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Careth Arnold's Hardrock 100 debut was anything but ordinary. After finishing second in one of the toughest ultramarathons in the world, Careth joins Katie to share what really happened during her 30-hour journey through the San Juan Mountains. From months spent acclimating in Silverton to battling pulmonary edema, wildfire smoke, and the mental challenge of racing when everything starts to unravel, this is an honest conversation about resilience, perspective, and learning from one of the biggest tests of her career. Careth also reflects on balancing elite racing with motherhood, self-coaching, and why she's already looking ahead to UTMB. This episode is edited and produced by the Sandyboy Productions Podcast Network.A big shout out to our sponsor Precision Fuel & Hydration. Go to pfandh.com to crush your next race with a personalized fuel & hydration plan. Use code "TTNP15" at checkout.A special thank you to Osprey for supporting this episode. Visit Osprey.com to explore their incredible products!
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In this episode, we review the high-yield topic of Pulmonary Medications from the Drugs section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
Dr. Yogesh Saini speaks with Dr. Michael Yaeger and Dr. Kymberly Gowdy about their article, Docosahexaenoic Acid and Its Metabolites Protects Against Ozone-induced Pulmonary Inflammation.
In this episode of the UConn Internal Medicine Podcast Series, we discuss the evolving role of biologic therapies in asthma and COPD. We review how biologics target Type 2 inflammation, how to identify patients with severe asthma who may benefit from therapy, and how biomarkers such as blood eosinophils, FeNO, IgE, and allergic sensitization guide treatment selection.We also explore newly approved biologics for COPD, practical differences between available agents, expected benefits, steroid-sparing effects, safety considerations, pregnancy counseling, helminth screening, and real-world barriers such as cost and insurance approval.This episode is designed for internal medicine trainees and clinicians looking for a practical framework to understand when to consider biologics, how to choose the right agent, and what to monitor after starting therapy.Hosts:Dr. Hossam Albeyoumi Mohammed, and Dr. Simran Umra, Chief Medicine Residents, UConn.Dr. Alisa Pasichnik, and Dr. Caroline McCauley, 3rd year medicine residents, UConn.Guests:Dr. Ethan Bernstein, Associate Program Director of the Department of Pulmonary and Critical Care Medicine, UConn.Dr. Angela Quental, incoming Assistant Professor in the Department of Pulmonary and Critical care medicine, UConn.Edited by:Dr. Hossam Albeyoumi Mohammed, Chief Medicine Resident, UConn.Music:LoFi Girl by Snoozy Beats | Free Music Archive | Livense: CC BY.
How do expert clinicians actually think? Why do diagnostic errors happen? And can artificial intelligence improve clinical reasoning without replacing physicians? In this episode of The Lebanese Physicians Podcast, I sit down with Dr. Raja-Elie Abdulnour, Pulmonary and Critical Care Physician at the Brigham and Women's Hospital and Editor-in-Chief of NEJM Clinician and Chief Clinical Innovation Officer NEJM Group , to explore the evolving relationship between clinical reasoning and AI. We discuss how physicians develop diagnostic expertise, the cognitive biases behind medical errors, the rise of AI-powered clinical decision support tools, the future of augmented intelligence in healthcare, and why human judgment, communication, and trust remain essential in medicine. Whether you're a medical student, resident, practicing clinician, or simply curious about the future of healthcare, this conversation offers valuable insights into how AI may transform the way we diagnose, learn, and care for patients. Topics Covered: How expert clinicians think System 1 vs. System 2 reasoning Diagnostic errors and cognitive biases AI performance in clinical diagnosis ChatGPT and medical decision-making AI scribes and workflow efficiency Augmented intelligence in healthcare The future of physician-AI collaboration Preserving clinical skills in the AI era #ClinicalReasoning #ArtificialIntelligence #AIinMedicine #MedicalEducation #HealthcareInnovation #ChatGPT #NEJM #MedicalAI #DiagnosticReasoning #AugmentedIntelligence #PhysicianLeadership #DigitalHealth #PulmonaryCriticalCare #TheLebanesePhysiciansPodcast #MedicineFuture On YouTube @thelebanesephysicianspodcast @nejmgroup
Host Maja Nikolic is joined by Dr. Eric Therasse and Dr. Marin Halut to explore pulmonary arteriovenous malformations and why these seemingly small vascular abnormalities can lead to serious neurologic complications. Together, they discuss the connection to hereditary hemorrhagic telangiectasia, key imaging findings, embolization techniques, treatment strategies, and practical tips for achieving successful patient outcomes. Interventional Management of Pulmonary Arteriovenous Malformations: Imaging Primer. Halut et al. RadioGraphics 2026; 46(1):e250041.
CardioNerds (Amit and Dan), Billy Joe Mullinax, and Saahil Jumkhawala discuss the long term management of pulmonary embolism with Dr. Soophia Naydenov. The episode focuses on the approach to patients who struggle with persistent symptoms like dyspnea and fatigue even after completing the acute phase of anticoagulation. This spectrum of disease, ranging from mild post-PE impairment to chronic thromboembolic pulmonary hypertension (CTEPH), requires a structured follow-up. The discussion covers the critical importance of identifying CTEPH early, the necessary timelines for follow-up, and the appropriate objective screening tools and invasive testing to guide patient care toward full functional recovery. Audio editing by CardioNerds academy intern, Grace Qiu. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Acronyms PE: Pulmonary Embolism PERT: Pulmonary Embolism Response Team CTEPH: Chronic Thromboembolic Pulmonary Hypertension QL: Quality of Life VTE: Venous Thromboembolism DASH: D-dimer, Age, Sex, History of non-provoked PE (a risk score) CPET: Cardiopulmonary Exercise Testing PFTs: Pulmonary Function Tests VQ Scan: Ventilation-Perfusion Scan DOACs: Direct Oral Anticoagulants TPA: Tissue Plasminogen Activator (Thrombolytics) ECMO: Extracorporeal Membrane Oxygenation Pearls: Post-PE “Syndrome” is a Spectrum: It is more accurately a spectrum of disease (sequelae of PE) rather than a single syndrome, ranging from mild fatigue/dyspnea to the most severe form, CTEPH. Structured Follow-up is Mandatory: All PE survivors need a structured follow-up, typically with checkpoints at 3, 6, 12, and 16–24 months, with the primary goal being to detect CTEPH, the deadliest, yet potentially curable, disease on the spectrum. Screening Should Be Objective and Practical: When screening for persistent symptoms, use objective assessment tools like the Post-VTE Functional Status (PVFS) scale or the Modified Medical Research Council (MMR-C) scale, as highly comprehensive but cumbersome tools (like the PE Quality of Life questionnaire) may not be practical for routine clinical use. Recurrence Risk Scores Aid in Anticoagulation Duration: Simple scores like the DASH score or the HERDO2 score (for women) can provide guidance when considering the continuation versus discontinuation of anticoagulation after the initial treatment phase. Invasive Testing for Persistent Symptoms: If a patient remains symptomatic at the 6-month mark despite normal non-invasive testing (chest X-ray, ECG, PFTs, six-minute walk, echo, VQ scan, CPET), consider invasive testing such as Right Heart Catheterization (RHC) at rest or with exercise, or an invasive CPET. Notes: Notes drafted by Saahil Jumkhawala. 1. The Spectrum of Post-PE Disease The term “post-PE syndrome” should be used with caution, as it refers to a spectrum of disease rather than a single entity. This spectrum includes symptoms (sequelae) that exist in a patient’s life following an incidental PE event that they did not have before. On one extreme is Chronic Thromboembolic Pulmonary Hypertension (CTEPH): The definition is clear, but it is the most deadly type, though thankfully rare (2% to 4%). It involves a residual clot and pulmonary hypertension identifiable at rest. In the middle is Chronic Thromboembolic Disease (CTED): Patients may have residual defects seen on a VQ or CT scan, but they do not have pulmonary hypertension. On the other side is a milder disease, which can include fatigue, dyspnea, or a patient’s perceived impairment, where the definitions of CTEPH and CTED are not met, but the patient remains symptomatic. 2. Structured Follow-up and Screening for Post-PE Symptoms Structured follow-up is key for all PE survivors, though the structure may vary based on available resources (PCP, Cardiology, Pulmonary, or multidisciplinary clinic). Recommended Timeline for Follow-up: Data from studies like ELOPE and FOCUS suggest checkpoints at 3, 6, 12, and up to 16 to 24 months. This timeline is designed to identify patients who may develop CTEPH. 88% of patients who develop CTEPH will be identified within about a year. A structured follow-up can reduce the delay in CTEPH diagnosis from 10–12 months to 4–6 months. Personal Practice Note: A quick 2–3 week/30-day check-in is recommended for severely ill patients (e.g., those who had TPA, profound shock, or ECMO support) to ensure medication compliance, manage symptoms, and identify red flags. Screening Tools (Objective Assessment): The first step is an inventory of patient symptoms, leaning toward objective rather than subjective assessment. Recommended Simple Tools: Modified Medical Research Council (MMR-C) for dyspnea evaluation. Post-VTE Functional Status (PVFS) scale. The Pulmonary Embolism Quality of Life (QL) questionnaire is comprehensive but long, making it tedious and better suited for research. Future Utility: Technology (AI/electronic tools) may assist in administering these questionnaires before the clinic visit, presenting the information as a “dashboard” for the provider. 3. Management of Persistent Symptoms and Further Testing Initial Non-Invasive Tests (Often done at 3 months): Echocardiogram VQ Scan Full PFTs Six-minute walk CPET Further Evaluation for Persistent Symptoms (e.g., at 6 months): If non-invasive tests (Chest X-ray, ECG, CPET) are normal but symptoms persist, more invasive testing should be considered as the patient has not returned to baseline. Repeat VQ scan or echocardiogram if symptoms have changed. Right Heart Catheterization (RHC) at rest or with exercise. Invasive CPET. PA gram (Pulmonary Angiogram) to assess vasculature. 4. Recurrence Risk and Anticoagulation Duration The decision to continue or discontinue anticoagulation depends on the patient’s risk factors, the situation of the PE (provoked or unprovoked), presence of active cancer, and patient preference. Recurrence Risk Scores: Simple scores are preferred for practicality. DASH Score. HERDO2 Score (particularly for women). The Vienna Score can be considered if the question is whether to restart anticoagulation after a disruption. Role of D-dimer in Abbreviation: While D-dimer can be used to guide the decision to restart anticoagulation after a planned pause (if D-dimer is high, resume), patient symptoms are preferable to guide management decisions like early abbreviation. 5. Prevention of Post-PE Syndrome Currently, there is no clear tool known to prevent the post-PE syndrome/spectrum of disease. Best Current Advice for Prevention/Recovery: Anticoagulation compliance. Pulmonary rehabilitation, which aids in faster recovery. General precautions, such as smoking cessation and body weight management. Future Research: Ongoing trials are investigating whether acute management strategies (e.g., using thrombolytics in intermediate-risk PE) can prevent long-term sequelae. (The PYTHO trial did not show a reduced rate of CTEPH in intermediate-risk PE patients who received thrombolytics). References: Khan, F., Tritschler, T., Kahn, S. R., & Rodger, M. A. “Venous Thromboembolism.” The Lancet, vol. 398, no. 10294, 2021, pp. 64-77. doi:10.1016/S0140-6736(20)32658-1. Kearon, C., & Kahn, S. R. “Long-Term Treatment of Venous Thromboembolism.” Blood, vol. 135, no. 5, 2020, pp. 317-325. doi:10.1182/blood.2019002364. Kahn, S. R., & de Wit, K. “Pulmonary Embolism.” The New England Journal of Medicine, vol. 387, no. 1, 2022, pp. 45-57. doi:10.1056/NEJMcp2116489. Di Nisio, M., van Es, N., & Büller, H. R. “Deep Vein Thrombosis and Pulmonary Embolism.” The Lancet, vol. 388, no. 10063, 2016, pp. 3060-3073. doi:10.1016/S0140-6736(16)30514-1. Chopard, R., Albertsen, I. E., & Piazza, G. “Diagnosis and Treatment of Lower Extremity Venous Thromboembolism: A Review.” JAMA, vol. 324, no. 17, 2020, pp. 1765-1776. doi:10.1001/jama.2020.17272.
This week we go back 2.5 years and delve into the world of cardiovascular surgery when we review a review of STS data on the pulmonary artery band (PAB). The STS assigns a STAT category of 4 to this operation, denoting higher risk for mortality. Is this warranted? Are all PAB candidates equal? What features are associated with higher or lower mortality rates in patients undergoing banding? Should the data in this work drive innovation to avoid the PAB in some settings? These are amongst the questions posed to the senior author of this week's work, cardiovascular surgeon Dr. Tara Karamlou who is Professor of Surgery at the Cleveland Clinic in Cleveland, Ohio. DOI: 10.1016/j.athoracsur.2023.09.020
Andy Cumpstey and Mike Grocott interview Kate Leslie about the SNaPP study (Sugammadex, Neostigmine, and Postoperative Pulmonary Complications). SNaPP is a pragmatic randomized study run from the University of Melbourne with the ANZCA Clinical Trials Network across 45 sites in Australia, New Zealand, and Hong Kong. Patients aged 40+ having major abdominal or thoracic surgery (≥2 hours, overnight stay) were randomized after induction to reversal with sugammadex or neostigmine, with anesthetists unblinded and encouraged to use quantitative neuromuscular monitoring. In this podcast Andy, Mike and Kate discuss the results and their implications for anaesthetists and healthcare systems. Find the paper here: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00158-X/fulltext -- Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood. Register here - https://ebpom.org/product/ebpom-world-congress-2026/
Dr. Stephanie Maximous chats with Dr. Timothy Rowe about his paper, "Impact of Simulation-Based Mastery Learning on Management of Massive Hemoptysis."
Commentary by Dr. Jian'an Wang.
CardioNerds (Dr. Billy-Joe Mullinax, Dr. Dinu Balanescu, and Dr. Jane Ehret) discuss risk stratification in acute pulmonary embolism with Dr. Stavros Konstantinides, Chair of the 2019 ESC Pulmonary Embolism Guidelines. Using a real-world case, this episode explores how modern PE care has moved beyond “massive” and “submassive” labels toward a dynamic, physiology-based approach. The discussion highlights the limitations of static risk scores, the importance of right ventricular dysfunction and biomarkers, and why normotension does not imply stability. Special emphasis is placed on intermediate-high risk PE, early identification of impending hemodynamic collapse, and the role of lactate, serial reassessment, and PERT teams in guiding escalation of care. Audio editing by CardioNerds intern, Joshua Khorsandi.The 2026 American multi-society PE guidelines were published after this episode was recorded. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Stable blood pressure does not mean low risk in PEHypotension is a late finding. Patients may have severe RV failure, hypoxia, and tissue hypoperfusion while remaining normotensive — a key concept behind “normotensive shock.” Risk stratification in PE must be dynamic, not staticLegacy scores like PESI and Bova provide a snapshot and predict 30-day mortality, but they do not capture short-term trajectory or impending hemodynamic collapse. Intermediate-high risk PE is a dangerous and heterogeneous groupPatients with RV dysfunction, positive biomarkers, tachycardia, hypoxemia, and elevated lactate may have in-hospital mortality approaching 15%, rivaling STEMI. Lactate is a critical but underutilized marker in PEElevated lactate reflects tissue hypoxia and early circulatory failure and may identify patients at risk for collapse before blood pressure declines. PERT enables physiology-driven, patient-centered PE carePERT teams operationalize continuous reassessment, integrate imaging, labs, and clinical trajectory, and allow timely escalation — shifting PE management from rigid categories to real-time decision-making. Notes Drafted by Dr. Jane Ehret. 1. What is the contemporary framework for risk stratification in acute pulmonary embolism? Modern PE risk stratification prioritizes hemodynamics and right ventricular (RV) function rather than clot burden. The 2019 ESC Guidelines classify PE into high risk, intermediate risk (low vs high), and low risk, based on: Hemodynamic status, RV dysfunction on imaging, and Cardiac biomarkers. This framework emphasizes early mortality risk but requires clinical context to guide escalation decisions. 2. Why is normotension insufficient to define “stability” in PE? Blood pressure is a late marker of circulatory failure in PE. Patients can maintain normal BP through Tachycardia, Increased sympathetic tone, and RV compensation. Many patients with preserved BP may already have shock physiology, including hypoxemia, elevated lactate, and RV failure — sometimes referred to as “normotensive shock.” 3. How should intermediate-risk PE be conceptualized clinically? Intermediate-risk PE is heterogeneous, ranging from patients who do well on anticoagulation to those who deteriorate rapidly. Intermediate-high risk PE is defined by RV dysfunction on imaging and positive cardiac biomarkers. Clinical features such as tachycardia, increasing oxygen requirement, and elevated lactate identify patients at highest risk within this group. 4. What are the strengths and limitations of commonly used PE risk scores? Legacy scores are useful for initial risk categorization but are static and limited in predicting short-term deterioration. Most scores were developed to predict mortality or complications at fixed time points rather than dynamic clinical trajectory. 5. What are the commonly used risk scores and clinical tools in PE, and what is each designed to predict? ESC Risk Stratification Algorithm: Identifies high-risk PE by hemodynamics. Uses PESI or sPESI in normotensive patients to distinguish low-risk from non–low-risk PE. Uses RV dysfunction and biomarkers to differentiate intermediate-low from intermediate-high risk. Forms the basis of many institutional PE pathways. PESI and sPESI: Validated to predict 30-day mortality. Widely used to identify low-risk patients appropriate for outpatient management. Heavily influenced by age and comorbidities. Bova Score: Predicts 30-day PE-related complications in normotensive patients. Composite PE Shock Score (CPES): Predicts normotensive shock in hemodynamically stable PE patients. Pulmonary Embolism Progression (PEP) Score: Predicts progression from intermediate-risk to high-risk PE within 72 hours of diagnosis. PE Short-term Clinical Outcomes Risk Estimation (PE-SCORE): Predicts clinical deterioration or death within 5 days of PE diagnosis. Hestia Criteria: Identifies low-risk PE patients safe for outpatient treatment. Wells' Criteria and Revised Geneva Score: Determine pretest probability for diagnostic triage. PERC Score: Rules out PE in very low-risk patients. 6. What is the role of biomarkers in PE risk stratification? Troponin and natriuretic peptides reflect RV myocardial injury and strain. Current guidelines treat biomarkers as binary (positive vs negative), despite risk being continuous. Biomarkers are most helpful for: Initial risk classification. They are less useful for: Short-interval monitoring and Detecting rapid clinical deterioration. 7. Why is lactate an important physiologic marker in PE? Lactate reflects global tissue hypoxia and impaired perfusion. Elevated lactate may identify patients with: Early circulatory failure and Increased risk of imminent hemodynamic collapse. Lactate is not currently included in ESC risk algorithms but may add important prognostic information in intermediate-risk patients. 8. How does trajectory influence decision-making in PE management? Risk stratification should be viewed as a dynamic process, not a one-time label. Worsening clinical trajectory may include: Rising heart rate, Increasing oxygen needs, Rising lactate, and Progressive RV dysfunction. Serial reassessment is essential for timely escalation of care. 9. What role do Pulmonary Embolism Response Teams (PERT) play in risk stratification? PERT facilitates: Multidisciplinary decision-making and Integration of imaging, biomarkers, and clinical physiology. PERT is most valuable for: Intermediate-risk and high-risk PE and Patients with complex comorbidities or uncertain trajectory. PERT enables a shift from category-based to physiology-driven PE care. References 1. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 2019;54(3):1901647. Published 2019 Oct 9. doi:10.1183/13993003.01647-2019 2. Leidi A, Bex S, Righini M, Berner A, Grosgurin O, Marti C. Risk Stratification in Patients with Acute Pulmonary Embolism: Current Evidence and Perspectives. J Clin Med. 2022;11(9):2533. Published 2022 Apr 30. doi:10.3390/jcm11092533 3. Choi WH, Kwon SU, Jwa YJ, et al. The pulmonary embolism severity index in predicting the prognosis of patients with pulmonary embolism. Korean J Intern Med. 2009;24(2):123-127. doi:10.3904/kjim.2009.24.2.123 4. Jiménez D, Aujesky D, Moores L, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010;170(15):1383-1389. doi:10.1001/archinternmed.2010.199 5. Chen X, Shao X, Zhang Y, et al. Assessment of the Bova score for risk stratification of acute normotensive pulmonary embolism: A systematic review and meta-analysis. Thromb Res. 2020;193:99-106. doi:10.1016/j.thromres.2020.05.047 6. Zhang RS, Yuriditsky E, Zhang P, et al. Composite Pulmonary Embolism Shock Score and Risk of Adverse Outcomes in Patients With Pulmonary Embolism. Circ Cardiovasc Interv. 2024;17(8):e014088. doi:10.1161/CIRCINTERVENTIONS.124.014088 7. Zhang RS, Alam U, Sharp ASP, et al. Validating the Composite Pulmonary Embolism Shock Score for Predicting Normotensive Shock in Intermediate-Risk Pulmonary Embolism. Circ Cardiovasc Interv. 2024;17(2):e013399. doi:10.1161/CIRCINTERVENTIONS.123.013399 8. Ehret J, Wakefield D, Badlam J, Antkowiak M, Erdreich B. Development of the Pulmonary Embolism Progression (PEP) score for predicting short-term clinical deterioration in intermediate-risk pulmonary embolism: a single-center retrospective study. J Thromb Thrombolysis. 2025;58(2):243-253. doi:10.1007/s11239-024-03051-5 9. Weekes AJ, Raper JD, Lupez K, et al. Development and validation of a prognostic tool: Pulmonary embolism short-term clinical outcomes risk estimation (PE-SCORE). PLoS One. 2021;16(11):e0260036. Published 2021 Nov 18. doi:10.1371/journal.pone.0260036 10. Zondag W, Hiddinga BI, Crobach MJ, et al. Hestia criteria can discriminate high- from low-risk patients with pulmonary embolism. Eur Respir J. 2013;41(3):588-592. doi:10.1183/09031936.00030412 11. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135(2):98-107. doi:10.7326/0003-4819-135-2-200107170-00010 12. Wolf SJ, McCubbin TR, Feldhaus KM, Faragher JP, Adcock DM. Prospective validation of Wells Criteria in the evaluation of patients with suspected pulmonary embolism. Ann Emerg Med. 2004;44(5):503-510. doi:10.1016/j.annemergmed.2004.04.002 13. Le Gal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006;144(3):165-171. doi:10.7326/0003-4819-144-3-200602070-00004 14. Kline JA, Mitchell AM, Kabrhel C, Richman PB, Courtney DM. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost. 2004;2(8):1247-1255. doi:10.1111/j.1538-7836.2004.00790.x 15. Kline JA, Courtney DM, Kabrhel C, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost. 2008;6(5):772-780. doi:10.1111/j.1538-7836.2008.02944.x
PainExam Podcast Show Notes Compression Fractures, Vertebroplasty, Kyphoplasty & Occipital Neuralgia for the ABA Pain Medicine Boards In this episode of the PainExam Podcast, Dr. David Rosenblum reviews two frequently tested topics on the ABA Pain Medicine Board Examination: Occipital Neuralgia and Vertebral Compression Fractures, including the indications, techniques, complications, and evidence surrounding vertebroplasty and kyphoplasty. Whether you are preparing for the ABA Pain Medicine Boards, ABPM, ABIPP, FIPP, or simply looking to strengthen your interventional pain knowledge, this episode covers essential board pearls, anatomy, diagnosis, imaging findings, and treatment options. Episode Highlights Occipital Neuralgia Topics discussed include: Anatomy of the greater, lesser, and third occipital nerves C2 dorsal ramus anatomy and clinical relevance Diagnostic criteria for occipital neuralgia Differentiating occipital neuralgia from: Cervicogenic headache Migraine Cluster headache Tension headache Physical examination findings Occipital nerve blocks Pulsed radiofrequency ablation Cryoneurolysis Peripheral nerve stimulation (PNS) Board Pearl The greater occipital nerve originates from the dorsal ramus of C2 and temporary pain relief following a diagnostic occipital nerve block strongly supports the diagnosis. Vertebral Compression Fractures Topics reviewed include: Osteoporotic vertebral compression fractures Thoracolumbar fracture patterns MRI findings STIR sequence interpretation Patient selection for vertebral augmentation Conservative treatment versus intervention Vertebroplasty technique Kyphoplasty technique Cement leakage and other complications Evidence supporting vertebral augmentation procedures Board Pearl Bone marrow edema on MRI STIR imaging is one of the most important findings suggesting an acute compression fracture. Kyphoplasty vs Vertebroplasty Vertebroplasty Direct injection of PMMA cement into the vertebral body Stabilizes micro-motion within the fracture Can provide rapid pain relief Kyphoplasty Balloon tamp creates a cavity before cement placement May partially restore vertebral body height May reduce risk of cement extravasation Often preferred in selected patients with significant vertebral collapse Commonly Tested Complications Cement leakage Pulmonary cement embolism Adjacent level fractures Infection Neurologic injury (rare) High-Yield ABA Pain Medicine Keywords Occipital Neuralgia Greater Occipital Nerve C2 Dorsal Ramus Third Occipital Nerve Cervicogenic Headache Peripheral Nerve Stimulation Vertebral Compression Fracture Kyphoplasty Vertebroplasty PMMA Cement STIR MRI Osteoporosis Cement Extravasation Upcoming Educational Meetings & Conferences 2026 ASPN Annual Meeting – Miami Learn more about the upcoming meeting hosted by the American Society of Pain and Neuroscience:
PainExam Podcast Show Notes Compression Fractures, Vertebroplasty, Kyphoplasty & Occipital Neuralgia for the ABA Pain Medicine Boards In this episode of the PainExam Podcast, Dr. David Rosenblum reviews two frequently tested topics on the ABA Pain Medicine Board Examination: Occipital Neuralgia and Vertebral Compression Fractures, including the indications, techniques, complications, and evidence surrounding vertebroplasty and kyphoplasty. Whether you are preparing for the ABA Pain Medicine Boards, ABPM, ABIPP, FIPP, or simply looking to strengthen your interventional pain knowledge, this episode covers essential board pearls, anatomy, diagnosis, imaging findings, and treatment options. Episode Highlights Occipital Neuralgia Topics discussed include: Anatomy of the greater, lesser, and third occipital nerves C2 dorsal ramus anatomy and clinical relevance Diagnostic criteria for occipital neuralgia Differentiating occipital neuralgia from: Cervicogenic headache Migraine Cluster headache Tension headache Physical examination findings Occipital nerve blocks Pulsed radiofrequency ablation Cryoneurolysis Peripheral nerve stimulation (PNS) Board Pearl The greater occipital nerve originates from the dorsal ramus of C2 and temporary pain relief following a diagnostic occipital nerve block strongly supports the diagnosis. Vertebral Compression Fractures Topics reviewed include: Osteoporotic vertebral compression fractures Thoracolumbar fracture patterns MRI findings STIR sequence interpretation Patient selection for vertebral augmentation Conservative treatment versus intervention Vertebroplasty technique Kyphoplasty technique Cement leakage and other complications Evidence supporting vertebral augmentation procedures Board Pearl Bone marrow edema on MRI STIR imaging is one of the most important findings suggesting an acute compression fracture. Kyphoplasty vs Vertebroplasty Vertebroplasty Direct injection of PMMA cement into the vertebral body Stabilizes micro-motion within the fracture Can provide rapid pain relief Kyphoplasty Balloon tamp creates a cavity before cement placement May partially restore vertebral body height May reduce risk of cement extravasation Often preferred in selected patients with significant vertebral collapse Commonly Tested Complications Cement leakage Pulmonary cement embolism Adjacent level fractures Infection Neurologic injury (rare) High-Yield ABA Pain Medicine Keywords Occipital Neuralgia Greater Occipital Nerve C2 Dorsal Ramus Third Occipital Nerve Cervicogenic Headache Peripheral Nerve Stimulation Vertebral Compression Fracture Kyphoplasty Vertebroplasty PMMA Cement STIR MRI Osteoporosis Cement Extravasation Upcoming Educational Meetings & Conferences 2026 ASPN Annual Meeting – Miami Learn more about the upcoming meeting hosted by the American Society of Pain and Neuroscience:
PainExam Podcast Show Notes Compression Fractures, Vertebroplasty, Kyphoplasty & Occipital Neuralgia for the ABA Pain Medicine Boards In this episode of the PainExam Podcast, Dr. David Rosenblum reviews two frequently tested topics on the ABA Pain Medicine Board Examination: Occipital Neuralgia and Vertebral Compression Fractures, including the indications, techniques, complications, and evidence surrounding vertebroplasty and kyphoplasty. Whether you are preparing for the ABA Pain Medicine Boards, ABPM, ABIPP, FIPP, or simply looking to strengthen your interventional pain knowledge, this episode covers essential board pearls, anatomy, diagnosis, imaging findings, and treatment options. Episode Highlights Occipital Neuralgia Topics discussed include: Anatomy of the greater, lesser, and third occipital nerves C2 dorsal ramus anatomy and clinical relevance Diagnostic criteria for occipital neuralgia Differentiating occipital neuralgia from: Cervicogenic headache Migraine Cluster headache Tension headache Physical examination findings Occipital nerve blocks Pulsed radiofrequency ablation Cryoneurolysis Peripheral nerve stimulation (PNS) Board Pearl The greater occipital nerve originates from the dorsal ramus of C2 and temporary pain relief following a diagnostic occipital nerve block strongly supports the diagnosis. Vertebral Compression Fractures Topics reviewed include: Osteoporotic vertebral compression fractures Thoracolumbar fracture patterns MRI findings STIR sequence interpretation Patient selection for vertebral augmentation Conservative treatment versus intervention Vertebroplasty technique Kyphoplasty technique Cement leakage and other complications Evidence supporting vertebral augmentation procedures Board Pearl Bone marrow edema on MRI STIR imaging is one of the most important findings suggesting an acute compression fracture. Kyphoplasty vs Vertebroplasty Vertebroplasty Direct injection of PMMA cement into the vertebral body Stabilizes micro-motion within the fracture Can provide rapid pain relief Kyphoplasty Balloon tamp creates a cavity before cement placement May partially restore vertebral body height May reduce risk of cement extravasation Often preferred in selected patients with significant vertebral collapse Commonly Tested Complications Cement leakage Pulmonary cement embolism Adjacent level fractures Infection Neurologic injury (rare) High-Yield ABA Pain Medicine Keywords Occipital Neuralgia Greater Occipital Nerve C2 Dorsal Ramus Third Occipital Nerve Cervicogenic Headache Peripheral Nerve Stimulation Vertebral Compression Fracture Kyphoplasty Vertebroplasty PMMA Cement STIR MRI Osteoporosis Cement Extravasation Upcoming Educational Meetings & Conferences 2026 ASPN Annual Meeting – Miami Learn more about the upcoming meeting hosted by the American Society of Pain and Neuroscience:
Today, Peggy Burkhard talks with Dr. Amar Kelkar of the Dana-Farber Cancer Institute about the medical side of survivorship after bone marrow, stem cell, or CAR-T transplant. The conversation begins with the important shift from the urgent “save my life” phase to the longer “protect my health” phase. Dr. Kelkar explains that this transition often starts around the 100-day mark, though timing varies by transplant center, geographical region and patient needs. A major theme is the need to restart routine care that may have been paused during transplant. Dental care, dermatology, ophthalmology, and primary care all become important again. Dental visits are especially important because oral graft-versus-host disease (GVHD) can cause dry mouth, irritation, cavities, and other problems. Skin checks matter because transplant can increase the risk of skin cancers. Dr. Kelkar stresses annual dermatology visits, sun protection, SPF 50 or higher, protective clothing, and smart decisions about sun exposure. Fatigue is another central topic. Dr. Kelkar describes post-transplant fatigue as different from normal tiredness. It can feel deep, physical, and mental, and it may last for months or even years. He encourages patients to pace themselves, listen to their bodies, and build activity back slowly. Returning to work also needs to be individualized. Some patients work remotely during treatment, while others may need extended disability or a gradual return. The episode also covers immune recovery and repeat vaccinations. Dr. Kelkar explains that after transplant, the immune system has been reset, and many childhood vaccines need to be repeated. Most programs begin revaccination around six, nine, or 12 months, depending on immune suppression and other factors. He reassures listeners that many patients have fewer vaccine symptoms early on because their immune systems are still rebuilding. Dr. Kelkar also reviews long-term screening and prevention. Survivors need routine cancer screenings, including mammograms, colonoscopies, lung cancer screening when appropriate, skin exams, and monitoring for thyroid or other changes. Metabolic health is also important. Steroids can affect blood sugar, transplant can change body composition, and quick weight loss often includes muscle loss. Nutrition support and exercise programs can help, and Peggy notes that Blood Cancer United offers nutrition services for patients and caregivers. Blood Cancer United's nutrition program provides free one-on-one consultations with oncology dietitians by phone or email. Bone health, hormone changes, sexual health, and early aging are also discussed. Dr. Kelkar explains that steroids, menopause, testosterone changes, vitamin D deficiency, and time indoors can affect bones. Many centers use DEXA scans and vitamin D supplementation. He also encourages patients to bring up sexual health concerns, including menopause symptoms, low testosterone, pain with intercourse, ulcers, or fear about resuming intimacy. The episode closes with practical advice for everyday life. Food restrictions often loosen around 100 days, but patients should reintroduce foods slowly and carefully. Raw foods, alcohol, tobacco, and inhaled smoke should generally be avoided, especially during the first year. Dr. Kelkar also emphasizes mental health support, counseling, and honest conversations with the medical team. Survivorship is a bumpy road, but the goal is to help patients regain control and thrive. Blood Cancer United Nutrition Offerings: https://bloodcancerunited.org/blood-cancer-care/adults/food-nutrition Thanks to this season's sponsors, Incyte and Sanofi. (00:00) Intro (01:16) Moving from acute treatment to survivorship (02:17) Dental, dermatology, ophthalmology, and routine care (05:45) Fatigue after transplant versus normal tiredness (08:35) Pacing yourself and avoiding setbacks (10:26) Returning to work after transplant (12:24) Resetting the immune system and repeat vaccinations (16:07) Secondary malignancy prevention and cancer screenings (18:59) Sun protection and skin cancer prevention (20:23) Metabolic health, blood sugar, and weight management (23:58) Bone health, vitamin D, DEXA scans, and early aging (29:32) Sexual health and hormonal changes (32:43) Everyday living after transplant (36:07) Psychological and cognitive hurdles in survivorship (38:16) Pulmonary function tests and liver monitoring (40:42) Closing thoughts National Bone Marrow Transplant Link - (800) LINK-BMT, or (800) 546-5268.nbmtLINK Website: https://www.nbmtlink.org/Check out our valued nbmtLINK resource books, some for sale, some free as downloadable, https://www.nbmtlink.org/shop/nbmtLINK Facebook Page: https://www.facebook.com/nbmtLINKFollow the nbmtLINK on Instagram! https://www.instagram.com/nbmtlink/The nbmtLINK YouTube Page can be found by clicking here.This content is provided for informational purposes only and is not intended to substitute for professional medical advice, diagnosis, or treatment. It is crucial to consult directly with a qualified healthcare professional regarding any medical conditions, treatment options, or other health concerns.The views and opinions expressed by the speakers are their own and do not necessarily reflect the official policy or position of the nbmtLINK. Unless otherwise stated in an official policy, the nbmtLINK does not endorse any specific treatments, products, or services mentioned by the speakers. Reliance on any information provided is solely at your own risk.The Marrow Masters Podcast is produced by JAG Podcast Productions: https://jagpodcastproductions.com/ Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
As part of the May issue, the European Respiratory Journal presents the latest in its series of podcasts. Deputy Chief Editor Don Sin interviews John Fahy (Division of Pulmonary and Critical Care Medicine, and the Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA) about his state-of-the-art review of the pathobiology and treatment of mucus plugs in asthma and COPD , published in this issue of the ERJ (https://doi.org/10.1183/13993003.02358-2025). Cite this podcast as: ERJ Podcast May 2026: Mucus plugs in asthma and COPD. Eur Respir J 2026; 67: 26E6705 [https://doi.org/10.1183/13993003.E6705-2026].
Pulmonary AVM may be rare, but missing them can lead to lifelong complications, especially in patients with hereditary hemorrhagic telangiectasia (HHT). How do you choose the right device and strategy to ensure long-term success with embolization? In this episode of the BackTable Podcast, host Dr. Kavi Krishnasamy is joined by Dr. Brian Funaki and Dr. Nima Kokabi to unpack the evolving treatment landscape for pulmonary arteriovenous malformations (PAVM). Through imaging breakdown, review of challenging real-world cases, and a discussion on advanced treatment strategies, the conversation tackles a key debate in pulmonary embolization: are plugs replacing coils as the new standard? --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Okamihttps://okamimedical.com/ --- Timestamps 00:00 - Introduction01:43 - Defining HHT and PAVM05:53 - Democratizing Interventions for HHT Patients08:83 - Recommendations to Embolize PAVM13:19 - Imaging Specificity and Procedural Preferences23:29 - Persistence Rates with Plugs and Coils25:59 - Lag in Utilization of Plugs29:18 - Comparison of LOBO to Alternative Vascular Plugs34:26 - Post Embolization Symptoms and Troubleshooting Methods39:04 - PAVM Cases and Treatments54:26 - Wrap Up and Credits --- More about this episode The discussion begins by defining HHT and PAVM, highlighting the risks associated with untreated PAVM and the critical need for genetic screening and multi-organ evaluation. Drs. Funaki and Kokabi review current treatment recommendations, surveillance imaging, and follow-up protocols, with special considerations for pediatric and high-risk patients. They explore practical tips for optimizing embolization performance, focusing on device selection and the evolving role of vascular plugs. By comparing different plug designs, such as wire count and pore size, and sharing lessons from challenging cases, including persistent lesions, tortuous anatomy, and pseudoaneurysm management, they provide advanced troubleshooting and decision-making strategies to achieve more durable, successful PAVM treatments. --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app
A mother, advocate and one woman's global fight for access. Beth Vanstone is working to ensure rare disease patients don't have to wait for the treatments they need to survive. Sometimes the most powerful friendships begin in the most unexpected places. Beth Vanstone and I first connected on social media. At the time, we were simply two moms navigating the complicated, emotional, and relentless world of cystic fibrosis. But eventually the online messages turned into something more meaningful. Then, Beth attended one of The Bonnell Foundation's Gala events. That's when we finally met in person. And from that moment on, we became dear friends. It's proof that social media, when used for connection and purpose, can build incredible relationships. But what inspires me most about Beth isn't just our friendship. It's her relentless determination. Beth is the mother of Madi, who was diagnosed with cystic fibrosis at just eight months old. Suddenly Beth was navigating a healthcare system, researching treatments, learning medical language, and fighting for her daughter's future. Beth didn't stop there. Instead of focusing only on her own family, she chose to fight for every family. Today, Beth is a powerful advocate in Canada and a member of the Ontario Rare Action Group, where she works to improve access to life-saving therapies for people living with rare diseases like Cystic Fibrosis. And the reality she's fighting against is one many people don't understand. Most healthcare systems, not just in Canada but around the world were built to treat common diseases. They weren't designed for rare conditions that affect smaller populations. Because of that, patients with rare diseases often face enormous barriers: long approval timelines, delayed access to medications, and exhausting advocacy battles just to receive treatments that already exist. In some cases, patients wait months — even years — for medications that could dramatically improve or extend their lives. Beth is working to change that. Through her advocacy, she's pushing for reforms that could make a real difference for patients across Canada and beyond: • Faster access to innovative therapies • Improved newborn screening programs • Better diagnostic pathways • Centers of excellence for rare diseases • Removing financial barriers like deductibles that prevent families from accessing public programs And she's also raising an important global conversation. Here in the United States, lawmakers have debated policies like the Most Favored Nation Model, which look to international drug pricing systems like those in Canada and Europe as a model. But Beth reminds us that every system has challenges, and for rare disease patients, those challenges can be life-changing. Because when access to medication is delayed… Access is denied. And that's why advocacy across borders matters. She's not just advocating for her daughter. She's advocating for every patient still waiting for their breakthrough. And today, we're talking about what needs to change and how all of us can help make it happen. 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
On this episode Gil and Gregg welcome Dr. Sai Praveen Haranath, Senior Vice President for Medical and Strategy at Apollo HealthAxis and Senior Consultant in Pulmonary and Critical Care at Apollo Hospitals, Hyderabad. Their conversation picks up where a chance green-room meeting at BioAsia 2026 left off. What follows is a candid, wide-ranging dialogue on the future of medicine: tele-critical care delivered from a command center in India to hospitals in rural America and the island of Fiji; AI tools that could restore empathy to time-starved clinicians; a 4.5-billion-person global access gap that demands urgent innovation; and Apollo's four-decade bet that prevention, technology, and human connection belong together. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen
Raja-Elie Abdulnour is the Chief Clinical Innovation Officer at NEJM Group and an associate physician in the Pulmonary and Critical Care Medicine Division at Brigham and Women's Hospital. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. A. Sikora, L.A. Celi, and R.-E.E. Abdulnour. Can AI Say “I Don't Know”? N Engl J Med 2026;394:1873-1875.
Pulmonary arterial hypertension (PAH) is a critical condition often overlooked in respiratory care. In the first in a series of podcasts about PAH, Brie Soldano, MBA, RRT, RRT-NPS, Respiratory Therapist‑Lead at Nemours Children's Hospital, and Lisa Fuchs, EdD, MHA, RRT, CHWC, FAARC, FNAP, AARC Director of Education, discuss the vital role respiratory therapists play in early detection and intervention. Brie highlights her experiences and actionable insights to improve patient outcomes while underscoring the importance of proactive care in managing PAH, especially in newborns with congenital heart defects. AARC thanks Linde and Mallinckrodt for their support of this episode of the AARC Perspectives Podcast. Send us your thoughts on this podcastThank you for listening! Learn more at aarc.org
In this episode, we review the high-yield topic of Methylxanthines from the Pulmonary section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
Beyond the Pearls: Cases for Med School, Residency and Beyond (An InsideTheBoards Podcast)
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Episode 243 NPTEFF Pulmonary Auscultation: Breath Sounds and What They Mean
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CardioNerds Drs. Dinu Balanescu, Billy-Joe Mullinax, and Mariana Garcia discuss systemic thrombolysis in pulmonary embolism with expert Dr. Allison Burnett. Audio editing by CardioNerds Academy intern, student doctor, Pace Wetstein. Pulmonary embolism is the third leading cause of cardiovascular death in the US, and high-risk PE carries a 30-day mortality risk as high as 30-50%. In this episode, we discuss the indications for systemic thrombolysis, including high-risk PE and cardiac arrest. We addressed how to appropriately select candidates for systemic thrombolysis, balancing the high risk of bleeding. Additionally, we discussed anticoagulation management and timing concurrent with lytic therapy, as well as the importance of multidisciplinary PERT teams. The 2026 American multi-society PE guidelines were published after this episode was recorded. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Risk stratification is crucial in acute pulmonary embolism care. Based on the ESC 2019 guidelines, low-risk PE patients are those who are normotensive with no evidence of right ventricular dysfunction. Intermediate risk includes two categories: intermediate-low, with normotensive patients who have a high PE score with negative biomarkers, and intermediate-high risk, which has elevated biomarkers or signs of RV strain. High-risk PE includes hemodynamically unstable patients (SBP
OsteoBites welcomes Caroline Maloney, MD, PhD, from the Medical College of Wisconsin, who will discuss her research on surgery-accelerated metastasis and developing perioperative therapies.Pulmonary metastasis remains the major cause of death in osteosarcoma. The timing of metastatic relapse defines clinically meaningful subgroups in osteosarcoma with patients who relapse within 6–12 months of surgical removal of their primary tumor having markedly worse survival (10-20%) than those who relapse after completion of therapy (40-50%). While surgical removal of the primary tumor is a fundamental component of the clinical care of solid tumors, surgery induces transient but profound changes in immune and inflammatory responses that can paradoxically accelerate the growth of metastatic disease. Dr. Maloney has demonstrated that surgical removal of the primary tumor accelerates the growth of pre-existing pulmonary metastatic disease and promotes expansion of M2‐like macrophages in the lung microenvironment. Strikingly, short term perioperative treatment with a RIPK2 inhibitor blocks this effect and reprograms macrophages toward an M1-like phenotype, implicating the NOD2–RIPK2 innate immune pathway as a key mediator of post‐surgical immune reprogramming. In contrast, the NOD2 agonist Mifamurtide has shown clinical efficacy when administered as adjuvant therapy to metastatic osteosarcoma patients after primary tumor resection. This data suggests that NOD/RIPK2 signaling may exert context-dependent effects, promoting either pro- or anti-tumor myeloid responses depending on the timing of activation relative to surgery. Understanding how surgical tumor removal alters systemic innate immunity and how RIPK2 signaling orchestrates these responses could identify new strategies to prevent early pulmonary relapse after surgery.
✨ Este domingo en Historias que Contar ✨Sadia Benzaquen nació en Caracas, Venezuela, el 6 de noviembre de 1972.Es el mayor de cuatro hermanos: Alex, Karen y Gastón, quien falleció en el año 2008.Hijo de José Benzaquen y Sara Wahnich de Benzaquen, ambos nacidos en Tetuán, Marruecos.Nieto de Mojluf y Sara Benzaquen, y de Yahya y Aziza Wahnich — todos nacidos en Tetuán — su historia familiar está marcada por la migración cuando el protectorado español dejó de gobernar la ciudad y pasó a control marroquí.La familia de su padre emigró primero a Israel.La de su madre, directamente a Venezuela.Sus padres se conocieron en Caracas, cuando su padre, trabajando en un barco israelí, hizo escala en Venezuela.Realizó sus estudios en el Hebraica y en el Moral y Luces (Promoción 1990), y se graduó como médico en la Escuela Luis Razetti de la Universidad Central de Venezuela en 1998, donde también ejerció — una etapa fundamental en su formación.En el 2003 emigró a Estados Unidos.Hoy vive en Philadelphia, donde es jefe del Departamento de Pulmonary, Critical Care, Sleep and Allergy en el Jefferson Einstein Medical Center y profesor de medicina en el Sidney Kimmel Medical College at Jefferson University.Durante la pandemia del COVID-19, su voz se convirtió en referencia para miles de personas.Esposo de Julie Simons, y padre de Joseph y Noah.
“Being a CF aunt has shaped so much of my life. Now I get the opportunity to turn that love and connection into helping even more people at Breathe Strong CF." Julie Dunn Eichenberg didn't just find the cystic fibrosis community, she's been part of it for more than 30 years as a proud CF aunt. That personal connection is what makes this next chapter so meaningful. Julie recently stepped into the role of Executive Director at BreatheStrong CF, where the focus is on helping people with cystic fibrosis live stronger, healthier lives through exercise, education, and empowerment. And while she brings decades of experience in leadership, fundraising, and relationship-building, she's honest about getting used to the role. She's learning. Listening. Figuring out the day-to-day. And really taking the time to understand how she can best serve the community in this new position. Before this, Julie spent 20 years at Turner Broadcasting System (now part of Warner Bros. Discovery), and later held leadership roles at Florida State University and Fan Data Insights. But no matter where her career took her, the CF community was always part of her life. She's also been deeply involved with the Cystic Fibrosis Foundation, serving as Chair of the Georgia Chapter and contributing at the national level. We talk about what it feels like to step into a leadership role that's so personal. The excitement, the pressure, and the responsibility that comes with it. Julie shares what she's learning, what's surprised her, and why her connection as a CF aunt continues to guide every decision she makes. Because for Julie, this isn't just a job, it's personal. 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
Better Edge : A Northwestern Medicine podcast for physicians
In this episode of Better Edge, Oncologist Seth M. Pollack, MD, discusses the evolving treatment landscape for leiomyosarcoma and highlights clinical trial data recently published in The Lancet Oncology. Dr. Pollack was co-author on the study, which evaluated the combination of cabozantinib, a multitargeted tyrosine kinase inhibitor, with temozolomide in patients with refractory soft tissue sarcomas. The conversation covers the biologic mechanisms underpinning this strategy, trial design and outcomes, and how the trial's findings compare with existing systemic therapies. The discussion also emphasizes the value of referral to specialized sarcoma centers with multidisciplinary expertise and access to subtype specific clinical trials.
Better Edge : A Northwestern Medicine podcast for physicians
In this episode of Better Edge, pulmonologist Maanasi Samant, MD, highlights the multidisciplinary approach to pulmonary embolism (PE) survivorship at Northwestern Medicine Canning Thoracic Institute's Blood Clot Clinic. The clinic offers structured follow-up for patients recovering from PE, with a focus on persistent symptoms, functional limitation, and early identification of chronic thromboembolic disease, including chronic thromboembolic pulmonary hypertension (CTEPH). Through standardized post-discharge evaluations, advanced diagnostics, coordinated anticoagulation management, and supportive counseling, the clinic addresses the full spectrum of post-PE syndrome. This comprehensive model supports earlier diagnosis of long-term complications, timely access to advanced therapies, and improved recovery and quality of life, serving as a centralized, evidence-based resource for referring pulmonologists.
Commentary by Dr. Jian'an Wang.
In this episode, Dr. Kathy Vidlock explores the physiology and real-world risks of pulmonary edema triggered by both intense physical exertion and high-altitude exposure. Drawing on clinical insight and wilderness medicine experience, she explains how fluid can accumulate in the lungs during extreme exercise and conditions like High-Altitude Pulmonary Edema, breaking down the underlying mechanisms in a clear and practical way. Listeners will learn how to recognize early warning signs—such as shortness of breath out of proportion to effort, cough, and decreased performance—and understand why these symptoms can rapidly become life-threatening. The episode also covers prevention strategies, including proper acclimatization, pacing, and risk awareness, along with guidance on when immediate descent or medical care is critical. Whether you're an athlete, climber, or backcountry traveler, this episode provides essential knowledge to help you stay safe in demanding environments.
The U.S. Environmental Protection Agency (EPA) changed the dollar value of a statistical life in January 2026, essentially dropping it to zero. What does that mean for the average American? As Anthony Gerber, MD, PhD, University of Kentucky, explains to Air Health Our Health host Erika Moseson, MD, MA, this means the agency will no longer account for the healthcare costs of air pollution and lost lives when determining how account how clean air policies and other key legislation affect communities. In this first part of a two-part series on the EPA's dollar value of a statistical life, Dr. Gerber explains what this change means and why is it significant.
Three decades caring for patients with CF, that's Dr. Alan H. Cohen. His experience continues to shape everything he does today. As a pediatric pulmonologist (board-certified) , he has walked alongside patients through some of their hardest moments, including advanced lung disease and transplantation. Dr. Cohen was previously co-director of the largest pediatric lung transplant program in North America.Those years at the bedside are what ultimately led Dr. Cohen into drug development, where he has spent more than 25 years working to turn scientific innovation into real-world therapies for people who are still waiting for better options. As the Chief Medical Officer of Arcturus Therapeutics, he brings both clinical perspective and urgency to the company's work in mRNA-based therapies for cystic fibrosis and other rare diseases.“Clinical trials aren't just about science, they're about people who are willing to help move the field forward.”In this thoughtful and engaging conversation, Dr. Cohen reflects on how cystic fibrosis care has evolved over the past 35 years, from symptom management to breakthroughs in gene therapy and mRNA technology. Dr. Cohen discusses why clinical trials are essential to progress, especially for rare diseases, and why patient participation plays such a critical role in moving new therapies forward. Dr. Cohen also shares how the strength of the CF community continues to inspire his work, offering both realism and hope for the future of CF research.You'll also hear more about the personal side of this wonderful scientist! The Arcturus team packed Bonnell Foundation Hospital Bags with comfort products for caregivers, and CF adults for California CF Clinics. #teamworkClinical trials are an important step to understand whether a medicine works for its intended purpose. Please see our active clinical trials below. For any questions email: Community@ArcturusRx.com. 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
In this episode, we review the high-yield topic of Pulmonary Edema from the Respiratory section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
In this episode of our Critical Care Series, we break down the fundamentals of mechanical ventilation with a practical, physiology-based approach designed for the bedside.Join us for a high-yield, clinically focused discussion covering ventilator modes, how ventilator breaths work (trigger, limit, and cycle), and how to interpret pressures and waveforms in the ICU. Whether you're an internal medicine resident, pulmonary fellow, or critical care learner, this episode will help you build a framework to understand and troubleshoot ventilators with confidence.Hosts:Dr. Tanya S. Jain and Dr. Avtandil Kochiashvili, Chief Medical Residents, UConnGuest Expert:Dr. Ethan Bernstein, Attending Physician, Pulmonary & Critical CareAuthor:Dr. Tanya S. Jain, Chief Medical Resident, UConnEdited by:Dr. Avtandil Kochiashvili, Chief Medical Resident, UConnMusic:LoFi Girl by Snoozy Beats | Free Music Archive | License: CC BY
In this week's episode we interview Joseph Parambil, MD, staff member in the department of pulmonary, allergy and critical care medicine at Cleveland Clinic, about the current challenges of interstitial lung disease, or ILD. · Intro by Adam J. Brown, MD 0:12 · Welcome back Joseph Parambil, MD 0:32 · But first, some medical history on ILD 1:04 · ILD vs. IPF 2:26 · A quick aside into silicosis and bleomycin 4:27 · Trying to describe pulmonary fibrosis 5:23 · The different types of ILD 9:44 · Finding a slow progression of disease and autoimmune conditions 10:59 · Pulmonary fibrosis diagnoses in 1963 14:41 · The modern era of ILD 16:22 · Nonspecific interstitial pneumonia 20:12 · Handing things over to Dr. Parambil 23:01 · Helping rheumatologists understand ILD/The alphabet soup 24:34 · The shift from biopsies and using immunosuppression 33:07 · Is the workup similar for UIP and NSIP? 35:26 · Is there a standard protocol for workup in terms of serologies? 36:30 · The danger of choosing the wrong treatment 38:43 · Immunosuppression in patients with pulmonary hypertension and ILD 40:52 · UIP and ANCA vasculitis 42:12 · Compared to ten years ago, how are we doing with treatments? 43:10 · Where are we with lung transplants? 50:49 · Looking at hematopoietic stem cell transplants 53:24 · The importance of early diagnosis 54:14 · Antifibrotic medicines 56:15 · Chronic and acute interstitial lung diseases 58:41 · Thank you, Dr. Parambil 1:03:54 · A conclusion from Dr. Brown 1:04:20 · Thank you for listening 1:04:55 We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. Joseph Parambil, MD, is a staff member in the Respiratory Institute and the director of the HHT Center of Excellence and the Vascular Anomalies Center at the Cleveland Clinic. He is associate professor of medicine at Cleveland Clinic's Lerner College of Medicine. He is certified by the American Board of Internal Medicine with additional specialty certification in pulmonary medicine and critical care medicine. References: Homolka J. CMAJ. 1987;PMID:3315158 Liebow A, et al. : "Frontiers of Pulmonary Radiology." The interstitial pneumonias, pp. 102-141. 1969. Grune & Stratton. Liebow A, et al. Calif Med. 1969;PMID:PMC1501512 Noble PW, et al. Am J Respir Cell Mol Biol. 2005;doi:10.1165/rcmb.F301 Scadding JG, et al. Thorax. 1967;doi:10.1136/thx.22.4.291 Disclosures: Brown and Parambil report no relevant financial disclosures.
