procedure complications, including fever and its managementOverview of rigid bronchoscopy and its indicationsImportance of understanding physiological changes during bronchoscopyEducational focus on acute pediatric care for current and aspiring PICU internsReferences:Reference 1: Sachdev A, Chhawchharia R. Flexible Fiberoptic Bronchoscopy in Pediatric Practice. Indian Pediatr. 2019 Jul 15;56(7):587-593. PMID: 31333214.Reference 2: Li SX, Tao XF, Wu HJ, Jin F, Zhu GH, Wang YS, Tang LF, Chen ZM, Wu L. Advances in pediatric flexible bronchoscopy. World J Pediatr. 2025 Oct;21(10):945-956. doi: 10.1007/s12519-025-00967-7. Epub 2025 Oct 4. PMID: 41045338; PMCID: PMC12578761.Reference 3: Truitt BA, Kasi AS, Kamat PP, Fundora MP, Simon DM, Guglani L. Cryoextraction via flexible bronchoscopy in children with tracheobronchial obstruction. Pediatr Pulmonol. 2023 Sep;58(9):2527-2534. doi: 10.1002/ppul.26540. Epub 2023 Jun 23. PMID: 37350368.

In which we interview Rani Elwy about her work at the intersection of implementation science and policy as she served as a Robert Wood Johnson health policy fellow in the US Senate focusing on menopause care. We discuss menopause policy, stigma, implementation and deimplementation challenges for menopause care, and what it was like to work as a policy fellow for Senator Patty Murray. Discussed on today's show:  Bauer MS, Kirchner J. Implementation science: What is it and why should I care? Psychiatry Res. 2020 Jan;283:112376. doi: 10.1016/j.psychres.2019.04.025. Epub 2019 Apr 23. PMID: 31036287. Lane-Fall MB, Curran GM, Beidas RS. Scoping implementation science for the beginner: locating yourself on the "subway line" of translational research. BMC Med Res Methodol. 2019 Jun 28;19(1):133. doi: 10.1186/s12874-019-0783-z. PMID: 31253099; PMCID: PMC6599376.

I say this with my full chest — Undertone was not lying when it said that it is "the scariest movie you'll ever hear." And I cannot un-hear it!In this spoiler-free episode, I explore Undertone (2025) and the psychology of sound.I talk about:How sound can help us form secure attachments The psychology behind "therapist voice"How sound helps regulate our nervous systemsWhy we are naturally drawn to live music as a primal actHow silence can help grow your brainHow the 8 of wands tarot card helps us explore our relationship to silence and the unknown Mental Health is Horrifying is hosted by Candis Green, Registered Psychotherapist and owner of Many Moons Therapy...............................................................Show Notes:Tarot for Creative Therapists — Join the waitlist for this course designed for mental health professions who want to learn how to confidently and ethically incorporate tarot into clinical work. (https://candisgreen.podia.com/tarot-for-creative-therapists)Podcast artwork by Chloe Hurst at Contempo MintTheme music is by Sound Gallery by Dmitry Taras via pixabay Thunder by Music by John Britton from PixabayAll sound effects and music via pixabay Undertone (2025)See ‘Undertone' with Dolby Atmos, or You'll Miss Half the HorrorEnhancing the Raw Sound of ‘Undertone' – with David Gertsman and Jon LawlessIan Tuason haunted his own house when making his new horror filmBady SL. The voice as a curative factor in psychotherapy. Psychoanal Rev. 1985 Fall;72(3):479-90. PMID: 3931132. Soma CS, Knox D, Greer T, Gunnerson K, Young A, Narayanan S. It's not what you said, it's how you said it: An analysis of therapist vocal features during psychotherapy. Couns Psychother Res. 2023 Mar;23(1):258-269. doi: 10.1002/capr.12489. Epub 2021 Nov 18. PMID: 36873916; PMCID: PMC9979575. Sawamura, Yasuaki, Why We Overstimulate Ourselves: How Sensory Overload Blocks Memory and Weakens Learning (March 31, 2025). How Music Resonates in the BrainGentle Whispering ASMR Moonlight Cottage ASMR 

You have probably heard of the vagus nerve, and (whether you realize it or not) have been exposed to some of the concepts of Polyvagal Theory in yoga classes. In fact, we have discussed the theory in a previous episode of the podcast. In today's episode, host Rachel Land and Yoga Medicine Therapeutic Specialist Valerie Knopik, PhD, revisit Polyvagal Theory and explore the latest scientific debate it has generated. They break down the original framework, the newer criticisms, and the ways scientific ideas evolve over time.  The conversation stays grounded in real-world teaching, especially around stress response, breath, and the role of relationships in helping people feel safe enough to practice. It is a thoughtful reminder that research can shift while the practical value of awareness, connection, and regulation remains central to yoga. "Science is never stagnant, and that's part of the beauty of science for me." — Valerie Knopik. — What You'll Learn: Vagus nerve roles in stress and relaxation response [3:24] Recent papers updating and challenging Polyvagal Theory (PVT) [4:41] The nature of the scientific method [7:12] Defining PVT [10:37]  Summarizing the current controversy: over-simplification of dorsal vs ventral vagus [25:29] Other points of contention: dorsal vagal and trauma response, heart rate variability as a measure of vagal tone, clinical over-use [31:41] Relevance to yoga teaching and practice [37:11] The "science of safety" in yoga: Yoga Medicine Mental Health & Wellness Teacher Training [44:00] — Links Mentioned: Watch this episode on YouTube Mental Health & Wellness Yoga Teacher Training  Yoga Medicine Podcast Research Roundup: Updates on Polyvagal Theory  Porges SW. Polyvagal Theory: Current Status, Clinical Applications, and Future Directions. Clin Neuropsychiatry. 2025 Jun;22(3):169-184. doi: 10.36131/cnfioritieditore20250301. PMID: 40735382; PMCID: PMC12302812 Grossman P et al. Why The Polyvagal Theory Is Untenable: An international expert evaluation of the polyvagal theory and commentary upon Porges, S.W. (2025). Clin. Neuropsychiatry, 22(3), 169-184. Clin Neuropsychiatry. 2026 Feb;23(1):100-112. doi: 10.36131/cnfioritieditore20260110. PMID: 41768017; PMCID: PMC12937499 Yoga Medicine Podcast Episodes: Epigenetics, Mental Health & Yoga  The Neuroscience of Resilience  Interoception Research & Yoga  Connect with Valerie Knopik, PhD: Facebook | Instagram | X | YMO Teacher Learn More: Find the full show notes at YogaMedicine.com/podcast-166. Learn more about insider tips, online classes or information on our teacher trainings at YogaMedicine.com. To support our work, please leave us a 5 star review with your feedback on iTunes/Apple Podcasts or wherever you listen to podcasts. 

You know how, when teaching finishes for the summer, you feel all-powerful and end up vastly over-estimating how much you'll be able to get done before the new academic year? And, have you ever noticed that the opposite happens once term starts up again: you're overwhelmed, you panic because you don't think you're going to manage to do everything, but then you surprise yourself and it's all fine in the end? Yeah, well, there's a reason for that. Join your imperfectionist pal for a speculative little dive into the psychology of perception, and some ideas about how you can smooth out the bumps and make nice, sensible plans all year round.ReferencesBalcetis E, Dunning D. Cognitive dissonance and the perception of natural environments. Psychol Sci. 2007 Oct;18(10):917-21. doi: 10.1111/j.1467-9280.2007.02000.x. PMID: 17894610.Balcetis E, Dunning D. Wishful seeing: more desired objects are seen as closer. Psychol Sci. 2010 Jan;21(1):147-52. doi: 10.1177/0956797609356283. Epub 2009 Dec 17. PMID: 20424036.Proffitt DR, Bhalla M, Gossweiler R, Midgett J. Perceiving geographical slant. Psychon Bull Rev. 1995 Dec;2(4):409-28. doi: 10.3758/BF03210980. PMID: 24203782.Proffitt DR, Stefanucci J, Banton T, Epstein W. The role of effort in perceiving distance. Psychol Sci. 2003 Mar;14(2):106-12. doi: 10.1111/1467-9280.t01-1-01427. PMID: 12661670.Schnall S, Zadra JR, Proffitt DR. Direct evidence for the economy of action: glucose and the perception of geographical slant. Perception. 2010;39(4):464-82. doi: 10.1068/p6445. PMID: 20514996; PMCID: PMC3298360.

