Podcasts about pubmed pmid

Le proteine in polvere possono essere utili come integrazione proteica, ma sono davvero necessarie per tutti? Analizziamo i vari tipi di proteine in polvere – dalle whey alle caseine, fino a quelle vegetali – per capire come scegliere quella più adatta in base a obiettivi, tolleranze e stile di vita. Segui Postura Da Paura su Instagram e Facebook per trovare altri consigli e informazioni per vivere una vita più equilibrata e serena. Per noi il movimento è una medicina naturale, visita il sito www.posturadapaura.com per trovare il programma di allenamento più adatto alle tue esigenze. Come promesso ecco le fonti citate durante la puntata: Boirie Y, Dangin M, Gachon P, Vasson MP, Maubois JL, Beaufrère B. Slow and fast dietary proteins differently modulate postprandial protein accretion. Proc Natl Acad Sci U S A. 1997 Dec 23; 94(26):14930-5. Geiser, M., 2003. The wonders of whey protein. NSCA's Perform. Train. J., 2: 13-15. Khan, S.H., 2013. Whey protein hydrolysates: Techno-functional perspective. Int. J. Applied Biol. Pharmaceut. Technol., 4: 1-3. O'Halloran F, Bruen C, McGrath B, Schellekens H, Murray B, Cryan JF, Kelly AL, McSweeney PLH, Giblin L. A casein hydrolysate increases GLP-1 secretion and reduces food intake. Food Chem. 2018 Jun 30;252:303-310. doi: 10.1016/j.foodchem.2018.01.107. Epub 2018 Jan 30. PubMed PMID: 29478546. Precision Nutrition. All About Protein Powder. https://www.precisionnutrition.com/all-about-protein-powders Shankar, J.R. and G.K. Bansal, 2013. A study on health benefits of whey proteins. Int. J. Adv. Biotechnol. Res., 4: 15-19 Somaye, F., M.N. Marzieh and N. Lale, 2008. Single Cell Protein (SCP) production from UF cheese whey by Kluyveromyces marxianus. proceedings of the 18th National Congress on Food Technology, October 15-16, 2008, Mashhad.

Curious about your micronutrient status? Wonder if you're still deficient even though you take a multivitamin and eat a whole foods diet? Want to know how a simple blood test can tell you exactly what to supplement with and what foods to focus on? Tune in to learn about micronutrient testing--from the mechanisms of testing, to why you might be deficient in the first place, to how you can use this data to optimize and thrive!    In this episode, we will cover micronutrient testing and what trends of deficiency can tell you about your health. Even if you eat “healthy” you can be deficient based on increased demand, inability to absorb or use, inadequate intake. Testing micronutrients can play a turnkey role in your wellness as we can see beyond the nutrient itself and see the story of the deficiency trends to address the root cause of imbalance. Plus we'll explore case studies, from a postmenopausal woman to a carnivore to someone dealing with chronic fatigue and brain fog and discuss actual interventions that made a world of difference for these clients!    Get the Cellular Nutrient Analysis Micronutrient Panel for only $374 with code MNT25 Includes a customized email review from Ali or Becki with diet, lifestyle & supplement recommendations!   Also in this episode:  Episode 261: Micronutrient Testing and Our Personal Results Episode 177: Why You Need Supplements Episode 178: Why You Need Supplements Part 2 Episode 247: Drug Induced Nutrient Deficiency How the Cellular Nutrient Analysis is different from a serum blood test Why you may be deficient despite a healthy diet and supplementation Case Study #1: Postmenopausal Woman with weight gain, anxiety, disrupted sleepThyroid Optimizer B-12 Boost Grassfed Whey Calm and Clear Force of Nature use code ALIMILLERRD Superfood Chicken Nuggets Case Study #2: Biohacker Carnivore doing everything right but under high stressB Complex Adaptogen Boost Case Study #3: Chronic fatigue and brain fogMultidefense with Iron GI Lining Support CoQ10 Complex Carnitine Complex Apple Cider Vinegar Shooter Noble Origins Organ Blend use code ALIMILLERRD ResearchArulselvan P, Fard MT, Tan WS, Gothai S, Fakurazi S, Norhaizan ME, Kumar SS. Role of Antioxidants and Natural Productsin Inflammation. Oxid Med Cell Longev. 2016;2016:5276130. Epub 2016 Oct 10. Review. PubMed PMID: 27803762; PubMed Central PMCID: PMC5075620. Angelo G, Drake VJ, Frei B. Efficacy of Multivitamin/mineral Supplementation to Reduce Chronic Disease Risk: A Critical Review of the Evidence from Observational Studies and Randomized Controlled Trials. Crit Rev Food Sci Nutr. 2015;55(14):1968-91. doi: 10.1080/10408398.2014.912199. Review. PubMed PMID: 24941429. Liguori I, Russo G, Curcio F, Bulli G, Aran L, Della-Morte D, Gargiulo G, Testa G, Cacciatore F, Bonaduce D, Abete P. Oxidative stress, aging, and diseases. Clin Interv Aging. 2018 Apr 26;13:757-772. doi: 10.2147/CIA.S158513. eCollection 2018. Review. PubMed PMID: 29731617; PubMed Central PMCID: PMC5927356. Rheaume-Bleue, K. Choosing the Right Vitamin K2: Menaquinone-4 vs Menaquinone-7. Clinical considerations of different forms of vitamin K2. Natural Medicine Journal (October, 2015)  Sanders, TAB., Functional Dietary Lipids, 2016. Linoleic Acid, Shichiri, M., Yoshida, Y., Niki E., 2014, Unregulated Lipid Peroxidation in Neurological Dysfunction, Omega-3 Fatty Acids in Brain and Neurological Health, Retrieved March 23, 2019 from    Sponsors for this episode:  This episode is sponsored by Wild Foods, a company that puts quality, sustainability, and health first in all of their products. They have everything from coffee to turmeric to medicinal mushrooms, and every single product is painstakingly sourced from small farms around the globe. They take their mission seriously to fix the broken food system, and believe real food is medicine. They've partnered with us to give you guys an exclusive discount, so use the code ALIMILLERRD for 12% off your order at WildFoods.co! 

Panel:Pramod Chandru and Shreyas Iyer.Music/Sound Effects: Bullet Train by tubebackr | https://www.tubebackrmusic.com/Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution-NoDerivs 3.0 Unported (CC BY-ND 3.0), https://creativecommons.org/licenses/by-nd/3.0/. Hands High by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Love Trip by Sarah Jansen Music | https://soundcloud.com/sarahjansenmusic, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Stay by Thomas Gresen | https://soundcloud.com/thomasgresen, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. References: Carne B, Kennedy M, Gray T. Review article: Crisis resource management in emergency medicine. Emerg Med Australas. 2012 Feb;24(1):7-13. doi: 10.1111/j.1742-6723.2011.01495.x. Epub 2011 Oct 13. Review. PubMed PMID: 22313554. St Pierre M, Hofinger G, Buerschaper C, Simon R. Crisis Management in Acute Care Settings: Human Factors, Team Psychology, and Patient Safety in a High Stakes Environment. (2nd edn) Springer, 2011. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

In this week's episode, Brett and Martin talk to Dr Mark Garvey, Consultant Clinical Scientist at University Hospitals Birmingham in the UK. We discuss a new paper from the UHB team which looks at the practical aspects of contamination within the splash radius of a clinical hand hygiene sink in a critical care area. The range of high risk equipment within the zone is quite interesting! Papers mentioned are as below. 1. Garvey MI, Williams N, Gardiner A, Ruston C, Wilkinson M, Kiernan M, et al. The sink splash zone. J Hosp Infect. https://doi:10.1016/j.jhin.2023.01.020   PubMed PMID: 36870392. 2. Garvey MI, Wilkinson MAC, Holden KL, Martin T, Parkes J, Holden E. Tap out: reducing waterborne Pseudomonas aeruginosa transmission in an intensive care unit. J Hosp Infect. 2019;102(1):75-81. https://doi:10.1016/j.jhin.2018.07.039 3. Garvey MI, Bradley CW, Holden E. Waterborne Pseudomonas aeruginosa transmission in a hematology unit? Am J Infect Control. 2018;46(4):383-6. Epub 20171128. https://doi:10.1016/j.ajic.2017.10.013 4. Garvey MI, Bradley CW, Wilkinson MAC, Bradley C, Holden E. Engineering waterborne Pseudomonas aeruginosa out of a critical care unit. Int J Hyg Environ Health. 2017;220(6):1014-9. https://doi:10.1016/j.ijheh.2017.05.011

In this week's episode, Brett and Martin talk to Dr Mark Garvey, Consultant Clinical Scientist at University Hospitals Birmingham in the UK. We discuss a new paper from the UHB team which looks at the practical aspects of contamination within the splash radius of a clinical hand hygiene sink in a critical care area. The range of high risk equipment within the zone is quite interesting! Papers mentioned are as below. 1. Garvey MI, Williams N, Gardiner A, Ruston C, Wilkinson M, Kiernan M, et al. The sink splash zone. J Hosp Infect. https://doi:10.1016/j.jhin.2023.01.020   PubMed PMID: 36870392. 2. Garvey MI, Wilkinson MAC, Holden KL, Martin T, Parkes J, Holden E. Tap out: reducing waterborne Pseudomonas aeruginosa transmission in an intensive care unit. J Hosp Infect. 2019;102(1):75-81. https://doi:10.1016/j.jhin.2018.07.039 3. Garvey MI, Bradley CW, Holden E. Waterborne Pseudomonas aeruginosa transmission in a hematology unit? Am J Infect Control. 2018;46(4):383-6. Epub 20171128. https://doi:10.1016/j.ajic.2017.10.013 4. Garvey MI, Bradley CW, Wilkinson MAC, Bradley C, Holden E. Engineering waterborne Pseudomonas aeruginosa out of a critical care unit. Int J Hyg Environ Health. 2017;220(6):1014-9. https://doi:10.1016/j.ijheh.2017.05.011

