Podcasts about practice committee

Avec Dr Philippe Major, neurologue pédiatrique, Stéphanie Benoit, nutritionniste de la clinique de neurologie, et Marianne Boulé, pharmacienne au CHU Sainte-Justine, nous allons:  Partie 1: définir l'épilepsie et l'impact qu'elle a sur la vie des patients ; distinguer les convulsions provoquées de celles non-provoquées ; discuter des principales lignes de traitements pharmacologiques ; Partie 2:  expliquer les principes de la diète cétogène chez les patients vivant avec une épilepsie réfractaire ; identifier les médicaments qui doivent être évités en diète cétogène ; résumer les traitements chirurgicaux et la neuromodulation.Références:Voir la description de l'épisode 7 | épilepsie (partie 1) pour toutes les autres références ;-Diète cétogène : Aliments sous ordonnance [Internet]. CHU Sainte-Justine. 2022. -Institut national d'excellence en santé et en services sociaux (INESSS). Le régime cétogène dans le traitement de l'épilepsie réfractaire. Juillet 2020.-Kossoff EH, Zupec-Kania BA, Auvin S et al. Practice Committee of the Child Neurology Society. Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group. Epilepsia Open. 2018 May 21;3(2):175-192. -VitaFlo. An introductory guide for the practical implementation of the ketogenic diet (KD) for the dietary management of epilepsy and neurometabolic disease. Mars 2020.-Neurochirurgie. [Internet]. CHU Sainte-Justine. 2022-Dallas J, Englot DJ, Naftel RP. Neurosurgical approaches to pediatric epilepsy: Indications, techniques, and outcomes of common surgical procedures. Seizure. 2020 Apr;77:76-85. -Stimulation du nerf vague. Dépliant produit par le CHU Sainte-Justine. Révisé en 2012.-Vagus Nerve Stimulation (VNS) Therapy. Epilepsy Foundation. 2024.-Unité de l'évaluation des technologies et des modes d'intervention en santé. Pertinence clinique de l'utilisation de la neurostimulation dans letraitement de troubles neurologiques (Dystonie ou épilepsie) pharmacorésistants. Rapport final version 2. Mars 2024.Merci pour l'écoute! Allez mettre une réaction sur vos épisodes préférés, partagez la bonne nouvelle sur Facebook/Instagram et abonnez-vous pour ne rien manquer

So you have a job offer. Now what? If you're a senior trainee or new-in-practice pathologist navigating contract negotiation for the first time, this episode is for you. Jennifer Woo, MD, FCAP, and Esther Yoon, MD, FCAP, from the New-in-Practice Committee chat with Practice Management Committee members Moira Larsen, MD, MBA, FCAP, and Cedric Bailey, DO, FCAP, about their contract negotiation advice and experiences. This episode is a collaboration between the New-in-Practice and Practice Management Committees and is one of two episodes on job searching tips.

Interviewing for your first job as a pathologist might seem intimidating. But this is an opportunity to not only showcase your abilities but to find out if the position and practice setting are a good fit for you and your career goals. Neha Varshney MD, FCAP, FASCP, from the New-in-Practice Committee, chats with Practice Management Committee members Karim Sirgi MD, MBA, and Jeremy S Ditelberg MD, FCAP, about their job interview advice and experiences. This episode is a collaboration between the New-in-Practice and Practice Management Committees and is one of two episodes on job searching tips.

Retirement may be years away, but it's never too early to start planning and saving. Abdul Abid, MD, a member of the New-in-Practice Committee talks with Brian Truscott, a certified financial planner and wealth management advisor who shared his tips on retirement plans, debt repayment, and investment considerations for early career pathologists.

Follow Clint: https://www.linkedin.com/in/clint-mehall-patents/ Today we talk to Clint Mehall, an experienced US-based Patent Attorney with more than 15 years of experience in the field. Clint is also the co-chair of the New York Intellectual Property Law Association's Patent Law & Practice Committee, and his blog phositb.com regularly gives a variety of practical insights into the patent process. Join us for Episode 62 as we discuss:

Infrastructure advocacy takes center stage this week with the ASCE Legislative Fly-In in Washington, D.C. Sarah Matin, P.E., M.ASCE, Orlando office principal for S&ME and chair of the ASCE Public Policy and Practice Committee, is one of the many ASCE members headed to Capitol Hill this week looking to keep the IIJA momentum going. In episode 138 of ASCE Plot Points, Matin talks about how IIJA funding is affecting work going on in Florida and what's next for infrastructure advocacy.

Welcome to Valuable Conversations with the UCL Institute for Innovation and Public Purpose. On this episode, Ph.D. student Nai Kalema and MPA alumni Justin Beirold talk to IIPP Visiting Professor of Practice, Damon Silvers. For over 30 years, Damon has been a leading voice in the US labour movement. He tells Justin and Nai how he got involved in labour activism during the dining hall worker strikes and anti-apartheid protests when he was an undergraduate at Harvard. He talks about how the labour movement has changed over his career, and how we are now at a crucial inflection point for aligning the objectives of unions, environmental activism, and innovation policy. As Damon is also a scholar of constitutional law, he also provides a lengthy explanation of the recent right-wing supreme court rulings in the US, and how we might be able to overcome them. This is a long interview - the longest we have done so far on this podcast. But it is also a really good conversation! So rather than cutting it into pieces, we've provided a few time stamps so you can skip around if you desire. We hope you enjoy our conversation with Damon Silvers! ******* - 3 min 40 sec: Damon's life journey, undergraduate labour activism. - 29 min 30 sec: the anti-apartheid movement - 35 minutes: How Damon started working for unions - 44 min 30 sec: The past, present, and future of the organised labour - 59 min 30 sec: Joining IIPP, and his lectures on "Climate Change, innovation, and the labour movement." - 1 hr 33 min: The US Supreme Court rulings of Summer 2022 ********Guest Bio: Damon A. Silvers a Visiting Professor in Labour Markets and Innovation at the UCL IIPP. He is on sabbatical from the AFL-CIO where is has served as the Director of Policy and Special Counsel for the AFL-CIO. He joined the AFL-CIO as Associate General Counsel in 1997. From 2008 to 2011, Mr. Silvers served as the Deputy Chair of the Congressional Oversight Panel for TARP. Mr. Silvers has also served on the Treasury Department's Financial Research Advisory Committee, as the Chair of the Competition Subcommittee of the United States Treasury Department Advisory Committee on the Auditing Profession and as a member of the United States Treasury Department Investor's Practice Committee of the President's Working Group on Financial Markets. Mr. Silvers led the successful efforts to restore pensions to the retirees of Cannon Mills lost in the Executive Life collapse and the severance owed to laid off Enron and WorldCom workers following the collapse of those companies. He served from 2003 to 2006 as pro bono Counsel to the Chairman of ULLICO, Inc. and in that capacity led the successful effort to recover over $50 million related to improperly paid executive compensation. Mr. Silvers received his J.D. with honors from Harvard Law School. He received his M.B.A. with high honors from Harvard Business School and is a Baker Scholar. Mr. Silvers is a graduate of Harvard College, summa cum laude, and has studied history at Kings College, Cambridge University. Recorded in Summer 2022 *******-Check out Damon's IIPP lectures on Labour, Innovation, and Climate Change: https://www.youtube.com/watch?v=u34XWAmzeJ0 -Blog: "The End of the Roberts Court" https://damonsilvers.substack.com/p/the-end-of-the-roberts-court -Follow Damon on Twitter:@DamonSilvers -See Damon's full bio: https://www.ucl.ac.uk/bartlett/public-purpose/people/damon-silvers Learn about our hosts: - Justin Beirold - https://www.ucl.ac.uk/bartlett/public-purpose/justin-beirold - Nai Kalema - https://www.ucl.ac.uk/bartlett/public-purpose/nai-lee-kalema -Follow IIPP on Twitter: @IIPP_UCL https://www.ucl.ac.uk/bartlett/public-purpose/ -Production and music by Justin Beirold

Status Epilepticus is one of the most common pediatric neurologic emergencies and requires prompt, targeted treatment to reduce patient morbidity and mortality. On this podcast, Pediatric Critical Care Physician, Dr. Renuka Mehta, Pediatric Resident Physician, Dr. Yvonne Ibe, and medical student, Emily Austin will discuss management for status epilepticus and rapid interventions that can be potentially lifesaving—because in seizure management, time is brain.  FREE CME Credit (requires sign-in):  Link Coming Soon! Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. An additional thanks to Dr. Lorna Bell, Dr. George Hsu, and Dr. Rebecca Yang who provided editing and peer review of today's discussion. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu Remember that all content during this episode is intended for educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. Thank you for your support! References: Alldredge, B. K., Gelb, A. M., Isaacs, S. M., Corry, M. D., Allen, F., Ulrich, S., Gottwald, M. D., O'Neil, N., Neuhaus, J. M., Segal, M. R., & Lowenstein, D. H. (2001). A Comparison of Lorazepam, Diazepam, and Placebo for the Treatment of Out-of-Hospital Status Epilepticus. New England Journal of Medicine, 345(9), 631–637. https://doi.org/10.1056/NEJMoa002141  Chamberlain, J. M., Kapur, J., Shinnar, S., Elm, J., Holsti, M., Babcock, L., Rogers, A., Barsan, W., Cloyd, J., Lowenstein, D., Bleck, T. P., Conwit, R., Meinzer, C., Cock, H., Fountain, N. B., Underwood, E., Connor, J. T., Silbergleit, R., Neurological Emergencies Treatment Trials, & Pediatric Emergency Care Applied Research Network investigators. (2020). Efficacy of levetiracetam, fosphenytoin, and valproate for established status epilepticus by age group (ESETT): a double-blind, responsive-adaptive, randomised controlled trial. Lancet (London, England), 395(10231), 1217–1224. https://doi.org/10.1016/S0140-6736(20)30611-5  Chamberlain, J. M., Okada, P., Holsti, M., Mahajan, P., Brown, K. M., Vance, C., Gonzalez, V., Lichenstein, R., Stanley, R., Brousseau, D. C., Grubenhoff, J., Zemek, R., Johnson, D. W., Clemons, T. E., & Baren, J. (2014). Lorazepam vs Diazepam for Pediatric Status Epilepticus: A Randomized Clinical Trial. JAMA, 311(16), 1652. https://doi.org/10.1001/jama.2014.2625  Chen, J., Xie, L., Hu, Y., Lan, X., & Jiang, L. (2018). Nonconvulsive status epilepticus after cessation of convulsive status epilepticus in pediatric intensive care unit patients. Epilepsy & Behavior: E&B, 82, 68–73. https://doi.org/10.1016/j.yebeh.2018.02.008  Fine, A., & Wirrell, E. C. (2020). Seizures in Children. Pediatrics in Review, 41(7), 321–347. https://doi.org/10.1542/pir.2019-0134  Glauser, T., Shinnar, S., Gloss, D., Alldredge, B., Arya, R., Bainbridge, J., Bare, M., Bleck, T., Dodson, W. E., Garrity, L., Jagoda, A., Lowenstein, D., Pellock, J., Riviello, J., Sloan, E., & Treiman, D. M. (2016). Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Currents, 16(1), 48–61. https://doi.org/10.5698/1535-7597-16.1.48  Hanhan, U. A., Fiallos, M. R., & Orlowski, J. P. (2001). Status epilepticus. Pediatric Clinics of North America, 48(3), 683–694. https://doi.org/10.1016/s0031-3955(05)70334-5  Kapur, J., Elm, J., Chamberlain, J. M., Barsan, W., Cloyd, J., Lowenstein, D., Shinnar, S., Conwit, R., Meinzer, C., Cock, H., Fountain, N., Connor, J. T., Silbergleit, R., & NETT and PECARN Investigators. (2019). Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus. The New England Journal of Medicine, 381(22), 2103–2113. https://doi.org/10.1056/NEJMoa1905795  Lyttle, M. D., Rainford, N. E. A., Gamble, C., Messahel, S., Humphreys, A., Hickey, H., Woolfall, K., Roper, L., Noblet, J., Lee, E. D., Potter, S., Tate, P., Iyer, A., Evans, V., Appleton, R. E., Pereira, M., Hardwick, S., Messahel, S., Noblet, J., … Hobden, G. (2019). Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial. The Lancet, 393(10186), 2125–2134. https://doi.org/10.1016/S0140-6736(19)30724-X  Raspall‐Chaure, M., Chin, R. F. M., Neville, B. G., Bedford, H., & Scott, R. C. (2007). The Epidemiology of Convulsive Status Epilepticus in Children: A Critical Review. Epilepsia, 48(9), 1652–1663. https://doi.org/https://doi.org/10.1111/j.1528-1167.2007.01175.x  Riviello, J. J., Ashwal, S., Hirtz, D., Glauser, T., Ballaban-Gil, K., Kelley, K., Morton, L. D., Phillips, S., Sloan, E., Shinnar, S., American Academy of Neurology Subcommittee, & Practice Committee of the Child Neurology Society. (2006). Practice parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology, 67(9), 1542–1550. https://doi.org/10.1212/01.wnl.0000243197.05519.3d  Sánchez Fernández, I., Abend, N. S., Agadi, S., An, S., Arya, R., Brenton, J. N., Carpenter, J. L., Chapman, K. E., Gaillard, W. D., Glauser, T. A., Goodkin, H. P., Kapur, K., Mikati, M. A., Peariso, K., Ream, M., Riviello, J., Tasker, R. C., & Loddenkemper, T. (2015). Time from convulsive status epilepticus onset to anticonvulsant administration in children. Neurology, 84(23), 2304–2311. https://doi.org/10.1212/WNL.0000000000001673  Trinka, E., Cock, H., Hesdorffer, D., Rossetti, A. O., Scheffer, I. E., Shinnar, S., Shorvon, S., & Lowenstein, D. H. (2015). A definition and classification of status epilepticus--Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia, 56(10), 1515–1523. https://doi.org/10.1111/epi.13121  Welch, R. D., Nicholas, K., Durkalski-Mauldin, V. L., Lowenstein, D. H., Conwit, R., Mahajan, P. V., Lewandowski, C., Silbergleit, R., & Neurological Emergencies Treatment Trials (NETT) Network Investigators. (2015). Intramuscular midazolam versus intravenous lorazepam for the prehospital treatment of status epilepticus in the pediatric population. Epilepsia, 56(2), 254–262. https://doi.org/10.1111/epi.12905 