In this episode, our expert panel dives into the critical, historically debated topic of early burn wound excision using a real-world case of a patient with massive surface area burns. We explore the dramatic shift from the pre-1970s "wait and watch" approach to the modern standard of early source control, backed by landmark literature showing reduced mortality and shorter hospital stays. The discussion also highlights the nuances of this timeline, covering specific scenarios where delaying surgery is actually safer due to physiologic instability, uncertain burn depths, or mass casualty events. Tune in to hear the evidence behind these clinical decisions and learn why modern burn surgeons believe that removing necrotic eschar early is the best way to dominate the day!Hosts: - Kathleen Romanowski – University of California Davis Hospital, Shriners Hospital Sacramento- Laura Johnson – Grady Memorial Hospital- Lauren Nosanov – Grady Memorial Hospital-  Victoria Miles – Louisiana State University Health Science Center, University Medical Center New OrleansLearning Objectives:- Review the historical development of early burn excision and understand how these studies shaped modern burn surgical practice.-  Evaluate contemporary evidence on the timing of burn excision.- Apply current evidence and clinical principles to operative decision-making, identifying key patient and injury factors that influence the timing of excision and grafting in patients with major thermal injury.References:- Thompson P, Herndon DN, Abston S, Rutan T. Effect of early excision on patients with major thermal injury. J Trauma. 1987 Feb;27(2):205-7. doi: 10.1097/00005373-198702000-00019. PMID: 3820353. https://pubmed.ncbi.nlm.nih.gov/3820353/-  Gray DT, Pine RW, Harnar TJ, Marvin JA, Engrav LH, Heimbach DM. Early surgical excision versus conventional therapy in patients with 20 to 40 percent burns. A comparative study. Am J Surg. 1982 Jul;144(1):76-80. doi: 10.1016/0002-9610(82)90605-5. PMID: 7046487. https://pubmed.ncbi.nlm.nih.gov/7046487/- De La Tejera G, Corona K, Efejuku T, Keys P, Joglar A, Villarreal E, Gotewal S, Wermine K, Huang L, Golovko G, El Ayadi A, Palackic A, Wolf SE, Song J. Early wound excision within three days decreases risks of wound infection and death in burned patients. Burns. 2023 Dec;49(8):1816-1822. doi: 10.1016/j.burns.2023.06.003. Epub 2023 Jun 15. PMID: 37369613; PMCID: PMC10721718. https://pubmed.ncbi.nlm.nih.gov/37369613/- Ramsey WA, O'Neil CF Jr, Corona AM, Cohen BL, Lyons NB, Meece MS, Saberi RA, Gilna GP, Satahoo SS, Kaufman JI, Schulman CI, Namias N, Proctor KG, Pizano LR. Burn excision within 48 hours portends better outcomes than standard management: A nationwide analysis. J Trauma Acute Care Surg. 2023 Jul 1;95(1):111-115. doi: 10.1097/TA.0000000000003951. Epub 2023 Apr 11. PMID: 37038260. https://pubmed.ncbi.nlm.nih.gov/37038260/- Hayashi K, Sasabuchi Y, Matsui H, Nakajima M, Otawara M, Ohbe H, Fushimi K, Ono K, Yasunaga H. Does early excision or skin grafting of severe burns improve prognosis? A retrospective cohort study. Burns. 2023 May;49(3):554-561. doi: 10.1016/j.burns.2023.01.013. Epub 2023 Feb 3. PMID: 36774244. https://pubmed.ncbi.nlm.nih.gov/36774244/- Janzekovic Z. Once upon a time ... how west discovered east. J Plast Reconstr Aesthet Surg. 2008;61(3):240-4. doi: 10.1016/j.bjps.2008.01.001. Epub 2008 Feb 1. PMID: 18243082. https://pubmed.ncbi.nlm.nih.gov/18243082/

🧭 REBEL Rundown 📌 Key Points Parallel Tasking: Transitioning from junior to senior roles in medicine involves both personal growth and the development of leadership skills, often simultaneously. Psychological safety: Creating this within teams is critical for fostering an environment where all members feel empowered to speak up and share insights. Big and Small Picture View: Effective leadership requires the ability to zoom in on specific tasks and zoom out to manage the big picture, ensuring comprehensive patient care. Timing is Everything: The act of asking the right questions at the right time can significantly enhance team dynamics and patient outcomes in high-pressure situations. Talk the Talk: Creating and practicing clear, structured communication strategies can assist in smooth transitions and effective leadership during medical emergencies. Click here for Direct Download of the Podcast. 👀Previously Covered and Related Content: REBEL EM: Titles Don’t Make LeadersEM Cases: Four Key Learnings from a Career in Emergency Medicine Leadership 📝 Introduction Welcome back to REBEL MIND, where MIND stands for Mastering Internal Negativity during Difficulty. Here we sharpen the person behind the practitioner by focusing on things that improve our performance, optimizing team dynamics and the human behavior that embodies the hidden curriculum of medicine. Hosted by Dr. Mark Ramzy, with special guest Dr. Dan Dworkis, an emergency physician and author of “The Emergency Mind,” this episode dives into the complex journey from junior to senior leadership in medical settings.You can learn more about Dan’s work and the Emergency Mind Project hereHe has a phenomenal book called “The Emergency Mind: Rewiring Your Brain for Performance Under Pressure“ that you can purchase here! Cognitive Question How do medical professionals effectively transition from junior to senior roles, and what mental shifts are necessary to manage these evolving responsibilities? 🏥How This Applies to the Emergency Department or ICU? Transitioning from a junior to a senior role in the emergency department or ICU is akin to stepping onto a new stage where the performance demands are higher, and the stakes significantly greater. While juniors focus on learning their craft and understanding themselves, seniors are expected to manage and lead entire teams, often making life-saving decisions under pressure. This transition challenges not only their clinical skills but also their ability to lead effectively and maintain psychological safety within their teams.By fostering an environment where every team member feels valued and heard, senior leaders can harness the collective intelligence of the group, ensuring better patient outcomes and a more effective response to emergencies. ⏩Immediate Action Steps for Your Next Shift **Exercise Intentional Questioning**: Start your next shift by focusing on how you ask questions. Aim to frame queries in a way that invites discourse and challenges assumptions.**Develop Peripheral Awareness**: As you conclude critical tasks, practice expanding your focus from the immediate to the wider context, considering broader departmental needs. **Promote Inclusive Participation**: Encourage junior team members to share their observations and insights by specifically inviting their input during debriefs and planning.**Conduct Leadership Experiments**: On your next shift, try altering your leadership approach—whether it’s how you communicate or delegate—and reflect on its effectiveness with colleagues. **Create Psychological Safety**: Work towards fostering a safe environment for open communication, ensuring that all team members feel comfortable speaking up without fear of retribution. Conclusion Transitioning from a junior to a senior leadership role in the medical field is not just about honing your clinical skills but also about growing as a leader who can guide a team under intense pressure. By focusing on intentional communication, fostering psychological safety, and keeping an eye on both the details and the bigger picture, you can enhance your effectiveness as a leader. Continuous reflection and feedback are essential to mastering these skills, ensuring that both you and your team provide the highest level of care for your patients. 🚨 Clinical Bottom Line Leadership in medicine is about more than making decisions—it’s about creating an atmosphere where every voice is heard, ensuring optimal functioning of the team. As you grow into your senior role, remember that fostering psychological safety and practicing strategic communication can make all the difference in patient outcomes and team dynamics. Further Reading Collins-Nakai R. Leadership in medicine. Mcgill J Med. 2006 Jan;9(1):68-73. PMID: 19529813Chen TY. Medical leadership: An important and required competency for medical students. Tzu Chi Med J. 2018 Apr-Jun. PMID: 29875585 Meet the Authors Mark Ramzy, DO Co-Editor-in-Chief Cardiothoracic Intensivist and EM Attending RWJBH / Rutgers Health, Newark, NJ Dan Dworkis, MD, PhD Founder of Emergency Mind Project Assistant Professor at Keck School of Medicine at USC and Chief Medical Officer at Mission Critical Team Institute Showing Slide 1 of 2 The post REBEL MIND – The Mental Jump: Moving from Junior to Senior Leadership in Emergency Care appeared first on REBEL EM - Emergency Medicine Blog.

The belief that IV dextrose is necessary to clear ketones in hyperemesis gravidarum originated from a logical, and now known to be outdated, extrapolation of basic starvation ketosis physiology and the treatment paradigm for diabetic ketoacidosis (DKA). The original experiments that led to this conclusion go back to the 1960s (Foster data). Not only is this outdated, but it is also physiologically incorrect. We've learned a lot about IV fluid replacement about hyperemesis gravidarum in the last several years- in the last data review was in January 2026 in Lancet. Even the correction of hyponatremia has evolved. Should we be following urine ketones for patients being treated for HG? Is Dextrose needed? Listen in for details.1. Nana M, Painter R, Williamson C et al. Hyperemesis gravidarum. The Lancet, Jan 2026; 407, 78-892. Clark SM, Zhang X, Goncharov DA. Inpatient Management of Hyperemesis Gravidarum. Obstet Gynecol. 2024 Jun 1;143(6):745-758. doi: 10.1097/AOG.0000000000005518. Epub 2024 Feb 1. PMID: 38301258.3. Ayus JC, et al.Correction rates and clinical outcomes in hospitalized adults with severe hyponatremia: a systematic review and meta-analysis. JAMA Intern Med. 2025;185(1):38-51. 4. ACOG Clinical Epert Series: Inpatient Management of Hyperemesis Gravidarium. Obstet Gynecol; 2024