In this episode, Holly Fernandez Lynch and I continue our discussion of clinical research ethics with co-hosts Rahima Ghafoori and Caroline Gozigian (UVA Law '23). In this Part 2 of our interview, we focus on questions of payment, exploitation, and trust. As a reminder, in Part I, Holly introduced the basic regulatory framework governing clinical trials, with a focus on laws and rules impacting payment. She also discussed the benefits of and concerns about human challenge studies, and shared some historical examples. Holly Fernandez Lynch, JD, MBE, is Assistant Professor of Medical Ethics in the Department of Medical Ethics and Health Policy at the Perelman School of Medicine (PSOM), University of Pennsylvania. She has a secondary appointment as an Assistant Professor of Law at the University of Pennsylvania Carey Law School.A lawyer and bioethicist by training, Professor Fernandez Lynch's scholarly work focuses on Food and Drug Administration (FDA) pharmaceutical policy, access to investigational medicines outside clinical trials, clinical research ethics, and the ethics of gatekeeping in health care. Her specific areas of expertise include Institutional Review Board (IRB) quality, payment to research participants, research prioritization, pre-approval access pathways (e.g., Expanded Access, Emergency Use Authorization, and Right to Try), and efforts to balance speed and certainty in drug approvals, including pathways that rely on post-approval trials such as accelerated approval. Links:Lynch HF, Darton TC, Levy J, McCormick F, Ogbogu U, Payne RO, Roth AE, Shah AJ, Smiley T, Largent EA. Promoting Ethical Payment in Human Infection Challenge Studies. Am J Bioeth. 2021 Mar;21(3):11-31. doi: 10.1080/15265161.2020.1854368. Epub 2021 Feb 4. PubMed PMID: 33541252.Shah SK, Miller FG, Darton TC, Duenas D, Emerson C, Lynch HF, Jamrozik E, Jecker NS, Kamuya D, Kapulu M, Kimmelman J, MacKay D, Memoli MJ, Murphy SC, Palacios R, Richie TL, Roestenberg M, Saxena A, Saylor K, Selgelid MJ, Vaswani V, Rid A. Ethics of controlled human infection to address COVID-19. Science. 2020 May 22;368(6493):832-834. doi: 10.1126/science.abc1076. Epub 2020 May 7. PubMed PMID: 32381590.Largent EA, Heffernan KG, Joffe S, Lynch HF. Paying Clinical Trial Participants: Legal Risks and Mitigation Strategies. J Clin Oncol. 2020 Feb 20;38(6):532-537. doi: 10.1200/JCO.19.00250. Epub 2019 Jun 14. PubMed PMID: 31199697.

Holly Fernandez Lynch and I discuss clinical research ethics, including challenge trials, research subject payment, and diversity in medical research with co-hosts Rahima          Ghafoori and Caroline Gozigian (UVA Law '23). In this episode, Holly introduces the basic regulatory framework governing clinical trials, with a focus on laws and rules impacting payment. She also discusses the benefits of and concerns about human challenge studies, and shares some historical examples. In the next episode, Part II of our interview, we explore issues of coercion, inducement, and exploitation more explicitly.Holly Fernandez Lynch, JD, MBE, is Assistant Professor of Medical Ethics in the Department of Medical Ethics and Health Policy at the Perelman School of Medicine (PSOM), University of Pennsylvania. She co-chairs the PSOM Research Ethics and Policy Series (REPS) and serves as Assistant Faculty Director of Online Educational Initiatives in the Department, where she helps lead the Master of Health Care Innovation. She has a secondary appointment as an Assistant Professor of Law at the University of Pennsylvania Carey Law School.A lawyer and bioethicist by training, Professor Fernandez Lynch's scholarly work focuses on Food and Drug Administration (FDA) pharmaceutical policy, access to investigational medicines outside clinical trials, clinical research ethics, and the ethics of gatekeeping in health care. Her specific areas of expertise include Institutional Review Board (IRB) quality, payment to research participants, research prioritization, pre-approval access pathways (e.g., Expanded Access, Emergency Use Authorization, and Right to Try), and efforts to balance speed and certainty in drug approvals, including pathways that rely on post-approval trials such as accelerated approval.Links:Lynch HF, Darton TC, Levy J, McCormick F, Ogbogu U, Payne RO, Roth AE, Shah AJ, Smiley T, Largent EA. Promoting Ethical Payment in Human Infection Challenge Studies. Am J Bioeth. 2021 Mar;21(3):11-31. doi: 10.1080/15265161.2020.1854368. Epub 2021 Feb 4. PubMed PMID: 33541252.Shah SK, Miller FG, Darton TC, Duenas D, Emerson C, Lynch HF, Jamrozik E, Jecker NS, Kamuya D, Kapulu M, Kimmelman J, MacKay D, Memoli MJ, Murphy SC, Palacios R, Richie TL, Roestenberg M, Saxena A, Saylor K, Selgelid MJ, Vaswani V, Rid A. Ethics of controlled human infection to address COVID-19. Science. 2020 May 22;368(6493):832-834. doi: 10.1126/science.abc1076. Epub 2020 May 7. PubMed PMID: 32381590.Largent EA, Heffernan KG, Joffe S, Lynch HF. Paying Clinical Trial Participants: Legal Risks and Mitigation Strategies. J Clin Oncol. 2020 Feb 20;38(6):532-537. doi: 10.1200/JCO.19.00250. Epub 2019 Jun 14. PubMed PMID: 31199697.

Dr. Teodor Grantcharov (https://twitter.com/TGrantcharovMD?s=20) is a bariatric surgeon at St. Michael's Hospital in Toronto. Dr. Grantcharov is world renowned for his work on the OR blackbox, a platform that allows for immense data capture (video, audio, physiologic) as well as advanced analytics. We asked Dr. Grantcharov about what it took to develop the OR blackbox, not just technologically, but culturally and institutionally. You can find out more about the OR blackbox at surgicalsafety.com. Links: 1. Quantifying recall bias in surgical safety: a need for a modern approach to morbidity and mortality reviews. https://pubmed.ncbi.nlm.nih.gov/30693745/ 2. Twitter discussion on best methods for recording open cases: https://twitter.com/ameerfarooq/status/1335675502313447426 3. OR Black Box: https://www.surgicalsafety.com/ 4. Gordon, L, Reed, C, Sorensen, JL, Schulthess, P, Strandbygaard, J, Mcloone, M et al.. Perceptions of safety culture and recording in the operating room: understanding barriers to video data capture. Surg Endosc. 2021; :. doi: 10.1007/s00464-021-08695-5. PubMed PMID:34608519 . 5. Nensi, A, Palter, V, Reed, C, Schulthess, P, Mcloone, M, Grantcharov, T et al.. Utilizing the Operating Room Black Box to Characterize Intraoperative Delays, Distractions, and Threats in the Gynecology Operating Room: A Pilot Study. Cureus. 2021;13 (7):e16218. doi: 10.7759/cureus.16218. PubMed PMID:34367818 PubMed Central PMC8341265. 6. Levin, M, McKechnie, T, Kruse, CC, Aldrich, K, Grantcharov, TP, Langerman, A et al.. Surgical data recording in the operating room: a systematic review of modalities and metrics. Br J Surg. 2021;108 (6):613-621. doi: 10.1093/bjs/znab016. PubMed PMID:34157080 . 7. Gallant, JN, Brelsford, K, Sharma, S, Grantcharov, T, Langerman, A. Patient Perceptions of Audio and Video Recording in the Operating Room. Ann Surg. 2021; :. doi: 10.1097/SLA.0000000000004759. PubMed PMID:33630449 . Bio (http://stmichaelshospitalresearch.ca/researchers/teodor-grantcharov/): Dr. Teodor Grantcharov completed his surgical training at the University of Copenhagen, and a doctoral degree in Medical Sciences at the University of Aarhus in Denmark. Dr. Grantcharov is a Professor of Surgery at the University of Toronto. He holds the Keenan Chair in Surgery at St. Michael's Hospital in Toronto. Dr. Grantcharov is the inaugural Director of the International Centre for Surgical Safety – a multidisciplinary group of visionary scientists with expertise in design, human factors, computer- and data science, and healthcare research. He previously held Canada Research Chair in Simulation and Surgical Safety and was awarded the Queen Elizabeth II diamond jubilee medal for his contributions to clinical research and patient safety in Canada. Dr. Grantcharov was awarded the honorary fellowship of the Imperial College in London, the honorary medal of the Bulgarian and Danish surgical societies and multiple national and international awards for his contributions to surgical education and surgical safety. Dr. Grantcharov's clinical interest is the area of minimally invasive surgery, while his academic focus is in the field of surgical innovation and patient safety. He has become internationally recognized as a leader in this area with his work on curriculum design, assessment of competence and impact of surgical performance on clinical outcomes. Dr. Grantcharov developed the Surgical Black Box, which aims to transform the safety culture in medicine and introduce modern safety management systems in the high-risk operating room environment. Dr. Grantcharov has more than 200 peer-reviewed publications and more than 200 invited presentations in Europe, South- and North America. He sits on numerous committees with Surgical Professional Societies in North America and Europe. He sits on the Editorial Boards of the British Journal of Surgery and Surgical Endoscopy.