On this episode of the Emoroid Digest Podcast, we sit down with Dr. Bashar Qumseya and discuss the American Society for Gastrointestinal Endoscopy (ASGE) Guidelines on the Endoscopic Management of Malignant Hilar Obstruction. Dr. Bashar Qumseya is an Associate Professor of Medicine at the University of Florida in Gainesville and the Director of Endoscopy at UF Health Shands Hospital. He also chairs the Standards of Practice Committee for ASGE.   Host: Dr. Chuma Obineme (GI Fellow) –  https://twitter.com/TypicallySilent  Co-Host: Dr. Jason Brown - https://med.emory.edu/directory/profile/?u=JMBROW2  Guest: Dr. Bashar Qumseya - https://twitter.com/Bashar_Qumseya Link to Review: https://pubmed.ncbi.nlm.nih.gov/34023067/ Link to Emoroid Digest Visual Summary: https://twitter.com/EmoryGastroHep/status/1518585675288829954?s=20&t=kVoDuFo_RGx1uPYLBc1kUQ Link to Emoroid Digest Website: https://med.emory.edu/departments/medicine/divisions/digestive-diseases/education/emoroid-digest.html  

2022 has seen a greater focus on encouraging gender equality at the workplace in Singapore. The White Paper on Singapore Women's Development released in March 2022 highlighted the introduction of laws which would encourage flexible work arrangements and support greater gender diversity on boards, to name a few. However, is there more that must be done to ensure gender diversity and equality at work? What are the greatest barriers facing women at the workplace? On the first episode of the third season, which is in conjunction with IPS' annual flagship conference, Singapore Perspectives 2023, host and Associate Director at the Institute of Policy Studies Liang Kaixin chats with two of our guests Corinna Lim, Executive Director of the Association of Women for Action and Research (AWARE) and Simran Toor, Chief Executive Officer at SG Her Empowerment Limited (SHE) about the laws that are in place to protect women at work, as well as what can be done to reduce the incidences of sexual harassment and unconscious gender bias at work. Find out more about sexism at work: Today (11 July 2022): Woman Up: From job interview to the boardroom, gender bias often follows women through each step of the career ladder CNA (9 April 2022): IN FOCUS: Beyond diversity quotas and anti-discrimination laws, can Singapore embrace gender equality at the workplace? The Straits Times (28 March 2022): 25 action plans from the White Paper on Singapore Women's Development Tripartite Alliance for Fair & Progressive Employment Practices (4 March 2022): Equipping and Supporting Women in the Workplace Today (3 March 2022): Over 1 in 5 S'poreans believe gender discrimination exists in the workplace: Survey About our guests: Corinna Lim Executive Director of the Association of Women for Action and Research (AWARE) Ms Corinna Lim is the Executive Director of AWARE, the Association of Women for Action and Research. Ms Lim joined AWARE as a member and volunteer in 1992 and has been a women's rights activist for close to 30 years.Since becoming Executive Director in 2010, Ms Lim has been responsible for a range of initiatives including the setting up of the Sexual Assault Care Centre, the only specialised service in Singapore that provides support to sexual assault victims. She also led teams at AWARE to successfully advocate for the enactment of the Protection from Harassment Act, the repeal of marital rape immunity, better access to housing for single parents, gender equal workplaces and greater support for low income families and caregivers of the elderly.In recognition of her contributions to civil society and the advancement of women's rights, Ms Lim received a Fulbright Scholarship (1998 – 1999). As Executive Director, Ms Lim has improved the governance and management of AWARE, resulting in AWARE being awarded the Charity Governance and Transparency awards in 2015.  Simran Toor Chief Executive Officer at SG Her Empowerment Limited (SHE) Ms Simran Toor began her legal career as a criminal prosecutor at the Attorney-General's Chambers of Singapore, and thereafter spent 15 years at a Big 4 law firm, where she specialised in white-collar investigations and regulatory matters. Ms Toor is a strong proponent of diversity, gender equity, and community development through outreach. Prior to leaving legal practice to join SHE, she was an elected member of the Council of the Law Society of Singapore, where she took a particular interest in promoting gender and access to justice issues. In particular, Ms Toor co-led the Law Society's Women in Practice Task Force that looked into the challenges facing women lawyers in the modern-day workplace. She also co-founded/chaired the Law Society's Women in Practice Committee that spearheaded the launch of a template anti-workplace harassment policy for adoption by all law firms. On Diversity is a podcast inspired by the Institute of Policy Studies Managing Diversities research programme. In each episode, we chat with guests to explore what diversity means to them, the changes they are making, and the changes they hope to see in an increasingly fragmented society. More from On Diversity Season 2 Episode 1: Conversations About Race, with Daniel Goh, Associate Professor of Sociology and Associate Provost of Undergraduate Education at National University of Singapore (NUS) and Haresh Tilani, Co-founder and Creative Director of Ministry of Funny Season 2 Episode 2: Stay-At-Home Dads, with Kelvin Seah, Stay-at-home Father and Adjunct Lecturer and Tam Wei Jia, Medical Doctor and Founder of Kitesong Global Season 2 Episode 3: The Plight of Buskers, with Yeo Ying Hao, Co-chairman of Buskers Assocation, and Louis Ng, Nee Soon GRC MP Season 2 Episode 4: Diversity in Elite Schools, with Gillian Koh, IPS Deputy Director and Senior Research Fellow, and Paul Jerusalem, master's student at NUS Season 2 Episode 5: The New Civil Society, with Carol Soon, IPS Senior Research Fellow and Head of Society and Culture, and Woo Qiyun, Environmentalist and creator of The Weird and Wild Season 2 Episode 6: The Young vs The Old, with Kanwaljit Soin, Orthopaedic and Hand Surgeon, and Teo Kay Key, IPS Research Fellow Season 2 Episode 7: Homelessness, with Harry Tan, IPS Research Fellow, and June Chua, Co-founder of T Project Season 2 Episode 8: What Makes Us Singaporean, with Matthew Matthews, Principal Research Fellow of IPS and Head of IPS Social Lab, and Oon Shu An, Singaporean actress and host Season 2 Episode 9: Youth Mental Health, with Dr Jacqueline Tilley, Assistant Professor of Clinical Psychology at the National Institute of Education (NIE) and Asher Low, Founder of Limitless See omnystudio.com/listener for privacy information.

In this episode, I sit down with fellow physiotherapist, Jodie Pulsifer to discuss the recent editorial Reframing beliefs and instiling facts for contemporary management of pregnancy-related pelvic girdle pain. Jodie Pulsifer, along with Susannah Britnell, Adrienne Sim, Sinead Dufour and Jessica Adaszynski have been credited for combing through all related evidence on the topic to create a helpful resource for clinicians and clients in infographic form. In this episode we discuss the details including: Causes of pelvic pain in pregnancyHow common messaging is misleading practitioners and clientsStability of the pelvis in pregnancyThe hormonal and postural changes expected in pregnancyThe importance of education, emotional wellbeing and sleep to manage painWays to self manage pelvic pain (exercise, support belts etc)The strongest predictor of resolution of pregnancy related pelvic girdle painJodie is a Registered Physiotherapist who graduated from UBC in 2012. Jodie trained in pelvic health physiotherapy in 2015 and loves the intersection of her interest in the human body and providing care that is not readily accessed in our current medical model.She loves both clinical work, supporting education of clients and clinicians and being an advocate for practice change on structural and educational levels. Jodie practices clinically in pelvic health and persistent pain in East Vancouver where she currently works in two treatment spaces within the walls of Pomegranate Community Midwives and Local Health Integrative Clinic. You can find Jodie through the Full Circle Physiotherapy Collective - a network of Pelvic Health Providers across the Lower Mainland, Fraser Valley and Vancouver Island. When not treating clinically, Jodie keeps herself motivated and engaged teaching with Pelvic Health Solutions and Reframe Rehab as well as volunteering on the Professional Development Advisory Committee for CPTBC and the Scope of Practice Committee for PABC. She also serves on the Steering Committee for Pain BC's Adaptive Mentorship Network and is currently participating in their mentorship program for her own continued growth and learning!  Jodie believes that listening, communication and the use of language are some of the most undervalued and essential tools humans and healthcare providers have and their role and impact should not be taken lightly. Jodie is passionate about care that considers your unique experience in your body, including healthcare inequities and social injustice.  Outside of her physio roles, Jodie tries to practice a life filled with small moments of goodness and joy in the chaos. Jodie loves to be in connection with the earth and her body so you will likely find her growing or cooking food with her 2 tiny humans, enjoying an espresso, ripping around on her longtail e-bike and running with her vigorously social Labradoodle, Leni.InstagramWebsite A link to the source:Article download here for a fee or reach out to associations/schools that have full text access for a copy. Physiotherapists with PABC can reach out directly to the librarian for the full editorial. https://bjsm.bmj.com/content/early/2022/08/19/bjsports-2022-105724  Thanks for joining me! Here is where you can find more:my online course to walk you through pregnancy, birth prep and postpartum recovery: https://mommyberries.comSupport the show

Rick Augsburger has worked for more than 25 years as a leader in the international development and humanitarian sector, focusing on leadership, staff resilience, program growth and strategy and is he a founding partner of the Konterra Group.   Prior to joining the KonTerra Group, Rick served as the deputy director of the Headington Institute (2007-2008), Director of Emergency Programs (1996-2005) and Deputy Director (2005-2007) for Church World Service, an international relief and development agency. He has a BA in Business Administration and is a graduate of the Harvard Business School Executive Leadership program in Performance Measurement and Management for Nonprofit Organizations.   Rick was also regional advisor for the United States Agency for International Development-OFDA in East Africa and the associate director for Mennonite Disaster Service. He brings more than twenty years of experience in humanitarian programming. He has traveled extensively working on relief and development programs in more than 70 countries. He has also led disaster rapid response teams and participated as a trainer and consultant for numerous humanitarian agencies.   From 2000 to 2005 Rick served as the co-chair of InterAction's Humanitarian Policy and Practice Committee. Prior to that he was a member of InterAction's executive board of directors and represented the U.S.-based humanitarian community on the United Nations Inter-Agency Standing Committee (IASC) Working Group.   My conversation with Rick Augsburger took place in 2021.   For more info about CWS, please check out this website. The Konterra Group is on Facebook and Twitter. You can also find Rick on Facebook.   We made a special Playlist #CWSsongs consisting of songs chosen by many of our podcast guests.   Please let me/us know via our email innovationhub@cwsglobal.org what you think about this new series. We would love to hear from you.   Please like/follow our Walk Talk Listen podcast and follow @mauricebloem on twitter and instagram.  Or check us out on our website 100mile.org (and find out more about our app (android and iPhone) that enables you to walk and do good at the same time!

In this CAPcast, New in Practice Committee members Drs. Alan Brown and Jaclyn Rudzinski discuss common financial challenges and issues for fellows and new attendings, including common pathology practice structures as well as the importance of balancing debts and savings. This episode is adapted from a New-in-Practice Committee Roundtable discussion originally recorded on Nov. 12, 2021. For more information on resources from the CAP New-in-Practice Committee, please visit CAP.org: https://www.cap.org/member-resources/new-in-practice.

Medical errors happen to all pathologists, and every pathologist wants to make sure that they never happen. Indeed, there are whole books on identifying and correcting errors that should be part of every lab's quality management plan and CAP accreditation is there to help pathologists prevent, catch, and correct errors. However what is often missed is the worry, mental effort and stress that pathologists who are new in practice feel regarding mistakes when they first started their careers. In this CAPcast, Drs. Richard Owings, Juanita Evans, and Yasmeen Butt discuss medical errors--how to confront and move on from them, as well as how to avoid them. Drs. Owings, Evans, and Butt are all members of the CAP's New in Practice Committee. Additional resources for pathologists who are early in their career are available on the New-in-Practice section of CAP.org: capatholo.gy/3btuncz.

Dr. Tim Vidale is the CEO of Momentous Sports Medicine and the former Physical Therapist and Assistant Rehab Coordinator for the Minnesota Twins. He is a graduate of Florida A&M University where he was a hurdler and decathlete on the track and field team. Dr. Vidale went on to attain his Doctorate of Physical Therapy from Rutgers University. Following graduation, Dr. Vidale relocated to Washington, D.C. where he earned his MBA from George Washington University. He attained the FAAOMPT distinction through the Institute for Athlete Regeneration. Prior to that he operated a sports Physical Therapy clinic in Washington, DC, while also serving as an Assistant Professor in the Doctor of Physical Therapy program at Howard University. He was the Head Physical Therapist for the DC Slayers and DC Furies Rugby clubs from 2012-2016 and served Team USA as a Physical Therapist at the 2015 Pan American Games in Toronto, Canada with the United States Olympic Committee. He also currently serves as the Physical Therapist for USA Softball National team. Dr. Vidale is a published author, with publications in internationally distributed textbooks and scholarly journals and is also a content reviewer for the International Journal of Sports Physical Therapy. Dr. Vidale is trained in Functional Dry Needling and is well versed in treating sports and orthopedic injuries. He sits on the State Board of Physical Therapy for Washington, DC, and currently serves as on the Nominating Committee for the American Academy of Sports Physical Therapy. Dr. Vidale is also the chairman of the Diversity, Equity and Inclusion Committee and serves on the Practice Committee in the AASPT, and is also involved in the American Physical Therapy Association, American College of Sports Medicine and the Private Practice Section. He resides in Washington, DC with his wife, Jeanna and daughters, Taryn and Sage.

