Podcasts about pmid

The ACOG 2025 guideline specifically recommends either oral or vaginal misoprostol for cervical ripening; it does not include buccal administration among its endorsed routes. With the rising rates of both obesity and labor induction, understanding the optimal agents for induction in obese patients is crucial. In a new study released ahead of print on March 4, 2026, in the AJOG, investigators from Indianapolis released findings from a secondary analysis of the IMPROVE trial (2019, AJOG) looking at the effect of obesity on buccal vs vaginal doses of misoprostol for cervical ripening. Listen in for details.1. Haas DM, Daggy J, Flannery KM, Dorr ML, Bonsack C, Bhamidipalli SS, Pierson RC, Lathrop A, Towns R, Ngo N, Head A, Morgan S, Quinney SK. A comparison of vaginal versus buccal misoprostol for cervical ripening in women for labor induction at term (the IMPROVE trial): a triple-masked randomized controlled trial. Am J Obstet Gynecol. 2019 Sep;221(3):259.e1-259.e16. doi: 10.1016/j.ajog.2019.04.037. Epub 2019 May 7. PMID: 31075246; PMCID: PMC7692024.2. ACOG July 2025: Cervical Ripening in Pregnancy, ACOG Clinical Practice Guideline No. 93. Bynarowicz, Taylor M. et al. The impact of body mass index on misoprostol dosing for labor induction: a comparison of vaginal and buccal dosage formsAmerican Journal of Obstetrics & Gynecology, Volume 0, Issue 0: https://www.ajog.org/article/S0002-9378(26)00126-2/fulltext4. Etrusco A, Sfregola G, Zendoli F, et al. Effect of Maternal Age and Body Mass Index on Induction of Labor Using Oral Misoprostol in Late-Term Pregnancies: A Retrospective Cross-Sectional Study. Gynecologic and Obstetric Investigation. 2024. 5. Prostaglandin Versus Mechanical Dilation and the Effect of Maternal Obesity on Failure to Achieve Active Labor: A Cohort Study.6. Beckwith L, Magner K, Kritzer S, Warshak CR. The Journal of Maternal-Fetal & Neonatal Medicine : The Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 2017.

This episode of EM Pulse dives into a critical intersection of clinical practice: the overlap between objective evidence-based medicine and the subjective influence of implicit bias. In a special collaboration with Don't Forget the Bubbles (DFTB), we are joined by experts from across the globe to discuss a landmark study on how clinical decision rules—specifically the PECARN (Pediatric Emergency Care Applied Research Network) imaging rules—impact disparities in pediatric trauma imaging. The Variables of Bias We often think of medical decision-making as a clean equation, but how much do factors like a patient's perceived race or ethnicity “creep” into our choices? The team explores the concept of equitable care—providing the best possible outcome regardless of factors outside a patient's control—and why awareness alone often isn’t enough to counteract the biases we all carry. Standardizing Equity: The Power of the Rule The core of this discussion centers on a prospective multicenter study titled “Perceived Race and Ethnicity on CT Use in Children with Minor Head or Abdominal Trauma.” * The Question: Do racial and ethnic disparities in CT use still exist in the “PECARN era”? The Twist: Why the researchers chose to look at clinician-perceived race rather than self-identification to capture what is actually happening in the provider's mind during a shift. The Finding: The guests discuss the surprising (and encouraging) results regarding how structured clinical rules can act as “equity builders.” A Global Perspective Bias isn’t just a local issue. With representation from UC Davis, UCSF, Children's National, and Athens, Greece, the panel looks at the international landscape of pediatric emergency care. They discuss: The barriers to implementing decision tools in different healthcare systems. The concept of “pediatric readiness” on a global scale. How these rules—originally developed in the U.S.—are being validated and adapted from Australia to Europe. Moving Beyond the “Black Box” While AI and machine learning are the buzzwords of the day, this episode highlights the beauty of “simple” statistical tools that are transparent and easy to use at the bedside. The guests share how they envision these findings changing their next shift—not by removing the “humanity” of the process, but by anchoring conversations with families in solid evidence. Check the Show Notes: We've included links to the original study and the companion blog post at Don't Forget the Bubbles, which features a deep dive into the data. You can also find the PECARN Pediatric Head Injury and Intra-abdominal Injury (IAI) rules on MDCalc to use on your next shift.   We want to hear from you! Connect with us on social media @empulsepodcast or on our website ucdavisem.com. Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Dr. Nate Kuppermann, Executive Vice President and Chief Academic Officer; Director, Children’s National Research Institute; Department Chair, Pediatrics, George Washington University School of Medicine and Health Sciences Dr. Nisa Atigapramoj, Pediatric Emergency Medicine Physician at UCSF Benioff Children’s Hospital Dr. Spyridon Karageorgos, Pediatric Emergency Medicine Physician at Aghia Sophia Children's' Hospital in Athens, Greece Resources: DontForgetTheBubbles.com: CT Use in Children with Minor Head or Abdominal Trauma Atigapramoj NS, McCarten-Gibbs K, Ugalde IT, Badawy M, Chaudhari PP, Yen K, Ishimine P, Sage AC, Nielsen D, Uppermann JS, Kravitz-Wirtz ND, Tancredi DJ, Holmes JF, Kuppermann N. Perceived Race and Ethnicity on CT Use in Children With Minor Head or Abdominal Trauma. Pediatrics. 2026 Feb 1;157(2):e2024070582. doi: 10.1542/peds.2024-070582. PMID: 41520991. PECARN Spotlight: Tools Validated Excuse Me, Your Bias is Showing PECARN **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

I raw meat the danger that some assume, or the superfood version of meat that others claim?  Let's look at the facts.   Some references: Micromorphology and geochemistry show controlled burning 30m inside Wonderwerk Cave, giving strong evidence that early Homo was using fire at least 1 million years ago. Berna F, Goldberg P, Horwitz LK, Brink JS, Holt S, Bamford M, Chazan M. 2012. Microstratigraphic evidence of in situ fire in the Acheulean strata of Wonderwerk Cave, Northern Cape province, South Africa. PNAS 109(20):E1215–E1220. PMID: 22474385. https://pubmed.ncbi.nlm.nih.gov/22474385/ Enamel crystal structure of carp teeth indicates low‑temperature, repeated heating, consistent with deliberate "oven‑like" cooking of fish by hominins ~780,000 years ago Zohar I, Biton R, Goren‑Inbar N, et al. 2022. Evidence for the cooking of fish 780,000 years ago at Gesher Benot Ya'aqov, Israel. Nature Ecology & Evolution 6:1797–1806. PMID: 36357607. https://www.nature.com/articles/s41559-022-01910-z   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

For preterm prelabor rupture of membranes, the standard protocol for latency augmentation has remained IV amoxicillin and erythromycin for 2 days, followed by oral amoxicillin and erythromycin for 5 additional days. Nonetheless, azithromycinhas largely replaced erythromycin in PPROM management due to supply shortages and tolerability.  Previous retrospective studies (2019) have found no difference in latency between single-dose and multi-day azithromycin regimens, but these studies did not measure actual drugconcentrations at the site of action. In that 2019 retrospective study, there was also no difference in incidence of chorioamnionitis, or neonatal outcomes when comparing different dosing regimens of the azithromycin with erythromycin, with the exception of respiratory distress syndrome being more common in the 5 day azithromycin group. However, a 2024 single-center,retrospective study from Annals Pharmacotherapy found significantly higher rates of histologic chorioamnionitis with single-dose azithromycin compared to 5-day regimens(62.6% vs 46.4%, P=0.006), despite similar latency periods. So, it's complicated. A 2025 systematic review of international guidelines found that 6 out of 17 clinical practice guidelines acknowledged uncertainty about the optimal antibiotic regimen. This was published in the AJOG. In this episode, wewill review a new publication from March 2026 in the AJOG which sought to compare the pharmacokinetic parameters of 1 g once vs 500 mg daily dosing of azithromycin in the setting of preterm prelabor rupture of membranes and simulate various dosing regimens to identify the optimal regimen that maintains amniotic fluid concentration of azithromycin over the minimum inhibitory concentration of common GU pathogens associated with intraamniotic infection orinflammation. But there is a BIG limitation. Listen in for details. 1.    Navathe R, Schoen CN, Heidari P, Bachilova S, Ward A, Tepper J, Visintainer P, Hoffman MK, Smith S, Berghella V, Roman A. Azithromycin vs erythromycin for the management of preterm premature rupture of membranes. Am J Obstet Gynecol. 2019 Aug;221(2):144.e1-144.e8. doi: 10.1016/j.ajog.2019.03.009. Epub 2019 Mar 20.PMID: 30904320.2.    Kua S, Roman A, Harbinson L, Groom K, Whitehead C. Systematic review of nationaland international clinical practice guidelines for management of preterm prelabor rupture of membranes. Am J Obstet Gynecol. 2025 Nov 22:S0002-9378(25)00866-X. 3.    Day KN, Vircks JA, Henricks CE, Reaves KM, Holmes AK, Florio KL. Latency Antibiotics in Preterm Prelabor Rupture of Membranes: A Comparison of Azithromycin Regimens. Ann Pharmacother. 2024 Mar;58(3):234-240. doi:10.1177/10600280231181135. Epub 2023 Jun 26. PMID: 38124306.4.   Boelig, Rupsa C. et al. Azithromycin in preterm prematurerupture of membranes: population pharmacokinetics and dose optimization. AmericanJournal of Obstetrics & Gynecology, March 2026.  SPONSER SITE: Visit www.perspectivemedical for more information on the Hemorrhage View C-Section Drape

Chuck and Chris begin a new initiative working with The Journal of Hand Surgery on a quarterly journal club.  Nash and Macerena will choose the articles from the previous quarter and Chris and Chuck will review the articles and discuss practical implications.  This first episode includes discussion of the following articles from Q4 of 2025:Porche KM, Spinner RJ, Bishop AT, Pulos N, Shin AY. Age-Related Effects on Peripheral Nerve Regeneration. J Hand Surg Am. 2025 Dec;50(12):1498-1504. PMID: 40817901.Cardenas D, Dogaroiu A, Harirah M, Zhang AY, Odobescu A, Sammer DM. Biomechanical Comparison of Suture Caliber and Number of Passes in Epitendinous Repair. J Hand Surg Am. 2025 Oct;50(10):1278.e1-1278.e6. PMID: 39903150.Ritchie B, Saini J, Mack ZE, Munn A, Dhaliwal G, Roach KE, Manske SL, White NJ. Weight-Bearing Computed Tomography Analysis of Scapholunate Ligament Injury. J Hand Surg Am. 2025 Nov;50(11):1304-1312. PMID: 40944679.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

In this week's Podcast: Nosema apis and Nosema Ceranae. Two, spore forming, parasitic Microsporidia!  They sound like something of a horror show for our bees and the effects of a heavy infection can be quite damaging. Listen in as I explain what it is, how you can identify it, and ultimately deal with it, so your bees can have a healthy and productive Summer.Hi, I'm Stewart Spinks, welcome to Episode 382 of my podcast, Beekeeping Short and Sweet.Please support us throught affiliate links below, they cost you nothing and help us continue to produce our content.References: Glavinic U, Blagojevic J, Ristanic M, Stevanovic J, Lakic N, Mirilovic M, Stanimirovic Z. Use of Thymol in Nosema ceranae Control and Health Improvement of Infected Honey Bees. Insects. 2022 Jun 24;13(7):574. doi: 10.3390/insects13070574. PMID: 35886750; PMCID: PMC9319372.Hive Five Multi Guard EntrancesBeekeeping Courses at Thorne Beehvies in Wragby Lincolnshire 2026Some of my Favourite Microscopy Books:Pollen Loads of the Honeybee by Dorothy HodgesRex Sawyer's Pollen IdentificationPollen Grains and Honeydew by Margaret AdamsThe Pollen Landscape by Joss BartlettPollen Microscopy by Norman ChapmanThe National Bee Unit Varroa Information can be found HEREBee Aware Varroa Information can be found HEREThorne Beehives Bees on a Budget Hive The Beekeeper's Dictionary websiteEthyl Acetate for colony destructions can be found hereGardening Potting Tray for effective frame cleaningStainless Steel Stock Pots for use as a double boiler. Get one slightly larger than the other to fit inside.Gas Stove for outdoor use to render wax and old comb.Contact Me at The Norfolk Honey CompanyVMD Website: Click HEREJoin Our Beekeeping Community in the following ways:Early Release & Additional Video and Podcast Content - Access HereStewart's Beekeeping Basics Facebook Private Group - Click HereTwitter - @NorfolkHoneyCo - Check Out Our FeedInstagram - @norfolkhoneyco - View Our Great PhotographsSign Up for my email updates by visiting my website hereAmazon links are affiliate links. I recieve a small commission should you choose to purchase.Support the show

There are hundreds of supplements on the market - all with promising claims for faster finish times, quicker recovery, and better health. But are all supplements worth the cost? We analyze the most recent research to divide popular supplements into three categories: not worth the cost, maybe useful for some, and highly recommended. (Disclaimer: this episode does not serve as medical advice. Please consult a medical professional before starting a new supplement.)Thank you to our sponsors:✨ Amazfit: User-friendly simple running watches with advanced features, at an affordable price point. Use link http://bit.ly/4nai73H for 10% off your purchase.✨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.✨Join us on Patreon.com/treadlightlyrunning or subscribe on Apple Podcasts for special subscriber-only content!In this episode, you'll learn:✅ Supplements that are a waste of money✅ Supplements that are sometimes useful, but do have risks✅ Why creatine supplementation is beneficial for runners✅ When vitamin D, iron, and other micronutrient vitamins may be beneficial✅ The most research-backed performance-enhancing supplement✅ If omega-3 supplements are beneficial for runners✅ Why third-party testing mattersReferencesPMID: 40650376

Listener discretion is advised. Japanese Airway Study: Kubo A, Kunitatsu K, Nakashima T, Horitani R, Kajimoto Y, Inoue S, Hironishi M. Association between endotracheal intubation and outcomes of nonshockable out-of-hospital cardiac arrest in Japan. BMC Emerg Med. 2025 Sep 24;25(1):185. doi: 10.1186/s12873-025-01341-6. PMID: 40993541; PMCID: PMC12462024.