CONSTRAINT INDUCED THERAPY II OVERVIEW: Pete: Yeah, although be forewarned that if you have questions, we may read it on the air and, uh...on the air! Are we on the air? I don't even know... Deb: Like WKRP In Cincinnati. Pete: Hey ‘now for the big sounds of the big town where the daddy-o of the radio in a city so nice they named it twice. New York, New York.' I was communications.... Deb: You've been waiting your whole life for this opportunity! Pete: I used to practice that...   EPISODE SUMMARY: This episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified is part 2 of Constraint Induced Therapy (CIT). Part 2 begins with Pete reiterating important points covered in Episode 1, including: Commitment is required for participation in a CIT program When NOT to wear the constraint: when ambulating, navigating stairs, bathing/washing, toileting and driving Review of frequently asked questions about CIT including compliance, dropout rate; that CIT is not an easy intervention but is worth it, hand dominance, location of infarct, use in acute stroke The conversation further evolved into: Research on the use of CIT at the acute stage and the VECTORS trial When it's safe to begin CIT Using Constraint Induced Therapy during the chronic phase – plateaus, taking breaks and having a strategic recovery plan What happens to the weaker side when the training focus is on the stronger side during the first 10 days following brain injury and why it's important to limit compensation What happens to the brain with intense exercise during the first 7 days – what intensity looks like and examples of how to determine intensity levels Using CIT with children Reimbursement for modified Constraint Induced Therapy Socialization, Groups, friendly competition and CIT Starting a CIT program: benefits to survivors and clinics All about lower extremity CIT, including how it's done and figuring out who it's appropriate for This engaging conversation goes deeper into Constraint Induced Therapy. Survivors, caregivers and clinicians alike will benefit... As always, we want to hear your top takeaways! LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION: The Brain Science Podcast with Ginger Campbell, MD. Episode 119 with Dr. Edward Taub Episode 120 with Dr. Edward Taub Lee, H. J., Moon, H. I, Kim, J. S., & Yi, T. I. (2019). Is there a dose-dependent effect of modified constraint-induced movement therapy in patients with hemiplegia? NeuroRehabilitation (Reading, Mass.); 45 (1), 57-66. doi: 10.3233/NRE-192721 Eras-Garcia, R., Matuti, G., Carrijo, D, Lea ̃o, A., & Cruz, D. (2019). Effects of modified constraint-Induced movement therapy on post-stroke functional and occupational performance. Archives of Physical Medicine and Rehabilitation (Late Breaking Research Poster). https://doi.org/10.1016/j.apmr.2019.10.043 Scott, S., Shade, H., Crowell, M, Lynch, M., Arpadi, L., Levine, A., Muro, A., et al. (2020). Use it or lose it? The diffusion of Constraint-Induced and Modified Constraint-Induced Therapy into OT practice. DOI: 10.5014/ajot.2020.74S1-PO2716 The EXCITE trial: Large multi-site constraint induced therapy trial Wolf SL, Winstein CJ, Miller JP, Taub E, Uswatte G, Morris D, Giuliani C, Light KE, Nichols-Larsen D; EXCITE Investigators. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA. 2006 Nov 1;296(17):2095-104. PubMed PMID: 17077374. Page, S.J., Levine, P., Sisto, S.A., Bond, Q., Johnston, M.V. Patients' and therapists' opinions of constraint-induced therapy. Clin Rehabil 2002; 16 (1): 55-60 Page SJ, Boe S, Levine P. What are the "ingredients" of modified constraint-induced therapy? An evidence-based review, recipe, and recommendations. Restor Neurol Neurosci. 2013 Feb 8. A journal article about the first time constraint induced therapy was tried in humans, by Lawrence Ince, MD. Ince J. Escape and avoidance conditioning of response in the plegic arm of stroke patients; a preliminary study. Psychonom Sci 1969; 16: 49-50. Compensatory movement early after brain injury: The news ain't good. LE CIT PROTOCOL Compelled Weightbearing Questions and Comments about the podcast: NogginsAndNeurons@gmail.com DONATE TO NOGGINS & NEURONS: Donate to Noggins And Neurons and get an Allstar Pete Trading Card Using your PayPal app:   RESOURCES: Pete's blog, book, Stronger After Stroke,  and  talks. Blog Book: Stronger After Stroke, 3rd edition Pete's talk for the American College of Rehabilitation Medicine. Deb's OT Resources: Deb's OT resources The OT's Guide to Mirror Therapy Tri-Fold Mirror (US address only) Occupational Therapy Intervention: Scavenger Hunt Visual Scanning for Adults REQUEST TO BE A GUEST ON NOGGINS & NEURONS. If you're passionate about stroke recovery and have information or a story you believe will help others, we'd love help you share it on the show. Complete the guest request form below and let's see if we're a good fit!   Guest Request Form MUSIC: “Soft Inspiration” by Scott Holmes/Scott Holmes Music/scottholmesmusic.com ✨Google Podcasts  ✨iTunes    ✨Spotify

Constraint Induced Therapy: Part I OVERVIEW: Pete: And I asked whoever answered the phone, may I please speak to Dr. Ince. And he goes ‘hello' and I'm in a panic because I'm like this is the guy! It took me three days to find him! And I'm like, ahh, Dr. Ince my name is Pete Levine and I'm doing a book on ah Constraint Induced Therapy and um Dr. Taub said that you were the first human to ever do it on humans and I'm really excited to talk to you... and he goes ‘I can't hear you. There doin' construction outside. Wait, let me close the door.' Boom! Door slams and he comes back and he tells me this fantastic story.  Pete quoting Dr. Ince: In 1967, I'm in a Macy's and I'm standing there next to this guy. I don't know who he is, and ah, we're at a table with toys and our wives are gone doing something, I don't what they were doing. And he was fooling with this toy...' Pete: I always imagine this toy was the monkey with the two cymbals going like shika tik tik. Pete quoting Dr. Ince: ‘And he was foolin' with this toy and we got to talking and I'm a physiatrist and he was doing this stuff and he invited me to his lab in Brooklyn...' Pete: And this is my best NY accent...I'm so sorry...you know I was born in Manhattan, so I have a little bit of right to do this. Pete quoting Dr. Ince: ‘And um, and I asked him: What you're doing with these monkeys... Can I do it with humans? And what I found was that it could be done with people. We did the experiment. We were the first to publish about it and with some people it was successful, with some people not so successful, and some people it was a total failure.' Pete: And that's still where we are today. Constraint Induced Therapy is not for everyone. I think you would agree. Deb: Yes. That's fascinating! What a cool life you have! Pete: I know! Lawrence Ince... he was so cool with me. Once he saw that I wasn't calling him to sell him life insurance or something...you know he was willing to talk. So, he was great. It was just great. It sends shivers up my spine still...   EPISODE SUMMARY: This episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified is all about Constraint Induced Therapy (CIT). CIT is a big topic and we talked for a long time – enough for two full episodes. In this part 1 section we: Heard about the history of CIT - that it began with Nobel Prize winner, Sir Charles Sherrington  Learned that Sir Charles Sherrington coined the words ‘synapse,' and ‘neuron,' and he talked about ‘neural networks.' That's not all, he drew neurons and synapses! Listen to learn why this is a BIG DEAL... Reviewed dorsal root rhizotomy and went deeper into it, including the procedure and process – according to Pete, it's a really great tool for spasticity treatment Learned about reflexes and movement Talked about the role of Operant Conditioning in CIT Compared differences between research done by Dr. Edward Taub and that performed by Dr. Stephen Page & Pete Levine Tied in the importance of home programs and clinic follow up for client follow through This episode begins with a bit of fascinating neuroscience history to include Nobel Prize winner Sir Charles Sherrington. There's no rabbit hole involved as it ties right into the topic of Constraint-Induced Therapy! Pete takes us along a journey into the research using his artful way of telling a story that keeps everyone captivated.  We transition smoothly from the early days of CIT into Dr. Edward Taub's work, and then onto detailed information around the modified version of CIT with our very own Peter G. Levine's work. As always, we want to hear your top takeaways! LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION: The Brain Science Podcast with Ginger Campbell, MD. Episode 119 with Dr. Edward Taub Episode 120 with Dr. Edward Taub Lee, H. J., Moon, H. I, Kim, J. S., & Yi, T. I. (2019). Is there a dose-dependent effect of modified constraint-induced movement therapy in patients with hemiplegia? NeuroRehabilitation (Reading, Mass.); 45 (1), 57-66. doi: 10.3233/NRE-192721 Eras-Garcia, R., Matuti, G., Carrijo, D, Lea ̃o, A., & Cruz, D. (2019). Effects of modified constraint-Induced movement therapy on post-stroke functional and occupational performance. Archives of Physical Medicine and Rehabilitation (Late Breaking Research Poster). https://doi.org/10.1016/j.apmr.2019.10.043 Scott, S., Shade, H., Crowell, M, Lynch, M., Arpadi, L., Levine, A., Muro, A., et al. (2020). Use it or lose it? The diffusion of Constraint-Induced and Modified Constraint-Induced Therapy into OT practice. DOI: 10.5014/ajot.2020.74S1-PO2716 The EXCITE trial: Large multi-site constraint induced therapy trial Wolf SL, Winstein CJ, Miller JP, Taub E, Uswatte G, Morris D, Giuliani C, Light KE, Nichols-Larsen D; EXCITE Investigators. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA. 2006 Nov 1;296(17):2095-104. PubMed PMID: 17077374. Page, S.J., Levine, P., Sisto, S.A., Bond, Q., Johnston, M.V. Patients' and therapists' opinions of constraint-induced therapy. Clin Rehabil 2002; 16 (1): 55-60 Page SJ, Boe S, Levine P. What are the "ingredients" of modified constraint-induced therapy? An evidence-based review, recipe, and recommendations. Restor Neurol Neurosci. 2013 Feb 8. A journal article about the first time constraint induced therapy was tried in humans, by Lawrence Ince, MD. Ince J. Escape and avoidance conditioning of response in the plegic arm of stroke patients; a preliminary study. Psychonom Sci 1969; 16: 49-50. Questions and Comments about the podcast: NogginsAndNeurons@gmail.com DONATE TO NOGGINS & NEURONS: Donate to Noggins And Neurons and get an Allstar Pete Trading Card Using your PayPal app:   RESOURCES: Pete's blog, book, Stronger After Stroke,  and  talks. Blog Book: Stronger After Stroke, 3rd edition Pete's talk for the American College of Rehabilitation Medicine. Deb's OT resources The OT's Guide to Mirror Therapy Tri-Fold Mirror (US address only) Occupational Therapy Intervention: Scavenger Hunt Visual Scanning for Adults REQUEST TO BE A GUEST ON NOGGINS & NEURONS. If you're passionate about stroke recovery and have information or a story you believe will help others, we'd love help you share it on the show. Complete the guest request form below and let's see if we're a good fit!   Guest Request Form MUSIC: “Soft Inspiration” by Scott Holmes/Scott Holmes Music/scottholmesmusic.com ✨Google Podcasts  ✨iTunes    ✨Spotify

In this week's episode, Drs Culleton and Banducci delve into sleep difficulties. Dr. Banducci talks about the underlying roots causes of sleep issues, along with some tips for sleep support. Dr. Culleton targets some pediatric focused topics when it comes to supporting sleep for babies and kids. For links or research mentioned in the episode, please head to @mommasmunchieslittlemonsters on Instagram and check out the link in our profile! Or check out the following from PubMed: PMID: 23853635, 23543804, 31255482, 26963375