We are unbelievably excited this week to be reviewing the hot-off-the-presses 2026 Multi-Society (AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN) Pulmonary Embolism Guidelines with lead author Dr. Mark A. Creager. We will talk about key updates in these guidelines compared to prior practice, including the new risk classification model, and provide an overview from diagnosis to follow-up. Given the clinical importance and prevalence of pulmonary embolism, these guidelines are certainly going to shape practice going forward, so this episode is a can’t miss! Watch the full video of this episode with graphics and helpful teaching visuals on our YouTube channel: https://www.youtube.com/@pulmpeeps Meet Our Guest Dr. Mark Creager is a Professor of Medicine at Dartmouth Hitchcock Medical Center where he specializes in Cardiovascular Medicine with an emphasis on venous thromboembolic disease. He served as the lead author of the 2026 Pulmonary Embolism Guidelines. Article and Reference Creager MA, Barnes GD, Giri J, Mukherjee D, Jones WS, Burnett AE, Carman T, Casanegra AI, Castellucci LA, Clark SM, Cushman M, de Wit K, Eaves JM, Fang MC, Goldberg JB, Henkin S, Johnston-Cox H, Kadavath S, Kadian-Dodov D, Keeling WB, Klein AJP, Li J, McDaniel MC, Moores LK, Piazza G, Prenger KS, Pugliese SC, Ranade M, Rosovsky RP, Russo F, Secemsky EA, Sista AK, Tefera L, Weinberg I, Westafer LM, Young MN. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2026 Feb 19:S0735-1097(25)10161-7. doi: 10.1016/j.jacc.2025.11.005. Epub ahead of print. PMID: 41712898. Key Learning Points Why these guidelines matter: This is the first joint AHA/ACC clinical practice guideline specifically on acute PE, bringing together a truly multidisciplinary writing committee (cardiology, pulmonology, hematology, emergency medicine, interventional radiology, surgery, and others). Prior guidelines existed from individual societies, but nothing this comprehensive had been updated in roughly five to six years. New PE clinical categories (A through E): One of the most impactful changes is replacing the old “massive/submassive” and “low/intermediate/high risk” labels with five categories that form a severity continuum. Category A is subclinical (incidental PE found on imaging in asymptomatic patients). Category B covers symptomatic but low-severity patients. Category C is where much of the clinical complexity lives — symptomatic, hemodynamically stable patients subdivided into C1, C2, and C3 based on RV function and biomarkers. Category D represents incipient cardiopulmonary failure (transient hypotension, normotensive shock with end-organ dysfunction). Category E is frank cardiopulmonary failure, with E2 being the sickest — refractory or recurrent cardiac arrest. Respiratory modifiers (hypoxia requiring supplemental oxygen) layer onto C, D, and E. Diagnostic approach: Clinical evaluation comes first — history, exam, and validated decision tools (Wells score, revised Geneva, PERC). If clinical probability is low and D-dimer is normal, imaging can be safely avoided. If either is concerning, imaging is warranted. CTPA remains the preferred imaging modality due to superior sensitivity, specificity, wide availability, and ability to assess clot burden and alternative diagnoses. VQ scanning is still appropriate when CTPA is contraindicated, and VQ SPECT offers better reproducibility and specificity than traditional planar VQ if available. Echocardiography is not a diagnostic test for PE but is important for risk stratification — RV size, TAPSE, and tissue Doppler measures all contribute prognostic information. Anticoagulation updates: Anticoagulation remains the cornerstone of treatment. For patients potentially needing advanced therapies (C3, D, E), parenteral anticoagulation is started first. A notable recommendation: low molecular weight heparin is generally preferred over unfractionated heparin, based on evidence showing more effective VTE risk reduction, more predictable pharmacokinetics, no need for routine monitoring, lower rates of heparin-induced thrombocytopenia, and no increase in major bleeding. The committee acknowledged this may create discomfort for clinicians accustomed to unfractionated heparin’s easy reversibility, but the difficulty of achieving and maintaining therapeutic levels with UFH was a significant concern. Advanced therapies: Catheter-based thrombolysis, mechanical thrombectomy, systemic thrombolysis, and surgical embolectomy all received mostly class 2B recommendations (“can consider”) for C3 and D categories, reflecting that current evidence shows improvement in short-term surrogate measures (RV/LV ratio, hemodynamics) but lacks definitive hard outcome data on mortality. For category E1 patients, recommendations are stronger (class 2A). Multiple trials are expected soon — HI-PEITHO, PEERLESS-2, PE-TRACT, PERSEVERE, TORPEDO, and PROG — that should substantially inform future updates. PERT teams: Pulmonary embolism response teams are encouraged, particularly for C3, D, and E patients. They’ve been shown to reduce length of stay. For institutions without PERT capability, establishing consultation networks with larger centers is recommended. Post-PE follow-up: Patients shouldn’t be “left in the wilderness” after discharge. The guidelines recommend communication within the first week to ensure understanding of diagnosis and treatment, an in-person visit at or before three months to assess for persistent symptoms and discuss anticoagulation duration, ongoing surveillance for chronic thromboembolic pulmonary disease, and periodic reassessment for those on extended anticoagulation. Infographics
Mawi, Paul, and Shelly discuss follow up on hypothermia, a listner email about neurogenic pulmonay edema, and an email about anesthesiologists as Respiratory Therapists during COVID. Join the Wise Guys for another medley of stories.
Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease that is often misdiagnosed, delaying treatment that can slow its course. Mridul Gupta, M.D., provides an overview of who is most affected, how to recognize and diagnose IPF, and what treatment approaches are available. Learn how clinicians and patients weigh the risks and benefits of treatment options (especially with older patients) and how more personalized therapies may be on the horizon.
Host: Darryl S. Chutka, M.D. Guest: Kathryn del Valle, M.D. Chronic liver disease can result in a variety of complications which can involve multiple organs. One of these complications can occur in the pulmonary vascular system. Two of the most clinically significant include hepatopulmonary syndrome and Portopulmonary hypertension. Patients with these syndromes may present to their primary care provider and if the medical condition is unrecognized, it can affect morbidity and ultimately the prognosis of the patient. What are the early symptoms and physical findings of hepatopulmonary syndrome and Portopulmonary hypertension? How are they diagnosed, and should we be screening patients with chronic liver disease for these pulmonary vascular disorders? My guest for this podcast is Dr. Kathryn del Valle, from the Division of Pulmonary and Critical Care at the Mayo Clinic and we'll be discussing “Pulmonary Vascular Complications of Liver Disease”. Connect with us! Mayo Clinic Talks Podcast Season 6 | Mayo Clinic School of Continuous Professional Development
In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Reena Mehra, professor in the Division of Pulmonary, Critical Care and Sleep Medicine at the University of Washington in Seattle, and Dr. Dennis Aukley, professor in the Division of Pulmonary, Critical Care, and Sleep Medicine at MetroHealth Medical Center, Case Western Reserve University in Cleveland, to discuss the newly released AASM clinical practice guidelines for evaluating and managing obstructive sleep apnea in hospitalized adults. The guidelines address a significant gap in inpatient care: how to systematically screen for sleep apnea in hospitalized patients, prioritize high-risk groups, determine when and where to perform testing, and ensure appropriate outpatient follow-up. Dr. Mehra and Dr. Aukley explain the impetus behind developing these guidelines and the PICO question process used to examine existing evidence, acknowledging the challenges of working with limited data in this emerging field. The conversation systematically walks through the four key recommendations: in-hospital screening for OSA as part of an evaluation and management pathway, use of inpatient PAP treatment for newly diagnosed or untreated moderate-to-severe OSA, availability of sleep medicine consultation, and implementation of discharge management plans to ensure timely diagnosis and effective outpatient management. Practical implementation receives extensive attention. How should patients be screened—using STOP-Bang or facility-specific methods? Should screening be built into the EMR? Which patient populations and hospital units should be prioritized? Who performs the screening—sleep navigators, nursing staff, or hospitalists? Can sleep consultations be conducted via telemedicine at the bedside? The experts emphasize the critical need for a program champion and comprehensive education initiatives. Dr. Aukley shares invaluable lessons from his experience creating an inpatient sleep program, discussing what he wishes he'd known before starting and practical insights gained through implementation. A particularly frustrating issue receives attention: patients who bring their own PAP devices to the hospital but never have them set up or used during their stay. The guidelines address this common scenario and provide frameworks for ensuring treated patients continue therapy during hospitalization. Legal liability considerations are explored: What responsibilities exist for untreated patients diagnosed with OSA during hospitalization? What about high-risk patients who haven't been formally diagnosed? The experts discuss strategies for ensuring outpatient follow-up, recognizing that effective discharge planning is essential for translating inpatient identification into long-term management. Whether you're considering establishing an inpatient sleep program, frustrated by gaps in hospital-based sleep apnea care, or seeking evidence-based approaches to identifying and managing OSA in hospitalized patients, this episode provides essential guidance and practical implementation strategies. Join us for this important discussion about bringing systematic sleep apnea evaluation and management into the inpatient setting.