This inaugural episode of the CardioNerds Pulmonary Embolism (PE) Series explores the evolution of acute PE care. Dr. Ibrahim Zahid, Dr. Dinu Balanescu, and Dr. Billy Joe Mullinax join guest expert Dr. Kenneth Rosenfield to discuss the shifting landscape of PE management. Pulmonary embolism (PE) remains a leading cause of cardiovascular mortality and a frequent diagnostic challenge, often masquerading as myocardial infarction or a benign illness. Over the past decade, PE care has evolved from anticoagulation-only strategies to nuanced, risk-stratified, multidisciplinary management. Modern approaches integrate hemodynamics, biomarkers, and advanced imaging to guide therapy, including catheter-directed interventions and large-bore thrombectomy. The Pulmonary Embolism Response Team (PERT) model addresses historical gaps by coordinating rapid, multispecialty decision-making and standardizing care pathways. The PERT Consortium further advances PE care through education, research, and the world's largest PE registry, while fostering leadership and research opportunities for trainees. Despite advances, long-term outcomes and post-PE syndromes remain important areas for future investigation. Audio editing by CardioNerds Academy intern, student doctor, Pace Wetstein. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls PE is a “master masquerader”—maintain suspicion for atypical presentations like myocardial infarction, heart failure, flu, or anxiety. Multidisciplinary management mediated through pulmonary embolism response teams improves outcomes and standardizes care. Risk stratification integrates hemodynamics, biomarkers, and imaging. Advanced therapies have expanded beyond anticoagulation. Long‑term follow‑up and post‑PE syndrome need more research. Notes Notes: Notes drafted by Dr. Ibrahim Zahid. 1. How has the clinical approach to PE changed over the past decade? PE is the third leading cause of cardiovascular death and historically under‑recognized. Symptoms mimic MI, HF, asthma, syncope, and more.PE is a silent killer, and it should be recognized more as a cause of spontaneous cardiac arrest. Where life threatening disease like stroke which is owned by neurological specialists and MI is primarily managed by cardiac specialists, PE is an entity without a professional home. The PERT Consortium brings the specialties together for PE care. 2. Ten years ago, a 58-year-old patient with a large bilateral PE, RV dilation, and positive biomarkers might have been managed with anticoagulation and close observation alone. Today, with evolving—but still uneven—data on advanced therapies, PE care feels far more nuanced and highly dependent on where you practice. What are the major gaps in traditional PE management that clinicians should recognize, and what care pathways should they be aware of across different hospital systems? Care has shifted from anticoagulation‑only to multidisciplinary approaches like catheter directed thrombectomy. Risk‑based pathways and the use of CT angiogram has improved early recognition. Risk stratification tools must be used as tools for early recognition of intermediate risk PE. Untreated PE leads to chronic complications like chronic thromboembolic disease and chronic thromboembolic pulmonary hypertension, which requires long term clinic follow up. 3. What is the role of risk stratification tools such as PeSI, sPeSI scores, cardiac biomarkers, and imaging findings in PE, and how do they guide treatment decisions in real world practice? Integrate vitals (blood pressure and heart rate), biomarkers (troponin, pro-BNP), RV/LV ratio assessment, acid‑base status, and scores. Tools include PESI, sPESI, BOVA, HESTIA, FAST, Geneva, NEWS, shock index. Vitals, lactate, acid-base status, and tools like NEWS or shock index track clinical evolution. PESI/sPESI estimate 30-day mortality and help identify low-risk patients who may be candidates for early discharge or outpatient therapy. Clinical judgment matters—scores don't fully capture clot burden, trajectory, or bleeding risk. 4. How was the pulmonary embolism response team created, and since its creation, what evidence or outcome data became available to support the PERT model? Originated after a sentinel case at MGH: A young, pregnant woman in her 30s, who collapsed at home, underwent thrombectomy, and had to be on ECMO for a few days. The case brought cardiology, cardiac surgeons and critical care physicians together for planning and improvement in her health, which was rewarding. Thereby, it was decided to bring specialties involved in PE care together to create a response team. The name of the team, Pulmonary Embolism Response Team (PERT), was coined by Richard Channick in the first meeting. Posters were set up all over the hospital to call a centralized line when an acute PE is recognized A meeting was held to present the concept of putting together a consortium, with development of action items and a PERT database. Enabled rapid multidisciplinary input using early teleconferencing tools. 5. Given concerns about having too many ‘cooks in the kitchen' during the initial PE call—especially with rotating teams—how can institutions reconcile workflow complexity with standardized pathways in a way that meaningfully supports and justifies the added burden on frontline clinicians? Every hospital's PERT is different, catering to their needs and workflow At least two disciplines are needed to make a PERTData is currently being collected to guide further on how the workflow can be standardized Most importantly, the team brings in resources that were not available prior to PERT formation. 6. What are the main goals of the PERT consortium, and how does it support clinicians and institutions involved? To improve care and improve outcomes for patients with PE Expand education, refine algorithms, standardize care with Centers of Excellence. Maintain the largest PE registry for research and outcomes improvement. 7. Beyond global networking, shared learning from successful systems, and the pathway toward Center of Excellence designation, what additional benefits can clinicians and health systems gain by participating in the PERT Consortium? The ability to learn from other systems, the ability to share experiences. Allow people to develop their professional careers like leadership experience, becoming a member of the trainee council Initiate projects and receive funding for your ideas 8. For trainees interested in pulmonary embolism care, how can a trainee be a champion at their institution? Does PERT provide assistance and how can they really contribute meaningfully even before becoming a fellow/attending? Medical students and residents interested in PE should reach out to the consortium and the consortium will hook you up with the correct mentors who can nurture you along. Listen to the podcasts. Participate with your local PERT team PERT wants involvement of people who are social media savvy to help spread the word on PE. Top three take-away points from this episode Acute PE care has advanced and multiple treatment modalities for acute PE including catheter directed therapy, large bore thrombectomy, are becoming standard of care. Multidisciplinary models like PERT improve coordination and outcomes. Trainees play a vital role in advancing PE care through involvement, research, and education References Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jiménez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ní Áinle F, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020 Jan 21;41(4):543-603. doi: 10.1093/eurheartj/ehz405. PMID: 31504429. https://pubmed.ncbi.nlm.nih.gov/31504429/ Rosovsky R, Zhao K, Sista A, Rivera-Lebron B, Kabrhel C. Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions. Res Pract Thromb Haemost. 2019 Jun 9;3(3):315-330. doi: 10.1002/rth2.12216. PMID: 31294318; PMCID: PMC6611377. https://pmc.ncbi.nlm.nih.gov/articles/PMC6611377/ Rosenfield K, Bowers TR, Barnett CF, Davis GA, Giri J, Horowitz JM, Huisman MV, Hunt BJ, Keeling B, Kline JA, Klok FA, Konstantinides SV, Lanno MT, Lookstein R, Moriarty JM, Ní Áinle F, Reed JL, Rosovsky RP, Royce SM, Secemsky EA, Sharp ASP, Sista AK, Smith RE, Wells P, Yang J, Whatley EM; Pulmonary Embolism Research Collaborative (PERC) Attendees. Standardized Data Elements for Patients With Acute Pulmonary Embolism: A Consensus Report From the Pulmonary Embolism Research Collaborative. Circulation. 2024 Oct;150(14):1140-1150. doi: 10.1161/CIRCULATIONAHA.124.067482. Epub 2024 Sep 12. PMID: 39263752; PMCID: PMC11698503. https://pubmed.ncbi.nlm.nih.gov/39263752/ Sharifi M, Awdisho A, Schroeder B, Jiménez J, Iyer P, Bay C. Retrospective comparison of ultrasound facilitated catheter-directed thrombolysis and systemically administered half-dose thrombolysis in treatment of pulmonary embolism. Vasc Med. 2019 Apr;24(2):103-109. doi: 10.1177/1358863X18824159. Epub 2019 Mar 5. PMID: 30834822. https://pubmed.ncbi.nlm.nih.gov/30834822/ Pandya V, Chandra AA, Scotti A, Assafin M, Schenone AL, Latib A, Slipczuk L, Khaliq A. Evolution of Pulmonary Embolism Response Teams in the United States: A Review of the Literature. J Clin Med. 2024 Jul 8;13(13):3984. doi: 10.3390/jcm13133984. PMID: 38999548; PMCID: PMC11242386. https://pubmed.ncbi.nlm.nih.gov/38999548/ Rivera-Lebron B., McDaniel M., Ahrar K., Alrifai A., Dudzinski D.M., Fanola C., Blais D., Janicke D., Melamed R., Mohrien K., et al. Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium. Clin. Appl. Thromb. Hemost. 2019;25:1076029619853037. doi: 10.1177/1076029619853037.https://pubmed.ncbi.nlm.nih.gov/31185730/

Probiotics. They are often marketed as the end of all and be all for all our health issues. And they CAN do some real good. There is NO DOUBT a connection with overall heath and gut health…and NO ONE can deny that. But probiotics gets grey for some women's health issues. A new prospective, single-arm, non-blinded, multicenter study across 31 hospitals in Japan is making some pretty dramatic claims regarding oral probiotics and recurrent spontaneous preterm birth (ePUB). Can oral probiotics reduce spontaneous recurrent preterm birth? Listen in for details. 1. Prevention of Recurrent Spontaneous Preterm Delivery Using Probiotics: Results from a Prospective, Single-Arm, Multicenter Trial. PPP trial Collaborators et al.American Journal of Obstetrics & Gynecology, Volume 0, Issue 02. Grev J, Berg M, Soll R. Maternal probiotic supplementation for prevention of morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2018 Dec 12;12(12):CD012519. doi: 10.1002/14651858.CD012519.pub2. PMID: 30548483; PMCID: PMC6516999.3. Jarde A, Lewis-Mikhael AM, Moayyedi P, Stearns JC, Collins SM, Beyene J, McDonald SD. Pregnancy outcomes in women taking probiotics or prebiotics: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2018 Jan 8;18(1):14. doi: 10.1186/s12884-017-1629-5. PMID: 29310610; PMCID: PMC5759212.4. Othman M, Neilson JP, Alfirevic Z. Probiotics for preventing preterm labour. Cochrane Database Syst Rev. 2007 Jan 24;2007(1):CD005941. doi: 10.1002/14651858.CD005941.pub2. PMID: 17253567; PMCID: PMC9006117.5. Timing of Probiotic Milk Consumption During Pregnancy and Effects on the Incidence of Preeclampsia and Preterm Delivery: A Prospective Observational Cohort Study in Norway.6. Nordqvist M, Jacobsson B, Brantsæter AL, Myhre R, Nilsson S, Sengpiel V. Timing of probiotic milk consumption during pregnancy and effects on the incidence of preeclampsia and preterm delivery: a prospective observational cohort study in Norway. BMJ Open. 2018 Jan 23;8(1):e018021. doi: 10.1136/bmjopen-2017-018021. PMID: 29362253; PMCID: PMC5780685.7. Gao Q, Sun Y, Qu Y, Li F, Li P. The effect of probiotic supplementation during pregnancy on pregnancy complications: An umbrella meta-analysis. Medicine (Baltimore). 2025 Dec 19;104(51):e46409. doi: 10.1097/MD.0000000000046409. PMID: 41430994; PMCID: PMC12727282.SPONSOR WEBSITE: Visit perspectivemedical.org to learn more about the Hemorrhage View C-Section Drape

Peptides are one of the most hyped skincare ingredients right now—but what do they actually do? In this episode, we break down peptides in simple, no-BS terms. You'll learn what peptides are, the different types used in skincare, what results are realistic, how to choose a peptide serum, and whether you really need peptides in every product. Plus, I'll share some of my favorite peptide products at both luxury and budget-friendly price points.If peptides have ever confused you—or felt overpromised—this episode will make it click.Purchase the Peptide Database HereWork with Ella 1:1 to build and/or adjust your skincare routine Peptides mentioned in this episode Liquid Peptides Advanced MP Serum: https://go.shopmy.us/p-45564299DR. WHITNEY BOWE BEAUTY | Peptide + HA Plumping Serum: https://go.shopmy.us/p-45564313MEDIK8 | Liquid Peptides: https://go.shopmy.us/p-45564326COSRX | The 6 Peptide Skin Booster Serum: https://go.shopmy.us/p-45564355GOOD MOLECULES | Super Peptide Serum: https://go.shopmy.us/p-45564899NATURIUM | Multi-Peptide Advanced Serum: https://go.shopmy.us/p-45564915PEACH & LILY | Copper Peptide Pro Firming Serum: https://go.shopmy.us/p-45564947BUBBLE SKINCARE | Water Slide Hydrating Serum: https://go.shopmy.us/p-45564997Shop more of my favorite products here: https://shopmy.us/ellaelstonA few relevant peptide studies (more linked in the Peptide Database)Lee E, Ahn DK, Kim JH, et al. Skin Anti-Aging and Moisturizing Effects of Low-Molecular-Weight Collagen Peptide Supplementation in Healthy Adults: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. J Microbiol Biotechnol. 2025;35:e2507008. Published 2025 Sep 11. doi:10.4014/jmb.2507.07008Skibska A, Perlikowska R. Signal Peptides - Promising Ingredients in Cosmetics. Curr Protein Pept Sci. 2021;22(10):716-728. doi:10.2174/1389203722666210812121129Badilli U, Inal O. Current Approaches in Cosmeceuticals: Peptides, Biotics and Marine Biopolymers. Polymers (Basel). 2025 Mar 18;17(6):798. doi: 10.3390/polym17060798. PMID: 40292641; PMCID: PMC11946782.