In this episode, Dr. Thomas Buchheit sheds light on who are good candidates for regenerative therapies, when and where to go for such therapies, and what the various types of regen therapies there are and how they work. Check out these slides that are referenced in the interview, "What do PRP, Stem Cells, and other Regenerative Therapies Really do?" Who is Dr. Buchheit? He is Director of The Regenerative Pain Therapies Program at Duke (DukeRPTP.org). He has practiced pain management and musculoskeletal medicine for the past 20 years and has published multiple papers clarifying the underlying biochemical and inflammatory mechanisms that drive chronic pain. He previously served as Division Chief for Pain Medicine in the Duke Department of Anesthesiology prior to focusing full time on the study and development of regenerative therapies for patients with osteoarthritis. He co-founded The Regenerative Pain Therapies Program in 2018 with Dr. William Maixner with the goal of moving beyond symptom management to address the underlying causes of degenerative conditions. The objective of the Program is to develop and deploy biologically-based interventions to improve long-term joint health by changing disease course. Dr. Buchheit is currently involved with researchers in the United States and Europe, investigating the foundational immune mechanisms of pain relief with PRP, autologous conditioned serum, and stem cells, and has lectured extensively on these topics. He has mentored with Dr. Peter Wehling and is currently one of the few clinical sites in the US to offer the Autologous Conditioned Serum Program from Düsseldorf, Germany. 3 Selected Publications: 1. Buchheit T, Huh Y, Maixner W, Cheng J, Ji RR. Neuroimmune modulation of pain and regenerative pain medicine. J Clin Invest. 2020. Epub 2020/04/07. doi:10.1172/JCI134439. PubMed PMID: 32250346. 2. Buchheit T. Future therapies and the expanding role for diagnostic ultrasound. Curr Opin Anaesthesiol. 2016 Oct;29(5):582–3. PMID: 27455044 3. Yin C, Buchheit TE, Park JJ. Acupuncture for chronic pain: an update and critical overview. Curr Opin Anaesthesiol. Oct, 2017;30(5):583-592. PMID: 28719458 Complete List of Published Work in MyBibliography: https://www.ncbi.nlm.nih.gov/myncbi/thomas.buchheit.1/bibliography/public/ Recent Presentations: Translational Pain Research Symposium, Duke Kunshan University and Fudan University, Kunshan China. June 21-23, 2017. Nerve Injury and Amputation: Phenotypes, Novel Markers, and Prevention. American Pain Society Annual Meeting, Milwaukee, WI. April 3-6, 2019. Applications for Regenerative Therapies: Is the Hype Justified? World Institute of Pain World Congress, Rome Italy (Virtual). August 26-29. Stem Cells and Regenerative Medicine: Reconciling basic science, translational application, and clinical outcomes. Pain Society of the Carolinas Annual Meeting, Asheville, NC (Virtual) September 18-19, 2020. Regenerative Medicine American Society of Regional Anesthesia and Pain Medicine Annual Pain Medicine Meeting. November 19- 21, 2020. Las Vegas, Nevada (Virtual). Regenerative Medicine Lecture. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/painless-pain-management/message Support this podcast: https://anchor.fm/painless-pain-management/support

We’re in the midst of a global pandemic and, of course, everyone’s attention is focused on COVID-19. Other podcasts have excellent coverage of this situation. In this episode, we’ll be discussing other important infections that continue to affect our communities: HIV, hepatitis C, and syphilis. Over the past year, the UC Davis ED implemented a massive screening effort to identify patients who have become infected. Dr. Larissa May explains how the screening works and some of the surprising trends we’ve seen. Infection rates were higher than expected and many patients had no idea they were infected! One patient tells us how screening positive for HIV, and being connected to care, changed his life.  This topic, as with so many issues we cover, brings up the broader question: what is the role of the emergency department in the healthcare system? We will explore this further in an upcoming episode and we would love to hear from YOU.  What do YOU see as the role of the emergency department in the broader health system? Send us your answer via on social media, @empulsepodcast, or through our website, ucdavisem.com. And please pass the word along to your friends and colleagues! ***Please rate us and leave us a review on iTunes! It helps us reach more people.*** Hosts: Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis Guest: Dr. Larissa May, Professor of Emergency Medicine with a Masters in Emerging Infectious Diseases, and Director of Emergency Department Antibiotic Stewardship at UC Davis. Resources: ACEP Policy Statement on HIV testing and screening in the ED Centers for Disease Control and Prevention (CDC) resources: Ending the HIV Epidemic: A Plan for America. HIV Nexus Clinician Resources Haukoos JS, Lyons MS, Rothman RE. The Evolving Landscape of HIV Screening in the Emergency Department. Ann Emerg Med. 2018 Jul;72(1):54-56. doi: 10.1016/j.annemergmed.2018.01.041. Epub 2018 Feb 17. PubMed PMID: 29459057; Leblanc J, Hejblum G, Costagliola D, Durand-Zaleski I, Lert F, de Truchis P, Verbeke G, Rousseau A, Piquet H, Simon F, Pateron D, Simon T, Crémieux AC; DICI-VIH (Dépistage Infirmier CIblé du VIH) Group. Targeted HIV Screening in Eight Emergency Departments: The DICI-VIH Cluster-Randomized Two-Period Crossover Trial. Ann Emerg Med. 2018 Jul;72(1):41-53.e9. doi: 10.1016/j.annemergmed.2017.09.011. Epub 2017 Oct 31. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

Ho già parlato molte altre volte di psiconutrizione e di psiconutraceutica, ovvero di quelle nuove aree della psichiatria e delle neuroscienze che si occupano di aiutare il trattamento delle malattie mentali mediante l’utilizzo di modifiche dietetiche e di integrazione di particolari nutrienti.In questo video faccio riferimento a diversi studi clinici, che vi riporto:Jacka FN, O'Neil A, Opie R, et al. A randomised controlled trial of dietary improvement for adults with major depression (the 'SMILES' trial). BMC Med. 2017;15:23Parletta N, Zarnowiecki D, Cho J, Wilson A, Bogomolova S, Villani A, Itsiopoulos C, Niyonsenga T, Blunden S, Meyer B, Segal L, Baune BT, O'Dea K. A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED). Nutr Neurosci. 2019 Jul;22(7):474-487. doi: 10.1080/1028415X.2017.1411320. Epub 2017 Dec 7. PubMed PMID: 29215971.Bogomolova S, Zarnowiecki D, Wilson A, et al. Dietary intervention for people with mental illness in South Australia. Health Promot Int. 2018;33:71-83.In tutti questi studi si evidenzia come una dieta ispirata a quella mediterranea, ma modificata con un maggior utilizzo di pesce e di grassi Omega-3, possa effettivamente prevenire la depressione e aiutare nel suo trattamento.Dovrebbero i medici iniziare a prescrivere non solo farmaci o psicoterapia ma anche cambiamenti dietetici ai loro pazienti depressi?#dieta #depressioneISCRIVETEVI AL MIO CANALE ► https://bit.ly/2zGIJorVi interessano la Psichiatria e le Neuroscienze? Bene, allora iscrivetevi a questo podcast, al mio canale YouTube e seguitemi sul web tramite il mio blog https://www.valeriorosso.comInoltre andate su Amazon a dare un’occhiata ai miei libri:“Psicobiotica” - Un nuovo modo di intendere il rapporto tra la Mente ed il Corpo….andate su: https://amzn.to/2IZwjhm“Psichiatria Rock” - 50 pensieri off line dal mio blog….andate su: https://amzn.to/2IVKKmJIl Dr. Valerio Rosso, su questo canale YouTube, si dedica a produrre delle brevi lezioni di psichiatria rivolte ai pazienti, agli operatori della salute mentale, a famigliari di pazienti ed a chiunque sia interessato alla psichiatria ed alle neuroscienze.

Ho già parlato molte altre volte di psiconutrizione e di psiconutraceutica, ovvero di quelle nuove aree della psichiatria e delle neuroscienze che si occupano di aiutare il trattamento delle malattie mentali mediante l’utilizzo di modifiche dietetiche e di integrazione di particolari nutrienti.In questo video faccio riferimento a diversi studi clinici, che vi riporto:Jacka FN, O'Neil A, Opie R, et al. A randomised controlled trial of dietary improvement for adults with major depression (the 'SMILES' trial). BMC Med. 2017;15:23Parletta N, Zarnowiecki D, Cho J, Wilson A, Bogomolova S, Villani A, Itsiopoulos C, Niyonsenga T, Blunden S, Meyer B, Segal L, Baune BT, O'Dea K. A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED). Nutr Neurosci. 2019 Jul;22(7):474-487. doi: 10.1080/1028415X.2017.1411320. Epub 2017 Dec 7. PubMed PMID: 29215971.Bogomolova S, Zarnowiecki D, Wilson A, et al. Dietary intervention for people with mental illness in South Australia. Health Promot Int. 2018;33:71-83.In tutti questi studi si evidenzia come una dieta ispirata a quella mediterranea, ma modificata con un maggior utilizzo di pesce e di grassi Omega-3, possa effettivamente prevenire la depressione e aiutare nel suo trattamento.Dovrebbero i medici iniziare a prescrivere non solo farmaci o psicoterapia ma anche cambiamenti dietetici ai loro pazienti depressi?#dieta #depressioneISCRIVETEVI AL MIO CANALE ► https://bit.ly/2zGIJorVi interessano la Psichiatria e le Neuroscienze? Bene, allora iscrivetevi a questo podcast, al mio canale YouTube e seguitemi sul web tramite il mio blog https://www.valeriorosso.comInoltre andate su Amazon a dare un’occhiata ai miei libri:“Psicobiotica” - Un nuovo modo di intendere il rapporto tra la Mente ed il Corpo….andate su: https://amzn.to/2IZwjhm“Psichiatria Rock” - 50 pensieri off line dal mio blog….andate su: https://amzn.to/2IVKKmJIl Dr. Valerio Rosso, su questo canale YouTube, si dedica a produrre delle brevi lezioni di psichiatria rivolte ai pazienti, agli operatori della salute mentale, a famigliari di pazienti ed a chiunque sia interessato alla psichiatria ed alle neuroscienze.

References: McDonald R, Keen CL.  Iron, zinc and magnesium nutrition and athletic performance.  Sports Med. 1988 Mar;5(3):171-84.https://www.ncbi.nlm.nih.gov/pubmed/3285436Heffernan, S. M., Horner, K., De Vito, G., & Conway, G. E. (2019). The Role of Mineral and Trace Element Supplementation in Exercise and Athletic Performance: A Systematic Review. Nutrients, 11(3), 696. doi:10.3390/nu11030696  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6471179/Micheletti A, Rossi R, Rufini S. Zinc status in athletes: relation to diet and exercise.  Sports Med. 2001;31(8):577-82. DOI: 10.2165/00007256-200131080-00002 https://www.ncbi.nlm.nih.gov/pubmed/11475319Heffernan SM, Horner K, De Vito G, Conway GE. The Role of Mineral and Trace Element Supplementation in Exercise and Athletic Performance: A Systematic Review. Nutrients. 2019 Mar 24;11(3). pii: E696. doi: 10.3390/nu11030696. PubMed  PMID: 30909645; PubMed Central PMCID: PMC6471179. https://www.ncbi.nlm.nih.gov/pubmed/30909645 Sim M, Garvican-Lewis LA, Cox GR, Govus A, McKay AKA, Stellingwerff T, Peeling P. Iron considerations for the athlete: a narrative review. Eur J Appl Physiol. 2019 Jul;119(7):1463-1478. doi: 10.1007/s00421-019-04157-y. Epub 2019 May 4. Review. PubMed PMID: 31055680.  https://www.ncbi.nlm.nih.gov/pubmed/31055680Shoemaker ME, Gillen ZM, Mckay BD, Bohannon NA, Gibson SM, Koehler K, Cramer JT. Sex-specific relationships among iron status biomarkers, athletic performance, maturity, and dietary intakes in pre-adolescent an adolescent athletes. J Int Soc Sports Nutr. 2019 Sep 18;16(1):42. doi: 10.1186/s12970-019-0306-7. PubMed PMID: 31533743; PubMed Central PMCID: PMC6751686.  https://www.ncbi.nlm.nih.gov/pubmed/31533743Nabhan D, Bielko S, Sinex JA, Surhoff K, Moreau WJ, Schumacher YO, Bahr R, Chapman RF. Serum ferritin distribution in elite athletes. J Sci Med Sport. 2019  Dec 27. pii: S1440-2440(19)30682-6. doi: 10.1016/j.jsams.2019.12.027. [Epub aheadof print] PubMed PMID: 31901316.   https://www.ncbi.nlm.nih.gov/pubmed/31901316

References:Adriana Sarah Nica, Adela Caramoci, Mirela Vasilescu, Anca Mirela Ionescu, Denis Paduraru, Virgil Mazilu.  Magnesium supplementation in top athletes - effects and recommendations. Medicina Sportiva (2015), vol. XI, no 1, 2482-2494 Journal of the Romanian Sports Medicine SocietyAikawa JW. Magnesium: its biological significance. Boca Raton, FL: CRC Press, 1981:21–38.Abbasi B, Kimiagar M, Sadeghnijat K, Shirazi MM, Hedayati M, Rashidkhani B. “The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial.”  J Res Med Sci. 2012 Dec 17 (12): 1161-9.PubMed PMID: 23853635. Arnaud MJ: Update on the assessment of magnesium status. Br J Nutr 2008;99(suppl 3):S24–S36 Brilla LR, Haley TF. Effect of magnesium supplementation on strength training in humans. J Am Coll Nutr 1992;11:326​​​​​​​Chandrasekaran NC, Weir C, Alfraji S, Grice J, Roberts MS, Barnard RT. Effects of magnesium deficiency--more than skin deep. Exp Biol Med (Maywood). 2014 Oct;239(10):1280-91. doi: 10.1177/1535370214537745. Epub 2014 Jun 13.Ebel H, Gunther T. Magnesium metabolism: a review. J Clin Chem Biochem 1980;18:257–70.Emelyanov A, Fedoseev G, Barnes PJ: Re- duced intracellular magnesium concentra- tions in asthmatic patients. Eur Respir J 1999;13:38–40.Fawcett WJ, Haxby EJ, Male DA: Magnesium: physiology and pharmacology. Br J Anaesth 1999;83:302–320.Institute of Medicine, Food and Nutrition Board. Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington, DC: National Academy Press, 1997.Guerrero-Romero F, Rodríguez-Morán M. Relationship between serum magnesium levels and C-reactive protein concentration, in non-diabetic, non-hypertensive obese subjects. Int J Obes Relat Metab Disord. 2002;26:469–74.Hosty´nek JJ, Hinz RS, Lorence CR, Price M, Guy RH. Metals and the skin. Crit Rev Toxicol 1993;23:171–235Jahnen-Dechent W, Ketteler M. Magnesium basics. Clin Kidney J 2012;5:i3–i14Kupetsky-Rincon EA1, Uitto J. Magnesium: novel applications in cardiovascular disease--a review of the literature. Ann Nutr Metb. 2012;61(2):102-10.Lansdown AB. Physiological and toxicological changes in the skin resulting from the action and interaction of metal ions. Crit Rev Toxicol1995;25:397–462.Mochizuki M, Akagi K, Inoue K, Shimamura K.[A single dose toxicity study of magnesium sulfate in rats and dogs]. J Toxicol Sci. 1998 May;23 Suppl 1:31-5Navarrete-Cortes A, Ble-Castillo JL, Guerrero-Romero F, Cordova-Uscanga R, Juárez-Rojop IE, Aguilar-Mariscal H, Tovilla-Zarate CA, Lopez-Guevara Mdel R. No effect of magnesium supplementation on metabolic control and insulin sensitivity in type 2 diabetic patients with normomagnesemia. Magnes Res. 2014 Apr-Jun;27(2):48-56. doi: 10.1684/mrh.2014.0361.Nedeltcheva AV, Kilkus JM, Imperial J, Schoeller DA, Peney PD. “Insufficient sleep undermines dietary efforts to reduce adiposity.”  ANN Intern Med. 2010 Oct 5:153(7):435-41. PubMed PMID: 20921542.Nowacki W, Daveau M, Malpuech-Bruge C. Inflammatory responsefollowing acute magnesium deficiency in the rat. Biochim Biophys Acta 2000;1501:91–8Nielsen FH, Johnson LK, Zeng H.  Magnesium supplementation improves indicators of low magnesium status and inflammatory stress in adults older than 51 years with poor quality sleep.  Magnes Res. 2010 Dec;23(4):158-68. doi: 10.1684/mrh.2010.0220. Epub 2011 Jan 4.Malon A, Brockmann C, Fijalkowska- Morawska J, Rob P, Maj-Zurawska M: Ionized magnesium in erythrocytes – the best magnesium parameter to observe hypo- or hypermagnesemia. Clin Chim Acta 2004; 349:67–73.Martin K, Jackson CF, Levy RG, Cooper PN. Ketogenic diet and other dietary treatments for epilepsy. Cochrane Database Syst Rev. 2016 Feb 9;2:CD001903. doi: 10.1002/14651858.CD001903.pub3.Meolie AL, Rosen C, Kristo D, Kohrman M, Gooneratne N, Aguillard RN, Fayle R, Troell R, Townsend D, Claman D, Hoban T, Mahowald M. Oral nonprescription treatment for insomnia: an evaluation of products with limited evidence; Clinical Practice Review Committee; American Academy of Sleep Medicine.J Clin Sleep Med. 2005 Apr 15;1(2):173-87.Rodríguez-Morán M, Guerrero-Romero F. Serum magnesium and C-reactive protein levels. Arch Dis Child. 2008;93:676–80University of Maryland Medical Center “Magnesium” access May 8. 2016 http://umm.edu/ health/medical/altmed/supplement/magnesiumShils ME. Magnesium. In: Shils ME, Olson JA, Shike M, eds. Modern nutrition in health and disease. 8th ed. Philadelphia: Lea & Febiger, 1993:164–84.Simsek E, Karabay M, Kocabay K: Assess- ment of magnesium status in newly diag- nosed diabetic children: measurement of erythrocyte magnesium level and magne- sium tolerance testing. Turk J Pediatr 2005; 47:132–137.Waring, RH  Report on Absorption of magnesium sulfate (Epsom salts) across the skin.  School of Biosciences, University of Birmingham. B15 2TT, U.K. r.h.waring@bham.ac.uk   URL http://www.epsomsaltcouncil.org/wpcontent/uploads/2015/10/report_on_absorption_of_magnesium_sulfate.pdfWinkelmann RK. The relationship of the structure of the epidermis to percutaneous absorption. Br J Dermatol 1969;81:11–22Witkowski M, Hubert J, Mazur A. Methods of assessment of magnesium status in humans: a systematic review. Magnes Res. 2011 Dec;24(4):163-80. doi: 10.1684/mrh.2011.0292.

Author: Don Stader, MD Educational Pearls: Abstinence from substances such as tobacco or alcohol are effective strategies to achieve long term sobriety However, abstinence is not an effective strategy for achieving sobriety with opiate use disorder (OUD) Up to 90% of those who use an abstinence-only strategy for OUD will relapse within a month.  Attending a rehabilitation facility increases mortality in those with OUD due to decreased tolerance and higher rates of overdose.  Medication-assisted therapy (MAT) with naltrexone, buprenorphine or methadone for OUD is supported by evidence, and is the preferred method for achieving remission References Nielsen S, Larance B, Degenhardt L, Gowing L, Kehler C, Lintzeris N. Opioid agonist treatment for pharmaceutical opioid dependent people. Cochrane Database Syst Rev. 2016 May 9;(5):CD011117. doi: 10.1002/14651858.CD011117.pub2. Review. PubMed PMID: 27157143. Medications for Opioid Use Disorder Save Lives. 2019 Mar 30;. doi: 10.17226/25310. Review. PubMed PMID: 30896911. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD Music credit: “Smooth Lovin” by Kevin MacLoed (incompetech.com). Licensed under Creative Commons By Attribution 3.0 License. http://creativecommons.org/licenses/by/3.0/