In this conversation, I am speaking with Susan Imus MA, LCPC, BC-DMT, GL-CMA, about her attempts to create language and theoretical scaffolding for the field of dance/movement therapy. Susan was motivated by a question: how does dance/movement therapy work? In her most recent article, Creating Breeds Creating. In H. Wentgrower and S. Chaiklin (Eds), Dance and Creativity Within Dance Movement Therapy: International Perspectives. Susan suggests several models for understanding the work of dance/movement therapy including Nine Funamental Mechanisms, A-FECT Model of Aesthetics and Culture, and The Continuum of Interdisciplinary Approaches. Susan writes about how the field of dance/movement therapy spans the realms of the somatic, the aesthetic, and the psychological, and each of these realms explain aspects how dance/movement therapy works. Susan has created these models as offerings to the field, with the hope that they can bolster education, research and collaboration within the field internationally. Susan is Associate Professor and the former Chair of the Department of Creative Arts Therapies in the School of Fine and Performing Arts at Columbia College Chicago. Susan has practiced, educated, and consulted in dance/movement therapy and the creative arts throughout the U.S. and abroad for 33 years. Susan is the former chair of the Education, Research, and Practice Committee for the American Dance Therapy Association (ADTA). She received the first Excellence in Education award by the ADTA in 2006. Susan, originally trained in nursing, has been employed as a dance/movement therapist by 10 different hospitals throughout her career in the Midwest and on the East Coast. Prestigious institutions include Harvard University's McLean Hospital and Harvard Pilgrim Healthcare, where she was recruited to assist in the development of chronic pain services through the Department of Medical Specialties. Susan teaches a course called Embodiment: A Way to Know Your Patient at Rush University Medical College and in the recent past at the Bioethics and Humanities Department in the Feinberg School of Medicine at Northwestern University. Susan is active in the Arts in Health community working with Rush Generations; a wellness program through the Social Work and Community Health Department at Rush University Medical Center. Susan and the studentsa (arts in health minor) received the Community Engagement Award by the organization in 2017.

Today on the show we are honored to have Dr. Alan Penzias, chair of the ASRM Practice Committee, to give us insight into how the committee works. Did you know that ASRM has different kinds of documents, each with it's own purpose and methodology? Click here to find out more More information on these topics is available at www.asrm.org Tell us your thoughts on the show by e-mailing asrm@asrm.org Please subscribe and rate the show on Apple podcasts, Google Play, or wherever you get your podcasts. ASRM Today Series Podcasts are supported in part by the ASRM Corporate Member Council

Dr. Therese Waterhous' Nuggets from today: Should Registered Dietitians be involved in Family Based Treatment? How to find free high-quality trainings for primary care doctors, dietitians and therapists Instilling HOPE Sharing advice to “Learn the family, their story and their fears…and respect.” And do not be afraid Listen in today to hear about the Eating Disorder Treatment Facilitator Therese S. Waterhous Ph.D., RDN, CEDRD-S, FAED is an eating disorder specialist in private practice in Corvallis, Oregon. She has worked with families and their children for over 30 years, having completed a pediatric fellowship at the University of Alabama at Birmingham during graduate school.    Therese was one of the founding board members for the international non-profit advocacy group FEAST-ED (Families Empowered and Supporting Treatment for Eating Disorders) she has worked with the Eating Disorders Coalition during two of its Washington DC lobbying days and she delivers many local talks to various groups, educating them about eating disorders.   Therese coauthored the ADA Practice Paper on nutrition interventions in eating disorders, she served as Director of the Sports, Cardiovascular and Wellness Nutrition practice group's subunit on disordered eating and eating disorders. She has served on the Oregon IAEDP (International Assn. for Eating Disorders Professionals) chapter board and currently serves on the national IAEDP Excellence in Practice Committee.    Therese served on the Academy for Eating Disorders (AED) special interest group on Family-Based Treatment and currently is active on the Medical Care Standards Committee and the Experts by Experience Committee of AED. In 2016-2017, she received and has executed work on a grant from the local Coordinated Care Organization to train other health care professionals about eating disorder evaluation and treatment and extend eating disorder treatment to underserved Oregonians.   Contact Therese at  https://willamettenutritionsource.com/   With your host Beth Harrell Follow Beth on Instagram

On this episode we discuss the document on vitrification released earlier this year. Our guest today is Dr. Sangita Jindal, the IVF Lab Director and associate professor at the Albert Einstein College of Medicine and Montefiore's Institute for Reproductive Medicine. Link to document: A review of best practices of rapid-cooling vitrification for oocytes and embryos: a committee opinion More information on these topics is at www.asrm.org Tell us your thoughts on the show by e-mailing asrm@asrm.org Please subscribe and rate the show on Apple podcasts ,Google Play, or wherever you get your podcasts. ASRM Today Series Podcasts are supported in part by the ASRM Corporate Member Council

Take a sneak peak at this month's Fertility and Sterility! Topics include new insights in male sterilization, obesity and risk of a euploid embryo miscarriage, endometrial preparation in frozen embryo transfers, as well as a look into three new Practice Committee documents for infertility providers. View Fertility and Sterility June 2021 Volume 115 Issue 6 View Fertility and Sterility at https://www.fertstert.org/

Karen welcomes Dr. Janet Courtney to the show for the conclusion of their two part conversation on Dr. Courtney's FirstPlay Therapy model. Janet A. Courtney, PhD, LCSW is Founder of FirstPlay Therapy® and Founder and Editor of FirstPlay® Café: An e-magazine for parents (womb to six Years). She is Director of Developmental Play & Attachment Therapies, Inc. She is a Registered Play Therapy-Supervisor, TEDx Speaker and presently Chair of the Association for Play Therapy Ethics and Practice Committee and past President of the Florida Association for Play Therapy and former Chair of the Viola Brody Award Committee. Awarded Third Place overall in the Best Practices Showcase for FirstPlay Therapy at the First 1000 Days Infant Mental Health Summit (Sept, 2018) along with the Children’s Healing Institute.

Karen welcomes Dr. Janet Courtney to the show for part one of their two part conversation on Dr. Courtney's FirstPlay Therapy model. Part two will be released on Tuesday, January 5th.   Janet A. Courtney, PhD, LCSW is Founder of FirstPlay Therapy® and Founder and Editor of FirstPlay® Café: An e-magazine for parents (womb to six Years). She is Director of Developmental Play & Attachment Therapies, Inc. She is a Registered Play Therapy-Supervisor, TEDx Speaker and presently Chair of the Association for Play Therapy Ethics and Practice Committee and past President of the Florida Association for Play Therapy and former Chair of the Viola Brody Award Committee. Awarded Third Place overall in the Best Practices Showcase for FirstPlay Therapy at the First 1000 Days Infant Mental Health Summit (Sept, 2018) along with the Children’s Healing Institute.

In this episode we have a discussion with Dr. Anne Steiner about testing and interpreting measures of ovarian reserve. To view this and all ASRM's Practice Committee documents, visit ASRM.org If you'd like to know more about the types of practice documents and the methodology of their creation, visit this page on ASRM.org

Medical errors happen all pathologists, and every pathologists wants to make sure that they never happen. Indeed, there are whole books on identifying and correcting errors that should be part of every lab's quality management plan and CAP accreditation is there to help pathologists prevent, catch, and correct errors. However what is often missed is the worry, mental effort and stress that pathologists who are new in practice feel regarding mistakes when they first their careers. In this CAPcast, Drs. Richard Owings, Juanita Evans, and Yasmeen Butt discuss medical errors--how to confront and move on from them, as well as how to avoid them. Drs. Owings, Evans, and Butt are all members of the CAP's New in Practice Committee. Additional resources for pathologists who are early in their career are available on the New-in-Practice section of CAP.org: https://capatholo.gy/3btuncz.

"One of the biggest challenges that PGT (preimplantation genetic testing) has presented to the field of IVF is this phenomenon of mosaic results - these results that neither clearly normal nor clearly abnormal but somewhere in between." - Emily Mounts, MS, CGC Mosaicism is very challenging topic and there are many unknowns that clinicians deal with regularly. ASRM Today speaks with Emily Mounts who is the Director of Genomic Services and a genetic counselor with ORM Fertility in Oregon, about the recent ASRM Practice Committee Opinion on "Clinical management of mosaic results from preimplantation genetic testing for aneuploidy (PGT-A) of blastocysts". Emily Mounts is a board-certified genetic counselor at ORM Fertility. She has been practicing in prenatal and reproductive genetics for over 20 years and is the Immediate Past Chair of the ASRM Genetic Counseling Professional Group. She is one of the primary authors of the forthcoming ASRM Committee Opinion publication, Clinical management of mosaic results from preimplantation genetic testing for aneuploidy (PGT-A) of blastocysts. This Practice Committee Opinion will be available on August 5, 2020. To view this and all ASRM's Practice Committee documents, visit ASRM.org If you'd like to know more about the types of practice documents and the methodology of their creation, visit this page on ASRM.org

In this episode, Dr, Janet Courtney talks with us a little bit about the creation of her books and trainings that focus on infant mental health, development play, and expressive therapies. Her passion for supporting infants, children, and families is contagious and the stories that she shares in this episode reflect the neuro-developmental as well as relational impact of this type of work. This episode is full of stories, clinical examples, and such wonderful information that could be useful to any therapist working with infants, children, and families. Enjoy! Janet A. Courtney, PhD, LCSW is Founder of FirstPlay Therapy® [an Infant Mental Health & Developmental Play Therapy model] and Founder and Editor of FirstPlay® Café: An e-magazine for parents (womb to six Years). She is Director of Developmental Play & Attachment Therapies, Inc. She is a Registered Play Therapy-Supervisor, TEDx Speaker and presently Chair of the Association for Play Therapy Ethics and Practice Committee and past President of the Florida Association for Play Therapy and former Chair of the Viola Brody Award Committee. Awarded Third Place overall in the Best Practices Showcase for FirstPlay Therapy at the First 1000 Days Infant Mental Health Summit (Sept, 2018) along with the Children’s Healing Institute. She is author and co-editor of Touch in Child Counseling and Play Therapy: An Ethical and Clinical Guide. New York, NY: Routledge, and her research into practitioner experiences of training in touch and Developmental Play Therapy is published in the American Journal of Art Therapy and the International Journal of Play Therapy. She is a contributing author for the chapter, “Touching Autism through Developmental Play Therapy” in the book, “Play-based Interventions for Children and Adolescents with Autism Spectrum Disorders;” and has a chapter in the book, Environmental Expressive Therapies (2017), titled: “The Art of Utilizing the Metaphorical Elements of Nature as ‘Co-Therapist’ in Ecopsychology Play Therapy.” She is also published in the Journal of Therapeutic Horticulture. She offers a certification in FirstPlay Therapy® (including FirstPlay® Infant Massage Storytelling) and provides training to professionals in the Ethical and Clinical Competencies of Touch, FirstPlay® Therapy, Ericksonian-based StoryPlay®, Expressive Therapies, and Ecopsychology Play Therapy. She has been invited to speak nationally and internationally including the Cayman Islands, England, Ireland, Morocco, Russia and the Ukraine. She is a provider through the Florida state boards of Mental Health and Massage Therapy, and an approved provider through the Association for Play Therapy. She specializes in Infant Mental Health and Infant Play Therapy, Attachment, and Trauma related issues. Dr. Courtney’s new form of Kinesthetic Storytelling® can be found in her children’s book, The Magic Rainbow. Website: www.FirstPlayTherapy.com and www.FirstPlaycafe.com Email Dr. Courtney at janetcourtneyphd@gmail.com Check out Janet's book, "Infant Play Therapy: Foundations, Models, Programs, and Practice"  Check out the Janet's newest book, "Healing Child and Family Trauma through expressive and Play Therapist: Art, Nature, Storytelling, Body & Mindfulness" Curative Touch Of A Magic Rainbow Hug Ted Talk First Play Trainings   Follow CTU on Instagram! Join the Creative Therapy Umbrella Hub Facebook group to further discuss, collaborate, and create with your fellow creative arts therapy community! Looking for more creative content? Sign up for our newsletter and get a free creativity guide! Have feedback? Fill out our anonymous survey to let us know your thoughts, concerns, questions, suggestions, and feedback. For us to serve you better, we need to hear YOUR voice!

