Podcasts about pmid

What is sarcopenia and why is this such an important topic for every woman over 40?  That is the topic of conversation today.  What is Sarcopoenia? Sarcopenia is to muscle what osteoporosis is to bone.  Significant loss of skeletal muscle mass and or muscle strength. Sarcopenia is tied to anabolic resistance in midlife women, making it harder to gain lean muscle growth or maintenance after 40. Older adults - both men and women - have to work harder to gain lean muscle mass.  Women have less overall body mass and muscle to begin with and more dramatic reductions in estrogen at menopause, than men experience loss of testosterone.  The key stimulus for muscle protein synthesis, will suffer more from loss of strength and mass if they aren't carefully offsetting it with planned and progressive resistance training.  For women, estrogen protects muscle and bone. We need and use testosterone which is the most abundant hormone in the female body - but it's the decline in estrogen that makes the difference in muscle preservation. What Contributes to Sarcopenia?  Malnutrition. Combined with sarcopenia, it's a predictor of all-cause mortality than sarcopenia alone.  The United States is one of the most overfed and undernourished countries in the world. We're not eating well enough to sustain health.  Sarcopenia is 100% avoidable.  How Do You Measure Sarcopenia? Strength Fat free mass and height Online calculators  There are physical tests or measures that include grip strength or calf circumference.  Women didn't measure or track their skeletal muscle mass decades ago to know where it was at peak. It's harder to say how much mass or strength you've lost.  The Surprising Statistics on What is Sarcopenia On average, muscle loss occurs 3-8% each decade starting at 30. That CAN accelerate during menopause transition. It isn't associated with loss of estrogen driving skeletal muscle protein synthesis down. It's the side effects of the decline of estrogen.  Not sleeping. Struggle exercising as hard or as long  Less support for your muscle from testosterone and growth hormone  Have cortisol, ghrelin and leptin hormone dysregulation that interferes with muscle and fat. We do have the ability to regain lean muscle.  It's proven (and shared in prior episodes) that 85+ individuals can gain both mass and strength.  Available Sarcopenia Assessments: SARC-F  A simple questionnaire that is a good point of reference but an easy assessment if you're active.  How it works: Includes 5 components with scale scores range from 0 to 10: Strength: How much difficulty do you have in lifting and carrying 10 pounds? Assistance in walking: How much difficulty do you have walking across a room, whether you use aids or need help to do this? Rise from a chair: How much difficulty do you have transferring from a chair or bed, whether you use aids or need help to do this? Climb stairs: How much difficulty do you have climbing a flight of 10 stairs? Falls: How many times have you fallen in the past year? Flipping 50 Fitness Scorecard  Helps not only measure strength and muscle mass but to see how you rank according to others in your age group.  Most important is progress, comparing you to you. Start where you are by benchmarking it and learn how to improve it. How is Sarcopenia Diagnosed? Fat-Free Mass Index: FFMI ≤ 15 kg/m2 Visit this URL to calculate (turn on metric to see result): https://ffmicalculator.org/ A strength test. What is Sarcopenia: The New Glossary Osteosarcopenia - low bone mass and low muscle mass Sarcobesity - low muscle mass and high fat mass Osteosarcobesity - low bone mass, low muscle mass and high fat mass  Osteobesity - low bone mass and high fat mass    The biggest risk of sarcopenia is falling due to instability and inability to “right” yourself when slips and falls occur. I promised we'd visit what's possible so here that is: A 1.9-3.3% increase in global muscle mass in humans is associated with a 4.1% to 5.8% lower fat mass and reduced A1c and fasting glucose in studies lasting 2 weeks to 3 years.   How to Avoid Sarcopenia? Resistance train 2x per week minimum, for some that's maximum. Know your recovery needs. Consume high protein foods and micronutrient dense foods at each meal.   Wouldn't it be wonderful if in 30 or 40 years, “What is sarcopenia?” is a question like “What is scurvy or rickets?” now which is never heard of. That starts with us.    References:  Nutrients. 2023, PMID: 38201856. Sports Medicine, 2025, PMID: 40576707. Advances in Nutrition 2025, PMID: 40222723. Scientific Reports, 2025, PMID: 39833326. Front Med (Lausanne), 2025, PMID: 40636391.   Other Episodes You Might Like: Previous Episode - Stronger Muscles, Longer Life: The Untold Value of this Accessible to All Anatomy Next Episode - How Mold Toxicity Affects Hormonal Balance During Menopause And Effective Detox Strategies More Like This: 5 Reasons You're Not Losing Weight or Gaining Muscle After 50 Protein for Menopause Hormone Support Where Protein Recommendations for Women Come From?   Resources:  Don't know where to start? Book your Discovery Call with Debra. Use Flipping 50 Scorecard & Guide to measure what matters with easy at-home self-assessment test you can do in minutes. Opening in August!! Join the Hot, Not Bothered! Challenge to learn why timing matters and why what works for others is not working for you.  

➡ CLICK HERE to send me a text, I'd love to hear what you thought about this episode! Leave your name in the text so I know who it's from! This week's episode is chock FULL of tips on how to set boundaries if and when we decide to return to social media after this summer detox. If you've been following along on your own detox, but fear the dip back into the socials like I do, this is the episode you don't want to miss. Thekla and I talk all about protecting ourselves and being mindfully aware of our intentions upon return. And if you want to dive more into some of the research we talk about in today's episode, here are the links you'll want (h/t Thekla!) Self-Compassion in the Age of Social Media ResourcesScholarly ArticlesCastelo, N., Kushlev, K., Ward, A.F., Esterman, M., & Reiner, P.B. (2025). Blocking mobile internet on smartphones improves sustained attention, mental health, and subjective well-being. PNAS Nexus, 4(2): pgaf017. https://doi.org/10.1093/pnasnexus/pgaf017. PMID: 39967678; PMCID: PMC11834938.Kuchar AL, Neff KD, Mosewich AD. Resilience and Enhancement in Sport, Exercise, & Training (RESET): A brief self-compassion intervention with NCAA student-athletes. Psychol Sport Exerc. 2023 Jul;67:102426. doi: 10.1016/j.psychsport.2023.102426. Epub 2023 Mar 28. PMID: 37665879.Wadsley M, Ihssen N. A Systematic Review of Structural and Functional MRI Studies Investigating Social Networking Site Use. Brain Sci. 2023 May 11;13(5):787. doi: 10.3390/brainsci13050787. Erratum in: Brain Sci. 2023 Jul 17;13(7):1079. doi: 10.3390/brainsci13071079. PMID: 37239257; PMCID: PMC10216498.Websites/OrganizationsCenter for Humane Technology. humanetech.comDigital Wellness Lab at Boston Children's Hospital. digitalwellnesslab.orgAfter Babel by Jonathan Haidt. (Substack)Scales/MeasuresThe Bergen Social Media Addiction Scale (BSMAS)Support the show

Today, we're diving into a condition that's as fascinating as it is complex: Achalasia—where the esophagus stops playing nice, and swallowing becomes a daily challenge. We're breaking down the latest evidence, comparing POEM, pneumatic dilation, and Heller myotomy, and digging into what actually matters when deciding how to treat each achalasia subtype. Join show hosts Drs. Jake Greenberg, Dana Portenier, Zach Weitzner, and Joey Lew as they discuss the past, present, and future of Achalasia management. Whether you're a medical student or a seasoned attending, this episode will arm you with the tools to think critically about diagnosis, tailor your treatment strategy, and stay ahead of the curve on the future of achalasia care. Hosts:  ·      Jacob Greenberg, MD, EdM, MIS Division Chief and Vice Chair for Education, Duke University ·      Dana Portenier, MD, MIS Fellowship Director, Duke University ·      Zachary Weitzner, MD, Minimally Invasive and Bariatric Surgery Fellow, Duke University, @ZachWeitznerMD ·      Joey Lew, MD, MFA, Surgical resident PGY-3, Duke University, @lew__actually Learning Goals:  By the end of this episode, listeners will be able to: ·      Describe the pathophysiology and key diagnostic criteria for achalasia, including the role of manometry, EGD, and esophagram. ·      Differentiate between the three subtypes of achalasia based on the Chicago Classification and understand the clinical significance of each. ·      Compare treatment options for achalasia—pneumatic dilation, Lap Heller myotomy, and POEM—including indications, efficacy, and long-term outcomes. ·      Interpret landmark studies (e.g., European Achalasia Trial, JAMA POEM trial) and their impact on treatment decision-making. ·      Recognize patient-specific factors (age, comorbidities, achalasia subtype) that influence the choice of therapy. ·      Discuss evolving technologies and future directions in achalasia management, including endoluminal robotics, ARMS, and combined anti-reflux strategies. ·      Outline a basic treatment algorithm for newly diagnosed achalasia, incorporating diagnostic steps and tailored interventions. ·      Appreciate the multidisciplinary approach to achalasia care, including the roles of MIS surgeons, gastroenterologists, and emerging procedural skillsets. References: ·      Boeckxstaens G, Elsen S, Belmans A, Annese V, Bredenoord AJ, Busch OR, Costantini M, Fumagalli U, Smout AJPM, Tack J, Vanuytsel T, Zaninotto G, Salvador R; European Achalasia Trial Investigators. 10‑year follow-up results of the European Achalasia Trial: a multicentre randomised controlled trial comparing pneumatic dilation with laparoscopic Heller myotomy. Gut. 2024 Mar;73(4):582‑589. doi: 10.1136/gutjnl‑2023‑331374. PMID: 38050085 https://pubmed.ncbi.nlm.nih.gov/38050085/ ·      He J, Yin Y, Tang W, Jiang J, Gu L, Yi J, Yan L, Chen S, Wu Y, Liu X. Objective Outcomes of an Extended Anti‑reflux Mucosectomy in the Treatment of PPI‑Dependent Gastroesophageal Reflux Disease (with Video). J Gastrointest Surg. 2022 Aug;26(8):1566–1574. doi:10.1007/s11605‑022‑05396‑9. PMID: 35776296 https://pubmed.ncbi.nlm.nih.gov/35776296/ ·      Modayil RJ, Zhang X, Rothberg B, et al. Peroral endoscopic myotomy: 10-year outcomes from a large, single-center U.S. series with high follow-up completion and comprehensive analysis of long-term efficacy, safety, objective GERD, and endoscopic functional luminal assessment. Gastrointest Endosc. 2021;94(5):930-942. doi:10.1016/j.gie.2021.05.014. PMID: 33989646. https://pubmed.ncbi.nlm.nih.gov/33989646/ ·      Ponds FA, Fockens P, Lei A, Neuhaus H, Beyna T, Kandler J, Frieling T, Chiu PWY, Wu JCY, Wong VWY, Costamagna G, Familiari P, Kahrilas PJ, Pandolfino JE, Smout AJPM, Bredenoord AJ. Effect of peroral endoscopic myotomy vs pneumatic dilation on symptom severity and treatment outcomes among treatment-naive patients with achalasia: a randomized clinical trial. JAMA. 2019 Jul 9;322(2):134–144. doi:10.1001/jama.2019.8859. PMID: 31287522. https://pubmed.ncbi.nlm.nih.gov/31287522/ ·      Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT; ACG Clinical Guidelines Committee. ACG clinical guidelines: Diagnosis and management of achalasia. Am J Gastroenterol. 2020 Sep;115(9):1393–1411. doi:10.14309/ajg.0000000000000731. PMID: 32773454; PMCID: PMC9896940 https://pubmed.ncbi.nlm.nih.gov/32773454/ ·      West RL, Hirsch DP, Bartelsman JF, de Borst J, Ferwerda G, Tytgat GN, Boeckxstaens GE. Long term results of pneumatic dilation in achalasia followed for more than 5 years. Am J Gastroenterol. 2002;97(6):1346-1351. doi:10.1111/j.1572-0241.2002.05771.x. PMID:12094848. https://pubmed.ncbi.nlm.nih.gov/12094848/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