Contributor: Taylor Lynch MD Educational Pearls: Melatonin is an endogenous hormone released primarily by the pineal gland Also released by extrapineal regions in the retina, the GI tract, and some immune cells Peak secretion occurs at night and is suppressed during the day Secretion and production decrease with age Older patients experience the greatest improvement in sleep latency and sleep quality Mechanism of action in the suprachiasmatic nucleus of the hypothalamus MT1 receptor Reduces normal firing MT2 receptor Shifts the circadian rhythm FDA approved for insomnia Decreases sleep latency by 7 minutes Increases total sleep time by 8 minutes FDA approved for circadian sleep-wake disorders Jet lag Most effective in west-to-east travel Best if crossing at least 5 time zones Shift work A study examined ED physicians and nurses with rotating shifts Modest increase in deep sleep percentage No difference in cognition or reaction time the day after taking melatonin Nurses on rotating night shifts experienced increased total sleep time by 20 minutes Dosing 0.5 - 3 mg is the most evidence-based dosing Higher doses increase the risk of rebound grogginess but do not improve outcomes References Ahmad SB, Ali A, Bilal M, et al. Melatonin and Health: Insights of Melatonin Action, Biological Functions, and Associated Disorders. Cell Mol Neurobiol. 2023;43(6):2437-2458. doi:10.1007/s10571-023-01324-w Herxheimer A, Petrie KJ. Melatonin for the prevention and treatment of jet lag. Cochrane Database Syst Rev. 2002;(2):CD001520. doi:10.1002/14651858.CD001520 Morgenthaler TI, Lee-Chiong T, Alessi C, Friedman L, Aurora RN, Boehlecke B, Brown T, Chesson AL Jr, Kapur V, Maganti R, Owens J, Pancer J, Swick TJ, Zak R; Standards of Practice Committee of the American Academy of Sleep Medicine. Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report. Sleep. 2007 Nov;30(11):1445-59. doi: 10.1093/sleep/30.11.1445. Erratum in: Sleep. 2008 Jul 1;31(7):table of contents. PMID: 18041479; PMCID: PMC2082098. Thottakam BMVJ, Webster NR, Allen L, Columb MO, Galley HF. Melatonin Is a Feasible, Safe, and Acceptable Intervention in Doctors and Nurses Working Nightshifts: The MIDNIGHT Trial. Front Psychiatry. 2020;11:872. Published 2020 Aug 27. doi:10.3389/fpsyt.2020.00872 Summarized and edited by Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/ Join our mailing list: http://eepurl.com/c9ouHf

When the ice cracked beneath Darven Miller's feet on December 13, 1979, it triggered a cascade of events that seemed impossible to survive. The 11-year-old remained trapped under the frozen surface of Duncan Creek for nearly 30 minutes, his body temperature plummeting to 82 degrees. By the time rescuers pulled him from the water, he had no pulse, no breathing, and pupils fixed and dilated—clinically dead by every measure. What the medical team at a small Wisconsin hospital did next, and what happened 70 minutes into their desperate resuscitation attempt, would challenge everything doctors thought they knew about the limits of human survival. This is a story about the microscopic margin between death and life, and about a boy who became a man determined to live every moment to the fullest. 00:00 Welcome to Crux 00:31 Ice Breaks Open 02:09 Setting the Scene 03:26 Under the Ice 04:19 Rescue at 30 Minutes 06:10 ER Fight Begins 06:54 Acidosis Explained 08:07 Rewarming and Defib 10:50 Heartbeat Returns 11:43 Wakes Up Asking Water 13:15 Rehab and Full Recovery 14:57 Why He Survived 17:40 Life After the Miracle 19:01 Lessons for Medicine 25:34 Final Takeaways 27:26 Listener Wrap Up Listen AD FREE: Support our podcast at patreaon: http://patreon.com/TheCruxTrueSurvivalPodcast Email us! thecruxsurvival@gmail.com Instagram https://www.instagram.com/thecruxpodcast/ Get schooled by Julie in outdoor wilderness medicine! https://www.headwatersfieldmedicine.com/ REFERENCES: 1. "45 years pass since boy survived cold water drowning," WEAU, March 23, 2024 2. "Boy who almost drowned as good as new," UPI Archives, December 15, 1980 3. "Recovery of a 62-year-old Man From Prolonged Cold Water Submersion," ScienceDirect, November 4, 2005 4. "Hypothermia. Cold-water drowning," PubMed, PMID: 2054134 5. "Survival after prolonged submersion in cold water without neurologic sequelae," PubMed, PMID: 7387271 6. "Ice Water Drowning Survival After 147-Minute Submersion and 7°C Hypothermic Circulatory Arrest," JACC: Case Reports, 2025 7. "How to bring cold water drowning victims back to life," MyPoolSigns Blog, March 11, 2025 8. "Cold water immersion: sudden death and prolonged survival," The Lancet, December 1, 2003 9. "Anna Bågenholm," Wikipedia, November 6, 2025 10.     "Successful resuscitation after drowning with severe hypernatraemia," PMC, December 2019 11.     "Hypothermia – Core EM," coreem.net 12.     "Duncan Creek Trail," GO Chippewa County Wisconsin 13.     "HSHS St. Joseph's Hospital," Hospital Sisters Health System website 14.     "St. Joseph's Hospital memorialized in exhibit at History Center in Chippewa Falls," Chippewa Herald-Telegram, November 29, 2024 15.     "Our History at HSHS Medical Group," HSHS website Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

A 5K and a marathon are objectively different distances - but they are also more similar than you think. If you've ever wondered why the 5K is technically a long-distance race, or what the difference between training for a mile and a marathon is, this episode is for you! We'll discuss the metabolic and mechanical differences of the short, middle, and long distances, plus how those theoretical differences translate into training. 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 or 50% off and free shipping on a subscription.✨Join us on Patreon.com/treadlightlyrunning or subscribe on Apple Podcasts for special subscriber-only content! In this episode, you'll learn:✅ Which race distances are aerobic, and which are anaerobic?✅ The mechanical differences between short, middle, and long distances✅ The spectrum of muscle fiber typology✅ The different metabolic demands of short, middle, and long distances✅ The training differences across the various distancesIf you enjoyed this episode, you may like:

Send a textBen and Daphna review a randomized controlled trial published in The Journal of Pediatrics by Dr. Ariel Salas and colleagues at UAB. The study investigates whether early high-dose vitamin D supplementation (800 IU/day starting day 1) in extremely preterm infants reduces the incidence of Bronchopulmonary Dysplasia (BPD) compared to standard care (starting day 14). The hosts discuss the physiologic rationale linking vitamin D to lung development, the use of impulse oscillometry to measure lung mechanics, and the secondary findings regarding metabolic bone disease. They explore why the "physiologic rationale" doesn't always translate to clinical significance.----Early Vitamin D Supplementation in Infants Born Extremely Preterm and Fed Human Milk: A Randomized Controlled Trial. Salas AA, Argent T, Jeffcoat S, Tucker M, Ashraf AP, Travers CP.J Pediatr. 2025 Dec;287:114754. doi: 10.1016/j.jpeds.2025.114754. Epub 2025 Jul 24.PMID: 40714046 Clinical Trial.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send a textIn this episode of Journal Club, Ben and Daphna review a retrospective cohort study from Pediatrics examining antibiotic duration for uncomplicated Gram-negative bloodstream infections in the NICU. The study, a collaboration between Nationwide Children's Hospital and UT Health San Antonio, compares outcomes between short course (≤8 days) and long course (≥9 days) therapy. The hosts discuss the startling finding that while recurrence rates were similar, the long-duration group had a 14% rate of developing multi-drug resistant (MDR) infections within 90 days, compared to 0% in the short-duration group.----Duration of Antibiotic Therapy for Gram-Negative Bloodstream Infections in the Neonatal Intensive Care Unit. Djordjevich CJ, Magers J, Cantey JB, Prusakov P, Sánchez PJ.J Pediatr. 2026 Jan 17:114993. doi: 10.1016/j.jpeds.2026.114993. Online ahead of print.PMID: 41554433 Free article.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Furf and Monty are back with another Pulm PEEPs Pearls episode. The topic of today’s discussion is an often discussed, but often misunderstood, test; the methacholine challenge. They’ll review when to utilize this test, how it should be performed, and the appropriate interpretation. Contributors This episode was prepared with research by Pulm PEEPs Associate Editor George Doumat. Dustin Latimer, another Pulm PEEPs Associate Editor, assisted with audio and video editing. Key Learning Points What the Test Measures Methacholine challenge is a direct bronchial provocation test of airway hyperresponsiveness (AHR), a core physiologic feature of asthma. Anyone will bronchoconstrict at high enough concentrations — the test looks for an abnormal threshold. The key endpoint is the PC20: the methacholine concentration causing a 20% fall in FEV1. Abnormal in adults: PC20 ≤ 8–16 mg/mL Test Performance Meta-analyses: pooled sensitivity ~60%, specificity ~90%. Real-world cohorts: sensitivity 55–62%, specificity 56–100% (varies by population, protocol, and threshold used). Not a standalone yes/no test — best used as part of a broader diagnostic pathway. Where It Fits in the Asthma Workup The test belongs in a stepwise approach: Step 1: Spirometry + bronchodilator response Step 2: Add FeNO and/or peak flow variability (if available) Step 3: If the picture is still unclear → methacholine challenge It is most useful for symptomatic patients with normal spirometry and no bronchodilator reversibility. Given its cost, mild risk, and discomfort, it should not be a first-line test — most asthma diagnoses do not require it. Technique and Medication Prep Technique ERS guidelines favor tidal breathing over deep inspiratory maneuvers. Deep breaths can be bronchoprotective and blunt the response, reducing sensitivity — especially in mild or well-controlled asthma. Medication Washout (to Avoid False Negatives) Medication ClassWashout PeriodShort-acting beta-agonists (SABA)≥ 6 hoursLong-acting beta-agonists (LABA)~24 hoursUltra-long-acting beta-agonists~48 hoursShort-acting anticholinergics (e.g., ipratropium)~12 hoursLong-acting muscarinic antagonists (LAMA, e.g., tiotropium)7 days Inhaled corticosteroids, leukotriene blockers, and antihistamines do not significantly affect the test acutely — continue these. Withdrawing ICS also carries its own risk for asthma patients. Practical tip: Spell out exactly what to hold and when — for both the patient and the PFT lab — at the time the test is ordered. Interpreting Results Negative Test (PC20 > 16 mg/mL) Very high negative predictive value in symptomatic adults. Makes current asthma quite unlikely (assuming proper test conduct). This is the test’s greatest strength: it is an excellent rule-out test. Positive Test (PC20 ≤ 8–16 mg/mL) More nuanced — airway hyperresponsiveness is not unique to asthma. Can be positive in: chronic cough, allergic rhinitis, COPD, and even some healthy asymptomatic individuals. A positive result raises probability but must be interpreted alongside the clinical story, variable respiratory symptoms, peak flow variability, FeNO, and ICS response. Safety and Risks Overall, the test is quite safe; significant adverse effects are rare. Temporary breathing discomfort is expected (bronchoconstriction is being induced). Severe bronchospasm is possible: A trained clinician should be available; SABA inhaler/nebulizer must be immediately on hand; a physician should be reachable in the facility. Contraindications / cautions: Avoid if FEV1 < 70% predicted or < 1–1.5 L (baseline obstruction greatly increases risk). Avoid within 3 months of an acute cardiac event (rare risk of cardiac events with unstable cardiac disease). Five Pearls — Quick Recap What it tests: Methacholine challenge is a direct test of AHR with high specificity but variable sensitivity — it belongs inside a diagnostic pathway, not as a standalone asthma test. When to use it: Most useful for symptomatic patients with normal spirometry and no bronchodilator response, after FeNO and peak flow variability have been considered. Technique and meds matter: Use tidal breathing protocol; respect washout intervals — especially the 7-day LAMA washout and 24–48 hour LABA window — to avoid false negatives. Safety: Generally safe, but can induce significant bronchoconstriction. Have a SABA available and avoid the test in patients with FEV1 < 70% predicted. Interpretation: A negative test (PC20 > 16 mg/mL) strongly argues against current asthma. A positive test raises probability but is not specific — interpret alongside the full clinical picture. References and Further Reading Coates AL, Wanger J, Cockcroft DW, Culver BH; Bronchoprovocation Testing Task Force: Kai-Håkon Carlsen; Diamant Z, Gauvreau G, Hall GL, Hallstrand TS, Horvath I, de Jongh FHC, Joos G, Kaminsky DA, Laube BL, Leuppi JD, Sterk PJ. ERS technical standard on bronchial challenge testing: general considerations and performance of methacholine challenge tests. Eur Respir J. 2017 May 1;49(5):1601526. doi: 10.1183/13993003.01526-2016. PMID: 28461290. Lee, J., & Song, J. U. (2021). Diagnostic comparison of methacholine and mannitol bronchial challenge tests for identifying bronchial hyperresponsiveness in asthma: a systematic review and meta-analysis. Journal of Asthma, 58(7), 883–891. https://doi.org/10.1080/02770903.2020.1739704 Davis BE, Blais CM, Cockcroft DW. Methacholine challenge testing: comparative pharmacology. J Asthma Allergy. 2018 May 14;11:89-99. doi: 10.2147/JAA.S160607. PMID: 29785128; PMCID: PMC5957064.