Near-Infrared Light Therapy After Stroke: Does the Science Hold Up? A viewer reached out recently with a question I have been getting more frequently: Does near infrared light therapy actually help the brain recover after stroke? It is a fair question — the claims circulating online range from cautiously promising to outright extraordinary. In this post, I am going to cut through the noise and look at what the peer-reviewed research actually shows. What is Near-Infrared Light Therapy? Near infrared (NIR) light therapy — also called photobiomodulation (PBM) or transcranial photobiomodulation (tPBM) when applied to the head — uses specific wavelengths of light (typically 630-1100 nm) to penetrate tissue and interact with cells at a biological level. This is not a tanning lamp or a heat lamp. The mechanism is specific: NIR light at the right wavelengths is absorbed by cytochrome c oxidase, a key enzyme in mitochondrial energy production. When stimulated, cytochrome c oxidase increases ATP synthesis — essentially giving cells more energy to carry out repair and function. For neurons recovering from ischaemic or haemorrhagic stroke, the theory is compelling: damaged brain cells that are energy-starved might benefit from an additional energy stimulus. The Mechanism: What the Biology Says The cytochrome c oxidase pathway is well-established in photobiology. What is less settled is whether light at therapeutic intensities can penetrate the skull deeply enough to reach relevant brain structures. Skull and scalp tissue absorb and scatter light substantially. Transcranial delivery requires sufficient power density (irradiance) at the source and long enough exposure to accumulate meaningful fluence (energy dose) at depth. Studies using ex vivo human skull specimens suggest that only 1-3% of surface irradiance reaches cortical tissue at clinically relevant depths — and deeper subcortical structures receive even less. This does not make tPBM ineffective — it means dosing is everything. And most consumer devices do not disclose their irradiance or fluence specifications, which makes comparing them to clinical trials nearly impossible. What the Research Shows Animal Studies: Encouraging Signals Several well-designed rodent studies have demonstrated that tPBM applied within hours to days of stroke onset reduces infarct volume, improves functional recovery, and modulates neuroinflammation. A 2019 study by Thunshelle et al. found tPBM reduced lesion size in ischaemic stroke models and improved neurobehavioural scores. Animal models are useful for mechanistic insights. However, rodent skulls are thinner and brain structures are more superficial than in humans — so translational accuracy is limited. Human Clinical Trials: More Complicated The human evidence is where the story becomes nuanced. The NeuroThera Effectiveness and Safety Trial (NEST-1 and NEST-2) were the most prominent early RCTs. NEST-1 (2007) reported positive outcomes for acute ischaemic stroke patients treated within 24 hours. However, NEST-2 (2009), a larger double-blind RCT with 660 patients, failed to replicate those results on its primary outcome measure. NEST-3 was halted early in 2013 after an interim analysis showed it was unlikely to meet its primary endpoint. What went wrong? Researchers identified several issues: heterogeneous stroke populations, inconsistent dosing protocols, and the fundamental challenge of transcranial light delivery in adults with varying skull thickness and tissue composition. More recent work has shifted focus. A 2023 review by Zomorrodi et al. examined pulsed tPBM and found preliminary evidence for cognitive and neurological benefits in traumatic brain injury and neurodegeneration — but noted the absence of large, well-powered RCTs in stroke specifically. The Consumer Device Problem Here is where I have to be direct with anyone considering purchasing a NIR device for home use. Clinical studies use medical-grade devices with precisely calibrated irradiance, typically 10-700 mW/cm2 at the source, with controlled exposure times to achieve specific fluence targets (often 0.9-36 J/cm2). Consumer devices vary enormously — and most do not publish their specifications at all. Buying a NIR cap or helmet marketed for brain wellness is not equivalent to receiving the protocol used in clinical research. This does not mean it is harmful. It means we do not know whether you are getting a therapeutic dose, a sub-therapeutic dose, or anything in between. The Stakes If you are in recovery from a stroke or brain injury and you are exploring every option — which I completely understand — the risk here is not primarily financial. The risk is investing hope, time, and energy into something that may or may not be delivering what clinical trials suggest is therapeutic. The opportunity, on the other hand, is real: the underlying biology is sound, and the research pipeline is active. This is an area worth watching closely. Three Actionable Steps Talk to your neurologist or rehab physician before purchasing any device. Ask specifically whether tPBM has been considered in your care plan and what the current clinical guidance is. If you want to explore the evidence yourself, search PubMed (pubmed.ncbi.nlm.nih.gov) for transcranial photobiomodulation stroke — filter for systematic reviews and RCTs published after 2018 for the most current picture. Check ClinicalTrials.gov (clinicaltrials.gov) for active trials recruiting stroke survivors for tPBM studies. Participation in a trial gives you access to a properly calibrated protocol and contributes to the evidence base. What Recovery Can Look Like When the brain is given the right conditions — adequate sleep, nutrition, rehabilitation, reduced inflammation, and potentially adjunct therapies that the evidence supports — healing happens in ways that can surprise both patients and clinicians. I have spoken with hundreds of stroke survivors on this channel who found approaches that contributed meaningfully to their recovery. Not a single one found a shortcut. But many found tools — used thoughtfully, in partnership with their medical team — that made a genuine difference. That is what this channel is about: doing the work so you can make informed decisions. References Lampl Y et al. Infrared laser therapy for ischemic stroke: a new treatment strategy. Stroke. 2007;38(6):1843-9. PMID: 17463313. pubmed.ncbi.nlm.nih.gov/17463313 Zivin JA et al. Effectiveness and Safety of Transcranial Laser Therapy for Acute Ischemic Stroke (NEST-2). Stroke. 2009;40(4):1359-64. PMID: 19233936. pubmed.ncbi.nlm.nih.gov/19233936 Thunshelle C, Hamblin MR. Transcranial Low-Level Laser (Light) Therapy for Brain Injury. Photomed Laser Surg. 2016;34(12):587-598. PMID: 27854434. pubmed.ncbi.nlm.nih.gov/27854434 Zomorrodi R et al. Pulsed Near Infrared Transcranial and Intranasal Photobiomodulation Significantly Modulates Neural Oscillations. Sci Rep. 2019;9(1):6309. PMID: 31004089. pubmed.ncbi.nlm.nih.gov/31004089 Bill Gasiamis is a stroke survivor and the host of the Recovery After Stroke podcast. He is not a medical professional. Nothing in this post constitutes medical advice. Always consult your treating physician before starting any new therapy. The post Near-Infrared Light Therapy After Stroke: Does the Science Hold Up? appeared first on Recovery After Stroke.

In this episode Dr. Rosy Boa discusses regression in pole dancing—plateaus, losing tricks, and fluctuating capacity—as a normal outcome of changing life circumstances like stress, finances, injury, caregiving, and disability, including impacts from COVID. She argues pole should not be prioritized over basic needs and warns against tying self-worth to specific tricks, which can create shame and identity crises when abilities change. As a coaching approach, she recommends building the skill of “noticing”: tuning into proprioception and interoception, identifying what feels physically pleasurable, and cultivating aesthetic appreciation beyond technical perfection. She suggests practicing by watching peer-level dancers and identifying non-technical qualities (expression, musicality, lines, novelty) to develop a softer lens that can be turned inward, supporting motivation, enjoyment, and longevity in pole.Are you a pole nerd interested in trying out online pole classes with Slink Through Strength? We'd love to have you! Use the code “podcast” for 10% off the Intro Pack and try out all of our unique online pole classes: https://app.acuityscheduling.com/catalog/25a67bd1/?productId=1828315&clearCart=true  Citations: Loureiro F, Ringold SM, Aziz-Zadeh L. Interoception in Autism: A Narrative Review of Behavioral and Neurobiological Data. Psychol Res Behav Manag. 2024 May 3;17:1841-1853. doi: 10.2147/PRBM.S410605. PMID: 38716258; PMCID: PMC11075678. (Movement/exercise is effective in supporting joint health, especially in patients who already have osteoarthritis)  Nayab S, Bilal Elahi M. The Impact of Exercise Interventions on Pain, Function, and Quality of Life in Patients With Osteoarthritis: A Systematic Review and Meta-Analysis. Cureus. 2024 Nov 25;16(11):e74464. doi: 10.7759/cureus.74464. PMID: 39726491; PMCID: PMC11669877. Chapters:00:00 Welcome and Setup00:53 Why We Regress01:29 Life Shifts and Capacity03:30 Losing Tricks Is Normal04:41 Identity Beyond Tricks06:44 Noticing What Feels Good09:14 Intrinsic Motivation in Practice11:39 Appreciating Others Differently13:47 Exercise to Train Your Eye16:55 Beauty in Every Stage20:10 Softness and Self Kindness20:39 Wrap Up and Shout Outs

From Barbara Robertson and Nancy Mohrbacher: Using new research in clinical practice? How do we do this? When is it time to let go of our old ways of doing things and incorporate new information? These are some of the questions Nancy and Barbara discuss in this episode of All Things Breastfeeding. Sometimes, incorporating new research in clinical practice is easy. It can be an “ah-ha” moment. Nancy had this when she learned about Suzanne Colson’s research on releasing babies’ reflexes to stimulate breastfeeding. She knew Suzanne’s description was true and immediately began incorporating Suzanne’s ideas into her practice. Barbara had this type of moment when she read Nancy’s article, “The Magic Number.” On the other hand, we can also suffer from confirmation bias. We may want to believe that we can use human milk for longer than the current recommendations (see article below), so we are happy when a study suggests this might be true. On the other hand, it can take 17 years or longer for research to become clinical practice. When should we wait? When is it time to change? Some clear guidance both Nancy and Barbara use is: “Will it be harmful?” It does not harm anyone to start playing around with latch and positioning, or adding extra milk removals, for someone struggling with milk supply. Take a listen to learn more about Nancy’s and Barbara’s thoughts on this subject. Enjoy! Resources: Colson SD, Meek JH, Hawdon JM. Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Hum Dev. 2008 Jul;84(7):441-9. doi: 10.1016/j.earlhumdev.2007.12.003. Epub 2008 Feb 19. PMID: 18243594.: https://pubmed.ncbi.nlm.nih.gov/18243594/ Anders, L. A., Mesite Frem, J., & McCoy, T. P. (2025). Flange size matters: A comparative pilot study of the Flange FITSTM guide versus traditional sizing methods. Journal of Human Lactation, 41(1), 54-64. https://pubmed.ncbi.nlm.nih.gov/39614713/ Mohrbacher, N. (2011). The Magic Number and Long-Term Milk Production. Clinical Lactation 2(1), 15-18. https://lactalearning.com/wp-content/uploads/2025/07/MohrbacherMagicNumber2011.pdf All Things Breastfeeding Episode 108: Tongue Tie Update: https://lactalearning.com/tongue-tie-update/ Scharff, A. Z., Sedlacek, L., de Oliveira Mekonnen, A., Liolios, I., Ritter, S., Fuchs, F., & Happle, C. (2026). Leftover Infant Milk After Bottle Feeding: Parental Practices and Microbiological Findings. medRxiv, 2026-02. https://www.medrxiv.org/content/10.64898/2026.02.13.26346179v1 The post All Things Breastfeeding Episode 110: Using Research in Clinical Practice appeared first on The Breastfeeding Center of Ann Arbor.