In this quick-hitting episode, Zach Baker, DPT, and Tyler Betteridge, DPT, break down a groundbreaking 2025 study that challenges the long-held "rest is best" approach to concussion care. Learn how sub-symptom threshold aerobic exercise can improve executive function in the early stages of sport-related concussion recovery—and what this means for your clinical practice. Quick, evidence-based, and directly applicable.Referenced Study:Rahimi et al. (2025). Sub-symptom threshold aerobic exercise improves executive function during the early stage of sport-related concussion recovery.PMID: 39936544 | DOI: 10.1080/02640414.2025.2453337

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

“Green spaces and trees are not an amenity—they're a necessity,” explains Marc Berman, Ph.D.  Marc Berman, Ph.D., environmental neuroscientist, professor and chair of psychology at the University of Chicago, and the founding director of the Environmental Neuroscience Lab, joins us today to dive deep into the powerful benefits of nature on our mental and physical health.  - What is environmental neuroscience? (~2:50) - The Nature Walk study (~6:20) - Green vs. blue spaces (~12:00) - How much nature do you need? (~18:10) - The case for more green spaces (~19:10) - Mental health benefits of being in nature (~22:55) - How different types of trees impact the benefits (~27:25) - The impact of natural disasters (~28:25) - Redesigning our  environments, schools, & workplaces (~31:00) - Nature for depression (~34:30)  - Why you should be ‘nature rising' (~36:15) - Berman's favorite places (~38:05) - Upcoming research (~40:30) - Start doing this today (~42:50) Referenced in the episode:  - Learn more about Berman & his lab (https://voices.uchicago.edu/bermanlab/berman/)  - Pick up his book, Nature and the Mind (https://www.amazon.com/Nature-Mind-Improves-Cognitive-Well-being/dp/1668058774)  - Check out his research (https://scholar.google.com/citations?user=zCT_0OQAAAAJ&hl=en)  - Research on green spaces and schoolchildren (PMID: 25204008)  - Research on crime and vegetation (https://doi.org/10.1177/001391601219731)  - Research on hospital recovery and nature views (PMID: 6143402)  We hope you enjoy this episode, and feel free to watch the full video on YouTube! Whether it's an article or podcast, we want to know what we can do to help here at mindbodygreen. Let us know at: podcast@mindbodygreen.com. Learn more about your ad choices. Visit megaphone.fm/adchoices

More than likely, your watch reports your resting heart rate (RHR) and heart rate variability (HRV) - but what do these numbers actually mean? We look at the science behind these metrics and discuss whether or not runners should use HRV and RHR to adjust their training. You will learn:✅ Why does resting heart rate matter for runners?✅ Should you use HRV to inform your training?✅ Does these metrics help you recover better?✅ Does tracking your HR improve your running performance?✅ Are your HRV trackers reliable?References: ✅ PMID: 35853460✅ PMID: 37516677✅PMID: 29686813Thank you to our sponsors:➡️Skratch: Naturally flavored, science-backed sport nutrition. Follow link Skratch Sample Pack and use code TREADLIGHTLY for 20% off your first purchase.➡️Boulderthon: If you're looking for a scenic Colorado race, Boulderthon offers it all: views, big race vibes, and faster courses this year. Use code RUNTOTHEFINISH to get $20 off your registration for the marathon, half, 10K, or 5K. Let's stay connected:➡️ Join our community at patreon.com/treadlightlyrunning➡️ Tread Lightly Running Podcast on Instagram: https://www.instagram.com/treadlightlyrunning/➡️ Laura Norris Running on Instagram: https://www.instagram.com/lauranorrisrunning/➡️ Hundreds of evidence-based training tips on Laura's website: https://lauranorrisrunning.com/➡️ Run to the Finish on Instagram: https://www.instagram.com/runtothefinish/?hl=en➡️ Thousands of running gear reviews and training guides:https://runtothefinish.com/

Our latest podcast discusses the newly launched DogMA app with researchers Dr Natasha Clark and Professor Eithne Comerford. Mobility issues from musculoskeletal diseases, like osteoarthritis, affect around 200,000 dogs annually, posing a significant challenge to their health and welfare. Although these diseases can affect dogs of any age, owners often miss early, subtle signs of gait abnormalities, leading to late diagnosis of osteoarthritis. The DogMA app was developed to address this by enabling early detection of mobility problems, including subtle signs of discomfort or decline often overlooked in routine care. DogMA is supported by scientific research led by Dr. Natasha Clark at the University of Liverpool, under the supervision of Professors Eithne Comerford and Karl Bates, in collaboration with Dogs Trust. By using the app for regular assessments, users can also contribute anonymized data to ongoing research at the University of Liverpool, helping to advance the understanding of canine mobility across the UK.ReferencesHere is the link to the paper discussed in today's podcast:Clark NL, Bates KT, Harris LK, Tomlinson AW, Murray JK, Comerford EJ. GenPup-M: A novel validated owner-reported clinical metrology instrument for detecting early mobility changes in dogs. PLoS One. 2023 Dec 27;18(12):e0291035. doi: 10.1371/journal.pone.0291035. PMID: 38150469; PMCID: PMC10752556.University of Liverpool page launching DogMAhttps://www.liverpool.ac.uk/life-course-and-medical-sciences/research/dogma/Download the app for free from your app store:Android: DogMA in the Google Play StoreiOS: DogMA in the Apple App StoreThis is the paper documenting radiographic and clinical OA in 23% of dogs less than 4 years of age:Enomoto M, de Castro N, Hash J, Thomson A, Nakanishi-Hester A, Perry E, Aker S, Haupt E, Opperman L, Roe S, Cole T, Thompson NA, Innes JF, Lascelles BDX. Prevalence of radiographic appendicular osteoarthritis and associated clinical signs in young dogs. Sci Rep. 2024 Feb 3;14(1):2827. doi: 10.1038/s41598-024-52324-9. PMID: 38310147; PMCID: PMC10838335. These are the COAST guidelines:Cachon T, Frykman O, Innes JF, Lascelles BDX, Okumura M, Sousa P, Staffieri F, Steagall PV, Van Ryssen B. COAST Development Group's international consensus guidelines for the treatment of canine osteoarthritis. Front Vet Sci. 2023 Aug 3;10:1137888. doi: 10.3389/fvets.2023.1137888. PMID: 37601753; PMCID: PMC10436090.

So many women say they're tired all the time in menopause.  Even those who do exercise to improve health, which would include energy levels, will often say, “I'm tired all the time.”   Let me share what I would do, and actually did at the end of 2019 when I found myself recovering from a big year of mental and physical stressors. 80% of the population don't exercise, specifically 80% of women don't lift weights the minimum times per week needed for optimal metabolic health. If you are one of those 20% you should be the most energetic people in the room wherever you go! If you exercise consistently and you're tired all the time, something isn't right. It may be about the exercise you're doing, the fuel you're consuming or absorbing, the way you're handling the stressors on your plate, or a combination. There may be something more going on, but often when you have this “check engine” light going on, addressing some changes will help.   This is the best place to start to address why you're tired all the time in menopause.   1. Stop Exercising “As Usual”  The mentality “This is the workout I always do. If I don't, I will lose my fitness” makes it worse! Even though metabolism changes are documented, pushing exercise to the brink of exhaustion is not the first line of defense in fixing it.  Science states, “The basal metabolism of the female body decreases significantly, which can mean a decrease in the basal metabolic rate (BMR) of up to 250–300 kcal per day.” This inspires a diet mentality that is of the eat less, exercise more, you're not going to benefit from this.  2. Move And Eat In Small Snacks  Small movements (exercise snacks) like walking 10 minutes 3 times a day, instead of a long walk, will be better for overall fatigue. This helps sustain blood sugar levels. If you are suffering from adrenal fatigue, you may have blood sugar dysregulation and you may not have an appetite in the morning. Eating in small snacks throughout the day can stabilize blood sugar levels too. Tired All the Time Isn't “Normal”    3. Track Food To Check On Macro And Micro Nutrient Intake  Cited in studies, key preventive nutrients in menopause are:  Vitamin D Calcium Vitamin C B Vitamins Protein I would also add: Magnesium Omega-3 We need protein and micronutrients to gain lean muscle and strength.   4. Consider Lab Testing For Micronutrient Sufficiency and Cortisol Levels (saliva vs blood, dried or wet urine)  Lab testing will tell if you are sufficient in levels of micronutrients. You can take a look at, are you in norms or are you optimal?   5. Support With Adaptogens To Help The Body Help Itself  Maca, Ashwaghanda, and Rhodiola I found the most benefit personally from Maca. I felt better within a week just taking a morning dose.   These are all steps you want to take whether you are or aren't on HRT. If you're progesterone is low and that's interfering with sleep, it can make a big difference. These things just cover the basics and relate to your exercise and fitness routine.    Additional steps you want to take: Check thyroid levels with a functional doctor. Get a stool test if your digestion isn't what it should be. That will tell you the status of your good and bad gut bacteria and let you know how to feed with the right probiotics so you feed the good ones and starve the bad.  Utilize a health coach who understands optimal levels vs norms of micronutrients. A doctor is necessary to help you interpret many things like thyroid and hormones as well as getting the right tests to begin with.  Seek support from a functional doctor who can recommend specific tests that differ from your traditional physician and help you sort out any of these.    References to Why You're Feeling Tired All the Time in Menopause:  PLoS One, 2024, PMID: 38421977. Nutrients, 2023, PMID: 38201856.   Other Episodes You Might Like: Previous Episode - You're Not Really Bloated! Next Episode - Stronger Muscles, Longer Life: The Untold Value of this Accessible to All Anatomy More Like This - Why It May Be Your Thoughts Keeping You Fat, Tired or Injured in Menopause More Like This - How to Make Progress without Tired All the Time Results   Resources:  Don't know where to start? Book your Discovery Call with Debra. Opening in August!! Join the Hot, Not Bothered! Challenge to learn why timing matters and why what works for others is not working for you. Balance hormones in menopause with Femmenessence® MacaPause®. Get your micronutrients tested with YourLabWork.  