"So the stakes are very high when you store cryopreserved embryos, eggs, sperm, testicular tissue, ovarian tissue, but even higher stakes when you cryopreserve and store tissue from cancer patients." --Sangita Jindal, Ph.D. In 2018, there were a number of notable failures of cryostorage which caused concern for patients and program safety for IVF in the United States. ASRM Today invited Dr. Sangita Jindal to speak about the ASRM Practice Committee Opinion titled, "Cryostorage of reproductive tissues in the IVF laboratory". Dr. Sangita Jindal is an Associate Professor in the Department of Ob/Gyn and Women’s Health, and Laboratory Director of Montefiore’s Institute for Reproductive Medicine and Health. Dr. Jindal received her Ph.D in reproductive physiology at the University of Toronto. In addition to her clinical expertise in all aspects of in vitro fertilization, andrology and infertility-related chemistry, Dr. Jindal supervises translational research on alterations in gene expression associated with ovarian aging in women. This Practice Committee Opinion will be available on August 5, 2020. To view this and all ASRM's Practice Committee documents, visit ASRM.org If you'd like to know more about the types of practice documents and the methodology of their creation, visit this page on ASRM.org

"One of the biggest challenges that PGT (preimplantation genetic testing) has presented to the field of IVF is this phenomenon of mosaic results - these results that neither clearly normal nor clearly abnormal but somewhere in between." - Emily Mounts, MS, CGC Mosaicism is very challenging topic and there are many unknowns that clinicians deal with regularly. ASRM Today speaks with Emily Mounts who is the Director of Genomic Services and a genetic counselor with ORM Fertility in Oregon, about the recent ASRM Practice Committee Opinion on "Clinical management of mosaic results from preimplantation genetic testing for aneuploidy (PGT-A) of blastocysts". Emily Mounts is a board-certified genetic counselor at ORM Fertility. She has been practicing in prenatal and reproductive genetics for over 20 years and is the Immediate Past Chair of the ASRM Genetic Counseling Professional Group. She is one of the primary authors of the forthcoming ASRM Committee Opinion publication, Clinical management of mosaic results from preimplantation genetic testing for aneuploidy (PGT-A) of blastocysts. This Practice Committee Opinion will be available on August 5, 2020. To view this and all ASRM's Practice Committee documents, visit ASRM.org If you'd like to know more about the types of practice documents and the methodology of their creation, visit this page on ASRM.org

Dr. Dennis Bailey discusses the role of dentists in sleep medicine. Dr. Bailey is a general dentist with a practice limited to the management of Sleep Related Breathing Disorders (Snoring and Sleep Apnea) utilizing oral appliances as well as Temporomandibular Disorders (TMD), Orofacial Pain and related headaches. He is a graduate of Indiana University School of Dentistry and completed a General Practice Residency at Miami Valley Hospital in Dayton, Ohio. He is a past president of the American Academy of Dental Sleep Medicine (1998-1999), is the founder and past-chair of the Oral Appliance Section and served on the Standards of Practice Committee for the American Academy of Sleep Medicine. He frequently lectures both in the US and internationally and has authored numerous texts, articles and chapters on the topic of Sleep Medicine and on the use of Oral Appliances by the dentist for the management of snoring and sleep apnea. He is currently a visiting lecturer in the Orofacial Pain and Sleep Medicine Program at UCLA School of Dentistry and is the Co-Director of the Mini-Residency in Sleep Medicine for the Dentist. Dr. Bailey is a Past-President (2013-2014) of the Colorado Sleep Society and is the chair for the Sleep Medicine Committee for the American Academy of Orofacial Pain from 2012 to the present. He has Diplomate status in the American Board of Orofacial Pain and in the American Board of Dental Sleep Medicine and is a Fellow in the Academy of General Dentistry, the American Academy of Orofacial Pain and the International College of Dentists.

Dr. Dennis Bailey discusses sleep disorders and airway issues in pediatric and adolescent patients. Dr. Bailey is a general dentist with a practice limited to the management of Sleep Related Breathing Disorders (Snoring and Sleep Apnea) utilizing oral appliances as well as Temporomandibular Disorders (TMD), Orofacial Pain and related headaches. He is a graduate of Indiana University School of Dentistry and completed a General Practice Residency at Miami Valley Hospital in Dayton, Ohio. He is a past president of the American Academy of Dental Sleep Medicine (1998-1999), is the founder and past-chair of the Oral Appliance Section and served on the Standards of Practice Committee for the American Academy of Sleep Medicine. He frequently lectures both in the US and internationally and has authored numerous texts, articles and chapters on the topic of Sleep Medicine and on the use of Oral Appliances by the dentist for the management of snoring and sleep apnea. He is currently a visiting lecturer in the Orofacial Pain and Sleep Medicine Program at UCLA School of Dentistry and is the Co-Director of the Mini-Residency in Sleep Medicine for the Dentist. Dr. Bailey is a Past-President (2013-2014) of the Colorado Sleep Society and is the chair for the Sleep Medicine Committee for the American Academy of Orofacial Pain from 2012 to the present. He has Diplomate status in the American Board of Orofacial Pain and in the American Board of Dental Sleep Medicine and is a Fellow in the Academy of General Dentistry, the American Academy of Orofacial Pain and the International College of Dentists.

Pierre Vigilance, MD, MPH is a population health expert joining the premiere episode of RadioRev to talk about social determinants of health. In this episode, Pierre lays the foundation for the SDoH season and answers questions like: How should we be talking about SDoH? Is there a dedicated dictionary of terms and definitions for SDoH? What are the biggest barriers that healthcare needs to overcome to successfully address SDoH? To connect with Pierre: LinkedIn: https://www.linkedin.com/in/pierrevigilance/ Junctional Thinking Podcast: https://junctionalthinking.simplecast.com/ Dr. Pierre Vigilance is a health executive with 20 years experience in community development, social determinants of health, people and operations management, population health strategy, and executive education from time spent working in the non-profit, government, and education sectors. He is a systems-level thinker who has established cross-sector partnerships to impact health and founded HealthUp as an advisory consultancy to assist organizations and companies dedicated to improving health and social outcomes in underserved communities. His client-partners range from community health and transportation agencies to municipal bodies considering “smart growth”, and an impact investment group focused on housing. He consistently makes use of human-centered design tools to gain a better perspective on the challenges faced by his clients and the people they serve. As the George Washington University School of Public Health’s (GWSPH) first Associate Dean for Practice from 2013 to July 2019 he led the school’s applied public health efforts. He continues to engage learners and serve in an advisory capacity to the school as an Adjunct Professor and is also an adjunct faculty member at the Institute for Emerging Health Professions at Thomas Jefferson University in Philadelphia. Prior to his time in academia Dr. Vigilance was the Health Commissioner for the District of Columbia from 2008-2011, and from 2002-2008 he served communities in Baltimore as an Assistant Health Commissioner in Baltimore City and Director of the Department of Health in Baltimore County. His early career postgraduate career was spent in the non-profit sector work where he directed a new case-management based substance abuse program seated in a community development corporation. Dr. Vigilance is a member of the Trinity Health Mid-Atlantic Board of Directors; and as an Advisory Board Member of the Millennium Alliance a tech, business, and educational advisory firm. He is also an advisor to civic tech company Seam Social Labs, and the workplace creativity outfit, Innovators Box. He has served as a member of the Practice Committee for the Association of Schools and Programs of Public Health (ASPPH); Board member for the non-profit, DC SCORES; and is an alumnus of the National Association of City & County Health Officials and the Association of State and Territorial Health Officials. A graduate of the Johns Hopkins University School of Medicine, and the Bloomberg School of Public Health at Johns Hopkins, he currently resides in Philadelphia, PA.

In episode two of the Identification season, Just Science interviews Suzanne Birdwell, a forensic artist with the Texas Department of Public Safety and the current Chair of the IAI Forensic Art Science and Practice Committee. With over 700 cases in her career, Suzanne Birdwell understands the nuances of forensic artistry. Through a collaborative process, forensic artists create likenesses to aid in recognition and identification of a criminal, a decedent, or a missing person. Listen along as our guest discusses sketching from memory, facial reconstruction, age progression, and other aspects of forensic artistry. This season is funded by the National Institute of Justice’s Forensic Technology Center of Excellence.

Episode 4 of the Family Docs: The Early Years Podcast – Leadership Skills. The OCFP's Early Years in Practice Committee member, Dr. Jillie Reston speaks with Dr. Elaine Blau about the importance of leadership.  Their conversation covers the skills and qualities of a good leader, the importance of self-awareness, the challenges of leadership, and other tips on how to lead. 

Wondering how the physical activity guidelines are going to change your practice? Ken Miller, PT, DPT, Chair of the Practice Committee for Home Health Section, tells us how the the 2019 Home Health toolkit is going to move the needle from reaction to prevention. We chat the 2018 physical activity guidelines: "Walking slowly with patients is not aerobic activity!" Talus Media Talks is a subsidiary of Talus Media: The PT News Project. You can find physical therapy news on our sister channel, Talus Media News. Check us out on Twitter, Facebook, & Instagram @TalusMedia, and head to our website at talusmedia.org for more information.

Past AANA presidents Sandra Ouellette and Nancy Bruton Maree join the program on this edition of the show to discuss how the CRNA profession has evolved to its current state. Sandra and Nancy will share stories of their experiences as presidents of the AANA. We'll also take a look at the future of the industry and some of the major issues facing CRNAs going forward. ----more---- Ms. Bruton-Maree graduated from N.C. Baptist Hospital School of Nurse Anesthesia, Guildford College (BS) & Wake Forest University (MS).  She is a member of Sigma Theta Tau and Chaired the NCANA Program and Publications Committees, served on NCANA Education & Research, Bylaws, Finance, & Strategic Planning Committees.  Ms. Bruton-Maree served as NCANA Secretary, President-Elect, and twice President of the NCANA.  Additionally, she served as AANA member Continuing Education Committee, Editorial Advisory Committee, Journal Editorial Advisory Board, Practice Committee, educator and Chairperson of the Council on Accreditation of Nurse Anesthesia Educational Programs, & Chairperson, Education Committee. She served as AANA Director, Region 2, AANA Vice-President, AANA President-Elect, & AANA President.  She also served as member, Vice-Chair & Chair of the N.C. Board of Nursing.  She served President of Anesthesia Review & Update from 2007 to 2017 and is retired as Program Director & Visiting Assistant Professor of Raleigh School of Nurse Anesthesia/UNCG.  Ms. Bruton-Maree was awarded the Helen Lamb Outstanding Educator award by the AANA in 2008, and the Agatha Hodgins Outstanding Accomplishment Award in 2018. Ms. Bruton-Maree is currently a Consulting Associate at the School of Nursing, Duke University.

Episode 3 of the Family Docs: The Early Years Podcast – Mentoring Opportunities.   Dr. Suzie Lotimer and Dr. Jobin Varughese, members of the OCFP's Early Years in Practice Committee speak with the OCFP Collaborative Mentoring Networks Clinical Lead, Dr. Arun Radhakrishnan about mentorship as a tool to improve and expand clinical practice.  

Greg Hartley, Assistant Professor of Clinical Physical Therapy in the Department of Physical Therapy, Miller School of Medicine at University of Miami, comes onto HET Podcast to talk about PT Residency and specifically Geriatric Residency, thoughts on having a national standardized clinical skills exam for PTs, his perspective working and being involved with ABPTRFE, and much more! This is Part 2.  Greg's Profile on University of Miami Website: http://pt.med.miami.edu/academics/faculty-and-staff/full-time-faculty/greg-hartley   ABPTRFE Website: http://www.abptrfe.org/home.aspx  APTA Website: http://www.apta.org/  Greg's Facebook Page: https://www.facebook.com/greg.hartley.12  Greg's Twitter Page: https://twitter.com/greghartleydpt  Greg's Instagram Page: https://www.instagram.com/hartley8549/    Biography: Dr. Hartley is Assistant Professor of Clinical Physical Therapy at the University of Miami Miller School of Medicine, Department of Physical Therapy. He is a Board-certified Geriatric Clinical Specialist and a Certified Exercise Expert for Aging Adults. He is currently the President of the Academy of Geriatric Physical Therapy (AGPT, 2018-2021), and has previously served the AGPT as Director and Secretary on the Board of Directors, and as Chair of the Practice Committee. Greg is the founding Program Director of the first APTA accredited geriatric residency in the U.S. He has been a member of the American Board of Physical Therapy Residency and Fellowship Education and its Accreditation Committee for more than 15 years and was Chair of this group twice, in 2008-2009 when it was still known as the Clinical Residency/Fellowship Credentialing Committee, and again in 2013-2014 after the group had become a Board. Greg also recently served as a member of APTA's Best Practices in Clinical Education Task Force. He has been elected as a delegate to the APTA House of Delegates 9 times (AL and FL), and has served on the Florida Physical Therapy Association (FPTA) Board of Directors and as FPTA Practice Chair. From 2005-2015, he was Director of Rehabilitation for a large post-acute care provider specializing in geriatric rehabilitation. Clinically, he has practiced in home healthcare, outpatient, sub-acute rehab, long -term care, acute care, and rehabilitation hospital settings.

Greg Hartley, Assistant Professor of Clinical Physical Therapy in the Department of Physical Therapy, Miller School of Medicine at University of Miami, comes onto HET Podcast to talk about PT Residency and specifically Geriatric Residency, thoughts on having a national standardized clinical skills exam for PTs, his perspective working and being involved with ABPTRFE, and much more! This is Part 1.  Greg's Profile on University of Miami Website: http://pt.med.miami.edu/academics/faculty-and-staff/full-time-faculty/greg-hartley   ABPTRFE Website: http://www.abptrfe.org/home.aspx  APTA Website: http://www.apta.org/  Greg's Facebook Page: https://www.facebook.com/greg.hartley.12  Greg's Twitter Page: https://twitter.com/greghartleydpt  Greg's Instagram Page: https://www.instagram.com/hartley8549/    Biography: Dr. Hartley is Assistant Professor of Clinical Physical Therapy at the University of Miami Miller School of Medicine, Department of Physical Therapy. He is a Board-certified Geriatric Clinical Specialist and a Certified Exercise Expert for Aging Adults. He is currently the President of the Academy of Geriatric Physical Therapy (AGPT, 2018-2021), and has previously served the AGPT as Director and Secretary on the Board of Directors, and as Chair of the Practice Committee. Greg is the founding Program Director of the first APTA accredited geriatric residency in the U.S. He has been a member of the American Board of Physical Therapy Residency and Fellowship Education and its Accreditation Committee for more than 15 years and was Chair of this group twice, in 2008-2009 when it was still known as the Clinical Residency/Fellowship Credentialing Committee, and again in 2013-2014 after the group had become a Board. Greg also recently served as a member of APTA's Best Practices in Clinical Education Task Force. He has been elected as a delegate to the APTA House of Delegates 9 times (AL and FL), and has served on the Florida Physical Therapy Association (FPTA) Board of Directors and as FPTA Practice Chair. From 2005-2015, he was Director of Rehabilitation for a large post-acute care provider specializing in geriatric rehabilitation. Clinically, he has practiced in home healthcare, outpatient, sub-acute rehab, long -term care, acute care, and rehabilitation hospital settings.