In this episode:Diving into the depths of psychological performance in sports, this episode of the TriDoc Podcast features an engaging discussion between host Jeff Sankoff and psychologist Dr. Jim Taylor. They explore the concept of mastering adversity as a way to enhance athletic performance, particularly in triathlons. The conversation kicks off with a humorous nod to Jeff's raspy voice, a remnant of his recent battle with a respiratory infection, which he cleverly ties into the theme of overcoming challenges. Dr. Taylor shares invaluable insights on resilience, emphasizing that the mental tools athletes develop through life experiences can be incredibly beneficial when facing adversity in sports. They discuss how athletes can prepare mentally for various scenarios during races, highlighting the importance of rehearsing potential challenges in advance. As they delve deeper, they touch upon the five attitudes that can hinder performance, including over-investment, perfectionism, fear of failure, preoccupation with results, and excessive expectations. By shedding light on these psychological barriers, Jeff and Dr. Taylor provide listeners with practical strategies to combat them, encouraging a mindset that prioritizes enjoyment and personal progress over rigid expectations and outcomes. This episode is a treasure trove for athletes looking to enhance their mental game while navigating the thrilling yet intimidating world of triathlons. The Medical Mailbag will be exploring the risk of swimming induced pulmonary edema in triathletes, and will investigate the data from studies done in Sweden to educate the audience on the risks and ways of ceasing the progression of pulmonary edema.Segments:[4:51]- Medical Mailbag: SIPE[36:13]- Interview: Dr. Jim TaylorLinksDr. Jim's Facebook page@drjimtaylor on Instagram@drjimtaylor on XDr. Jim on YouTube
This inaugural episode of the CardioNerds Pulmonary Embolism (PE) Series explores the evolution of acute PE care. Dr. Ibrahim Zahid, Dr. Dinu Balanescu, and Dr. Billy Joe Mullinax join guest expert Dr. Kenneth Rosenfield to discuss the shifting landscape of PE management. Pulmonary embolism (PE) remains a leading cause of cardiovascular mortality and a frequent diagnostic challenge, often masquerading as myocardial infarction or a benign illness. Over the past decade, PE care has evolved from anticoagulation-only strategies to nuanced, risk-stratified, multidisciplinary management. Modern approaches integrate hemodynamics, biomarkers, and advanced imaging to guide therapy, including catheter-directed interventions and large-bore thrombectomy. The Pulmonary Embolism Response Team (PERT) model addresses historical gaps by coordinating rapid, multispecialty decision-making and standardizing care pathways. The PERT Consortium further advances PE care through education, research, and the world's largest PE registry, while fostering leadership and research opportunities for trainees. Despite advances, long-term outcomes and post-PE syndromes remain important areas for future investigation. Audio editing by CardioNerds Academy intern, student doctor, Pace Wetstein. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls PE is a “master masquerader”—maintain suspicion for atypical presentations like myocardial infarction, heart failure, flu, or anxiety. Multidisciplinary management mediated through pulmonary embolism response teams improves outcomes and standardizes care. Risk stratification integrates hemodynamics, biomarkers, and imaging. Advanced therapies have expanded beyond anticoagulation. Long‑term follow‑up and post‑PE syndrome need more research. Notes Notes: Notes drafted by Dr. Ibrahim Zahid. 1. How has the clinical approach to PE changed over the past decade? PE is the third leading cause of cardiovascular death and historically under‑recognized. Symptoms mimic MI, HF, asthma, syncope, and more.PE is a silent killer, and it should be recognized more as a cause of spontaneous cardiac arrest. Where life threatening disease like stroke which is owned by neurological specialists and MI is primarily managed by cardiac specialists, PE is an entity without a professional home. The PERT Consortium brings the specialties together for PE care. 2. Ten years ago, a 58-year-old patient with a large bilateral PE, RV dilation, and positive biomarkers might have been managed with anticoagulation and close observation alone. Today, with evolving—but still uneven—data on advanced therapies, PE care feels far more nuanced and highly dependent on where you practice. What are the major gaps in traditional PE management that clinicians should recognize, and what care pathways should they be aware of across different hospital systems? Care has shifted from anticoagulation‑only to multidisciplinary approaches like catheter directed thrombectomy. Risk‑based pathways and the use of CT angiogram has improved early recognition. Risk stratification tools must be used as tools for early recognition of intermediate risk PE. Untreated PE leads to chronic complications like chronic thromboembolic disease and chronic thromboembolic pulmonary hypertension, which requires long term clinic follow up. 3. What is the role of risk stratification tools such as PeSI, sPeSI scores, cardiac biomarkers, and imaging findings in PE, and how do they guide treatment decisions in real world practice? Integrate vitals (blood pressure and heart rate), biomarkers (troponin, pro-BNP), RV/LV ratio assessment, acid‑base status, and scores. Tools include PESI, sPESI, BOVA, HESTIA, FAST, Geneva, NEWS, shock index. Vitals, lactate, acid-base status, and tools like NEWS or shock index track clinical evolution. PESI/sPESI estimate 30-day mortality and help identify low-risk patients who may be candidates for early discharge or outpatient therapy. Clinical judgment matters—scores don't fully capture clot burden, trajectory, or bleeding risk. 4. How was the pulmonary embolism response team created, and since its creation, what evidence or outcome data became available to support the PERT model? Originated after a sentinel case at MGH: A young, pregnant woman in her 30s, who collapsed at home, underwent thrombectomy, and had to be on ECMO for a few days. The case brought cardiology, cardiac surgeons and critical care physicians together for planning and improvement in her health, which was rewarding. Thereby, it was decided to bring specialties involved in PE care together to create a response team. The name of the team, Pulmonary Embolism Response Team (PERT), was coined by Richard Channick in the first meeting. Posters were set up all over the hospital to call a centralized line when an acute PE is recognized A meeting was held to present the concept of putting together a consortium, with development of action items and a PERT database. Enabled rapid multidisciplinary input using early teleconferencing tools. 5. Given concerns about having too many ‘cooks in the kitchen' during the initial PE call—especially with rotating teams—how can institutions reconcile workflow complexity with standardized pathways in a way that meaningfully supports and justifies the added burden on frontline clinicians? Every hospital's PERT is different, catering to their needs and workflow At least two disciplines are needed to make a PERTData is currently being collected to guide further on how the workflow can be standardized Most importantly, the team brings in resources that were not available prior to PERT formation. 6. What are the main goals of the PERT consortium, and how does it support clinicians and institutions involved? To improve care and improve outcomes for patients with PE Expand education, refine algorithms, standardize care with Centers of Excellence. Maintain the largest PE registry for research and outcomes improvement. 7. Beyond global networking, shared learning from successful systems, and the pathway toward Center of Excellence designation, what additional benefits can clinicians and health systems gain by participating in the PERT Consortium? The ability to learn from other systems, the ability to share experiences. Allow people to develop their professional careers like leadership experience, becoming a member of the trainee council Initiate projects and receive funding for your ideas 8. For trainees interested in pulmonary embolism care, how can a trainee be a champion at their institution? Does PERT provide assistance and how can they really contribute meaningfully even before becoming a fellow/attending? Medical students and residents interested in PE should reach out to the consortium and the consortium will hook you up with the correct mentors who can nurture you along. Listen to the podcasts. Participate with your local PERT team PERT wants involvement of people who are social media savvy to help spread the word on PE. Top three take-away points from this episode Acute PE care has advanced and multiple treatment modalities for acute PE including catheter directed therapy, large bore thrombectomy, are becoming standard of care. Multidisciplinary models like PERT improve coordination and outcomes. Trainees play a vital role in advancing PE care through involvement, research, and education References Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jiménez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ní Áinle F, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020 Jan 21;41(4):543-603. doi: 10.1093/eurheartj/ehz405. PMID: 31504429. https://pubmed.ncbi.nlm.nih.gov/31504429/ Rosovsky R, Zhao K, Sista A, Rivera-Lebron B, Kabrhel C. Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions. Res Pract Thromb Haemost. 2019 Jun 9;3(3):315-330. doi: 10.1002/rth2.12216. PMID: 31294318; PMCID: PMC6611377. https://pmc.ncbi.nlm.nih.gov/articles/PMC6611377/ Rosenfield K, Bowers TR, Barnett CF, Davis GA, Giri J, Horowitz JM, Huisman MV, Hunt BJ, Keeling B, Kline JA, Klok FA, Konstantinides SV, Lanno MT, Lookstein R, Moriarty JM, Ní Áinle F, Reed JL, Rosovsky RP, Royce SM, Secemsky EA, Sharp ASP, Sista AK, Smith RE, Wells P, Yang J, Whatley EM; Pulmonary Embolism Research Collaborative (PERC) Attendees. Standardized Data Elements for Patients With Acute Pulmonary Embolism: A Consensus Report From the Pulmonary Embolism Research Collaborative. Circulation. 2024 Oct;150(14):1140-1150. doi: 10.1161/CIRCULATIONAHA.124.067482. Epub 2024 Sep 12. PMID: 39263752; PMCID: PMC11698503. https://pubmed.ncbi.nlm.nih.gov/39263752/ Sharifi M, Awdisho A, Schroeder B, Jiménez J, Iyer P, Bay C. Retrospective comparison of ultrasound facilitated catheter-directed thrombolysis and systemically administered half-dose thrombolysis in treatment of pulmonary embolism. Vasc Med. 2019 Apr;24(2):103-109. doi: 10.1177/1358863X18824159. Epub 2019 Mar 5. PMID: 30834822. https://pubmed.ncbi.nlm.nih.gov/30834822/ Pandya V, Chandra AA, Scotti A, Assafin M, Schenone AL, Latib A, Slipczuk L, Khaliq A. Evolution of Pulmonary Embolism Response Teams in the United States: A Review of the Literature. J Clin Med. 2024 Jul 8;13(13):3984. doi: 10.3390/jcm13133984. PMID: 38999548; PMCID: PMC11242386. https://pubmed.ncbi.nlm.nih.gov/38999548/ Rivera-Lebron B., McDaniel M., Ahrar K., Alrifai A., Dudzinski D.M., Fanola C., Blais D., Janicke D., Melamed R., Mohrien K., et al. Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium. Clin. Appl. Thromb. Hemost. 2019;25:1076029619853037. doi: 10.1177/1076029619853037.https://pubmed.ncbi.nlm.nih.gov/31185730/
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.
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