In this episode of 'Science of Slink,' Dr. Rosy Boa addresses common misconceptions about the role of the Latissimus Dorsi (lats) muscles in pole dancing. She explains the anatomy and function of the lats, debunks myths about their role in overhead movements, and offers tips on when and how to effectively train these muscles. Essential for pole dancers, the episode also covers related topics like muscle contraction, scapula stabilization, and potential causes of pain from tight lats. Dr. Boa recommends resources and exercises for better shoulder mechanics and performance in pole dancing.Are you a pole nerd interested in trying out online pole classes with Slink Through Strength? We'd love to have you! Use the code “podcast” for 10% off the Intro Pack and try out all of our unique online pole classes: https://app.acuityscheduling.com/catalog/25a67bd1/?productId=1828315&clearCart=true Chapters:00:00 Introduction and Episode Overview01:14 Common Misconceptions About Lats01:52 Understanding Muscle Function03:15 Anatomy of the Lats05:50 Lats in Pole Dancing07:36 Scapula Mechanics and Misconceptions11:03 Training and Flexibility Recommendations15:18 Conclusion and Further ReadingCitations: Bhatt CR, Prajapati B, Patil DS, Patel VD, Singh BG, Mehta CD. Variation in the insertion of the latissimus dorsi & its clinical importance. J Orthop. 2013 Mar 7;10(1):25-8. doi: 10.1016/j.jor.2013.01.002. PMID: 24403744; PMCID: PMC3768243.https://pmc.ncbi.nlm.nih.gov/articles/PMC3768243/ Miniato MA, Mudreac A, Borger J. Anatomy, Thorax, Scapula. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538319/Paksoy, A., Akgün, D., Gebauer, H., Karczewski, D., Lacheta, L., Tokish, J. M., ... & Moroder, P. (2024). The latissimus dorsi creates a dynamic track for the inferior angle of the scapula during arm abduction in humans. Journal of Orthopaedic Surgery and Research, 19(1), 193.Pouliart N, Gagey O. Significance of the latissimus dorsi for shoulder instability. I. Variations in its anatomy around the humerus and scapula. Clin Anat. 2005 Oct;18(7):493-9. doi: 10.1002/ca.20185. PMID: 16092134.Links:Learn more about join the Science of Slink membership www.scienceofslink.comJoin the Essentials of Slink waitlist! https://mailchi.mp/slinkthroughstrength.com/essentials-of-slinkUse the code “TURNINGTHREE” for 25% off any drop in class: https://www.slinkthroughstrength.com/online-pole-dancing-classes-sign-up

Podcast family, in this episode we will reply to 2 questions raised by our 2 of our podcast family members. The first pertains to a real world, HORRIBLE tragedy of hepatic rupture in pregnancy (no identifiable information released). We will review how and why this happens and what is the single, 5-letter, clinical diagnosis that makes this a possibility. Secondly, we will answer this question: Can MagSo4 ALONE lead to pulmonary edema. The answer is YES. Listen in for details.1. ACOG PB 222;20202. COMMONLY USED MAGNESIUM SULFATE UNCOMMONLY CAUSING PULMONARY EDEMAVYATA, VISHRUTH et al.CHEST, Volume 162, Issue 4, A10293. Singh Y, Kochar S, Biswas M, Singh KJ. Hepatic Rupture Complicating HELLP Syndrome in Pregnancy. Med J Armed Forces India. 2009 Jan;65(1):89-90. doi: 10.1016/S0377-1237(09)80072-5. Epub 2011 Jul 21. PMID: 27408207; PMCID: PMC4921511.4. Escobar Vidarte MF, Montes D, Pérez A, Loaiza-Osorio S, José Nieto Calvache A. Hepatic rupture associated with preeclampsia, report of three cases and literature review. J Matern Fetal Neonatal Med. 2019 Aug;32(16):2767-2773. doi: 10.1080/14767058.2018.1446209. 

Dr. Ruth Brown-Ennis joined the podcast again, this time to discuss the latest research on mental health issues seen in people with mosaic Down syndrome.   Article (https://onlinelibrary.wiley.com/doi/10.1002/ajmg.b.33022) Brown RC, D'Aguilar A, Hurshman Q, NailorZee R, York TP, Capone G, Amstadter AB, Jackson-Cook C. Internalizing Psychiatric Symptoms in People With Mosaicism for Trisomy 21. Am J Med Genet B Neuropsychiatr Genet. 2025 Jan 16:e33022. doi: 10.1002/ajmg.b.33022. Epub ahead of print. PMID: 39821956. International Mosaic Down Syndrome Association https://www.imdsa.org   If you would like to suggest a topic for us to cover on the podcast, please send an e-mail to DownSyndromeCenter@chp.edu. If you would like to partner with the Down Syndrome Center, including this podcast, please visit https://givetochildrens.org/downsyndromecenter. We are thankful for the generous donation from Caring for Kids – The Carrie Martin Fund that provides the funding for the podcast recording equipment and hosting costs for this podcast.  

In this episode of the Epigenetics Podcast, we talked with Dr. Joseph Ecker from the Salk Institute about his work on high-resolution genome-wide mapping technologies, specifically how the regulation of gene expression is influenced by DNA methylation, chromatin accessibility, and non-coding RNAs across various cell types and developmental stages. During our conversation, we delve into Dr. Ecker's contributions to the characterization of the genome of Arabidopsis thaliana, a project pivotal in the plant genomics field, where he collaborated on the early sequencing efforts that dramatically outpaced expectations. He highlights the technological advancements that enabled such efficient sequencing and how this foundational work opened new avenues for exploring transcriptional activity. We also discuss Dr. Ecker's pivotal work on the comprehensive DNA methylation map of Arabidopsis, which he developed in collaboration with other researchers. This groundbreaking study established the links between methylation patterns and gene expression, paving the way for further research into how these epigenetic marks influence over gene regulation. He elaborates on the significance of transitioning from traditional methods to more sophisticated techniques, such as RNA-seq, and the lessons learned from sequencing projects that have since been applied to human biology. Dr. Ecker's transition to studying human cells is further explored as he discusses the profiling of DNA methylation in induced pluripotent stem cells (iPSCs), revealing how epigenetic memory can influence cellular differentiation and development. He underscores the importance of understanding these methylation patterns, particularly as they relate to conditions like Alzheimer's disease and stem cell biology, where he examines potential applications of his findings in medical research. As our conversation progresses, we touch upon Dr. Ecker's ongoing projects that utilize advanced multi-omic techniques to investigate the epigenomes of the human brain, focusing on how DNA methylation and gene expression change with age and in the context of neurodegenerative diseases. He details the collaboration efforts with various consortia aimed at cataloging gene regulatory networks and understanding the complex interactions that take place within the brain throughout different life stages.   References Mozo T, Dewar K, Dunn P, Ecker JR, Fischer S, Kloska S, Lehrach H, Marra M, Martienssen R, Meier-Ewert S, Altmann T. A complete BAC-based physical map of the Arabidopsis thaliana genome. Nat Genet. 1999 Jul;22(3):271-5. doi: 10.1038/10334. PMID: 10391215. Zhang X, Yazaki J, Sundaresan A, Cokus S, Chan SW, Chen H, Henderson IR, Shinn P, Pellegrini M, Jacobsen SE, Ecker JR. Genome-wide high-resolution mapping and functional analysis of DNA methylation in arabidopsis. Cell. 2006 Sep 22;126(6):1189-201. doi: 10.1016/j.cell.2006.08.003. Epub 2006 Aug 31. PMID: 16949657. Lister R, O'Malley RC, Tonti-Filippini J, Gregory BD, Berry CC, Millar AH, Ecker JR. Highly integrated single-base resolution maps of the epigenome in Arabidopsis. Cell. 2008 May 2;133(3):523-36. doi: 10.1016/j.cell.2008.03.029. PMID: 18423832; PMCID: PMC2723732. Lister R, Pelizzola M, Dowen RH, Hawkins RD, Hon G, Tonti-Filippini J, Nery JR, Lee L, Ye Z, Ngo QM, Edsall L, Antosiewicz-Bourget J, Stewart R, Ruotti V, Millar AH, Thomson JA, Ren B, Ecker JR. Human DNA methylomes at base resolution show widespread epigenomic differences. Nature. 2009 Nov 19;462(7271):315-22. doi: 10.1038/nature08514. Epub 2009 Oct 14. PMID: 19829295; PMCID: PMC2857523. Lister R, Pelizzola M, Kida YS, Hawkins RD, Nery JR, Hon G, Antosiewicz-Bourget J, O'Malley R, Castanon R, Klugman S, Downes M, Yu R, Stewart R, Ren B, Thomson JA, Evans RM, Ecker JR. Hotspots of aberrant epigenomic reprogramming in human induced pluripotent stem cells. Nature. 2011 Mar 3;471(7336):68-73. doi: 10.1038/nature09798. Epub 2011 Feb 2. Erratum in: Nature. 2014 Oct 2;514(7520):126. PMID: 21289626; PMCID: PMC3100360.   Related Episodes Epigenetic Reprogramming During Mammalian Development (Wolf Reik) Single Cell Epigenomics in Neuronal Development (Tim Petros)   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

We're back with another episode of Push Dose Pearls with ED Clinical Pharacist, Haley Burhans! In this episode, we break down the essentials of managing agitation in the ED—starting with why you should avoid diphenhydramine in the elderly and benzodiazepines in the 3 D's: drunk, delirium, and dementia. We discuss how to quickly assess the cause, choose the right medication, and decide between IM and IV routes. And Haley offers some key safety tips and considerations for special populations, including kids and the elderly.  Was this episode helpful? What other medications would you like to learn more about? Hit us up 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: ACEP's New Clinical Policy on Severe Agitation. By Molly E.W. Thiessen, MD, FACEP | on February 12, 2024 Pediatric Education and Advocacy Kit (PEAK): Agitation Hoffmann JA, Pergjika A, Konicek CE, Reynolds SL. Pharmacologic Management of Acute Agitation in Youth in the Emergency Department. Pediatr Emerg Care. 2021 Aug 1;37(8):417-422. doi: 10.1097/PEC.0000000000002510. PMID: 34397677; PMCID: PMC8383287. Gerson R, Malas N, Feuer V, Silver GH, Prasad R, Mroczkowski MM. Best Practices for Evaluation and Treatment of Agitated Children and Adolescents (BETA) in the Emergency Department: Consensus Statement of the American Association for Emergency Psychiatry. West J Emerg Med. 2019 Mar;20(2):409-418. doi: 10.5811/westjem.2019.1.41344. Epub 2019 Feb 19. Erratum in: West J Emerg Med. 2019 May;20(3):537. doi: 10.5811/westjem.2019.4.43550. Erratum in: West J Emerg Med. 2019 Jul;20(4):688-689. doi: 10.5811/westjem.2019.4.44160. PMID: 30881565; PMCID: PMC6404720.. **** 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.