Warwick Mihaly is a director of Mihaly Slocombe Architects in Melbourne. Warwick is a leader in the architecture profession. He is instrumental in championing positive change within the industry through mentoring the next generation of architects through lecturing, as a Director of Member Services at ArchiTeam, Practice Committee member at the Australian Institute of Architects, and through founding and cultivating Australia’s most widely read business blog for architects, Panfilo.co On this episode, we discuss architecture fee models, the economic landscape for architects, sharing your ideas to educate clients and how architects can borrow from startup culture. You can help Warwick to make a case for architecture by pledging to the ArchiTeam / RAsP crowdfunding campaign on Pozible.com Visit https://vanityprojects.com/ for more information about this interview plus dozens of other interviews with successful architects and consultants.    

Episode 1 of the Family Docs: The Early Years Podcast – Transitioning to Practice.   Dr. Britta Laslo and Dr. Corey Bricks, members of the OCFP's Early Years in Practice Committee speak with MD Financial Management consultant Saif Khan and HealthForceOntario regional advisor James Draper on the key considerations when building your practice.

Carole Lewis and Ken Miller come onto the Show for a discussion on advice/issues for the hospital/home care physical therapist. They discuss the biggest issues in hospital/home care therapy along with some solutions, thoughts on the recommendations from the Best Practices in Physical Therapist Clinical Education Task Force, most important clinical pearls that a hospital/home care therapist should know, best pieces of advice for the hospital/home care clinician, how to avoid burnout, & what are the best post professional resources for development in these settings. Carole discusses the changes she has seen based on her recommendations from her McMillan lecture and much more!   Biographies: Carole Lewis is the 2106 McMillan Lecturer and her lecture “our Future Selves: Unprecedented Opportunities” and she is the 2nd McMillan lecturer that we have had on the podcast! She is the President of GREAT Seminars which is a continuing education company for physical and occupational therapists. Dr. Lewis currently serves on the Medical Faculty at George Washington University as a full adjunct professor in the Department of Geriatrics and is a Clinical Professor at the University of Maryland. She has published extensively in the field of aging, including professional articles, books, textbooks, and books for the lay audience. Her accomplishments include receiving the APTA's Lucy Blair Service Award and the Section on Geriatrics' highest honor, the Joan Mills Award & the Section on Geriatrics' Clinical Excellence Award. She is also a Catherine Worthington Fellow for the APTA. She has served the profession by volunteering for many local and national offices and served as the president of both the DC chapter and the Section on Geriatrics of the APTA. Dr. Lewis has lectured extensively. She has spoken in over 48 states. Her international lectures include Australia, New Zealand, Japan, Finland, Canada, China and Israel. She combines her diverse education and extensive clinical background to provide medically substantiated and usable information for today's practicing clinician   Kenneth L Miller, PT, DPT, GCS, CEEAA is a board certified geriatric specialist with over 20 years of clinical practice in multiple practice settings with the older adult population. Dr. Miller is a physical therapist clinical educator for a healthcare system focusing on home care best practices and optimal transitions with the frail population. He mentors an interdisciplinary staff in the home setting utilizing the clinical setting to promote patient safety with patient engagement and interaction. Additionally, he serves as an adjunct professor in the post professional DPT program at Touro College in Bay Shore, New York where he has developed multiple courses on the care of the older adult population and has presented nationally at the Combined Sections Meeting and NEXT Conferences of the APTA. As the Chair of the Practice Committee of the Home Health Section of the APTA, he led the development of the Providing Physical Therapy in the Home handbook and other resources such as home health student roadmap and toolkit and the home health section's objective test toolbox. He is a member of the Editorial Boards of Topics in Geriatric Rehabilitation and GeriNotes publications and serves as a manuscript reviewer for the Journal of Geriatric Physical Therapy. Most recently is an author of the chapter on pharmacology in a geriatric text book called “Physical Therapy for the Older Adult” published by Wolters Kluwer and edited by Dr. Carole Lewis. Links AMEDEO, The Medical Literature Guide: http://amedeo.com/  The Moving Target Screen: https://www.greatseminarsonline.com/mts/  APTA's Council on Prevention, Health Promotion, and Wellness:  http://www.apta.org/PHPW/  The Academy of Health and Promotion Therapies:  https://www.aphpt.org/  Great Seminars Twitter Page: https://twitter.com/GR8Seminars  Ken Miller's Twitter Page: https://twitter.com/kenmpt  Great Seminars Facebook Page #1: https://www.facebook.com/greatseminarsonline/   Great Seminars Facebook Page #2:https://www.facebook.com/greatseminarsandbooks/ 

Happy Holidays PEC Podcast listeners!  Have you ever been asked, "So, what can an EMS Medical Director do?"  Instead of delving into all the things that a Medical Director can do, NAEMSP will be publishing a position statement titled: EMS Physician-Performed Clinical Interventions in the Field.    To delve into what this position statement will say, the PEC Podcast team interviews Dr. John Gallagher, the chair of the NAEMSP Standards and Practice Committee, about this fantastic statement.    Dr. John Gallagher Enjoy this small batch podcast and click here to download now!   We hope you enjoy this podcast and THANK YOU For listening! Hawnwan Philip Moy MD Scott Goldberg MD, MPH Jeremiah Escajeda MD, MPH Joelle Donofrio DO      

Dr. Ken Miller joins us, this week, on Pain Reframed.  Ken has more than 20 years of experience working primarily with older adults and more than 7 years teaching other PTs how to, best, do the same. Ken has been an educator, physical therapist and consultant for the home health industry for over 20 years and serves as a guest lecturer, adjunct teaching assistant and adjunct professor in the DPT program at Touro College in Bay Shore, New York. He has presented on a variety of topics including: objective testing, professionalism, interdisciplinary team modeling, osteoporosis, differential diagnosis of dizziness, documentation, patient engagement, student program development and home health regulations. He serves as Chair of the Practice Committee of the Home Health Section (HHS) of the APTA. As the Chair, he led the development of the Providing Physical Therapy section in the home handbook, Third Edition, Home health student program road map and tool kit and the home health section objective test toolbox. Ken has authored numerous articles for the Journal of Geriatric Physical Therapy, GeriNotes and The Quarterly Report Newsletters. Ken shares his insights and advice on how to incorporate the ICF model as well as how to focus on key variables like depression, inactivity, and other obstacles that the older population faces when it comes to persistent pain and effective treatment. LINKS: http://www.apta.org/ICF/ @kenmpt http://ispinstitute.com http://evidenceinmotion.com @eimteam

Happy Summer Everyone! To help you deal with the impending heat, we've got a fantastic podcast episode with our favorite Standards & Practice section of NAEMSP for your listening pleasure.  Right click here to download now! In this episode we will be discussing two position statements with (Click the title for a link to the position statements): 1. Physician Oversight of Pediatric Care in Emergency Medical Services Dr. Toni Gross 2.  EMS Treatment of Special/Rare Conditions using Prescribed Medications not Routinely Carried by EMS   Dr. Craig Cooley Along with our current and former chairs of Standards & Practice Committee...   Dr. John Gallagher (Current Chair) Dr. John Lyng (Immediate past chair) Please enjoy this podcast episode and stay tuned for our July Episode! Hawnwan Philip Moy MD Scott Goldberg MD, MPH Jeremiah Escajeda MD, MPH Joelle Donofrio DO    

Children the world over are fascinated with what can possibly “fit” in their orifices.  Diagnosis is often delayed.  Anxiety abounds before and during evaluation and management.     Most common objects:1,2 Food Coins Toys Insects Balls, marbles Balloons Magnets Crayon Hair accessories, bows Beads Pebbles Erasers Pen/marker caps Button batteries Plastic bags, packaging Non-pharmacologic techniques Set the scene and control the environment.  Limit the number of people in the room, the noise level, and minimize “cross-talk”.  The focus should be on engaging, calming, and distracting the child. Quiet room; calm parent; “burrito wrap”; guided imagery; have a willing parent restrain the child in his or her lap – an assistant can further restrain the head. Procedural Sedation Most foreign bodies in the ear, nose, and throat in children can be managed with non-pharmacologic techniques, topical aids, gentle patient protective restraint, and a quick hand.  Consider sedation in children with special health care needs who may not be able to cooperate and technically delicate extractions.  Ketamine is an excellent agent, as airway reflexes are maintained.3  Remember to plan, think ahead: where could the foreign body may be displaced if something goes wrong?  You may have taken away his protective gag reflex with sedation.  Position the child accordingly to prevent precipitous foreign body aspiration or occlusion. L’OREILLE – DAS OHR – вухо – THE EAR – LA OREJA – 耳 – L'ORECCHIO Essential anatomy: The external auditory canal. Foreign bodies may become lodged in the narrowing at the bony cartilaginous junction.4  The lateral 1/3 of the canal is flexible, while the medial 2/3 is fixed in the temporal bone – here is where many foreign bodies are lodged and/or where the clinician may find evidence of trauma.  Pearls: Ask yourself: is it graspable or non-graspable?5 Graspable: 64% success rate, 14% complication rate Non-graspable: 45% success rate, 70% complication rate5 If there is an insect in the external auditory canal, kill it first. They will fight for their lives if you try to dismember or take them out.  “In the heat of battle, the patient can become terrorized by the noise and pain and the instrument that you are using is likely to damage the ear canal.”5,6  Use lidocaine jelly (preferred), viscous lidocaine (2%), lidocaine solution (2 or 4%), isopropyl alcohol, or mineral oil. Vegetable matter? Don’t irrigate it – the organic material will swell against the fixed structure, and cause more pain, make it much harder to extract, and may increase the risk of infection. Pifalls: Failure to inspect after removal – is there something else in there? Failure to assess for abrasions, trauma, infection – if any break in skin, give prophylactic antibiotic ear drops Law of diminishing returns: probability of successful removal of ear foreign bodies declines dramatically after the first attempt   LE NEZ – DIE NASE – ніс – THE NOSE – LA NARIZ – 鼻 – IL NASO Essential anatomy: Nasopharyngeal and tracheal anatomy. Highlighted areas indicate points at which nasal foreign bodies may become lodged.4 Pearls: Consider using topical analgesics and vasoconstrictors to reduce pain and swelling – and improve tolerance of/cooperation with the procedure. Use 0.5% oxymetolazone (Afrin) spray and a few drops of 2 or 4%   Pros: as above.  Cons: possible posterior displacement of the foreign body.7 Be ready for the precipitous development of an airway foreign body Pitfalls: Beware of unilateral nasal discharge in a child – strongly consider retained foreign body.8 Do not push a foreign body down the back of a patient's throat, where it may be aspirated into the trachea. Be sure to inspect the palate for “vacuum effect”: small or flexible objects may be found on the roof of the mouth, just waiting to be aspirated.   LA GORGE – DER HALS – горло – THE THROAT – LA GARGANTA – 喉 – LA GOLA Before we go further – Remember that a foreign body in the mouth or throat can precipitously become a foreign body in the airway.  Foreign body inhalation is the most common cause of accidental death in children less than one year of age.9,10 Go to BLS maneuvers if the child decompensates. Infants under 1 year of age – back blows: head-down, 5 back-blows (between scapulae), 5 chest-thrusts (sternum).  Reassess, repeat as needed. Children 1 year and up, conscious – Heimlich maneuver: stand behind patient with arms positioned under the patient’s axilla and encircling the chest. The thumb side of one fist should be placed on the abdomen below the xiphoid process. The other hand should be placed over the fist, and 5 upward-inward thrusts should be performed. This maneuver should be repeated if the airway remains obstructed.  Alternatively, if patient is supine, open the airway, and if the object is readily visible, remove it.  Abdominal thrusts: place the heel of one hand below the xiphoid, interlace fingers, and use sharp, forceful thrusts to dislodge.  Be ready to perform CPR. Children 1 year and up, unconscious – CPR: start CPR with chest compressions (do not perform a pulse check). After 30 chest compressions, open the airway. If you see a foreign body, remove it but do not perform blind finger sweeps because they may push obstructing objects further into the pharynx and may damage the oropharynx.  Attempt to give 2 breaths and continue with cycles of chest compressions and ventilations until the object is expelled. Chest films are limited: 80% of airway foreign bodies are radiolucent.11  Look for unilateral hyperinflation on expiratory films: air trapping.  Essential anatomy: Most esophageal foreign bodies in children occur at the level of the thoracic inlet / cricopharyngeus muscle (upper esophageal sphincter).  Other anatomically narrow sites include the level of the aortic arch and the lower esophageal sphincter. Coin en face – in the esophagus – lodged at the thoracic inlet.12  The pliable esophagus accommodates the flat coin against the flat aspect of the vertebra.11 Beware the “double-ring” sign: this is a button battery13 This is an emergency: the electrolyte-rich mucosa conducts a focal current from the narrow negative terminal of the battery, rapidly causing burn, necrosis, and possibly perforation.  Emergent removal is required. Button batteries that have passed into the stomach do not require emergent intervention – they can be followed closely. Not a button battery, not a sharp object, not a long object? If there is no obstruction, consider revaluation the next day – may wait up to 24 hours for passage.14  Sharieff et al.15 found that coins found in the mid to distal esophagus within 24 hours all passed successfully. What conditions prompt urgent removal? Size Infants: objects smaller than 2 cm wide and 3 cm long will likely pass the pylorus and ileocecal valve10 Children and adults: objects smaller than 2 cm wide and 5 cm long will likely pass the pylorus and ileocecal valve9 Character Sharp objects have a high rate of perforation (35%)1 Pearls: History is essential. Believe the parents and assume there is an aspirated/ingested foreign body until proven otherwise. History of choking, has persistent symptoms and/or abnormal xray? Broncoscopy! Cohen et al.16 found that of 142 patients evaluated at a single site university hospital, 61 had a foreign body. Of the 61 patients, 42 had abnormal physical exams and radiographs and 17 had either abnormal physical exams or radiographs, and 2 had normal physical exams and radiographs, but both had a history of persistent cough.  Bottom line: history of choking PLUS abnormal exam, abnormal films, or persistent symptoms, evaluate with bronchoscopy. For patients with some residual suspicion of an aspirated foreign body (mild initial or improving symptoms; possibly abnormal chest x-ray; low but finite risk), consider chest CT with virtual bronchoscopy as a rule-out strategy.17,18 Outpatients who have passed a small and non-concerning object into the stomach or beyond: serial exams and observing stools – polyethylene glycol 3350 (MiraLAX) may be given for delayed passage19 Pifalls: A single household magnet will likely pass through the GI tract, with the aforementioned dimensional caveats. Two or more magnets, however, run the risk of attraction and trans-bowel wall pressure necrosis. Not all magnets are created equal. Neodymium magnet toys (“buckyballs”) were recalled in 2014 (but are still out there!) due to their highly attractive nature.  These magnets must be removed to avoid bowel wall ischemia. 19–21 Patients should avoid wearing belt buckles or metallic buttons in case of single magnet ingestion while waiting for the single magnet to pass DES OUTILS DU MÉTIER – DIE HANDWERKSZEUG – Знаряддя праці – TOOLS OF THE TRADE – LAS HERRAMIENTAS DEL OFICIO – GLI ATTREZZI DEL MESTIERE –  仕事のツール It’s best to keep your armamentarium as large as you can.   Curette A small foreign body in the lateral 1/3 of the auditory canal may be amenable to a simple curettage.  Hair beads (if the central hole is accessible) may be manipulated out with the angled tip of a rigid curette.  Steady the operating hand by placing your hypothenar eminence on the child’s zygoma or temporal scalp, to avoid jutting the instrument into the ear canal with sudden movement.  There is a large selection of disposable simple and lighted curettes on the market. Right-angle Hook Various eponymous hooks are available for this purpose; one in popular use is the Day hook, which may be passed behind the foreign body.22  An inexpensive and convenient alternative to the commercially available right-hooks is a home-made version: make your own by straightening out a paperclip and bending it to a right angle23 at 2-3 mm from the end (be sure not to use the type that have a friable shiny metallic finish, as the residue may be left behind in the ear canal).  If it is completely lodged, use of a right-angle hook will likely only cause trauma to the canal. Alligator forceps Alligator forceps are best for grasping soft objects like cotton or paper.  Smooth, round or oval objects are not amenable to extraction with alligator forceps.  When using them, be sure to get a firm, central grip on the object, to avoid tearing it into smaller, less manageable pieces.  Pro tip: Look before you grip! Be careful to visualize the area you are gripping, to avoid pulling on (and subsequently avulsing) soft tissue in the ear canal. Cyanoacrylate (Dermabond®, SurgiSeal®) Apply cyanoacrylate to either side of a long wooden cotton swab (the lecturer prefers the cotton tip side, for improved grip/molding around object).  Immediately apply the treated side to the object in the ear canal in a restrained patient.  Steady the hypothenar eminence on the child’s face to avoid dislodgement of the cotton swab with sudden movement.  Apply the treated swab to the foreign body for 30-60 seconds, to allow bonding.  Slowly pull out the foreign body.  Re-visualize the ear canal for other retained foreign bodies and abrasion or ear canal trauma. Did the cyanoacrylate drip?  Did the swab stick to the ear canal? No problem – use 3% hydrogen peroxide or acetone.24  Pour in a sufficient amount, allow to work for 10 minutes.  Both agents help to dissolve ear wax, the compound, or both.  Repeat if needed to debond the cyanoacrylate from the ear canal.24,25 Irrigation Irrigation is the default for non-organic foreign bodies that are not amenable to other extraction techniques.  Sometimes the object is encased in cerumen, and the only “instrument” that will fit behind the foreign body is the slowly growing trickle of water that builds enough pressure to expulse it.  Do not use if there is any organic material involved: the object will swell, causing much more pain, difficulty in extraction, and possibly setting up conditions for infection. Position the child either prone or supine, gently restrain (as above).  Let gravity work for you: don’t irrigate in decubitus position with the affected ear up.  It may be more accessible to you, but you may never get the foreign body out. To use a butterfly needle: use a small gage (22 or 24 g) butterfly set up, cut off the needle, connect the tubing to a 30 mL syringe filled with warm or room-temperature water. Insert the free end of the tubing gently, and “secure” the tubing with your pinched fingers while irrigating (think of holding an ETT in place just after intubation and before taping/securing the tube).  Gently and slowly increase the pressure you exert as you irrigate. To use an IV or angiocatheter: use a moderate size (18 or 20 g) IV, remove the needle and attach the plastic catheter to a 20 mL syringe, and irrigate as above. Acetone Acetone has been used successfully to remove chewing gum, Styrofoam, and superglue from the ear canal24,26,27  Use in cases where there is no suspicion of perforation of the tympanic membrane. Docusate Sodium (Colace®) Cerumen is composed of sebaceous ad ceruminous secretions and desquamated skin.  Genetic, environmental, and anatomical factors combine to trap a foreign body in the external canal.  Use of a ceruminolytic such as docusate sodium may help to loosen and liberate the foreign body.28  Caveat medicus: Adding docusate sodium will make the object more slippery – this may or may not be an issue given the nature of the foreign body. In the case where loosening the ear wax may aid extraction (and will not cause a slippery mess), consider filling the ear canal will docusate sodium (Colace), having the child lie with the affected side up, waiting 15 minutes, and proceeding.  This is especially helpful when planning for irrigation. Magnets Rare earth magnets (a misnomer, as their components are actually abundant) such as neodymium can be useful in retrieving metallic foreign bodies (e.g. button batteries in the nose or ears).29,30  Magnetic “pick-up tools” – used by mechanics, engineers, and do-it-yourselfers – are inexpensive and readily available in various sizes, shapes, and styles such as a telescoping extender.  Look for a small tip diameter (to fit in the ear canal as well as the nose) and a strong “hold” (at least a 3-lb hold). Alternatively, you may purchase a strong neodymium bar magnet (30- to 50-lb hold) to attach to an instrument such as an alligator forceps, pick-up forceps, or small hemostat (a pacemaker magnet may also work).  The magnetic bar, placed in your palm at the base of the instrument, will conduct the charge (depending on the instrument) and allow you to retrieve many metallic objects.31  Although stainless steel is often said to be “non-magnetic”, it depends on the alloy used, and some may actually respond to the strong rare earth magnet.  Most stainless steel has a minimum of 10.5% chromium, which gives the steel its 'stainless' properties (essentially corrosion resistance).  A basic stainless steel has a “ferritic” structure and is magnetic.  Higher-end stainless steel such as in kitchen cutlery have an “austenitic” structure, with more chromium added, and so less magnetic quality.  (Ironically, the more “economical” instruments in the typical ED suture kit have less chromium, and so are more magnetic – use these with your neodymium bar magnet to conduct the magnetic charge and extract the metallic foreign body.) Bottom line: if it’s metal, it’s worth a try to use a magnet.  Even if the metal is very weakly magnetic, the strong neodymium magnet may still be able to exert a pull on it and aid in extraction. Snare Technique A relatively new method, described by Fundakowski et al.32 consists of using a small length of 24-gauge (or similar) wire (available inexpensively online, and kept in your personal “toolkit”; see Appendix B below) to make a loop that is secured by a hemostat (the 24-gauge wire is easily cut into strips with standard trauma scissors).  After treatment with oxymetolazone (0.05%) and lidocaine (1 or 2%) topically, the loop is passed behind the foreign body (in the case report, a button battery).  Pull the loop toward you until you feel that it is sitting up against the button battery.  Now, turn the hemostat 90° to improve your purchase on the foreign body.  Pull gently out.  This technique is especially useful when the foreign body has created marked edema, either creating a vacuum effect or making it difficult for other instruments to pass. Balloon Catheters (Katz extractor®, Fogarty embolectomy catheter) Small-caliber devices (5, 6, or 8 F) originally designed for use with intravascular or bladder catheterization may be used to extract foreign bodies from the ear or nose.7,33  A catheter designed specifically for foreign body use is the Katz extractor.  Inspect the ear or nose for potential trauma and to anticipate bleeding after manipulation (especially the nose).  Deflate the catheter and apply surgical lubricant or 2% lidocaine jelly. Insert the deflated catheter and gently pass the device past the foreign body.  Inflate the balloon and slowly pull the balloon and foreign body out.  Re-inspect after extraction. NB, from the manufacturer of the Katz extractor, InHealth: “the Katz Extractor oto-rhino foreign body remover is intended principally for extraction of impacted foreign bodies in the nasal passages. This device may also be used in the external ear canal, based upon clinical judgment.” Mother’s kiss The mother’s kiss was first described in 1965 by Vladimir Ctibor, a general practitioner from New Jersey.34 “The mother, or other trusted adult, places her mouth over the child’s open mouth, forming a firm seal as if about to perform mouth-to-mouth resuscitation. While occluding the unaffected nostril with a finger, the adult then blows until feeling resistance caused by closure of the child’s glottis, at which point the adult gives a sharp exhalation to deliver a short puff of air into the child’s mouth. This puff of air passes through the nasopharynx, out through the non-occluded nostril and, if successful, results in the expulsion of the foreign body. The procedure is fully explained to the adult before starting, and the child is told that the parent will give him or her a “big kiss” so that minimal distress is caused to the child. The procedure can be repeated a number of times if not initially successful.”34 Positive Pressure Ventilation with Bag Valve Mask This technique is an approximation of the above mother’s kiss technique – useful for unwilling parents or unsuccessful tries.10,25  The author prefers to position the child sitting up.  A self-inflating bag-mask device is fitted with a very small mask: use an abnormally small mask (otherwise inappropriately small for usual resuscitative bag-mask ventilation) to fit over the mouth only.  Choose an infant mask that will cover the child’s mouth only.  Occlude the opposite nostril with your finger while you form a tight seal with the mask around the mouth. Deliver short, abrupt bursts of ventilation through the mouth – be sure to maintain good seals with the mask and with your finger to the child’s nostril – until the foreign body is expulsed through the affected nostril. Beamsley Blaster (Continuous Positive Pressure) Technique For the very uncooperative child with a nasal foreign body amenable to positive pressure ventilation who fails the mother’s kiss and bag-mask technique, a continuous positive pressure method may be used. Connect one end of suction tubing to the male adaptor (“Christmas tree”) of an air or oxygen source.  Connect the other end of the suction tubing to a male-to-male adaptor (commonly used for chest tube connections or connecting / extending suction tubes).  Insert the end of the device into the child’s unaffected nostril.  The air flow will deliver positive pressure ventilation continuously. With this technique there is a theoretical risk of barotrauma to the lungs or tympanic membranes.  However, there is only one case reported in the literature of periorbital subcutaneous emphysema. To minimize this risk, some authors recommend limiting to a maximum of four attempts using any positive pressure method.10 Nasal speculum Optimize your visualization with a nasal speculum.  The nostrils, luckily, will accommodate a fair amount of distention without damage.  Hold the speculum vertically to avoid pressure on and damage to the vessel-and-nerve-rich nasal septum.  Hold the handle of the speculum in the palm of your hand comfortably and while placing your index finger on the patient’s ala.  This will help to control the speculum and your angle of sight. Your other hand is then free to use a hook or other tool for extraction. Lighting is especially important when using the nasal speculum: a focused procedure light or head lamp is very helpful.  The author keeps a common camping LED headlamp in his bag for easy access. Suction tips / catheters Various commercial and non-commercial suction devices are on the market for removal of foreign bodies.  All connect to wall suction, and vary by style, caliber of suction, and tip end interface.  A commonly available suction catheter is the Frazier suction tip (right), a single-use device used in the operating room. A modification to suction can be made with the Schuknecht foreign body remover (left; not to be confused with the suction catheter of the same name): a plastic cone-shaped tip placed on the end of the suction catheter to increase vacuum surface area and seal.  Laryngoscope and Magill Forceps If a child aspirates and occludes his airway, return to BLS maneuvers (as above).  If the child becomes obtunded, use direct laryngoscopy to visualize the foreign body and remove with the Magill forceps.  Hold the laryngoscope in your left hand as per usual.  Hold the Magill forceps in your right hand – palm side down – to grasp and remove the foreign body.  Take-home Points  Beware the “vacuum palate”: a flat (especially clear plastic) foreign body hiding on the palate Take seriously the complaint of foreign body without obvious evidence on initial inspection – believe that something is in there until proven otherwise Control the environment, address analgesia and anxiolysis, have a back-up plan Motto Like a difficult airway: plan through the steps MERCI – DANKE – Дякую – THANK YOU – GRACIAS –  ありがとう— GRAZIE Appendix A: Prevention At the end of the visit, after some rapport has been established, counsel the caregivers about age-appropriate foods and “child-proofing” the home.  This is a teachable moment – and only you can have this golden opportunity! Age-appropriate foods 0-6 months: breastmilk or formula 6-9 months: introduce solid puree-consistency foods 9-12 months: small minced solids that require no chewing (well cooked, soft, chopped foods) Although molars (required for chewing) erupt around 18 months, toddlers need to develop coordination, awareness to eat hard foods that require considerable chewing. Not until 4 years of age (anything that requires chewing to swallow):             Hot dogs             Nuts and seeds             Chunks of meat or cheese             Whole grapes             Hard or sticky candy             Popcorn             Chunks of peanut butter             Chunks of raw vegetables             Chewing gum Child-proofing the home Refer parents to the helpful multi-lingual site from the American Academy of Pediatrics: http://www.healthychildren.org/English/safety-prevention/at-home/Pages/Childproofing-Your-Home.aspx An abbreviated list: use age-appropriate toys and “test” them out before giving them to your child to verify that there are no small, missing, or loose parts.  Secure medications, lock up cabinets (especially with chemicals), do not store chemicals in food containers, secure the toilet bowl, and unplug appliances. Parents should understand that “watching” their child alone cannot prevent foreign body aspiration: a recent review found that in 84.2% of cases, incidents resulting in an airway foreign body occurred in the presence of an adult.35 Best overall tip: get down on all fours and inspect your living area from the child’s perspective.  It is amazing what you will find when you are least expecting it. Appendix B: The Playbook's ENT Foreign Body Toolkit Although your institution should supply you with what you need to deal with routine problems, we all struggle with having just what we need when we need it.  High-volume disposable items such as cyanoacrylate (Dermabond), curettes, supplies for irrigation, alligator forceps, and the like certainly should be supplied by the institution.  However, some things come in very handy as our back-up tools. NB: we should be cognizant of the fact that tools that must be sterilized or autoclaved are not good candidates for our personal re-usable toolkits. These items can all be found inexpensively – shop around online, or in home improvement stores: Head lamp, LED camping style: $5-15 Neodymium magnet “pick-up tool”: $5-15 Neodymium bar magnet: $6-20 Wire, 24-gauge, spool of 25 yards (for snare technique): $6 Day hook: $15-20 References Chapin MM, Rochette LM, Annest JL, Haileyesus T, Conner KA, Smith GA. Nonfatal Choking on Food Among Children 14 Years or Younger in the United States, 2001–2009. Pediatrics. 2013;132(2):275-281. doi:10.1542/peds.2013-0260. Committee on Injury V. Policy Statement—Prevention of Choking Among Children. Pediatrics. 2010:peds.2009-2862. doi:10.1542/peds.2009-2862. Brown L, Denmark TK, Wittlake WA, Vargas EJ, Watson T, Crabb JW. Procedural sedation use in the ED: management of pediatric ear and nose foreign bodies. Am J Emerg Med. 2004;22(4):310-314. Heim SW, Maughan KL. Foreign bodies in the ear, nose, and throat. Am Fam Physician. 2007;76(8):1185-1189. DiMuzio J, Deschler DG. Emergency department management of foreign bodies of the external ear canal in children. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol. 2002;23(4):473-475. Leffler S, Cheney P, Tandberg D. Chemical immobilization and killing of intra-aural roaches: an in vitro comparative study. Ann Emerg Med. 1993;22(12):1795-1798. Kiger JR, Brenkert TE, Losek JD. Nasal foreign body removal in children. Pediatr Emerg Care. 2008;24(11):785-792; quiz 790-792. doi:10.1097/PEC.0b013e31818c2cb9. Kadish HA, Corneli HM. Removal of nasal foreign bodies in the pediatric population. Am J Emerg Med. 1997;15(1):54-56. Tahir N, Ramsden WH, Stringer MD. Tracheobronchial anatomy and the distribution of inhaled foreign bodies in children. Eur J Pediatr. 2009;168(3):289-295. doi:10.1007/s00431-008-0751-9. Rempe B, Iskyan K, Aloi M. An Evidence-Based Review of Pediatric Retained Foreign Bodies. Pediatr Emerg Med Pract. 6(12). Digoy GP. Diagnosis and management of upper aerodigestive tract foreign bodies. Otolaryngol Clin North Am. 2008;41(3):485-496, vii - viii. doi:10.1016/j.otc.2008.01.013. Loren Yamamoto, Inaba A, DiMauro R. Radiologic Cases in Pediatric Emergency Medicine; University of Hawaii. Radiol Cases Emerg Med. http://www.hawaii.edu/medicine/pediatrics/pemxray/zindex.html. Accessed February 20, 2015. Painter K. Energizer makes button battery packages safer for kids. USA Today. ASGE Standards of Practice Committee, Ikenberry SO, Jue TL, et al. Management of ingested foreign bodies and food impactions. Gastrointest Endosc. 2011;73(6):1085-1091. doi:10.1016/j.gie.2010.11.010. Sharieff GQ, Brousseau TJ, Bradshaw JA, Shad JA. Acute esophageal coin ingestions: is immediate removal necessary? Pediatr Radiol. 2003;33(12):859-863. doi:10.1007/s00247-003-1032-4. Cohen S, Avital A, Godfrey S, Gross M, Kerem E, Springer C. Suspected Foreign Body Inhalation in Children: What Are the Indications for Bronchoscopy? J Pediatr. 2009;155(2):276-280. doi:10.1016/j.jpeds.2009.02.040. Haliloglu M, Ciftci AO, Oto A, et al. CT virtual bronchoscopy in the evaluation of children with suspected foreign body aspiration. Eur J Radiol. 2003;48(2):188-192. doi:10.1016/S0720-048X(02)00295-4. Jung SY, Pae SY, Chung SM, Kim HS. Three-dimensional CT with virtual bronchoscopy: a useful modality for bronchial foreign bodies in pediatric patients. Eur Arch Otorhinolaryngol. 2011;269(1):223-228. doi:10.1007/s00405-011-1567-1. Hussain SZ, Bousvaros A, Gilger M, et al. Management of ingested magnets in children. J Pediatr Gastroenterol Nutr. 2012;55(3):239-242. doi:10.1097/MPG.0b013e3182687be0. Brown JC, Otjen JP, Drugas GT. Too attractive: the growing problem of magnet ingestions in children. Pediatr Emerg Care. 2013;29(11):1170-1174. doi:10.1097/PEC.0b013e3182a9e7aa. Brown JC, Otjen JP, Drugas GT. Pediatric magnet ingestions: the dark side of the force. Am J Surg. 2014;207(5):754-759; discussion 759. doi:10.1016/j.amjsurg.2013.12.028. Menner AL. Pocket Guide to the Ear: A Concise Clinical Text on the Ear and Its Disorders. Thieme; 2011. Colina D, Dudek S, Lin M. Tricks of the Trade: ENT Dilemmas - How Do I Get That Out of There? ACEP News. http://www.acep.org/Clinical---Practice-Management/Tricks-of-the-Trade--ENT-Dilemmas---How-Do-I-Get-That-Out-of-There-/?__taxonomyid=118010. Published July 2009. Accessed February 5, 2015. Abadir WF, Nakhla V, Chong P. Removal of superglue from the external ear using acetone: case report and literature review. J Laryngol Otol. 1995;109(12):1219-1221. Kadish H. Ear and Nose Foreign Bodies “It is all about the tools.” Clin Pediatr (Phila). 2005;44(8):665-670. doi:10.1177/000992280504400803. Chisholm EJ, Barber-Craig H, Farrell R. Chewing gum removal from the ear using acetone. J Laryngol Otol. 2003;117(4):325. doi:10.1258/00222150360600995. White SJ, Broner S. The use of acetone to dissolve a Styrofoam impaction of the ear. Ann Emerg Med. 1994;23(3):580-582. Singer AJ, Sauris E, Viccellio AW. Ceruminolytic effects of docusate sodium: a randomized, controlled trial. Ann Emerg Med. 2000;36(3):228-232. doi:10.1067/mem.2000.109166. Bledsoe RD. Magnetically adherent nasal foreign bodies: a novel method of removal and case series. Am J Emerg Med. 2008;26(7):839.e1-e839.e2. doi:10.1016/j.ajem.2008.01.036. Dolderer JH, Kelly JL, Morrison WA, Penington AJ. FOREIGN-BODY RETRIEVAL USING A RARE EARTH MAGNET: Plast Reconstr Surg. 2004;113(6):1869-1870. doi:10.1097/01.PRS.0000119869.01081.1C. Yeh B, Roberson JR. Nasal magnetic foreign body: a sticky topic. J Emerg Med. 2012;43(2):319-321. doi:10.1016/j.jemermed.2010.02.013. Fundakowski CE, Moon S, Torres L. The snare technique: a novel atraumatic method for the removal of difficult nasal foreign bodies. J Emerg Med. 2013;44(1):104-106. doi:10.1016/j.jemermed.2012.07.070. Chan TC, Ufberg J, Harrigan RA, Vilke GM. Nasal foreign body removal. J Emerg Med. 2004;26(4):441-445. doi:10.1016/j.jemermed.2003.12.024. Cook S, Burton M, Glasziou P. Efficacy and safety of the “mother’s kiss” technique: a systematic review of case reports and case series. Can Med Assoc J. 2012;184(17):E904-E912. doi:10.1503/cmaj.111864. Gregori D, Morra B, Snidero S, et al. Foreign bodies in the upper airways: the experience of two Italian hospitals. J Prev Med Hyg. 2007;48(1):24-26. This post and podcast are dedicated to Linda Dykes, MBBS(Hons) for her can-do attitude and collaborative spirit.  Thank you for sharing your knowledge, experience, and heart with the world.

For the next two weeks, the Fordham IPLJ Podcast will feature the Fordham IPLJ Symposium, divided into the opening presentation and three panels on various intellectual property topics. In this episode, listen to the Copy-Right v. Copy-Left Panelists discuss where IP law should be to promote innovation--whether that means less restriction or strong IP protections to secure the initial innovation in the first place. Moderator: Professor N. Cameron Russell. Panelists: Lauren Emerson, Senior Associate at Baker Botts LLP; Joseph Farco, Associate at Locke Lord and Co-Chair of the New York Intellectual Property Law Association’s Copyright Law & Practice Committee; Mary Rasenberger, Executive Director of the Authors Guild; James Vasile, Director of New America's Open Internet Tools Project.

Seemingly vague, but potentially dangerous... common, but possibly with consequences... ...or maybe just plain frustrating. Let's talk risk stratification, diagnosis, and management. Primary or Secondary? We can make headache as easy or as complicated as we like, but let's break it down to what we need to know now, and what the parents need to know when they go home. Primary headaches: headaches with no sinister secondary cause – like tension or migraine – are of course diagnoses of exclusion (cluster headache is exceedingly rare in children). Secondary headaches: headaches due to some underlying cause -- are what we need to focus on first. The list of etiologies is vast; here is just a sampling: How do I sort this out? Ask yourself three main questions: Is it a tumor? Is it an infection? Is it a bleed? Is it a tumor? Some historical features are high-yield in screening for signs or symptoms consistent with a space occupying lesion. Progression and worsening of symptoms over time Associated vomiting Pain only in the occiput Headache that is worse with Valsalva – ask if coughing, urinating, or defecating affects the headache Does this headache wake the child from sleep? Is it worse in the morning just after getting up? Conversely, the absence of some historical features may increase suspicion of a space-occupying lesion No family history of migraine No associated aura with the headache. Who needs neuroimaging? The short answer is, if the child has an abnormal exam finding, then obtain a non-contrast head CT in the ED.  If you’re worried enough to get imaging, then you should not feel great about sending him to an expedition to MRI. The reassuring point is that for a child with a normal neuro exam, we have time to figure this out. For the recurrent headache, outpatient MRI really is the way to go if at all possible – not only do we forgo unnecessary radiation, but MRI is more likely to reveal the cause – or rule out the concern. Medina et al. in Pediatrics reported on children with headache suspected of having a brain tumor. They stratified patients into low, intermediate, and high risk, based on clinical predictors from the history and physical. All had imaging. They then calculated probability of tumor in each group. The low risk group had a 0.01% probability of tumor. The intermediate group 0.4%, and the high-risk group had only a 4% probability of tumor. The take-home message is that in the stable patient with a normal neurologic exam and no red flags, time is on our side. The American Academy of Neurology's most recent guidelines, published first in 1994 and revised in 2004. 1. Neuroimaging on a routine basis is not indicated with recurrent headaches and a normal neurologic exam 2. Neuroimaging should be considered in children with an abnormal exam. 3. Neuroimaging should be considered in children with recent onset of severe headache, change in the type of headache, or associated features that suggest neurologic dysfunction Is it an infection? This is nothing new: if you think you need to perform a lumbar puncture, then you’re right. Go after the diagnosis when it meets your threshold for testing. The difficulty is in the child who just has a headache, plus or minus symptoms that may be viral syndrome. Dr Curtis et al. in Pediatrics did a systematic review of Clinical Features Suggestive of Meningitis in Children.  In the history, only obvious features were helpful in this study: bulging fontanel in the infant or neck stiffness in the older child.  Both increased the likelihood of meningitis by 8-fold. In the physical examination, the only reliable predictors in this study were poor general appearance or a change in behavior. You will catch those cases, because you would have tuned into meningitis early on -- especially in the unvaccinated. What about all-comers with fever and headache? The presence of a high fever (so greater than 40 °C) only conferred a positive likelihood ratio of 2.9, only marginally predictive. Reassuring is that for temperatures less than 40 °C, the LR was 1 for meningitis. In other words, a fever less than 40 °C was just as likely to be present with or without meningitis. Is it a bleed? Does this child have some underlying disorder? For example, sickle cell disease, hypertension, rheumatologic disease, or some other endocrine or metabolic disease, such as a mitochondrial disorder? In chronically ill children, consider cerebral sinus venous thrombosis, vasculitis, ischemia, or hemorrhage. Arteriovenous malformation (AVM) is the hemorrhage we fear the most. We really don’t know enough about arteriovenous malformations in the brain to say what is the typical presentation. They may be completely asymptomatic, until they rupture. Even the headache presentation is variable. Think, headache PLUS. New headache plus…vomiting. Headache plus…it’s unilateral and new for the patient. Headache plus…a new seizure. Headache plus…focal neuro deficits, that may be transient, due to a vascular steal phenomenon. Two illustrative cases of arteriovenous malformation: 1. An eleven-year-old girl presents to the ED with new headache, nausea, and vomting in the morning, then had a generalized seizure later that day, and presents with a low GCS. She was intubated, CT confirmed the AVM. She had a right frontal intraparenchymal bleed with midline shift. She underwent clot evacuation and extirpation of the intertwined arteries and veins. 2. A nine-year old girl presented to the ED with headache for two days, constant, then one day of nausea and vomiting. On presentation, she was altered, and had slow-reacting pupils. She also underwent evacuation, and only on histopathology did they find a single, arterialized vein. Primary Headache: Presumptive Impression Tension headaches are the most common in children and adults. As in adults, the tension headache is band-like, pressure, tighetening, and often associated with muscle aches in the neck and shoulders. Find out how often they occur, and whether there is any pattern of worsening symptoms, or if the symptoms seem to be related to sleep hygiene, video games, too much digital screen time. Also, screen for lack of exercise, poor diet, stress, and all of the other good questions you usually ask. Treat the cause or counsel about lifestyle modification, and offer PO hydration and an NSAID, like ibuprofen or acetaminophen (paracetamol). Non-pharmacologic techniques like heat packs, rest, stress relief, and a little TLC always help. Be careful not to encourage overreacting to the headache – sometimes we see a pattern of headache, attention, and more headache that can take root. Also look for overuse of medications, which may be the culprit in up to 50% of chronic headaches. Taking NSAIDs 3 or more times per week is associated with medication-induced headache, or cephalalgia medicamentosa. We often fail to identify migraine headaches in children in the ED, likely for two reasons: prevalence of migraine increases with age, and children don’t present exactly like adults. Stewart et al. in Neurology, report a prevalence of migraine in children that increases with age: 3 to 7 years of age was 2%; 7 to 11 years of age, 7%; and 11 to 20 years of age, 20% Pearl: migraines are most commonly bilateral and temporal in children.  They resemble "adult" tension headaches, but are much more severe. We may not be able to sort this out in the ED.  The point here is that migraines in children are more common that we may expect, and they can interfere with school performance, with social development, or even with family dynamics and overall stress burden. Primary Headache Diagnosis: Not (Usually) "Our Thing" You noticed that we treated before we knew exactly the etiology; such is Emergency Medicine. We may not be able to make a specific, definitive primary headache diagnosis in the ED, but we should be aware of the criteria to help counsel patients and families. Tension headache is the most common, but it requires multiple, similar episodes: Migraine headache (without aura) requires less episodes, but more specific features: An aura is a fast-pass to diagnosis of migraine:   Primary Headache Management So how do we treat primary headaches? If you feel this is a mild tension headache, fluids by mouth and a simple NSAID are probably all that is needed, in addition to a heaping dose of reassurance.  Ibuprofen (10 mg/kg/dose q 6h, up to 600 mg) for a short course has the most evidence basis.  Acetaminophen (paracetamol) (15 mg/kg/dose q6 h) for a short course may also be given. Abortive treatments with the triptans may have been tried at home, but if they are coming to see us, we are past the point where triptans will be helpful. For the primary headache that is resistant to NSAIDs, IV therapy may be considered. If you’re going for IV, a nice evidence-based migraine cocktail is the following: 1. A bolus of 20 ml/kg of normal saline, up to a liter 2. Ketorolac (0.5 mg/kg; max, 30 mg) 3. Diphenhydramine (2 mg/kg; max, 50 mg) 4. Prochlorperazine (0.1 mg/kg; max, 10 mg) Dr Kaar et al. in Pediatric Emergency Care evaluated the safety and efficacy of their institution’s standardized pediatric migraine practice guideline in the emergency department, which used ths cocktail, based on the best evidence available. In their retrospective chart review, they found the average visual pain scale drop from 7.8 to 2.1 There were no adverse events reported. So, really you can treat children with migraines very similarly to adults. Other treatments on the horizon (still under investigation) in children include IV adjuncts such as magnesium, valproic acid, and dexamethasone. Aftercare and Recurrence Prevention For everyone who is going home, take just a moment to talk about the importance of sleeping well, eating well, getting exercise, limiting digital screen time, and trying to improve ways of dealing with stress. When all else fails, and the parent has “heard it all”: get them started on a headache diary. Take a piece of paper, fold it in half, and start a template for them to work on in a spiral notebook.  Start a sample entry for them, with the date and time the headache started, what it felt like, what was happening just before, what made the headache better, any dose of medications given, how long it lasted, and what the patient did after. There are even free apps that will track the headache pattern. This is the first thing a neurologist will start them on – and it’s sometimes a selling point to the parent that the time spent waiting for a referral to a neurologist is not waste – they will actually be in better shape and can move things along faster.  It also gives them some sens of control of what can be a draining situation. Summary and Mental Road Map If you were thinking meningitis or acute bleed, especially with fever or meningismus, get a CT first if you see signs of increased intracranial pressure, or if there is an abnormal neuro exam. Otherwise go straight to the lumbar puncture (LP). In the afebrile child with a normal exam, give symptomatic relief, briefly counsel them, and arrange for follow-up. In the afebrile child with an abnormal exam, obtain a CT in the ED. If negative, either admit for MRI if you are still concerned, or consider LP for idiopathic intracranial hypertension (pseudotumor cerebri). Talk with parents early about expectations, and offer them some friendly advice on prevention. Refer patients to the primary care provider or neurologist if the presentation is more involved. After a good history and physical examination in the ED that results in no red flags, we have time on our side. Help the family through the process by explaining the next steps and what can be done in the meantime. Compassion and a plan: sometimes these are our most powerful allies.   References Ajiboye N et al. Cerebral Arteriovenous Malformations: Evaluation and Management. Scientific World J. 2014; vol 2014. Bachur RG, Monuteaux MC, Neuman MI. A comparison of acute treatment regimens for migraine in the emergency department. Pediatrics. 2015 Feb;135(2):232-8. doi: 10.1542/peds.2014-2432. Chiappedi M, Balottin U. Medication overuse headache in children and adolescents. Curr Pain Headache Rep. 2014 Apr;18(4):404. doi: 10.1007/s11916-014-0404-9. Curtis S, Stobart K, Vandermeer B, Simel DL, Klassen T. Clinical features suggestive of meningitis in children: a systematic review of prospective data. Pediatrics. 2010;126(5):952-60. Gonzalez LF, Bristol RE, Porter RW, Spetzler RF. De novo presentation of an arteriovenous malformation. Case report and review of the literature. J Neurosurg. 2005 Apr;102(4):726-9. Kaar CR, Gerard JM, Nakanishi AK. The Use of a Pediatric Migraine Practice Guideline in an Emergency Department Setting. Pediatr Emerg Care. 2016 Jul;32(7):435-9. doi: 10.1097/PEC.0000000000000525. Lewis DW, Ashwal S, Dahl G, Dorbad D, Hirtz D, Prensky A, Jarjour I; Quality Standards Subcommittee of the American Academy of Neurology; Practice Committee of the Child Neurology Society. Practice parameter: evaluation of children and adolescents with recurrent headaches: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2002 Aug 27;59(4):490-8. Lewis D, Ashwal S, Hershey A, Hirtz D, Yonker M, Silberstein S; American Academy of Neurology Quality Standards Subcommittee; Practice Committee of the Child Neurology Society.Practice parameter: pharmacological treatment of migraine headache in children and adolescents: report of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society.Neurology. 2004 Dec 28;63(12):2215-24. Medina LS, Kuntz KM, Pomeroy S. Children With Headache Suspected of Having a Brain Tumor: A Cost-Effectiveness Analysis of Diagnostic Strategies. Pediatrics. 2001;108(2):255-63. Richer L, Billinghurst L, Linsdell MA, Russell K, Vandermeer B, Crumley ET, Durec T, Klassen TP, Hartling L. Drugs for the acute treatment of migraine in children and adolescents. Cochrane Database Syst Rev. 2016 Apr 19;4:CD005220. Stewart WF, Lipton RB, Celentano DD, Reed ML. Prevalence of migraine headache in the United States. JAMA. 1992;267:64-69. Tascu A et al. Spontaneous intracranial hemorrhage in children – ruptured lobar arteriovenous malformations: report of two cases. Romanian Neurosurgery. 2015; 29(23) 1: 85-89. This post and podcast are dedicated to Mark Wilson, PhD, BSc, MBBChir, FRCS(SN), MRCA, FIMC, FRGS for his #FOAMed generosity, candor, humility, and dedication to the care of the acutely ill and injured. Thank you. Pediatric Headache Powered by #FOAMed -- Tim Horeczko, MD, MSCR, FACEP, FAAP

If you experience any technical difficulties with this video or would like to make an accessibility-related request, please send a message to digicomm@uchicago.edu. Part of University of Illinois Chicago's Voices lecture series at Gallery 400.Arturo Herrera (Venezuelan, born 1959) received his MFA from the University of Illinois, Chicago. Selected solo exhibitions of Herrera"i? 1/2 s work include those held at Ikon Gallery, Birmingham, United Kingdom (2007), Art Gallery of Ontario (2002), Whitney Museum of American Art (2001), UCLA Hammer Museum (2001), Centre d"i? 1/2 Art Contemporain, Geneva (2000), Renaissance Society, University of Chicago (1998), and the Museum of Contemporary Art, Chicago (1995). Selected group exhibitions include Comic Abstraction (Museum of Modern Art, New York, 2007), The Moderns, Castello di Rivoli, Torino (2003), Splat Boom Pow! The Influence of Cartoons in Contemporary Art (Contemporary Art Museum, Houston, 2003), Whitney Biennial (Whitney Museum of American Art, 2002), The Americans (Barbican Art Centre, London, 2001), and Painting at the Edge of the World (Walker Art Center, Minneapolis, 2001). Selected awards include a John Simon Guggenheim Foundation (2005), DAAD Fellowship (2003), Pollock-Krasner Foundation award (1998), and an ArtPace Fellowship (1998). The artist lives in Berlin.

If you experience any technical difficulties with this video or would like to make an accessibility-related request, please send a message to digicomm@uchicago.edu. Part of University of Illinois Chicago's Voices lecture series at Gallery 400.Arturo Herrera (Venezuelan, born 1959) received his MFA from the University of Illinois, Chicago. Selected solo exhibitions of Herrera"i? 1/2 s work include those held at Ikon Gallery, Birmingham, United Kingdom (2007), Art Gallery of Ontario (2002), Whitney Museum of American Art (2001), UCLA Hammer Museum (2001), Centre d"i? 1/2 Art Contemporain, Geneva (2000), Renaissance Society, University of Chicago (1998), and the Museum of Contemporary Art, Chicago (1995). Selected group exhibitions include Comic Abstraction (Museum of Modern Art, New York, 2007), The Moderns, Castello di Rivoli, Torino (2003), Splat Boom Pow! The Influence of Cartoons in Contemporary Art (Contemporary Art Museum, Houston, 2003), Whitney Biennial (Whitney Museum of American Art, 2002), The Americans (Barbican Art Centre, London, 2001), and Painting at the Edge of the World (Walker Art Center, Minneapolis, 2001). Selected awards include a John Simon Guggenheim Foundation (2005), DAAD Fellowship (2003), Pollock-Krasner Foundation award (1998), and an ArtPace Fellowship (1998). The artist lives in Berlin.

If you experience any technical difficulties with this video or would like to make an accessibility-related request, please send a message to digicomm@uchicago.edu. Artist Geof Oppenheimer and political sciences Professor Julie Cooper will discuss Oppenheimer's work as it is situated in the arena of the aesthetics of politics, and contemplate the future possibilities of contemporary art in the broader social fabric. Geof Oppenheimer is currently a Harper & Schmidt Fellow and Assistant Professor in the Department of Visual Arts. He has exhibited at the PS1 Contemporary Arts Center, Long Island City, NY; The Project, New York; The Contemporary Museum, Baltimore; MC, Los Angeles; Cohan & Leslie, New York; Berkeley Art Museum, Berkeley; Manchester Metropolitan University, Manchester and SF Camerawork, San Francisco. He has received awards from the Eisner Foundation (2001), Grand Mariner Foundation (2001) and is a recipient Fleishhacker Foundation Eureka Fellowship (2005), . He is represented by The Project, New York. Julie Cooper is Assistant Professor of political science at the University of Chicago. Her research interests include early modern political theory and Jewish political thought. She is currently completing a book entitled Modesty and Dignity in Modern Political Theory.