In this episode of the Pediatric and Developmental Pathology, our hosts Dr. Mike Arnold (@MArnold_PedPath) and Dr. Jason Wang speak with Dr. Aida Glembocki, a Pediatric Pathologist and Masters Degree candidate at the University of Toronto, and Dr. Robert Siddaway, an Oncology Investigator at The Hospital for Sick Children in Toronto.   Hear about how The Hospital for Sick Children applies RNA sequencing in pediatric cancer diagnosis to reduce costs and identify key information for diagnostic classification. We also hear about their article in Pediatric and Developmental Pathology: Fusion-Negative Rhabdomyosarcoma: Clinical Application of Targeted RNA Sequencing   Related article: Siddaway R, Glembocki AI, Arnoldo A, Staunton J, Liu APY, Yuki KE, Yu M, Cohen-Gogo S, Shlien A, Villani A, Whitlock JA, Hitzler J, Tabori U, Levine AB, Lafrenière A, Nagy A, Chen H, Ngan BY, Somers GR, Abdelhaleem M, Chami R, Hawkins C. Clinical utility of targeted RNA sequencing in cancer molecular diagnostics. Nat Med. 2025 Oct;31(10):3524-3533. doi: 10.1038/s41591-025-03848-8. Epub 2025 Jul 17. PMID: 40676318.   Featured public domain music: Summer Pride by Loyalty Freak

The ACOG states that, “Iron deficiency anemia during pregnancy has been associated with an increased risk of low birth weight, preterm delivery, and perinatal mortality and should be treated with iron supplementation in addition to prenatal vitamins. In addition, there may be an association between maternal iron deficiency anemia and postpartum depression, with poor results in mental and psychomotor performance testing in offspring”. Screening for anemia is included in most prenatal lab sets. However, up to 42% of women who enter prenatal care are iron deficient BEFORE anemia is detected. Iron deficiency itself, even without anemia, has also been linked to pregnancy morbidity. The ACOG currently does not have a statement endorsing universal ferritin screening in pregnancy outside of established anemia, but new data is challenging this (Jan 2026, Lancet). Listen in for details. 1. ACOG PB 2332. Wasim T, Bushra N, Nasrin T, Humayun S, Tajammul A, Khawaja KI, Irshad S, Fatima S, Yasin A, Zamora J, Cano-Ibáñez N, Fernandez-Felix BM, Khan KS; Ferritin screening and iron treatment for maternal anaemia and fetal growth restriction prevention (FAIR) Study Group. Intravenous iron for non-anaemic iron deficiency in pregnancy: a multicentre, two-arm, randomised controlled trial. Lancet Haematol. 2026 Jan;13(1):e22-e29. doi: 10.1016/S2352-3026(25)00315-1. PMID: 41482443.3. https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2024.15196

Robotic surgery has moved from novelty to norm, and in this episode of Behind the Knife, Drs. James Jung and Joey Lew sit down with urologic pioneer and Medtronic CMO Dr. Jim Porter to dissect how we got here, what the data really say about “the death of laparoscopy,” and where competing robotic platforms like Hugo may take the field next. From ergonomics and education to economics and global access, they tackle both the hype and the hard questions around robotics as the future of minimally invasive surgery.Hosts: ·      James Jung, MD, PhD, Assistant Professor of Surgery, Duke University·      Joey Lew, MD, MFA, Surgical resident PGY-3, Duke University, @lew__actuallyLearning Goals: By the end of this episode, listeners will be able to:·      Describe key clinical, ergonomic, and educational drivers behind the rapid adoption of robotic surgery in the United States and globally.·      Summarize current evidence comparing robotic and laparoscopic approaches for common procedures, including where outcomes are equivalent, inferior, or clearly superior.·      Explain how surgeon ergonomics, trainee experience, and video-based learning influence practice patterns and learning curves in minimally invasive surgery.·      Discuss the role of cost, reimbursement structures, and market competition (e.g., Medtronic Hugo vs da Vinci) in shaping robotic adoption across different health systems.·      Anticipate how next-generation, task- or organ-specific robotic platforms may further change standards of care in minimally invasive surgery.References:·      Violante T, Ferrari D, Novelli M, Larson DW. The Death of Laparoscopy - Volume 2: A Revised Prognosis. A retrospective study. Ann Surg. 2025 Jun 16. doi: 10.1097/SLA.0000000000006792. Epub ahead of print. PMID: 40518997. https://pubmed.ncbi.nlm.nih.gov/40518997/·      Yu Yoshida, Yoshiro Itatani, Takehito Yamamoto, Ryosuke Okamura, Koya Hida, Kazutaka Obama, Single-incision plus one robot-assisted surgery (SIPORS) using the Hugo robotic-assisted surgery (RAS) system for rectal cancer, Annals of Coloproctology, 10.3393/ac.2025.00787.0112, 41, 6, (586-591), (2025). https://pubmed.ncbi.nlm.nih.gov/41486916/Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma 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

We've all seen it: the patient whose chart is “flagged” with a penicillin allergy, but when you dig into the history, the story doesn’t quite add up. Maybe it was a stomach ache in the 90s, or maybe they're just carrying a “inherited” allergy from a parent. In this episode of EM Pulse, we sit down with ED Clinical Pharmacist Haley Burhans to discuss why these labels are more than just a nuisance—they're a clinical liability—and how a simple tool can empower you to fix them on the fly. The Hidden Danger of the “Safe” Choice Choosing a non-beta-lactam antibiotic because of a questionable allergy label feels like the path of least resistance, but the data tells a different story. We explore how “playing it safe” can actually lead to: Worse Outcomes: Why second line antibiotics often mean higher treatment failure rates. The “Superbug” Factor: The surprising link between penicillin allergy labels and the rise of MRSA and VRE in our communities. The C. diff Connection: Why alternative choices might be setting your patient up for a much more difficult recovery. The Solution: The PEN-FAST Score How do you move from “I think this might not be a true allergy” to “I am confident this antibiotic is safe”? Haley introduces the PEN-FAST score, a validated scoring tool designed to risk-stratify patients based on a few key historical questions. The Mnemonic: We break down the PEN-FAST acronym so you know exactly which three questions to ask to risk-stratify your patient in seconds. IgE vs. The Rest: Learn to distinguish between the “true” dangerous hypersensitivity and the delayed reactions that shouldn’t stop you from using the best drug for the job. The “Amoxicillin Rash”: We dive into this common pediatric “gotcha.”, why many kids end up with a lifelong allergy label after a routine ear infection, and why it often has nothing to do with the drug itself. The Bottom Line: Patients with low PEN-FAST scores are considered low risk, making an oral challenge under observation in the ED a reasonable option. Higher scores may require shared decision-making or referral. Why the ED is the Perfect Place for a “Challenge” Delabeling isn’t just for the allergist’s office. We argue that the Emergency Department is actually the ideal setting to challenge these allergies. The “Oral Challenge”: Learn the practical steps for performing a trial dose in the department. Safety First: Why your environment and expertise make you uniquely qualified to handle the “what-ifs” better than anyone else. Key Takeaways Question the Label: The vast majority of reported penicillin allergies are inaccurate due to patients outgrowing the allergy or misinterpreting common side effects as allergic reactions. History is Everything: Dig deeper than just “rash.” Ask about the timing relative to the dose, specific appearance (hives vs. flat rash), and what treatment was required (epinephrine vs. antihistamines). Use PEN-FAST: Utilize this tool to objectify the risk. Document Tolerance: Even if you don’t fully delete the allergy label, if you successfully treat the patient with another beta-lactam (like ceftriaxone), document that tolerance clearly to aid future clinicians. Cephalosporins are likely safe: Later-generation cephalosporins generally have very low cross-reactivity and are usually safe options even in truly allergic patients How do you handle documented penicillin allergies? Do you use the PEN-FAST tool? Share your experience with us on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Haley Burhans, PharmD, Emergency Medicine Clinical Pharmacist at UC Davis Resources: PEN-FAST Score on MDCalc Penicillin Allergy Evaluation Should Be Performed Proactively in Patients with a Penicillin Allergy Label – A Position Statement of the American Academy of Allergy, Asthma & Immunology Staicu ML, Vyles D, Shenoy ES, Stone CA, Banks T, Alvarez KS, Blumenthal KG. Penicillin Allergy Delabeling: A Multidisciplinary Opportunity. J Allergy Clin Immunol Pract. 2020 Oct;8(9):2858-2868.e16. doi: 10.1016/j.jaip.2020.04.059. PMID: 33039010; PMCID: PMC8019188. Yang C, Graham JK, Vyles D, Leonard J, Agbim C, Mistry RD. Parental perspective on penicillin allergy delabeling in a pediatric emergency department. Ann Allergy Asthma Immunol. 2023 Jul;131(1):82-88. doi: 10.1016/j.anai.2023.03.023. Epub 2023 Mar 27. PMID: 36990206. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.  

In this Complex Care Journal Club podcast episode, Drs. Kathleen Chiotos and Jeffrey Gerber discuss a post hoc time-series analysis of clinician feedback reports and antibiotic prescribing for community-acquired pneumonia in children with medical complexity (CMC). They describe why children with medical complexity are often excluded from guideline-based interventions, what the data suggest about antibiotic choice and duration in this population, and next steps to design studies that include all children. SPEAKERS Kathleen Chiotos, MD, MSCE Associate Professor of Anesthesiology and Critical Care University of Pennsylvania, Children's Hospital of Philadelphia Jeffery Gerber, MD, PhD Professor of Pediatrics and Epidemiology University of Pennsylvania School of Medicine; Children's Hospital of Philadelphia HOST Kristina Malik, MD Assistant Professor of Pediatrics, University of Colorado School of Medicine Medical Director, KidStreet Pediatrician, Special Care Clinic, Children's Hospital Colorado DATE Initial publication date: February 17, 2026. JOURNAL CLUB ARTICLE Chiotos K, Dutcher L, Grundmeier RW, Szymczak JE, Lautenbach E, Neuhauser MM, Hicks LA, Hamilton KW, Li Y, Muller BM, Meyahnwi D, Congdon M, Kane E, Hart J, Utidjian L, Cressman L, Jaskowiak-Barr A, Gerber JS. Off-target Impact of Clinician Feedback Reports on Antibiotic Use in Children With Medical Complexity Hospitalized With Community-Acquired Pneumonia. J Pediatric Infect Dis Soc. 2025 Oct 2;14(10):piaf089. doi: 10.1093/jpids/piaf089. PMID: 41051365. OTHER ARTICLES REFERENCED Chiotos K, Dutcher L, Grundmeier RW, Meyahnwi D, Lautenbach E, Neuhauser MM, Hicks LA, Hamilton KW, Li Y, Szymczak JE, Muller BM, Congdon M, Kane E, Hart J, Utidjian L, Cressman L, Jaskowiak-Barr A, Gerber JS. Impact of Clinician Feedback Reports on Antibiotic Use in Children Hospitalized With Community-acquired Pneumonia. Clin Infect Dis. 2025 Feb 24;80(2):263-270. doi: 10.1093/cid/ciae593. PMID: 39656188; PMCID: PMC12120840. Feudtner C, Feinstein JA, Zhong W, Hall M, Dai D. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr. 2014 Aug 8;14:199. doi: 10.1186/1471-2431-14-199. PMID: 25102958; PMCID: PMC4134331. TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/as/bgxn4mqgk45zjxhxpxgxf3px/Chiotos_and_Gerber_podcast_2-13-26 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. 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 Chiotos K, Gerber JS, Malik K. Evidence for Everyone: Studying Antibiotic Use for Pneumonia in Children With Medical Complexity. 2/2026. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/evidence-for-everyone-studying-antibiotic-use-for-pneumonia-in-children-with-medical-complexity.

Well, even though low dose aspirin has been recommended for the reduction of preeclampsia risk for many years, 2 controversies persist: 1. who should get it, and 2. the dose we should use. While the current US recommendation still focuses on 81 mg low dose aspirin, initiated after 12 weeks of gestation (based on risk factors), there's increased movement and growing data supporting both universal adoption and the higher dose of 162 mg. In this episode, we will briefly summarize brand new data out of UT Southwestern which was just published at the SMFM Annual Pregnancy meeting in Las Vegas. Listen in for details.1. https://www.smfm.org/news/new-studyroutine-aspirin-therapypreventsseverepreeclampsiainat-risk-populations2. ACOG CO 7433. The Effect of Aspirin on the Risk of Preeclampsia Based on the Fetal Medicine Foundation First Trimester Risk.4. Bujold E, Rolnik DL, Poon L, Syngelaki A, Wright D, Nicolaides KH. The effect of aspirin on the risk of preeclampsia based on the Fetal Medicine Foundation first-trimester risk. Am J Obstet Gynecol. 2025 Oct 31:S0002-9378(25)00808-7. doi: 10.1016/j.ajog.2025.10.032. Epub ahead of print. PMID: 41177290.