Contributor: Don Stader, MD Educational Pearls: The eye is surrounded by relatively inflexible tissues such as the bone of the orbit and the fibrous tissue of the eye. This makes it relatively susceptible to damage from outside compression, which is most common from trauma. This phenomenon is called ocular compartment syndrome (OCS)  Look for OCS when patients have face, head or direct eye trauma  OCS will present with a swollen, bulging eye associated with pain and blurry vision. Typically diagnosed with an elevated intraocular pressure (>40) OCS needs to be treated with a lateral canthotomy to help expand the area around the eye, reducing the pressure. Can’t see the eye due to swelling? Use paper clips to make eyelid retractors! References Lima V, Burt B, Leibovitch I, Prabhakaran V, Goldberg RA, Selva D. Orbital compartment syndrome: the ophthalmic surgical emergency. Surv Ophthalmol. 2009 Jul-Aug;54(4):441-9. doi: 10.1016/j.survophthal.2009.04.005. Review. PubMed PMID: 19539832. Rowh AD, Ufberg JW, Chan TC, Vilke GM, Harrigan RA. Lateral canthotomy and cantholysis: emergency management of orbital compartment syndrome. J Emerg Med. 2015 Mar;48(3):325-30. doi: 10.1016/j.jemermed.2014.11.002. Epub 2014 Dec 16. PubMed PMID: 25524455. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Contributor: Dylan Luyten, MD Educational Pearls: Those that are hypokalemic are often hypomagnesemic, and should receive magnesium (Mg) supplementation if repleting potassium Mg levels are typically not necessary - if someone is suspect to have hypomagnesemia, just given them Mg Mg increases the AV node refractory period and therefore may be helpful as an adjunct to those in atrial fibrillation with a rapid ventricular response Mg is the preferred treatment for seizure prophylaxis in preeclampsia. All patients with suspected preeclampsia should get 4g Mg IV over 20 min Mg may reduce hospital admissions in those with severe asthma, though it has not shown to have mortality or other benefits in acute exacerbations Editor’s note: and we didn’t even touch on magnesium in headaches References Huang CL, Kuo E. Mechanism of hypokalemia in magnesium deficiency. J Am Soc Nephrol. 2007 Oct;18(10):2649-52. doi: 10.1681/ASN.2007070792. Epub 2007 Sep 5. Review. PubMed PMID: 17804670. Ismail Y, Ismail AA, Ismail AA. The underestimated problem of using serum magnesium measurements to exclude magnesium deficiency in adults; a health warning is needed for "normal" results. Clin Chem Lab Med. 2010 Mar;48(3):323-7. doi: 10.1515/CCLM.2010.077. PubMed PMID: 20170394. Heitz C, Morgenstern J, Bond C, Milne WK. Hot Off the Press: Low-dose Magnesium Sulfate Versus High Dose in the Early Management of Rapid Atrial Fibrillation: Randomized Controlled Double-blind Study. Acad Emerg Med. 2019 Sep;26(9):1093-1095. doi: 10.1111/acem.13720. Epub 2019 Mar 18. PubMed PMID: 30815951. Levy Z, Slesinger TL. Does intravenous magnesium reduce the need for hospital admission among adult patients with acute asthma exacerbations?. Ann Emerg Med.2015 Jun;65(6):702-3. doi: 10.1016/j.annemergmed.2014.07.019. Epub 2014 Aug 13. PubMed PMID: 25128007. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Contributor: Aaron Lessen, MD Educational Pearls: Patients with psychiatric complaints are often complicated to disposition from the main ED, and many will require inpatient psychiatric stays Some health systems have dedicated psychiatric ED’s that are specialized in taking care of these patients For example, in Oakland, CA, EMS are permitted to “clear” a patient for transport to a psych-only facility. 5-year retrospective study of this system showed 40% of psych patients were cleared by EMS for transfer directly to a psychiatric facility Only 0.3% of these patients “bounced back" and required an emergency department visit This technique could be used elsewhere to provide the most appropriate care for psych patients  References Trivedi TK, Glenn M, Hern G, Schriger DL, Sporer KA. Emergency Medical Services Use Among Patients Receiving Involuntary Psychiatric Holds and the Safety of an Out-of-Hospital Screening Protocol to "Medically Clear" Psychiatric Emergencies in the Field, 2011 to 2016. Ann Emerg Med. 2019 Jan;73(1):42-51. doi: 10.1016/j.annemergmed.2018.08.422. Epub 2018 Sep 28. PubMed PMID: 30274946. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Author: Jared Scott, MD Educational Pearls: Study from Hennepin County EM studied the efficacy of different drugs for agitation, which included 737 patients Most patients in this study were male and *surprise* drunk Compared doses of common sedatives with primary outcome of sedation at 15 minutes (all intramuscular) haloperidol 5 mg ziprasidone 20 mg olanzapine 10 mg midazolam 5 mg haloperidol 10 mg with the main outcome of agitation at 15 minutes Intramuscular midazolam resulted in the lowest level of agitation at 15 minutes, followed by ziprasidone. There were no differences in adverse effects. References Klein LR, Driver BE, Miner JR, Martel ML, Hessel M, Collins JD, Horton GB, Fagerstrom E, Satpathy R, Cole JB. Intramuscular Midazolam, Olanzapine, Ziprasidone, or Haloperidol for Treating Acute Agitation in the Emergency Department. Ann Emerg Med. 2018 Oct;72(4):374-385. doi: 10.1016/j.annemergmed.2018.04.027. Epub 2018 Jun 7. PubMed PMID: 29885904. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Author: Dylan Luyten, MD Educational Pearls: While certain aspects of the history, exam, and EKG may increase likelihood of ACS, there is no one element that performs well on its own  Elements of the history have been found to have different likelihood ratios, which can increase or decrease the probability of a patient having ACS Likelihood ratios greater than one increase the chance of the patient having the disease. Ratios less than one decrease it   Bilateral arm radiation is one of very few historical features that increases the likelihood of ACS ST depressions are one of the few EKG findings with a high LR for ACS Scoring systems such as the HEART score can be useful to risk stratify your patients   References Fanaroff AC, Rymer JA, Goldstein SA, Simel DL, Newby LK. Does This Patient With Chest Pain Have Acute Coronary Syndrome?: The Rational Clinical Examination Systematic Review. JAMA. 2015 Nov 10;314(18):1955-65. doi: 10.1001/jama.2015.12735. Review. PubMed PMID: 26547467. Backus BE, Six AJ, Kelder JC, Bosschaert MA, Mast EG, Mosterd A, Veldkamp RF, Wardeh AJ, Tio R, Braam R, Monnink SH, van Tooren R, Mast TP, van den Akker F, Cramer MJ, Poldervaart JM, Hoes AW, Doevendans PA. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013 Oct 3;168(3):2153-8. doi: 10.1016/j.ijcard.2013.01.255. Epub 2013 Mar 7. PubMed PMID: 23465250.   From CarePoint PA Academy, 2019

Author: David Holland, MD Educational Pearls: Hallucinogenics have been used for a variety of cultural and religious reasons for thousands of years In the 1960’s a Harvard professor began experimenting with psilocybin mushrooms. There was resulting public outcry, eventually leading to all hallucinogens being listed as schedule I drugs Common hallucinogens include: LSD (acid), Mescaline (peyote), DMT (ayahuasca), Psilocybin (mushrooms), MDMA (ecstacy) Effects vary by specific drug but may include auditory/visual hallucinations, increased empathy, loss of fear Physiologic effects often include mydriasis, tachycardia, hyperthermia and hypertension  Recent neuroimaging studies have shown increased neural connectivity in people after administration of hallucinogens Each hallucinogen has a specific dose and duration, some can last half a day or more    References Heal DJ, Gosden J, Smith SL. Evaluating the abuse potential of psychedelic drugs as part of the safety pharmacology assessment for medical use in humans.Neuropharmacology. 2018 Nov;142:89-115. doi: 10.1016/j.neuropharm.2018.01.049. Epub 2018 Feb 8. Review. PubMed PMID: 29427652. Garcia-Romeu A, Kersgaard B, Addy PH. Clinical applications of hallucinogens: A review. Exp Clin Psychopharmacol. 2016 Aug;24(4):229-68. doi: 10.1037/pha0000084. Review. PubMed PMID: 27454674; PubMed Central PMCID: PMC5001686. Bogenschutz MP, Johnson MW. Classic hallucinogens in the treatment of addictions.Prog Neuropsychopharmacol Biol Psychiatry. 2016 Jan 4;64:250-8. doi: 10.1016/j.pnpbp.2015.03.002. Epub 2015 Mar 14. Review. PubMed PMID: 25784600. From CarePoint PA Academy

Author: Rachel Brady, MD Educational Pearls: Elderly patients (>65 years old) have a higher trauma mortality compared to younger patients, even though they have lower mechanisms of injury  Elder trauma is often under-triaged due to low-energy mechanisms and lack of physiologic response due to age and medications such as beta-blockers. Do not be reassured by normal vital signs.  Image elderly patients with head injury aggressively since they are at high risk of intracranial bleeds Be sure to ask about anticoagulation use. Up to 15% of asymptomatic head injury patients  on warfarin will have intracranial bleeds on CT.  Be on the lookout for unstable C-spine injuries such as type II odontoid fractures Central cord syndrome is a possibility with any neck extension injury Rib fractures are common, with mortality increasing greatly with more than 2 ribs involved The elderly are more prone to musculoskeletal injuries due to loss of bone density Always discuss goals of care with these patients  References Rathlev NK, Medzon R, Lowery D, Pollack C, Bracken M, Barest G, Wolfson AB, Hoffman JR, Mower WR. Intracranial pathology in elders with blunt head trauma. Acad Emerg Med. 2006 Mar;13(3):302-7. doi: 10.1197/j.aem.2005.10.015. PubMed PMID: 16514123. Keller JM, Sciadini MF, Sinclair E, O'Toole RV. Geriatric trauma: demographics, injuries, and mortality. J Orthop Trauma. 2012 Sep;26(9):e161-5. doi: 10.1097/BOT.0b013e3182324460. PubMed PMID: 22377505. Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma.2000 Jun;48(6):1040-6; discussion 1046-7. doi: 10.1097/00005373-200006000-00007. PubMed PMID: 10866248. Hashmi A, Ibrahim-Zada I, Rhee P, Aziz H, Fain MJ, Friese RS, Joseph B. Predictors of mortality in geriatric trauma patients: a systematic review and meta-analysis. J Trauma Acute Care Surg. 2014 Mar;76(3):894-901. doi: 10.1097/TA.0b013e3182ab0763. Review. PubMed PMID: 24553567. Brooks SE, Peetz AB. Evidence-Based Care of Geriatric Trauma Patients. Surg Clin North Am. 2017 Oct;97(5):1157-1174. doi: 10.1016/j.suc.2017.06.006. Review. PubMed PMID: 28958363.

Educational Pearls: Buprenorphine is a semi-synthetic derivative of the opium poppy FDA approved for the treatment of opiate use disorder and chronic pain Benefit in emergency department use is the ceiling effect - producing less euphoria as well as respiratory depression with higher doses  It has an onset of 30-60 minutes, peak effect at 1-4 hours Duration of action depends is dose dependent, typically 6-12 hours, but can be as long as 24-72 hours in doses over 16 mg Use buprenorphine in those in moderate to severe opiate withdrawal Clinical Opioid Withdrawal Scale (COWS) can be used to assess and score severity of withdrawal A reasonable starting dose is 8mg. A second dose can be given after an hour, ranging from 8-24 mg depending on symptoms still present Buprenorphine can induce withdrawals so someone needs to be in true withdrawals for it to provide benefit References https://www.mdcalc.com/cows-score-opiate-withdrawal https://ed-bridge.org Herring AA, Perrone J, Nelson LS. Managing Opioid Withdrawal in the Emergency Department With Buprenorphine. Ann Emerg Med. 2019 May;73(5):481-487. doi: 10.1016/j.annemergmed.2018.11.032. Epub 2019 Jan 5. Review. PubMed PMID: 30616926. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Contributor: Jared Scott, MD Educational Pearls: The CDC recommends rabies prophylaxis if there was a direct encounter with a possibly rabid animal except... Bats are treated differently since their bites may be very superficial and not seen/felt. All people with possible close encounters with a bat should receive rabies prophylaxis  From 1990-2007 there were 34 rabies cases associated with bats:  6 of these had a reported bat bite 15 there was a reported exposure but no reported bite 11 had no reported bat exposure but DNA testing revealed that the rabies came from a bat  References Pieracci EG, Pearson CM, Wallace RM, Blanton JD, Whitehouse ER, Ma X, Stauffer K, Chipman RB, Olson V. Vital Signs: Trends in Human Rabies Deaths and Exposures - United States, 1938-2018. MMWR Morb Mortal Wkly Rep. 2019 Jun 14;68(23):524-528. doi: 10.15585/mmwr.mm6823e1. PubMed PMID: 31194721; PubMed Central PMCID: PMC6613553. https://www.cdc.gov/rabies/specific_groups/doctors/index.html Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Herzlich Willkommen auf dem Fitness Fakten mit Lea Podcast! Heute spreche ich über Kalorien und über die verschiedenen Faktoren auf die ihr achten müsst um den Verbrauch zu verstehen. Folgt mir doch gerne auch auf Instagram für mehr wissenswerte Beiträge: https://www.instagram.com/lealoveslifting_official/ Die im Podcast genannten Studien: Tappy L. Thermic effect of food and sympathetic nervous system activity in humans. Reprod Nutr Dev. 1996;36(4):391-7. Review. Donahoo WT, Levine JA, Melanson EL. Variability in energy expenditure and itscomponents. Curr Opin Clin Nutr Metab Care. 2004 Nov;7(6):599-605. Review. PubMed PMID: 15534426 Levine JA. Nonexercise activity thermogenesis (NEAT): environment and biology. Am J Physiol Endocrinol Metab. 2004 May;286(5):E675-85. Review. Erratum in: Am J Physiol Endocrinol Metab. 2005 Jan;288(1):E285. PubMed PMID: 15102614.

