Podcasts about pulmonary

Welcome to Transmission Interrupted! In this episode, host Jill Morgan sits down with the principal investigators of NETEC—Dr. Aneesh Mehta, Dr. Vikramjit Mukherjee, and Dr. John Lowe—to reflect on a decade of advancing special pathogen preparedness across the U.S. healthcare system. Together, they revisit the origins of NETEC, tracing back to the transformative events of the 2014 Ebola outbreak, and share their unique journeys as infectious disease experts, critical care clinicians, and scientists on the front lines. The conversation dives into the challenges and lessons learned while building a national network equipped for high-consequence infectious diseases, the evolution from isolated specialty units to a system-wide approach, and the critical importance of healthcare worker safety. You'll hear insights on what it takes to maintain readiness in a landscape of ever-changing threats, the value of interdisciplinary collaboration, and a call to expand this “tight-knit club” of preparedness champions. Whether you're a healthcare professional, public health advocate, or just curious about how the U.S. prepares for medical crises, this episode delivers an inspiring look at the past, present, and future of special pathogen response—and why it matters to us all. Guests John-Martin Lowe, PhD John-Martin Lowe, PhD, is the director of the Global Center for Health Security, assistant vice chancellor for health security training and education, and professor of Environmental, Agricultural and Occupational Health at the University of Nebraska Medical Center. At the University of Nebraska Medical Center, he leads research and training initiatives to advance environmental risk assessment and infection control for high consequence pathogens. As a virologist and environmental exposure scientist, Dr. Lowe has worked extensively throughout the U.S., Africa, Asia and Europe as an educator, researcher, and in health emergency risk management related to infectious disease, infection control and emergency response. As a professor of environmental and occupational health, his expertise focuses on infectious disease risk assessment and management of risk for clinical, community and industrial environments. Dr. Lowe also has extensive experience in emerging pathogens and health security. He is co-PI for the U.S. National Emerging Special Pathogens Training and Education Center, established an international network for emerging infectious diseases, and served lead investigator for a multi-country bio-surveillance network in Africa. He has experience in a broad range of health security topics from surveillance, public health response and clinical response to health emergencies. Dr. Lowe led successful COVID-19 efforts in 2020 at the National Quarantine Unit and Nebraska Biocontainment Unit to provide monitoring and care for repatriated U.S. citizens exposed to and infected with SARS Coronavirus 2. He also led early and continued efforts to characterize the transmission dynamics of SARS Coronavirus 2 which were presented to in a joint meeting hosted by the Academy of Medicine and American Public Health Association on April 15, 2020. Dr. Aneesh Mehta, MD, FIDSA, FAST Aneesh Mehta is a Professor of Medicine and of Surgery at Emory University School of Medicine, and also serves as the Chief of Infectious Diseases Services and Assistant Director of Transplant Infectious Diseases at Emory University Hospital. He is a board-certified infectious diseases physician, who received an MD from the University of Oklahoma and completed Internal Medicine and Infectious Diseases training at Emory University. Aneesh has been one of the core physicians of the Emory Serious Communicable Diseases Unit (SCDU) since 2009. He was admitted physician for Emory's first patient with Ebola Virus Disease and was highly involved in care of the four patients with EVD, one patient with Lassa Fever, and several PUIs cared for by the Emory SCDU. During the Ebola activation, Aneesh was involved in all aspects of unit management, patient care, laboratory handling, and research. Aneesh is a co-Principal Investigator at NETEC. He also has been involved in development of the Special Pathogens Research Network Biorepository and evaluation of Medical Countermeasures. Vikramjit Mukherjee, MD, FRCP (Edin) Vikramjit Mukherjee is an intensive care physician who serves as the Chief of Critical Care at NYC Health+Hospitals/Bellevue. He also is the Chief of Bellevue's Special Pathogens Program. Dr. Mukherjee is an Associate Professor of Medicine in the Division of Pulmonary, Critical Care and Sleep Medicine at the NYU Grossman School of Medicine. Dr. Mukherjee serves as co-Principal Investigator for NETEC, as a steering committee member for the National Special Pathogens System of Care, and as an executive member of the Task Force for Mass Critical Care. His research interests include special pathogen preparedness and mass critical care. Vikramjit Mukherjee completed his medical training at Armed Forces Medical College, India, before arriving in the United States. Here, he completed his residency and chief residency at Georgetown University/Washington Hospital Center and fellowship and chief fellowship in Pulmonary and Critical Care Medicine at New York University Medical Center. Following completion of training in 2015, he joined faculty in the Division of Pulmonary, Critical Care and Sleep Medicine at New York University Grossman School of Medicine. Host Jill Morgan, RN Emory Healthcare, Atlanta, GA Jill Morgan is a registered nurse and a subject matter expert in personal protective equipment (PPE) for NETEC. For 35 years, Jill has been an emergency department and critical care nurse, and now splits her time between education for NETEC and clinical research, most of it centering around infection prevention and personal protective equipment. She is a member of the Association for Professionals in Infection Control and Epidemiology (APIC), ASTM International, and the Association for the Advancement of Medical Instrumentation (AAMI). Resources About NETECNETEC LeadershipTransmission Interrupted PodcastNational Special Pathogen System (NSPS)NETEC Resource Library About NETEC A Partnership for Preparedness The National Emerging Special Pathogens Training and Education Center's mission is to set the gold standard for special pathogen preparedness and response across health systems in the U.S. with the goals of driving best practices, closing knowledge gaps, and developing innovative resources. Our vision is a sustainable infrastructure and culture of readiness for managing suspected and confirmed special pathogen incidents across the United States public health and health care delivery systems. For more information visit NETEC on the web at www.netec.org. NETEC Consultation Services Assess and Advance Your Readiness for Special Pathogens with Free, Expert Consulting. NETEC offers free virtual and onsite readiness consulting to help health care facilities and EMS agencies prepare for special pathogen events. Our targeted support services are delivered by experts selected and assigned to each inquiry based on the unique needs of your organization. Have a question? Ask a NETEC expert. For more information visit: netec.org/consulting-services.

This week I'm reading from Shannon Cain's book 'Journey of an Eternal Soul: My Journey Through Past Lives to Spiritual Awakening'  Transcend to a higher plane through this gripping memoir of spiritual discovery. Join me as I recount my profound past life regression journey that forever changed my perspective. Through enthralling sessions with the gifted La Donna Permenter, I accessed secrets from distant times and planets. I lived as a fierce warrior, devoted husband, accused witch, and extraterrestrial from an advanced civilization, recalling intricate details about these vivid past lives. My soul traveled through mystical realms where I encountered spirit guides and my council on the other side. They shed light on karmic patterns and offered guidance to align me with my true path. This experience awakened dormant gifts and abilities within me. The revelations from my soul's journey have already created a monumental spiritual awakening, improving all aspects of my life. But this is only the beginning. The adventure continues as I seek answers to humanity's biggest mysteries. What wisdom lies in the Akashic records? Where do our loved ones go when they pass? What is the meaning of life? Unlock these secrets and more as you join me on this captivating voyage of self-discovery! Bio My name is Shannon Cain, and I'm proof that the universe has a sense of humor. Born into the rolling hills of Kentucky where survival often mattered more than spirituality, I spent decades believing I was broken, weird, and fundamentally flawed. What I didn't understand was that the very experiences that felt like curses were actually preparing me for the greatest adventure of my life. I'm not a professional writer—I barely made it through high school and have always struggled with traditional learning. I'm not a certified therapist or ordained minister. I don't have letters after my name or degrees on my wall. What I do have is a direct line to experiences that transformed not just my understanding of life and death, but my entire relationship with reality itself. After twenty years of marriage to my soulmate and six children who continue to teach me what unconditional love looks like, I thought I had life figured out. I was successful in business, comfortable in my routines, and thoroughly convinced that the strange experiences of my childhood were just imagination running wild. Then the universe decided it was time for me to remember who I really was. This book chronicles that remembering—the past-life regressions that showed me I had lived before and would live again, the communications with deceased relatives that proved love transcends death, the journeys to other dimensions that revealed the magnificent architecture of consciousness itself. I'm sharing this story not because I want attention or credibility, but because I was given a mission: help others understand that the strange experiences they're having aren't signs of mental illness but evidence of awakening. The vivid dreams, the sense of knowing things you've never learned, the feeling that this world isn't quite real—trust those experiences. They're pointing you toward the truth of who you really are. We live in an incredible time when more humans are remembering their spiritual nature than ever before in recorded history. If this book finds its way to you, it's probably no accident. Something in your soul recognizes these truths, even if your logical mind wants to dismiss them. Listen to that recognition. Follow it. Because on the other side of that leap of faith lies a reality more beautiful and interconnected than you ever dared imagine. The whispers are calling you home. All you have to do is listen. Shannon Cain currently lives in Jacksonville, Florida, with his wife and children, where he continues to explore the endless frontier of consciousness while somehow managing to pay the bills and remember to take out the trash. https://www.amazon.com/dp/B0FQJZN5XP   La Donna Permenter I have been driven my entire life with the desire to help people, by working in the medical field I have been able to fulfill that dream. I have spent 35 years in the medical field starting in the EMS services, then 25 (+) years in Pulmonary and Infectious Disease working with a wonderful group of doctors at the forefront of HIV-AIDS in the late 80's.  I also spent several years as a clinical manager for a large pain management practice. In 2009, I started my own company in the outpatient mental health field.  I built the practice into a group of 12 Psychotherapists,  including Licensed Mental Health Counselors, Licensed Clinical Social Workers and Psychologists. I enjoyed my many years in medicine, and I see now how all of this was also a part of my journey, by experiencing the interactions with all of the beautiful people that were my patients over the years. It was during this time that I realized there had to be another way to expand on the care to assist people further and in a much deeper way.  In medicine we focus on healing the body, but we must not forget to integrate the healing of the body, mind and the Soul. With this desire to expanded and connect at a deeper level, I sold the mental health practice and dedicated myself full time to what I now know is my true calling in life, completely. During many years of research and studying to expand my knowledge on this level of deeper care, I discovered Dolores Cannon's QHHT -Quantum Healing Hypnosis Technique /PLR regression therapy. It was Dolores Cannon that developed the practice of QHHT; she developed this procedure over her 50 years of success, helping others awaken to their life purpose. I realized that this is my calling, and I promptly became a certified dedicated provider. I have spent hundreds of hours of study and practical hands on application throughout the studies of QHHT -Quantum Healing Hypnosis Technique. https://yoursoulrecovery.com/ https://www.pastliveshypnosis.co.uk/https://www.patreon.com/ourparanormalafterlifeMy book 'Verified Near Death Experiences' https://www.amazon.com/dp/B0DXKRGDFP Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

This week I'm talking to Shannon Cain about his book 'Journey of an Eternal Soul: My Journey Through Past Lives to Spiritual Awakening' and we are also joined by Past Life Regression practitioner La Donna Permenter. Transcend to a higher plane through this gripping memoir of spiritual discovery. Join me as I recount my profound past life regression journey that forever changed my perspective. Through enthralling sessions with the gifted La Donna Permenter, I accessed secrets from distant times and planets. I lived as a fierce warrior, devoted husband, accused witch, and extraterrestrial from an advanced civilization, recalling intricate details about these vivid past lives. My soul traveled through mystical realms where I encountered spirit guides and my council on the other side. They shed light on karmic patterns and offered guidance to align me with my true path. This experience awakened dormant gifts and abilities within me. The revelations from my soul's journey have already created a monumental spiritual awakening, improving all aspects of my life. But this is only the beginning. The adventure continues as I seek answers to humanity's biggest mysteries. What wisdom lies in the Akashic records? Where do our loved ones go when they pass? What is the meaning of life? Unlock these secrets and more as you join me on this captivating voyage of self-discovery! Bio My name is Shannon Cain, and I'm proof that the universe has a sense of humor. Born into the rolling hills of Kentucky where survival often mattered more than spirituality, I spent decades believing I was broken, weird, and fundamentally flawed. What I didn't understand was that the very experiences that felt like curses were actually preparing me for the greatest adventure of my life. I'm not a professional writer—I barely made it through high school and have always struggled with traditional learning. I'm not a certified therapist or ordained minister. I don't have letters after my name or degrees on my wall. What I do have is a direct line to experiences that transformed not just my understanding of life and death, but my entire relationship with reality itself. After twenty years of marriage to my soulmate and six children who continue to teach me what unconditional love looks like, I thought I had life figured out. I was successful in business, comfortable in my routines, and thoroughly convinced that the strange experiences of my childhood were just imagination running wild. Then the universe decided it was time for me to remember who I really was. This book chronicles that remembering—the past-life regressions that showed me I had lived before and would live again, the communications with deceased relatives that proved love transcends death, the journeys to other dimensions that revealed the magnificent architecture of consciousness itself. I'm sharing this story not because I want attention or credibility, but because I was given a mission: help others understand that the strange experiences they're having aren't signs of mental illness but evidence of awakening. The vivid dreams, the sense of knowing things you've never learned, the feeling that this world isn't quite real—trust those experiences. They're pointing you toward the truth of who you really are. We live in an incredible time when more humans are remembering their spiritual nature than ever before in recorded history. If this book finds its way to you, it's probably no accident. Something in your soul recognizes these truths, even if your logical mind wants to dismiss them. Listen to that recognition. Follow it. Because on the other side of that leap of faith lies a reality more beautiful and interconnected than you ever dared imagine. The whispers are calling you home. All you have to do is listen. Shannon Cain currently lives in Jacksonville, Florida, with his wife and children, where he continues to explore the endless frontier of consciousness while somehow managing to pay the bills and remember to take out the trash. https://www.amazon.com/dp/B0FQJZN5XP La Donna Permenter I have been driven my entire life with the desire to help people, by working in the medical field I have been able to fulfill that dream. I have spent 35 years in the medical field starting in the EMS services, then 25 (+) years in Pulmonary and Infectious Disease working with a wonderful group of doctors at the forefront of HIV-AIDS in the late 80's.  I also spent several years as a clinical manager for a large pain management practice. In 2009, I started my own company in the outpatient mental health field.  I built the practice into a group of 12 Psychotherapists,  including Licensed Mental Health Counselors, Licensed Clinical Social Workers and Psychologists. I enjoyed my many years in medicine, and I see now how all of this was also a part of my journey, by experiencing the interactions with all of the beautiful people that were my patients over the years. It was during this time that I realized there had to be another way to expand on the care to assist people further and in a much deeper way.  In medicine we focus on healing the body, but we must not forget to integrate the healing of the body, mind and the Soul. With this desire to expanded and connect at a deeper level, I sold the mental health practice and dedicated myself full time to what I now know is my true calling in life, completely. During many years of research and studying to expand my knowledge on this level of deeper care, I discovered Dolores Cannon's QHHT -Quantum Healing Hypnosis Technique /PLR regression therapy. It was Dolores Cannon that developed the practice of QHHT; she developed this procedure over her 50 years of success, helping others awaken to their life purpose. I realized that this is my calling, and I promptly became a certified dedicated provider. I have spent hundreds of hours of study and practical hands on application throughout the studies of QHHT -Quantum Healing Hypnosis Technique. https://yoursoulrecovery.com/ https://www.pastliveshypnosis.co.uk/https://www.patreon.com/ourparanormalafterlifeMy book 'Verified Near Death Experiences' https://www.amazon.com/dp/B0DXKRGDFP Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Episode 214: Valley Fever Complications. Dr. Arreaza:
Welcome back to the podcast. I'm Dr. Arreaza, and today we're talking about a topic that's very relevant here in the Central Valley but often not well known in the rest of the country, it is called ValleyFever, or coccidioidomycosis. For more info about the Valley Fever diagnosis and initial treatment, please go to our previous podcast on the subject! Episode 143, recorded by wonderful Dr. Lovedip Kooner.  To help us walk through this, I'm joined by Jordan, a medical student. Jordan, welcome back and Dr. Schlaerth, please introduce yourself.  Jordan:
Thanks, Dr. Arreaza. This is such an important topic, especially in endemic areas like where we live, the Central Valley of California, and Arizona. The public may think of Valley Fever as a mild pneumonia that just goes away eventually. But that's not always the case. Some patients develop serious, life-altering complications, and a small but important number develop disseminated disease. Dr. Arreaza:
Exactly. So today, we're going to break this down systematically: pulmonary complications, dissemination to other organs, CNS disease, musculoskeletal involvement, systemic symptoms, and then we'll touch on treatment principles and why follow-up matters so much. Dr. Schlaerth: Valley Fever can be missed in areas where it is not as common as in the Valley. 1989, earthquake in LA.Pneumonias that is not responding to treatment can be pulmonary cocci. Dr. Arreaza:
Before we dive into specific complications, let's zoom out. What percentage of patients get a complicated disease? Jordan:
So, most infections are self-limited, but about 5–10% of patients develop chronic or progressive pulmonary disease, and 1% develop extrapulmonary disseminated disease. That sounds small, but given how common Valley Fever is in endemic areas, that's still a lot of people. Dr. Arreaza:
And the complications can be devastating, and they are not always in primary infection. Dr. Schlaerth: Dissemination can be silent. We don't know exactly why dissemination happens; some ethnicities are more susceptible or other groups. Dr. Arreaza:
Let's start where Valley Fever usually begins: the lungs. What are the major pulmonary complications clinicians should know about? Jordan:
The most common long-term complications are chronic pulmonary sequelae. These include: cavitary disease, pulmonary nodules, bronchiectasis, pulmonary fibrosis, and pleural complications like effusions, empyema, or pneumothorax. Dr. Arreaza:
Cavitary disease comes up a lot. What does that look like clinically? Jordan:
Cavities form in about 5–15% of cases. Many are asymptomatic, but symptomatic cavities can cause fever, fatigue, cough, sputum production, dyspnea, and hemoptysis. The tricky part is that symptoms often wax and wane, and even with treatment, current antifungals don't eradicate the organism from chronic cavities. Dr. Arreaza:
That's very unfortunate, and sometimes those cavities remain and patients might not know that they have them, and those cavitary lesions may rupture. Jordan:
Yes, rupture can lead to pyopneumothorax, which is a surgical emergency requiring prompt intervention. Dr. Kooner: Hello everyone, this is Dr. Kooner, and today I want to talk about one of my favorite topics: coccidioidal cavitary disease—because nothing says “fun lung pathology” like a hole in the lung that refuses to leave. Coccidioidal cavitary disease is a chronic pulmonary manifestation of infection. Many times, it's found incidentally on imaging. Sometimes patients are being evaluated for respiratory symptoms, sometimes for systemic complaints, and sometimes for something completely unrelated—like when a chest X-ray was ordered for a pre-op clearance and suddenly… surprise cavity. Pulmonary cavities develop in about 5-10% of patients with Valley Fever. Most of the time, they appear as thin-walled residual lesions. They can be solitary or multiple, and they can range from a few centimeters to much larger. And while textbooks love to show the “classic look,” in real life they can be a little more… creative. These cavities can persist for years. Some patients feel completely fine and never know they have one. Others develop chronic symptoms or complications like rupture into the pleural space, secondary infection, or bleeding, which is when everyone suddenly becomes very interested in that cavity. Here's an important teaching point: about 20% of patients with cavitary disease also have disseminated infection, most commonly involving bone. This challenges the old-school teaching that cavitary lung disease and dissemination rarely happen together.  One major risk factor for cavitary disease—and for more severe or complicated infection overall—is diabetes mellitus. So how do patients usually present? Symptoms often overlap with classic Valley Fever symptoms. The most common presenting symptoms for cavitary disease that usually trigger evaluation are cough, hemoptysis, fever, and shortness of breath. Diagnosis and monitoring rely heavily on chest imaging. Plain chest X-rays are usually enough for stable disease. CT scans are typically saved for when you're worried about complications. Serologic testing is also key, especially complement fixation titers. In general, higher titers correlate with more severe disease and higher relapse risk. Management depends on symptoms and host factors.If the patient is asymptomatic and immunocompetent, they often don't need antifungal therapy. These patients can usually be followed with periodic clinical and imaging monitoring watch closely and don't panic. Symptomatic patients are typically treated with oral triazoles, most commonly fluconazole or itraconazole. Treatment is long—usually at least 6 to 12 months, and often longer—because symptoms love to come back once therapy stops. These medications are usually suppressive rather than curative, although newer data suggests triazoles may help with cavity closure in some patients. Relapses happen in about 25 to 33% of immunocompetent patients, and even more often in immunocompromised patients or transplant recipients. Many of these patients end up needing long-term or even indefinite therapy. Not ideal—but still better than uncontrolled disease. Surgery still has a role, but it's more selective now. It's usually reserved for complications like life-threatening hemoptysis or rupture into the pleural space. Early ruptures might be managed with chest tube drainage. More complicated or delayed cases may need decortication or lung resection. So, the big picture: symptomatic coccidioidal cavitary disease can be a chronic management challenge. It requires individualized treatment decisions, prolonged therapy for many patients, and long-term follow-up with imaging and serologic monitoring to catch relapses early and prevent complications. And if there's one takeaway, it's this: if you find a stable cavity in someone known to have Valley Fever, sometimes the best move is careful monitoring—not chasing it with endless tests that make everyone nervous, including the patient. Thanks for listening—and remember, sometimes the lung keeps souvenirs from infections… and sometimes those souvenirs stick around for years. Now, let's continue with the discussion about pulmonary nodules. This is Dr. Kooner, signing off.    

Interview with Michael Costa, MD, and Manu Paul, MD

A Podcast from Obstetrics & Gynecology highlighting the latest research and practice updates in the field. This episode features an interview with Dr. Cynthia Gyamfi-Bannerman, author of "Childhood Pulmonary Outcomes After Late Preterm Antenatal Corticosteroids."

When Insurance Gets Between Doctors and PatientsDr. Elizabeth Ames and Dr. Caleb Bupp are deeply committed to their patients. But like so many clinicians today, they're spending an extraordinary amount of time battling insurance companies instead of practicing medicine.Between prior authorizations, step therapy requirements, and outright coverage denials, physicians and their teams are buried in paperwork, often at the direct expense of patient care. Time that should be spent listening, diagnosing, and treating is instead consumed by forms, phone calls, and appeals.Boston Globe reporter Jonathan Saltzman raised the concern and Dr. Ames brought it to my attention. The reporter talks about, a new program rolled out by Blue Cross Blue Shield of Massachusetts. The insurer says the initiative is designed to control rising healthcare costs for its 3 million members, noting that costs have increased by 30 percent since 2021. But, the program specifically targets physicians who bill for the most expensive visits. The reason for the increased expense, which is discussed in our podcast, is because doctors are choosing to spend more time with rare disease patients who have complicated health issues. They need to spend more time with complex medical needs patients than say, someone with a sore throat.Drs. Ames and Bupp warn that this approach fundamentally misunderstands patient care, particularly for those with complex or rare conditions. “These patients don't need less time; they need more” says Dr. Ames. Physicians argue that policies like this risk rushed appointments, strained doctor/patient relationships, and poorer outcomes. Nowhere is this more concerning than in the rare disease community, where delays and denials can be devastating.Dr. Elizabeth Ames and Dr. Caleb Bupp talk about what this looks like in real life. As pediatric geneticists, they see firsthand how insurance barriers impact families already navigating diagnostic odysseys, uncertainty, and fear. Their work sits at the intersection of cutting-edge science and deeply human stories, and insurance interference often disrupts both. Dr. Ames, “Usually we get faxes saying, this has been denied and we start working on it. But the family gets a letter that the drug they need, the process is delayed by a “no”. We try and have good communication and say, “hey, we got this denial,” we're working on it. But I think it's deaths by a thousand cuts for the family. Families take the denial as, “I'm not worth of coverage, and that's really hard”. Dr. Bupp says they have had to hire genetic counselors, a job that didn't exist even 5 years ago, “We have a job description in our organization for it now because of the complexities that come with trying to unravel these insurance situations”.We should also note that Dr. Ames, Dr. Bupp, and I all serve on the Rare Disease Advisory Council (RDAC) in Michigan. “I think rare disease advocacy, there is power in numbers. One person can be a huge difference maker, but it's not one plus one equals two. It really exponentially grows, and I think with things like rare disease advisory councils, that gives you a better connection within your state, for state government and for advocacy. And I also think, or I hope, that it gives a place for an individual to plug in and that can then magnify and amplify. their voice so that they're not alone”. Many states have RDAC's, You can see if your state has an RDAC. For more on the Michigan RDACIn this article and in the podcast we are not speaking on behalf of the council, but it's important to understand why bodies like RDAC exist in the first place. Michigan is home to approximately one million people living with rare diseases, and the RDAC was created to ensure their voices, and experiences help shape policy. RDAC meetings are open to the public, and anyone in Michigan can participate and offer public comment. We hope you join our meetings via zoom (sometimes hybrid).This conversation isn't just about insurance policies. It's about time, trust, and whether our healthcare system truly serves patients, especially those with the most complex needs. Speak up, share your story. Advocate. Make a difference, Mold the future, for future generations.To look at the Everylife Diagnosis Odyssey https://everylifefoundation.org/delayed-diagnosis-study/ discussed in the podcast.  Everylife impact of diagnosis: https://everylifefoundation.org/burden-study/ Please like, subscribe, and comment on our podcasts!Please consider making a donation: https://thebonnellfoundation.org/donate/The Bonnell Foundation website:https://thebonnellfoundation.orgEmail us at: thebonnellfoundation@gmail.com Watch our podcasts on YouTube: https://www.youtube.com/@laurabonnell1136/featuredThanks to our sponsors:Vertex: https://www.vrtx.comViatris: https://www.viatris.com/enRead us on Substack: https://substack.com/@lstb?utm_campaign=profile&utm_medium=profile-pageWatch our trailer of Embracing Egypt: https://youtu.be/RYjlB25Cr9Y

Guest: Ravi Kalhan, MD Guest: MeiLan K. Han, MD, MS For patients with chronic obstructive pulmonary disease (COPD), exacerbations are early indicators of disease progression—not just isolated events. In this expert-led discussion, Drs. Ravi Kalhan and Meilan Han break down the latest GOLD updates, explain how to use eosinophil counts to guide treatment, and discuss when to consider adding biologic therapy. Dr. Kalhan is the Louis A. Simpson Professor of Pulmonary Medicine and Director of the Asthma and COPD Program at Northwestern Medicine in Chicago. Dr. Han is a Professor of Medicine and Chief of the Division of Pulmonary and Critical Care at the University of Michigan Health in Ann Arbor. This episode of Deep Breaths: Updates from CHEST was supported by a non-promotional, non-CME educational program brought to you by CHEST in collaboration with and sponsored by GSK.

Editor's Choice: Interstitial lung disease in targeted therapies: A Society of Gynecologic Oncology clinical practice statement

In this episode of The Wellness Reset, we're joined by Dr. Nimish Shah, a practicing Consultant at the Department of Pulmonary & Sleep Medicine at Sir H. N. Reliance Foundation Hospital, with over 16 years of clinical experience.Join us as we uncover:Why Sleep & Breathing Are Non-Negotiables for Long-Term HealthSleep Apnea: Symptoms, self-checks & when testing becomes essentialSleep Quality Over Quantity: Why REM & deep sleep matter more than hours sleptMelatonin Explained: When it helps, when it harms & why dosage mattersAir Pollution & Lung Health: Why exposure needs immediate attentionWomen & Children at Risk: Non-smoker lung disease, outdoor play & the hidden dangers of vapingAnd much more…

Early detection and advanced surgical care are changing the outlook for lung cancer. Discover how robotic technology is helping doctors treat lung cancer earlier, safer and with a faster recovery. Featuring thoracic surgeon Gavin Henry, MD, FACS.  For more information about Dr. HenryFor more information about Thoracic Surgery at the Tate Cancer CenterFor other locations in Maryland

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Association of Pulmonary Artery Compliance and Adverse Cardiac Events.

Tuberculosis (TB) explained clearly, including Mycobacterium tuberculosis features and transmission, as well as tuberculosis pathophysiology. We also look at tuberculosis symptoms (pulmonary and extrapulmonary), as well as diagnosis (including tuberculin / Mantoux) and treatment.PDFs available here: https://rhesusmedicine.com/pages/microbiology-and-infectious-diseaseConsider subscribing (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is Tuberculosis? 0:32 Tuberculosis Microbiology2:44 Tuberculosis Pathophysiology5:50 Tuberculosis Symptoms (Pulmonary Tuberculosis) 6:40 Tuberculosis Symptoms (Extrapulmonary Tuberculosis) 9:13 Tuberculosis Diagnosis11:55 Tuberculosis Treatment LINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/ReferencesMSD Manual Professional Edition (2025) Tuberculosis (TB). MSD Manual Professional Edition. Available at: https://www.msdmanuals.com/professional/infectious-diseases/mycobacteria/tuberculosis-tb#Treatment_v1010798BMJ Best Practice (2025) Pulmonary tuberculosis – Management approach. BMJ Best Practice. Available at: https://bestpractice.bmj.com/topics/en-gb/165/management-approachCenters for Disease Control and Prevention (2024) About Bovine Tuberculosis in Humans. CDC. Available at: https://www.cdc.gov/tb/about/m-bovis.htmlBMJ Best Practice (2025) Tuberculosis – Epidemiology. BMJ Best Practice. Available at: https://bestpractice.bmj.com/topics/en-gb/166/epidemiologyMSD Manual Professional Edition (2025) Extrapulmonary Tuberculosis (TB). MSD Manual Professional Edition. Available at: https://www.msdmanuals.com/professional/infectious-diseases/mycobacteria/extrapulmonary-tuberculosis-tbWikipedia (2025) Tuberculosis. Wikipedia. Available at: https://en.wikipedia.org/wiki/TuberculosisRadiopaedia (2025) Ghon lesion | Radiology Reference Article. Radiopaedia.org. Available at: https://radiopaedia.org/articles/ghon-lesion?lang=gbPlease remember this podcast and all content from Rhesus Medicine is meant for educational purposes only and should not be used as a guide to diagnose or to treat. Please consult a healthcare professional for medical advice. 

Dr. Stephanie Maximous and Dr. Megan Conroy chat about her article, "Entrustment Decision Making in the Intensive Care Unit: It's About More Than the Learner."

We discuss the diagnosis and management of SCAPE in the ED. Hosts: Naz Sarpoulaki, MD, MPH Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/SCAPEv2.mp3 Download Leave a Comment Tags: Acute Pulmonary Edema, Critical Care Show Notes Core EM Modular CME Course Maximize your commute with the new Core EM Modular CME Course, featuring the most essential content distilled from our top-rated podcast episodes. This course offers 12 audio-based modules packed with pearls! Information and link below.  Course Highlights: Credit: 12.5 AMA PRA Category 1 Credits™ Curriculum: Comprehensive coverage of Core Emergency Medicine,  with 12 modules spanning from Critical Care to Pediatrics. Cost: Free for NYU Learners $250 for Non-NYU Learners Click Here to Register and Begin Module 1 The Clinical Case Presentation: 60-year-old male with a history of HTN and asthma. EMS Findings: Severe respiratory distress, SpO₂ in the 60s on NRB, HR 120, BP 230/180. Exam: Diaphoretic, diffuse crackles, warm extremities, pitting edema, and significant fatigue/work of breathing. Pre-hospital meds: NRB, Duonebs, Dexamethasone, and IM Epinephrine (under the assumption of severe asthma/anaphylaxis). Differential Diagnosis for the Hypoxic/Tachypneic Patient Pulmonary: Asthma/COPD, Pneumonia, ARDS, PE, Pneumothorax, Pulmonary Edema, ILD, Anaphylaxis. Cardiac: CHF, ACS, Tamponade. Systemic: Anemia, Acidosis. Neuro: Neuromuscular weakness. What is SCAPE? Sympathetic Crashing Acute Pulmonary Edema (SCAPE) is characterized by a sudden, massive sympathetic surge leading to intense vasoconstriction and a precipitous rise in afterload. Pathophysiology: Unlike HFrEF, these patients are often euvolemic or even hypovolemic. The primary issue is fluid maldistribution (fluid shifting from the vasculature into the lungs) due to extreme afterload. Bedside Diagnosis: POCUS vs. CXR POCUS is the gold standard for rapid bedside diagnosis. Lung Ultrasound: Look for diffuse B-lines (≥3 in ≥2 bilateral zones). Cardiac: Assess LV function and check for pericardial effusion. Why not CXR? A meta-analysis shows LUS has a sensitivity of ~88% and specificity of ~90%, whereas CXR sensitivity is only ~73%. Importantly, up to 20% of patients with decompensated HF will have a normal CXR. Management Strategy 1. NIPPV (CPAP or BiPAP) Start NIPPV immediately to reduce preload/afterload and recruit alveoli. Settings: CPAP 5–8 cm H₂O or BiPAP 10/5 cm H₂O. Escalate EPAP quickly but keep pressures to avoid gastric insufflation. Evidence: NIPPV reduces mortality (NNT 17) and intubation rates (NNT 13). 2. High-Dose Nitroglycerin The goal is to drop SBP to < 140–160 mmHg within minutes. No IV Access: 3–5 SL tabs (0.4 mg each) simultaneously. IV Bolus: 500–1000 mcg over 2 minutes. IV Infusion: Start at 100–200 mcg/min; titrate up rapidly (doses > 800 mcg/min may be required). Safety: ACEP policy supports high-dose NTG as both safe and effective for hypertensive HF. Use a dedicated line/short tubing to prevent adsorption issues. 3. Refractory Hypertension If SBP remains > 160 mmHg despite NIPPV and aggressive NTG, add a second vasodilator: Clevidipine: Ultra-short-acting calcium channel blocker (titratable and rapid). Nicardipine: Effective alternative for rapid BP control. Enalaprilat: Consider if the above are unavailable. Troubleshooting & Pitfalls The “Mask Intolerant” Patient Hypoxia is the primary driver of agitation. NIPPV is the best sedative. * Pharmacology: If needed, use small doses of benzodiazepines (Midazolam 0.5–1 mg IV). AVOID Morphine: Data suggests higher rates of adverse events, invasive ventilation, and mortality. A 2022 RCT was halted early due to harm in the morphine arm (43% adverse events vs. 18% with midazolam). The Role of Diuretics In SCAPE, diuretics are not first-line. The problem is redistribution, not volume excess. Diuretics will not help in the first 15–30 minutes and may worsen kidney function in a (relatively) hypovolemic patient. Delay Diuretics until the patient is stabilized and clear systemic volume overload (edema, weight gain) is confirmed. Disposition Admission: Typically requires CCU/ICU for ongoing NIPPV and titration of vasoactive infusions. Weaning: As BP normalizes and work of breathing improves, infusions and NIPPV can be gradually tapered. Take-Home Points Recognize SCAPE: Hyperacute dyspnea + severe HTN. Trust your POCUS (B-lines) over a “clear” CXR. NIPPV Immediately: Don’t wait. It saves lives and prevents tubes. High-Dose NTG: Use boluses to “catch up” to the sympathetic surge. Don’t fear the dose. Avoid Morphine: Use small doses of benzos if the patient is struggling with the mask. Lasix Later: Prioritize afterload reduction over diuresis in the hyperacute phase. Read More

In this season 8 premiere of Talking Sleep, host Dr. Seema Khosla welcomes three members of the AASM guideline committee—Dr. Rami Khayat, Professor and Division Chief of Pulmonary, Allergy & Critical Care Medicine and Director of Penn State Health Sleep Services; Dr. Shirine Allam, Professor of Medicine at Emory University and Program Director for the Pulmonary and Critical Care Fellowship at the Atlanta VA Medical Center; and Dr. Christine Won, Medical Director of Yale Centers for Sleep Medicine and Professor of Medicine at Yale University—to discuss the newly released AASM clinical practice guidelines for central sleep apnea treatment. The conversation begins with the rigorous process behind guideline development, clarifying the distinction between evidence-based recommendations and expert opinion. The panel systematically walks through each recommendation, addressing CPAP use across various CSA etiologies including primary CSA, heart failure-related CSA, medication-induced CSA, treatment-emergent CSA, and CSA due to medical conditions. A surprising recommendation against BPAP without backup rate generates discussion about why backup rates matter and why heart failure patients are excluded from certain BPAP recommendations. The experts tackle the controversial topic of adaptive servo-ventilation (ASV), explaining why it's now conditionally recommended even for heart failure patients despite SERVE-HF trial concerns. They clarify that newer ASV algorithms differ from devices used in that study and emphasize the importance of patient-provider shared decision-making and treatment at experienced centers. Practical implementation guidance covers oxygen therapy for heart failure and high-altitude CSA, including insurance coverage challenges. The panel discusses acetazolamide use across multiple CSA etiologies, providing concrete advice on prescribing and follow-up protocols. Transvenous phrenic nerve stimulation receives attention as an option for select patients, with candid discussion about its invasive nature, accessibility limitations, and high costs. The episode addresses the shift toward viewing CSA treatment as chronic disease management, including billing code G211 implications. The experts emphasize that guidelines guide but don't constrain clinical judgment, stressing the importance of monitoring beyond AHI—including patient symptoms and quality of life improvements. Whether you're treating complex central sleep apnea, navigating insurance coverage, or seeking clarity on when ASV is appropriate, this review provides essential guidance for implementing evidence-based CSA treatment. Join us for this season premiere that translates complex guidelines into practical clinical applications.

A black leather jacket, black hoop earrings, black T-shirt and pants. You may visualize a rock star, and Colin Hemez is a rock star of sorts, but he actually works in a white coat, a doctors coat. Yes, he's a scientist.Dr. Hemez brings a remarkable blend of science, creativity, and purpose to the fight against cystic fibrosis. Colin was born in France and raised in the high-desert town of Los Alamos, New Mexico, an environment steeped in scientific discovery. Summers interning at Los Alamos National Laboratory sparked his early fascination with how innovation can change lives.At Yale, he explored the intersection of engineering and art, studying biomedical engineering alongside art history to understand both the precision of science and the elegance of design. But it was a research trip to the Arctic University of Norway that set his path in motion. While building mathematical models of antibiotic resistance, a challenge many people with cystic fibrosis face, Colin discovered his true calling.Today, he's a PhD student in Dr. David R. Liu's renowned laboratory at Harvard, working at the cutting edge of gene editing for cystic fibrosis. Every day, Colin is pushing boundaries, imagining a future where science doesn't just treat CF but has the power to rewrite its story.We had to so much fun talking in this podcast. Born in France we talk about Colin's wonderful siblings and parents. They're all incredibly smart and making a huge difference in our world.Outside the lab, Colin reflected on the grounding role of art, music, and outdoor exploration, coping mechanisms that keep him connected to the world he's trying to impact. Looking ahead, he's both hopeful and driven: gene editing for cystic fibrosis is no longer a distant dream but a rapidly approaching reality with global implications. His aspirations are bold, but so is the science.In his view, the future of CF research depends on collaboration, imagination, and staying rooted in why the work matters: to bring healthier, longer lives within reach for every person living with this disease. We sure love his passion for science. You won't want to miss this Amazing Podcast. To watch Colin's PhD  https://drive.google.com/file/d/1HizIGiqGdKDgIifT7HF9t0UDVgv0tOKE/view Please like, subscribe, and comment on our podcasts!Please consider making a donation: https://thebonnellfoundation.org/donate/The Bonnell Foundation website:https://thebonnellfoundation.orgEmail us at: thebonnellfoundation@gmail.com Watch our podcasts on YouTube: https://www.youtube.com/@laurabonnell1136/featuredThanks to our sponsors:Vertex: https://www.vrtx.comViatris: https://www.viatris.com/en

Pulmonary embolisms don't always announce themselves... sometimes they ambush. One minute your patient is walking with physical therapy, the next they're hypotensive, hypoxic, and coding. This re-released early episode dives deep into why PE patients can look deceptively stable… right up until they aren't.In this episode, I revisit one of my earliest case-based teachings on pulmonary embolism, updated with an added segment on vasopressin use in obstructive shock from PE. Through real bedside stories from my time as a rapid response and ER nurse, we break down the physiology behind PE-related collapse, why intubation isn't always the answer, and how to think through management when the right ventricle is failing in front of you. This is a sobering but essential refresher on one of the most dangerous diagnoses we encounter.Topics discussed in this episode:Why pulmonary embolism is a common cause of in-hospital cardiac arrest (even if it's not common overall)Classic and subtle PE presentations and why they're often missedA real-time rapid response case: stable to crashing in minutesRisk factors for PE and the anticoagulation double-edged swordObstructive shock explained: what's actually killing the patientRight ventricular failure, septal bowing, and the spiral of deathWhy intubation can worsen outcomes in massive PEVasopressors in PE: norepinephrine, epinephrine, and vasopressinThe unique benefits of vasopressin in obstructive shockThrombolysis vs. thrombectomy: when TPA helps — and when it's deadlyBedside echo findings that point to massive PEWhy PE patients can crash during transport (and what to always bring)Nursing vigilance, rapid escalation, and activating help earlyWhen perfect care still isn't enough and the heart of nursing in end-of-life momentsMentioned in this episode:CONNECT

As 2025 comes to a close, the ATS Breathe Easy podcast is highlighting one of our most important episodes of the year on the importance of environmental justice, both for the quality of our air and for the quality of life of future generations. Erika Moseson, MD, of the Air Health Our Heath podcast hosts this week's episode with guest Daniel Croft, MD, MPH, ATSF. Dr. Croft is associate professor in the Division of Pulmonary and Critical Care Medicine and the Department of Environmental Medicine at the University of Rochester Medical Center. On this episode we share insights from the Climate Change and Respiratory Health: Opportunities to Contribute to Environmental Justice: An Official American Thoracic Society Workshop Report: https://pubmed.ncbi.nlm.nih.gov/40311081/ For additional discussion on environmental health, please also view our recent Breathe Easy episode “EPA Rollbacks Spell Grave Impacts on Public Health” for an up-to-date discussion of current national changes related to health care, environmental health and environmental justice: https://www.youtube.com/watch?v=51ZzGPj8UF4 For more on what you can do in your community, listen to the Air Health Our Health episode "Bypass Toxic Politics" with Dr Anthony Gerber of the American Thoracic Society Environmental Health Policy Committee: https://creators.spotify.com/pod/profile/airhealthourhealth/episodes/Bypass-Toxic-Politics--Dr-Gerber-on-Local-and-State-Action-for-Healthy-Air-and-Communities-e2tug4n/a-abobsm0 

Venous Thromboembolism refers to the presence of blood clots in veins, in particular deep vein thrombosis and pulmonary embolism. We cover both, including Virchow's Triad and the pathophysiology of pulmonary embolism. Also included are the signs and symptoms of pulmonary embolism and deep vein thrombosis, as well as the diagnosis and treatment of both. PDFs available here: https://rhesusmedicine.com/pages/respiratoryConsider subscribing (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Buy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is Venous Thromboembolism?0:32 Normal Cardiac and Pulmonary Circulation 0:59 Deep Vein Thrombosis Pathophysiology (& Most Common Veins)1:24 Pulmonary Embolism Pathophysiology 3:52 Venous Thromboembolism Pathophysiology (Virchow's Triad)5:32 Signs and Symptoms of Deep Vein Thrombosis5:49 Signs and Symptoms of Pulmonary Embolism6:25 Venous Thromboembolism Diagnosis8:18 Pulmonary Embolism ECG Findings8:53 Treatment of Deep Vein Thrombosis / Pulmonary EmbolismLINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/ReferencesStone, J., Hangge, P., Albadawi, H., Wallace, A., Shamoun, F., Grace Knuttien, M., Naidu, S. & Oklu, R., 2017. Deep vein thrombosis: pathogenesis, diagnosis, and medical management. Cardiovascular Diagnosis and Therapy, 7(Suppl 3), pp.S276–S284. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778510/. PubMed CentralMSD Manuals Professional, 2025. Pulmonary embolism (PE) – Pulmonary Disorders. [online] Available at: https://www.msdmanuals.com/professional/pulmonary-disorders/pulmonary-embolism/pulmonary-embolism-pe.Turetz, M., Sideris, A.T., Friedman, O.A. & Triphathi, N., 2018. Epidemiology, pathophysiology, and natural history of pulmonary embolism. Seminars in Interventional Radiology. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986574/. PubMed CentralMSD Manuals Professional, 2025. Deep Venous Thrombosis (DVT) – Cardiovascular Disorders / Peripheral Venous Disorders. [online] Available at: https://www.msdmanuals.com/professional/cardiovascular-disorders/peripheral-venous-disorders/deep-venous-thrombosis-dvt.Disclaimer: Please remember this video and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition. The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice.

A new study out of India shows a bit of crossover between sarcoidosis and lung cancer.  In this episode of the FSR Sarc Fighter podcast, I'll take a look at the study and what it reveals — including a new drug, Metformin, previously used to treat Type 2 Diabetes, that may show promise based on the study's findings.  For what it's worth, I'll also share the terrors of surgery for my ruptured Achilles.       Show Notes:  Donate to FSR: https://stopsarcoidosis.rallybound.org/gratitude-and-giving-2025 FSR Biomarker Summit: https://www.stopsarcoidosis.org/fsr-convenes-global-leaders-for-landmark-clinic-alliance-meeting-and-sarcoidosis-biomarker-summit/ Sarcoidosis News Study from India: https://sarcoidosisnews.com/news/new-genetic-clues-connect-sarcoidosis-lung-cancer-risk More from FSR: https://www.stopsarcoidosis.org/fsr-receives-confirmation-from-the-department-of-labor-ensuring-patient-access-to-fmla-for-participation-in-clinical-trials/ MORE FROM JOHN: Cycling with Sarcoidosis http://carlinthecyclist.com/category/cycling-with-sarcoidosis/ Do you like the official song for the Sarc Fighter podcast?  It's also an FSR fundraiser! If you would like to donate in honor of Mark Steier and the song, Zombie, Here is a link to his KISS account.  (Kick In to Stop Sarcoidosis)  100-percent of the money goes to the Foundation.  https://stopsarcoidosis.rallybound.org/MarkSteier The Foundation for Sarcoidosis Research https://www.stopsarcoidosis.org/ Donate to my KISS (Kick In to Stop Sarcoidosis) fund for FSR  https://stopsarcoidosis.rallybound.org/JohnCarlinVsSarcoidosis?fbclid=IwAR1g2ap1i1NCp6bQOYEFwOELdNEeclFmmLLcQQOQX_Awub1oe9bcEjK9P1E My story on Television https://www.stopsarcoidosis.org/news-anchor-sarcoidosis/ email me  carlinagency@gmail.com #sarcoidosis #sarcoidosisawareness #fmla #fmlaclarification #metformin  

JHLT: The Podcast returns with an episode discussing the paper, "High Antiphospholipid Antibody Titers and Outcomes of Pulmonary Endarterectomy: A Single-Center Retrospective Observational Cohort Study," from the December issue of JHLT.   They are joined by the first author, Camille Miard, MD, and senior author, François Stéphan, MD, PhD, both from the cardiothoracic intensive care unit at Hôpital Marie Lannelongue in Paris.   The discussion explores: Whether antiphospholipid antibody titers could predict postoperative outcomes for CTEPH patients undergoing pulmonary endarterectomy (PEA) How APS patients differed from non-APS patients in the PEA cohort The changes in clinical practice at Marie Lannelongue after the study's findings   For the latest studies from JHLT, visit www.jhltonline.org/current, or, if you're an ISHLT member, access your Journal membership at www.ishlt.org/jhlt.   Don't already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.

In this episode of ASTCT Talks, supported by an educational grant from Sanofi US, Dr. Corey Cutler, from Dana-Farber Cancer Institute, and Dr. Guang-Shing Cheng, from the University of Washington and Fred Hutchinson Cancer Center, discuss how to identify and manage non-infectious lung complications following allogeneic transplant. From differentiating infection versus inflammation to managing conditions like organizing pneumonia (OP), this conversation offers practical insights for clinicians.For a deeper dive, explore Dr. Cheng's many publications on pulmonary topics in the Journal of Transplantation and Cellular Therapy. Additionally, read the article “Late-Onset Noninfectious Pulmonary Complications after Hematopoietic Stem Cell Transplantation” by Harris et al. shared in a September 2024 GVHD Supplement collection by the journal.

Jennifer Keeley and Mary Whittenhall, experienced nurse practitioners in the field of pulmonary hypertension, discuss the management of cough in patients receiving inhaled therapies for pulmonary hypertension and interstitial lung disease. #GossamerBioPartner #sponsored This Special Edition episode is sponsored by Gossamer Bio. Jennifer Keeley, DPN: My name's Jennifer Keeley. I'm a nurse practitioner and I practice in a large academic institution in Pittsburgh, Pennsylvania, Allegheny Health Network, specifically Allegheny General Hospital. I am a nurse practitioner there and have been in the clinic over 10 years, and in the PH space as a nurse practitioner for over 15 years, as a registered nurse for almost 20 years. So, I have a lot of experience and I'm really excited to be here today to talk about inhaled therapies and cough. Mary Whittenhall, MSN: My name is Mary Whittenhall. I'm also a nurse practitioner. I am currently an advanced practice provider at Pulmonary and Sleep Associates in East Providence, Rhode Island. I've been in pulmonary hypertension for about 11 years now. In that time, I have worked in a variety of settings, both inpatient and outpatient, managing patients with pulmonary vascular disease, and have also touched upon patients with interstitial lung disease and pulmonary hypertension.  I get very excited when I hear about new opportunities for our PH patients. I think a lot about even when I started in pulmonary hypertension and the therapies that were available to our patients. Many of these therapies had been around for a little bit of time. But also something that I think is extremely exciting is that there's just been a rapid progression in development of therapies. And now, with the focus of looking at these therapies as potentially disease modifying, not necessarily slowing the progression of disease. With the advent of all of these new therapies, there become more options for our patients, as well. Often, patients can't tolerate some of the medications that we have due to side effects and despite lots of work to manage these side effects, the patients are not always successful. One of the great things being involved in an academic center is that we have the ability to help link patients to cutting edge research, particularly looking at a new drug that is an inhaled therapy that has shown significant promise in improving the lives of patients with pulmonary hypertension. As a part of the PH community, we all do quite a bit of networking with each other, as well as with our patients and other colleagues in the space. In that time, we did network regarding the study and have participated in some activities where we're looking at the data from the Phase 2 part of this trial and then also looking at some of the side effect management related to the medication, which seemingly is well tolerated. However, for some patients it may not come extremely easy. I think that's where the role of the nurse or the advanced practice provider really comes in this space is that we have a real strong dedication to helping educate patients about ways to manage these side effects. We want patients to be able to continue with therapies. We don't want them to say, "Well, this isn't working for me, it's time to move on." I think that we have a lot of strategies and a lot of experience with trying to help patients really figure out the best way to manage these things and to be confident that they can continue on with obviously the biggest benefit of improving their pulmonary vascular disease. Jennifer Keeley, DPN: We actually met at an advisory board last year. It was an advisory board consistent of registered nurses and nurse practitioners who, just like Mary and myself, have vast experience with patients and therapies, not just in the inhaled space, but more conventional pulmonary vasodilator medications that have been used in our patients for many, many years. As Mary had suggested before, when we start to think about newer agents, many, many of them are not the conventional pulmonary vasodilator medications, but disease modifying agents. Now, we've acquired an armamentarium of medications. So, inhaled delivery is just a really great option to avoid systemic side effects on top of each other. Our PH patients today, many of them are on more than three therapies, many of them are on four or even more therapies, so the delivery of the medication is just one aspect. When we talk about cough and side effects, I like to think about it and explain to my patient when we talk about side effects, particularly cough, to imagine a Venn diagram with cough being in the middle and what affects cough. You see this outward circle, how we deliver it, what kind of device we deliver it in. The drug, how small, large are the particle size? Is it easy enough to use for our patients? The formulation, is it dry powdered versus inhaled aerosolized? And then finally, just the patient themselves. What's their background? What type of PAH do they have? So, we can talk a little bit more about this, but just to get us started, this is how this developed and we had a lovely advisory board meeting with seralutinib and Gossamer Bio, and this was the outcome of it. We produced a lovely poster. This is a conversation if you will, that Mary and I are going to have based on what we talked about and the poster production, that came out of that wonderful advisory board. Mary Whittenhall, MSN: Inhaled therapies are unique in a way in that they actually have direct access to the lungs. So, when you think of an oral medication, an oral medication needs to be digested in the gut and sometimes that systemic digestion takes a while. Additionally, it's also often that we see patients that have more systemic side effects when we're using an oral formulation. Intravenous or subcutaneous formulations of these medications tend to cause pretty strong systemic side effects for patients, and there tends to be a lot of management that we need to do to help make these side effects more tolerable. For most of our patients, I say to them, "You're going to think I'm cruel because I don't really want these side effects to go away." In a way, we look at them almost as if you have a cup and your cup is full of water and after the top of the water hits the rim of the cup, then the water starts to spill over onto the sides of the cup. I think of other medications that we typically prescribe for patients in that way that when we get that spill over, so to speak, it's an indication that we've actually targeted all of those receptors that we want to help with vasodilation. Now that we're looking at other medications that don't really necessarily look at vasodilation, we're looking more at treating the blood vessels in a different way or affecting the process for which those blood vessels become diseased. I think that the side effects become different and I think they become less. In working with inhaled therapies, as you can imagine, the number one side effect that most patients will complain of is cough. Sometimes we have patients who have an underlying cough already, and that's usually not related to PAH, but in PH-ILD where we now have an FDA indication to use another inhaled therapy, we've seen in treating these patients that baseline cough is something that is extremely problematic for them before they even start therapies. So, trying to find ways to improve that baseline cough, treat any underlying symptoms, things like acid reflux as well, that may cause that, treating seasonal allergies, et cetera, and then, obviously, managing any additional overlapping side effects that may occur because of the new therapy that they're on. Jennifer Keeley, DPN: I think that's a really important part, is to talk with the patient, educate the patient on these inhaled therapies. First and foremost, that cough is almost an expected side effect. These are patients particularly with our interstitial lung disease patients that have PAH, cough is a part of their daily life. It's important to document and ascertain what these patients' baseline cough is. In many, many clinics, particularly pulmonary PAH clinics, and I'm sure much like Mary's, many of my colleagues have recommended using validated cough questionnaires so that we can get a really, really good baseline of what that patient's baseline cough is. Are you coughing at night? Do you have mucus? How long have you been coughing? Does it interfere with the quality of your life? Do you cough at night? Does it keep you up? Does it interrupt your sleep? Those kinds of things that help differentiate acute cough versus chronic cough. Many of these patients cough every day. They also have other inhaled therapies such as our ILD patients that are also on corticosteroids, many of them on inhaled corticosteroid therapy that can thin the oral pharynx, the posterior pharynx, and really affect the degree of nerve innervation in the posterior pharynx in the mouth. So, just really understanding what the patient's baseline cough is and educating them on the fact that cough is likely going to be a side effect with the use of this inhaled therapy. Certainly, as we continue to use the therapy, we would hope that the cough can be mitigated either through some lifestyle modifications, some natural remedies, and even some medical remedies such as bronchodilators. But really teaching the patient about the medication and inherently that this is likely going to induce a cough, but that we have mitigation strategies to help dissipate the cough. I always like to tell my patients also in the clinical trials, particularly the Phase 2 clinical trials that are out there that patients had a lot of cough. The patients on drug that were in most of the Phase 2 clinical trials for seralutinib and even for treprostinil inhaled, 30 to 40% of them experienced cough. But at the same token, the placebo-based patients that did not receive drug in these Phase 2 clinical trials also had a lot of cough. So, what that's telling you is yes, you're going to get probably some more cough, but it's likely not going to be that much or more far advanced than the cough that you're already experiencing. I also think it's important to tell these patients, many, many patients that experienced cough did not stop the medication. Actually, in these Phase 2 clinical trials, very few stop the medication. So, that gives you a really good big picture that we are pretty good at educating our patients how to mitigate cough, and if we aren't, then we should learn how to do so. Mary Whittenhall, MSN: I think it's important for us to set some expectations for patients when we're talking about cough. We've already discussed a bit that cough can happen for people from other things outside of their lung disease, but it's important to also look at what may be causing the cough when we are giving a patient an inhaled therapy. So, any type of inhaled therapy, whether that be a dry powder, a mist, whether that's nebulized or through in actuated inhaler, there are particles inside of that medication as it's going in and those little particles, when your lungs inhale that medication, those particles are penetrating your lungs and your lungs are not accustomed to them being there. It's almost as if your lungs are saying, "I don't recognize this. I don't know why this is here," and it may feel like it's an irritant, so you may start coughing as a result of that, but the cough is not necessarily a bad thing. Those particles are there, and the job is to essentially help deliver the medicine to penetrate that lung tissue and then for your body then to absorb the medicine. Your airways and your blood vessels inside of your lungs are extremely close to each other. So, when you inhale that medication, those little blood vessels are also right next to where those airways are, and then that is how those blood vessels then absorb that medication, because they're so close to the site at which those particles come into your lungs. Jennifer Keeley, DPN: I think this is an important concept to understand. They choose the form of delivery based on the goal of delivering the most medication efficiently to the distal bronchioles. That's where the disease is. It's in the distal arteries. So, trying to formulate how we get these very powerful, oftentimes disease modifying agents into the periphery of the lungs can be very challenging. Dry powdered inhaler is one form that the variability of delivery is not as dispersed as an aerosolized. So, it's more efficient delivery to the place where the medication needs to work the best, and that's in the distal periphery of the lungs. Unfortunately, one thing you have to deal with is that oftentimes these medications, dry powdered medications, not just in the PH space, but there's a lot of other dry powdered inhalers in the COPD space, as well. Oftentimes, what happens is these powdered particles get dispersed extra thoracically. So, they get dispersed in the oral mucosa, in the posterior pharynx, on the way down into the stomach. That's wherein we have to deal with mitigating side effects. The biggest side effect of these particles, even though they're very small, is cough. So, technique comes into play. Mitigating things to coat the posterior pharynx come into play. Re-education comes into play. Show me again how you're doing this inhalation, because I don't think that you're holding this okay. In one instance, I had a patient that was inhaling dry powdered inhaler with the medication right out of the refrigerator. So, the medication was cold. It was clumping at the back of her throat. All of these things really take into consideration how we most efficiently get the medicine to these pulmonary arterial hypertension patients where their disease is oftentimes very difficult to get to, and other forms of medications that are systemic, orals, parenterals that have first pass metabolism, and so you're going to get more side effects from those medications. So, I always teach my patients, "Hey, we're a couple steps ahead because we're bypassing the type of metabolism that you get with orals and even parenterals." Mary Whittenhall, MSN: There are so many challenges that these patients face. Oftentimes, patients have never been sick before they develop this, and now we're putting them on multiple therapies, multiple modalities, telling them that there's going to be side effects and they need to learn how to manage them. It's certainly a lot to handle. But I think one of the best things that we have in our PH community is that we really work so hard to partner with the patients and their loved ones and forming this relationship, fostering that relationship as time goes on, I believe that these patients really do trust us and that what we're telling them is things are going to be okay. We are going to be there by your side. We're not going to give you this medicine and then say, "See you in six months. Hope everything goes well." We're really going to be working with them. In some cases in my specialty clinic, we have nurses, we have a pharmacist, a pharmacy tech, and then our advanced practice providers that check in with these patients quite regularly. We are actually taking the initiative to reach out to them versus the patient who may be having trouble advocating for themselves or feeling like, "Really, I don't want to be a pain, but this is challenging for me." We are really in touch with them, and that connection also helps to keep patients on therapy. So, what are some of the specific techniques to manage or mitigate cough? This is something that was a real hot topic at our last advisory meeting. We put together a bunch of folks in the room who deal with other inhaled therapies and patients that have cough and said, "Well, what do you tell patients to do?" First and foremost is to look at any other potentially underlying conditions that may be causing cough and ensure that treatment of those underlying conditions is optimized. I think cough is actually the number one referral for any type of pulmonary practice, but it is a really, really broad differential when it comes down to it. We obviously look first at things like environmental factors. If this could be seasonal allergies, then we try treating patients with antihistamines. Perhaps some of those are intranasal, as well, that may help with some things like rhinorrhea or post nasal drip. Acid reflux is actually a huge, huge reason for cough. Many patients say, 'Well, I don't get acid reflux. I don't feel that burning in my chest after I eat," but come to find out that it can actually be a silent trigger. So, treating patients with medicines that help to reduce acid or suppress acid will oftentimes help with that cough. On top of that, when we're dealing with patients that are on inhalers and now we're adding another inhaled therapy. I find that for some patients that are on actual inhalers that sometimes they do better with nebulized treatments. The nebulized treatments are slower, and may have a bit of a better penetration into the lungs and the patients tend to like it. It is one of those things that you do need to be compliant with in order to really see the benefits to it. I will say that oftentimes, again, partnering with the patient, giving them specific instructions about how to do all of this, we can really see some improvement to those symptoms. Then, there's just basic over-the counter measures and precautions, things like making sure that when you're eating that you're not laying down at least for 60 minutes after you've been eating. If you do have acid reflux, trying to sleep with two pillows or a wedge pillow, that can help to keep the head of your bed elevated. Some of our patients have those really fancy adjustable beds that are also quite helpful for that. I think that sometimes things like basic cough drops actually can be quite wonderful and helpful. Drinking very cold or very warm water or tea, adding some honey to that if a patient isn't diabetic, things like that tend to really help with cough. We reinforce these measures when we start therapies like this. Jennifer Keeley, DPN: In terms of mitigation, I think it's really important on technique. This is why, as Mary had alluded to, it's so important to follow up closely with these patients, particularly our elderly patients who sometimes don't, if they have connective tissue disease or scleroderma, have a lot of good fine motor coordination. A couple of things that I wanted to touch on with regards to that… One, these inhalers are typically high resistance, low flow. So, these are not the type of patients that need to be taking in very forceful inhalations with these inhalers and thank goodness, because we're talking about patients that have inflammatory interstitial lung disease, as well as pulmonary vascular disease. So their degree of inspiratory effort is actually minimal to disperse that medication to the distal pulmonary bronchials. It's equivalent to them taking a deep breath in when you ask them to auscultate their lungs. So it's not a big forceful breath. The other thing is too, a lot of times, sometimes more variability in the disbursement of the drug is better in compliance with some patients. Dry-powdered inhalers, again, do not take a very big forceful effort, but some of them, because they are powder, some of the medication will actually hit the back of the throat as it goes down and can cause some irritation, whereas the nebulized form does have a variability in disbursement and can be more easily tolerated in some. The other issue is the technique itself. Oftentimes, we ask them in some of the inhaled therapies to lower the device itself so that the tongue doesn't protrude and get in the way, because if medication gets on the tongue, the next swallow that they take, that medication is going to hit their posterior pharynx, and they're going to probably cough pretty aggressively. I always start off by telling my patients, "Cough is not a bad thing. It's actually a protective reflex and it's involuntary. So, if you cough, don't actually negate it. Don't think it's a bad thing." It's actually a very protective mechanism that avoids irritation in most of our patients probably already irritated mucosa. So, that's how I like to start the conversation. There's so many good techniques that we can share with them over time, and I might add that each patient is different. Each patient needs to have a personalized plan. When we talk about giving patients warm tea, typically chamomile, chamomile tea in itself is anti-inflammatory. Then, when you add something like honey, which is also a soothing, anti-inflammatory natural remedy, you have to really think to yourself, "They're getting honey. If they're diabetic, we don't want to give them too much honey." But, you have to make sure that their swallowing technique is good. There's no aspiration there, particularly if we give them cough drops. Then, just simple things that actually numb or anesthetize the back of the throat are very, very helpful for elderly patients who do have very friable tissue and mucosa from previous therapies like inhaled corticosteroids, as I had talked about before. Dairy products, I tend to ask my patients to avoid those. They can produce a lot of mucus, which these coughs that we see in our inhaled therapy patients are typically tend to be dry coughs, but some patients that have concomitant asthma, COPD, along with their ILD that are using these inhaled therapies can actually have more of a congested mucoid cough. So, avoiding dairy before and after use is always very smart. Avoiding alcohol, avoiding acidic drinks like orange juice, also very, very helpful. Mary Whittenhall, MSN: The part about technique I think is so, so important here. Oftentimes, when patients start these therapies, when they are approved in that space, the specialty pharmacy has a nurse educator that will come out to the patient's home and provide education not only about the medication, but about the administration of that medication. In many cases, the patients will take their first dose while the nurse is present so that the nurse can then critique whether or not the patient took it appropriately and how they tolerated it. I'm going to give a shout out to our nurse educators from the specialty pharmacies, because they are also a really crucial set of eyes and ears for us out in the community. They do provide education to the patients in the home. We have had situations where the patient has done well while the nurse is there, and then two weeks later we get a call from the patient saying, "I can't do this. This isn't working for me." And I'll say, "Okay. Well, you have a couple options. We can have you come in to the clinic and I want you to bring your device with you, and I would like to watch you do a treatment, or I can have the nurse come out and see you again and go over that." And they'll say, "I already know what I'm doing. I don't need that." But in many instances, we have found that they have adjusted their technique. They might've gotten into some bad habit since the nurse has left them. So, really reinforcing that is important. The other thing that I wanted to bring up is that some of our patients with connective tissue disease also have thickness in their tongues. So, their tongues become thicker and more sclerotome as their connective tissue disease progresses. For some of those patients, it is actually hard for them to get their tongue flat enough so that they can get the medication down into their lungs. So, working with those patients to find strategies to help rectify that. I will say that it is not impossible, it just takes maybe a little extra work. Jennifer Keeley, DPN: Inhaled therapies in themselves are pretty portable. Mary had alluded to a little bit earlier, our patients with pulmonary vascular disease, PAH, that are on parenteral therapies, delivering the conventional pulmonary vasodilator therapies. As we get into the new disease modifying agents such as seralutinib, which are anti-fibrotic, anti-inflammatory, anti-prolific medications, these are portable therapies that are actually modifying the disease. So they're portable. They're easy to use. They're easy to use for our patients, again, that are elderly or are younger and are still working, they have a professional life, they don't have to wear a pump that's 24/7 oftentimes. They can use these inhaled therapies first to see if they can avoid parenteral therapy with prostacyclins. Their quality of life is improved immensely. When you can take an inhaled therapy two to four times a day and really improve quality of life, decrease cough, decrease dyspnea, or shortness of breath on exertion. Sometimes, these patients that do very, very well can actually reduce their supplemental oxygen needs. Just improving their walk distances without having to stop or have excessive dyspnea, improves their quality of life. More time spent with loved ones and more time spent in social environments rather than sitting at home. These wonderful inhaled portable therapies have significantly changed our patients' lives and improved their quality of lives. Mary Whittenhall, MSN: This community I think is phenomenal. It's made up of so many great people. There are many patients who have been a part of this space for a long time who really want to help other patients who may be newer to the journey than them. I'm a big advocate for support groups. We've had an extremely active support group in our area for a long time, and I often partner some of my patients that have been with me for quite some time with some of the new patients that may need a bit more help. I can tell them things and my colleagues can tell them things. Oftentimes, the same message doesn't resonate. It resonates differently, I think when it comes from a peer, a patient who may have experienced the same thing as them. One of the things that I really try to drive home with our patients is just that sense of empowerment. Connect with these other folks in the community. They want to help you. They remember what it feels like being newly diagnosed or starting a new therapy or transitioning from another therapy. What that change is like. One of the other things I tell my patients is that we all sit at the same table. I'm not better than you. Maybe I have this information, but this information is for you. It's for you to take and to improve your life. If that information doesn't work for you, then you come back to me with some feedback and we come up with something else that's going to be more helpful to you. I really think having an equal playing field with them and having a very open and honest dialogue is what is going to help our patients do the best. If patients don't feel comfortable reaching out to other local patients or connecting with an in-person support group, there are tons of online resources through the PHA, through phaware®, Team Phenomenal Hope, lots of great groups out there that do things virtually. I think in some ways for some patients, anonymity is important, so being able to protect that is an option for them, but to be able to still get what they need so they can become the best advocate for themselves that they can. Jennifer Keeley, DPN: I stress so importantly to my patients, we are here today in this great environment and we have the armamentarium of medications to treat because of patients just like you that have contributed to the science of the disease and implemented themselves and engaged in these clinical trials. Right now we have an ongoing clinical trial for seralutinib called PROSERA, that's enrolling as we speak. Patients are the best advocates, not only for themselves, but for other patients, and they talk. There's a lot of social media out there where patients communicate amongst themselves and they say, "Through the help of my provider and through the help of my family, I was hesitant to start this additional therapy." They do have, at this juncture, and I don't think it's such a bad thing, they do have a little bit of a pharmacy burden now. Again, these aren't our patients that are on one or two therapies. They're on four or more oftentimes. When you take in our ILD patients, they're also on disease modifying agents, as well, for their interstitial lung disease. So again, I think it's really important for patients to communicate amongst themselves and share their ups and downs in the disease, but also share the rewards that come with surviving and living with PAH. I think one thing that we really do have to understand though is like many other chronic diseases, PH is a personalized disease. You need to have a personalized approach for your patients. That's why it's so very important to do a really good history of your patients and understand not only what their baseline cough is, but who they are, what their personal history is. Are they working? Who's helping to care for them? Who's helping to make that chamomile tea with honey? Who's going to the store to get that? A personalized approach is so important for these patients, I can't stress that enough. Mary Whittenhall, MSN: Special thanks to everybody involved in this project. This was extremely exciting. To my co-podcaster, Jennifer Keeley, who is amazing, and all of us in the PH community are extremely lucky to have her. We are all aware that you are all rare, and we are grateful to be able to help you in this journey. Jennifer Keeley, DPN: Thank you so much, Mary, and what a pleasure it's been to speak with you about cough and inhaled therapies, and thank you to Gossamer Bio for this opportunity and for the opportunity that led to this podcast, which was a significant advisory board amongst specialists in our field, advanced practice providers and registered nurses who were able to convene in a great open space and talk about this. I think this moves our science forward. It helps us to talk about the disease and take better care of our patients. Again, my name is Jennifer Keeley. It's been such a pleasure to deal with my good friend Mary Whittenhall today, and we're aware that our patients are very rare. Learn more about pulmonary hypertension trials at www.phaware.global/clinicaltrials. Follow us on instagram, facebook and x.com @phaware. Engage for a cure: www.phaware.global/donate #phaware Share your story: info@phaware.com Like, Subscribe and Follow us: www.phawarepodcast.com. #phawareMD #PHILD @GossamerBio @AHNtoday

Mehlman Qbanks: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://qbanks.mehlmanmedical.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠IG: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/mehlman_medical/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Telegram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://mehlmanmedical.com/subscribe/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Dr. Nitin Seam chats with Dr. Sara Murray and Dr. Avraham Cooper about their articles, "Large Language Models and Medical Education: Preparing for a Rapid Transformation in How Trainees Will Learn to Be Doctor" and "AI and Medical Education — A 21st-Century Pandora's Box."

Send us a textToday's guest is someone who brings compassion, intellect, and a genuine love for medicine to everything he does. Dr. Mahmoud Ibraheem is a Pulmonary and Critical Care physician whose medical journey has taken him from Bahrain to New York, Florida, and Texas. Those experiences shaped who he is as a physician. Beyond medicine, Dr. Ibraheem is passionate about mental health, music, and making medicine more human. He's also a proud husband to a brilliant cardiologist and devoted dog dad to Xena and Blue. In other words, he's very well-rounded.You might know him from Instagram, where he shares insight and humor about life in medicine under the handle @icuboy_meded.As Mahmoud told his story, I was filled with wonder at his joyful personality. His journey reminds us that medicine isn't just about surviving intense situations; it's about bringing heart, humor, and humanity into every encounter.In the five-minute snippet: Mahmoud's gone to the dogs! For Mahmoud's bio, visit my website (link below).Tik TokThreadsXContact The Conversing Nurse podcastInstagram: https://www.instagram.com/theconversingnursepodcast/Website: https://theconversingnursepodcast.comYour review is so important to this Indie podcaster! You can leave one here! https://theconversingnursepodcast.com/leave-me-a-reviewWould you like to be a guest on my podcast? Pitch me! https://theconversingnursepodcast.com/intake-formCheck out my guests' book recommendations! https://bookshop.org/shop/theconversingnursepodcast I've partnered with RNegade.pro! You can earn CE's just by listening to my podcast episodes! Check out my CE library here: https://rnegade.thinkific.com/collections/conversing-nurse-podcast Thanks for listening!

Lung cancer is the most prevalent cancer in the Rochester and Finger Lakes region. That's according to experts at the University of Rochester Medical Center. They say screening has been underutilized due to the stigma of the disease. This hour, we discuss their efforts to change that. They also explain what they call a "soup to nuts" approach to addressing the disease, which includes prevention and screening, early diagnosis, and advanced treatment options. Our guests: Racquel Stephen, health, equity and community reporter and producer for WXXI News Charles Kamen, Ph.D., M.P.H., associate director of community outreach and engagement at Wilmot Cancer Institute at the University of Rochester Medical Center M. Patricia Rivera, M.D., C. Jane Davis & C. Robert Davis Distinguished Professor in Pulmonary Medicine and chief of the Pulmonary and Critical Care Medicine Division at University of Rochester Medical Center Joyce Lucas, patient ---Connections is supported by listeners like you. Head to our donation page to become a WXXI member today, support the show, and help us close the gap created by the rescission of federal funding.---Connections airs every weekday from noon-2 p.m. Join the conversation with questions or comments by phone at 1-844-295-TALK (8255) or 585-263-9994, email, Facebook or Twitter. Connections is also livestreamed on the WXXI News YouTube channel each day. You can watch live or access previous episodes here.---Do you have a story that needs to be shared? Pitch your story to Connections.

Dr. Sumedha Sonde, pulmonologist and critical care physician at Hamilton Physician Group - Specialty Care in Dalton, Georgia. Dr. Sonde completed residency training in Anesthesia and Pain Management and additional residency training in Internal Medicine. She then completed a Pulmonary and Critical Care fellowship in New York.Dr. Sonde treats patients with sleep or pulmonary disorders. chronic obstructive pulmonary disease (also referred to as COPD), asthma, pulmonary fibrosis, lung cancer, COVID conditions, pneumonia, acute and chronic pulmonary hypersensitivity conditions, pulmonary hypertension, bronchiolitis, and more. For more information or an appointment at Hamilton Physician Group - Specialty Care, call 706-529-3072 or visit VitruvianHealth.com/specialtycare. This program in no way seeks to diagnose or treat illness or to replace professional medical care. Please see your healthcare provider if you have a health problem.

Dr. Sumedha Sonde, pulmonologist and critical care physician at Hamilton Physician Group - Specialty Care in Dalton, Georgia. Dr. Sonde completed residency training in Anesthesia and Pain Management and additional residency training in Internal Medicine. She then completed a Pulmonary and Critical Care fellowship in New York.Dr. Sonde treats patients with sleep or pulmonary disorders. chronic obstructive pulmonary disease (also referred to as COPD), asthma, pulmonary fibrosis, lung cancer, COVID conditions, pneumonia, acute and chronic pulmonary hypersensitivity conditions, pulmonary hypertension, bronchiolitis, and more. For more information or an appointment at Hamilton Physician Group - Specialty Care, call 706-529-3072 or visit VitruvianHealth.com/specialtycare. This program in no way seeks to diagnose or treat illness or to replace professional medical care. Please see your healthcare provider if you have a health problem.

 Smoking is the main risk factor for COPD in the United States and many other countries. However, it is important to recall that there are other causes of COPD, from birth experiences to environmental exposures. COPD expert Meilan K. Han MD, MS, University of Michigan Health, discusses non-smoking causes of COPD, what patients can do to manage their symptoms, and how clinicians and communities can help. Air Health Our Health podcast creator Erika Moseson, MD, MA, of Legacy Health in Oregon hosts. Patient resources: - ATS COPD resources: https://site.thoracic.org/patient-resources/chronic-obstructive-pulmonary-disease-copd - GOLD COPD resources: https://goldcopd.org/patients-advocacy-groups/ - American Lung Association COPD resources: https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/resource-library  - UpToDate COPD resources: https://www.uptodate.com/contents/stable-copd-overview-of-management 

Dr. Sumedha Sonde, pulmonologist and critical care physician at Hamilton Physician Group - Specialty Care in Dalton, Georgia. Dr. Sonde completed residency training in Anesthesia and Pain Management and additional residency training in Internal Medicine. She then completed a Pulmonary and Critical Care fellowship in New York.Dr. Sonde treats patients with sleep or pulmonary disorders. chronic obstructive pulmonary disease (also referred to as COPD), asthma, pulmonary fibrosis, lung cancer, COVID conditions, pneumonia, acute and chronic pulmonary hypersensitivity conditions, pulmonary hypertension, bronchiolitis, and more. For more information or an appointment at Hamilton Physician Group - Specialty Care, call 706-529-3072 or visit VitruvianHealth.com/specialtycare. This program in no way seeks to diagnose or treat illness or to replace professional medical care. Please see your healthcare provider if you have a health problem.

What defines excellence in cystic fibrosis clinical care? Peter Mogayzel discusses the latest therapeutic guidelines, managing pulmonary exacerbations, the role of home monitoring, and how multidisciplinary teams work together to support patients in leading full, active lives. Timestamps: 00:00 – Introduction 00:41 – Key guidelines 01:54 – Multisystem disease 02:32 – Pulmonary exacerbations 04:04 – Chronic medications 05:37 – Home monitoring 08:15 – Multidisciplinary care

Exercise is key for managing symptoms for COPD patients. On World COPD Day, host Amy Attaway, MD, Cleveland Clinic, talks to Rachel Evans, MD, University of Leicester, and Russell Winwood, a patient advocate known as the "COPD Athlete", about how exercise can improve patient outcomes. They also discuss the annual Big Baton Pass, an international COPD awareness event, the importance for pulmonary rehabilitation, and the community built around COPD advocacy and support for patients. Learn more about the COPD Baton Pass: https://copdbatonpass.org/ 

Troy Kinne’s heart is in the right place. As in, it’s on the wrong side.

As new studies uncover better treatments and practices, it is important to develop new clinical practice guidelines to ensure patients receive the best care. Julio A. Ramirez, MD, Norton Healthcare and University of Louisville, and co-lead of the guideline panel, dives into the process of creating an update clinical practice guideline for community-acquired pneumonia with host Eddie Qian, MD, Vanderbilt University Medical Center, as well as the importance to the medical community and patients when making key care decisions. Check out the Community-Acquired Pneumonia Clinical Practice Guideline: https://www.atsjournals.org/doi/10.1164/rccm.202507-1692ST

Mehlman Qbanks: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://qbanks.mehlmanmedical.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠IG: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/mehlman_medical/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Telegram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://mehlmanmedical.com/subscribe/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

On this episode of JHLT: The Podcast, the Digital Media Editors host a discussion on the paper, "Impact of donor specific antibodies on longitudinal lung function and baseline lung allograft dysfunction."   They are joined by the first author, Muhtadi Alnababteh, MD, Assistant Professor at the University of Maryland and Staff Clinician at the National Institutes of Health, and senior author Michael Keller, MD, of the Pulmonary and Critical Care division at the University of Maryland.   The discussion explores: Common characteristics of patients who developed donor-specific antibodies (DSA) Differences in outcomes depending on when DSA developed Associations between the development of DSA and antibody-mediated rejection, and related time frames For the latest studies from JHLT, visit www.jhltonline.org/current, or, if you're an ISHLT member, access your Journal membership at www.ishlt.org/jhlt.   Don't already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.

Katarina Zeder, MD, PhD, joins CHEST® Journal Podcast Moderator Matt Siuba, DO, MS, to discuss her research into the ways in which longitudinal pulmonary arterial pressure trajectories inform clinical outcome in patients undergoing kidney transplantation.  DOI: 10.1016/j.chest.2025.05.024 Disclaimer: The purpose of this activity is to expand the reach of CHEST content through awareness, critique, and discussion. All articles have undergone peer review for methodologic rigor and audience relevance. Any views asserted are those of the speakers and are not endorsed by CHEST. Listeners should be aware that speakers' opinions may vary and are advised to read the full corresponding journal article(s) for complete context. This content should not be used as a basis for medical advice or treatment, nor should it substitute the judgment used by clinicians in the practice of evidence-based medicine. 

Send us a textOn this episode, we interview Dr. Wigdan Farah, a pulmonologist in Mayo Clinic's Division of Pulmonary & Critical Care Medicine to discuss several respiratory conditions seen commonly in pilots seeking medical certification -- then review aeromedical implications and requirements.

Listener discretion is advised. Thank you to Pulmonologist Nick Ghionni and host of the EmCrit Podcast, Dr. Scott Weingart for coming onto the podcast and talking about approaches to the assessment and management of the often vague and really sick patient with respiratory distress.

In this episode, Dr. Sergio Zanotti discusses the administration of vasopressor agents through peripheral intravenous lines (or what we refer to as “peripheral vasopressors”). He is joined by Dr. Elizabeth Munroe, a practicing pulmonary/critical care physician and an Assistant Professor of Pulmonary and Critical Care at Intermountain Health in Salt Lake City, Utah. Her research interests include evidence-based resuscitation practices in early sepsis and septic shock, vasopressor administration practices, peripheral vasopressor use, and clinical trials, particularly novel, pragmatic clinical trial designs. Additional resources: Peripheral Vasopressor Use in Early Sepsis-Induced Hypotension. ES Munroe, et al. JAMA Network 2025: https://pubmed.ncbi.nlm.nih.gov/40864467/ Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. Shapiro NI, et al. CLOVERS Trial. New Engl J of Med 2025: https://pubmed.ncbi.nlm.nih.gov/36688507/ Overview of Peripheral Vasopressor Use in an Academic Health System. D Shyu, et al. Ann Am Thorac Soc 2025: https://pubmed.ncbi.nlm.nih.gov/40126143/ Safety of peripheral intravenous administration of vasoactive medication. J Cardenas-Garcia, et al. J Hosp Med 2015: https://pubmed.ncbi.nlm.nih.gov/26014852/ Books mentioned in this episode: Ending Medical Reversal- Improving Outcomes, Saving Lives. By Vinayak K. Parsad, et al: https://bit.ly/4nhCNam

How I Survived Meth Addiction, Lung Failure, and Found Purpose Anthony Carrasco was a meth addict by 15, and nearly dead by 35. Diagnosed with PH after years of drug use, his story spiraled from homelessness to hospice. But a double lung transplant and a deep surrender to recovery transformed everything. This Special Edition Episode Sponsored by: Johnson & Johnson Learn more about pulmonary hypertension trials at www.phaware.global/clinicaltrials. Follow us on social @phaware Engage for a cure: www.phaware.global/donate #phaware Share your story: info@phaware.com @JNJInnovMed

Breathing is a hot topic and we wanted to start the conversation with Helen Vanderburg, a world champion synchronized swimmer, gym owner, international presenter and a woman who has possibly taught a greater variety of fitness modalities than anyone else we know. This conversation includes key ways to use breath to activate, balance, and restore the body and mind and provides practical examples for exploring and expanding the use of breath with your clients and classes.Moving Conversation Socials    Brian's Book on Low Back Pain and Conditions:  Back Exercise; Stabilize, Mobilize and Reduce Pain  https://a.co/d/8IUb7L6    Email: movingconvos@gmail.com  IG: @movingconvos  FB: Moving Conversations    Brian  IG: @fit4lifedc  FB: https://www.facebook.com/brianrichey/     Nora  IG: nora.s.john.7  FB: https://www.facebook.com/nora.s.john.7 

Treating Meth-Associated PAH Without Judgment Dr. Brandon Jakubowski takes us into the underrecognized world of stimulant-induced pulmonary arterial hypertension. From misdiagnoses to under-prescribing life-saving therapies, he lays out the systemic gaps and stigmas preventing patients from getting the care they need. This Special Edition Episode Sponsored by:  Johnson & Johnson Learn more about pulmonary hypertension trials at www.phaware.global/clinicaltrials. Follow us on social @phaware Engage for a cure: www.phaware.global/donate #phaware Share your story: info@phaware.com #phawareMD @JNJInnovMed @UTSWMedCenter

Learning how to perform procedures on patients is an important part of medical training, but how do programs decide what to teach? And how do they integrate the latest technology? Host Eddie Qian, MD, from Vanderbilt University Medical Center, talks to Meredith Pugh, MD, MSCI, and Kaele Leonard, MD, of Vanderbilt University Medical Center. Together, they discuss how they think about working with trainees and fellows when it comes to teaching important procedures. 

Fluid overload is a common problem in critically ill patients. In this episode, Dr. Sergio Zanotti discuss recognizing and managing fluid overload in the ICU with guest Dr. Michael J. Connor, Jr., a practicing intensivist and nephrologist. Dr. Connor is a Professor and Senior Physician of Critical Care Medicine & Nephrology at the Divisions of Pulmonary, Allergy, Critical Care, and Sleep Medicine and Renal Medicine at Emory University School of Medicine. Additionally, he serves as the director of critical care nephrology at the Emory Critical Care Center at Grady Memorial Hospital. Additional resources European Society of Intensive Care Medicine Clinical Practice Guideline on fluid therapy in adult critically ill patients: Part 3- fluid removal at de-escalation phase. Intensive Care Med 2025: https://pubmed.ncbi.nlm.nih.gov/40828463/ Optimizing Fluid Therapy in the Critically Ill. International Fluid Academy website – 2025: https://www.fluidacademy.org/2025/01/17/optimising-fluid-therapy-in-the-critically-ill-introduction-to-7d/ Fluid overload in the ICU: evaluation and management. R. Claure-Del Granado and R. L. Mehta. BMC Nephrology 2016: https://pubmed.ncbi.nlm.nih.gov/27484681/ Books and music mentioned in this episode: Think Again: The Power of Knowing What You Don't Know. By Adam Grant: https://bit.ly/4gZvz9c RUSHMERE. By Mumford & Sons: https://bit.ly/473FzKc

Show notes at pharmacyjoe.com/episode1066. In this episode, I'll discuss empiric posaconazole to prevent influenza-associated pulmonary aspergillosis. The post 1066: Can Empiric Posaconazole Prevent Influenza-Associated Pulmonary Aspergillosis? appeared first on Pharmacy Joe.

We review the diagnosis, risk stratification, & management of acute pulmonary embolism in the ED. Hosts: Vivian Chiu, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Acute_Pulmonary_Embolism.mp3 Download Leave a Comment Tags: Pulmonary Show Notes Core Concepts and Initial Approach Definition: Obstruction of pulmonary arteries, usually from a DVT in the proximal lower extremity veins (iliac/femoral), but may be tumor, air, or fat emboli. Incidence & Mortality: 300,000–370,000 cases/year in the USA, with 60,000–100,000 deaths annually. Mantra: “Don't anchor on the obvious. Always risk stratify and resuscitate with precision.” Risk Factors: Broad, including older age, inherited thrombophilias, malignancy, recent surgery/trauma, travel, smoking, hormonal use, and pregnancy. Clinical Presentation and Risk Stratification Presentation: Highly variable, showing up as anything from subtle shortness of breath to collapse. Acute/Subacute: Dyspnea (most common), pleuritic chest pain, cough, hemoptysis, and syncope. Patients are likely tachycardic, tachypneic, hypoxemic on room air, and may have a low-grade fever. Chronic: Can mimic acute symptoms or be totally asymptomatic. Pulmonary Infarction Signs: Pleuritic pain, hemoptysis, and an effusion. High-Risk Red Flags: Signs of hypotension (systolic blood pressure < 90 mmHg for over 15 minutes),

En este episodio del ECCpodcast, exploramos el SCAPE, o “Sympathetic Crashing Acute Pulmonary Edema”. Este síndrome representa una forma dramática de edema agudo de pulmón mediado por un colapso súbito de la función cardiopulmonar, con un componente simpático dominante que desencadena una cascada crítica de deterioro. A lo largo del episodio, desglosamos la fisiopatología, el diagnóstico diferencial, el manejo clínico y las estrategias avanzadas de intervención para SCAPE. Este artículo resume y amplía los puntos clave discutidos, con la intención de ofrecerte un recurso educativo robusto, ya seas médico, paramédico, enfermero o profesional de atención crítica. ¿Qué es SCAPE? SCAPE (Sympathetic Crashing Acute Pulmonary Edema) se refiere a una forma de edema pulmonar agudo con características distintivas: Inicio súbito: El paciente suele estar previamente normotenso o hipertenso, sin antecedentes inmediatos de insuficiencia cardiaca congestiva descompensada. Activación simpática intensa: Elevaciones abruptas en la presión arterial y frecuencia cardíaca desencadenan un círculo vicioso de congestión pulmonar y deterioro ventilatorio. Hipoxia severa y ansiedad extrema: El paciente se presenta en franca angustia respiratoria, luchando por aire y con sensación inminente de muerte. Esta condición es potencialmente reversible con un tratamiento rápido y apropiado, lo cual contrasta con otras causas de edema pulmonar en pacientes con falla sistólica crónica. Fisiopatología de SCAPE: Una tormenta simpática SCAPE no es simplemente edema pulmonar. Es el resultado de una descarga adrenérgica descontrolada, en muchos casos precipitada por un evento hipertensivo agudo o crisis de ansiedad. Hipertensión severa repentina → aumento de la poscarga → disfunción ventricular izquierda transitoria. Esto causa congestión pulmonar aguda, en minutos, con extravasación de líquido en los alvéolos. El resultado: edema pulmonar con dificultad respiratoria extrema, hipoxia, y ansiedad severa. En lugar de una descompensación progresiva de insuficiencia cardíaca, aquí vemos una crisis hemodinámica inducida por una tormenta simpática, en pacientes que usualmente tienen una fracción de eyección normal. Presentación clínica: El paciente que “se estrella” frente a ti El paciente con SCAPE puede presentarse con: Disnea súbita y severa Sibilancias generalizadas (puede confundirse con un cuadro asmático) Presión arterial muy elevada, típicamente ≥180 mmHg sistólica Frecuencia respiratoria y cardíaca elevadas Sudoración profusa, ansiedad extrema Rales bilaterales hasta vértices Uso de músculos accesorios Saturación de O₂ marcadamente reducida Estos signos deben diferenciarse de otras causas de disnea aguda como EPOC, asma, TEP, síndrome ansioso o neumonía. Diagnóstico diferencial: ¿Es SCAPE o no? El diagnóstico de SCAPE es principalmente clínico. Algunos elementos clave para distinguirlo incluyen: Diagnóstico diferencial Diferenciador clave Asma No hay historia asmática, no hay respuesta a broncodilatadores EPOC No hay hipersecreción crónica ni patrón obstructivo previo TEP No suele haber hipertensión severa ni edema pulmonar radiológico Neumonía Inicio más insidioso, fiebre, consolidación localizada Ansiedad No explica rales ni saturación baja sostenida El hallazgo de rales bilaterales, taquicardia, hipertensión severa, y signos de hipoxia crítica, especialmente en ausencia de historia de ICC, apunta fuertemente a SCAPE. Tratamiento inmediato: Qué hacer en los primeros 5 minutos En SCAPE, cada minuto cuenta. El manejo temprano es vital para revertir el curso clínico. El tratamiento se enfoca en tres pilares fundamentales: 1. Ventilación no invasiva (VNI) inmediata Iniciar CPAP o BiPAP en cuanto se identifica el cuadro. CPAP de inicio: 10 cmH₂O Mejora la oxigenación, recluta alvéolos colapsados, y reduce la precarga. Reduce la necesidad de intubación orotraqueal. 2. Nitroglicerina en bolos y goteo No es una hipertensión “de fondo” — se trata de una crisis aguda. Bolos de nitroglicerina IV de 400-800 mcg cada 2-3 minutos son preferibles al goteo lento. Luego se inicia goteo continuo a dosis altas (100-200 mcg/min). Objetivo: reducir rápidamente la poscarga. 3. Evitar intubación temprana La intubación agrava el cuadro si no se ha optimizado primero la poscarga. El uso agresivo de VNI y vasodilatadores puede evitar la necesidad de intubación en la mayoría de los casos. ¿Y los diuréticos? Un error común es administrar furosemida o torasemida como primer paso. En SCAPE: El paciente no tiene sobrecarga de volumen, sino redistribución aguda de fluidos por hipertensión. El diurético puede empeorar la hipotensión posterior. Puede considerarse después de estabilizar la presión y la oxigenación, no antes. Rol del ultrasonido en SCAPE El ultrasonido pulmonar y cardíaco a pie de cama puede ser útil: Pulmonar: líneas B difusas bilaterales, indicativas de edema intersticial. Cardíaco: disfunción ventricular izquierda, cavidades no dilatadas (útil para diferenciar de ICC crónica). El uso del ecógrafo puede reforzar el diagnóstico clínico y guiar intervenciones tempranas. Perlas prácticas del ECCpodcast Durante el episodio, se destacan múltiples “perlas clínicas” útiles para el manejo operativo de SCAPE: La mayoría de los pacientes con SCAPE tienen FEVI normal: no son pacientes con ICC descompensada. La sibilancia no siempre es asma: los rales y sibilancias en SCAPE vienen de edema, no de broncoespasmo. La nitroglicerina en bolo es tu mejor aliada: no temas usar dosis elevadas bajo monitoreo. No pierdas tiempo con diuréticos ni con salbutamol en estos casos. Usa CPAP agresivamente desde el inicio. No intubes a menos que hayas fallado en revertir el cuadro con VNI + nitro. Contexto prehospitalario: ¿Qué puede hacer el paramédico? Desde la perspectiva de atención prehospitalaria: Iniciar CPAP tan pronto como se identifique el cuadro. Administrar nitroglicerina sublingual en dosis repetidas, si no se cuenta con acceso IV. Monitorear la presión constantemente. SCAPE requiere agresividad controlada, no intervención ciega. Notificar al hospital del cuadro clínico temprano para que se preparen con VNI e intervenciones avanzadas. Conclusiones del episodio SCAPE representa una emergencia hipertensiva de alta mortalidad si no se trata de forma rápida y dirigida. El abordaje debe ser: Rápido Guiado por la fisiopatología Alejado de viejos esquemas de manejo de ICC Centrado en VNI + nitroglicerina Recursos adicionales Algoritmo de manejo de SCAPE en formato PDF Infografía resumen de SCAPE para descargas clínicas Referencias a estudios y guías clínicas mencionadas