Chuck and Chris begin a new initiative working with The Journal of Hand Surgery on a quarterly journal club.  Nash and Macerena will choose the articles from the previous quarter and Chris and Chuck will review the articles and discuss practical implications.  This first episode includes discussion of the following articles from Q4 of 2025:Portney DA, Lee CP, Wolf JM, Strelzow JA, Stepan JG. A Changing Landscape in Surgical Treatment of Basilar Thumb Arthritis: Is the Rate of Denervation Increasing? J Hand Surg Am. 2025 Oct;50(10):1280.e1-1280.e8. PMID: 39918526.Earp BE, Zhang D, Benavent KA, Ostergaard PJ, Blazar PE. The Use of Telemedicine Postoperative Visits Following Carpal Tunnel and Trigger Digit Releases: A Randomized Clinical Trial. J Hand Surg Am. 2025 Dec;50(12):1431-1437. PMID: 41117725.Amen TB, Ibrahim LI, Gillinov SM, Torabian KA, Dean MC, Liimakka A, Lee SK. Glucagon-like peptide-1 Agonists and Common Hand Procedures: Perioperative and Postoperative Risks and Complications. J Hand Surg Am. 2025 Nov;50(11):1297-1303. PMID: 41055617.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

In this episode of the Epigenetics Podcast, we talked with Srinjan Basu from Imperial College London to talk about his work on how chromatin architecture and epigenetic mechanisms orchestrate developmental gene expression programs. We begin by exploring Dr. Basu's early work at Harvard which involved pioneering Raman-based label-free imaging, allowing the study of chromatin dynamics in live tissue. Here, he tackles technical challenges faced in visualizing DNA interactions, emphasizing the shift from 2D to 3D analysis and the importance of real-time observation of chromatin behavior under various conditions. This segues into his groundbreaking research on single transcription factors interacting with chromatin, revealing subtle but significant changes in the dynamics of gene regulation. We transition into the complexities of chromatin architecture as Dr. Basu recounts his efforts in mapping the entire mouse genome in single pluripotent cells, unearthing unexpected heterogeneity among cells. This heterogeneity raises intriguing questions about its impact on cellular function, prompting ongoing investigations into chromatin dynamics and the role of remodeling complexes like NuRD in cell fate transitions. Dr. Basu elucidates how recent studies have begun to bridge the gaps in understanding how transcription factors and chromatin dynamics interact during cellular decisions, particularly emphasizing the influence of mechanical signals and the intrinsic properties of cells. His research underscores the idea that stem cells undergo a preparatory phase for differentiation, highlighting the critical balance of intrinsic and extrinsic factors that govern genetic expression and cellular outcomes. We also talk about Dr. Basu's current research trajectory, focusing on enhancing imaging techniques to study gene dynamics in tissue contexts relevant to developmental biology and disease states. He illustrates a vision for future projects that integrate advanced imaging tools to investigate transcription factor dynamics and chromatin interactions in live cells and embryos, furthering the understanding of decision-making processes in cellular contexts. References Stevens TJ, Lando D, Basu S, et al. 3D structures of individual mammalian genomes studied by single-cell Hi-C. Nature. 2017 Apr;544(7648):59-64. DOI: 10.1038/nature21429. PMID: 28289288; PMCID: PMC5385134. Basu S, Needham LM, Lando D, et al. FRET-enhanced photostability allows improved single-molecule tracking of proteins and protein complexes in live mammalian cells. Nature Communications. 2018 Jun;9(1):2520. DOI: 10.1038/s41467-018-04486-0. PMID: 29955052; PMCID: PMC6023872. Related Episodes Advanced Optical Imaging in 3D Nuclear Organisation (Lothar Schermelleh) Analysis of 3D Chromatin Structure Using Super-Resolution Imaging (Alistair Boettiger) Single-Molecule Imaging of the Epigenome (Efrat Shema) Contact Epigenetics Podcast on Mastodon Epigenetics Podcast on Bluesky Dr. Stefan Dillinger on LinkedIn Active Motif on LinkedIn Active Motif on Bluesky Email: podcast@activemotif.com

90s nostalgia is everywhere right now, and it's not a random coincidence.In this episode, I explore the documentary In Search of Darkness 1995-1999 (2026) and the psychology of nostalgia. I talk about:How we define nostalgiaThe mental health benefits of nostalgiaHow nostalgia is particularly beneficial for those suffering with dementia or cognitive declineWhy we cling to nostalgia in times of change or uncertaintyWhen we need to be careful about over-indulging in nostalgiaThe three of cups and how this tarot card evokes nostalgic feelings for meMental Health is Horrifying is hosted by Candis Green, Registered Psychotherapist and owner of Many Moons Therapy...............................................................Show Notes:Want to work together? I offer 1:1 virtual psychotherapy for Ontario residents, along with tarot, horror, and dreamwork services (anywhere my bat signal reaches), both individually and through my group program, the Final Girls Club. Podcast artwork by Chloe Hurst at Contempo MintGet up to 20% Cozy Earth with promo code HORRIFYING. If you get a survey post-purchase, be sure to let them know Candis sent you! Get 20% off In Search of Darkness 1995-1999 with promo code HORRORFRIENDS26.Woods B, O'Philbin L, Farrell EM, Spector AE, Orrell M. Reminiscence therapy for dementia. Cochrane Database Syst Rev. 2018 Mar 1;3(3):CD001120. doi: 10.1002/14651858.CD001120.pub3. PMID: 29493789; PMCID: PMC6494367.Ismail S, Christopher G, Dodd E, Wildschut T, Sedikides C, Ingram TA, Jones RW, Noonan KA, Tingley D, Cheston R. Psychological and Mnemonic Benefits of Nostalgia for People with Dementia. J Alzheimers Dis. 2018;65(4):1327-1344. doi: 10.3233/JAD-180075. PMID: 30149444.

Send a textIn this episode of Journal Club, Ben and Daphna review a prospective cohort study from the Journal of Perinatology that examines the care of neonates following in-utero growth restriction. The hosts unpack the critical distinction between Fetal Growth Restriction (FGR) and Small for Gestational Age (SGA), highlighting how the "decay of information" in the NICU can lead clinicians to overlook early risk factors as babies grow. They discuss the study's alarming findings regarding the six-fold increased risk of Necrotizing Enterocolitis (NEC) in SGA infants and the importance of maintaining a comprehensive medical history throughout a patient's stay.----Care of neonates following in-utero growth restriction: A prospective cohort study exploring neonatal morbidity. Alda MG, Wood AG, MacDonald T, Charlton JK.J Perinatol. 2025 Sep;45(9):1219-1225. doi: 10.1038/s41372-025-02397-9. Epub 2025 Aug 21.PMID: 40841433 Free PMC article.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

In this week's nugget, Plant-Based Health Professionals' founder, Dr Shireen Kassam takes us through two recently published papers exploring what oncologists may and may not know about diet and cancer, the reasons for this, and what they tell their patients.Kassam S, Kassam Z, Nemirovsky D, et al. Oncologists Knowledge and Attitudes Towards Providing Dietary Guidance to Patients With Cancer. American Journal of Lifestyle Medicine. 2026;0(0). doi:10.1177/15598276251414349Patel A, Kassam S, Shah UA. Food for Thought: Addressing a Research Gap for Dietary Trials in Hematologic Malignancies. Blood Cancer Discov. 2025 Sep 3;6(5):406-411. doi: 10.1158/2643-3230.BCD-25-0141. PMID: 40778663; PMCID: PMC12405862.And please don't forget to rate, review and subscribe to the podcast, and share this episode with one other person today.If you'd like to support our work and be part of a growing community of like-minded people working towards creating a healthier and more sustainable future please join the Plant-Based Health Professionals UK following the link below:https://plantbasedhealthprofessionals.com/membershipYou don't have to be a health care professional to join, but by doing so you're not only supporting our work, you'll be improving your own health; with membership starting from as little as £15 a year, join us now and be part of the change you want to see.

There has been a shift in cervical cancer screening from primary cytology based to HPV based. Even HPV screening has had its evolution from physician collected samples to patient self-collection, either in a clinical setting or at home with an approved collection system. In May 2025, the FDA cleared the first at-home self-collection kit for HPV screening, specifically the Teal Wand by Teal Health. Now, we are seeing the advent of POSSIBLY another avenue for cervical HPV testing- although it is a bit awkward: the use of menstrual blood as an HPV screening test. In this episode we will review a new cross-sectional, population-based study from China which compared testing menstrual blood for human papillomavirus during cervical cancer screening to clinician-collected cervical samples for human papillomavirus (HPV). This concept, and these results, are not new at all! And there are important limitations to consider at this time. Listen in for details.1. Testing menstrual blood for human papillomavirus during cervical cancer screening in China: cross sectional population based study. BMJ 2026; 392 doi: https://doi.org/10.1136/bmj-2025-084831 (Published 04 February 2026)BMJ 2026;392:e084831https://www.bmj.com/content/392/bmj-2025-0848312. Naseri S, Young S, Cruz G, Blumenthal PD. Screening for High-Risk Human Papillomavirus Using Passive, Self-Collected Menstrual Blood. Obstet Gynecol. 2022 Sep 1;140(3):470-476. doi: 10.1097/AOG.0000000000004904. Epub 2022 Aug 3. PMID: 35926207; PMCID: PMC9377370.3. Fokom Domgue J, Chandra M, Oladoyin O, Desai M, Yu R, Shete S. Women's Preferences for Home-Based Self-Sampling or Clinic-Based Testing for Cervical Cancer Screening. JAMA Netw Open. 2026;9(2):e2558841. doi:10.1001/jamanetworkopen.2025.58841

Send a textIn this episode of Journal Club, Ben and Daphna review a non-inferiority trial from the European Journal of Pediatrics exploring surfactant administration thresholds in preterm neonates. The study, conducted in India, compares a 30% versus 40% FiO2 threshold for babies 26-32 weeks gestational age. The hosts break down the counterintuitive findings regarding respiratory support duration in younger subgroups and discuss the broader implications of using rigid FiO2 heuristics versus individualized patient assessment. They also debate how resource availability influences clinical protocols and the potential benefits of "LISA" (Less Invasive Surfactant Administration) for avoiding intubation.----Higher (40%) versus lower (30%) FiO2 threshold for surfactant administration in preterm neonates between 26 and 32 weeks of gestational age: a non-inferiority randomized controlled trial. Haq MI, Datta V, Bandyopadhyay T, Nangia S, Anand P, Murukesan VM.Eur J Pediatr. 2025 Nov 25;184(12):793. doi: 10.1007/s00431-025-06628-1.PMID: 41288797 Clinical Trial.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

How do you make an embryo stick? Is there anything you can do to improve embryo transfer success? And how do you know which advice is science-backed versus fertility folklore?  In this special solo Q&A episode of Brave & Curious, Dr. Lora Shahine answers the questions patients ask most often when preparing for an embryo transfer. What really matters during an IVF embryo transfer? Using real questions from Instagram, YouTube, and her own practice, she walks listeners through fresh vs. frozen embryo transfer, what happens on transfer day, whether you need a full bladder, lying down afterward, Valium use, pineapple cores, French fries, genetic testing, ERA testing, and how uterine lining preparation actually works. Listeners will come away with a clearer understanding of embryo transfer success rates, frozen embryo transfer protocols, and implantation timing, and get their real questions answered. In this episode you'll hear: [1:27] What should I expect on transfer day? [8:00] What happens post-transfer? [9:35] Funny myths: pineapple cores & McDonalds french fries [13:46] Fresh vs. frozen transfer myths [20:18] Pre-transfer testing and ERA [24:37] Natural vs. medicated transfer protocols [28:30] Conclusion & final thoughts Links and Resources: Embryo Transfer: What to Expect on YouTube Does the Embryo Fall Out: Embryo Transfer Tips on YouTube Fresh vs. Frozen Transfers: Pros and Cons on YouTue Studies Mentioned: Randomized Controlled Trial for FET Protocols: PMID: 38944045 Retrospective analysis Perinatal Outcomes with FET protocols PMID:33926401 Randomized Controlled Trial for ERA before FET PMID: 36472596 Randomized Controlled Trial Bedrest after embryo transfer: PMID:31520259 Dr. Shahine's Weekly Newsletter on Fertility News and Recommendations Follow @drlorashahine Instagram | YouTube | Tiktok | Her Books