Marcela Belleza, Caio Bastos e Nathalie Santana para conversar sobre incidentaloma adrenal em 4 clinicagens:- Avaliação de malignidade- Há produção de hormônio?- Tem indicação de cirurgia?- Como fazer o acompanhamentoReferências:1. Vassiliadi DA, Delivanis DA, Papalou O, Tsagarakis S. Approach to the Patient With Bilateral Adrenal Masses. J Clin Endocrinol Metab. 2024 Jul 12;109(8):2136-2148. doi: 10.1210/clinem/dgae164. PMID: 38478374.2. Martin Fassnacht, Stylianos Tsagarakis, Massimo Terzolo, Antoine Tabarin, Anju Sahdev, John Newell-Price, Iris Pelsma, Ljiljana Marina, Kerstin Lorenz, Irina Bancos, Wiebke Arlt, Olaf M Dekkers, European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors, European Journal of Endocrinology, Volume 189, Issue 1, July 2023, Pages G1–G42, https://doi.org/10.1093/ejendo/lvad0663. Rowe NE, Kumar R, Schieda N, Siddiqi F, McGregor T, McAlpine K, Violette P, Bathini V, Eng M, Izard J. Diagnosis, Management, and Follow-Up of the Incidentally Discovered Adrenal Mass: CUA Guideline Endorsed by the AUA. J Urol. 2023 Oct;210(4):590-599. doi: 10.1097/JU.0000000000003644. Epub 2023 Aug 9. PMID: 37556768.4. Yip L, Duh QY, Wachtel H, Jimenez C, Sturgeon C, Lee C, Velázquez-Fernández D, Berber E, Hammer GD, Bancos I, Lee JA, Marko J, Morris-Wiseman LF, Hughes MS, Livhits MJ, Han MA, Smith PW, Wilhelm S, Asa SL, Fahey TJ 3rd, McKenzie TJ, Strong VE, Perrier ND. American Association of Endocrine Surgeons Guidelines for Adrenalectomy: Executive Summary. JAMA Surg. 2022 Oct 1;157(10):870-877. doi: 10.1001/jamasurg.2022.3544. PMID: 35976622; PMCID: PMC9386598.5. Di Dalmazi G, Vicennati V, Garelli S, Casadio E, Rinaldi E, Giampalma E, Mosconi C, Golfieri R, Paccapelo A, Pagotto U, Pasquali R. Cardiovascular events and mortality in patients with adrenal incidentalomas that are either non-secreting or associated with intermediate phenotype or subclinical Cushing's syndrome: a 15-year retrospective study. Lancet Diabetes Endocrinol. 2014 May;2(5):396-405. doi: 10.1016/S2213-8587(13)70211-0. Epub 2014 Jan 29. PMID: 24795253.6. Rafael B Giorgi, Marcelo V Correa, Flávia A Costa-Barbosa, Claudio E Kater, Cyclic Subclinical Hypercortisolism: A Previously Unidentified Hypersecretory Form of Adrenal Incidentalomas, Journal of the Endocrine Society, Volume 3, Issue 3, March 2019, Pages 678–686, https://doi.org/10.1210/js.2018-00385

F is for Fournier! Jody reviews pathophysiology, diagnosis, and treatment of this (thankfully) uncommon condition.References:1) Stevens, D.L., & Baddour, L.M. Necrotizing soft tissue infections. UpToDate. https://www.uptodate.com/contents/ necrotizing-soft-tissue-infections2) Bersoff-Matcha SJ, Chamberlain C, Cao C, Kortepeter C, Chong WH. Fournier Gangrene Associated With Sodium-Glucose Cotransporter-2 Inhibitors: A Review of Spontaneous Postmarketing Cases. Ann Intern Med. 2019 Jun 4;170(11):764-769. doi: 10.7326/M19-0085. Epub 2019 May 7. PMID: 31060053.3) Jean Alfred Fournier. Wikipedia. https://en.wikipedia.org/ wiki/Jean_Alfred_Fournier

Bloating is incredibly common - and while some of it is completely normal, for many people, it can start to feel unpredictable, persistent and disruptive to daily life. It may even worsen during the second half of the menstrual cycle (aka the luteal phase), when rising and falling levels of progesterone and estrogen slow digestion and increase gut sensitivity. In this episode, we're talking about the many causes of bloating (spoiler: it's more than just food), why it tends to fluctuate across different phases of your cycle, and what to do when it starts getting in the way of how you feel, function, or move through your day.You'll leave this episode with a better understanding of your body and practical ways to start identifying patterns and reducing discomfort, without over-restricting or falling into food fear.If you enjoyed this episode, we'd love to hear it; leave a rating and review!Episode links:Free Hormone + Gut Health Toolkit1-on-1 Nutrition Coaching ProgramsReferencesIovino P, Bucci C, Tremolaterra F, Santonicola A, Chiarioni G. Bloating and functional gastro-intestinal disorders: where are we and where are we going? World J Gastroenterol. 2014 Oct 21;20(39):14407-19. doi: 10.3748/wjg.v20.i39.14407. PMID: 25339827; PMCID: PMC4202369.Judkins TC, Dennis-Wall JC, Sims SM, Colee J, Langkamp-Henken B. Stool frequency and form and gastrointestinal symptoms differ by day of the menstrual cycle in healthy adult women taking oral contraceptives: a prospective observational study. BMC Womens Health. 2020 Jun 29;20(1):136. doi: 10.1186/s12905-020-01000-x. PMID: 32600463; PMCID: PMC7325082.Mendelson S, Anbukkarasu P, Cassisi JE, Zaman W. Gastrointestinal functioning and menstrual cycle phase in emerging young adult women: a cross-sectional study. BMC Gastroenterol. 2023 Nov 21;23(1):406. doi: 10.1186/s12876-023-03036-3. PMID: 37990300; PMCID: PMC10664285Pati GK, Kar C, Narayan J, Uthansingh K, Behera M, Sahu MK, Mishra D, Singh A. Irritable Bowel Syndrome and the Menstrual Cycle. Cureus. 2021 Jan 14;13(1):e12692. doi: 10.7759/cureus.12692. PMID: 33614302; PMCID: PMC7883586.

Send us a textEarly full enteral nutrition with fortified milk in very preterm infants: a randomized clinical trial.Salas AA, Gunawan E, Jeffcoat S, Nguyen K.Am J Clin Nutr. 2025 May;121(5):1117-1123. doi: 10.1016/j.ajcnut.2025.02.019. Epub 2025 Feb 21.PMID: 39986385 Clinical Trial.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textExtended Caffeine for Apnea in Moderately Preterm Infants: The MoCHA Randomized Clinical Trial.Carlo WA, Eichenwald EC, Carper BA, Bell EF, Keszler M, Patel RM, Sánchez PJ, Goldberg RN, D'Angio CT, Van Meurs KP, Hibbs AM, Ambalavanan N, Cosby SS, Newman NS, Vohr BR, Walsh MC, Das A, Ohls RK, Fuller J, Rysavy MA, Ghavam S, Brion LP, Puopolo KM, Moore R, Baack ML, Colaizy TT, Baserga M, Osman AF, Merhar SL, Poindexter BB, DeMauro SB, Kumar V, Cotten CM; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.JAMA. 2025 Jun 24;333(24):2154-2163. doi: 10.1001/jama.2025.5791.PMID: 40294395 Clinical Trial.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textPerinatal Urinary Tract Dilation: Recommendations on Pre-/Postnatal Imaging, Prophylactic Antibiotics, and Follow-up: Clinical Report.Anthony Herndon CD, Otero HJ, Hains D, Sweeney RM, Lockwood GM; Section on Urology; Section on Nephrology; Section on Radiology; Section on Hospital Medicine.Pediatrics. 2025 Jul 1;156(1):e2025071814. doi: 10.1542/peds.2025-071814.PMID: 40518141 Review.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textLate Permissive Hypercapnia for Mechanically Ventilated Preterm Infants: A Randomized Trial.Travers CP, Gentle SJ, Shukla VV, Aban I, Yee AJ, Armstead KM, Benz RL, Laney D, Ambalavanan N, Carlo WA.Pediatr Pulmonol. 2025 Jun;60(6):e71165. doi: 10.1002/ppul.71165.PMID: 40525736 Free PMC article. Clinical Trial.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Does it feel like scoliosis has made you shorter? The reality is that's probably the case but you're not stuck that way.In this episode of Ahead of the Curve, I'm breaking down why scoliosis can reduce your height and, more importantly, what you can do to change that. You'll learn the three biggest contributors to height loss with scoliosis and what steps you can take to address each one.You'll hear how things like dehydrated fascia, wedged discs, and poor decompression strategies play a major role—and why just stretching or strength training isn't enough.Plus, I'll share how one Scoliosis Strength Collective member actually gained a full inch of height in her 60s and how you can apply the same approach.Living with scoliosis doesn't mean giving up on strength, mobility, or even your height. This episode is a great place to start taking it back.Resources Mentioned:Google Review From Scoliosis Strength Collective Member Who Gained 1 Inch!Check Out The Fascia Comparison Photo HereSchedule a Discovery Call w/ MeghanMy Virtual Scoliosis Coaching ServicesMy WebsiteFREE At-Home Exercises For ScoliosisResearch Studies Mentioned:Sarma A, Barman B, Das GC, Saikia H, Momin AD. Correlation between the arm-span and the standing height among males and females of the Khasi tribal population of Meghalaya state of North-Eastern India. J Family Med Prim Care. 2020 Dec 31;9(12):6125-6129. doi: 10.4103/jfmpc.jfmpc_1350_20. PMID: 33681051; PMCID: PMC7928122.Trask M, Yang S, Gupta A, Yaszay B, Bauer JM, Redding G. Body mass index adjustments in children with early onset scoliosis: arm span BMI. Spine Deform. 2025 Jul;13(4):1263-1267. doi: 10.1007/s43390-025-01056-5. Epub 2025 Feb 23. PMID: 39987549.

In this episode of the Saving Lives Podcast, we review a July 2025 study from the Journal of Intensive Care comparing methylprednisolone and hydrocortisone for severe pneumonia treatment. The discussion focuses on how these findings may influence clinical decisions, particularly for patients with septic shock. The Vasopressor & Inotrope HandbookAmazon: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Affiliate Link)My Store: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)Sato T, Sasabuchi Y, Inokuchi R, Aso S, Yasunaga H, Doi K. Mortality of severe pneumonia treated with methylprednisolone versus hydrocortisone: a propensity-matched analysis. J Intensive Care. 2025 Jul 15;13(1):39. doi: 10.1186/s40560-025-00810-1. PMID: 40665428; PMCID: PMC12261853.

What's best for skin closure at C-Section? Staples or suture? This debate has raged for over 20 years. Past data has shown greater odds of wound complications with metal staples compared to suture. But new a meta-analysis from June 2025 is challenging the prior results. In this episode, we will explore the data from 2010 to present day. PLUS, we will summarize a separate meta-analysis examining if wound dressing removal is tied to any wound complication. This was just published July 15, 2025 in the “Pink” journal. Listen in for details. 1. 2010: Basha SL, Rochon ML, Quiñones JN, Coassolo KM, Rust OA, Smulian JC. Randomized controlled trial of wound complication rates of subcuticular suture vs staples for skin closure at cesarean delivery. Am J Obstet Gynecol. 2010 Sep;203(3):285.e1-8. doi: 10.1016/j.ajog.2010.07.011. PMID: 20816153.2. 2015: Mackeen AD, Schuster M, Berghella V. Suture versus staples for skin closure after cesarean: a metaanalysis. Am J Obstet Gynecol. 2015 May;212(5):621.e1-10. doi: 10.1016/j.ajog.2014.12.020. Epub 2014 Dec 19. PMID: 25530592.3. Jan 2025: Gabbai D, Jacoby C, Gilboa I, Maslovitz S, Yogev Y, Attali E. Comparison of complications and surgery outcomes in skin closure methods following cesarean sections. Arch Gynecol Obstet. 2025 Jul;312(1):125-129. doi: 10.1007/s00404-024-07911-6. Epub 2025 Jan 25. PMID: 39862268; PMCID: PMC12176926.4. June 2025: Post-cesarean skin closure with metal staples versus subcuticular suture in obese patients: A systematic review and meta-analysis of randomized controlled trials. Luis Sanchez-Ramos et al (Univ Florida). https://onlinelibrary.wiley.com/doi/pdf/10.1002/pmf2.700615. DRESSING REMOVAL: July 15, 2025: Leshae A Cenac, Serena Guerra, Alicia Huckaby, Gabriele Saccone, Vincenzo Berghella. Early Wound Dressing (soft gauze/tape dressing) Removal after Cesarean Delivery: A Meta-Analysis of Randomized Trials: Short title: early wound dressing removal after cesarean, American Journal of Obstetrics & Gynecology MFM, 2025; https://doi.org/10.1016/j.ajogmf.2025.101739.6. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf

What is death anxiety?  We spend the first 15 minutes of the podcast addressing this question.  And maybe this was unfair to our guests, the fabulous dynamic duo of palliative psychiatrists Dani Chammas and Keri Brenner (listen to their prior podcasts on therapeutic presence and the angry patient).  After all, we invited them on to our podcast to discuss death anxiety, then Eric and I immediately questioned if death anxiety was the best term for what we want to discuss! Several key points stood out to me from this podcast, your key points may differ: The “anxiety” in “death anxiety” is not a pathological phenomenon or a DSM diagnosis;  it references an existential concern that is fundamental to the human experience .  To me,” awareness of mortality” might be a better term, but in fairness, the idea of “death anxiety” was coined well before the formal establishment of “anxiety disorders.” The ways in which death anxiety manifests in our patient's choices and behaviors varies tremendously, and our responses as clinicians must be individualized. There is no “one size fits all” approach. In one example Dani discusses, a pain level of 1.5/10 might be overwhelming, because for a patient  in remission from cancer any pain might signal return of cancer.  Some manifestations of death anxiety can be debilitating, others lead to tremendous personal growth, connection to others, and a drive toward finding meaning in their illness experience.   Death anxiety impacts us as clinicians, not only through countertransference, that word that I still can't define (sorry Dani and Keri!), but also through our own unexamined fears about death. As clinicians who regularly care for people who are dying, we might find ourselves becoming “used to” death. Is this a sign that we are inured to the banality of death, and less able to empathize with the death anxiety experienced by our patients or their families? Or could it reflect our acceptance of the finitude of life, prompting us to live in the present moment? Perhaps it is something else entirely. The key is that looking inwards to understanding our own unique relationship with mortality can deepen our ability to authentically accompany the experiences of our patients. I mean, don't fear the reaper, right?  Sorry, no cowbell in my version, but you do get my son Kai, home from college, on guitar for the audio only podcast version. Here are some resources for listeners wanting to learn more about this topic: Books: Yalom ID. Existential Psychotherapy. New York, NY: Basic Books; 1980. Yalom ID. Staring at the Sun: Overcoming the Terror of Death. San Francisco, CA: Jossey-Bass; 2008. Solomon S, Greenberg J, Pyszczynski T. The Worm at the Core: On the Role of Death in Life. New York, NY: Random House; 2015. Becker E. The Denial of Death. Free Press; 1973. Articles: Emanuel LL, Solomon S, Chochinov HM, et al. Death Anxiety and Correlates in Cancer Patients Receiving Palliative Care. J Palliat Med. 2023;26(2):235-243. Chochinov HM, McClement SE, Hack TF, et al. Death anxiety and correlates in cancer patients receiving outpatient palliative care. J Palliat Med. 2023;26(12):1404–1410. doi:10.1089/jpm.2022.0052. Clark D. Between hope and acceptance: the medicalisation of dying. BMJ. 2002;324(7342):905–907. doi:10.1136/bmj.324.7342.905. Vess M, Arndt J, Cox CR, Routledge C, Goldenberg JL. The terror management of medical decisions: The effect of mortality salience and religious fundamentalism on support for faith-based medical intervention. J Pers Soc Psychol. 2009;97(2):334–350. Menzies RE, Zuccala M, Sharpe L, Dar-Nimrod I. The effects of psychosocial interventions on death anxiety: A meta-analysis and systematic review of randomized controlled trials. J Anxiety Disord. 2018;59:64–73. doi:10.1016/j.janxdis.2018.09.00 Brown TL, Chown P, Solomon S, Gore G, De Groot JM. Psychosocial correlates of death anxiety in advanced cancer: A scoping review. Psychooncology. 2025;34(1):45–56. doi:10.1002/pon.70068. Tarbi EC, Moore CM, Wallace CL, Beaussant Y, Broden EG, Chammas D, Galchutt P, Gilchrist D, Hayden A, Morgan B, Rosenberg LB, Sager Z, Solomon S, Rosa WE, Chochinov HM. Top Ten Tips Palliative Care Clinicians Should Know About Attending to the Existential Experience. J Palliat Med. 2024 Oct;27(10):1379-1389. doi: 10.1089/jpm.2024.0070. Epub 2024 Mar 28. PMID: 38546453.  

We have covered Low Dose Aspirin (LDA) for pre-natal preeclampsia prevention MANY times before. But here's a good clinical question: Since preeclampsia can also pop-up in the first 6 weeks postpartum (pp), should we continue it in the immediate pp interval? There is a new publication, an RCT, in the AJOG that looked to answer this- and we will highlight that publication in this episode. PLUS, we will briefly summarize a separate publication from the American J Perinatology back in 2023 that also provided some clinical insights on this topic. Listen in for details.1. The association between postpartum aspirin use and NT-proBNP levels as a marker for maternal cardiac health: a randomized-controlled trial; July 2025 (AJOG): https://www.sciencedirect.com/science/article/pii/S00029378250047522. Christenson E, Stout MJ, Williams D, Verma AK, Davila-Roman VG, Lindley KJ. Prenatal Low-Dose Aspirin Use Associated with Reduced Incidence of Postpartum Hypertension among Women with Preeclampsia. Am J Perinatol. 2023 Mar;40(4):394-399. doi: 10.1055/s-0041-1728826. Epub 2021 May 3. PMID: 33940641.3. Mendoza M, Bonacina E, Garcia-Manau P, et al. Aspirin Discontinuation at 24 to 28 Weeks' Gestation in Pregnancies at High Risk of Preterm Preeclampsia: A Randomized Clinical Trial. JAMA. 2023;329(7):542–550. doi:10.1001/jama.2023.0691

Discover the future of pain management on this episode of Atomic Anesthesia as we explore a major breakthrough: the FDA approval of suzetrigine, a first-in-class, nonopioid pain medication. Guided by cutting-edge research and expert editorial insight from Anesthesiology, we dig into how suzetrigine works—targeting the NaV1.8 sodium channel in peripheral nerves—and what this means for patients and providers facing acute pain. You'll hear about the pivotal NAVIGATE clinical trials, real-world patient experiences, and the medication's advantages over traditional opioids, including fewer side effects and no risk of addiction. Whether you're a healthcare professional, patient, or someone passionate about medical innovation, join us to learn how suzetrigine is poised to reshape pain relief and help bridge the gap left by the opioid crisis.References:Bertoch T, D'Aunno D, McCoun J, Solanki D, Taber L, Urban J, Oswald J, Swisher MW, Tian S, Miao X, Correll DJ, Negulescu P, Bozic C, Weiner SG. Suzetrigine, a Nonopioid Na V 1.8 Inhibitor for Treatment of Moderate-to-severe Acute Pain: Two Phase 3 Randomized Clinical Trials. Anesthesiology. 2025 Jun 1;142(6):1085-1099. doi: 10.1097/ALN.0000000000005460. Epub 2025 Mar 21. PMID: 40117446; PMCID: PMC12061372.Rathmell JP, Clark JD, Eisenach JC. Suzetrigine: First in a New Class of Nonopioid Analgesics for Acute Pain. Anesthesiology. 2025 Jun 1;142(6):989-991. doi: 10.1097/ALN.0000000000005465. Epub 2025 May 13. PMID: 40358331.

It's time we finally had this conversation and unravel the truth around hormonal birth control. What seemed like a helpful solution on the surface for most doctors in prescribing hormonal birth control for teenagers has altered the lives of multiple generations and coaches like us here at the SF Coaching Method are here to put the pieces back together. I'll dive into the physiology of hormonal birth control, why it's a life altering decision, why clarity is power, and more.   Time Stamps:   (0:50) Hormonal Birth Control (2:47) Rethinking Our Relationship With Our Body (5:10) The Physiology of Hormonal Birth Control (11:26) Life Altering Decisions in Teenage Years (13:17) Diving Into The Research (17:30) Clarity Is Power (18:30) Next Steps ---------- DM Me "Win 83" and I'll Send You Our Hormone Health Essentials Resource ---------- PMID: 28942706 – Hormonal contraception and risk of depression in adolescents PMID: 30393667 – Nutrient depletion associated with hormonal contraceptive use PMID: 33380661 – Hormonal contraceptives and systemic inflammation PMID: 31697258 – Bioidentical hormones in menopause: Safety and benefits ---------- Apply for SF Coaching Method  https://sarahfechter.ac-page.com/sfhq-cc Complimentary Health Content  https://sarahfechter.ac-page.com/Health_Wellness_Community ----------  Follow Me On Instagram - https://www.instagram.com/sarahfechter.ifbbpro/   Check Out My Website - https://www.sarahfechter.com ----------  This Podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, other professional health care services, or any professional practice of any kind. Any reliance on the information provided in this Podcast is done at your own risk and Sarah Fechter Fitness LLC expressly disclaims any and all liability or responsibility for any direct, indirect, incidental, special, consequential or other damages arising out of any individual use of, reference to, reliance on, or inability to use, this Podcast or the information presented in this Podcast. All contents and design for this Podcast are owned by Sarah Fechter Fitness LLC. Always consult your professional team before beginning any exercise or nutrition program.

Short term weight loss sounds great BUT it's not all fat – it's muscle! Muscle will be much harder to regain as we age because of anabolic resistance..  Clothes might feel loose and you get weight loss compliments. But short term weight loss is just giving a “false positive” honeymoon period. This might mean you divorced muscle, the love of your life.   1. Muscle Mass Loss (Sarcopenia) Protein Deficiency Protein is essential for building and maintaining muscle tissue. Insufficient protein intake exacerbates muscle atrophy and increases the risk of falls and injuries. Excessive Cardio Prolonged cardio can lead to a breakdown of muscle tissue for energy, particularly if glycogen stores are depleted. This can worsen age-related muscle loss and counteract maintaining strength and function. 2. Bone Health (Osteoporosis) Protein Deficiency Protein is needed for bone health and bone density. Inadequate protein intake, especially after menopause, increases the risk of osteoporosis and fractures. Osteoporosis Risks After menopause, risk of osteoporosis increases due to declining estrogen levels and can weaken bones prone to fracture. Sarcopenia and Osteoporosis Link Having both increases the risk of falls and fractures. Poor nutrition leads to sarcopenic obesity and increases the risk of osteoporosis. 3. Other Negative Effects Reduced Physical Function Since inadequate protein leads to muscle loss, this reduces strength, impaired balance, and decreased ability to perform daily activities. Slow-Healing Injuries Protein repairs tissues. Deficiency can slow wound healing and recovery from injuries. Weakened Immune Function Amino acids from protein build antibodies and maintain a healthy immune system. Low protein intake can lead to frequent illnesses and infections. Potential Cardiac Issues (Excessive Cardio) Associated with potential adverse cardiac effects, such as myocardial fibrosis and an increased risk of atrial fibrillation, in some individuals. Musculoskeletal Injuries (Excessive Cardio) Increases the risk of musculoskeletal issues like osteoarthritis and stress fractures.   What Can You Do Instead of A Short Term Weight Loss Recommendations: Prioritize protein intake with 30 grams each meal. Balance cardio and strength training to build and maintain muscle mass. Listen to your body and avoid pushing yourself too hard or engaging in prolonged, strenuous exercise if it causes excessive fatigue or pain.   References:  Chucherd O, Vallibhakara O, Vallibhakara SA, Sophonsritsuk A, Chattrakulchai K, Anantaburarana M. Association of Sarcopenic Obesity and Osteoporosis in Postmenopausal Women: Risk Factors and Protective Effects of Hormonal Therapy and Nutritional Status. Arch Osteoporos. 2025 Jun 26;20(1):83. doi: 10.1007/s11657-025-01573-w. PMID: 40569474; PMCID: PMC12202630. Filip Vuletić, Berte Bøe, Considerations in the Aging Female Athlete, Operative Techniques in Sports Medicine, Volume 32, Issue 2, 2024, 151091, ISSN 1060-1872, https://doi.org/10.1016/j.otsm.2024.151091.   Other Episodes You Might Like: Previous Episode - Simple Ways to Know if You're Following Protein Rules in Menopause Next Episode - What to Do When Joints Hurt, Ache or Need Replaced? A Doctor Viewpoint More Like This - Protein for Menopause Hormone Support   Resources:  Join the Flipping50 Membership for evidence-based workout programs. Short & Easy Exercise videos in this 5 Day Flip Challenge. Get the Flipping 50 Protein & Fiber supplements for women over 50 to support muscle health, enhance recovery, and meet daily nutritional needs.  