How did Mimi Morgan defy the odds? Once bedridden and facing daunting diagnoses like Parkinson's disease, rheumatoid arthritis, and the effects of a stroke, Mimi's story is one of extraordinary resilience. From relying on multiple medications to now living a vibrant, adventurous life—lifting weights, swimming in icy waters, and thriving as an artist and equestrian—Mimi has become an inspiration to many. In this second interview, we dive deeper into her remarkable transformation and the unconventional path she took to heal herself. Tune in and discover the mystery behind Mimi Morgan's journey to health and vitality—you won't want to miss what's next. X @mimikmorgan https://x.com/mimikmorgan?s=21 IG @mimimorgank https://www.instagram.com/mimikmorgan/ Mimi's Website www.Just10moresteps.com Randomized Controlled Trial Showing significant improvement in Parkinson's disease with ketogenic diets, over a week designed Mediterranean diet: Low-fat versus ketogenic diet in Parkinson's disease: A pilot randomized controlled trial Authors: Phillips MCL, Murtagh DKJ, Gilbertson LJ, Asztely FJS, Lynch CDP Journal: Movement Disorders. 2018 Aug;33(8):1306-1314 DOI: 10.1002/mds.27390 PMID: 30098269 PubMed link: https://pubmed.ncbi.nlm.nih.gov/30098269/ PMC free full text: https://pmc.ncbi.nlm.nih.gov/articles/PMC6175383/ Wiley publisher link: https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mds.27390   Join my NEW 90-day Carnivore Challenge group on Mighty Networks below! https://dr-chaffee-s-90-day-carnivore-challenge.mn.co/landing/ If you liked this and want to learn more go to my new website www.DrAnthonyChaffee.com

In this episode of "PICU Doc on Call," Drs. Monica Gray and Pradip Kamat from Children's Healthcare of Atlanta dive into the use of inhaled anesthetics, especially isoflurane, in the pediatric ICU. We're focusing on those tough cases: refractory status asthmaticus and status epilepticus. We'll chat about why isoflurane is our go-to over other agents like sevoflurane, desflurane, or nitrous oxide, and break down its bronchodilatory and anticonvulsant properties. We'll also touch on important pharmacology concepts, such as MAC and the blood-gas partition coefficient, and discuss how we approach dosing and ventilator management when using isoflurane.Of course, we'll also discuss the potential adverse effects that can come with prolonged use, and why it's important to stop other sedatives and beta-agonists once you start isoflurane. Join us as we walk through the practical aspects and pearls for using inhaled anesthetics in the PICU!Show Highlights:Use of inhaled anesthetics in pediatric intensive care units (PICU)Focus on isoflurane for managing refractory status asthmaticus and status epilepticusComparison of inhaled anesthetic agents: isoflurane, sevoflurane, nitrous oxide, and desfluraneImportance of minimum alveolar concentration (MAC) and blood-gas partition coefficient in anesthetic pharmacodynamicsMechanism of action of isoflurane in airway management and bronchodilationClinical administration techniques for isoflurane in critically ill childrenVentilator management principles for intubated children with status asthmaticusRole of isoflurane in refractory and super-refractory status epilepticusPotential adverse effects and considerations for prolonged isoflurane useSummary of pharmacologic concepts essential for safe isoflurane therapy in pediatric patientsReferences:Rogers Text Book of Pediatric Intensive Care: Chapter 47: Acute Severe Asthma. Stewart C, Brilli RJ. pages 763-775Reference 1: Stetefeld HR, Schaal A, Scheibe F, Nichtweiß J, Lehmann F, Müller M, Gerner ST, Huttner HB, Luger S, Fuhrer H, Bösel J, Schönenberger S, Dimitriadis K, Neumann B, Fuchs K, Fink GR, Malter MP; IGNITE Study Group, with support from the German Neurocritical Care Society (DGNI). Isoflurane in (Super-) Refractory Status Epilepticus: A Multicenter Evaluation. Neurocrit Care. 2021 Dec;35(3):631-639. doi: 10.1007/s12028-021-01250-z. Epub 2021 Jul 20. PMID: 34286464; PMCID: PMC8692280.Reference 2: Zeiler FA, Zeiler KJ, Teitelbaum J, Gillman LM, West M. Modern inhalational anesthetics for refractory status epilepticus. Can J Neurol Sci. 2015 Mar;42(2):106-15. doi: 10.1017/cjn. 2014.121. Epub 2015 Jan 9. PMID: 25572922.Reference 3: Werner HA. Status asthmaticus in children: a review. Chest. 2001 Jun;119(6):1913-29. doi: 10.1378/chest. 119.6.1913. PMID: 11399724.Reference 4: Gill B, Bartock JL, Damuth E, Puri N, Green A. Case report: Isoflurane therapy in a case of status asthmaticus requiring extracorporeal membrane oxygenation. Front Med (Lausanne). 2022 Nov 8;9:1051468. doi: 10.3389fmed. .2022.1051468. PMID: 36425104; PMCID: PMC9679515.

Carbohydrates, caffeine, and water (sometimes with electrolytes): these seem so simple, but they all improve performance when taken before a race. In this episode, we discuss how to structure your pre-race meal before a 5K to marathon, including what to eat, how to time it, and how to avoid GI upset.Thank you to our sponsors:✨Wahoo KICKR RUN: A treadmill that feels like running outdoors. Shop here: http://bit.ly/4nai73H and read the full review: https://runtothefinish.com/wahoo-kickr-run-treadmill/✨Probio: NSF-certified, clinically dosed, all-in-one supplement. Use this link for 40% off your order and an additional 10% and free shipping on a subscription.✨Title Nine: Comfortable sports bras that actually fit, from a women-owned company. Use code RUNTOTHEFINISH for free shipping at https://runtothefinish.com/title-nine/✨Join us on Patreon.com/treadlightlyrunning or subscribe on Apple Podcasts for special subscriber-only content!In this episode, you'll learn:✅ Why pre-race carbohydrates are beneficial at even the harder, shorter distances✅ Why simple carbs are ideal before a race✅ How to prevent GI upset on race day✅ How to time your pre-race meals (including before late-start races)✅ Caffeine timing before a race✅ How to hydrate before a raceReferences

Arianna Trionfo from Nemours joins the show this month to discuss her recent research on early weightbearing after flatfoot reconstruction in CP. The gang also delves into DDH, trauma, congenital scoliosis and more in the lightning round. Your hosts are Carter Clement from Manning Family Children's, Tyler McDonald from University of South Alabama, Steph Logterman from Central Texas Pediatric Orthopedics, and Will Morris from TSRH. Music by A.A. Aalto.   The Effect of Immediate Weight Bearing After Planovalgus Foot Reconstruction in Ambulatory Children With Cerebral Palsy. Church et al. JPO. PMID: 41178517. https://pubmed.ncbi.nlm.nih.gov/41178517/   Screening MRI in Congenital EOS: Is It Safe to Delay Advanced Imaging to Decrease Early Anesthesia? Mostafa et al. JPO. PMID: 41582879. https://pubmed.ncbi.nlm.nih.gov/41582879/   Treatment of Displaced Femoral Neck Fractures in Children: Mid-Term Outcomes and Predictors of Failure. Liu et al. JPO. PMID: 41587289. https://pubmed.ncbi.nlm.nih.gov/41587289/   To Wean or Not to Wean: A Randomized Controlled Trial of Pavlik Harness Weaning in Infantile Developmental Dysplasia of the Hip. Kuka et al. JPO. PMID: 41641599. https://pubmed.ncbi.nlm.nih.gov/41641599/   Is the Hip Located? What is the Value of Advanced Imaging at the Time of Spica Exchange for Infantile Hip Dysplasia? Beck et al. JPO. PMID: 41552950. https://pubmed.ncbi.nlm.nih.gov/41552950/   Revisiting Traditional Risk Factors: Implications for Risk Stratification in Developmental Dysplasia of the Hip. Nielsen et al. JPO. PMID: 41563881. https://pubmed.ncbi.nlm.nih.gov/41563881/   The Effect of Pre-Bending Flexible Nails on Outcomes Following Stabilization of Paediatric Forearm Fractures. Levitt et al. JPO. PMID: 41358790. https://pubmed.ncbi.nlm.nih.gov/41358790/

In response to increasing surgeon burnout, unsustainable clinical demands, and ongoing loss of surgeon autonomy in the setting of employee-based models, the American College of Surgeons is speaking out. In this episode, hosts Dr. Steven Thornton and Dr. Emma Burke sit down with Dr. Douglas Wood, Chair of Surgery at the University of Washington and Dr. Thomas Varghese, Editor-in-Chief of the Journal of the American College of Surgeons, to discuss the new ACS Workplace Standards Framework. The conversation covers how this initiative grew out of discussions around unionization, what domains the framework addresses — from call intensity and OR block access to administrative burden and inpatient census limits — and how specialty-specific guidelines can be developed and implemented at the local level. Dr. Wood and Dr. Varghese also reflect on the culture of "unlimited endurance" that has long defined surgery, why meaningful systems-level change is both necessary and achievable, and how improving workplace sustainability could transform the pipeline of future surgeons for generations to come.Hosts: Emma Burke and Steven ThorntonGuests: Dr. Douglas Wood & Dr. Thomas Varghese Jr.Papers Discussed:1. Wood DE, Wolinsky PR, Dodgion CM, et al. Developing Specialty-Specific Workplace Standards for Surgeons: A Framework to Support Sustainable Surgical Careers. Journal of the American College of Surgeons, 2026. DOI: 10.1097/XCS.0000000000001880 https://pubmed.ncbi.nlm.nih.gov/41773743/2. Varghese TK Jr. Toward Sustainable Surgical Practice: Defining Workplace Standards for the Modern Era. J Am Coll Surg. 2026 Mar 3. doi: 10.1097/XCS.0000000000001888. Epub ahead of print. PMID: 41773737. https://pubmed.ncbi.nlm.nih.gov/41773737/***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please 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://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

“GOOD VIBRATIONS”: Its not just a Marky Mark song, but it is also part of GYNECOLOGIC SEXUAL HEALTH! In this episode, we will highlight an April 2026 new qualitative study on women's vibrator use, as well as a separate publication (on a similar topic) also released in April 2026 in the journal Menopause.1. Leong KA, Carlton CE, Deverdis EC, Grimes CL, Jacobs BE, Rogers RG, Roberts BL. Intimacy and empowerment in urogynecology: a qualitative exploration of vibrator use. Am J Obstet Gynecol. 2026 Apr;234(4):1103-1111. doi: 10.1016/j.ajog.2025.11.037. Epub 2025 Dec 2. PMID: 41344528.2. Lehmiller JJ, Graham CA, Ferrall L, Mendelson EA, Prine MS. The role of masturbation in relieving symptoms associated with menopause. Menopause. 2026 Apr 1;33(4):384-394. doi: 10.1097/GME.0000000000002675. PMID: 41217890; PMCID: PMC13011940.

Contributor: Aaron Lessen, MD Educational Pearls: What are the common causes of agitation in the elderly? Baseline dementia causing a behavioral disturbance Delirium precipitated by an acute medical problem such as a UTI, pneumonia, overdose/side effect of home medications, urinary retention, constipation, pain, hypoxia, electrolyte abnormality, etc. Exacerbation of a primary psychotic condition such as schizophrenia or bipolar disorder. What environmental changes can help reduce agitation? Maintain a quiet, calm, uncluttered environment Dim the lights Ensure the patient has their glasses, hearing aids, and dentures Avoid excessive lines such as foleys Minimize restraints and other forms of immobilization Reassure the patient frequently and have the family check in with the patient What are the best options if medications are required? If the patient is unsafe or non-pharmacologic measures fail, consider a second-generation ("atypical") antipsychotic using the lowest effective dose: Olanzapine Risperidone Quetiapine One special consideration is Dementia with Lewy Bodies, which can be very sensitive to antipsychotics. In this case, Quetiapine is the preferred agent. Avoid when possible: Diphenhydramine and other anticholinergics, which can worsen delirium (including urinary retention and sedation) Benzodiazepines, which may worsen confusion, falls, and respiratory depression Haloperidol, which has a higher risk of extrapyramidal symptoms and QT prolongation than many atypicals References Badwal K, Kiliaki SA, Dugani SB, Pagali SR. Psychosis Management in Lewy Body Dementia: A Comprehensive Clinical Approach. J Geriatr Psychiatry Neurol. 2022 May;35(3):255-261. doi: 10.1177/0891988720988916. Epub 2021 Jan 19. PMID: 33461372. Kurlan R, Cummings J, Raman R, Thal L; Alzheimer's Disease Cooperative Study Group. Quetiapine for agitation or psychosis in patients with dementia and parkinsonism. Neurology. 2007 Apr 24;68(17):1356-63. doi: 10.1212/01.wnl.0000260060.60870.89. PMID: 17452579. Shenvi C, Kennedy M, Austin CA, Wilson MP, Gerardi M, Schneider S. Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool. Ann Emerg Med. 2020 Feb;75(2):136-145. doi: 10.1016/j.annemergmed.2019.07.023. Epub 2019 Sep 26. PMID: 31563402; PMCID: PMC7945005. Summarized and edited by Jeffrey Olson, MS4 Donate: https://emergencymedicalminute.org/donate/ Join our mailing list: http://eepurl.com/c9ouHf

Climate change in the context of healthcare can feel overwhelming but it doesn't have to be paralyzing. We're diving into the intersection of climate change and antimicrobial resistance with a focus on practical, actionable steps healthcare organizations can take.   Drs. Shreya Doshi, Andrea Pallotta and Preeti Jaggi join Dr. Whitney Buckel to talk about what's real, what matters for healthcare, and where stewardship teams can make a meaningful impact. References: 1.       Sustainabil‑ID. https://sustainabil-id.com/ 2.       National Academy of Medicine. Climate Collaborative.https://nam.edu/our-work/programs/climate-and-health/climate-collaborative/ 3.       Medicine for a Changing Planet. https://www.medicineforachangingplanet.org 4.       Cascades Canada. https://cascadescanada.ca/ 5.       EcoRxChoice. https://ecorxchoice.com 6.       Rx for Climate. https://www.rxforclimate.org/ 7.       Practice Greenhealth. https://practicegreenhealth.org 8.       Healthcare Without Harm. https://healthcarewithoutharm.org 9.       Healthcare Sustainability and Infectious Diseases. _J Pediatric Infect Dis Soc._https://academic.oup.com/jpids/pages/healthcare-sustainability-and-infectious-diseases 10.    PubMed. PMID: 40434281. https://pubmed.ncbi.nlm.nih.gov/40434281/ 11.    PubMed Central. PMC12616928. https://pmc.ncbi.nlm.nih.gov/articles/PMC12616928/ 12.    Sustainable Healthcare Networks. Scale and spread quality improvement initiative promoting metronidazole IV‑to‑oral switch.https://networks.sustainablehealthcare.org.uk/resources/scale-and-spread-quality-improvement-initiative-promoting-metronidazole-iv-oral-switch- Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) or @breakpointspodcast_sidp (https://www.instagram.com/breakpointspodcast_sidp/)https://www.instagram.com/breakpointspodcast_sidp/?hl=en Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/ SIDP welcomes pharmacists and non-pharmacist members with an interest in infectious diseases, learn how to join here: https://sidp.org/Become-a-Member Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, Stitcher, Google Play, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/

Yes we have covered antenatal corticosteroids in the late preterm interval on several episodes in the past- it's DEJA VU! However, there is new data in the American Journal of Perinatology (April 2026 ) that is helpful for us as clinicians as we do “shared decision making” with patients in offering betamethasone in the late preterm interval. Listen in for details.1. Zigron R, Rotem R, Erlichman I, Rottenstreich M, Rosenbloom JI, Porat S, Rottenstreich A. Factors associated with the development of neonatal hypoglycemia after antenatal corticosteroid administration: It's all about timing. Int J Gynaecol Obstet. 2022 Aug;158(2):385-389. doi: 10.1002/ijgo.13975. Epub 2021 Oct 30. PMID: 34625970.2. Asirwatham A, Loke R, Rose S, Ho J, Leung K, Leftwich HK. Neonatal Hypoglycemia after Antenatal Late Preterm Steroids. Am J Perinatol. 2026 Apr;43(5):616-620. doi: 10.1055/a-2663-5798. Epub 2025 Aug 4. PMID: 40759170.3. ALPS Trial. NEJM. Published April 7, 2016;374:1311-1320

Send me a derm question or story!In this week's episode, we explore an interesting feline case that illustrates why no detail should ever be overlooked. When a "perky nose" complaint actually becomes plasma cell pododermatitis.Using this case as a guide, we highlight how critical it is to go beyond the presenting complaint. A thorough dermatologic exam, combined with a detailed history, can uncover subtle abnormalities that completely change your diagnostic path, treatment plan, and ultimately, patient outcome. It's a good reminder that even when a diagnosis seems obvious, there could be clinical clues that point you a different direction.We discuss how this case unfolded, what could have been missed with a more limited approach, and practical strategies to ensure you're consistently gathering complete information in every appointment.References:Declercq J, DeBosschere H. Nasal swelling due to plasma cell infiltrate in a cat without plasma cell pododermatitis. Vet Dermatol. 2010;21:412–414. doi: 10.1111/j.1365-3164.2010.00869.x.Brosseau G. Feline plasma cell pododermatitis. Can Vet J. 2022 May;63(5):545-548. PMID: 35502252; PMCID: PMC9009751.Timestamps00:00 Intro03:50 The Swollen Nose07:02 Deflated Paws09:12 Biopsy and Diagnosis Confirmation12:09 Importance of Looking at the Complete History16:53 Outro

A career in surgery has a profound impact on those who practice the craft. High rates of poor mental health are well described but incompletely understood. One potential mechanism for advancing our understanding of surgeon well-being is studying surgeons' emotional experiences. Shame, a self-conscious emotion reflecting how an individual feels about themselves, could be a particularly powerful lens. In this series on shame in surgery, we explore what we know about shame in surgery and what shame can tell us about learning and working as surgeons.In this third episode, we talk with Drs. Sheina Theodore and Tejal Brahmbhatt about their study examining the relationship between internalized shame states and burnout among surgery residents. They make a compelling case that addressing the well-being crisis in surgery requires looking beyond external stressors to the internal experience of shame: the quiet, invisible voice that tells residents they aren't good enough, and ask what role the culture of surgery plays in that internal monologue. Host: Steven ThorntonGuests:1.    Sheina Theodore (Assistant Professor of Surgery, Boston University)2.    Tejal Brahmbhatt (Associate Professor of Surgery, Cedars Sinai Medical Center) Publications Discussed:1.    Smith SM, Kobzeva-Herzog A, McGillen P, Castagne-Charlotin M, Davies J, Sanchez SE, Dechert T, Brahmbhatt TS, Theodore S. Internalized Shame Experiences and Burnout in General Surgery Residents. J Surg Educ. 2025 Apr;82(4):103447. doi: 10.1016/j.jsurg.2025.103447. Epub 2025 Feb 6. PMID: 39919584. https://pubmed.ncbi.nlm.nih.gov/39919584/***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please 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://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