Contributor: Nick Hatch, MD Educational Pearls: Dalbavancin (Dalvance®) is an antibiotic that can be used for skin and soft tissue infections, providing MRSA coverage It cannot be used in other infections or sepsis Dalbavancin may be appealing as a single dose lasts about 2 weeks Expense is currently a large barrier to use Patients with a vancomycin allergy will likely be allergic to Dalbavancin as the two are related References Patel M, Smalley S, Dubrovskaya Y, Siegfried J, Caspers C, Pham V, Press RA, Papadopoulos J. Dalbavancin Use in the Emergency Department Setting. Ann Pharmacother. 2019 Jun 3;:1060028019855159. doi: 10.1177/1060028019855159. [Epub ahead of print] PubMed PMID: 31155916. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Contributor: Michael Hunt, MD Educational Pearls: Due to the efficacy of vaccination, epiglottitis is now more common in adults than children Risk factors include smoking and other immunocompromising co-morbidities, such as diabetes Epiglottitis can present with sore throat and fever, with potential rapid progression to respiratory distress and stridor Diagnosis can include x-ray to look for the “thumbprint sign," nasofiberoptics, and/or CT Antibiotics are mainstay of treatment but severe cases may need establishment of a definitive airway, typically done with fiberoptics in the operating room due to the potential to irritate the epiglottitis with traditional laryngoscopy References Li RM, Kiemeney M. Infections of the Neck. Emerg Med Clin North Am. 2019 Feb;37(1):95-107. doi: 10.1016/j.emc.2018.09.003. Review. PubMed PMID: 30454783. Tsai YT, Huang EI, Chang GH, Tsai MS, Hsu CM, Yang YH, Lin MH, Liu CY, Li HY. Risk of acute epiglottitis in patients with preexisting diabetes mellitus: A population-based case-control study. PLoS One. 2018;13(6):e0199036. doi: 10.1371/journal.pone.0199036. eCollection 2018. PubMed PMID: 29889887; PubMed Central PMCID: PMC5995441. Guerra AM, Waseem M. Epiglottitis. [Updated 2018 Nov 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430960/ Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Contributor: Jared Scott, MD Educational Pearls: Cerebellar strokes make up a disproportionate number of missed or delayed diagnosis for stroke likely due to the subtle nature of the presentation Cerebellar strokes can present with vomiting, dizziness, and ataxia.  Unlike anterior circulation stroke, exam findings in a cerebellar stroke are ipsilateral to the lesion  On neuro exam, findings may include: Dysmetria: lack of coordination with overshooting/undershooting intended position of limb Dysdiadochokinesia: difficulty with rapid alternating movements Ataxia Nystagmus Consider a cerebellar stroke in patients presenting with vomiting and dizziness without an alternative diagnosis References Edlow JA, Newman-Toker DE, Savitz SI. Diagnosis and initial management of cerebellar infarction. Lancet Neurol. 2008 Oct;7(10):951-64. doi: 10.1016/S1474-4422(08)70216-3. Review. PubMed PMID: 18848314. Datar S, Rabinstein AA. Cerebellar infarction. Neurol Clin. 2014 Nov;32(4):979-91. doi: 10.1016/j.ncl.2014.07.007. Epub 2014 Sep 13. Review. PubMed PMID: 25439292. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Contributor: Charleen Gnisci, PharmD Educational Pearls: Causes of increased intracranial pressure may include intracranial hemorrhage, malignancy, and trauma.  While definite treatment is to remove the offending cause, there are emergency medicine   Non-pharmacologic methods include elevating head of bed and removing noxious stimuli Pharmacologic options include mannitol and hypertonic saline Hypertonic saline is best delivered through a central line but not required Both these agents benefit from adequate renal function Before using mannitol, be sure to inspect the bag to ensure that it has not precipitated. If it has, try warming the bag before administration.  References https://pulmccm.org/critical-care-review/hyperosmolar-therapy-for-increased-intracranial-pressure-review-nejm/ Burgess S, Abu-Laban RB, Slavik RS, Vu EN, Zed PJ. A Systematic Review of Randomized Controlled Trials Comparing Hypertonic Sodium Solutions and Mannitol for Traumatic Brain Injury: Implications for Emergency Department Management. Ann Pharmacother. 2016 Apr;50(4):291-300. doi: 10.1177/1060028016628893. Epub 2016 Jan 29. Review. PubMed PMID: 26825644. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

deSouza IS et al. Accuracy of Physical Examination, Ankle-Brachial Index, and Ultrasonography in the Diagnosis of Arterial Injury in Patients With Penetrating Extremity Trauma: A Systematic Review and Meta-analysis. Acad Emerg Med. 2017 Aug;24(8):994-1017. doi: 10.1111/acem.13227. Review. PubMed PMID: 28493614. https://onlinelibrary.wiley.com/doi/full/10.1111/acem.13227

Contributor: Don Stader, MD Educational Pearls: Antiplatelets include aspirin and clopidogrel, and are generally used for arterial clotting (MI, stroke) Anticoagulants such as coumadin, Xarelto, Eliquis are generally used for venous clotting (DVT/PE) Growing data suggests that dual antiplatelet therapy (aspirin+clopidogrel) is superior to aspirin alone in reducing stroke for diagnosed with TIA References: Kheiri B, Osman M, Abdalla A, Haykal T, Swaid B, Ahmed S, Chahine A, Hassan M, Bachuwa G, Al Qasmi M, Bhatt DL. Clopidogrel and aspirin after ischemic stroke or transient ischemic attack: an updated systematic review and meta-analysis of randomized clinical trials. J Thromb Thrombolysis. 2019 Feb;47(2):233-247. doi: 10.1007/s11239-018-1786-z. PubMed PMID: 30511260. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Contributor: Michael Hunt, MD Educational Pearls: Tetracycline antibiotics such as minocycline can cause greyish hyperpigmentation This hyperpigmentation can sometimes be reversible but not always Minocycline has been used for its effects in autoimmune and neurological diseases, where it is  often taken chronically, which can lead to increased pigmentation   References La Placa M, Infusino SD, Balestri R, Vincenzi C. Minocycline-Induced Blue-Gray Discoloration. Skin Appendage Disord. 2017 Aug;3(3):161-162. doi: 10.1159/000469712. Epub 2017 Apr 22. PubMed PMID: 28879193; PubMed Central PMCID: PMC5582477.   Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD  

Today’s episode featured Dr. Dominique Harmath on the topic of Tennis Injury Risk,Training Load and Recovery. Whether you are a competitive tennis player, coach, parent orsomeone that just loves playing the sport, this podcast will explain how to manage training loads to reduce the risk of injury and take you through some recovery strategies to meet performance goals.Dr. Harmath is an evidence-based chiropractor and a Sports Sciences Resident with theRoyal College of Chiropractic Sports Sciences Canada, the most extensive sport specialtytraining program in the chiropractic profession. She has received international awards for her research and work in the field. Her passion lies with helping people move better to enhance their quality of life and achieve their sports performance goals. Her approach to care is individualized and she is trained in active release therapy (ART), soft tissue treatment, medical acupuncture, adjustment and joint mobilization, soft tissue tools, rehabilitation, and exercise prescription. As a former professional tennis player, four-time Canadian Junior National Champion andtop 50 Division I NCAA player for Rice University in Houston, Dr. Harmath holds a specialinterest in biomechanical movement and injury prevention strategies in sport. She has worked with various sports events including International Tennis Federation tournaments, The Toronto Triathlon and The Taekwondo Championships.For a free 15-minute functional assessment (use code: NSAShow) or for additional questions please contact Dr. Harmath at:Instagram: @thesportstherapistEmail: dr.harmath@esmclinics.comResearch References:Gabbett TJ. Debunking the myths about training load, injury and performance:empirical evidence, hot topics and recommendations for practitioners. Br J Sports Med. 2018 Oct 26. pii:bjsports-2018-099784. doi:10.1136/bjsports-2018-099784.[Epub ahead ofprint] PubMed PMID: 30366966.Wahl P, Güldner M, Mester J. Effects and sustainability of a 13-day high-intensity shock microcycle in soccer. J Sports Sci Med. 2014;13:259–65.Bosquet L, Montpetit J, Arvisais D, et al. Effects oftapering on performance: a meta-analysis. Med SciSports Exerc 2007;39:1358–65.

Contributor: Peter Bakes, MD Educational Pearls: While there are many different types of medical error, one of the most common errors in emergency medicine is failure to diagnose Systematic error in thinking that negatively affects judgement Medical errors are often driven by cognitive biases, which include anchoring, attribution, and availability   Anchoring bias occurs when early information leads to premature closure on a single diagnosis. There is subsequent failure to consider alternative diagnoses, even in the face of conflicting new data and test results. Attribution bias occurs when assumptions about personal and medical characteristics are made about a specific group of people. Availability bias occurs when recent experiences drive providers to over or under consider diagnoses. References Croskerry P. Cognitive forcing strategies in clinical decisionmaking. Ann Emerg Med. 2003 Jan;41(1):110-20. doi: 10.1067/mem.2003.22. PubMed PMID: 12514691. Redelmeier DA. Improving patient care. The cognitive psychology of missed diagnoses. Ann Intern Med. 2005 Jan 18;142(2):115-20. doi: 10.7326/0003-4819-142-2-200501180-00010. PubMed PMID: 15657159. https://www.nuemblog.com/blog/cognitive-bias Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Author: Sam Killian, MD Educational Pearls: Abuse occurs by breathing in volatile substances such as solvents, glues, paints, butane, and propane Inhalants are generally depressants Estimated that 100-125 people die every year in the US from acute inhalant abuse. Short-term effects include memory impairment, slurred speech, diplopia, seizures, and cardiac arrhythmias Long term effects include renal dysfunction, neuropathy, blindness and cognitive blunting Evaluation includes a detailed lung exam, cardiac monitoring, and assessments of oxygenation and renal function Treatment is generally supportive.  References Lipari RN. Understanding Adolescent Inhalant Use. 2013;. Review. PubMed PMID: 28722849. Howard MO, Bowen SE, Garland EL, Perron BE, Vaughn MG. Inhalant use and inhalant use disorders in the United States. Addict Sci Clin Pract.2011 Jul;6(1):18-31. Review. PubMed PMID: 22003419; PubMed Central PMCID: PMC3188822. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Author:  Nick Hatch, MD Educational Pearls: Pregnancy is a hypercoagulable state, which predisposes women to venous thromboembolism, but also elevates levels of circulating d-dimer A recent study evaluated the YEARS protocol in combination of adjusted d-dimer cutoffs in pregnant women to evaluate for DVT and PE Using this protocol, only 1 DVT was missed. No PE’s were missed. This protocol has growing evidence as an option in pregnant women in whom you must rule out a DVT/PE but more validating studies are likely necessary References van der Pol LM, Tromeur C, Bistervels IM, Ni Ainle F, van Bemmel T, Bertoletti L, Couturaud F, van Dooren YPA, Elias A, Faber LM, Hofstee HMA, van der Hulle T, Kruip MJHA, Maignan M, Mairuhu ATA, Middeldorp S, Nijkeuter M, Roy PM, Sanchez O, Schmidt J, Ten Wolde M, Klok FA, Huisman MV. Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism. N Engl J Med. 2019 Mar 21;380(12):1139-1149. doi: 10.1056/NEJMoa1813865. PubMed PMID: 30893534. Summarized by Will Dewispelaere, MS3 | Edited by Erik Verzemnieks, MD  