This week’s Pulm PEEPs Pearls episode is all about spontaneous breathing trials (SBTs). SBTs are a standard part of the daily practice in the intensive care unit, but the exact methods vary across ICUs and institutions. Listen in to hear about the most common methods of SBTs, the physiology of each method, and what the evidence says. Contributors This episode was prepared with research by Pulm PEEPs Associate Editor George Doumat. Dustin Latimer, another Pulm PEEPs Associate Editor, assisted with audio and video editing. Key Learning Points What an SBT is really testing An SBT is a stress test for post-extubation work of breathing, not just a ventilator check. The goal is to balance sensitivity and specificity: Too hard → unnecessary failures and delayed extubation Too easy → false positives and higher risk of reintubation Common SBT modalities and how they compare T-piece No inspiratory support and no PEEP Highest work of breathing Most “physiologic” but often too strict Pressure support (PS) + PEEP (e.g., 5/5 or 8/5) Offsets ETT resistance and provides modest assistance Easier to pass than T-piece CPAP (0/5) No inspiratory help, but provides PEEP to counter ETT resistance Sits between PS and T-piece in difficulty Evidence favors pressure-supported SBTs for most patients Large meta-analysis (~6,000 patients, >40 RCTs): Pressure-supported SBTs increase successful extubation (~7% absolute benefit) No increase in reintubation rates Trials (e.g., FAST trial): Patients pass SBTs earlier Leads to earlier extubation and fewer ventilator-associated risks Bottom line: A 30-minute PS 5/5 SBT is evidence-based and appropriate for most stable ICU patients When a T-piece still makes sense T-piece SBTs are useful when: Cost of reintubation is high Difficult airway Prior failed extubation Pretest probability of success is low Prolonged or difficult weaning Tracheostomy vs extubation decisions Need to mimic physiology without positive pressure In LV dysfunction or pulmonary edema even small amounts PEEP may significantly improve physiology Some centers use a hybrid approach: PS SBT → short confirmatory T-piece before extubation CPAP as a middle ground Rationale: Allows full patient effort while compensating for ETT resistance Evidence: Fewer and smaller trials Possible modest improvement in extubation success No clear mortality or LOS benefit Reasonable option based on patient physiology, institutional protocols, and clinician comfort No single “perfect” SBT mode Across PS, T-piece, CPAP, and newer methods (e.g., high-flow via ETT) there are no consistent differences in mortality or length of stay What matters most: Daily protocolized screening Thoughtful bedside clinical judgment Matching SBT difficulty to patient-specific risk Institutional variation is normal—and acceptable Examples: PS 10/5 in postoperative surgical ICU patients PS 5/0 as an intermediate difficulty option Key question clinicians should ask: What does passing or failing this specific SBT tell me about this patient's likelihood of post-extubation success? Take-home pearls SBTs are stress tests of post-extubation physiology. PS 5/5 for 30 minutes is a strong default for most ICU patients. T-piece trials are valuable when false positives are costly or physiology demands it. CPAP is reasonable but supported by less robust data. Consistency, daily screening, and judgment matter more than the exact mode. References and Further Reading Burns KEA, Khan J, Phoophiboon V, Trivedi V, Gomez-Builes JC, Giammarioli B, Lewis K, Chaudhuri D, Desai K, Friedrich JO. Spontaneous Breathing Trial Techniques for Extubating Adults and Children Who Are Critically Ill: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2024 Feb 5;7(2):e2356794. doi: 10.1001/jamanetworkopen.2023.56794. PMID: 38393729; PMCID: PMC10891471. Burns KEA, Sadeghirad B, Ghadimi M, Khan J, Phoophiboon V, Trivedi V, Gomez Builes C, Giammarioli B, Lewis K, Chaudhuri D, Desai K, Friedrich JO. Comparative effectiveness of alternative spontaneous breathing trial techniques: a systematic review and network meta-analysis of randomized trials. Crit Care. 2024 Jun 8;28(1):194. doi: 10.1186/s13054-024-04958-4. PMID: 38849936; PMCID: PMC11162018. Subirà C, Hernández G, Vázquez A, Rodríguez-García R, González-Castro A, García C, Rubio O, Ventura L, López A, de la Torre MC, Keough E, Arauzo V, Hermosa C, Sánchez C, Tizón A, Tenza E, Laborda C, Cabañes S, Lacueva V, Del Mar Fernández M, Arnau A, Fernández R. Effect of Pressure Support vs T-Piece Ventilation Strategies During Spontaneous Breathing Trials on Successful Extubation Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial. JAMA. 2019 Jun 11;321(22):2175-2182. doi: 10.1001/jama.2019.7234. Erratum in: JAMA. 2019 Aug 20;322(7):696. doi: 10.1001/jama.2019.11119. PMID: 31184740; PMCID: PMC6563557. Burns KEA, Wong J, Rizvi L, Lafreniere-Roula M, Thorpe K, Devlin JW, Cook DJ, Seely A, Dodek PM, Tanios M, Piraino T, Gouskos A, Kiedrowski KC, Kay P, Mitchell S, Merner GW, Mayette M, D’Aragon F, Lamontagne F, Rochwerg B, Turgeon A, Sia YT, Charbonney E, Aslanian P, Criner GJ, Hyzy RC, Beitler JR, Kassis EB, Kutsogiannis DJ, Meade MO, Liebler J, Iyer-Kumar S, Tsang J, Cirone R, Shanholtz C, Hill NS; Canadian Critical Care Trials Group. Frequency of Screening and Spontaneous Breathing Trial Techniques: A Randomized Clinical Trial. JAMA. 2024 Dec 3;332(21):1808-1821. doi: 10.1001/jama.2024.20631. PMID: 39382222; PMCID: PMC11581551. Mahul M, Jung B, Galia F, Molinari N, de Jong A, Coisel Y, Vaschetto R, Matecki S, Chanques G, Brochard L, Jaber S. Spontaneous breathing trial and post-extubation work of breathing in morbidly obese critically ill patients. Crit Care. 2016 Oct 27;20(1):346. doi: 10.1186/s13054-016-1457-4. PMID: 27784322; PMCID: PMC5081985. Yi LJ, Tian X, Chen M, Lei JM, Xiao N, Jiménez-Herrera MF. Comparative Efficacy and Safety of Four Different Spontaneous Breathing Trials for Weaning From Mechanical Ventilation: A Systematic Review and Network Meta-Analysis. Front Med (Lausanne). 2021 Nov 22;8:731196. doi: 10.3389/fmed.2021.731196. PMID: 34881255; PMCID: PMC8647911.​

In this research review, we are highlighting what Greg Nuckols has put together around the impact of sleep (or lack of it) on strength. The two studies below look at how sleep impacts strength and the findings weren't quite as big as you might have thought. We discuss what this means, how it applies and how you still want to focus on sleep to make sure it is a priority but also that you can still get work done if you fall short on any given night.1. Craven J, McCartney D, Desbrow B, Sabapathy S, Bellinger P, Roberts L, Irwin C. Effects of Acute Sleep Loss on Physical Performance: A Systematic and Meta-Analytical Review. Sports Med. 2022 Jun 16. doi: 10.1007/s40279-022-01706-y. Epub ahead of print. PMID: 35708888.2. Knowles OE, Drinkwater EJ, Urwin CS, Lamon S, Aisbett B. Inadequate sleep and muscle strength: Implications for resistance training. J Sci Med Sport. 2018 Sep;21(9):959-968. doi: 10.1016/j.jsams.2018.01.012. Epub 2018 Feb 2. PMID: 29422383. #complicatedsimple #progressive #openminded #PBE #EBP #noagenda #performance #training #nutrition #health #wellness #athlete #athletictraining #science #chiropractic #rehab #prevention #clinicallypressed #phd

Contributor: Alec Coston, MD Educational Pearls: Disclaimer: this has nothing to do with the ER but is too cool to not talk about. Condition: Carbamoyl phosphate synthetase 1 (CPS1) deficiency Rare inborn error of metabolism Inability to properly break down ammonia Leads to severe hyperammonemia and hepatic encephalopathy Natural history: Without treatment, typically fatal within the first few weeks of life Even with current standard treatments, life expectancy is often limited to ~5–6 years Breakthrough treatment: A team of researchers at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania developed the CRISPR-based targeted gene therapy for this patient. First-of-its-kind precision approach tailored to the patient's specific mutation Key components of the therapy: Whole-genome sequencing to identify the exact CPS1 mutation Creation of a custom base-editing enzyme designed to correct that specific mutation Design of a guide RNA to direct the base editor to the precise genomic location Delivery method: Lipid nanoparticles used to deliver the gene-editing machinery Nanoparticles can be targeted to specific tissues Why the liver works well: CPS1 is primarily expressed in hepatocytes The liver is relatively easy to target with lipid nanoparticles Hepatocytes divide frequently, allowing edited genes to be passed on as cells replicate Long-term impact: Once edited, cells continue producing functional CPS1 enzyme Potential for durable, possibly lifelong correction from a single treatment References https://www.nih.gov/news-events/news-releases/infant-rare-incurable-disease-first-successfully-receive-personalized-gene-therapy-treatment Choi Y, Oh A, Lee Y, Kim GH, Choi JH, Yoo HW, Lee BH. Unfavorable clinical outcomes in patients with carbamoyl phosphate synthetase 1 deficiency. Clin Chim Acta. 2022 Feb 1;526:55-61. doi: 10.1016/j.cca.2021.11.029. Epub 2021 Dec 29. PMID: 34973183. Bharti N, Modi U, Bhatia D, Solanki R. Engineering delivery platforms for CRISPR-Cas and their applications in healthcare, agriculture and beyond. Nanoscale Adv. 2026 Jan 5. doi: 10.1039/d5na00535c. Epub ahead of print. PMID: 41640466; PMCID: PMC12865601. Summarized and edited by Jeffrey Olson MS4 Donate: https://emergencymedicalminute.org/donate/ Join our mailing list: http://eepurl.com/c9ouHf

In this episode host, Erin Gallardo, PT, DPT, NCS speaks with Chris McElderry, PT, DPT, NCS about how dry needling can be used in neuro rehab, particularly for people post-stroke. Chris explains why he pursued dry needling, how using it in PT differs from acupuncture, and walks through what a typical session looks like, including safety, side effects, and billing considerations. He shares clinical examples of using dry needling to address spasticity, hypertonicity, pain, and range of motion limitations, and discusses current research on short-term effects for spasticity and pain reduction. Erin and Chris also clarify the differences between spasticity and hypertonicity, touch on contracture management, and highlight where dry needling can be a useful adjunct—not a standalone cure—in helping neuro clients move and feel better. Follow Chris McElderry, PT, DPT, NCS @theneuroguy_dpt  Ebrahimzadeh M, Nakhostin Ansari N, Abdollahi I, Akhbari B, Dommerholt J. Changes in Corticospinal Tract Consistency after Dry Needling in a Stroke Patient. Case Rep Neurol Med. 2024 Sep 14;2024:5115313. doi: 10.1155/2024/5115313. PMID: 39309410; PMCID: PMC11416164. Fakhari Z, Ansari NN, Naghdi S, Mansouri K, Radinmehr H. A single group, pretest-posttest clinical trial for the effects of dry needling on wrist flexors spasticity after stroke. NeuroRehabilitation. 2017;40(3):325-336. doi: 10.3233/NRE-161420. PMID: 28222554. Fernández-de-Las-Peñas C, Pérez-Bellmunt A, Llurda-Almuzara L, Plaza-Manzano G, De-la-Llave-Rincón AI, Navarro-Santana MJ. Is Dry Needling Effective for the Management of Spasticity, Pain, and Motor Function in Post-Stroke Patients? A Systematic Review and Meta-Analysis. Pain Med. 2021 Feb 4;22(1):131-141. doi: 10.1093/pm/pnaa392. PMID: 33338222. Núñez-Cortés R, Cruz-Montecinos C, Vásquez-Rosales P, et al. Effectiveness of dry needling in the treatment of spasticity in stroke patients: A systematic review. J Body Mov Ther. 2020;24(3):113-122. Suputtitada A, et al. Emerging theory of sensitization in post-stroke muscle spasticity: Implications for dry needling and other interventions. Front Rehabil Sci. 2023;4:1169087. Valencia-Chulián R, Heredia-Rizo AM, Moral-Munoz JA, Lucena-Anton D, Luque-Moreno C. Dry needling for the management of spasticity, pain, and range of movement in adults after stroke: A systematic review. Complement Ther Med. 2020 Aug;52:102515. doi: 10.1016/j.ctim.2020.102515. Epub 2020 Jul 16. PMID: 32951759.

Well podcast family, we are back with another installment of our “You ask, We answer” edition. We've got 2 fascinating and real-world clinical conundrums in this episode, both suggested by two separate podcast family members. The first has to do with RH IG maternal administration. Here's the question: If a patient receives routine, prophylactic RH IG at 28 weeks but then has maternal trauma say 1 or 2 weeks after, does she still require an additional dose of RH IG? That's a good question because it's not as intuitive as you would think. We will explain in this episode and there is a bit of a contradiction in the guidance. The second question has to do with finding an asymptomatic uterine rupture at cesarean section. Is there such a thing as a “partial” (silent) uterine rupture? There's recent data from 2025 about this. Listen in for details.1. ACOG PB 181; 2017. 2. Baek S, Froese V, Morgenstern B. Risk Profiles and Outcomes of Uterine Rupture: A Retrospective and Comparative Single-Center Study of Complete and Partial Ruptures. J Clin Med. 2025 Jul 15;14(14):4987. doi: 10.3390/jcm14144987. PMID: 40725680; PMCID: PMC12295210.3. Vandenberghe G, Bloemenkamp K, Berlage S, Colmorn L, Deneux-Tharaux C, Gissler M, Knight M, Langhoff-Roos J, Lindqvist PG, Oberaigner W, Van Roosmalen J, Zwart J, Roelens K; INOSS (the International Network of Obstetric Survey Systems). The International Network of Obstetric Survey Systems study of uterine rupture: a descriptive multi-country population-based study. BJOG. 2019 Feb;126(3):370-381. doi: 10.1111/1471-0528.15271. Epub 2018 Jun 12. PMID: 29727918.

In this episode of "PICU Doc on Call," Drs. Pradip Kamat and Rahul Damania dive into a pediatric ICU case involving a 4-year-old girl who presents with severe anemia and bleeding, ultimately diagnosed with von Willebrand disease (VWD). They chat about the causes and different types of VWD, walk through the key clinical features, and break down how to diagnose and manage this condition. Drs. Kamat and Damania highlight the important roles of desmopressin and factor concentrates in treatment. Throughout the episode, they stress the need to recognize VWD in kids who have mucosal bleeding and offer practical tips for intensivists on lab evaluation and treatment strategies for this common inherited bleeding disorder.Show Nighlights: Clinical case discussion of a 4-year-old girl with severe anemia and bleeding symptomsDiagnosis of von Willebrand disease (VWD) and its significance in pediatric critical careEtiology and pathogenesis of von Willebrand diseaseClassification of von Willebrand disease into types (Type 1, Type 2 with subtypes, Type 3)Clinical manifestations and symptoms associated with VWDDiagnostic approach for identifying von Willebrand disease, including laboratory testsManagement strategies for VWD, including desmopressin and von Willebrand factor concentratesRole of adjunctive therapies such as antifibrinolytics and hormonal treatmentsImportance of multidisciplinary collaboration in managing complex bleeding disordersOverview of the pathophysiology of von Willebrand factor and its role in hemostasisReferences:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter ***.Reference 1: Leebeek FW, Eikenboom JC. Von Willebrand's Disease. N Engl J Med. 2016 Nov 24;375(21):2067-2080.Reference 2: Ng C, Motto DG, Di Paola J. Diagnostic approach to von Willebrand disease. Blood. 2015 Mar 26;125(13):2029-37.Platton S, Baker P, Bowyer A, et al. Guideline for laboratory diagnosis and monitoring of von Willebrand disease: A joint guideline from the United Kingdom Haemophilia Centre Doctors' Organisation and the British Society for Hematology. Br J Haematol 2024 May;204(5):1714-1731.Mohinani A, Patel S, Tan V, Kartika T, Olson S, DeLoughery TG, Shatzel J. Desmopressin as a hemostatic and blood-sparing agent in bleeding disorders. Eur J Haematol. 2023 May;110(5):470-479. doi: 10.1111/ejh.13930. Epub 2023 Feb 12. PMID: 36656570; PMCID: PMC10073345.

Unlike most of our episodes, this episode isn't filled with practical tips that we want you to implement in your training. Instead, we're taking you into the science and practice of elite runner training. You'll learn about how they structure their training volume and intensity, the crucial training components they don't skip, and more!Thank you to our sponsors:✨ Amazfit: User-friendly simple running watches with advanced features, at an affordable price point. Use link http://bit.ly/4nai73H for 10% off your purchase.✨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.✨Join us on Patreon.com/treadlightlyrunning or subscribe on Apple Podcasts for special subscriber-only content!In this episode, you'll learn:✅ How elite runners find financial support for their training✅ Why elite runners train in groups✅ The crucial training component that elites include (and recreational runners often skip)✅ How many miles/hours per week do elite runners train?✅ Elite runner training intensity and sample workoutsReferences

Nurses are the backbone of patient care, but their role in antibiotic and diagnostic stewardship is still underrecognized. In this episode of The SHEA Podcast, host Dr. Marisa Holubar is joined by Dr. Eileen Carter and Dr. David Ha to explore why nurses are essential to stewardship success. Together, they discuss the evidence behind nursing engagement, persistent barriers to involvement, and real-world examples where nurse-led initiatives have reduced antibiotic use, infections, and waste. From IV-to-PO transitions to penicillin allergy assessment and diagnostic stewardship, this conversation offers practical strategies for engaging nurses, leveraging shared governance, and building stronger, more effective stewardship programs across care settings. References: Thurman Johnson C, Ridge LJ, Hessels AJ. Nurse Engagement in Antibiotic Stewardship Programs: A Scoping Review of the Literature. J Healthc Qual. 2023 Mar-Apr 01;45(2):69-82. doi: 10.1097/JHQ.0000000000000372. Epub 2022 Dec 12. PMID: 36729679; PMCID: PMC9991980. Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and Management of Penicillin Allergy: A Review. JAMA. 2019 Jan 15;321(2):188-199. doi: 10.1001/jama.2018.19283. PMID: 30644987. Carter EJ, Schramm C, Baron K, Zolla MM, Zavez K, Banach DB. Perceived usefulness of a mnemonic to improve nurses' evaluation of reported penicillin allergies. Antimicrob Steward Healthc Epidemiol. 2023 Jul 11;3(1):e124. doi: 10.1017/ash.2023.177. PMID: 37502243; PMCID: PMC10369439. Carter EJ, Zavez K, Schramm C, Zolla MM, Baron K, Banach DB. Multifaceted implementation strategy to improve the evaluation of penicillin allergies in perioperative patients: a pre-post feasibility implementation study. Infect Control Hosp Epidemiol. 2024 Oct 30;45(12):1-7. doi: 10.1017/ice.2024.119. Epub ahead of print. PMID: 39473231; PMCID: PMC11663472. Resources: ANCC Magnet Recognition Program: https://www.nursingworld.org/organizational-programs/magnet/ Breakpoints, The SIDP Podcast: https://breakpoints-sidp.org/18-waking-the-sleeping-giant-engaging-nurses-in-antimicrobial-stewardship/

Fetal Microcephaly has an incidence of 2 to 12 in10,000 births in the USA and can be diagnosed prenatally via ultrasound (in second or early third trimester) or postnatally via measurement of head circumference (HC).  Antepartum, this is a unique diagnosis since we are mainly used to using PERCENTAGES for biometrics and for fetal weight, butmicrocephaly is not diagnosed by HC percentage- but by Standard Deviation (SD). Microcephaly has been linked to developmental delay, seizures, as well as feeding, vision and hearing problems.  Prognosis depends on the severityof the microcephaly and whether it is associated with other anomalies. What SD is diagnostic of microcephaly? What are the potential etiologies? What genetic syndromes are most associated with true microcephaly? Is fetal cranial MRIrecommended? Listen in for details. 1.     Sukenik-Halevy R, Golbary Kinory E, Laron KenetT, Brabbing-Goldstein D, Gilboa Y, Basel-Salmon L, Perlman S. Prenatalgender-customized head circumference nomograms result in reclassification ofmicrocephaly and macrocephaly. AJOG Glob Rep. 2023 Jan 29;3(1):100171. doi:10.1016/j.xagr.2023.100171. PMID: 36864987; PMCID: PMC9972400.2.     SOGC CO (2019) No. 380-Investigation andManagement of Prenatally Identified Microcephaly3.     Fetal Medicine Foundation: Microcephaly; https://fetalmedicine.org/education/fetal-abnormalities/brain/microcephaly

🧭 REBEL Rundown 📌 Key Points 💨 HFNC met criteria for non-inferiority to BPAP for preventing intubation or death within 7 days in four of the five ARF subgroups.🧪 Bayesian dynamic borrowing increased power across subgroups but created variable certainty, especially in smaller groups such as COPD.🫁 The immunocompromised hypoxemia subgroup did not meet non-inferiority, leading to early trial stopping for futility.️ Rescue BPAP use, subgroup-specific exclusion criteria, and non-standardized BPAP delivery are important contextual factors that influence how subgroup results should be interpreted. Click here for Direct Download of the Podcast. 📝 Introduction Bilevel Positive Airway Pressure (BPAP) has long been a foundational modality in the management of acute respiratory failure (ARF), particularly in COPD exacerbations and cardiogenic pulmonary edema, where it can rapidly reduce work of breathing and improve gas exchange. It remains a core tool in our respiratory support arsenal.High-flow nasal cannula (HFNC), however, has expanded what we can offer patients by delivering many of the same physiologic benefits through a far more comfortable interface. With high flows, modest PEEP, and effective dead-space washout, HFNC can improve oxygenation and decrease work of breathing while preserving the ability to talk, cough, eat, and interact with staff and family. This combination of physiologic support and tolerability makes HFNC especially attractive in patients where comfort, anxiety, or cardiovascular stability are key considerations, and in settings where prolonged noninvasive support may be needed. Rather than competing with BPAP, HFNC broadens our options in ARF and allows us to better match the modality to the patient and their underlying disease process.The RENOVATE trial set out to answer a high-impact question across five distinct etiologic groups: Is HFNC non-inferior to BPAP (NIV) for preventing intubation or death in acute respiratory failure? 🧾 Paper Azoulay É, et al. High-Flow Nasal Oxygen vs Noninvasive Ventilation in Patients With Acute Respiratory Failure: The RENOVATE Randomized Clinical Trial. JAMA. 2025 PMID: 39657981 🔙Previously Covered On REBEL: HFNC: Part 1 – How It WorksHFNC: Part 2 – Adult and Pediatric IndicationsFLORALI and AVOID TrialFLORALI-2: NIV vs HFNC as Pre-Oxygenation Prior to IntubationThe Pre-AeRATE Trial – HFNC vs NC for RSI ️ What They Did CLINICAL QUESTION Is HFNC non-inferior to BPAP for rate of endotracheal intubation or death at 7 days in patients with acute respiratory failure due to a variety of causes? STUDY DESIGN Multicenter, randomized non-inferiority trial33 Brazilian hospitalsNov 2019 – Nov 2023Adaptive Bayesian hierarchical modeling with dynamic borrowingOpen label, outcome adjudicators blindedPatients were classified into 5 subgroups SUBGROUPS 1. Non-immunocompromised hypoxemiaSpO₂ < 90% on room air orPaO₂ < 60 mm Hg on room air plusIncreased respiratory effort (accessory muscle use, paradoxical breathing, thoracoabdominal asynchrony) orRespiratory rate > 25 breaths/min2. Immunocompromised hypoxemiaDefined as:Use of immunosuppressive drugs for >3 monthsOR high-dose steroids >0.5 mg/kg/dayOR solid organ transplantOR solid tumors or hematologic malignancies (past 5 years)OR HIV with AIDS / primary immunodeficiency3. COPD exacerbation with acidosisHigh clinical suspicion of COPD as primary diagnosisRR >25 with accessory muscle use, paradoxical breathing, and/or thoracoabdominal asynchronyABG: pH 454. Acute cardiogenic pulmonary edema (ACPE)Sudden onset dyspnea and rales± S3 heart soundNo evidence of aspiration, infection, or pulmonary fibrosisCXR consistent with pulmonary edema5. Hypoxemic COVID-19 (added June 2023)Added due to deviations between expected and observed outcome proportionsAny patient across the other 4 groups with PCR-confirmed SARS-CoV-2 infection in any of the above groups POPULATION Inclusion Criteria:≥18 yrs with ARF* in one of 5 pre-defined subgroups excluding COPD was defined by the following:Hypoxemia with SpO₂

How are hospitals using AI and HPC to assist them in helping save lives? This week, Technology Now is joined by Keith Perry, Senior Vice President and Chief Information Officer at St. Jude Children's Research Hospital to explore how St Jude uses the latest technologies to help treat and prevent illness and catastrophic disease, giving patients and families more time, and more hope, when it comes to diagnosis.This is Technology Now, a weekly show from Hewlett Packard Enterprise. Every week, hosts Michael Bird and Sam Jarrell look at a story that's been making headlines, take a look at the technology behind it, and explain why it matters to organizations.About Keith:https://www.linkedin.com/in/keith-perry-8562347/Sources:Hernigou P. Ambroise Paré III: Paré's contributions to surgical instruments and surgical instruments at the time of Ambroise Paré. Int Orthop. 2013 May;37(5):975-80. doi: 10.1007/s00264-013-1872-y. Epub 2013 Apr 12. PMID: 23580029; PMCID: PMC3631503.https://www.surgicalholdings.co.uk/history-of-surgical-instruments.htmlSmith-Bindman R, Kwan ML, Marlow EC, et al. Trends in Use of Medical Imaging in US Health Care Systems and in Ontario, Canada, 2000-2016. JAMA. 2019;322(9):843–856. doi:10.1001/jama.2019.11456https://caferoentgen.com/2023/10/07/a-tale-of-two-hands-the-story-behind-the-two-famous-radiographs-captured-by-wilhelm-roentgen/https://www.orau.org/health-physics-museum/collection/shoe-fitting-fluoroscope/index.html

Contributors: Travis Barlock MD, Ian Gillman PA, Jacob Altholz MD, Jeffrey Olson MS4 In this episode, EM attending Travis Barlock and medical student Jeffrey Olson listen in to the two remaining cases presented from EMM's recent event, Tox Talk 2025.  Talk 1- Methemoglobinemia- Ian Gillman Cyanosis + chocolate-colored blood + normal PaO₂ + pulse ox stuck at ~85% = Methemoglobinemia → Treat with methylene blue The medications that can cause it can be remembered with… Watch out with methylene blue as it can cause serotonin syndrome While treating with methylene blue the pulse ox can drop dramatically but this is not a real drop in oxygenation but rather an effect of how the methylene blue affects the sensor BADNAPS: causes of methemoglobinemia Benzocaine Aniline Dyes Dapsone Nitrites/Nitrates (Found in meds, preservatives, and well water) Antimalarials Pyridium Sulfonamides Talk 2- Intratecal TXA and Hierarchy of Controls for Error Avoidance - Jacob Altholz Hierarchy of Controls in terms of error prevention includes all of the layers of protection which can be categorized as elimination, substitution, engineering controls, administration controls, and PPE References Centers for Disease Control and Prevention. (2022, April 28). Hierarchy of controls. National Institute for Occupational Safety and Health. https://www.cdc.gov/niosh/learning/safetyculturehc/module-3/2.html Pushparajah Mak RS, Liebelt EL. Methylene Blue: An Antidote for Methemoglobinemia and Beyond. Pediatr Emerg Care. 2021 Sep 1;37(9):474-477. doi: 10.1097/PEC.0000000000002526. PMID: 34463662. Produced by Jeffrey Olson, MS4 Donate: https://emergencymedicalminute.org/donate/ Join our mailing list: http://eepurl.com/c9ouHf