歡迎嚟到 搞乜咁科學 GMG Science 第37集！今集嘅主題係《醫生好邋遢與用口測性格 Doctors Not Washing Hands & Juicy Personality Scans

Intrahepatic Cholestasis of Pregnancy (ICP) has dichotomous effects: Benign for the mother (although the itching it causes may be a qualify of life issue, yet potentially devasting for the child in-utero. In 2021, SMFM released Consult series 53 on the subject. This, together with the ACOG 's CO 831 (Medically Indicated Late Preterm and early term delivery) also from 2021 provide management options for ICP. However, this month- July 2025- Dr. Cynthia Gyamfi-Bannerman et al published a new proposed ICP classification and management schema that is easy to follow. Listen in for details. ​ SMFM CS #53,2021​ ACOG CO #831, 2021​ Sarker M, Ramos GA, Ferrara L, Gyamfi-Bannerman C. Simplifying Management of Cholestasis: A Proposal for a Classification System. Am J Perinatol. 2025 Jul;42(9):1229-1234. doi: 10.1055/a-2495-3553. Epub 2024 Dec 4. PMID: 39631774

What does it mean to be free? It's a question that's puzzled philosophers for millennia. But what does it mean to be metabolically free? If you've ever felt hangry, crashed after a meal, or dealt with type 2 diabetes, you've experienced the opposite — metabolic imprisonment.My guest today, Ben Azadi, knows this firsthand. In 2008, Ben was obese and unhealthy, struggling to find answers. After shedding 80 pounds and turning his health around, he dedicated his life to helping others do the same. Today, he's a functional health expert, bestselling author, and the founder of Keto Kamp, a global brand empowering people to use ancient healing tools like fasting and the ketogenic lifestyle. His new book, Metabolic Freedom: A 30-Day Guide to Restore Your Metabolism, Heal Hormones & Burn Fat, lays out the blueprint to reclaim your health.In this episode, we dive into:What metabolism really is — and why “slow” or “fast” metabolism may be a mythA groundbreaking study that disproves the idea that metabolism slows with ageWhy fasting insulin is a better marker of health than weight or glucose aloneThe surprising power of “Vitamin G” — gratitude — on your metabolic functionBen's top daily habits and biohacks to supercharge your metabolismBen's approach is all about education over medication — empowering you to take control, rather than outsourcing your health. Ben has also made a personal impact on a member of my family.Links:

[1] Does the pursuit of excellence in medicine conflict with the pursuit of well-being? This is Episode #1 which was first released on 17, 2024. Description: -  Adam invites Dr. Lisa Rosenbaum to discuss her recent publication in the NEJM titled Being Well while Doing Well — Distinguishing Necessary from Unnecessary Discomfort in Training.   This thought-provoking paper is the 3rd in a series of 4 essays in the NEJM by Dr. Rosenbaum.  It's a social commentary on recent cultural and societal changes and their impact on medical education. We discuss Lisa's critical perspectives on the important notions of wellness and professional identity in our field.   Length of Episode: 40 minutes   Article discussed: Rosenbaum L. Being Well while Doing Well - Distinguishing Necessary from Unnecessary Discomfort in Training. N Engl J Med. 2024 Feb 8;390(6):568-572. doi: 10.1056/NEJMms2308228. Epub 2024 Jan 17. PMID: 38231543. https://pubmed.ncbi.nlm.nih.gov/38231543/  Resources to check out :  Dr. Rosenbaum's recent related publications    https://www.nejm.org/doi/10.1056/NEJMms2308228 Being Well while Doing Well — Distinguishing Necessary from Unnecessary Discomfort in Training   https://pubmed.ncbi.nlm.nih.gov/38265727/ Beyond Moral Injury - Can We Reclaim Agency, Belief, and Joy in Medicine?   https://pubmed.ncbi.nlm.nih.gov/38197811/ On Calling - From Privileged Professionals to Cogs of Capitalism?   https://pubmed.ncbi.nlm.nih.gov/38170694/ What Do Trainees Want? The Rise of House Staff Unions   Podcast ‘Not Otherwise Specified' https://not-otherwise-specified-podcast.nejm.org/e/tough-love/     Contact us: keylime@royalcollege.ca   Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski    

In this Complex Care Journal Club podcast episode, Dr. Miriam Shapiro, Ms. Kate Detwiler, and Dr. Vanessa Madrigal discuss a survey of families with children with chronic conditions about ethical challenges they have experienced in their child's care and sources of support. They describe the residual distress reported by families, implications for clinical practice, and next steps from this work. SPEAKERS Miriam Shapiro, MD Associate Professor‌, Affiliate Faculty, and Pediatric Intensivist University of Minnesota Medical School University of Minnesota Center for Bioethics Masonic Children's Hospital Kathryn Detwiler, MBA Parent Advocate, Parent Researcher Program Manager, Complex Care Children's National Hospital Vanessa Madrigal, MD, MSCE, HEC-C Associate Professor, Director Pediatric Ethics Program, and Pediatric Critical Care Medicine The George Washington University Children's National Hospital HOST Kathleen Huth, MD, MMSc Pediatrician, Complex Care Service, Division of General Pediatrics Boston Children's Hospital Assistant Professor of Pediatrics Harvard Medical School DATE Initial publication date: July 7, 2025. JOURNAL CLUB ARTICLE Shapiro MC, Detwiler K, Shepard J, Bernhard T, Li X, Boss RD, Madrigal VN. Ethical Challenges in Pediatric Medical Complexity: A Survey of Parents. J Pediatr. 2025 Apr;279:114478. doi: 10.1016/j.jpeds.2025.114478. Epub 2025 Jan 27. PMID: 39864504; PMCID: PMC12013584. OTHER ARTICLES REFERENCED Cho HL, Grady C, Tarzian A, Povar G, Mangal J, Danis M. Patient and Family Descriptions of Ethical Concerns. Am J Bioeth. 2020 Jun;20(6):52-64. doi: 10.1080/15265161.2020.1754500. PMID: 32441594; PMCID: PMC7673656. Pang J, Batson L, Detwiler K, Miller ME, Thorndike D, Boss RD, Shapiro MC. Where do families turn? Ethical dilemmas in the care of chronically critically Ill children. Monash Bioeth Rev. 2024 Jul 8. doi: 10.1007/s40592-024-00201-6. Epub ahead of print. PMID: 38976209. TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/as/p9cpbchs45rp3xq8p747pv83/July_CCJCP_Shapiro_Madrigal_Detwiler_Transcript_7-2-25‌ Clinicians across healthcare professions, advocates, researchers, and patients/families are all encouraged to engage and provide feedback! You can recommend an article for discussion using this form: https://forms.gle/Bdxb86Sw5qq1uFhW6. Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Shapiro MC, Detwiler K, Madrigal VN, Huth K. Families Face Ethical Challenges More Often Than They Change a G Tube: Rethinking Our Care. 7/2025. OPENPediatrics. https://soundcloud.com/openpediatrics/families-face-ethical-challenges-more-often-than-they-change-a-g-tube-rethinking-our-care.

I think I've been exercise resistant much of the time in spite of working out and eating right.   Dr. Coyle shows us that we need at least 8500 steps a day for an hour workout to have the metabolic fat-burning effects we want it to have.   Coyle EF, Burton HM, Satiroglu R. Inactivity Causes Resistance to Improvements in Metabolism After Exercise. Exerc Sport Sci Rev. 2022 Apr 1;50(2):81-88. doi: 10.1249/JES.0000000000000280. Erratum in: Exerc Sport Sci Rev. 2022 Jul 01;50(3):172. doi: 10.1249/JES.0000000000000295. PMID: 35025844.   Online Courses: https://richardhazel.podia.com (The new Unlock the Mystery of Chronic Pain: Peripheral Nerve Entrapment Course is on sale for the month of July. Use JULY100 at checkout for $100 off)  