A career in surgery has a profound impact on those who practice the craft. High rates of poor mental health are well described but incompletely understood. One potential mechanism for advancing our understanding of surgeon well-being is studying surgeons' emotional experiences. Shame, a self-conscious emotion reflecting how an individual feels about themselves, could be a particularly powerful lens. In this series on shame in surgery, we explore what we know about shame in surgery and what shame can tell us about learning and working as surgeons. In this second episode, we talk with Dr. ElAbd and Dr. Zammit about their study examining the relationship between shame-based learning, grit, and burnout across surgical specialties. Their findings highlight how grit may both protect against burnout and mediate whether residents go on to shame others. Host: Steven ThorntonGuests:1.    Rawan ElAbd (Plastic Surgery Resident, McGill University)2.    Dino Zammit (Assistant Professor of Plastic Surgery, McGill University)Publications Discussed:1.    ElAbd R, Pu L, Esmonde-White C, ElHawary H, Vorstenbosch J, Zammit D. Association of Grit and Shame Based Learning on Burnout in Surgical Training: A Single Institution Analysis. J Surg Educ. 2025 Sep;82(9):103583. doi: 10.1016/j.jsurg.2025.103583. Epub 2025 Jun 27. PMID: 40580606.https://pubmed.ncbi.nlm.nih.gov/40580606/***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please 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://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

A career in surgery has a profound impact on those who practice the craft. High rates of poor mental health are well described but incompletely understood. One potential mechanism for advancing our understanding of surgeon well-being is studying surgeons' emotional experiences. Shame, a self-conscious emotion reflecting how an individual feels about themselves, could be a particularly powerful lens. In this series on shame in surgery, we explore what we know about shame in surgery and what shame can tell us about learning and working as surgeons.In this first episode, we talk with Dr. Will Bynum and Professor Luna Dolezal about how they understand shame in medicine, why it's so hard to see even when it's everywhere, and how developing what they call "shame competence" might be one of the most important steps we can take toward humanizing surgical training.Host: Steven ThorntonGuests: Will Bynum (Associate Professor of Family Medicine, Duke University) Luna Dolezal (Professor of Philosphy and Medical Humanities, Exeter University) Publications Discussed: Dolezal L, Bynum W. Shame competence: addressing the effects of shame in health care. Lancet. 2024 Oct 19;404(10462):1514-1515. doi: 10.1016/S0140-6736(24)02269-4. PMID: 39426826. https://pubmed.ncbi.nlm.nih.gov/39426826/ The Nocturnists. Shame in Medicine: The Lost Forest [podcast series]. The Nocturnists; 2022. https://thenocturnists.org/shameinmedicine Nguyen LN, Bynum WE 4th. When I Say…self-conscious emotions. Med Educ. 2021 Mar;55(3):291-292. doi: 10.1111/medu.14425. Epub 2020 Dec 23. PMID: 33289140. https://pubmed.ncbi.nlm.nih.gov/33289140/ Tracy, J. L., Robins, R. W., & Tangney, J. P. (Eds.). (2007). The self-conscious emotions: Theory and research. The Guilford Press. ***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please 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://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Iron-deficiency anemia during pregnancy is associated withseveral adverse pregnancy outcomes, including severe maternal morbidity, preeclampsia, placenta previa, and placental abruption. It makes sense that diagnosing and treating anemia and its underlying causes in earlypregnancy may reduce the risk of adverse outcomes, but evidence has been scarce…until now. In this episode, we will review a new retrospective study based on nationwide data that examines this very issue (Green journal, April 2026).Listen for details. 1.  Booman A, Bateman BT, Siadat S, Berube C, Igbinosa I, Leggett C, Lyell DJ, Main EK, Leonard SA. Pregnancy Outcomes Associated With Anemia in the First Trimesterand Anemia Resolution by Late Pregnancy. Obstet Gynecol. 2026 Apr 1;147(4):518-527. doi: 10.1097/AOG.0000000000006183. Epub 2026 Feb 6. PMID:41643193; PMCID: PMC12880618.2.  ACOG OCC 5: Severe Maternal Morbidity: Screening and Review; 2016 and reaffirmed 20253.  ACOG PB 233

Contributor: Aaron Lessen, MD Educational Pearls: Patients with pulmonary embolism (PE) are divided into three risk categories Low risk (non-massive PE): patients are stable Treatment: prescribe anticoagulants and discharge home Intermediate risk (submassive PE): patients are stable but display evidence of clot burden such as elevated troponin, elevated BNP, and/or right heart strain Treatment is controversial High risk (massive PE): patients are unstable with hypotension, hypoxia, and/or respiratory distress Treatment: IV thrombolysis to prevent decompensation A recent randomized controlled trial evaluated treatment of intermediate risk PE patients Patients were randomized to receive either thrombectomy with anticoagulation or anticoagulation alone The primary outcome evaluated changes in right ventricular enlargement at 48 hours A controversial primary outcome because it does not speak to mortality or incidence of other necessary aggressive interventions Low clinical significance The study found that thrombectomy significantly reduced right ventricular enlargement faster than anticoagulation alone. However, there was no statistical difference in mortality or need for other treatments Treatment for intermediate risk PE patient remains controversial The same study will have second follow-up at 90 days to see if there are other benefits References Lookstein RA, Konstantinides SV, Weinberg I, Dohad SY, Rosol Z, Kopeć G, Moriarty JM, Parikh SA, Holden A, Channick RN, McDonald B, Nagarsheth KH, Yamada K, Rosovsky RP; STORM-PE Trial Investigators. Randomized Controlled Trial of Mechanical Thrombectomy With Anticoagulation Versus Anticoagulation Alone for Acute Intermediate-High Risk Pulmonary Embolism: Primary Outcomes From the STORM-PE Trial. Circulation. 2026 Jan 6;153(1):21-34. doi: 10.1161/CIRCULATIONAHA.125.077232. Epub 2025 Nov 3. PMID: 41183181. Summarized by Meg Joyce, MS2 | Edited by Meg Joyce & Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/

Send us Fan MailIn this Journal Club episode, Ben and Daphna dive into the American Academy of Pediatrics' February Clinical Report on Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy. Daphna, who presented this paper at the Florida Neonatal Neurologic Network, walks us through the key action statements — from the established 33.5°C target temperature to the more nuanced discussions around late cooling (6–24 hours), gestational age eligibility at 35 weeks, and the controversial question of cooling mild HIE. They also cover optimal MRI timing post-rewarming, continuous EEG monitoring, early enteral feeds during cooling, and the growing evidence supporting the "cool cuddle." A must-listen for anyone navigating the evolving landscape of HIE management!----Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy: Clinical Report. Zanelli SA, Wusthoff CJ, Lucke AM, Kaufman DA; Committee on Fetus and Newborn; Section on Neurology.Pediatrics. 2026 Feb 1;157(2):e2025073627. doi: 10.1542/peds.2025-073627.PMID: 41581784 Review.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!

Join Dr. Jeff Jarvis as he interviews podcase friend and frequent contributor, now-Dr Tanner Smida for the first of a two-part interview where we discuss his defense of his PhD. Dr Smida discusses four papers that inform cardiac arrest resuscitation, as well as lessons he learned about conducting well-designed observational studies. Although his dissertation was built around only 4 papers, here is Dr Smida's entire bibliography:1.        Smida T, Willson C, Salerno J, Weiss L, Salcido DD. Can you get there from here? An analysis of walkability among PulsePoint CPR alert dispatches. Resuscitation. 2020 Mar 1;148:135-139. doi: 10.1016/j.resuscitation.2019.12.038. Epub 2020 Jan 18. PMID: 31962177.2.        Patterson PD, Weiss LS, Weaver MD, Salcido DD, Opitz SE, Okerman TS, Smida TT, Martin SE, Guyette FX, Martin-Gill C, Callaway CW. Napping on the night shift and its impact on blood pressure and heart rate variability among emergency medical services workers: study protocol for a randomized crossover trial. Trials. 2021 Mar 16;22(1):212. doi: 10.1186/s13063-021-05161-4. PMID: 33726840; PMCID: PMC7962082.3.        Smida T, Koller AC, Menegazzi JJ, Salcido DD. Early cytotoxic lymphocyte localization to the brain following resuscitation in a porcine model of asphyxial cardiac arrest: A pilot study. Resusc Plus. 2021 Apr 28;6:100125. doi: 10.1016/j.resplu.2021.100125. PMID: 34223383; PMCID: PMC8244478.4.        Smida T, Salerno J, Weiss L, Martin-Gill C, Salcido DD. PulsePoint dispatch associated patient characteristics and prehospital outcomes in a mid-sized metropolitan area. Resuscitation. 2022 Jan;170:36-43. doi: 10.1016/j.resuscitation.2021.11.007. Epub 2021 Nov 11. PMID: 34774964.5.        Smida T, Menegazzi JJ, Crowe RP, Weiss LS, Salcido DD. Association of prehospital hypotension depth and dose with survival following out-of-hospital cardiac arrest. Resuscitation. 2022 Sep 30;180:99-107. doi: 10.1016/j.resuscitation.2022.09.018. Epub ahead of print. PMID: 36191809.6.        Smida T, Menegazzi JJ, Crowe RP, Bardes J, Scheidler JF, Salcido DD. Association of prehospital post-resuscitation peripheral oxygen saturation with survival following out-of-hospital cardiac arrest. Resuscitation. 2022 Dec;181:28-36. doi: 10.1016/j.resuscitation.2022.10.011. Epub 2022 Oct 19. PMID: 36272616.7.        Smida T, Menegazzi J, Crowe R, Scheidler J, Salcido D, Bardes J. A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation. Prehosp Emerg Care. 2023 Feb 13:1-7. doi: 10.1080/10903127.2023.2169422. Epub ahead of print. PMID: 36652451.8.        Smida T, Menegazzi J, Scheidler J, Martin PS, Salcido D, Bardes J; CARES Surveillance Group. A retrospective comparison of the King Laryngeal Tube and iGel supraglottic airway devices: A study for the CARES surveillance group. Resuscitation. 2023 Apr 28:109812. doi: 10.1016/j.resuscitation.2023.109812. Epub ahead of print. PMID: 37120129.9.        Smida T, Price BS, Scheidler J, Crowe R, Wilson A, Bardes J. Stay and play or load and go? The association of on-scene advanced life support interventions with return of spontaneous circulation following traumatic cardiac arrest. Eur J Trauma Emerg Surg. 2023 May 10. doi: 10.1007/s00068-023-02279-9. Epub ahead of print. PMID: 37162554.10.  Smida T, Menegazzi JJ, Crowe RP, Salcido D, Martin PS, Scheidler J, James Bardes. The Association of Combined Prehospital Hypotension and Hypoxia With Outcomes Following Out-of-Hospital Cardiac Arrest Resuscitation. Prehosp Emerg Care. 2023 Jul 26:1-9. doi: 10.1080/10903127.2023.2238820. Epub ahead of print. PMID: 37494278.11.  Smida T, Menegazzi JJ, Crowe RP, Salcido DD, Bardes J, Myers B. The Association of Prehospital End-Tidal Carbon Dioxide with Survival Following Out-of-Hospital Cardiac Arrest. Prehosp Emerg Care. 2023 Sep 26:1-7. doi: 10.1080/10903127.2023.2262566. Epub ahead of print. PMID: 37751228.12.  Smida T, Bonasso P, Bardes J, Price BS, Seifarth F, Gurien L, Maxson R, Letton R. Reverse shock index multiplied by the motor component of the Glasgow Coma Scale predicts mortality and need for intervention in pediatric trauma patients. J Trauma Acute Care Surg. 2024 Jan 26. doi: 10.1097/TA.0000000000004258. Epub ahead of print. PMID: 38273438.13.  Suchko S, Smida T, Crowe RP, Menegazzi JJ, Scheidler JF, Shukis M, Martin PS, Bardes JM, Salcido DD. The association of clinical, treatment, and demographic characteristics with rearrest in a national dataset. Resuscitation. 2024 Mar;196:110135. doi: 10.1016/j.resuscitation.2024.110135. Epub 2024 Feb 7. PMID: 38331343.14.  Smida T, Crowe R, Jarvis J, Ratcliff T, Goebel M. A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Prehosp Emerg Care. 2024 Feb 28:1-23. doi: 10.1080/10903127.2024.2321285. Epub ahead of print. PMID: 38416867.15.  Smida T, Crowe RP, Martin PS, Scheidler JF, Shukis M, Price BS, Bardes JM. A retrospective, multi-agency ‘target trial emulation' for the comparison of post-resuscitation epinephrine to norepinephrine.  Resuscitation.  2024 April; doi: 10.1016/j.resuscitation.2024.110201. Epub ahead of print.16.  Smida T, Crowe RP, Merrill PW, Scheidler JF. A Simpler Method for Choosing Adult i-gel Size: An Evaluation of Real-World Prehospital Data. Air Med J. 2024 May-Jun;43(3):259-261. doi: 10.1016/j.amj.2024.03.011. Epub 2024 Apr 5. PMID: 38821710.17.  Niemann B, Zarfoss E, Victory J, Smida T, Petros K, Sestito M, Bardes J. Evaluation of Oral Vasoactive Medications to Maintain Mean Arterial Pressure in Spinal Cord Injury. J Surg Res. 2024 Aug 12;302:339-346. doi: 10.1016/j.jss.2024.07.059. Epub ahead of print. PMID: 39137515.18.  Smida T, Price BS, Mizener A, Crowe RP, Bardes JM. Prehospital Post-Resuscitation Vital Sign Phenotypes are Associated with Outcomes Following Out-of-Hospital Cardiac Arrest. Prehosp Emerg Care. 2024 Aug 15:1-8. doi: 10.1080/10903127.2024.2386445. Epub ahead of print. PMID: 39088816.19.  Smida T, Voges L, Crowe R, Scheidler J, Bardes J. Prehospital Transcutaneous Cardiac Pacing in the United States: Treatment Epidemiology, Predictors of Treatment Failure, and Associated Outcomes. Prehosp Emerg Care. 2024 Sep 4:1-8. doi: 10.1080/10903127.2024.2393768. Epub ahead of print. PMID: 39150824.20.  Smida T, Dayal S, Bardes J, Scheidler J. Association of Prehospital Rearrest With Outcome Following Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis of Observational Studies. Prehosp Emerg Care. 2024 Oct 18:1-9. doi: 10.1080/10903127.2024.2408628. Epub ahead of print. PMID: 39321386.21.  Smida T, Cheskes S, Crowe R, Price BS, Scheidler J, Shukis M, Martin PS, Bardes J. The association between initial defibrillation dose and outcomes following adult out-of-hospital cardiac arrest resuscitation: A retrospective, multi-agency study. Resuscitation. 2025 Jan 23:110507. doi: 10.1016/j.resuscitation.2025.110507. Epub ahead of print. PMID: 39855423.22.  Smida T, Crowe R, Price BS, Scheidler J, Martin PS, Shukis M, Bardes J. A retrospective 'target trial emulation' comparing amiodarone and lidocaine for adult out-of-hospital cardiac arrest resuscitation. Resuscitation. 2025 Jan 23:110515. doi: 10.1016/j.resuscitation.2025.110515. Epub ahead of print. PMID: 39863130.23.  Nordstrom NK, Smida T, Bardes JM, Brown C, Wilson A. A contemporary analysis of pr...

Listener discretion is advised. References: Cook CE, Thigpen CA. Five good reasons to be disappointed with randomized trials. J Man Manip Ther. 2019 May;27(2):63-65. doi: 10.1080/10669817.2019.1589697. Epub 2019 Mar 14. PMID: 30935322 Fernainy P, Cohen AA, Murray E, Losina E, Lamontagne F, Sourial N. Rethinking the pros and cons of randomized controlled trials and observational studies in the era of big data and advanced methods: a panel discussion. BMC Proc. 2024 Jan 18;18(Suppl 2):1. doi: 10.1186/s12919-023-00285-8. Erratum in: BMC Proc. 2024 Aug 16;18(1):16. doi: 10.1186/s12919-024-00299-w. PMID: 38233894 Ramchurn TP, Nundy S. Randomised clinical trials in surgery: are we at a crossroads? Ann Med Surg (Lond). 2023 Nov 7;86(1):3-6. doi: 10.1097/MS9.0000000000001457. PMID: 38222736

Join the Johns Hopkins Thoracic Surgery Subspecialty team on this rapid research review revealing how investigative efforts have changed the way we view and use Veno-venous (VV) ECMO therapy in the pre-lung transplant patient population working to avoid ventilator dependence and the associated morbidity while facilitating continued ambulation and preoperative optimization. Hosts:- Dr. Alfred J. Casillan, MD, PhDAttending Thoracic Surgeon Johns Hopkins Hospital - Kyla Rakoczy, MD Johns Hopkins General Surgery ResidentReferences:Awake ECMO as Bridge to Lung Transplantation Fuehner T, Kuehn C, Hadem J, Wiesner O, Gottlieb J, Tudorache I, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. American Journal of Respiratory and Critical Care Medicine. 2012;185(7):763–768. PMID: 22268135 Link: https://pubmed.ncbi.nlm.nih.gov/22268135/Predictors of Successful ECMO Bridging Tipograf Y, Salna M, Minko E, Grogan EL, Sonett JR, Bacchetta MD. Outcomes of extracorporeal membrane oxygenation as a bridge to lung transplantation. Annals of Thoracic Surgery. 2019;107(5):1456–1463. PMID: 30790550 Link: https://pubmed.ncbi.nlm.nih.gov/30790550/Intubation Status and ECMO Bridging Outcomes Zhou AL, Jennings MR, Akbar AF, et al. Utilization and outcomes of nonintubated extracorporeal membrane oxygenation as a bridge to lung transplant. Journal of Heart and Lung Transplantation. 2025;44(4):661–669. PMID: 39486773 Link: https://pubmed.ncbi.nlm.nih.gov/39486773/ECMO Duration and Waitlist Mortality Shou BL, Kalra A, Zhou AL, et al. Impact of extracorporeal membrane oxygenation bridging duration on lung transplant outcomes. Annals of Thoracic Surgery. 2024;118(2):496–503. PMID: 38740080 Link: https://pubmed.ncbi.nlm.nih.gov/38740080/Mechanical Ventilation as a Risk Marker Mason DP, Thuita L, Alster JM, Murthy SC, Budev MM, Mehta AC, et al. Lung transplantation in recipients requiring mechanical ventilation: outcomes and risk factors. Journal of Thoracic and Cardiovascular Surgery. 2010;139(1):114–119. PMID: 19931096 Link: https://pubmed.ncbi.nlm.nih.gov/19931096/***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please 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://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Modern medicine has come a long way in its fight against diabetes. We now have continuous glucose monitors (CGM) and automated insulin delivery (AIDs) systems. These have revolutionized patient care. The FDA has approved devices for use in pregnancy as “nonadjunctive use” (meaning they may be used alone), although capillary finger stick assessments are currently still considered the Gold Standard. While the most robust data in support of CGMs is for preexisting Type 1 DM (Class B or beyond) and Type 2, there is recent growing support for CGM use in GDM patients, although some limitations still apply. Listen in for details.1. Feig DS, et al; CONCEPTT Collaborative Group. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet. 2017 Nov 25;390(10110):2347-2359. doi: 10.1016/S0140-6736(17)32400-5. Epub 2017 Sep 15. Erratum in: Lancet. 2017 Nov 25;390(10110):2346. 2. Benhalima K, Durnwald C, Sweeting A et al.Application of continuous glucose monitoring and automated insulin delivery technologies for pregnant women with type 1, type 2, or gestational diabetes: an international consensus statementThe Lancet Diabetes & Endocrinology, 2025; 14, 157-1773. Salmen BM, Reurean-Pintilei D, Salmen T, Bohîlțea RE. Exploring Continuous Glucose Monitoring in Gestational Diabetes: A Systematic Review. Life (Basel). 2025 Aug 28;15(9):1369. doi: 10.3390/life15091369. PMID: 41010309; PMCID: PMC12470761.4. Wyckoff JA, Lapolla A, Asias-Dinh BD, et al.Preexisting Diabetes and Pregnancy: An Endocrine Society and European Society of Endocrinology Joint Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism. 20255. American Diabetes Association Professional Practice Committee for Diabetes*; 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2026. Diabetes Care 1 January 2026; 49 (Supplement_1): S321–S338. https://doi.org/10.2337/dc26-S0156. Burk J, Ross GP, Hernandez TL, Colagiuri S, Sweeting A. Evidence for improved glucose metrics and perinatal outcomes with continuous glucose monitoring compared to self-monitoring in diabetes during pregnancy. Am J Obstet Gynecol. 2025 Sep;233(3):162-175. doi: 10.1016/j.ajog.2025.04.010. Epub 2025 Apr 10. PMID: 40216177.7. Linder T, et al; GRACE study collaborative group. Glycaemic control and pregnancy outcomes with real-time continuous glucose monitoring in gestational diabetes (GRACE): an open-label, multicentre, multinational, randomised controlled trial. Lancet Diabetes Endocrinol. 2026 Jan;14(1):50-61. doi: 10.1016/S2213-8587(25)00288-8. Epub 2025 Nov 24. PMID: 41308662.8. Valent AM, et al. Real-Time Continuous Glucose Monitoring in Pregnancies With Gestational Diabetes Mellitus: A Randomized Controlled Trial. Diabetes Care. 2025 Sep 1;48(9):1581-1588. doi: 10.2337/dc25-0115. PMID: 40730104; PMCID: PMC12368369.9. Kusinski LC, et al. Continuous Glucose Monitoring Metrics and Pregnancy Outcomes in Women With Gestational Diabetes Mellitus: A Secondary Analysis of the DiGest Trial. Diabetes Care. 2025 Aug 19:dc250452. doi: 10.2337/dc25-0452. Epub ahead of print. PMID: 40828742; PMCID: PMC7618813.10. García-Moreno RM, et al. Efficacy of continuous glucose monitoring on maternal and neonatal outcomes in gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials. Diabet Med. 2022 Jan;39(1):e14703. doi: 10.1111/dme.14703. Epub 2021 Oct 13. PMID: 34564868.11. Amylidi-Mohr Set,.et al (DipGluMo): an open-label, single-centre, randomised, controlled trial. Lancet Diabetes Endocrinol. 2025 Jul;13(7):591-599. doi: 10.1016/S2213-8587(25)00063-4. Epub 2025 May 26. Erratum in: Lancet Diabetes Endocrinol. 2026 Mar;14(3):e6. doi: 10.1016/S2213-8587(25)00403-6. PMID: 40441173.