Author: Chris Holmes, MD Educational Pearls: Hallucinogenic drugs have been in use since ancient times for both medical and recreational purposes Ayahausca is an ancient psychedelic with origins in Bolivia that causes intense vomiting followed by a psychedelic experience This and other hallucinogens are gaining gaining interest for their use in depression with some startling positive initial results References https://www.nationalgeographic.com/culture/2019/05/ancient-hallucinogens-oldest-ayahuasca-found-shaman-pouch/ Carhart-Harris RL et. al. Psilocybin with psychological support for treatment-resistant depression: six-month follow-up. Psychopharmacology (Berl). 2018 Feb;235(2):399-408. doi: 10.1007/s00213-017-4771-x. Epub 2017 Nov 8. PubMed PMID: 29119217; PubMed Central PMCID: PMC5813086. Palhano-Fontes F et. al. Rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression: a randomized placebo-controlled trial. Psychol Med. 2019 Mar;49(4):655-663. doi: 10.1017/S0033291718001356. Epub 2018 Jun 15. PubMed PMID: 29903051; PubMed Central PMCID: PMC6378413. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Author:  Nick Hatch, MD Educational Pearls: Postpolypectomy electrocoagulation syndrome (PES) is a rare complication of polypectomy and electrocautery during colonoscopy Occurs when cautery causes transmural thickening from a contact burn Patients can present as if they have peritonitis, with guarding, leukocytosis, fever, etc. CT is the imaging of choice mainly to evaluate for bowel perforation as PES may not be seen on imaging Treatment is often with antibiotics and supportive care - in severe cases, hospitalization may be required. References Benson BC, Myers JJ, Laczek JT. Postpolypectomy electrocoagulation syndrome: a mimicker of colonic perforation. Case Rep Emerg Med. 2013;2013:687931. doi: 10.1155/2013/687931. Epub 2013 Jul 15. PubMed PMID: 23956889; PubMed Central PMCID: PMC3728495. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Author: Dylan Luyten, MD Educational Pearls: Actual wait times are weakly correlated to patient satisfaction but the difference between perceived/expected wait times and actual wait times is strongly correlated Having others in the room or with the patient while they wait also has a positive effect Under-promising and over-delivering can result in better patient experience Managing up others and services provided also is demonstrated to improve satisfaction Perceived time with health care members (physicians, APPs, nurses, etc) also is supported to improve satisfaction Sitting with patients increases the perception of time   References Trout A, Magnusson AR, Hedges JR. Patient satisfaction investigations and the emergency department: what does the literature say?. Acad Emerg Med. 2000 Jun;7(6):695-709. Review. PubMed PMID: 10905652. Sonis JD, Aaronson EL, Lee RY, Philpotts LL, White BA. Emergency Department Patient Experience: A Systematic Review of the Literature. J Patient Exp. 2017;5(2):101–106. doi:10.1177/2374373517731359   Summarized by Will Dewispelaere, MS3 | Edited by Erik Verzemnieks, MD

S4P Radio, sleep science audio abstract review 11: Sleep practices implemented by team sport coaches and sport science support staff.   In our latest S4P audio abstract, we look at a new publication from the journal of science and medicine in sport titled “Sleep practices implemented by team sport coaches and sports science support staff: A potential avenue to improve athlete sleep?”. Written by Kathleen Miles, the aim of the study was to assess sleep hygiene knowledge of high-performance team sport coaches and sports science support staff, the sleep practices they implement with athletes; and the barriers to the more frequent use of these practices. You can access Kathleen’s paper at the link below, along with some important information from the Sleep Health Foundation, on good sleep habits and how to achieve them!   Sleep practices implemented by team sport coaches and sports science support staff: A potential avenue to improve athlete sleep? - https://www.ncbi.nlm.nih.gov/pubmed/30685228   Good Sleep Habits - https://www.sleephealthfoundation.org.au/pdfs/Good-Sleep-Habits.pdf   Contact me at iandunican@sleep4performance.com.au   www.sleep4performance.com.au   Twitter @sleep4perform   You can also listen to S4P Radio on You Tube and Spotify   Miles KH, Clark B, Fowler PM, Miller J, Pumpa KL. Sleep practices implemented by team sport coaches and sports science support staff: A potential avenue to improve athlete sleep? J Sci Med Sport. 2019 Jan 19. pii: S1440-2440(18)31239-8. doi: 10.1016/j.jsams.2019.01.008. [Epub ahead of print] PubMed PMID: 30685228.      

Author: Michael Hunt, MD Educational Pearls: A recent study evaluated the relationship between abnormal orthostatic vital signs and serious outcomes within 30 days in patients over 60 presenting to the ED with syncope Of the roughly 2000 patients enrolled, about ⅓ had abnormal orthostatic vital signs There was no statistically significance between orthostatic vital signs and serious outcomes in 30 days Editor's note: study used a composite end-point of multiple serious outcomes References White JL, Hollander JE, Chang AM, Nishijima DK, Lin AL, Su E, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Nicks BA, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC. Orthostatic vital signs do not predict 30 day serious outcomes in older emergency department patients with syncope: A multicenter observational study. Am J Emerg Med. 2019 Mar 25;. doi: 10.1016/j.ajem.2019.03.036. [Epub ahead of print] PubMed PMID: 30928476. Summarized by Will Dewispelaere, MS3 | Edited by Erik Verzemnieks, MD  

Author: Sam Killian, MD Educational Pearls: A recent study in Pediatrics compared the rates of antibiotic prescriptions for acute respiratory infections (ARIs) between direct to consumer (DTC) telemedicine, urgent care, and primary care providers Among the nearly 530,000 visits studied, the rate of antibiotic prescription was 52%, 42% and 31% for telemedicine, urgent care, and primary care providers, respectively Nearly 4/10 antibiotic prescriptions from telemedicine visits were not indicated based on antibiotics guideline recommendations References Ray KN, Shi Z, Gidengil CA, Poon SJ, Uscher-Pines L, Mehrotra A. Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits. Pediatrics. 2019 May;143(5). doi: 10.1542/peds.2018-2491. Epub 2019 Apr 8. PubMed PMID: 30962253. Summarized by Will Dewispelaere, MS3 | Edited by Erik Verzemnieks, MD

Steven Stovitz, MD, MS, directs the University of Minnesota's Program in Primary Care Sports Medicine and is the associate director of the University of Minnesota's Sports Medicine Fellowship. His clinical work is divided between the University of Minnesota's Sports Medicine clinic and Orthopedic clinic along with the athletics department, where he is a team physician for University's athletes. Dr. Stovitz's research involves the intersection of clinical medicine and epidemiology, as well as a variety of issues related to the study of obesity. He is a fellow of the American College of Sports Medicine and a senior associate editor with the BJSM. He has a special interest in evidence informed medicine and he challenges us with specific clinical settings where patients and doctors commonly make ‘inferior' choices. Why does this happen? A thought-provoking podcast that may be best enjoyed at home with focus rather than driving on a windy coastal road! See also: Stovitz SD, Shrier I. Sickle cell trait, exertion-related death and confounded estimates. http://bjsm.bmj.com/content/48/4/285.long Stovitz SD, Shrier I. Medical decision making and the importance of baseline risk. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809433/ Stovitz SD. Confusion surrounding false-positive rates: distinguishing the definition from the important clinical question. Curr Sports Med Rep. 2014 Mar-Apr;13(2):69-70. doi: 10.1249/JSR.0000000000000032. PubMed PMID: 24614417. Stovitz SD, Shrier I. Injury rates in team sport events: tackling challenges in assessing exposure time. http://bjsm.bmj.com/content/46/14/960.long

Kenneth R. Means, MD (Curtis National Hand Center) discusses treatment of wrist arthritis. (13 minutes) related reading recommended by the featured guest Garcia-Elias M, Lluch AL, Stanley JK. Three-ligament tenodesis for the treatment of scapholunate dissociation: indications and surgical technique. J Hand Surg Am. 2006 Jan;31(1):125-34. PubMed PMID: 16443117. Saltzman BM, Frank JM, Slikker W, Fernandez […]

David Slutsky, MD (Harbor UCLA) discusses treatment of scapholunate instability. (16 minutes) related reading recommended by the featured guest Slutsky DJ. Current innovations in wrist arthroscopy. J Hand Surg Am. 2012 Sep;37(9):1932-41. doi: 10.1016/j.jhsa.2012.06.028. Review. PubMed PMID: 22916867. Luchetti R, Atzei A, Cozzolino R, Fairplay T. Current role of open reconstruction of the scapholunate ligament. J […]

David Moss, MD (George Washington University) discusses treatment of elderly patients with distal radius fractures. (14 minutes) related reading recommended by the featured guest Shah AS, Verma MK, Jebson PJ. Use of oral vitamin C after fractures of the distal radius. J Hand Surg Am. 2009 Nov;34(9):1736-8. doi: 10.1016/j.jhsa.2009.08.013. PubMed PMID: 19896015. Gehrmann SV, Windolf J, […]

Prosper Benhaim, MD, FACS (UCLA) discusses his experience with various treatments for Dupuytren’s contracture including needle aponeurotomy and collagenase injection. (20 minutes) related reading recommended by the featured guest Pess GM, Pess RM, Pess RA. Results of needle aponeurotomy for Dupuytren contracture in over 1,000 fingers. J Hand Surg Am. 2012 Apr;37(4):651-6. PubMed PMID: 22464232. […]