Dr. Harish Kinni, a triple-board-certified emergency medicine and critical care physician and assistant professor at the Mayo Clinic, provides an overview of the fundamentals of ventilator care for emergency department professionals. We will review key modes that we should know, the variables to set, how to adjust them for your patient's needs, and provide troubleshooting tips and tricks for when things suddenly go awry. This is sure to be one of the most helpful chapters of Always on EM, but don't let it take your breath away! CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Swart P, Nijbroek SGLH, Paulus F, Neto AS, Schultz MJ. Sex Differences in Use of Low Tidal Volume Ventilation in COVID-19-Insights From the PRoVENT-COVID Study. Front Med (Lausanne). 2022 Jan 3;8:780005. doi: 10.3389/fmed.2021.780005. PMID: 35300177; PMCID: PMC8923734. McNicholas BA, Madotto F, Pham T, Rezoagli E, Masterson CH, Horie S, Bellani G, Brochard L, Laffey JG; LUNG SAFE Investigators and the ESICM Trials Group. Demographics, management and outcome of females and males with acute respiratory distress syndrome in the LUNG SAFE prospective cohort study. Eur Respir J. 2019 Oct 17;54(4):1900609. doi: 10.1183/13993003.00609-2019. PMID: 31346004. Swart P, Deliberato RO, Johnson AEW, Pollard TJ, Bulgarelli L, Pelosi P, de Abreu MG, Schultz MJ, Neto AS. Impact of sex on use of low tidal volume ventilation in invasively ventilated ICU patients-A mediation analysis using two observational cohorts. PLoS One. 2021 Jul 14;16(7):e0253933. doi: 10.1371/journal.pone.0253933. PMID: 34260619; PMCID: PMC8279424. Evans, Laura1; Rhodes, Andrew2; Alhazzani, Waleed3; Antonelli, Massimo4; Coopersmith, Craig M.5; French, Craig6; Machado, Flávia R.7; Mcintyre, Lauralyn8; Ostermann, Marlies9; Prescott, Hallie C.10; Schorr, Christa11; Simpson, Steven12; Wiersinga, W. Joost13; Alshamsi, Fayez14; Angus, Derek C.15; Arabi, Yaseen16; Azevedo, Luciano17; Beale, Richard18; Beilman, Gregory19; Belley-Cote, Emilie20; Burry, Lisa21; Cecconi, Maurizio22; Centofanti, John23; Coz Yataco, Angel24; De Waele, Jan25; Dellinger, R. Phillip26; Doi, Kent27; Du, Bin28; Estenssoro, Elisa29; Ferrer, Ricard30; Gomersall, Charles31; Hodgson, Carol32; Hylander Møller, Morten33; Iwashyna, Theodore34; Jacob, Shevin35; Kleinpell, Ruth36; Klompas, Michael37; Koh, Younsuck38; Kumar, Anand39; Kwizera, Arthur40; Lobo, Suzana41; Masur, Henry42; McGloughlin, Steven43; Mehta, Sangeeta44; Mehta, Yatin45; Mer, Mervyn46; Nunnally, Mark47; Oczkowski, Simon48; Osborn, Tiffany49; Papathanassoglou, Elizabeth50; Perner, Anders51; Puskarich, Michael52; Roberts, Jason53; Schweickert, William54; Seckel, Maureen55; Sevransky, Jonathan56; Sprung, Charles L.57; Welte, Tobias58; Zimmerman, Janice59; Levy, Mitchell60. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Critical Care Medicine 49(11):p e1063-e1143, November 2021. | DOI: 10.1097/CCM.0000000000005337  Fan E, Del Sorbo L, Goligher EC, Hodgson CL, Munshi L, Walkey AJ, Adhikari NKJ, Amato MBP, Branson R, Brower RG, Ferguson ND, Gajic O, Gattinoni L, Hess D, Mancebo J, Meade MO, McAuley DF, Pesenti A, Ranieri VM, Rubenfeld GD, Rubin E, Seckel M, Slutsky AS, Talmor D, Thompson BT, Wunsch H, Uleryk E, Brozek J, Brochard LJ; American Thoracic Society, European Society of Intensive Care Medicine, and Society of Critical Care Medicine. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2017 May 1;195(9):1253-1263. doi: 10.1164/rccm.201703-0548ST. Erratum in: Am J Respir Crit Care Med. 2017 Jun 1;195(11):1540. doi: 10.1164/rccm.19511erratum. PMID: 28459336. Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, Oczkowski S, Levy MM, Derde L, Dzierba A, Du B, Aboodi M, Wunsch H, Cecconi M, Koh Y, Chertow DS, Maitland K, Alshamsi F, Belley-Cote E, Greco M, Laundy M, Morgan JS, Kesecioglu J, McGeer A, Mermel L, Mammen MJ, Alexander PE, Arrington A, Centofanti JE, Citerio G, Baw B, Memish ZA, Hammond N, Hayden FG, Evans L, Rhodes A. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Crit Care Med. 2020 Jun;48(6):e440-e469. doi: 10.1097/CCM.0000000000004363. PMID: 32224769; PMCID: PMC7176264. Wang W, Scharfstein D, Wang C, Daniels C, Needham D, Brower R, NHLBI ARDS Clinical Network. Estimating the Causal Effect of Low Tidal Volume Ventilation on Survival in Patients with Acute Lung Injury. J R Stat Soc Ser C Appl Stat. 2011. PMC: PMC3197806 Brower RG, Thompson BT, NIH/NHLBI/ARDSNetwork. Tidal volumes in acute respiratory distress syndrome--one size does not fit all. Crit Care Med. 2006. Hager DN, Krishman JA, Hayden D, Brower RG, ARDSNet NIH / NHLBI. Tidal Volume Reduction in Patients with acute Lung Injury When Plateau Pressures Are Not High. Am J Resp Crit Care Med. 2005. Rubenfeld GD, Cooper C, Carter G, Thompson BT, Hudson LD. Barriers to providing lung protective ventilation to patients with acute lung injury. Crit Care Med. 2004. Chatburn RL, El-Khatib M, Mireles-Cabodevila E. A taxonomy for mechanical ventilation: 10 fundamental maxims. Respir Care. 2014 Nov;59(11):1747-63. doi: 10.4187/respcare.03057. Epub 2014 Aug 12. PMID: 25118309. Guo L, Wang W, Zhao N, Guo L, Chi C, Hou W, Wu A, Tong H, Wang Y, Wang C, Li E. Mechanical ventilation strategies for intensive care unit patients without acute lung injury or acute respiratory distress syndrome: a systematic review and network meta-analysis. Crit Care. 2016 Jul 22;20(1):226. doi: 10.1186/s13054-016-1396-0. PMID: 27448995; PMCID: PMC4957383. Rice TW, Wheeler AP, Bernard GR, Hayden DL, Schoenfeld DA, Ware LB, NIH NHLBI ARDS Network. Comparison of the Sp02/FI02 Ratio and the PaO 2/FI02 in Patients with Acute Lung Injury or ARDS. Chest. 2007. Zhang G, Burla MJ, Caesar BB, Falank CR, Kyros P, Zucco VC, Strumilowska A, Cullinane DC, Sheppard FR. Emergency Department SpO2/FiO2 Ratios Correlate with Mechanical Ventilation and Intensive Care Unit Requirements in COVID-19 Patients. West J Emerg Med. 2024 May;25(3):325-331. doi: 10.5811/westjem.17975. PMID: 38801037; PMCID: PMC11112664.   WANT TO WORK AT MAYO? EM Physicians: https://jobs.mayoclinic.org/emergencymedicine EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs   Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

In this episode of the Saving Lives Podcast, we break down a 2025 study from Intensive Care Medicine that emulates a target trial on the use of sodium bicarbonate in ICU patients with metabolic acidosis. With over 6,000 patients across 12 Australian ICUs, the study reveals a small but significant reduction in mortality and RRT use with bicarbonate therapy. Tune in to learn how this could transform our clinical approach to acidemia in the critically ill patients.The Vasopressor & Inotrope HandbookAmazon: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Affiliate Link)My Store: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)Citation: Blank SP, Blank RM, Laupland KB, Tabah A, Gill D, Kumar A, White K, Attokaran A, Luke S, Whebell S, Garrett P, McCullough J, McIlroy P, Ramanan M; Queensland Critical Care Research Network (QCCRN). Sodium bicarbonate administration for metabolic acidosis in the intensive care unit: a target trial emulation. Intensive Care Med. 2025 Jun;51(6):1-9. doi: 10.1007/s00134-025-07979-x. Epub 2025 Jun 10. PMID: 40493225; PMCID: PMC12208957.

In this episode of the Saving Lives Podcast, we review a comprehensive 2025 meta-analysis on mortality risk factors in pulmonary embolism. Learn which clinical signs, biomarkers, and imaging findings most strongly predict outcomes — and how they can guide triage and therapy decisions in acute PE cases. A must-listen for anyone managing thromboembolic disease in the critically ill patients.The Vasopressor & Inotrope HandbookAmazon: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Affiliate Link)My Store: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)Citation: You W, Fan XY, Chen Y, Wang XL, Song J, Nie CC, Dong Q. Risk Factors for Mortality in Patients with Pulmonary Embolism-A Meta-Analysis. J Intensive Care Med. 2025 May 5:8850666251326539. doi: 10.1177/08850666251326539. Epub ahead of print. PMID: 40320917.

Ever feel like your brain just works differently - like how you need more space, more quiet, or more time to think? In this solo episode of The Ambitious Introvert®, I'm diving into some fascinating (and science-backed) reasons why that's not just in your head - it's actually how your brain is wired.We'll explore three key ways introverts process, respond, and recharge that set us apart - not in a “fix yourself” kind of way, but in a “ohhhh, that's why I do that!” kind of way. If you've ever second-guessed the way you work or wondered why other people seem to thrive on things that drain you, this one's for you.Here's what we cover:Why dopamine floods can feel overwhelming, and which neurotransmitter is the introvert's secret weapon for calm focus.The surprising way introverts use more brain energy, and what it means for your fatigue levels and social battery.What really happens when you pause before speaking, and why your slower processing is actually a strength.How your brain's default mode influences decision-making, reflection, and creativity by taking the long roadWhether you're an introvert wanting to better understand your own patterns or someone who leads or lives with one, this episode will help you reframe how you think about energy, focus, and expression.MENTIONED STUDIES:◾️ Laney, M. O. (2002). The Introvert Advantage – explains dopamine sensitivity and acetylcholine rewards◾️Johnson, D. L., & Wiebe, J. S. et al. (1999). Cerebral Blood Flow and Personality: A PET Study. Am J Psychiatry, 156(2), 252–257. (PMID 9989562)CONNECT WITH EMMA-LOUISE:Website: https://theambitiousintrovert.com/ LinkedIn: https://www.linkedin.com/in/emmalouparkes/Instagram: https://www.instagram.com/emmalouparkesSign up to receive my monthly Introverts Only digest, delivering all the best introvert-friendly resources straight to your inbox, minus the scroll here.PREMIUM SUPPORT: Interested in working with me 1:1? Learn more and apply here.

Send us a textProphylactic hydrocortisone and the risk of sepsis in neonates born extremely preterm.Baud O, Lehert P; PREMILOC study group.Eur J Pediatr. 2025 Jun 14;184(7):419. doi: 10.1007/s00431-025-06248-9.PMID: 40515786 Clinical Trial.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textFrom Warm to Cold: Feeding Cold Milk to Preterm Infants with Uncoordinated Oral Feeding Patterns.Ferrara-Gonzalez L, Kamity R, Htun Z, Dumpa V, Islam S, Hanna N.Nutrients. 2025 Apr 26;17(9):1457. doi: 10.3390/nu17091457.PMID: 40362766 Free PMC article. Clinical Trial.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textNorepinephrine versus Dopamine for Septic Shock in Neonates: A Randomized Controlled Trial.Mazhari MYA, Priyadarshi M, Singh P, Chaurasia S, Basu S.J Pediatr. 2025 Jul;282:114599. doi: 10.1016/j.jpeds.2025.114599. Epub 2025 Apr 17.PMID: 40252959 Clinical Trial.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textAll-cause mortality and infection-related outcomes of hospital-initiated kangaroo care versus conventional neonatal care for low-birthweight infants: a systematic review and meta-analysis.Minotti C, Jost K, Aghlmandi S, Schlaeppi C, Sieswerda E, van Werkhoven CH, Schulzke SM, Bielicki JA.Lancet Child Adolesc Health. 2025 Jul;9(7):470-483. doi: 10.1016/S2352-4642(25)00130-0. Epub 2025 May 26.PMID: 40441171 Free article.As 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 episode of the Saving Lives Podcast, we review a 2025 NEJM-Evidence study analyzing over 21,000 cases of severe hyponatremia to determine the safest and most effective correction rates. Learn why moderate correction (8–10 mmol/L/day) may actually reduce mortality, and how central pontine myelinolysis (CPM) remains rare even with faster correction. The Vasopressor & Inotrope HandbookI have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. Amazon: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Affiliate Link)My Store: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)Citation: Seethapathy H, Zhao S, Ouyang T, Passos C, Sarang A, Cheung PW, Waikar SS, Steele DJR, Kalim S, Allegretti AS, Ayus JC, Nigwekar SU. Severe Hyponatremia Correction, Mortality, and Central Pontine Myelinolysis. NEJM Evid. 2023 Oct;2(10):EVIDoa2300107. doi: 10.1056/EVIDoa2300107. Epub 2023 Sep 26. PMID: 38320180.