This episode of EM Pulse dives into one of the most stressful scenarios in the ED: the febrile infant in the first month of life. Traditionally, a fever in this age group has meant an automatic “full septic workup,” including the dreaded lumbar puncture (LP). But times are changing. We sit down with experts Dr. Nate Kuppermann and Dr. Brett Burstein to discuss a landmark JAMA study that suggests we might finally be able to safely skip the LP in many of our tiniest patients. The Study: A Game Changer for Neonates Our discussion centers on a massive international pooled study evaluating the PECARN Febrile Infant Rule specifically in infants aged 0–28 days. While previous guidelines were conservative due to a lack of data for this specific age bracket, this study provides the evidence we've been waiting for. The Cohort: A large pool of infants across multiple countries. The Findings: The PECARN rule demonstrated an exceptionally high negative predictive value for invasive bacterial infections. The Big Win: The rule missed zero cases of bacterial meningitis. Defining the Danger: SBI vs. IBI The experts break down why we are shifting our terminology and our clinical focus. Serious Bacterial Infection (SBI)  Historically, this was a “catch-all” term including Urinary Tract Infections (UTIs), bacteremia, and meningitis. However, UTIs are generally more common, easily identified via urinalysis, and typically less life-threatening than the other two. Invasive Bacterial Infection (IBI)  This term refers specifically to bacteremia and bacterial meningitis. These are the “high-stakes” infections the PECARN rule is designed to rule out. Dr. Kuppermann notes that we should ideally view bacteremia and meningitis as distinct entities, as the clinical implications of a missed meningitis case are far more severe. The HSV Elephant in the Room One of the primary reasons clinicians hesitate to skip an LP in a neonate is the fear of missing Herpes Simplex Virus (HSV) infection. Low Baseline Risk: While the overall risk of HSV in a febrile infant is low, the risk of “isolated” HSV (meningitis without other signs or symptoms) is even rarer. Screening Tools: Most infants with HSV appear clinically ill. Clinicians can also use ALT (liver function) testing as a secondary screen – transaminase elevation is a common marker for systemic HSV. Clinical Judgment: If the baby is well-appearing, has no maternal history of HSV, no vesicles, and no seizures, the risk of missing HSV by skipping the LP is exceptionally low. Practical Application: Shared Decision-Making This isn’t just about the numbers—it’s about the parents. “Families don’t mind their babies being admitted… They do not want the lumbar puncture. It is the single most anxiety-provoking aspect of care.” — Dr. Brett Burstein The PECARN “Low-Risk” Criteria:  (Remember, this rule applies only to infants who are not ill-appearing.) Urinalysis: Negative Absolute Neutrophil Count (ANC): ≤ 4,000/mm³ Procalcitonin (PCT): ≤ 0.5 ng/mL The Bottom Line: If an infant is well-appearing and meets these criteria, physicians can have a nuanced conversation with parents about the risks and benefits of forgoing the LP, while still admitting the child for observation (often without empiric antibiotics) while cultures brew. Key Takeaways The “Well-Appearing” Filter: If an infant looks ill, the rule does not apply. These patients require a full workup, including an LP, regardless of lab results. Meticulous Physical Exam: Assess for a strong suck, normal muscle tone, brisk capillary refill, and any rashes or vesicles. History is Key: Always ask about maternal GBS/HSV status, pregnancy or birth complications, prematurity, sick contacts, and any changes in feeding, stooling or activity. Procalcitonin: PCT is the superior inflammatory marker for this rule. If your facility only offers traditional markers like CRP, the PECARN negative predictive value cannot be strictly applied. In the words of Dr. Kuppermann: “If you don’t have it, for God’s sakes, just get it! ALT to Screen for HSV: While not part of the official PECARN rule, our experts suggest that significantly elevated liver enzymes should raise suspicion for systemic HSV. Observe, Don’t Discharge: Being “low risk” does not mean the infant goes home. All infants ≤ 28 days still require admission for 24-hour observation and blood/urine cultures. We want to hear from you! Does this change how you approach febrile neonates in the ED? How do you handle shared decision-making with parents? Connect with us on social media @empulsepodcast or on our website ucdavisem.com. Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Dr. Nate Kuppermann, Executive Vice President and Chief Academic Officer; Director, Children’s National Research Institute; Department Chair, Pediatrics, George Washington University School of Medicine and Health Sciences Dr. Brett Burstein, Clinician-Scientist and Pediatric Emergency Medicine Physician at Montreal Children’s Hospital, McGill University Resources: Burstein B, Waterfield T, Umana E, Xie J, Kuppermann N. Prediction of Bacteremia and Bacterial Meningitis Among Febrile Infants Aged 28 Days or Younger. JAMA. 2026 Feb 3;335(5):425-433. doi: 10.1001/jama.2025.21454. PMID: 41359314; PMCID: PMC12687207“Hot” Off the Press: Infant Fever Rule “Hot” Off the Press: Infant Fever Rule Do I really need to LP a febrile infant with a UTI? PECARN Infant Fever Update: 61-90 Days Kuppermann N, Dayan PS, Levine DA, Vitale M, Tzimenatos L, Tunik MG, Saunders M, Ruddy RM, Roosevelt G, Rogers AJ, Powell EC, Nigrovic LE, Muenzer J, Linakis JG, Grisanti K, Jaffe DM, Hoyle JD Jr, Greenberg R, Gattu R, Cruz AT, Crain EF, Cohen DM, Brayer A, Borgialli D, Bonsu B, Browne L, Blumberg S, Bennett JE, Atabaki SM, Anders J, Alpern ER, Miller B, Casper TC, Dean JM, Ramilo O, Mahajan P; Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN). A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatr. 2019 Apr 1;173(4):342-351. doi: 10.1001/jamapediatrics.2018.5501. PMID: 30776077; PMCID: PMC6450281. Pantell RH, Roberts KB, Adams WG, Dreyer BP, Kuppermann N, O’Leary ST, Okechukwu K, Woods CR Jr; SUBCOMMITTEE ON FEBRILE INFANTS. Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics. 2021 Aug;148(2):e2021052228. doi: 10.1542/peds.2021-052228. Epub 2021 Jul 19. Erratum in: Pediatrics. 2021 Nov;148(5):e2021054063. doi: 10.1542/peds.2021-054063. PMID: 34281996. ****Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.  

Stress fractures are common injuries in athletes and military recruits, that's' understandable- based on the physical forces placed on the long bones. A stress fracture can be defined as a partial or complete fracture of the bone that is a result from repeated application of stress lower than that required to fracture the bone in a single loading situation. In pregnancy, the body is subjected to various physiological changes that make women more vulnerable. In this pregnancy, we will highlight a REAL patient case which our team cared for on the inpatient service where a simple cough at 34 weeks leads to a painful spontaneous rib fracture! Is there any data published on this? Are serum tests for bone turn-over required as part of this workup? Listen in for clinical pearls!1. 1962: Long A.E.: “Stress fracture of the ribs associated with pregnancy”. Surg. Clin. North Am., 1962, 42, 909.2. 2000: Baitner AC, Bernstein AD, Jazrawi AJ, Della Valle CJ, Jazrawi LM. Spontaneous rib fracture during pregnancy. A case report and review of the literature. Bull Hosp Jt Dis. 2000;59(3):163-5. PMID: 11126720. https://pubmed.ncbi.nlm.nih.gov/11126720/3. 2015: Rib stress fractures in pregnancy: a case report and review of literature. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/file:///C:/Users/hchapa/Downloads/1575956493464-5157163%20(1).pdf4. Zhang Y, Li R, Zhang J, Zhou W, Yu F. Changes in Serum Concentrations of Bone Turnover Markers in Healthy Pregnant Women. International Journal of Clinical Practice. 2023.

Contributor: Alec Coston, MD Educational Pearls: BiPAP is often effective in severe asthma, but many patients struggle with mask tolerance due to intense air hunger–driven anxiety, often compounded by hypoxia. Benzodiazepines are commonly used for anxiety, but they can depress respiratory drive, making clinical improvement difficult to interpret (a lower RR may reflect sedation rather than true physiologic improvement). Low-dose fentanyl is a useful alternative when patients cannot tolerate BiPAP despite coaching. Opioids blunt the perception of dyspnea and are well established for treating air hunger. When carefully titrated, fentanyl provides anxiolysis without significant respiratory suppression. It is rapidly titratable (e.g., 25 mcg IV every 5 minutes). Evidence primarily comes from palliative and oncology literature, but growing clinical experience supports its use in severe asthma to improve BiPAP tolerance. Failure of fentanyl should prompt escalation to ketamine, often signaling impending need for intubation. References Pang GS, Qu LM, Tan YY, Yee AC. Intravenous Fentanyl for Dyspnea at the End of Life: Lessons for Future Research in Dyspnea. Am J Hosp Palliat Care. 2016 Apr;33(3):222-7. doi: 10.1177/1049909114559769. Epub 2014 Nov 25. PMID: 25425740. Summarized and edited by Meg Joyce, MS2 Donate: https://emergencymedicalminute.org/donate/ Join our mailing list: http://eepurl.com/c9ouHf

Hitting the wall is dreaded amongst all marathoners – but it doesn't have to be an inevitable experience. This episode delves into the research and statistics of hitting the wall in the marathon. Then, we provide you with a clear, practical guide of how to train, pace, and fuel so you can avoid hitting the wall.✨Join us on Patreon.com/treadlightlyrunning or subscribe on Apple Podcasts starting in December, when we'll be releasing special subscriber-only content!In this episode, you'll learn:✅ What does hitting the wall feel like?✅ What role does glycogen play in hitting the wall (or avoiding it)?✅ Pacing strategies to avoid hitting the wall✅ Why carb loading matters✅ How training can be protective against hitting the wall✅ Does dehydration cause you to hit the wall?✅ What to do if you hit the wallIf you enjoyed this episode, you may also like:

Is the 25-40g of protein per meal max a thing of the past? In a very recent article that released this month, "The Anabolic Response to Protein Ingestion During Recovery from Exercise Has No Upper Limit in Magnitude and Duration in Vivo in Humans" (PMID: 38118410), we see that a 100g protein intake has a "greater and prolonged anabolic response" than the traditional and previously thought of upper limit of 25g. What does this mean for clients? Listen in as I explain more about the study and its application. Topics discussed:- Protein and Upper Limit to Muscle Gain- Muscle Protein Synthesis- Study Details- Application of The Study- Gut Health Considerations- Reminders---------- ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Live Program for Coaches: The Functional Nutrition and Metabolism Specialization ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.metabolismschool.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠---------- [Free] Metabolism School 101: The Video Series⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.metabolismschool.com/metabolism-101⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠----------Subscribe to My Youtube Channel: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://youtube.com/@sammillerscience?si=s1jcR6Im4GDHbw_1⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠----------⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Grab a Copy of My New Book - Metabolism Made Simple⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠---------- Stay Connected: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram: @sammillerscience⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Youtube: SamMillerScience⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Facebook: The Nutrition Coaching Collaborative Community⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠TikTok: @sammillerscience⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠----------“This Podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast and the show notes or the reliance on the information provided is to be done at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment and is for educational purposes only. Always consult your physician before beginning any exercise program and users should not disregard, or delay in obtaining, medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions. By accessing this Podcast, the listener acknowledges that the entire contents and design of this Podcast, are the property of Oracle Athletic Science LLC, or used by Oracle Athletic Science LLC with permission, and are protected under U.S. and international copyright and trademark laws. Except as otherwise provided herein, users of this Podcast may save and use information contained in the Podcast only for personal or other non-commercial, educational purposes. No other use, including, without limitation, reproduction, retransmission or editing, of this Podcast may be made without the prior written permission of Oracle Athletic Science LLC, which may be requested by contacting the Oracle Athletic Science LLC by email at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠operations⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@sammillerscience.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠. By accessing this Podcast, the listener acknowledges that Oracle Athletic Science LLC makes no warranty, guarantee, or representation as to the accuracy or sufficiency of the information featured in this Podcast."

We have covered the subject of whether to include the decidual (innermost) layer when closing the uterine incision during cesarean section (CS) on at least 2 episodes. The most recent was in September 2025, when we focused on a published (September 2025) systematic review and meta-analysis from the Green Journal. Back then, we compared those new findings to our prior episode from 2023 on the same matter. Well, we are back at it again with the same subject as there is a new EXPERT REVIEW from the AJOG on hysterotomy closure technique which just came out January 2026. What did these authors conclude? There are also some controversial suggestions made by the authors. Listen in for details. 1. Antoine C, Meyer JA, Silverstein J, Buldo-Licciardi J, Lyu C, Timor-Tritsch IE. Endometrium-Free Closure Technique During Cesarean Delivery for Reducing the Risk of Niche Formation and Placenta Accreta Spectrum Disorders. Obstet Gynecol. 2025 Jun 1;145(6):674-682. doi: 10.1097/AOG.0000000000005813. Epub 2025 Jan 9. PMID: 39787602. 2. Gialdini, Celina et al.Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews. eClinicalMedicine- Lancet (June 2024), Volume 72, 102632 3. Dahlke, Joshua D. MD; Mendez-Figueroa, Hector MD; Maggio, Lindsay MD, MPH; Sperling, Jeffrey D. MD, MS; Chauhan, Suneet P. MD, Hon DSc; Rouse, Dwight J. MD. The Case for Standardizing Cesarean Delivery Technique: Seeing the Forest for the Trees. Obstetrics & Gynecology 136(5):p 972-980, November 2020. | DOI: 10.1097/AOG.0000000000004120 4. Antoine C, Timor-Tritsch IE, Bujold E, Young BK, Reece EA. Endometrium-free closure technique for hysterotomy incision at cesarean delivery. Am J Obstet Gynecol. 2026 Jan;233(6S):S103-S114. doi: 10.1016/j.ajog.2025.07.009. PMID: 41485813.

In resuscitative trauma surgery every second counts. Can time and lives be saved by moving interventions closer to the point of injury? In this episode, we discuss a recent journal article on prehospital resuscitative thoracotomy as a treatment for traumatic cardiac arrest. Opening the chest on the street, who should do it, why should we do it, and for whom?• Hosts:  Mr Prashanth Ramaraj. General Surgery trainee, Edinburgh rotation. @LonTraumaSchool Dr Roisin Kelly. Major Trauma Junior Clinical Fellow, Royal London Hospital.  Mr Max Marsden. Resuscitative Major Trauma Fellow, Royal London Hospital. @maxmarsden83 Mr Christopher Aylwin. Consultant Trauma & Vascular Surgeon, Royal London Hospital and Co-Programme Director MSc Trauma Sciences at Queen Mary University of London. @cjaylwin Mr Zane Perkins. Consultant Trauma & UGI Surgeon, Royal London Hospital and Prehospital Surgeon at London's Air Ambulance. @ZBPerkins  • Learning objectives: A)    To be aware of the steps of a resuscitative thoracotomy (RT)B)     To understand the rational for prehospital (PH) trauma interventions.C)     To understand the timelines required to optimise success in PH RT.D)    To be familiar with the training governance for clinicians undertaking PH RT.E)     To recognise that PH RT is predominantly an intervention for cardiac tamponade.F)     To understand the contexts in which PH RT might be successful as a standardised intervention.• References: Perkins ZB, Greenhalgh R, Ter Avest E, Aziz S, Whitehouse A, Read S, Foster L, Chege F, Henry C, Carden R, Kocierz L, Davies G, Hurst T, Lendrum R, Thomas SH, Lockey DJ, Christian MD. Prehospital Resuscitative Thoracotomy for Traumatic Cardiac Arrest. JAMA Surg. 2025 Feb 26;160(4):432–40. doi: 10.1001/jamasurg.2024.7245. PMID: 40009367; PMCID: PMC11866073. https://pubmed.ncbi.nlm.nih.gov/40009367/ ter Avest, E., Kocierz, L., Alvarez, C. et al. Improving decision-making for prehospital Resuscitative Thoracotomy in traumatic cardiac arrest: a data-driven approach. Crit Care 29, 485 (2025). https://doi.org/10.1186/s13054-025-05705-z. https://pubmed.ncbi.nlm.nih.gov/41233917/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma 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