IUDs are under the umbrella of long-acting, reversible contraceptives, and they’re the oldest one of these in use today. Research: Baldauf, P et al. “A Report on the Hysteroscopic Removal of a Gräfenberg Ring After Almost Fifty Years in Utero.” Geburtshilfe und Frauenheilkunde vol. 74,11 (2014): 1023-1025. doi:10.1055/s-0034-1383130. https://pmc.ncbi.nlm.nih.gov/articles/PMC4245252/ Case Western Reserve University. “Intrauterine device (IUD).” https://artsci.case.edu/dittrick/online-exhibits/history-of-birth-control/contraception-in-america-1950-present-day/intrauterine-device-iud/ Cooper, James Fryer. “Technique of contraception: the principles and practice of anti-conceptional methods.” Day-Nichols Inc., Publishers. 1928, 1930. https://archive.org/details/techniqueofcontr0000jame/ Corbett, Megan and Brandy Bautista. “A History: The IUD.” Reproductive Health Access Project. 3/20/2024. https://www.reproductiveaccess.org/2024/03/a-history-the-iud/ Curtis, Kathryn M. et al. “U.S. Selected Practice Recommendations for Contraceptive Use, 2024.” Centers for Disease Control. 8/8/2024. https://www.cdc.gov/mmwr/volumes/73/rr/rr7303a1.htm Dickinson, Robert L. et al. “Contraception: A Medical Review of the Situation.” American Journal of Obstetrics and Gynecology 1924-11: Vol 8 Iss 5. https://archive.org/details/in.ernet.dli.2015.50850/page/n585/ Edwards, Baylee A., "Ernst Gräfenberg (1881–1957)". Embryo Project Encyclopedia ( 2022-11-17 ). ISSN: 1940-5030 https://hdl.handle.net/10776/13358 Fallas, Rebecca and Helen King. “IUD or not IUD? Did the Hippocratics invent the first intrauterine device?. Mistaking Histories. 7/18/2017. https://mistakinghistories.uk/2017/07/18/iud-or-not-iud-did-the-hippocratics-invent-the-first-intrauterine-device/ Fotinos, Diane J. “Gold Stemmed Pessaries: A Shadow of the Past.” UT Health. 9/11/2019. https://library.uthscsa.edu/2017/09/gold-stemmed-pessaries-a-shadow-of-the-past/ Goldstuck, Norman D. “Reducing Barriers to the use of the Intrauterine Contraceptive Device as a Long Acting Reversible Contraceptive.” African Journal of Reproductive Health / La Revue Africaine de la Santé Reproductive, December 2014, Vol. 18, No. 4 (December 2014). Via JSTOR. https://www.jstor.org/stable/24362040 Goodhue PA. The Dalkon Shield debate. Conn Med. 1983 Mar;47(3):138-41. PMID: 6851548. Haubacher, David. “The Checkered Past and Bright Future of Intrauterine Contraception in the United States.” Perspectives on Sexual and Reproductive Health , Mar. - Apr., 2002. Via JSTOR. https://www.jstor.org/stable/3030213 Homei, Aya. “Why did the Japanese Government take so long to approve the intrauterine contraceptive device?.” Reproductive biomedicine & society online vol. 6 45-54. 16 Oct. 2018, doi:10.1016/j.rbms.2018.09.002 Hubacher, David. “The Checkered History and Bright Future of Intrauterine Contraception In the United States.” Perspectives on Sexual and Reproductive Health. Vol. 34, Issue 2. https://www.guttmacher.org/journals/psrh/2002/03/checkered-history-and-bright-future-intrauterine-contraception-united-states Hutchings, Jane E. et al. “The IUD After 20 Years: A Review of Worldwide Experience.” International Family Planning Perspectives, Vol. 11, No. 3 (Sep., 1985). https://www.jstor.org/stable/2947998 Jones, R. W., et al. “Clinical Experience With The Dalkon Shield Intrauterine Device.” The British Medical Journal, vol. 3, no. 5872, 1973, pp. 143–45. JSTOR, http://www.jstor.org/stable/25420726. Accessed 5 Mar. 2026. Klapperich, Catherine M. “From the Dalkon Shield to Britney Spears’ IUD: Why Diverse Teams Need to Be Involved in Contraceptive Design.” The Brink. Boston University. 7/1/2021. https://www.bu.edu/articles/2021/from-the-dalkon-shield-to-britney-spears-iud-why-diverse-teams-need-to-be-involved-in-contraceptive-design/ Lopes-Garcia, E. A., Carmona, E. V., Monteiro, I., & Bahamondes, L. (2023). Assessment of pain and ease of intrauterine device placement according to type of device, parity, and mode of delivery. The European Journal of Contraception & Reproductive Health Care, 28(3), 163–167. https://doi.org/10.1080/13625187.2023.2189500 Margulies, Lazar. “History of Intrauterine Devices.” Bull. N. Y. Acad. Med. Vol. 51, No. 5, May 1975. Museum of Contraception and Abortion. “Tenrei Ota (1900-1985).” https://muvs.org/en/topics/pioneers/tenrei-ota-1900-1985-en/ Oppenheimer, W.. “Prevention of pregnancy by the graefenberg ring method.” American Journal of Obstetrics & Gynecology, Volume 78, Issue 2, 446 – 454. https://www.ajog.org/article/0002-9378(59)90203-0/abstract Peipert, Jeffrey F. “Lippes loop and the first IUDs: lessons from a bygone era.” American Journal of Obstetrics & Gynecology, Volume 219, Issue 2, 127 – 128. https://www.ajog.org/article/S0002-9378(18)30488-5/fulltext Peipert, Jeffrey F. “Lippes loop and the first IUDs: lessons from a bygone era.” American Journal of Obstetrics & Gynecology, Volume 219, Issue 2, 127 – 128 . https://www.ajog.org/article/S0002-9378(18)30488-5/fulltext Thiery, M. “Pioneers of the intrauterine device.” The European Journal of Contraception and Reproductive Health Care. Volume 2, Number 1, March 1997. The Parthenon Publishing Group International Publishers. Thomsen, Russel J. “An Atlas of Intrauterine Contraception.” Hemisphere Publishing Company. 1982. Tietze, Christopher and Sarah Lewit. “Intra-Uterine Contraceptive Devices: Proceedings of the Conference, April 30-May 1, 1962, New York City.” Exerpta Medica Foundation. Willingham, Emily. “A ‘Simple’ Piece of Plastic.” American Scientist. May-June 2012. https://www.americanscientist.org/article/a-simple-piece-of-plastic World Health Organization. “Selected practice recommendations for contraceptive use.” Fourth Edition. https://iris.who.int/server/api/core/bitstreams/582c8182-f4b1-406b-b5e7-d81c1870df93/content See omnystudio.com/listener for privacy information.