In this episode, we analyze a June 2025 study from the Journal of Intensive Care, which shows that lower hemoglobin levels at admission are strongly associated with worse outcomes in cardiogenic shock. We dive into the data from the FRENSHOCK registry, uncover key subgroup findings, and discuss implications for transfusion strategies. Could this shift how we manage anemia in shock? Tune in and find out.The Vasopressor & Inotrope HandbookI have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. Amazon: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Affiliate Link)My Store: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)Citation: Cherbi M, Levy B, Merdji H, Puymirat E, Bonnefoy E, Vardon F, Elbaz M, Morel O, Leurent G, Lamblin N, Gerbaud E, Gautier P, Roubille F, Delmas C. Hemoglobin in cardiogenic shock: the lower, the poorer survival. J Intensive Care. 2025 Jun 23;13(1):36. doi: 10.1186/s40560-025-00805-y. PMID: 40551259.

Hypoglycemia can be subtle—or dangerously obvious—and knowing when and how to treat it is critical. In her first episode as our new Push Dose Pearls expert, Emergency Medicine Clinical Pharmacist, Haley Burhans, joins us to break it down. We discuss glucose thresholds by age, when to draw critical labs, and how to choose the right treatment—whether it's oral glucose, IV dextrose, or IM or intranasal glucagon. From neonates to older adults, Haley delivers practical, evidence-based pearls to help you manage low blood sugar safely and effectively in the ED. Was this episode helpful? What other medications would you like to learn more about? Hit us up 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: Gandhi K. Approach to hypoglycemia in infants and children. Transl Pediatr. 2017 Oct;6(4):408-420. doi: 10.21037/tp.2017.10.05. PMID: 29184821; PMCID: PMC5682370. Rickels MR, Ruedy KJ, Foster NC, Piché CA, Dulude H, Sherr JL, Tamborlane WV, Bethin KE, DiMeglio LA, Wadwa RP, Ahmann AJ, Haller MJ, Nathan BM, Marcovina SM, Rampakakis E, Meng L, Beck RW; T1D Exchange Intranasal Glucagon Investigators. Intranasal Glucagon for Treatment of Insulin-Induced Hypoglycemia in Adults With Type 1 Diabetes: A Randomized Crossover Noninferiority Study. Diabetes Care. 2016 Feb;39(2):264-70. doi: 10.2337/dc15-1498. Epub 2015 Dec 17. PMID: 26681725; PMCID: PMC4722945.. MD Calc GIR (Glucose Infusion Rate) Calculator **** 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.

What if IVF didn't have to mean so many shots? Could a new protocol allow for fewer shots, less office visits, AND be less expensive?  In this episode of Brave & Curious, Dr. Lora Shahine is joined by Dr. Linnea Goodman to answer these questions and more. They review Dr. Goodman's research into a protocol, not new to the fertility field around the world, but new to most listeners in the United States that has many benefits to IVF patients. Dr. Linnea Goodman is a board-certified reproductive endocrinologist and infertility specialist. Throughout her career, Dr. Goodman has been dedicated to advancing the field of reproductive medicine through both clinical excellence and innovative research. Currently, Dr. Goodman practices at Virginia Fertility & IVF, where she specializes in minimally invasive office procedures aimed at optimizing fertility outcomes. In this episode you'll hear: [1:16] Meet Dr. Linnea Goodman: reproductive endocrinologist and researcher [2:24] IVF shots & their necessity [4:45] Provera Protocol is a game-changer [14:35] Research & evidence for the Provera Protocol  [22:19] A patient-centered approach [25:00] Research Outcomes [27:07] Innovations in IVF: Progestins [29:32 The patient experience: benefits and side effects of progestins [32:36 What does the future hold?  Resources mentioned:  http://vafertility.com Massin N, et al. New stimulation regimens: endogenous and exogenous progesterone use to block the LH surge during ovarian stimulation for IVF. Hum Reprod Update. 2017 Mar 1;23(2):211-220. doi: 10.1093/humupd/dmw047.PMID: 28062551  R Beguería, et al. Medroxyprogesterone acetate versus ganirelix in oocyte donation: a randomized controlled trial. Hum Reprod. 2019 May 1;34(5):872-880 doi:10.1093/humrep/dez034. PMID: 30927417 Giles J, et al. Medroxyprogeseterone acetate is a useful alternative to a gonadotropin-releasing hormone antagonist in ooxyte-donation: a randomized controlled trial. Fert Stert 2021;116: 404-412. PMID: 33814126. DOI: 10.1016/j.fertnstert.2021.02.036 Welp A, et al. Oral medroxyprogesterone acetate for the use of ovulation suppression in in vitro fertilization: a cohort trial. Fertil Steril 2024 May;121(5):806-813. PMID: 38253117 DOI: 10.1016/j.fertnstert.2024.01.026   Dr. Shahine's Weekly Newsletter on Fertility News and Recommendations Follow @drlorashahine Instagram | YouTube | Tiktok | Her Books

Join the Behind the Knife Surgical Oncology Team as we discuss the two key studies investigating optimal management strategies of neuroendocrine tumors of the small bowel. Hosts: - Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center - Daniel Nelson, DO, FACS (@usarmydoc24) is Surgical Oncologist/HPB surgeon at Kaiser LAMC in Los Angeles. - Connor Chick, MD (@connor_chick) is a 2nd Year Surgical Oncology fellow at Ohio State University. - Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a 1st Year Surgical Oncology fellow at MD Anderson. - Beth (Elizabeth) Barbera, MD (@elizcarpenter16) is a PGY-6 General Surgery resident at Brooke Army Medical Center Learning Objectives: In this episode we review two important papers that discuss optimal management strategies of neuroendocrine tumors (NET) of the small bowel.  The first paper by Singh and colleagues discusses the NETTER-2 trial investigating the role of radioligand therapy for NET as a first-line treatment.  The second article by Maxwell et all challenges surgical dogma regarding optimal debulking cutoffs for debulking of NET. Links to Papers Referenced in this Episode: 1.     Singh S, Halperin D, Myrehaug S, Herrmann K, Pavel M, Kunz PL, Chasen B, Tafuto S, Lastoria S, Capdevila J, García-Burillo A, Oh DY, Yoo C, Halfdanarson TR, Falk S, Folitar I, Zhang Y, Aimone P, de Herder WW, Ferone D; all the NETTER-2 Trial Investigators. [177Lu]Lu-DOTA-TATE plus long-acting octreotide versus high‑dose long-acting octreotide for the treatment of newly diagnosed, advanced grade 2-3, well-differentiated, gastroenteropancreatic neuroendocrine tumours (NETTER-2): an open-label, randomised, phase 3 study. Lancet. 2024 Jun 29;403(10446):2807-2817. doi: 10.1016/S0140-6736(24)00701-3. Epub 2024 Jun 5. PMID: 38851203. https://pubmed.ncbi.nlm.nih.gov/38851203/ 2.     Maxwell JE, Sherman SK, O'Dorisio TM, Bellizzi AM, Howe JR. Liver-directed surgery of neuroendocrine metastases: What is the optimal strategy? Surgery. 2016 Jan;159(1):320-33. doi: 10.1016/j.surg.2015.05.040. Epub 2015 Oct 9. PMID: 26454679; PMCID: PMC4688152. https://pubmed.ncbi.nlm.nih.gov/26454679/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Contributor: Taylor Lynch, MD Educational Pearls: How do we risk-stratify chest-pain patients? One option is the HEART score This score predicts a patient's 6-week risk of a major adverse cardiac event. Ex. Cath procedure, CABG, PCI, death H stands for History Ask 1) Was the patient diaphoretic? 2) Did they have nausea and/or vomiting? 3) Did the pain radiate down the right or left arm? 4) Was it exertional? Yes to one = one point. Two or more = two points. E stands for EKG One point for left ventricular hypertrophy, t-wave inversions, new bundle-branch blocks. No points for first degree AV block, benign early repolarization, or QT-prolongation Two points for ST-depression A stands for Age >65 gets two points 45-64 gets one point R stands for Risk factors Hypertension, hyperlipidemia, diabetes, obesity, family history, smoking, previous MI, previous CABG, stroke, peripheral arterial disease 1-2 risk factors get 1 point More than two risk factors gets two points T stands for Troponin 1-3x upper limit of normal gets one point >3x upper limit of normal gets two points This gives you a score between zero and ten 0-3 points, patients have a ~2% chance of an adverse event These patients likely go home 4-6 points, patients have a ~20% chance of an adverse event These patients get admitted or expedited outpatient stress test/echo 7-10 points, patients have a ~60% chance of an adverse event Admit and call cardiology. These patients likely get catheterized References Backus BE, Six AJ, Kelder JC, Bosschaert MA, Mast EG, Mosterd A, Veldkamp RF, Wardeh AJ, Tio R, Braam R, Monnink SH, van Tooren R, Mast TP, van den Akker F, Cramer MJ, Poldervaart JM, Hoes AW, Doevendans PA. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013 Oct 3;168(3):2153-8. doi: 10.1016/j.ijcard.2013.01.255. Epub 2013 Mar 7. PMID: 23465250. Laureano-Phillips J, Robinson RD, Aryal S, Blair S, Wilson D, Boyd K, Schrader CD, Zenarosa NR, Wang H. HEART Score Risk Stratification of Low-Risk Chest Pain Patients in the Emergency Department: A Systematic Review and Meta-Analysis. Ann Emerg Med. 2019 Aug;74(2):187-203. doi: 10.1016/j.annemergmed.2018.12.010. Epub 2019 Feb 2. PMID: 30718010. https://www.mdcalc.com/calc/1752/heart-score-major-cardiac-events Summarized by Jeffrey Olson, MS4 | Edited by Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/

You have a patient with complicated diverticulitis s/p IR drain with colo-cutaneous fistula and colo-vaginal fistula. They are scheduled for surgery. How will you do it? What is the role for hand assist? How can hand assist help? Tune in to find out! Join Drs. Peter Marcello, Jonathan Abelson, and Tess Aulet as they discuss high yield papers discussing hand assist laparoscopy in Colon and Rectal surgery.  Learning Objectives 1. Describe the technical considerations and how to do hand assist laparoscopic surgery (HALS) 2. Discuss the indications for use of HALS 3. Review literature supporting use of HALS   References: Marcello PW, Fleshman JW, Milsom JW, Read TE, Arnell TD, Birnbaum EH, Feingold DL, Lee SW, Mutch MG, Sonoda T, Yan Y, Whelan RL. Hand-assisted laparoscopic vs. laparoscopic colorectal surgery: a multicenter, prospective, randomized trial. Dis Colon Rectum. 2008 Jun;51(6):818-26; discussion 826-8. doi: 10.1007/s10350-008-9269-5. Epub 2008 Apr 17. PMID: 18418653. https://pubmed.ncbi.nlm.nih.gov/18418653/ Jacobs C, Read TE. "Peek port": avoiding conversion during laparoscopic colectomy-an update. Surg Endosc. 2020 Sep;34(9):3944-3948. doi: 10.1007/s00464-019-07165-3. Epub 2019 Oct 4. PMID: 31586252. https://pubmed.ncbi.nlm.nih.gov/31586252/ Heneghan HM, Martin ST, Kiran RP, Khoury W, Stocchi L, Remzi FH, Vogel JD. Laparoscopic colorectal surgery for obese patients: decreased conversions with the hand-assisted technique. J Gastrointest Surg. 2013 Mar;17(3):548-54. doi: 10.1007/s11605-012-2089-x. Epub 2012 Nov 27. PMID: 23188222. https://pubmed.ncbi.nlm.nih.gov/23188222/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen